Infertility is the inability to conceive a child naturally. Infertility can be due to problems in both men and women. Certain medical conditions such as Poly-Cystic Ovarian Syndrome (PCOS), endometriosis, premature ovarian failure, premature menopause, varicocele, and pelvic infections, scrotal and testicular injuries, etc. cause unexpected onset of infertility. Apart from those, the upsurge in lifestyle risk factors is also found to be one of the key drivers for the high occurrence of infertility among men and women.

The major lifestyle factors that have contributed to infertility include increased use of tobacco, high alcohol consumption, rising levels of obesity and stress, couples opting to plan a child at a later age, etc. While clinical solutions can help overcome the medical factors, there is a dire need to create awareness on the lifestyle risk factors, especially amongst the youngsters, to avoid suffering from infertility later in life.

• Damage to fallopian tubes: Damaged or blocked fallopian tubes keep sperms from getting to the egg or block the passage of the fertilised egg into the uterus.
• Polycystic ovary syndrome (PCOS): PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity. Abnormal hair growth on the face or body, increase in body weight and excessive acne are some of the symptoms of PCOS.
• Endometriosis occurs when the tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may block fallopian tubes and keep an egg and sperm from uniting.
• Premature ovarian failure: Ovulation or the process of egg maturing stops in women under the age of 40. Eggs are no longer produced, oestrogen production is lowered leading to infertility.
• Poor quality oocytes: X chromosome abnormalities, autosomal causes, autoimmune disorders can affect the quality of the eggs in women. In cases of women at the end of their reproductive age, the egg quality decreases even if she may be menstruating. In premenopausal women, there is often both quantitative as well as qualitative decline in oocytes, which hampers the fertility.
• Cancer treatment such as radiotherapy and chemotherapy can cause the ovarian reserve to deplete in women. Additionally, ovarian cancer can directly result in infertility.

• About 40% of male infertility is because of either Azoospermia (absence of viable sperms in the semen) or Asthenozoospermia (reduced sperm motility)
• Sometimes men are able to produce sperms in sufficient quantity but the quality is poor. This causes difficulty in conception. This is called as oligospermia.
• Male infertility can be caused by acute infections such as smallpox, mumps, other viral infections, and chronic infections like TB, leprosy, prostatitis, etc.
• Varicocele: An enlargement of the veins that wraps around the testicles and affects sperm development. It occurs in about 15 to 20 percent of infertile men.
• Other medical causes such as cryptorchidism (undescended testes), aplasia (congenital obstructions), vasectomy, post-infective ejaculatory disturbances and sexual dysfunctions are also common.

• Trans vaginal ultrasonography to evaluate uterus and ovaries
• HSG [ Hysterosalpingography ] or SSG [ sonosalpingography ] are tests in which a dye is injected in to the uterus to look for pathology in the uterus and patency of the tubes
• Laparoscopy is a minor surgery that uses a thin, lighted tube put through a cut (incision) in the belly to analyse the abdominal organs or the female pelvic organs. Laparoscopy is used to find problems such as ovarian cysts, adhesions, fibroids and infections. Tissue samples can be taken for biopsy through the tube (laparoscope). Fallopian tubes patency can be checked.
• Diagnostic hysteroscopy is a procedure where a hysteroscope, a thin, lighted tube is inserted into the vagina to examine the cervix, the inside of the uterus and the fallopian tubes. This is often used to diagnose the causes of abnormal bleeding and other uterine problems.
• Anti-Mullerian Hormone (AMH) test is a simple blood test that helps detect the number of eggs left in a woman’s ovarian reserve

• Semen analysis is the most important test for assessing male fertility. The count, motility (activity) and morphology (structure) of the sperm in the semen gives valuable information on whether a man has impaired fertility.
• Sperm DNA Fragmentation is a specialised sperm function test that assesses the quality of the genetic material in the sperm. In some men, the sperm count and motility may seem adequate but the quality of the sperm may be deficient. This can be assessed by evaluating the sperm DNA. This test is prescribed in cases where there has been a failure of previous IVF cycles, recurrent abortions, unexplained infertility, or semen parameters of uncertain quality.

Being overweight or underweight can reduce the chances of conceiving. Overweight or obese women often have problems with ovulation. Obesity not only impairs ovulation but also has detrimental effects on the endometrial development and implantation. The hormonal imbalance that comes with obesity often leads to insulin resistance. That is a major risk factor on the road to diabetes.

