Understanding your diagnosis is the first step toward successful treatment. Our specialists have treated over 300,000 couples with a wide range of fertility conditions.
40%
Female Factor
40%
Male Factor
20%
Combined / Unexplained
Conditions affecting female reproductive health and fertility
PCOS is one of the most common hormonal disorders affecting women of reproductive age, causing irregular ovulation and reduced fertility.
Endometriosis causes tissue similar to the uterine lining to grow outside the uterus, leading to pain, scarring, and fertility challenges.
Uterine fibroids are non-cancerous growths in the uterus that can distort the uterine cavity and interfere with implantation and pregnancy.
Blocked fallopian tubes prevent the egg and sperm from meeting, making natural conception impossible and requiring assisted reproduction.
Poor ovarian reserve means fewer eggs are available for fertilisation, but specialised IVF protocols can still achieve pregnancy.
Premature ovarian failure (POF) causes the ovaries to stop functioning before age 40, but parenthood is still possible with donor eggs.
Underactive thyroid (hypothyroidism) disrupts menstrual cycles and implantation, but is easily treated to restore fertility.
Elevated prolactin levels suppress ovulation and can cause milky discharge from the breasts, but respond well to medication.
Uterine polyps are soft growths in the uterine cavity that can prevent embryo implantation and are easily removed hysteroscopically.
A thin uterine lining (endometrium) prevents embryo implantation. Targeted therapies can build the lining to support a successful pregnancy.
Cervical factor infertility occurs when the cervical mucus prevents sperm from reaching the egg, often addressed successfully with IUI or IVF.
Recurrent implantation failure (RIF) is when embryos repeatedly fail to implant during IVF, requiring specialised investigation and personalised treatment.
Overgrowth of the uterine lining due to unopposed oestrogen. Atypical hyperplasia carries malignant risk and must be treated before IVF.
Persistent low-grade inflammation of the endometrial lining caused by bacteria, impairing embryo implantation. Often asymptomatic and missed on routine investigation.
A displaced window of implantation where the endometrium reaches peak receptivity earlier or later than assumed. Detected by the ERA test.
An IVF complication where excessive follicle recruitment causes fluid shift, ovarian enlargement, and in severe cases cardiovascular compromise.
Twisting of the ovary on its ligamentous supports cuts off blood supply and can cause irreversible ovarian damage if not surgically corrected promptly.
Follicular or corpus luteum cysts form during normal ovarian activity. Most resolve spontaneously but can delay IVF stimulation.
Loss of normal ovarian function before age 40, causing oestrogen deficiency and infertility. Spontaneous pregnancy is rare (5â10%).
Fewer than 3 oocytes retrieved in a stimulated IVF cycle despite maximal stimulation. Classified by the Bologna criteria.
Fertility declines sharply after 35 due to reduced ovarian reserve and rising oocyte aneuploidy rates. IVF success rates fall steeply after 40.
Low AMH and AFC in women under 35, years before expected menopause. Requires urgent fertility evaluation and possible egg banking.
An autoimmune prothrombotic condition that causes placental microthrombi, leading to recurrent miscarriage (especially second-trimester) and thrombosis.
Elevated uterine or peripheral NK cells are associated with recurrent miscarriage and implantation failure. Immunological protocols may help.
SLE can reduce ovarian reserve, cause recurrent pregnancy loss, and increase preterm birth risk. Requires multidisciplinary management.
Absence of one X chromosome causes premature ovarian insufficiency. Spontaneous pregnancy is rare; egg donation is the principal fertility option.
Women with 55â200 CGG repeats in FMR1 have a 20% risk of premature ovarian insufficiency and a 50% chance of passing the full mutation to sons.
Inherited or acquired clotting disorders cause placental microthrombi, resulting in miscarriage or foetal growth restriction.
Implantation outside the uterine cavity is life-threatening and may result in tube removal, reducing future natural fertility.
3 or more consecutive pregnancy losses before 12 weeks. A structured investigation finds a treatable cause in ~50% of cases.
Two or more pregnancy losses between 12â24 weeks. More likely to have structural or thrombotic causes than first-trimester losses.
Fluid from a hydrosalpinx drains into the uterine cavity and is embryotoxic, reducing implantation rates by up to 50%.
A benign pituitary adenoma that hypersecrets prolactin, suppressing GnRH and causing amenorrhoea, galactorrhoea, and infertility.
Elevated prolactin without a pituitary tumour suppresses ovulation. Drug causes must always be excluded before treatment.
Ascending genital tract infection damaging the fallopian tubes, leading to tubal factor infertility in up to 20% of affected women.
Mycobacterium tuberculosis infection of the female genital tract causes severe tubal occlusion and endometrial scarring â a significant cause of infertility in India.
Involuntary spasm of vaginal muscles prevents penetration, making natural intercourse impossible. Requires medical and psychological management.
Elective oocyte cryopreservation allows women to preserve fertility before age-related decline, providing flexibility for later parenthood.
