What Is Infertility?
Defining Infertility
Infertility is defined medically as the inability of a couple to achieve pregnancy after twelve months of regular, unprotected sexual intercourse. For women who are 35 years of age or older, this threshold is reduced to six months, because egg quality and ovarian reserve decline more steeply after this age and earlier intervention significantly improves outcomes. Infertility does not mean that pregnancy is impossible. It means that conception has not occurred within the expected timeframe, and that an evaluation to understand why — and what can be done about it — is now warranted.
Infertility is remarkably common. Worldwide, approximately one in six couples experience difficulty conceiving at some point in their reproductive lives. In India, studies suggest that infertility affects between 10 and 15 percent of married couples, though the true figure may be higher due to underreporting driven by social stigma. What this means is that if you are struggling to conceive, you are not alone — and you are not facing a situation without solutions.
Primary and Secondary Infertility
Primary infertility refers to the situation where a couple has never been pregnant and is unable to conceive. Secondary infertility refers to the inability to conceive or carry a pregnancy to term after having previously achieved at least one successful pregnancy. Secondary infertility is often more emotionally complex than primary infertility, because the couple has the experience of parenthood — and the painful contrast with a situation that was once possible and now seems not to be. Both forms of infertility are fully within the scope of Dr. Krishnakumar’s practice, and both deserve the same thorough, compassionate, and evidence-based evaluation.
Causes of Infertility — The Complete Picture
One of the most persistent and damaging misconceptions about infertility is that it is primarily a female problem. This is simply not true. Infertility has equal origins across the sexes. Approximately 40 percent of infertility cases in couples are attributable to male factor causes. Another 40 percent are attributable to female factor causes. The remaining 20 percent involve a combination of male and female factors, or cases where no specific cause can be identified despite thorough investigation — what is known as unexplained infertility.
The practical implication of this is important: when a couple comes to Dr. Krishnakumar for infertility evaluation, both partners are assessed comprehensively from the very first consultation. Evaluating only the woman while assuming the man is fertile is one of the most common and costly errors in infertility management. It delays diagnosis, wastes time, and can result in treating the wrong partner for the wrong reason.
Female Causes of Infertility
Polycystic Ovarian Syndrome (PCOS) is the single most common hormonal disorder affecting reproductive-age women in India, estimated to affect approximately 20 percent of women in this demographic. PCOS disrupts ovulation, causing irregular or absent menstrual cycles, and it creates a hormonal environment that can interfere with fertilisation and implantation even when ovulation does occur.
Endometriosis affects approximately 10 percent of women of reproductive age and is one of the most underdiagnosed conditions in Indian medicine. It can damage the fallopian tubes, disrupt ovarian function, and create an environment hostile to fertilisation and implantation. Laparoscopic excision by a trained surgeon — not just hormonal suppression — is the definitive treatment.
Fallopian tube damage or blockage prevents the egg and sperm from meeting. Tubal disease most commonly results from pelvic inflammatory disease, previous infections, or prior surgery. HSG is used to assess tubal patency.
Uterine abnormalities — including fibroids, polyps, Asherman’s syndrome, and congenital uterine malformations — can interfere with implantation. Many of these conditions are correctable with hysteroscopic surgery.
Diminished ovarian reserve refers to a reduction in the number and quality of eggs remaining in the ovaries. It is a natural part of ageing but can occur prematurely.
Thyroid disorders — both hypothyroidism and hyperthyroidism — significantly affect fertility and pregnancy outcomes and are common in Indian women.
Male Causes of Infertility
Male infertility accounts for approximately 40 percent of all infertility cases in couples, yet it remains deeply stigmatised in the Indian cultural context. Many couples spend years pursuing female-focused investigations and treatments before a semen analysis is finally performed — only to find that the primary cause of their infertility was male.
Low sperm count (oligospermia) means fewer sperm are present in the ejaculate than required for natural conception. Azoospermia is the complete absence of sperm.
Low sperm motility (asthenospermia) means that sperm cannot swim effectively. Abnormal sperm morphology (teratospermia) refers to sperm with structural abnormalities that prevent fertilisation.
Surgical Retrieval: In cases of complete azoospermia — where no sperm are present in the ejaculate at all — surgical sperm retrieval using TESA (Testicular Sperm Aspiration) or PESA (Percutaneous Epididymal Sperm Aspiration) can often recover sperm directly from the testes, which are then used for ICSI.
Timely Intervention
When Should You See a Specialist?
General Guidance
If you are under 35, you should see a fertility specialist after twelve months of trying to conceive without success. If you are 35 or older, do not wait twelve months — see a specialist after six months.
Immediate Consultation
If you have irregular menstrual cycles, a known diagnosis of PCOS or endometriosis, a history of pelvic inflammatory disease, or thyroid dysfunction, do not wait at all — see a specialist from the outset.
Pregnancy Loss
Two or more pregnancy losses — regardless of when they occurred in pregnancy — warrant a specialist evaluation before trying again. Recurrent pregnancy loss has specific, identifiable causes.
Male Health
For men, if there is a known history of varicocele, testicular injury, undescended testes, previous cancer treatment, or if a semen analysis has already shown abnormal results, seeing a specialist immediately is appropriate.
Infertility and Emotional Health
The emotional burden of infertility is significant and real, and it is often invisible to the world outside the couple experiencing it. The medical appointments, the waiting, the hope that rises and falls with each cycle, the social pressure of a culture that equates marriage with children and infertility with failure — all of this accumulates. Couples often feel isolated in their experience, unable to speak openly about what they are going through.
Dr. Krishnakumar’s clinic acknowledges this reality explicitly. Every consultation is a confidential, non-judgmental space. Questions about lifestyle, sexual history, previous pregnancies, and relationship dynamics are asked with sensitivity and respect. Uncertainty is often more distressing than a difficult truth. Dr. Krishnakumar tells the truth, clearly and compassionately, because he believes that informed patients make better decisions and cope better with the inevitable uncertainties of fertility treatment.
Starting Your Evaluation
The first step is a consultation with Dr. Krishnakumar. For most couples, the initial evaluation — including blood tests, semen analysis, pelvic ultrasound, and hormonal profiling — can be completed within two to three weeks. A clear diagnosis and treatment plan is typically available within four to six weeks of first consultation.
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