Infertility is a disease with major emotional as well as physical components. Unlike other diseases, infertility is also a disease that involves two people, the male and female partners. In over half the number of cases, the male partner has a fertility problem or both partners have a combined problem. But it is regardless to think of who has the primary medical problem, as infertility is a couple's problem or disease.

               Infertility affects every aspect of a couple`s life, their marriage, sex life, social relationships and finances. Friends and relatives may be insensitive of what the couple is experiencing resulting in strained relationships. Couples may argue as a result of infertility discussing about which friends or relatives to tell, how often to have sex, what treatment to pursue and whether or not to adopt. Infertility also can adversely affect an individual's self image and self esteem.

               Multiple body functions must be operating normally in order to conceive a baby and carry a pregnancy to term. The man must be producing healthy, motile, swimming sperm in enough quantities to fertilize an egg cell. The woman's cervical mucus must be at the right PH and in consistency to facilitate the sperm's journey to the reproductive tract; the ovaries must release healthy eggs; her fallopian tubes must be free of blockages; the uterine environment must be suitable for implantation of a fertilized egg; and all along the way, the endocrine system must be secreting various reproductive hormones in the right sequence and at proper levels for the pregnancy to occur.

               Some men produce either no sperm at all called as azoospermia or very few healthy sperm  known as oligospermia. Several medical conditions are known which cause these conditions, common causes are :-

Varicocele
               Varicocele is a major cause of male infertility and occurs when a vein that carries blood out of the scrotum dilates, much like a varicose vein in another location. As a result, a pool of blood forms around the testicles, raising the temperature of the scrotum. The elevated temperature hinders the maturation process of sperm. Sperms develop best in an environment that is slightly cooler than body temperature.

Infections
              Sexually transmitted diseases can trigger events leading to male infertility. Mumps after puberty causes damage to the testicles. A reduced amount of ejaculated semen may cause inflammation of the seminal vesicles. Semen that does not liquefy properly can result from infections or from sperm antibodies. Chronic prostatitis- the inflammation of the prostrate gland, can also cause sperm motility problems.

               Ductal blockage is a very common feature.  An infection in the testes may leave scar tissue that blocks the epididymis. Congenital abnormality may occur in the minute ducts, that carry sperm from  the testicles to the penis.

               Low levels of testosterone due to any cause, may result in defective sperm production. Hypogonadism  is a severe deficiency  observed in many individuals. They show chain of sign and symptoms such as secondary sexual characters, obesity, gynaecomazia, genetic causes and tumors of the pituitary gland which can prevent production of all reproductive hormones. Leydwig cells are defective and unable to respond to testosterone. Abnormalities of the thyroid or adrenal glands may have an indirect effect on fertility.

               Autoimmunity is a condition in which the antibodies of the immune system attack specific cells in the body, mistaking them for antigens. The most common example of this is the development of  antibodies after vasectomy. Antibodies bind to specific parts of  the sperm such as the head or tail and cause problems. Sperm may stick together and fail to interact with cervical mucous or fail to penetrate the egg.

              Cryptorchidism is a failure of the testes to descend from the abdomen into the scrotum during fetal life. The genetic disease 'cystic fibrosis' of the testes, that is the complete absence of the vas deferens. Some men are born with structural problems, such as blockage in the epididymis or ejaculatory ducts which may  affect  fertility. Hypospadiasis, a birth defect in which the urinary opening is on the underside of the penis, which prevent sperm from reaching the cervix.

              Most of the males with infertility problems, have problem in sexual intercourse such as impotence, premature ejaculation, dyspareunia and the painful intercourse. Psychlogical and sexual perversions can contribute to infertility, although these conditions are usually treatable. Retrograde ejaculation occurs when the muscles of the urethra do not pump properly during orgasm and sperm are forced backward into the bladder instead of forward out of the urethra. This condition can occur temporarily due to the chemical  medications, diabetes, multiple sclerosis, bladder neck or prostate surgery.

Lifestyle Factors
              Stress may interfere with the hormones and reduce sperm counts. Smoking impairs sperm  motility and reduces sperm lifespan. Narcotics, panprak, alcohol may reduce sperm count. Obesity and excessive endurance exercise may also reduce sperm production. Low levels of dietary selenium and zinc, which are necessary for the formation and maturation of sperm, are associated with an increased risk of infertility. Vitamin C deficiency causes sperms to clump together (agglutinate), which impairs movement.

