The first step in the treatment is to evaluate the cause of infertility in the female. Once the cause is determined, a personalised treatment is suggested as per individual diagnosis.

• In women having ovulation problems, simple medication to facilitate egg growth and release is suggested as the first step.
• In women with tubal block, either laparoscopic surgery or IVF based on the severity of the disease is suggested.
• In women with mild stage endometriosis detection after laparoscopic surgery, woman are suggested natural or simple treatment like IUI (Intra Uterine Insemination) as the first step. In moderate to severe stage endometriosis, IVF- In Vitro Fertilisation is the way forward.
• In women with age-related fertility problems, IUI or IVF is suggested based on the age and duration of trying.
• In unexplained infertility, IUI or IVF is suggested.

Miscarriage, abortion or termination of pregnancy can lead to infertility caused by tubal block. Blockage of fallopian tubes can happen due to a secondary infection after a abortion.

The common treatment options for women are ovulation induction, laparoscopic surgery for mild tubal disease and endometriosis and assisted reproductive technologies such as IUI (Intra Uterine Insemination) and IVF (In Vitro Fertilisation also known as test tube baby). 

IUD-intrauterine contraceptive device is usually used as a contraceptive method after the 1st child is born to space out pregnancies or prevent further pregnancies.

It can cause secondary subfertility/infertility, it is a medical term used when a couple can't conceive a second child. Generally, it is safe to use them, sometimes secondary infection can lead to tubal blockage or tubal diseases. If the tubal block has set in, then ART-IVF is suggested or if the tubal block is mild, tubal surgery can be considered.

Birth control pills are used for various reasons, such as regularising periods or bringing down male hormone levels in conditions such as PCOS/PCOD. There are other indications too for the use of birth control pills apart from contraceptive purposes, which is the primary indication.

The use of birth control pills only temporarily blocks the hormones leading to ovulation. After stopping pill use, the hormone levels return to normal, and ovulation occurs. Hence, there is no long term effect of the pill to cause infertility.

Irregular menstrual cycles are indicative that egg growth and release are not happening. In medical terms, this is called anovulation. Most patients with irregular menstrual cycles suffer from a medical problem called PCOS. Due to hormonal disturbances, egg growth and release does not occur, making it difficult to achieve pregnancy naturally. However, PCOS can be treated with simple medication to facilitate egg growth so that pregnancy occurs naturally. It is important to seek advice from a  fertility specialist who shall offer a personalised treatment as per your diagnosis.

Eggs are picked up by the fallopian tube, and fertilisation occurs in the distal end of the fallopian tube. If the tube is blocked or damaged, then fertility is impaired. The most common cause of tubal damage is sexually transmitted infection or infection occurring following abortion. In India, genital tuberculosis is common and is an important cause of infertility.

Fertility in women begins to drop as they grow older. Women are most fertile in their 20's, and their fertility begins to drop as they reach 32 years of age and beyond, it becomes difficult to conceive naturally due to the depleting quality of fertile eggs. If you are a woman over the age of 32 wanting to start a family, we recommend you to seek advice from a fertility expert.

Semen analysis is a very simple test to assess fertility in men.

Here are some of the most common causes that could be related directly to infertility in men:

• Lifestyle issues such as smoking, alcohol, stress, and obesity can negatively influence sperm count.
• Hormonal imbalances too can be a cause of infertility in men.
• Tubal blockage – spermatic cord is a tube like structure that carries sperm from the testis, and it's blockage can cause infertility. These blockages could result from either a sexually transmitted infection or tuberculosis, surgery, or a genetic/inherited condition.
• Some infections can interfere with sperm production or sperm health or cause scarring that blocks the passage of sperm. These include inflammation of the epididymis or some sexually transmitted diseases, including gonorrhoea or HIV.
• Congenital or genetic causes such as Klinefelter's syndrome (chromosomal abnormality) or hereditary conditions related to deletion of genes from the Y chromosome (male chromosome).
• Long-term use of steroids or treatments for cancer can cause impairment of sperm production, leading to subfertility.

However, about 40% of men with infertility present with abnormal semen analysis for idiopathic reasons. For these men, no specific treatment is available and Assisted Reproductive Technologies such as IUI/IVF are the way forward.

