Infertility is not a woman’s problem. It is a medical problem of the male or female reproductive system. In about one third of cases, the cause is traced to the woman, another third of cases are traced to the man. The rest are caused by unknown factors or a physiological incompatibility.

Around one in six couples find difficulty in conceiving within the first year of unprotected intercourse and 1 in 12 couples will remain childless after this. Infertility is a symptom that can be found in both the man and the woman and there may be contributing factors from both partners.

In 40 per cent of cases, however, the problem is principally with the male partner. Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children. Conception is a complicated process that depends upon many factors:

*the production of healthy sperm by the man and healthy eggs by the woman 

*unblocked fallopian tubes that allow the sperm to reach the egg

*the sperm's ability to reach the egg 

* the sperm's ability to fertilise the egg when they meet

*the ability of the fertilised egg (embryo) to become implanted in the woman's uterus

*a good quality embryo

For the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When any one of these factors is impaired, infertility can result.

A couple is considered infertile if the woman does not conceive a child after one year of unprotected, well-timed intercourse or she has been unable to carry a pregnancy to a live birth. The diagnosis is sped up for women over 35 — treatment is normally recommended after six months of trying to conceive.

Infertility is not only a physical condition — it is an emotional and social condition with accompanying feelings and issues. The infertile couple needs support and consideration from the treatment team, friends, family, and each other.

It is important to see both the partners as soon as possible so that they can be investigated simultaneously. The man needs to undergo few tests to find out about the quality of the sperms and any other associated problems.

The first test required is the Semen Analysis. It is important to abstain from intercourse for three days prior to the test. The sample should be given to the laboratory within 30 minutes for the accuracy of the report. The count, the motility and the morphology or normalcy of the sperms, are the three main criteria looked for by this test.

A number of infertile men will have low count, low motility and increased number of abnormal sperms to account for the problem.

The blood test for the hormones will help to assess the testicular function. There are certain endocrinal conditions, which can be treated effectively if diagnosed early. At the same time, a severe testicular damage can be suspected to avoid further unnecessary tests.

The Doppler ultrasound of the scrotum is helpful to diagnose the presence of the Varicocele. In this condition, the blood vessels around the testes are dilated and more in number. It can affect the sperm production resulting in the infertility.

The management of the infertile couple is simultaneous. The gynaecologist should treat any problems in the women to save the time.  The aim is to improve the quality of the sperms so that the chances of the fertilisation are increased. The endocrinal problem such as, Hypogonadism, should be referred to the specialist. If the semen analysis shows the signs of infection, it is treated with the antibiotics.

It is found that the treatment of Varicocele has about 60 –80% chances to improve the count, motility and the morphology. The operation for the Varicocele can be done through the groin incisions.

In certain cases it is found that there are no sperms in the semen analysis, called Azoospermia. The further tests are needed to find out whether there is testicular failure to produce the sperms or any obstruction to the passage of the sperms.

Unfortunately, nothing can be done be for the primary testicular failure and the adoption or the artificial insemination of the donor sperms remains the only choices with the couple. The obstructive azoospermia can be treated by the surgery.

The author is consultant andrologist, Sagar Apollo Hospital