Infertility is the inability to conceive after a year of unprotected intercourse in women under 35, or after six months in women over 35, or the inability to carry a pregnancy to term.

Both male and female factors contribute to infertility. Some studies suggest that male and female factors contribute equally. In many cases it may not be possible to definitely explain the reasons for infertility. It is essential that both the male and female partners be evaluated during an infertility work up.

Many things can change a woman's ability to have a baby. These include age, smoking, excess alcohol use, stress, poor diet, being overweight or underweight, sexually transmitted infections (STIs), health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency.

Anything that raises the temperature of the scrotum such as the use of hot tubs or long baths or over-tight clothing can harm sperm production. A variety of medicines and recreational drugs can also decrease male fertility. These include alcohol, cigarettes as well as certain medications. Studies have also shown that environmental factors have contributed to decreasing sperm counts over the years.

Most physicians advise you not to be concerned unless you have been trying to conceive for at least one year. If the female partner is over 30 years old, has a history of pelvic inflammatory disease, painful periods, recurrent miscarriage, or irregular periods, it might be prudent to seek help sooner. If the male partner has a known or suspected low sperm count, then it would also be prudent to seek help sooner than waiting a year.

For a normal couple, it often takes a number of perfectly timed cycles before pregnancy is achieved. The chances of getting pregnant each cycle decreases as you get older. If you are 20-25, your chance per cycle is about 25%. At 25-30 your chances are about 20%. At 30-35 it is about 15%. After 35 it may be about 10% per ovulatory cycle, and the chances continue the downward trend.

This is an x-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the x-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility.

During the IVF cycle, women do put on some weight (small weight gain) due to fluid retention, specifically during the superovulation phase (stimulation phase). However, this is temporary and once the superovulation stops, the hormones are excreted. Thus, there is no long-term weight gain or loss due to IVF.

The treatment options for infertility depend on the profile of the patients, male and female factors related to infertility and the choice of the couple. Usually, the common techniques available are Ovulation Induction with Timed Intercourse or Intra Uterine Insemination, Intra Uterine Insemination and In Vitro Fertilization.

Fertility drugs might cause a mild reaction in some patients, and may involve hot flushes, feeling down, irritability and restlessness. These symptoms disappear in a short time.

In some patients, ovarian hyper-stimulation syndrome (OHSS) is observed as an over-reaction to fertility drugs. It could cause symptoms like swollen stomach, stomach pains and nausea. Patients must contact their infertility clinician immediately in such cases.

There is no pain during IVF apart from the injections which woman receives. However, in some patients, ovarian torsion could be another observed side-effect. Mild pelvic discomfort arises because the size of ovaries increases during the stimulation period.

The other side-effects of IVF during pregnancy include ectopic pregnancy and multiple births. When an embryo develops in the fallopian tube rather than in the womb, the pregnancy is said to be an ectopic pregnancy. Ectopic pregnancy can cause vaginal bleeding, low pregnancy hormone levels and miscarriage. Hormone tests and scans are used to detect ectopic pregnancies and patients must call the doctor immediately when they observe vaginal bleeding or stomach pain.

Multiple births is another risk associated with fertility treatment. Your clinician would discuss this risk with you before the embryo transfer procedure.

Is there any chance that going through multiple IVF cycles can result in increased endometriosis?

No. There is no study which has proven so. Prolonged infertility, per se, has been associated with endometriosis.

The success rates for IVF treatment depend on the individual patient profile, the quality of oocytes obtained, the embryo after fertilization and many other factors. The maternal age plays a large role in the success rate of the treatment. As a woman ages, her ovarian reserve is depleted and the probability of obtaining good quality oocytes and embryos reduces. Although many infertility clinics showcase success rates of 50%, 60% etc., it might not be so for every patient they handle. In many cases, the success rates mentioned could be for more than one cycle.

Infertility, by itself, is not a genetic disorder. But some of the reasons for infertility like PCOS, premature ovarian failure, Endometriosis, etc. have been associated with a genetic linkage. These might increase the risk of infertility. In case of males, genetic conditions such as Y-chromosome microdeletion, Kleinfelter's syndrome are associated with infertility.

The duration of the treatment largely depends on the individual profile of the patients. Since no infertility treatment has a 100% success rate, the treatment duration would depend on a number of factors. Most infertility treatments, from initial work-up to the treatment would take between 6 months to one year.

Egg donor is an option for patients, when there are genetic or inheritable diseases running in the family (X-linked genetic disorders), advanced maternal age, poor ovarian reserve, and when the woman has had a recurrent implantation failure.

Egg donors can be sourced through registered ART banks as per regulatory guidelines. Infertility clinics may help guide patients to contact such registered banks.

When the patient is advised for egg donor, the clinic suggests the patients on registered donor banks which may be contacted.

Every time a woman gets her period, the lining of the uterus (which is called the endometrium) breaks down and is shed as menstrual flow. When a woman has endometriosis, the tissue that makes up the lining of the uterus also shows up in other parts of her body including the ovaries, the bowels, and the bladder. During her period, this tissue breaks down - but since it is outside the uterus it cannot leave the body, and cysts and scar tissue may form as a result. The adhesions present in the pelvic area make the pelvic organs rather fixed. Any motion of these organs (e.g. during intercourse), could produce pelvic pain.

Uterine fibroids are tumors which grow from the muscle cells of the uterus (womb). Presence of fibroids is a common gynecological condition which is mostly non-cancerous

Patients suffering from heavy or irregular uterine bleeding, facing difficulty in voiding urine or stools, experiencing heaviness or fullness in lower abdomen and who have a difficulty in conceiving could be suffering from uterine fibroids.

Removal of the uterus (hysterectomy) was the only solution for fibroids earlier. However, there are plenty of treatment options available currently, like GnRH analogues, uterine artery embolisation, myolysis, MRI guided focused ultrasound, Open and Laparoscopic Myomectomy.

Obesity during pregnancy is associated with increased risk for both the baby and the mother, and increases the risk of maternal high blood pressure by 10 times. Excessive weight in pregnant mothers is associated with a higher risk of hypertension, gestational diabetes, urinary infection, Cesarean section delivery and toxemia. Infants born to women who are obese during pregnancy are more likely to have high birth weight and, therefore, may face a higher rate of Cesarean section delivery and low blood sugar which can be associated with brain damage and seizures.