When is it called infertility
Doctors use the word infertility when a couple has not conceived after 12 months of regular sex without contraception. If the woman is 35 or older, evaluation is usually advised after 6 months. It is a medical condition, not a personal failure, and it is common. Roughly one in six people worldwide face it at some point.
The cause may lie with the woman, the man, both partners, or may stay unexplained after all tests. For this reason, both partners should be checked from the start. In many Indian families the woman alone is sent for tests, which delays answers.
Common causes
| Area | Examples | Usual first test |
|---|---|---|
| Ovulation | PCOS, thyroid problems, high prolactin | Hormone blood tests, scan |
| Tubes and pelvis | Past infection, tuberculosis, endometriosis | Tube test such as HSG |
| Uterus | Fibroids, polyps, scar tissue | Ultrasound |
| Sperm | Low count, poor movement | Semen analysis |
| Unexplained | All basic tests normal | No single test |
Irregular periods often point to an ovulation problem. PCOS is one of the most frequent reasons and usually responds to treatment. Age matters too. The number and quality of eggs fall with age, faster after the mid-thirties.
What happens at the first visit
- The doctor asks both of you about how long you have been trying, your periods, past pregnancies, surgeries, illnesses and medicines.
- Questions about how often you have sex and any difficulty with it are routine. Honest answers help.
- Height, weight and blood pressure are checked. The woman may have a pelvic examination with her consent.
- Initial tests are ordered for both partners, often timed to certain days of the menstrual cycle.
- A follow-up visit is fixed to review the reports and discuss a plan.
Carry old reports, scan films and discharge summaries. Write down the dates of your last three or four periods.
Expect the full work-up to take one or two menstrual cycles, since some tests are tied to particular days. Try not to change doctors midway unless you need to, because repeating tests costs time and money.
Tests you may be advised
For the woman
Blood tests check thyroid, prolactin and other hormones. A test called AMH, along with a scan count of small follicles, gives an idea of egg reserve. A pelvic ultrasound scan looks at the uterus and ovaries. A tube test checks whether the fallopian tubes are open. The usual one is an X-ray with dye called HSG, which can cause cramps for a short time. Not every woman needs every test. A laparoscopy or hysteroscopy is advised only when there is a specific reason.
For the man
A semen analysis is simple, low in cost compared with other tests and gives a lot of information. The sample is usually given after two to five days without ejaculation. If the result is abnormal, it is commonly repeated after some weeks, since counts change over time. Mention any recent fever or illness, as it can lower the count for some weeks. Further hormone tests or a scan may follow.
Treatment paths
Treatment depends on the cause, the woman's age and how long you have been trying. The doctor decides what suits your case. Broadly, the options are:
- Lifestyle changes: reaching a healthy weight, stopping tobacco, limiting alcohol and timing sex around ovulation.
- Treating a specific problem: correcting thyroid levels, or surgery for certain polyps, fibroids or blocked tubes.
- Ovulation induction: tablets or injections that help the ovary release an egg, with scan monitoring.
- Assisted methods: IUI or IVF when simpler steps have not worked or are unlikely to work.
- Donor eggs or sperm, or adoption: options some couples consider after counselling.
Doctors normally begin with the simplest suitable option and move step by step. How quickly they move on depends mainly on age and on the test findings. A couple in their twenties with normal reports may be asked to keep trying for some more months, while an older couple may be advised active treatment early.
Fertility medicines should be taken only under supervision. Unmonitored use raises the chance of twins or triplets and of ovarian overstimulation. Women trying for a pregnancy are generally advised to take folic acid. Ask your doctor about it.
Looking after yourself along the way
Tests and treatment cycles can be tiring, and pressure from relatives adds to it. Feeling sad, angry or anxious is common. Go to appointments together where possible. Decide as a couple how much you want to share with family. Many people find counselling or a support group useful. Stress alone has not been shown to cause infertility, so do not blame yourself.
Ask about the likely number of visits, the time each step takes and the expected expenses. Costs vary by city, hospital and case. Be careful with anyone who guarantees a pregnancy.
When to see a gynecologist sooner
You do not need to wait a full year if any of these apply:
- Age 35 or above
- Periods that are very irregular, absent or extremely painful
- A history of pelvic infection, tuberculosis, or surgery on the abdomen or pelvis
- Two or more miscarriages
- Known endometriosis, fibroids or thyroid disease
- A male partner with past testicular surgery, injury, mumps after puberty or problems with erection or ejaculation
- Past cancer treatment in either partner
Seek urgent care if you have a missed period with one-sided lower abdominal pain, bleeding or dizziness, as this can be a sign of ectopic pregnancy.
This page is general information for readers in India. It is not medical advice. Speak to a qualified gynecologist about your own health.