The problems of infertility are faced from the time of evolution of man and will probably remain with us0 forever. Infertility is defined as the couple's inability to conceive after one year of unprotected coitus (with adequate coital frequency).

• ?  25% be pregnant in the first month
• ?  63% be pregnant in six months
• ?  75% be pregnant in nine months
• ?  80% be pregnant in twelve months
• ?  90% be pregnant in eighteen months

Since the peak fecundity in females is between the age of 20 to 35 and declines thereafter, the couple is investigated and treated earlier in the case of older couples.

The incidence of fertility is 15% to 22%. Out of the infertile couples, the female factor is responsible in 45%, the male factor in 30% to 35%, while in the others the cause remains obscure or unexplained.

The fertility of a couple depends on the normal interaction of a number of factors. The male must be able to produce large numbers of healthy spermatozoa, they must have traverse the male reproductive system and be discharged at ejaculation into the anatomically normal female reproductive system. The sperm must then penetrate the cervical mucus and ascend through the uterus into the fallopian tubes where fertilization must occur. Simultaneously the female, who must have an intact hypothalamic-pituitary-ovarian axis, must release the ovum at the correct time. The expelled ovum must have entered the patent and freely mobile fallopian tubes and must have been transported to the area where fertilization will occur. Following fertilization the blastocyst must travel toward the endometrial cavity where nidation must take place in an endometrium, which has been appropriately prepared by hormone action. The slightest defect in these basic events in wither partner leads to infertility.

• 1.   Endocrine Causes
• 2.   Genetic Effects
• 3.   Non-endocrine effects
  • a) Nutrition
  • b) Smoking / Tobacco chewing
  • c) Alcohol
  • d) Heat
• 4.   Varicocoele:

  This is a condition where there is dilatation and incompetence of the internal spermatic vein leading to a failure in the thermo-regulatory mechanism of the pampiniform plexus of veins. These patients show semen of poor quality with a low count, reduced motility, and a high ratio of immature cells.

  Varicocoele if no other cause is found responsible then surgery should be planed. A day care surgery either by conventional method or Laparoscopically gives very satisfactory result.

• 5.   Infection
• 6.   Physical Abnormality
• 7.   Metabolic disorders
• 8.   Block
• 9.   Testicular Causes
• 10. Immunological Causes
• 11. Physical and Chemical Agents

• 1.   General
  • a) Severe illness
  • b) Nutritional disorder
  • c) Anxiety
• 2.   Cervical
  • a) Infections
  • b) Hostile Mucus
  • c) Hypoplastic cervix
  • d) Cervical Anomalies
• 3.   Uterine
  • a) Development
  • b) Infections
  • c) Luteal Phase insufficiency
• 4.   Endocrine
  • a) Hypothalamic Dysfunction
  • b) Pituitary Failure
  • c) Thyroid Disturbance
  • d) Adrenal Hyperplasia
  • e) Androgen Excess
  • f) P.C.O.D.
• 5.   Tubal and peritoneal factors
  • a) Adhesion
  • b) Infections
• 6.   Endometriosis
• 7.   Immunological Infertility