IVF using eggs from a young donor offers the highest success rates (~50â60% per transfer) for women with poor reserve or premature ovarian failure.
The dominant follicle undergoes luteinisation but does not rupture to release the egg despite normal LH surge and progesterone rise.
Cycles longer than 35 days indicate infrequent ovulation, common in PCOS and hypothalamic amenorrhoea. Significantly reduces monthly chances of conception.
The most common hormonal disorder in women of reproductive age affecting 8â13%, diagnosed by the Rotterdam criteria. The leading cause of anovulatory infertility.
Endometriosis implants penetrating >5 mm into peritoneal tissue affect the uterosacral ligaments, rectovaginal septum, bowel, or bladder, causing severe pain and reduced fertility.
Stage IâII endometriosis with peritoneal implants. Altered peritoneal environment and inflammatory cytokines may impair fertilisation.
Endometrial glands and stroma within the uterine muscle impair uterine contractility, reducing embryo implantation rates and increasing miscarriage risk.
The sella turcica appears empty on MRI due to CSF herniation. May be associated with hypopituitarism causing FSH/LH deficiency and infertility.
Women with family history of early menopause, FMR1 premutation, or autoimmune conditions should have proactive ovarian reserve testing and fertility counselling.
Insufficient progesterone production after ovulation shortens the luteal phase, preventing adequate endometrial preparation for embryo implantation.
A mild late-onset form of CAH caused by 21-hydroxylase deficiency, resulting in androgen excess that can mimic PCOS and impair ovulation.
A common PCOS subtype where cells do not respond effectively to insulin, leading to elevated androgen levels that disrupt ovulation.
PCOS occurring in women of normal body weight. Often underdiagnosed because the classic overweight presentation is absent, yet anovulation still impairs fertility.
Excess androgen (male hormone) levels in women, disrupting ovulation and causing hirsutism, acne, and menstrual irregularity.
Loss of menstruation due to suppressed GnRH secretion, often triggered by extreme energy deficit, excessive exercise, or psychological stress.
Prolonged exposure to high cortisol levels disrupts the HPG axis, suppressing ovulation and causing metabolic and reproductive dysfunction.
Underactive thyroid elevates TSH and prolactin, disrupting the menstrual cycle and reducing egg quality. Even subclinical hypothyroidism reduces IVF success rates.
Excess thyroid hormone disrupts the menstrual cycle and increases miscarriage risk. Graves disease is the most common cause in women of reproductive age.
Elevated anti-TPO antibodies â even with normal TSH â are associated with implantation failure, recurrent miscarriage and reduced IVF success.
Fibroids growing into the uterine cavity distort the endometrial lining, reducing implantation rates and increasing miscarriage risk.
Fibroids embedded within the myometrium; those >4 cm or distorting the cavity can reduce IVF implantation rates and increase preterm labour risk.
Intrauterine adhesions formed after uterine surgery or infection obliterate the cavity, blocking implantation and causing recurrent pregnancy loss.
A midline fibrous partition within the uterine cavity is the most common MÃŧllerian anomaly and consistently associated with increased miscarriage rate.
Partial fusion failure of MÃŧllerian ducts creates a heart-shaped uterus, increasing miscarriage and preterm birth rates.
A MÃŧllerian anomaly where only half the uterus forms, significantly increasing risks of miscarriage, preterm birth, and malpresentation.
A mild uterine anomaly with a small midline indentation of the uterine fundus. Associated with second-trimester loss; impact on first-trimester loss is debated.
Narrowing of the cervical canal impedes sperm entry and embryo transfer procedures, and can cause retrograde menstruation contributing to endometriosis.
Blockage at the cornual end of the fallopian tube prevents sperm from reaching the egg. Often due to tubal spasm, polyps, or salpingitis isthmica nodosa.
Blockage at the fimbrial end of the tube prevents egg pick-up. Often results from adhesions secondary to endometriosis or pelvic infection.
Fibrous bands around the fallopian tubes impair their mobility even when the tubal lumen is patent, reducing natural conception rates.
Conditions affecting male reproductive health and fertility
Azoospermia â the complete absence of sperm in the ejaculate â affects 1% of men, but surgical sperm retrieval and ICSI can still achieve fatherhood.
Oligospermia is a sperm count below 16 million per mL, reducing the chances of natural conception but treatable with IUI or ICSI-IVF.
Asthenozoospermia is when less than 42% of sperm are motile, limiting their ability to reach and fertilise the egg.
Teratozoospermia means most sperm have abnormal shape, reducing their ability to penetrate and fertilise an egg.
Varicocele is an enlargement of veins in the scrotum that raises testicular temperature and impairs sperm production and quality.
Retrograde ejaculation causes semen to enter the bladder instead of exiting through the penis, but sperm can be retrieved from urine for IUI or IVF.
Hormonal imbalances in men â including low testosterone or high oestrogen â reduce sperm production and can often be corrected medically.
