Inability to conceive after about one year of unprotected sex is a matter of concern and is considered as infertility. Evaluation of infertility and specific identification of the problem can be done by physical examination and biochemical tests of the couple. Both the partners need to be equally involved in consultation, as there are equal chances of either of them having a specific problem. Moreover, no matter who has the problem, this is the time of emotional understanding and supporting each other. A majority of infertility problems are due to four common causes :

1 Problems related to fallopian tubes : A block of the fallopian tubes due to prior infection or surgery impedes fertilisation. Tubal blocks due to infection can be resolved by treatment with antibiotics; in some cases microsurgery is of help.
2 Problems related to ovary : Infrequent ovulation because of cysts in the ovaries, emotional stress or major illness can cause infertility. Thyroid dysfunction can also affect ovulation and can be treated through hormone therapy.
3 Problems related to the uterus : Uterine environment that is hostile to sperm mobility can cause infertility. Abnormal quantity or quality of cervical mucus due to infectioj, narrowing of the cervical canal due to blockage or due to prior surgery, abnormal shape of the uterus or cervix can impede sperm transport. Antibiotic treatment or use of vaginal creams can overcome these problems. Minor corrective surgery is sometimes recommended.

4 Male factors : Abnormal sperms or low sperm count in the semen is one of the major causes of infertility. Sperm counts may be temporarily lowered due to a variety of factors such as poor diet, excessive alcohol or smoking, drug abuse, prostrate infection or exposure to radiation or chemicals. Hormonal treatment to improve sperm counts or artificial insemination is of help to overcome these problems.
Counselling, help of the gynaecologist and support from the partner can help overcome infertility problems easily. There are new technologies now available in the form of 'in vitro fertilisation' and 'assisted reproductive technoloies' to help infertile couples. Depending on the specific problem faced by the couple, appropriate manipulation of the gametes or embryo can be carried out to ensure pregnancy. More about this elsewhere.

In 1978 Dr. Patrick Steptoe and Dr. Robert Edwards reported the first baby born following 'in vitro fertilisation' and initiated the era of hope for a number of infertile couples. In India, Dr. S.Mukherji in Calcutta and Dr. Indira Hinduja and Dr. Anand Kumar in Bombay successfulluy launched the technological breakthrough. Several clinics for assisted reproduction have been developed in the country. Some of the major technologies now available have been briefly listed below. The choice of the technology the couple can use, depends essentially on the cause of the infertility.

1    In vitro fertilisation and embryo transfer (IVF-ET) : If natural fertalisation fails, it is possible to carry it out under artificial conditions in a test-tube or a perti dish. This called 'in vitro fertilisation'. The woman is given hormones to stimulate the follicles and the growth of the follicles is monitored by checking the hormonal levels in the blood. At the appropriate stage of maturation, eggs are collected with the use of a 'laparoscope' or by transvaginal sonography. The egg is then kept in a petri dish and mixed with the sperms to allow fertilisation. The embryo is allowed to develop to about four-to-eight cell stage and then transferred by inserting a catheter into the woman's uterus. IVF-ET is most commonly recommended for women who have blocked or damaged fallopian tubes. The success rate of pregnancy by IVF is low and is a stressful experience for the couple, more so to the woman as her physiology is modulated aftificially.

Gamete intra fallopian transfer (GIFT) : This is modified IVF procedure. The ova and the sperms are collected and together placed in the fallopian tube by a clinical procedure. The fertilisation and transport of the embryo to the site of implantation in the uterus occurs as a natural process. This technique is recommended in cases of unexplained infertility or when cervical and uterine factors impede fertilisation.

Micromanipulation of gametes : Microscopic procedures have been developed to manipulate eggs and sperms to circumvent barriers between them for fertilisation. These greatly reduce the number of sperms required for in vitro fertilisation. Among the battery of techiniques are :
1    PZD or partial dissection of the oocyte membrane (zona pellucida);
2    SUZI or subzonal sperm insertion;
3    ICSI or intra-cytoplasmic sperm injection.

Intra uterine insemination (IUI) or artificial insemination (AI) : These procedures are performed if teh semen is poor in sperm count or the sperm motility is abnormal. The ovarian follicular development in the woman is monitored by ultrasonography. When a mature Graffian follicle is observed, within twenty-four to forty-eight hours about a million or more processed sperms are injected into the uterus by a catheter. These reproductive  technologies and other allied procedures have led to:

(1)    Ovum donations : In women when ovum cannot be produced due to irreparable ovarian dysfunction, ovum donated by another woman can be used in the IVF-ET procedure.
(2)    Sperm banking : Sperms collected from donors (or husband) can be preserved at low temperature (cryopreserved) and used to fertilise the egg as and when required.
(3) Surrogate motherhood : It is possible to stimulate a woman hormonally and induce pregnancy by IVF-ET, using donor eggs and donor sperms. In other words, it is possible to 'hire a womb'. It is also possible to become a 'surrogate mother'
(4)     Post-menopausal pregnancy : One of the major outcomes of the assisted reproductive technologies is that it is possible to hormonally prime a post-menopausal woman and induce pregnancy by IVF-ET, using donor egg and sperms.
(5)    Pre-implantation genetic diagonosis : This technique is extremely useful in cases couples who have a high risk of having an abnormal baby. It involves the removal of a single cell from an in vitro fertilised embryo and its genetic analysis, using modern molecular biology techniques to identify the presence of defective gene.
All these techniques have an emotional and social impact and have to be carried out by conditional consent and total cooperation of the partner.