Fertility is defined as a woman's ability to conceive. Infertility is a couple's inability to conceive after 1 year of unprotected intercourse. This is when an evaluation of both partners has to be done to find out the cause.
Infertility affects more couples than many people realise, and the experience of trying to conceive without success can be emotionally draining. The important message I want every couple to hear is that infertility has identifiable causes in the majority of cases, and once the cause is found, treatment can be directed appropriately. An evaluation is not the beginning of a difficult journey - it is the point at which the right path forward becomes clear.
Causes of Infertility in Women
In women, common causes are blockage of fallopian tubes, ovulatory dysfunction as in polycystic ovaries where there is delayed formation of eggs or no egg formation, endometriosis, poor egg quality due to advanced maternal age, fibroids, etc.
The fallopian tubes are the pathway through which the egg travels from the ovary to the uterus. When they are blocked, usually as a result of previous pelvic infection, endometriosis, or prior surgery, the egg and sperm cannot meet naturally. Polycystic ovary syndrome, or PCOS, is one of the most common causes of ovulatory dysfunction I see in my practice. In PCOS, eggs develop irregularly or not at all, making conception difficult without treatment. Endometriosis, where the uterine lining grows outside the uterus, can affect tubal function, egg quality, and the uterine environment. Ovarian reserve declines with age, which is why advanced maternal age is an increasingly relevant factor in fertility evaluation.
Causes of Infertility in Men
In men, the common causes are sperm abnormalities like low sperm count or low motility, less number of normal forms, absence of sperm, erectile dysfunction.
Male factor infertility contributes to approximately 40 to 50 percent of infertility cases, which is why evaluating both partners from the outset matters. A semen analysis is one of the simplest and most informative first investigations - it assesses sperm count, motility, and morphology. Low count, poor motility, or abnormal morphology each reduce the probability of natural conception but do not eliminate it, and there are treatments available for each. Complete absence of sperm, called azoospermia, may indicate either a blockage in the reproductive tract or a problem with sperm production itself, and the distinction guides treatment.
Unexplained Infertility
Unexplained infertility is an entity where no obvious cause is found after evaluation. This accounts for a significant proportion of infertility cases and can be particularly frustrating for couples who have undergone a full assessment expecting a clear answer. In unexplained infertility, standard investigations including semen analysis, ovulation assessment, and tubal evaluation all return normal results. This does not mean that nothing is wrong - it means that the current tests have not identified the cause. Treatment is still possible and effective, and the approach typically begins with the least invasive option appropriate for the couple's clinical profile.
Why Is Infertility on the Rise?
17.5% of the adult population worldwide are affected by infertility (WHO, 2023)
Recent rise in infertility is due to late marriage, choosing career over pregnancy, postponing the child bearing until late age and most importantly the current lifestyle. Lifestyle has a major bearing on conception.
Across my practice at Birthright Fertility by Rainbow Hospitals, Banjara Hills, Hyderabad, I see this pattern clearly. Women who have prioritised their education and careers - entirely reasonably - find themselves trying to conceive in their mid-thirties, when ovarian reserve is naturally lower and the probability of conception per cycle has declined. Obesity, stress, smoking, alcohol, and physical inactivity all affect both egg and sperm quality. The encouraging message is that many lifestyle factors are modifiable, and addressing them as part of an infertility evaluation can make a meaningful difference to outcomes. If you have been trying to conceive for a year or more, or for six months if you are over 35, the right next step is a structured evaluation - not continued waiting.
To book a consultation with Dr. Sudharani Bairraju at Birthright Fertility by Rainbow Hospitals, Banjara Hills, Hyderabad, call 07337390606 / 080 69237022.
Written by Dr. Sudharani Bairraju, MBBS (Sri Venkateswara Medical College, Tirupathi, 1997), DNB Obstetrics and Gynaecology (St Theresa's General Hospital, Hyderabad, 2007), Postgraduate Certification in Clinical Embryology, Fellowship in Minimally Invasive Surgeries, Fellowship in Advanced Gynaecological Endoscopy, Senior Consultant Obstetrician and Gynaecologist, Infertility (IVF) Specialist and Laparoscopic Surgeon, Birthright Fertility by Rainbow Hospitals, Banjara Hills, Hyderabad. Phone: 07337390606 / 080 69237022.
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