PCOS is a common disorder that is caused by hormonal imbalance in the body, thereby disrupting the ovulation process and eventually leading to infertility when not diagnosed and treated at the right time. It is crucial for women with PCOS to keep their weight in check. Moreover, obesity also makes it more challenging to become pregnant, no matter whether one is using natural means or assisted reproductive techniques such as in-vitro fertilisation (IVF).

Although much of the focus on obesity and infertility is on women, it affects men too. The range of impact include reduced sperm count, lowered levels of testosterone, physical constraints, reduced libido, erectile dysfunction,  hypertension and uncontrolled diabetes which deteriorates the quality of semen.

In today’s modern, fast paced society, it is easy for people to become stressed. For years, scientists have been researching the causes leading to stress and its impact on human health. With the world becoming more technologically advanced each day, most of us spend a big chunk of our time with our cell phones, laptops or tablets, which are glued to our ears or our eyes. Apart from the other health hazards technology has to our eyes, spine and limbs, it also affects us mentally leading to stress, and stress in turn not a good sign for men and women planning to start a family.

In women specifically, it's important to differentiate between constant and sudden stress. If the stress level is high but fairly consistent, the body will likely acclimate to it and can still ovulate each cycle. It's sudden stress – such as an accident or a death in the family – that can throw the cycle off and interfere with ovulation, and therefore can cause women to be unable to conceive naturally. This, however, varies from woman to woman. Some women find that even a trip out of town can delay ovulation. Others have found that a severely traumatic incident did not impact their cycle at all.

During pregnancy, a woman is often in various emotional states because of the hormones. A woman trying to carry a pregnancy to term during stressful times can also place the foetus at risk. Stress, as it does in many areas of our lives, interferes with the reproductive process and is a cause for infertility and miscarriages. Generally, a stressed person is not a very healthy person. People living with high stress levels are typically overly tired and filled with nervous tension, which may cause them to choose poor dietary and lifestyle habits.

In men, studies link high levels of stress hormones as one of the reasons for the decrease in the production and quality of sperms. According to reports, male infertility occurs in about 30-40% of infertile couples. Psychological stress is seen to boost the levels of stress hormones while lowering the production of male hormone, testosterone, which may subsequently cause a loss of libido in men and affect their reproductive health.

Often the ill effects of childlessness are far more severe for women than they are for men. Childless women are subjected to the additional risks of social discrimination in many forms (restrictions on their participation in social celebrations), allowing husband to remarry. These things happen irrespective of whether the childlessness is due to her being infertile or because the husband is infertile. The fact however is, impaired fertility of male partner is causative in approximately 50% of all the couples unable to conceive spontaneously.Infertility research has been neglected both as a health problem and as a subject for social science research, as in the past few decades greater amount of emphasis is placed on controlling unwanted fertility. As a result, very little work has been carried out in the past on this important subject. Thus, there is a need to explore, this rarely explored phenomenon.

Infertility research has been neglected both as a health problem and as a subject for social science research, as in the past few decades greater amount of emphasis is placed on controlling unwanted fertility. As a result, very little work has been carried out in the past on this important subject. Thus, there is a need to explore, this rarely explored phenomenon.

In some of the regions, infertility is found to be widespread and its prevalence reaching such proportions that it can well be considered as a public health issue, affecting the life of the whole society.  In its extreme, infertility compounded by pregnancy wastage, infant and child mortality may lead to depopulation, which poses serious threat to the social and economic development of the region.

Many fertility specialists in India also suspect that infertility is largely psychosomatic among the educated and employed upper and middle classes. Experts also feel that lifestyle changes of the 21^stcentury have adversely affected fertility, resulting in low sperm count, infections, chronic disease, and erectile dysfunction in the male and damaged fallopian tubes, low egg production and fibroids in the female. The problem is prevalent among professionals in the fast mode, such as busy professionals in the software and IT sector. Working at the computer for 8-12 hours at a stretch, lack of attention/time for nutrition and a disturbed sleep cycle have all become perfect ingredients for infertility.

Infertility is as much a social problem as it is a health issue. With increasing awareness, infertility treatment is becoming more acceptable across all communities in India. In recent years, India has become a preferred destination for infertility treatment with the number of international patients increasing exponentially. This can be attributed to the low costs, standardised fertility services, highly specialised doctors and a high success rate found here. In spite of the huge growth in IVF cycles in the last 5 years, India has amongst the least number of IVF treatment cycles as compared to developed countries. IVF treatment represents both a big opportunity as well as a huge challenge in India. The challenges include access to the latest technology, research, training, infrastructure, equipment, drugs, internationally accepted protocols and non-standard pricing.

