Infertility means not being able to get pregnant or conceive after one year of trying (or six months if a woman is 35 or older).

Pregnancy is the result of a process that has many steps. To get pregnant:

• A woman's body must release an egg from her ovaries (ovulation).

• The egg must go through a fallopian tube toward the uterus (womb).

• A man's sperm must join with (fertilize) the egg along the way.

• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

Yes. Today around 15% of the Indian population both male and female are infertile.

No, infertility is not always a woman's problem. Both women and men can have problems that causes infertility.

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. May include absent or irregular menstrual periods.

• There are two main causes of ovulation:

• Polycystic Ovarian Syndrome (PCOS) and is the most common cause of female infertility.

• Primary Ovarian Insufficiency (POI). POI occurs when a woman's ovaries stop working normally before she is 40. (different from early menopause).

Less common causes of fertility problems in women include:

• Blocked fallopian tubes

• Physical problems with the uterus

• Uterine fibroids

Following are the reasons that can increase the risk of infertility:

• Age

• Smoking

• Excess alcohol use

• Stress

• Poor diet

• Athletic training

• Being overweight or underweight

• Sexually transmitted infections (STIs)

Many couples wait till the age of 35-40 to conceive. Age is a growing cause of fertility problems. About one-third of couples in which the woman is over 35 have fertility problems.

How age has a negative effect on pregnancy:

• Her ovaries become less able to release eggs

• Less number of eggs left and are not as healthy.

• Health conditions.

• Chances of having a miscarriage

Experts suggest at least one year. Women 35 or older should see their doctors after six months of trying.

Women should talk to their doctors if they have:

• Irregular periods or no menstrual periods

• Very painful periods

• Endometriosis

• Pelvic inflammatory disease

• More than one miscarriage

It is good for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby and can even answer questions on fertility and give tips on conceiving.

They will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners' health and sexual histories.

In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a man's hormones.

In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by:

• Writing down changes in her morning body temperature for several months

• Writing down how her cervical mucus looks for several months

• Using a home ovulation test kit (available at drug stores)

Doctors can also check ovulation with blood tests or with the help of an ultrasound.

If ovulation is normal, there are other fertility tests available

• Hysterosalpingography: This is an x-ray of the uterus and fallopian tubes. A special dye is injected into the uterus through vagina . If the tube moves freely, then there is no problem but if it doesn’t then it means that there are physical blocks present inside and prevents the egg from moving. And therefore, it can’t even reach the sperm.

• Laparoscopy : A minor surgery to see inside the abdomen. The doctor uses a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems.

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology or a combination of all of these. Doctors recommend specific treatments for infertility based on:

• Test results

• How long the couple has been trying to get pregnant

• The age of both the man and woman

• The overall health of the partners

• Preference of the partners

In women, some physical problems can also be corrected with surgery.

We have very good success rates in terms of ART.

Some things that affect the success rate of ART include:

• Age of the partners

• Reason for infertility

• Clinic

• Type of ART

• If the egg is fresh or frozen

• If the embryo is fresh or frozen

ART can be expensive and time-consuming. But it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is multiple fetuses.

Intrauterine insemination (IUI) is an infertility treatment and is generally referred to as artificial insemination. In this procedure, the woman is injected with specially prepared sperm. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.

IUI is often used to treat:

• Mild male factor infertility

• Women who have problems with their cervical mucus

• Couples with unexplained infertility

Assisted reproductive technology (ART) is a group of different methods used to help infertile couples. ART works by removing eggs from a woman's body. The eggs are then mixed with sperm to make embryos and then injected in the woman's body.

Common methods of ART include:

• In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman's fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man's sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman's uterus.

• Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.

• Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman's fallopian tube. So fertilization occurs in the woman's body. Few practices offer GIFT as an option.

• Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.

ART procedures sometimes involve the use of donor eggs, donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs or when they both have a genetic disease that can be passed on to the baby. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.