Infertility is defined as inability to conceive within 1 year of regular unprotected coitus. Husband and wife have equal share in producing a child & are equally responsible for not having one. In 35 % couples the husband is responsible, in 35 % the wife, and in the rest 30 % both the partners are at fault.
Every Couple, unless they want to delay expect that the wife will be pregnant immediately after marriage. If she does not and gets her period, there is disappointment. This happens nearly every month. As time passes anxiety increases, despair gets. Most of the anxiety is created due to lack of knowledge and understanding. In the developing world, it is further complicated by the media’s irrelevant and misleading literature and lay persons who themselves do not understand the scientific basis. There are also centers run by unqualified persons who advise and offer remedies on sex and childlessness. They exploit the situation and instead of relieving, increase complexities. Their advice & remedies are mostly risky. In such a scenario it is important that couple understands the basics and seek the correct advice.
Overview By nature all living beings desire to have offspring mainly for inheritance but there can be other reasons. This has been the case from the times of Adam and Eve. Scientists developed and evolved the various concepts and methods from the prehistoric times.
First there have been search of disabilities and diseases thought to prevent women and men to have children. Then the concept that fertility is a natural physiological phenomenon and inability to conceive may not be necessarily due to some disease. There are various factors in men and women that play collective role for parenthood. Evaluation of factors and not the search for diseases or disability is the policy for diagnosis.
With increasing knowledge of factors which influence a given couple’s chance of conceiving either spontaneously or with treatment, emphasis shifted from diagnosis to prognosis. An investigative procedure should merit its prognostic value and not the diagnostic, e.g. a childless couple with more then 5 or 10 years uninterrupted marital life seeks help, and one should weigh the advantage of ART over cumbersome investigation. Similarly, if male factor demands ICSI, we only need investigations pertaining to the procedure which are not many. The infertile couples seeking conception are classified into 2 broad groups.
- Absolute infertility. The evaluations of the couple indicate that without therapy, the woman is unlikely to conceive. This includes an ovulation, complete tubal occlusion and Azoospermia.
- Reduced fertility chances. The woman still has a considerable chance to conceive spontaneously with time, e.g., Endometrioses, oligozoopermia or luteal phase insufficiency.