Age
There is definite decline in live birth rates as age advances. The Chronological age can be misleading and is poorly correlated with ovarian ageing. One may have accelerated Oocyte loss leading on to reduced reserves. So it is sooner the better.
Tubal Factors
Tuberculosis, Ectopic pregnancy, Abdomino-pelvic surgery, Intrauterine devices, surgical abortion etc are few of the causes of tubal occlusion. HSG (hysterosalphingograpy) SSG (Sonosalphingograpy) are the common modalities to diagnose the tubal factor in infertility. Though Laparoscopy is gold standard, disadvantage is, it is expensive, invasive and requires anaesthesia, hence may be opted in cases where operative intervention is anticipated.
Endometriosis
Endometriosis is characterized by presence of endometrial glands outside the uterine cavity and subsequent ill effects causing painful menses, Infertility and Endometriomas (cyst in ovary) etc. Management depends on Age, ovarian reserves and Duration of Infertility. Not all require IVF/ICSI, Expectant management and Ovulation induction with IUI (see section on IUI ) in early stages do yield results.
Male factors
Altered semen parameters in form morphology, motility or numbers like low numbers (oligospermia) to no numbers (Azoospermia) can be cause of infertility (see section male Infertility)
Life style factors
Preconception screening, counselling and management is desired for optimal outcomes. High BMI, Tobacco smoking, and alcohol to name a few, need attention. Folic acid supplementation prior to pregnancy is welcome.
Uterine factors
Poor Endometrium ,Fibroids,Uterine anamolies and Intra uterine adhesions may pose problems for conception.
Recurrent Pregnancy Loss
Anovulation
Anovulation is inability to produce an egg every cycle. Will discuss more in PCOS section
Unexplained Infertility.