Reduced sperm motility impairs the ability of sperm to reach and fertilise the egg. Defined as <30% progressive motility by WHO 2021 criteria.
High proportion of abnormally shaped sperm (<4% normal forms by strict Kruger criteria). Affects fertilisation capacity and embryo development.
Complete absence of sperm in ejaculate due to a blockage in the ductal system, despite normal sperm production in the testes.
No sperm in ejaculate due to impaired sperm production. Sperm may still be retrieved from the testis via mTESE in ~50â60% of cases.
High levels of DNA damage in sperm reduce fertilisation rates, impair embryo development, and increase miscarriage risk even with normal semen parameters.
Immune antibodies that bind to sperm surface antigens, causing agglutination and inability to penetrate cervical mucus or zona pellucida.
Low pituitary gonadotropin secretion results in testosterone deficiency and absent or severely impaired spermatogenesis.
Failure of one or both testes to descend into the scrotum impairs sperm production. Risk of infertility and testicular cancer is increased.
Inability to achieve or maintain erection sufficient for intercourse prevents natural conception. Psychogenic and organic causes must be distinguished.
Inadequate testosterone production causes androgen deficiency and impaired spermatogenesis leading to infertility.
The most common sex chromosome aneuploidy in males. Small testes, azoospermia, and low testosterone are the norm, but focal spermatogenesis allows sperm retrieval via mTESE in ~50% of cases.
CFTR mutations cause congenital bilateral absence of the vas deferens (CBAVD), resulting in obstructive azoospermia despite normal spermatogenesis.
Conditions that can affect both partners or have combined causes
Unexplained infertility is diagnosed when all standard tests are normal yet pregnancy has not occurred â advanced ART often reveals the cause.
Recurrent pregnancy loss (3 or more miscarriages) has identifiable causes in most cases, and a tailored treatment plan can achieve a successful pregnancy.
Advanced maternal age (35+) reduces egg quantity and quality, but IVF with PGT-A and egg donation offer excellent paths to successful pregnancy.
One partner carries a balanced chromosomal rearrangement with no personal health impact, but gametes can carry unbalanced chromosomes causing recurrent miscarriage.
BMI >30 disrupts the HPG axis, worsens insulin resistance, reduces egg quality, impairs endometrial receptivity, and reduces IVF success rates.
Both Type 1 and Type 2 diabetes affect egg quality, sperm parameters, and early embryo development. Poor glycaemic control increases miscarriage and congenital anomaly rates.
Cigarette toxins accelerate oocyte depletion, damage sperm DNA, impair implantation, and double ectopic pregnancy risk. IVF success rates are significantly lower in smokers.
Even moderate alcohol intake reduces IVF success rates, disrupts menstrual cycles, and impairs sperm parameters. Heavy use causes significant reproductive toxicity.
Most miscarriages are caused by chromosomally abnormal embryos. Risk increases steeply with maternal age â at 40, >60% of embryos are aneuploid.
Inability to conceive or carry a pregnancy after a previous successful pregnancy. Often underestimated emotionally; causes may be new or progressive.
Multiple failed IVF attempts require a structured review of each stage to identify modifiable factors.
Total fertilisation failure or <30% fertilisation despite adequate eggs and sperm suggests a defect in egg activation or sperm-egg interaction.
Embryos fail to develop beyond early cleavage or show fragmentation and arrest. Often reflects oocyte mitochondrial dysfunction or chromosomal abnormality.
Chemotherapy and pelvic radiation cause gonadal damage. Egg, embryo, or sperm freezing before treatment preserves fertility options.
Using donor sperm for insemination or IVF in couples where the male partner has no viable sperm, carries a serious genetic condition, or for single women.
A surrogate carries a pregnancy on behalf of the intended parents. Gestational surrogacy is the norm and is legally permitted in India under specific conditions.
Vitamin D receptors are present in ovarian follicles and endometrium. Deficiency is associated with lower IVF success rates and higher miscarriage risk.
MTHFR C677T and A1298C polymorphisms reduce folate metabolism efficiency. Associated with elevated homocysteine, recurrent pregnancy loss, and neural tube defect risk.
Cluster of metabolic abnormalities (central obesity, insulin resistance, dyslipidaemia, hypertension) amplifies PCOS severity and reduces IVF success rates.
Chronic psychological stress activates the HPA axis, suppressing GnRH pulsatility and impairing ovulation and endometrial receptivity.
Multiple pregnancy increases maternal and neonatal risks (prematurity, low birth weight). Single embryo transfer policy significantly reduces but does not eliminate multiples.
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse (or 6 months if the woman is over 35). It affects approximately 1 in 6 couples worldwide and can stem from factors in either partner or a combination of both.
At Iswarya Fertility, we conduct thorough diagnostic evaluations for both partners to identify the root cause. Our fertility specialists use advanced diagnostics including hormonal profiling, ultrasound imaging, semen analysis, and genetic testing to create a personalised treatment plan.
Book a consultation with our fertility specialists for a complete diagnosis