What is IUI (Intrauterine Insemination)?

This is a basic treatment in Assisted Reproductive Technology (ART) usually carried out along with ovarian stimulation. Ovarian Stimulation involves oral or injectable medications that are given to the female partner to stimulate the ovaries to produce more follicles. To ensure safety, the follicular growth and the hormone levels are carefully monitored using vaginal ultrasounds and blood tests. This is done for women who have problems in egg production.In IUI, a processed fraction of semen, containing only motile sperms is injected directly in to the uterus using a special catheter, at around the time of ovulation. IUI is the first line of ART treatment when simpler treatments fail.

Who is it for?

It is recommended for couples with mild to moderate decrease in sperm count, motility and unexplained infertility. Younger women have a higher chance of achieving a pregnancy via this method.

What is IVF (In-vitro Fertilisation)?

IVF is a treatment where the woman’s eggs are removed, fertilised with the man’s sperm in a laboratory and the resulting embryo put back in to the uterus. The woman is given hormonal injections to stimulate the ovary with appropriate monitoring to produce a higher number of eggs (average 8 to 12). These are removed using transvaginal sonography under general anaesthesia which requires 3-4 hours of hospitalisation. The husband’s semen is collected and processed to separate normal motile sperms. If the man is not available or unable to produce semen, a previously cryopreserved (frozen) sample is used. The eggs and sperm are then allowed to fertilise and develop in the laboratory incubators for three to five days. The best two embryos are then put back into the uterus.

Who is it for?

• Cases of severe male infertility
• Women with damage to, or without, Fallopian Tubes
• Women with resistant Polycystic Ovarian Syndrome
• Women with endometriosis when other routine treatments have failed
• Couples with unexplained infertility where treatments such as Artificial Insemination (IUI), have failed
• Women with advanced age
• Fertility preservation for social or medical reasons

What is Intra-Cytoplasmic Sperm Injection (ICSI)?

ICSI is a process where a single sperm is injected directly into the egg under high magnification using a micromanipulator machine. The main objective of ICSI is to improve the chances of fertilisation. The earlier part of treatment involving ovarian stimulation and egg retrieval are the same as in IVF. It is recommended in cases of severe male infertility, previous fertilisation failures with IVF and situations in which there are a limited number of oocytes available. But now most of the IVF centres do ICSI for all patients owing to its better fertilization rate.

What is egg/sperm donation?

Egg/sperm donation is often a successful treatment for infertility in women and men who can no longer produce healthy gametes. Egg/sperm donation is an anonymous process, and confidentiality is maintained on the records of both the donors and the recipients. It offers couples privacy and secrecy, so that they need not worry about societal acceptance of their child. The donor gametes often come from donors who are married and have healthy children, and hence the success rates are generally higher when compared to other IVF cycles. IUI or IVF can be done with sperm donation, but egg donation treatment is only possible with IVF.

How to prepare for an IVF cycle?

Proper planning for an IVF cycle will increase the chances of a successful pregnancy. The outcome will be positive and the risk of side effects due to drugs and medication will be reduced drastically. A happy mind and a relaxed body are what all successful IVF treatments need. The importance of the couple being prepared from emotional stability to health and finances is very vital to attain a successful pregnancy through IVF. Some guidelines to follow before an IVF treatment are given below:

• Proper intake of vitamins and minerals, trace elements and antioxidants
• Both the partners need to be checked for any medical problems which can reduce the chances of success like thyroid and diabetes. If diagnosed with any problem, it is advised to have it treated before starting IVF
• Couples need to be made aware of the success rates, which is high for women of younger age group even with IVF procedure
• Being pregnant through an IVF is a joyous feeling; however it is important to understand the reasons behind a failed IVF cycle and look for the next treatment option with a positive attitude

When is my fertile period?

It is a myth that women can get pregnant at any time during their menstrual cycle. The fact is that achieving pregnancy actually depends a lot on the timing. A woman can get pregnant only during a limited number of days during the menstrual cycle. This is known as the fertile window or fertile period. To understand the fertile window, one has to understand the menstrual cycle.

Most women have a 28-30 day menstrual cycle, however, it is normal to be an exception too. For a woman with a regular menstrual cycle, the fertile window usually lasts the same seven days each month – five days before ovulation and two days after ovulation. Ovulation is the process of a mature egg being released from one of the ovaries.

