Infertility

Infertility is usually defined as not becoming pregnant after 12 months of regular, unprotected sex (or 6 months if the woman is over 35). It affects both men and women — roughly one-third of cases are male factor, one-third female factor, and the rest combined or unexplained. In India, infertility is common but under-discussed, and stigma often delays seeking help.

When to see a Health Expert

• After 12 months of trying without success (6 months if woman over 35).
• Sooner if irregular cycles, known PCOS, endometriosis, thyroid disease, prior pelvic surgery or infection, or a known male factor.
• Both partners should be evaluated — not just the woman. Infertility is not "the woman's problem" — this is a persistent and incorrect cultural assumption in India.

What evaluation involves

• Detailed history for both partners.
• Semen analysis for the man — the simplest, cheapest, most important first test.
• Ovulation check for the woman (mid-cycle blood test).
• Blood tests — thyroid, prolactin, sometimes AMH (egg reserve).
• Pelvic ultrasound — for PCOS, fibroids, cysts.
• Tubal patency test — HSG or laparoscopy — checks if fallopian tubes are open.
• Genetic and hormonal work-up in selected cases.

Common treatable causes

• PCOS — weight loss, medicines to help ovulation.
• Blocked tubes — sometimes surgery; more often proceed directly to IVF.
• Endometriosis — laparoscopy; sometimes IVF.
• Low sperm count/motility — lifestyle changes, treating infections, varicocele surgery; often IUI or IVF/ICSI.
• Ovulation problems — medicines to induce ovulation.

Treatment options, broadly

• Lifestyle — healthy weight, stop smoking and alcohol, treat diabetes/thyroid.
• Medicines to induce ovulation.
• IUI (intrauterine insemination).
• IVF/ICSI — in vitro fertilisation with or without sperm injection.
• Donor gametes, surrogacy, or adoption in specific situations — all with ethical and legal safeguards under Indian ART law.

A note on stigma

Blame, silence and secrecy make infertility much harder than it needs to be. Most causes are treatable. Most couples who seek help in time have children. You have nothing to hide, and nothing to be ashamed of — see a Health Expert together, as early as you choose.