Now, let's discuss some of the low sperm count treatments available for achieving pregnancy.

There is no specific treatment designed to bring a low sperm count to be normal. In some cases, hormonal abnormalities can respond to medication such as clomiphene citrate or gonadotropins injections. Improving lifestyle measures may help to a certain extent only.

Many treatment options are available, based on circumstances and your consultations with your specialists, the right way forward is chosen. Intrauterine insemination or IUI is often a go-to treatment for conception. IUI is recommended when some good quality sperm is available. The highest quality sperms are selected, prepared and injected into the uterus, where they are left to fertilise the eggs naturally.

No single medicine can cure all kinds of male infertility issues. Depending on the cases, the possible treatment options include the following:

1. In cases of problems related to sexual intercourse like premature ejaculation or erectile dysfunction, medication combined with counselling will be recommended.

2. If the patient has a varicocele (dilated veins in the scrotum) in severe grade associated with pain. In that case, the way forward is to get it corrected or surgically repaired. However, the vast majority of men experience mild varicocele, in such cases correction of varicocele does not increase sperm count.

3. A bacterial infection may be affecting the sperm count or fertility, for which antibiotics may be prescribed.

4. Hormone treatments and medications in cases where there is an influence of low hormone levels.

5.  Lifestyle choices can also play a role, and the following actions can improve sperm count and overall health.

• Obesity or being overweight can affect sperm count. It will help if the patient maintains a healthy lifestyle through diet and exercise.

• Certain deficiencies, are revealed through blood test. The patient would be required to include new foods or take supplements to help restore the deficiencies vitamin and mineral levels.

• It's a known fact that substance abuse like heavy drinking and drug or tobacco use needs to be avoided at all costs if you are serious about conceiving.

• Underlying medical conditions can affect your sperm count. Patients with low sperm count need to seek advice of a fertility specialist. Treatment options are discussed based on individual needs.

Male fertility tests such as semen analysis determine sperm count and sperm motility. The findings of this analysis help us determine the problem areas in conception.

A normal semen analysis gives a broad outline of sperm count and motility. Though this provides general guidance on whether major factors related to male fertility are ruled out, some men can have fertility issues despite having an average sperm count. These need additional tests to assess, and these advanced tests are suggested when necessary.

While there's no fixed formula to guarantee male fertility, but many people are relieved to find that lifestyle changes can enhance the chances of becoming fertile. The lifestyle changes include quitting smoking, limiting caffeine, avoiding alcohol, eating well, taking dietary supplements, maintaining a healthy weight and reducing stress.

IUI is offered as an initial step for couples diagnosed with unexplained subfertility. Mild male factor subfertility/infertility such as marginally low sperm count can be treated with the help of IUI.

Many couples prefer IUI, as it is a quick, simple and not too invasive, which makes it a great option to achieve pregnancy. The success rate with one cycle is around 20%, one may need 3-4 inseminations before pregnancy is achieved.

However, IUI's work with no blockages in the fallopian tubes with healthy sperm and eggs. In case of irregular ovulation, experts may administer IUI with the aid of some fertility drugs.

The success rate in one cycle of IUI is 20-25%. The patient can be offered a maximum of 6 cycles. The majority of the pregnancies happen in the first three cycles. If pregnancy does not occur at the end of 3 cycles, further options like Laparoscopic surgery followed by three more cycles of IUI or IVF are discussed.

Usually, most pregnancies that result from IUI happen in the first three cycles. If a couple is unsuccessful in the first three IUI cycles, then case profile suggests either laparoscopic surgery followed by three more cycles of IUI or IVF. If problems with fertilisation are the reason for couples not getting pregnant, it cannot be corrected with IUI. These couples need IVF to achieve a pregnancy.

In Vitro Fertilisation (IVF) is an assisted reproductive technology – where the fertilisation occurs outside the body, therefore called "in vitro" or even as "test-tube" babies. It is the process of fertilisation by extracting eggs, retrieving a sperm sample, and manually combining an egg and sperm in a laboratory dish. The embryos are then transferred to the uterus.

IVF bypasses all the medical issues that cause infertility and in cases where there has been a blockage or damage to the fallopian tubes and male infertility, such as decreased sperm or motility and in case of genetic disorders and unexplained infertility.

