By Dr. Devika Gunasheela, Infertility Specialist, Cauvery Gunasheela IVF Centre

In the modern society, with increasing education and career opportunity, young men and women are postponing child-bearing and parenthood to late thirties. Youngsters are also exposed to lifestyle changes like lack of physical exercise, change in eating habits which gives rise to obesity.  Pollution and healthy disorders such as diabetes are all contributing to rise in fertility problems. 

Infertility means difficulty in getting pregnant after 1 year of having regular intercourse without the use of contraception.  About 15% of couple who are trying to conceive are not able to do so by the end of 1 year. 

You should consider having an evaluation if:

• You have not become pregnant after 1 year of having regular sexual intercourse.

• You are older than 35 years and have not become pregnant after trying for 6 months.

• If there is a known cause for fertility problem like endometriosis.

• If periods are not regular.

Infertility evaluation may point to an underlying cause, which can guide treatment.  It usually begins with a medical history, physical examination and few basic tests. 

Evaluation of a woman will include a basic menstrual, sexual and medical history followed by physical examination and preliminary imaging and blood tests to evaluate uterus, fallopian tubes and egg reserve. 

For men, evaluation usually includes medical history, physical examination and semen analysis to look for count, motility and appearance of the sperm.

Both men and women should be evaluated simultaneously.  8-10% of the times the problem can only be in man.  34-35% of the times the problem can be in both man and woman.  Hence, both should be tested.

Fertility problems can cause:

In women

• Age – As age advances, quantity and quality of the eggs start to decrease.

• Weight – Having overweight or severely underweight can cause imbalance in hormones, irregular periods and affect ovulation.

• Ovulation problems – PCO (Polycystic Ovaries) can give rise to hormone imbalance, irregular periods and there women may not ovulate regularly.

• Endometriosis – Large blood filled cysts in the ovary.

• PID – Previous pelvic inflammatory disease can cause scarring and damage of fallopian tubes.

• Large fibroids – May also cause problems in getting pregnant.

• Damaged fallopian tubes – By infection like tuberculosis (TB)

• Genetic abnormalities like translocation in the chromosomes.

In men

• Infections like Mumps can damage testes and sperm production.

• Medicines like sulpasalazine, anabolic steroids, allopurinol, chemotherapy – Can have effect on sperm production.

• Inguinal hernia repair may cause blockage of the duct, which carry sperm and thereby affect fertility.

• Hyperprolactinemia

• Chromosomal abnormalities like Klinefelter syndrome.

• Overweight

No cause can be found in about 20% of couple with infertility.

 Various tests are done for both men and women:

In women

• Pelvic scan is done to assess size and shape of uterus and ovaries.  It also helps to determine if there are structural abnormalities such as fibroids or ovarian cysts and also to detect ovulation.

• Blood tests for FSH (Follicle stimulating Hormone), E2(Estradiol), AMH (Antimullerian Hormone) to assess the ovarian function.  Thyroid and prolactin hormones are also assessed as they can have influence on ovulation.

• HSG (Hysterosalpingography) – This is a first test to evaluate tubal patency.

In men

• Semen analysis is done to assess the number of sperm, shape of the sperm and the way the sperm move.

• Blood tests – Certain hormones like testosterone prolactin which have influence on the sperm production and with having sex, may be tested depending on the problem and semen analysis report.

• Doppler scan – In some cases a Doppler ultrasound examination of the scrotum is done to look at blood vessels of the testes.

You may not have all of these tests and procedures.  Some are done depending on the history or previous test reports.