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Infertility

What is Infertility?

Infertility is a medical condition in which a couple is unable to conceive (get pregnant) after 12 months of regular, unprotected sexual intercourse.

For women over 35 years of age, infertility is usually evaluated after 6 months of trying, since fertility naturally declines with age.

Types of Infertility

  • Primary infertility: When a person or couple has never been able to conceive.
  • Secondary infertility: When they have conceived before but are unable to conceive again.

Causes of Infertility

Infertility can affect either partner or both, and it can result from a wide variety of factors:

In Women:

✅ Ovulation disorders (like PCOS, premature ovarian failure)
✅ Blocked or damaged fallopian tubes (due to infections, endometriosis, or surgery)
✅ Uterine abnormalities (fibroids, polyps, scarring)
✅ Age-related decline in egg quantity and quality
✅ Hormonal imbalances
✅ Chronic illnesses or lifestyle factors

In Men:

✅ Low sperm count or poor sperm quality
✅ Blockages in the reproductive tract
✅ Hormonal problems
✅ Testicular injury, infections, or varicocele
✅ Lifestyle factors (smoking, alcohol, obesity, stress)

When to Seek Help?

You should consider consulting a fertility specialist if:

  • You’re under 35 and haven’t conceived after 1 year of trying.
  • You’re over 35 and haven’t conceived after 6 months of trying.
  • You have known reproductive health issues (irregular periods, history of pelvic infections, undescended testes, etc.)
  • You’ve experienced multiple miscarriages.

Diagnosis and Treatment

Infertility evaluation usually involves:

  • Detailed medical history and physical exams
  • Hormonal tests and ultrasound scans (in women)
  • Semen analysis (in men)
  • Imaging tests to check the uterus and fallopian tubes
  • Sometimes, minimally invasive procedures like laparoscopy or hysteroscopy

Treatment depends on the underlying cause and may include:

  • Medication to stimulate ovulation
  • Surgery to correct anatomical problems
  • Intrauterine insemination (IUI)
  • In-vitro fertilization (IVF) or ICSI
  • Use of donor eggs, sperm, or embryos
  • Lifestyle changes

The Evolution of Assisted Reproduction

The birth of Louise Brown, the world’s first IVF baby in 1978, marked the beginning of a revolution in infertility treatment.

Since then, IVF and its extensions—such as preimplantation genetic testing, stem cell research, and the ethical debates surrounding assisted reproduction—have continued to captivate both scientific and public attention. While many of these concepts emerged in the 1970s, IVF remains a topic of daily relevance, with over 2 million IVF babies born worldwide—a testament to decades of clinical, scientific, and ethical progress.

Advances in IVF and Beyond

Initially, IVF addressed female infertility issues like blocked fallopian tubes, endometriosis, PCOS, and unexplained infertility. Severe male infertility became treatable with the introduction of Intracytoplasmic Sperm Injection (ICSI) about 20 years ago. This technique involves injecting a single sperm directly into an egg, enabling conception even with extremely low sperm counts or poor motility.
For men with no sperm in the ejaculate (azoospermia), sperm can now be extracted directly from the testicles (TESA) or the epididymis (PESA) and used with ICSI—eliminating the need for donor sperm.

A third major breakthrough has been the vitrification (cryopreservation) of eggs and embryos. Clinics now achieve higher success rates with frozen embryo transfers compared to fresh transfers, with success rates rising from 35–40% to about 50% per cycle in well-equipped centers.

As more women choose to focus on education and careers, many delay childbearing into their late 30s, when egg quality declines significantly. Today, women can preserve their fertility by freezing their eggs at a younger age, safeguarding their genetic potential for later use.

For milder infertility or sexual dysfunction, the simpler technique of intrauterine insemination (IUI) remains effective.

Preimplantation genetic testing (PGT) is another valuable tool, especially for women over 35 or those with a history of miscarriage. By testing embryos for genetic abnormalities before transfer, PGT improves success rates and reduces the risk of passing on genetic disorders.

Third-Party Reproduction

Third-party reproduction—including donor sperm, donor eggs, and gestational surrogacy—offers hope to couples facing complex infertility challenges.