               Apart from poor egg quality, there are dozens of conditions that can potentially cause female infertility. In many cases, the problems can be medically or bypassed through assisted reproductive techniques. The most common causes of infertility in women are :

Ovulation and Hormonal Disorders
               Dysfunctional uterine Bleeding is the prime cause of the woman’s ovaries not producing eggs. Polycystic ovarian disease is a hormonally based, very common condition characterized by scanty or absence menstruation. The disease usually  forms multiple cysts in the ovaries. Thyroid disorders also impair fertility. Egg production diminishes because of age, other  hormonal  imbalances or other problems.

Pelvic inflammatory disease and tubal block
               Pelvic Inflammatory Disease is the major cause of infertility worldwide. PID includes a variety of  infections caused by different bacteria  that can affect the uterus, fallopian tubes, ovaries, appendix, parts of the intestine that lie in the pelvic area, or, in the worst case, the entire pelvic area causing peritonitis. The sites of infection most often implicated in infertility are in the fallopian tubes, a condition known as salpingitis. Infection of the reproductive tract are usually caused by a sexually transmitted diseases, tuberculosis and chlamydiasis.They can also stem from a miscarriage, abortion and childbirth.  Severe or frequent attacks of PID can eventually cause scarring, abscess formation and tubal damage  that result in infertility.

Tumors
              Fibroids can interfere with embryo implantation or fetal growth. High levels of oestrogen seem to stimulate growth of fibroid tumors; heredity may also be a factor in their development. Endometriosis is estimated in many cases. This disorder develops when fragments of the endometrial lining are implanted in other areas of the pelvis. These endometrial implants respond to hormonal changes, slowly increasing in number and size with each menstrual cycle and eventually causing scarring and inflammation. Endometrial implanted in the ovaries or fallopian tubes are particularly likely to cause infertility, even if the endometriosis is mild.

              Pelvic adhesions are usually caused by surgery or infection. Pelvic adhesions are the scar tissues that are formed between two or more internal organs. Infertility can occur when the adhesions attach to the ovaries or fallopian tubes.

              Bands of scar tissue that bind together after abdominal surgery or infection can restrict the movement of ovaries and fallopian tubes and may cause infertility. Laparoscopic surgery is less likely to cause adhesions than standard open surgery.

Auto immunity
              Immunological infertility is sometimes diagnosed when the woman's immune system produces "anti-sperm antibodies" that  attack her partner's sperm.

Implantation Failure
              Luteal phase defect is a general term referring to problems in the corpus luteum that result in inadequate production of progesterone. As progesterone is necessary for thickening and preparing the uterine lining, the ovum fails to implant in the endometrium successfully. Younger women who experience recurrent spontaneous abortions have a luteal phase defect. Frequent abortions may impair a woman's fertility. The cervix weakens and is unable to sustain a pregnancy. Scar tissue may be formed inside the uterine cavity after multiple abortions resulting in a closed uterus. Infertility, therefore, results from implantation failure.

Life style
               Although most of the woman's estrogen is manufactured in her ovaries, minimum is produced in fat cells. Because a normal hormonal balance is essential for the process of conception, it is not surprising that extreme weight levels, either high or low, can contribute to infertility especially if their periods are irregular. A correlation has been found between caffeine consumption and infertility. Caffeine is found not only in coffee but also in tea, many soft drinks, chocolate, and a number of common medications can impair conception and also have adverse effects on the developing fetus. Sexual practices such as having multiple partners, not using condoms and having intercourse during a period increases the risk. The sexually transmitted organisms cause pelvic inflammatory disease leading to infertility. Psychologic factors may be a contributing risk factor for infertility. One interesting small study reported a significantly higher incidence of pregnancy loss in women who experienced both high stress and prolonged menstrual cycles. Depression may have a direct effect on hormones that regulate reproduction.

               Before seeking a doctor's advice, you'll want to do everything possible on your own to get pregnant. Even if your self-help efforts fail, they can generate important information to help your doctor to diagnose your problem and save precious time. Here are some techniques you can try:

Notice changes that occur with ovulation. Some women experience a slight twinge in their lower right or left abdomen when they ovulate. Around the same time, you may notice that your cervical mucus, which can occur as a normal vaginal discharge has become watery and copious.
Have intercourse every other day. Waiting for 48 hours between the lovemaking sessions provides enough time for a new generation of sperm cells to reach maturation.
Have intercourse during the middle of your menstrual cycle. Counting the first day of your last period as day one, be sure to have intercourse on days 11, 13, 15 and 17 or days 12, 14,16 and 18.

