Infertility can be defined as failure to achieve pregnancy during one year of frequent, unprotected intercourse. Evaluation generally begins after 12 months, but it can be initiated earlier if infertility is suspected based on history or if the female partner is older than 35 year.
Infertility causes generally can be divided one-third due to male factors, one- third due to female factors and one-third due to either both the male and female factors or no cause can be found. In order to have successful conception, a woman need to produce mature eggs in the process called ovulation and men should produce enough number of good healthy sperm. Intercourse must happen in the right fertile period of the month for fertilisation and subsequently implantation to happen.
There are various general and specific causes of infertility. General factors for both male and female includes advanced age, unhealthy weight (underweight or overweight), smoking, excessive alcohol consumption, either lack or exercise or excessive exercise, having underlying chronic medical illnesses such as diabetes, autoimmune diseases, thyroid disorder, side-effects from medication like anti-depressant and psychological cause like depression, anxiety and extreme stress.
Specific male infertility causes includes genetic defects (Klinefelter syndrome), undescended testis, epididymitis secondary to STD, testicular infection, male sexual dysfunction such as premature ejaculation and erectile dysfunction. Specific female infertility causes includes PCOS, hyperprolactinaemia, thyroid disoder, PID secondary to STD infection, endometriosis, fibroid, adenomyosis, scarring from previous surgery (Asherman syndrome), genetic (Turner's syndrome), premature ovarian failure and previous pelvic radiation or chemotherapy treatment.
Clinical assessment of infertility required comprehensive menstrual history, coital frequency and complete coitus, medical, surgical and medications history, past obstetric and gynecological information and social history. Investigations for female infertility are full hormonal profile work-up including testosterone level (for polycystic ovarian syndrome/PCOS), thyroid function test and day 21 progesterone (to evaluate ovulation), STD screening, ultrasound pelvis and hysterosalpingography to assess tubal patency. Investigations for male infertility includes hormonal profile, seminal fluid analysis, STD screening and ultrasound of testes.
In 10–15% of couples, a specific cause for their infertility is not found. A diagnosis of unexplained cause is made once other causes of infertility have been ruled out from the investigations of both couples. Infertility treatment depends on the underlying cause. Fertility medication can be given to induce ovulation. Non-pharmacological treatment including assisted reproductive treatment such as intrauterine insemination (IUI), in-vitro fertilization (IVF) and intracytoplasmic sperm insemination (ICSI).
Couples are also advised on ideal coital frequency and keeping track of the 'fertile window' which includes the five days preceding and the day of anticipated ovulation to improve chance of conception. Both partners should be encouraged to stop smoking, avoid alcohol consumption and recreational drugs and for women to limit caffeine intake. Both partners are encouraged to practice a healthy lifestyle and exercise regularly.
Infertility can cause significant physical, psychological and emotional stress to any couple looking to start a family. It is important to get an assessment early and talk to a medical professional about your fertility concern.