Technically, a woman can get pregnant only on the day of ovulation, when the mature egg is pushed down the fallopian tube and is made available for fertilisation. The fertile period of seven days takes into account the lifespan of sperm, usually five days, and the lifespan of the egg, which is 24 hours. If the egg is not fertilised in the 24 hours after ovulation, it disintegrates and begins to exit the body, thereby starting the next menstrual cycle. The rule of thumb is that ovulation occurs at the midpoint of a woman’s menstrual cycle.

• Myth #1: Infertility is a woman’s problem / Men don’t have infertility problems
  Fact: For years it was believed that the woman was responsible for infertility, but we know today that it affects both men and women equally. Therefore the joint evaluation of the couple is critical to obtain an adequate diagnosis.
• Myth #2: Infertility is uncommon
  Fact: In India, 27.5 million couples who are actively seeking children suffer from infertility*
• Myth #3: IVF always results in twins or triplets
  Fact: Recent advances in the technology have made it possible to get a high success rate with the transfer of just 1 embryo.
• Myth #4: Age doesn't affect fertility if you're healthy.
  Fact: While certain unhealthy habits, like smoking, may speed up the effect of age on fertility, living a healthy lifestyle will not stop your biological clock. Fertility begins to decline in a woman starting at age 27. At age 35, that decline speeds up, and after 40, it declines even more steeply. A healthy lifestyle cannot stop the natural process of aging.
• Myth #5: IVF is considered unnatural. 
  Fact: The fertilization of an egg by a sperm is the most natural way in which the genetic composition of the man and the women combine to form a baby. Since this process is not possible inside a woman’s body either because of tubal blockage or poor sperm count, IVF helps in bringing the egg and the sperm together outside the body.
• Myth #6: Egg freezing is useful only for women who have cancer
  Fact: This helps with Planned Parenthood, incase women want to wait or want to have a child later on in life
• Myth #7: IVF babies are not normal
  Fact: IVF babies are as naturally born as other children. In fact, until one is told, it is impossible to distinguish between IVF baby and other children.

Myth #1: You have no control over the success of an IVF cycle

Fact: The results of an IVF cycle are to a large degree based upon a thorough evaluation of the couple ad choosing the right technique and treatment and there are a number of things your doctor can do before you begin to optimize success rates. The more informed you are, the better you will understand what IVF success entails.

Myth #2: Stick to bed rest after embryo transfer

Fact: There's no need to put your life on pause after the embryo transfer. This idea is an absolute myth. In fact, a study done in Egypt found that women who were on bed rest for 24 hours following a transfer had a lower success rate compared to those who returned to their usual routine.

Myth#3: Infertility only happens to couples who have never had a child before

Fact: Fact: Unfortunately for many couples who have a child and wish to conceive again, a variety of factors can contribute to what is known as "secondary infertility." A number of problems could have occurred since the last conception, such as endometrioses anovulation, tubal disease or decline in the concentration of sperms in male.

Myth #4: Herbal remedies can help with IVF

Fact: There's no data showing that herbs are safe to take while you're trying to conceive. Add to that the fact that many herbs come from overseas with detectable levels of mercury and no guarantee of safety and that some are even inadvisable to take during pregnancy.

Adoption is a beautiful experience providing us with an opportunity to render selfless love to our dear ones.

Prospective Adoptive Parents (PAPs) usually have plethora of questions as they embark on this journey. With dearth of reliable resources on adoption, lack of similar experience within the family, myths perpetrated through films and hearsay.

They wonder how long the wait for their child could be. Should the child look similar to them? Do older children bond as well as infants? Is it possible to adopt a new born baby? How and when do they tell their family and friends? Will their employer grant them adoption leave? Do they tell the child about its adoption - if yes, when and how? So on and so forth...

If you are a PAP or their close family & friend having similar doubts, do not worry. We shall guide you step-by-step in your journey of adoption. We shall help you discover the child-centric approach to adoption, get familiar with adoption guidelines, refer you to counsellors and adoptive parents, support you with resources and prepare you in bringing your little joy home.

We recommend the following steps to gain an easy introduction to adoption:

Pre-Adoption Phase:

1. Understand Adoption
2. Know about Adoption Guidelines
3. Register for Adoption
4. Meet Adoptive Families
5. Do Not "CHOOSE" a Child
6. Complete Legal Proceedings

Post-Adoption Phase:

1. Involve Family & Friends
2. Do Regular Medical Check-Up
3. Tell the Child about Adoption
4. Support the child in its Teens
5. Discuss Adoption at home, per context
6. Champion Adoption as Parent