Even today, in my clinical practice, one pattern continues to repeat itself—the woman walks in first. She is educated, aware, and empowered in every other aspect of life. Yet, when it comes to infertility, the responsibility is often placed on her.
It is time we correct this narrative.
When should you consult an infertility specialist?
If you are below 35 years and have been trying to conceive for one year without success, you should seek evaluation. If you are 35 years or older, this timeline reduces to six months. In the presence of known risk factors—irregular cycles, prior infections, or medical conditions—earlier consultation is advisable.
How do we evaluate infertility?
Infertility assessment is always couple-centric.
The first step includes a comprehensive clinical evaluation of both partners. For women, we perform an ultrasound to assess the uterus and ovaries, along with hormonal tests and ovulation tracking. For men, a semen analysis evaluates sperm count, motility, and morphology. We also address sexual health concerns, which are often underreported but clinically relevant.
Understanding the real contributors to infertility
Infertility is not a single-cause condition—it is multifactorial.
• Female factors contribute to 30–40%
• Male factors contribute to 30–40%
• Combined factors account for 10–20%
• And importantly, unexplained infertility contributes to 10–20%
Unexplained infertility is not “no problem”—it is “no obvious problem.”
This is where the complexity lies.
In these cases, all standard investigations—ovulation, tubal patency, uterine structure, and semen parameters—appear normal. Yet, conception does not occur. This segment is particularly challenging because the issue may lie in subtle physiological or molecular dysfunctions that current diagnostics cannot fully capture.
These may include:
• Poor egg or sperm quality at a microscopic level
• Fertilisation defects
• Early embryo development issues
• Implantation failure within the uterus
In the Indian context, where couples often delay consultation or rely on fragmented evaluations, unexplained infertility can become a silent and prolonged struggle.
Key contributing factors
For women, causes include lifestyle factors, PCOS, tubal damage (including post-infectious and tuberculosis-related), endometriosis, adenomyosis, diminished ovarian reserve, and uterine abnormalities.
For men, lifestyle factors remain a leading contributor, along with low sperm count, poor motility, abnormal morphology, and DNA fragmentation.
A shift in mindset is critical
Infertility is not an individual issue—it is a shared diagnosis. When both partners come forward together, it reduces diagnostic delays, improves treatment precision, and strengthens emotional resilience.
More importantly, it reframes infertility from blame to collaboration.
Because in reality, the question is not “who is responsible?”
It is “how do we move forward, together?”
