Updated: Apr 25, 2019
If a couple cannot conceive after trying, they should do a check.
Conception happens when a sperm swims up into the womb and fertilises an egg in the fallopian tube. This allows the fertilized embryo to implant itself onto the womb lining and grow.
Any couple who cannot conceive after 12 months of actively trying should seek medical attention. It is preferable that both partners see the doctor together so that the appropriate investigation and counseling can take place. I would advise women aged above 35 years to seek medical attention urgently as the pregnancy success is lower in older women.
Depending on the causes, varying treatment modalities can be offered. In cases of anovulation, drugs that enhance ovulation — e.g. clomiphene may be prescribed to help the couple conceive. This can result in side effects such as nausea and bloatedness, twin pregnancies (10% chance) and may increase the risk of ovarian cancer in cases of prolonged and unregulated usage. Therefore, clomiphene can be safely prescribed for 6 cycles.
Laparoscopic (key-hole) surgery can be useful to treat tubal blockages, fibroids or endometriosis. Ovarian drilling is done for polycystic ovaries to induce ovulation.
Assisted reproductive techniques (ARTs), such as intra-uterine insemination (IUI) or in-vitro fertilizations (IVF), may be employed in some couples. In cases of severe sperm issues, intra-cytoplasmic sperm injection (ICIS) can be used. This refers to the injection of a single sperm to fertilize the egg. All these can only happen after detailed counseling of the procedural risks and benefits.
In the most difficult couples or for those adverse to ART, child adoption can be considered.