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Comprehensive guide to infertility causes, diagnosis, and treatment. Expert fertility care from Dr. Anju Bala at North Delhi Uro & Gynae Clinic.
Infertility affects approximately 1 in 8 couples trying to conceive. Yet, many suffer in silence due to social stigma and lack of information. At North Delhi Uro & Gynae Clinic, we provide compassionate, comprehensive fertility evaluation and treatment to help couples achieve their dream of parenthood.
Infertility is defined as the inability to conceive after one year of regular, unprotected sexual intercourse (or 6 months if the woman is over 35 years old). It’s a medical condition, not a personal failure.
Primary Infertility: – Couples who have never been pregnant despite trying – Accounts for 85-90% of infertility cases
Secondary Infertility: – Couples who have been pregnant before but cannot conceive again – May have different causes than primary infertility – Often psychologically challenging
Contributing Factors:
Female factor infertility: 40-50% of cases Male factor infertility: 30-40% of cases Combined factors: 10-15% of cases Unexplained infertility: 10-15% of cases
PCOS (Polycystic Ovary Syndrome): – Anovulation (no ovulation) – Most common cause of anovulation – Treatable with medications – Success rates: 70-80% with ovulation induction
Hypothalamic-Pituitary Disorders: – Amenorrhea (absent periods) – Causes: Low body weight, excessive exercise, stress, pituitary disease – Restoration of normal weight/health often restores ovulation
Ovarian Insufficiency: – Premature menopause (<40 years) – Genetic or autoimmune causes – Reduced fertility, may require donor eggs
Thyroid Disorders: – Hypothyroidism interferes with ovulation – Hyperthyroidism affects fertility – Treatable with medication
Luteal Phase Defect: – Inadequate progesterone production – Controversial diagnosis – Affects implantation
Tubal Blockage: – Scarring from: – Pelvic inflammatory disease (PID) – Sexually transmitted infections – Previous surgery – Endometriosis – Preventable with early STI treatment
Tubal Dysfunction: – Impaired tubal peristalsis (movement) – Reduces sperm and egg transport – Often from endometriosis or scarring
Diagnosis: – Hysterosalpingography (HSG): X-ray with dye – Sonohysterography: Ultrasound with saline – Diagnostic laparoscopy: Gold standard
Treatment: – Tubal reconstruction: 30-50% success rate – IVF: Bypass tubal issues, 40-50% success
Structural Abnormalities: – Uterine fibroids (benign tumors) – Adenomyosis (tissue in uterine muscle) – Asherman syndrome (intrauterine adhesions) – Septate uterus (congenital abnormality)
Treatments: – Fibroid removal (myomectomy): 40-60% success – Adhesiolysis: Remove adhesions – Metroplasty: Correct uterine shape – Surgery before IVF may improve success
Uterine Polyps and Fibroids: – Endometrial polyps reduce implantation – Removal improves pregnancy rates – Fibroids outside cavity: Less impact
Thin Endometrium: – Inadequate thickness for implantation – Usually <7mm is concerning – Causes: Previous D&C, infections, scarring – Treatments: Estrogen, sildenafil (limited evidence)
Endometritis: – Chronic endometrial inflammation – From infection or other causes – Reduces implantation – Treatable with antibiotics if infectious
Immune Factors: – NK cell dysfunction – Antiphospholipid antibodies – Still controversial – Limited proven treatments
Menstrual history (regularity, flow) – Sexual history and frequency – Contraceptive history – Previous pregnancies and outcomes – Medical history (surgery, infections, medications) – Family history – Lifestyle factors (stress, exercise, weight) – Symptoms of endometriosis or PCOS
General health assessment – Pelvic examination – Assessment for signs of PCOS or endometriosis
Basal Body Temperature (BBT): – Track temperature daily – Rise indicates ovulation – Low-tech, inexpensive – Less reliable, affected by sleep, illness
Ovulation Predictor Kits: – Detect LH surge – Accurate 12-24 hours before ovulation – Help timing of intercourse – Over-the-counter, affordable
Mid-Luteal Progesterone Level: – Blood test 7 days before period – Confirms ovulation if elevated – Single test, limited information
Ultrasound Monitoring: – Direct visualization of follicle growth – Confirms ovulation – Guides timing of intercourse or insemination – Gold standard for ovulation assessment
Evaluates sperm count, motility, morphology – Essential part of infertility workup – Normal or abnormal guides treatment
Transvaginal Ultrasound: – Assesses ovaries (size, follicles) – Evaluates uterus and endometrium – Detects fibroids, polyps, adenomyosis – Screen for PCOS