  • Sperm donation helps men with total testicular failure or those unable to afford ICSI.
  • Egg donation is used when women experience premature ovarian failure or repeated IVF failures due to poor egg quality.
  • Gestational surrogacy is an option for women unable to carry a pregnancy due to uterine issues.

These procedures are governed by the ethical, religious, and legal framework laid out in India’s ART and Surrogacy Acts of 2022, which our clinic fully adheres to.

Emerging areas of research—such as stem cell therapy to improve egg and uterine quality, epigenetics (maternal DNA influence even with donor eggs), and intra-ovarian PRP treatment—are showing promise but require further study before routine use.

Infertility in the Indian Context

In India, despite overpopulation concerns, infertility is a growing health problem. According to WHO, infertility has risen from 1 in 16 couples in 1982 to nearly 1 in 4 today. In metropolitan cities, infertility among women over 30 is as high as 46%.
Factors contributing to this include delayed marriage and childbearing, widespread contraceptive use, endometriosis, PCOS, genital tuberculosis, and rising male infertility.

Indian women tend to have lower ovarian reserves and poorer outcomes from IVF compared to Caucasian women, partly due to higher rates of PCOS, genital tuberculosis, obesity, smoking, and delayed motherhood. Studies confirm that South Asian women experience earlier onset of infertility and poorer IVF outcomes.

Diagnosing and Treating Infertility

An initial evaluation includes:

  • Clinical history and examination
  • Transvaginal ultrasound
  • Semen analysis
  • Hormone tests (FSH, LH, Prolactin, TSH)
  • Laparoscopy and hysteroscopy if needed

Common causes include:

  • Hormonal disorders causing anovulation
  • Blocked fallopian tubes (often due to tuberculosis)
  • Endometriosis
  • Male factors (low sperm count, motility, or azoospermia)
  • Unexplained infertility

About 40% of couples can conceive with conventional medical or surgical treatments, including laparoscopic or hysteroscopic surgeries, ovulation induction, and correction of hormonal imbalances. For the remaining 60%, Assisted Reproductive Technologies (ART) provide effective solutions.

Assisted Reproductive Techniques

Intrauterine Insemination (IUI)

Ideal for mild male infertility, sexual dysfunction, or unexplained infertility. Involves placing washed, concentrated sperm directly into the uterus around ovulation. Success rates range from 10–30% per cycle.

In-Vitro Fertilization (IVF)

Women undergo controlled ovarian stimulation, and eggs are retrieved and fertilized with sperm in a laboratory. Embryos are transferred back to the uterus or frozen for future use. Success rates are around 40–50% per cycle, higher with better AMH levels.

Intracytoplasmic Sperm Injection (ICSI)

The most effective treatment for severe male infertility. Sperm is directly injected into the egg under a microscope. Success rates are comparable to IVF, even when sperm is retrieved through TESA or PESA in cases of azoospermia.

Egg, Sperm, and Embryo Donation

For women with poor egg quality or premature menopause, donor eggs combined with IVF offer about 60% success rates. Donor sperm remains a cost-effective option for severe male infertility. Embryo donation helps couples where both partners are infertile, achieving up to 70% success.

Surrogacy

For women with a damaged or absent uterus, surrogacy allows them to have a biological child. Success rates can reach 70% with donor eggs.

Facts vs. Myths

  • Many PCOS patients respond well to ovulation induction or IVF.
  • IVF is effective even for advanced endometriosis and tubal damage.
  • ICSI enables men with very poor sperm parameters to father biological children.
  • Menopausal women can conceive through egg donation with success rates similar to younger women.

Coping with IVF Failure

Even at the best centers, IVF success rates per cycle are about 30–40%. However, cumulative success over 3 cycles can reach 70–80%. Thats’s what our primary focus and target at Rotunda Hygeia is. Counseling after a failed cycle is crucial to understand what went wrong—egg quality, fertilization, embryo development, or uterine issues—and to plan next steps.

Our team is always available for guidance and support after unsuccessful attempts.