Medical History and Physical Examination
               The first step in any infertility work up is a complete medical history and physical examination of both partners.  Sexual technique and timing, menstrual history, lifestyle issues, such as smoking and drugs, alcohol and caffeine consumption and a profile of the patient's general medical and emotional health can help the physician decide on appropriate tests.

Laboratory Tests

Semen Analysis
              The basic test to evaluate a man's fertility is a semen analysis. To perform this test, a man collects a sample of his semen in a collection jar during masturbation either at home or at the laboratory.  A man should abstain from ejaculation for four days before the test, because each ejaculation can reduce the number of sperms. A semen analysis should be repeated at least three times over several months. The analysis reports on any abnormalities in sperm count, motility and morphology, as well as any problem in the semen.

Sperm Count
              A low sperm count should not be viewed as a definitive diagnosis of infertility but rather as an indicator of a fertility problem. Counts of less than 20 million per milliliter are currently considered strong indicators of infertility, although pregnancy is sometimes possible even with such low counts.

Sperm Motility
              Motility is the speed and quality of movement. It is graded on a 1 to 4 ranking system.

Grade 1 sperm wriggles sluggishly and makes little forward progress.
Grade 2 sperm moves forward, but is either very slow or does not move in a straight line.
Grade 3 sperm moves in a straight line at a reasonable speed and can home on an egg accurately.
Grade 4 sperm is as accurate as Grade 3 sperm, but moves at terrific speed. Sperms that clump together may indicate that antibodies to the sperm are present.

Sperm Morphology
               Morphology is the structure of the sperm. About 60% of the sperm should be normal in size and shape for adequate fertility. Determining the morphology of the sperm is particularly important for the success of the fertility treatment.

Seminal Fluid
              The semen itself is analyzed for abnormalities. Most men ejaculate 2.5 to 5 cc of semen. Amounts of 2.5 cc may indicate of prostate problems or frequent intercourse. Normal semen is liquefied within 20 minutes by certain enzymes. If it remains sticky, fertility may be impaired. An absence of fructose indicates that an obstruction has occurred either in the vas defererens or  in the epididymis, since fructose is added to the semen in the epididymis. Conversely, if there is fructose in the semen but no sperm, then the channel from  the epididymis is open but there is a defect in sperm production. Thus infections may be detected.

Blood Tests
               Blood tests are taken to evaluate hormone levels. Blood studies include FSH, LH, testosterone, estrogen and progesterone as prescribed to the appropriate partners. Blood studies for thyroid function and prolactin levels are also measured.

Postcoital Test
                   The postcoital is designed to evaluate the effect of a woman's cervical mucus on a man's sperm. To perform this test, a woman is asked to come into the physician's Laboratory within two to 24 hours after intercourse at mid-cycle, when ovulation occurs. A small sample of cervical mucus is obtained and examined under a microscope. The problem is detected if the physician observes no surviving sperm or no sperm at all. Imaging studies.

Ultrasound
               Ultrasound is a noninvasive method for evaluating the uterus and ovaries by using sound waves rather than by x-rays and should be the first procedure. A series of ultrasounds may be an accurate and cost effective method for tracking ovulation. Fibroid tumors and ovarian cysts can be diagnosed as well. In males, ultrasonogram is helpful to detect the tumors  varicocele .

Hysterosalpingography
               Hysterosalpingography is performed for the female partner to discover possible blockage in the fallopian  tubes and abnormalities in the uterus. To determine this, a tube is inserted into the cervix through which a dye is injected. The dye passes into the uterus and up through the fallopian tubes. If the dye is seen emerging from the end of the tube, it is proved of no blockage. The procedure may reveal other conditions, including endometrial polyps, fibroid tumors or structural abnormalities of the uterus and tubes. In some cases, it may restore fertility, probably by clearing away tiny tubal blockages.
 
Testicle Biopsy
               Occasionally, a testicle biopsy may be performed for male partner in which tissue samples are removed under anesthesia. A biopsy is most useful for detecting obstruction in the  transport system, when sperm production looks normal, but the count is low.

               As far as the long-term impact is concerned, some couples have a hard time recovering financially, while others find their interpersonal relationships permanently changed. Many couples don’t know how to proceed treatments. I have come across many cases of infertility in medical history due to  “Hormonal Therapy”. The hormonal preparation have an adverse effect on your health that would make a person permanently infertile, obese and plenty of “Iotrogenic diseases” may also occur.

               I am inspired from the fact that Homoeopathy is the best treatment for infertility, while treating the causative factors such as Varicocele, Hypogonadism, Polycystic Ovarian Disease, Fibroids, Endometriosis and Thyroid disorders. I was also successful with many cases.