Hysterosalpingography (HSG): – X-ray with dye injection – Evaluates uterine shape and cavity – Assesses tubal patency – Therapeutic: May improve fertility for 2-3 cycles – Usually performed in follicular phase
Sonohysterography: – Ultrasound with saline injection – Better visualization of intrauterine pathology – Detects polyps and adhesions – Non-invasive alternative to HSG
Hysteroscopy: – Direct visualization of uterine cavity – Diagnostic and therapeutic – Removes polyps, fibroids, adhesions – Gold standard for intrauterine pathology
Laparoscopy: – Visualization of pelvic organs – Diagnoses endometriosis – Allows treatment during procedure – Requires anesthesia
Hormonal Assessment: – FSH (Follicle-Stimulating Hormone) – LH (Luteinizing Hormone) – Prolactin – Testosterone – Thyroid function (TSH) – Day 3 FSH: Assess ovarian reserve
Ovarian Reserve Testing: – Anti-Müllerian Hormone (AMH): Best predictor – Antral Follicle Count (AFC): On ultrasound – Both assess remaining egg supply
Other Tests: – Rubella immunity – Blood type and antibody screen – Infectious disease screening (HIV, Hepatitis) – Genetic testing (if indicated)
Lifestyle Modifications: – Weight optimization (BMI 18.5-24.9) – Regular exercise – Stress reduction – Smoking cessation – Limit alcohol – Healthy diet – Success rate: 20-30% improvement in ovulation
Timing of Intercourse: – Fertile window: 5 days before ovulation + day of ovulation – Regular intercourse (every 2-3 days) covers fertile window – Ovulation predictors aid timing – Success rate: Varies with ovulatory status
Ovulation Induction
Clomiphene Citrate: – Stimulates FSH release – Promotes follicle development – Dosage: 50-150 mg daily for 5 days – Success: 70-80% ovulation rate, 40-50% pregnancy rate – Side effects: Hot flashes, mood changes – Trial: 3-6 cycles
Letrozole (Femara): – Aromatase inhibitor – Increases FSH – Similar effectiveness to clomiphene – May be better for lean women, PCOS – Success: 70-80% ovulation, 40-50% pregnancy
Gonadotropins (FSH, hCG, HMG): – Injected hormones – More potent than oral agents – For clomiphene failures – Requires frequent monitoring – Success: 80-90% ovulation rate – Higher cost, OHSS risk
IUI (Intrauterine Insemination): – Sperm placed directly in uterus – Combines ovulation induction with IUI – Success: 10-20% per cycle – Best for: Mild male factor, unexplained, timing issues – Cost-effective option – Requires patent tubes
IVF (In Vitro Fertilization): – Most effective for most causes of infertility – Success: 40-50% per cycle for women <35 years – Declining success with age: – 35-37 years: 35-40% – 38-40 years: 25-35% – >40 years: 10-20% – Requires: Hormone stimulation, egg retrieval, fertilization, embryo transfer – Treatment cycle: 2-3 weeks
ICSI (Intracytoplasmic Sperm Injection): – Single sperm injected into egg – For male factor infertility – Success: 50-75% fertilization rate
PGT (Preimplantation Genetic Testing): – Tests embryos for chromosomal abnormalities – Reduces miscarriage risk – Improves pregnancy rates with advanced age – Additional cost
For Tubal Disease: – Tubal reconstruction: 30-50% success – Results declining with severe damage – IVF better option with complete blockage
For Fibroids: – Myomectomy: Fibroid removal – Success: 40-60% pregnancy improvement – Depends on fibroid location, size, number
For Adhesions: – Adhesiolysis: Separation of adhesions – Success: Depends on extent – Recurrence common
For Adenomyosis: – Hysterectomy only cure (eliminates fertility) – Other treatments offer symptom relief
Unexplained Infertility Management
Treatment Approach: – Start with ovulation induction + IUI – Escalate to IVF after 3-6 cycles of IUI – Earlier IVF if age >35 years – Empiric treatment often successful
Emotional Impact: – Infertility affects mental health – Depression, anxiety common – Relationship stress – Social isolation
Support Available: – Counseling and psychotherapy – Support groups – Partner involvement in treatment – Stress reduction techniques
When to Seek Fertility Care
Consult Dr. Anju Bala For: – Inability to conceive after 1 year (or 6 months if >35 years) – Known or suspected fertility issues – Multiple miscarriages – Irregular or absent periods – Endometriosis diagnosis – PCOS diagnosis – Desire for fertility assessment
The Bottom Line
Infertility is treatable. With proper evaluation and appropriate treatment, 85-90% of couples conceive. The key is early evaluation, accurate diagnosis, and individualized treatment planning.
Don’t wait. Seek fertility evaluation today.
Contact North Delhi Uro & Gynae Clinic: – Address: C-5, Model Town 3, New Delhi 110009 – Phone: 9910118030 – Doctor: Dr. Anju Bala (MBBS, MD, DNB) – Obstetrician & Gynaecologist
Your dream of parenthood is achievable.