IVF is recommended to overcome the following issues of infertility or subfertility

1. Issues with Fallopian Tube – damaged or blocked.
2. Male infertility, such as decreased sperm count or motility.
3. Ovulation disorders such as premature ovarian failure.
4. Certain genetic disorders.
5. Unexplained infertility  

Normally one cycle of IVF in women under 35 years of age with two good quality embryos replaced at the blastocyst stage is 65%. In general, at good clinics, the chances of conception in one cycle across all ages is around 50%. Hence the cumulative success rates of conception in 3 cycles are very high and close to 8 or 9 times out of 10.

Some of the factors which affect the success rates of IVF are as follows:

• A woman's age is the most crucial factor that influences the success rates of IVF. Success rates with IVF are high in women under 35 years of age. However, as the woman ages, the chances of conception are best with IVF treatment than any other treatments.
• Certain indications such as male factor, anovulation (PCOS), tubal disease and endometriosis have better rates of success with IVF compared to couples undergoing IVF due to poor ovarian reserve, unexplained subfertility, problems in both partners such as low sperm count and poor egg reserve, a prolonged period of subfertility and genital tuberculosis.
• Women with a history of previous pregnancies, miscarriages or ectopic pregnancy, seem to have better chances of conceiving with the help of IVF than others. Women with a good ovarian reserve have a better chance of pregnancy than others.
• One of the most critical factors determining the success rate of IVF is your choice of the IVF centre and the doctor's expertise in performing IVF along with their credentials and training. 

Usually, with diagnosis of unexplained subfertility, AMH-Anti Mullerian Hormone test is conducted. If the results show that the egg reserve is poor then IVF treatment is advised.

Even though the success rates are higher in the first three cycles, a total of six cycles of IUI can be tried. Most pregnancies are achieved with IUI in the first three cycles. Hence, it is advisable to discuss the next step with your fertility doctor at the end of three IUI cycles. 

If the woman is young and has good quality and number of eggs, then laparoscopy followed by three more IUI cycles can be tried before IVF.

If the woman's age is more than 35, it's better to opt for IVF.

9 out of 10 women conceive after three cycles of IVF only if the procedure is carried out at a good IVF centres. 

The IVF process is not difficult, but you need emotional support during the process. In good clinics, counselling is offered to help you get through the entire process. In good clinics, the success rate is high, and with good emotional support, you will be able to achieve a pregnancy soon. 9 out of 10 women conceive after three cycles of IVF only if the procedure is carried out at a good IVF centres. 

IVF stands for In Vitro Fertilisation. In Vitro Fertilisation (IVF) is one of the commonly used methods of fertility treatment, which can be captured in 5 stages:

Step 1: Ovulation Induction: Egg production is stimulated with medication. Tests such as ultrasound are conducted to examine the ovaries to assess the response to medication. Blood tests might be suggested in some patients to check hormone levels.

Step 2: Egg Retrieval: Minor surgical procedure is used to retrieve the eggs. The procedure uses ultrasound imaging to guide a hollow needle through the vaginal probe of the scanner to remove the eggs. This process is done under short anaesthesia.

Step 3: Collection of Sperm: The sperm sample is collected from the husband, which is required for fertilisation of the egg.

Step 4: Fertilisation Process: The most active sperm is mixed with an egg and placed inside a special incubator to assist fertilisation. The eggs are monitored to confirm whether fertilisation and cell division is taking place. Once this happens, the fertilised eggs are considered embryos.

Step 5: Embryo Assessment, Transfer and Implantation: The last step in the process entails embryo transfer into the woman's uterus.

From Egg retrieval to fertilisation it takes three to five days. A small plastic tube is placed through the cervix into the uterine cavity to transfer embryos. Once the embryo transfer process is complete, one can go home and continue a normal life. Too much rest isn't usually recommended. Most clinics and specialists have 50% success rates for IVF for one cycle, which means that more than one cycle could be needed for successful conception.

If Clomid 6 cycles haven't worked, then the next step is usually IUI. If there are additional issues such as advanced age of the female partner or problems with sperm count, then IVF is the way forward. Though general guidelines can be given, treatment is very individualised. It would be prudent to discuss this with a good fertility specialist.