Reviewed by Dr. Shradha Chakhaiyar, MS (OB-GYN), MRCOG (London), IVF Specialist, 📅 April 2026
📋 Table of Contents
- What Is Infertility?
- How Common Is It in India & Bihar?
- Types of Infertility
- Causes in Women
- Causes in Men
- Lifestyle & Environmental Causes
- Diagnosis — Tests for Couples
- Treatment Options
- Infertility in Bihar — What to Know
- When to See a Specialist
- How Shradha IVF Can Help
- Frequently Asked Questions
What Is Infertility?
Infertility is defined by the World Health Organization (WHO) as the inability to achieve a clinical pregnancy after 12 months or more of regular, unprotected sexual intercourse. For women over 35, this timeframe is shortened to 6 months. Infertility can affect either or both partners — it is a medical condition, not a personal failing, and it is treatable in the majority of cases.
Infertility is not always about the inability to conceive — it also includes the inability to carry a pregnancy to term. Recurrent miscarriage, for instance, is considered part of the infertility spectrum when it repeatedly prevents a live birth.
Understanding infertility begins with understanding the reproductive process: for a pregnancy to occur, a woman must ovulate (release an egg), that egg must be fertilised by sperm in the fallopian tube, and the resulting embryo must successfully implant in the uterus. Any disruption at any step — hormonal, structural, or genetic — can prevent pregnancy.
How Common Is Infertility in India — and in Bihar?
Infertility rates in India range from 3.9% to 16.8%, depending on the region, with Bihar, Uttar Pradesh, and Madhya Pradesh reporting higher clinical prevalence than national averages. Several factors drive this: higher rates of untreated reproductive infections, delayed access to specialist care, PCOS underdiagnosis (particularly outside major cities), and the social stigma that prevents couples from seeking help early.
In Bihar specifically, many couples try for 2–5 years before consulting a specialist — often because of stigma, lack of awareness, or the mistaken belief that infertility is incurable. In reality, the vast majority of infertility cases have an identifiable cause and a treatable pathway.
What are the Different Types of Infertility?
Primary Infertility
A couple is diagnosed with primary infertility when they have never achieved a pregnancy despite trying for 12 months (or 6 months for women over 35). This is the most common presentation at fertility clinics and often has a clear treatable cause once properly investigated.
Secondary Infertility
Secondary infertility occurs when a couple who has previously conceived — successfully or not — is now unable to conceive again. Many couples are surprised by secondary infertility because they assume a prior pregnancy means fertility is guaranteed. Causes include age-related ovarian decline, new conditions like endometriosis, post-pregnancy hormonal changes, or changes in sperm health.
Unexplained Infertility
When standard investigations — ovarian reserve, semen analysis, fallopian tube assessment, uterine evaluation — return normal results but conception does not occur, the diagnosis is unexplained infertility. This affects approximately 10–15% of infertile couples and can be particularly distressing because there is no clear “fix.” Advanced treatments such as IVF often overcome unexplained infertility even without a specific cause identified.
Male Factor Infertility
Male factor infertility — where the problem lies solely or partially with the male partner — contributes to 40–50% of all infertility cases. This proportion is significantly underrecognised in Indian society, where infertility is often incorrectly attributed to women by default.
What Causes Infertility in Women?
Female infertility arises from disruptions in the reproductive process — ovulation, the fallopian tubes, the uterus, or hormonal regulation. Here are the most common causes seen in Indian women:
Ovulation Disorders
The most common cause of female infertility is Problems with ovulation, which prevent the monthly release of a mature egg. Causes include:
- PCOS (Polycystic Ovary Syndrome) — PCOD/ PCOS affects 1 in 5 Indian women. Characterised by elevated androgens, irregular periods, and absent or infrequent ovulation. One of the most treatable causes of infertility in India.
- Premature Ovarian Insufficiency (POI) — ovaries stop functioning normally before age 40, depleting egg reserve prematurely.
- Hypothalamic dysfunction — excessive stress, extreme weight loss, or intense exercise disrupts the hormonal signals that trigger ovulation.
- Thyroid disorders — both thyroid types, hypothyroidism and hyperthyroidism, can disrupt fertility and ovulation cycles. Thyroid dysfunction is common in Indian women and frequently goes untested.
Fallopian Tube Blockage or Damage
Blocked or damaged fallopian tubes prevent sperm from reaching the egg and prevent the fertilised egg from travelling to the uterus. Common causes in India include:
- Pelvic Inflammatory Disease (PID) from untreated sexually transmitted or reproductive tract infections — a significant cause in Bihar, where RTIs often go untreated for years
- Previous pelvic surgery, appendicitis, or ruptured appendix, causing adhesions
- Endometriosis — where endometrial tissue grows outside the uterus, causing scarring and tubal damage
- Prior ectopic pregnancy that required surgical removal of a tube
Endometriosis
Endometriosis affects approximately 10% of women globally and is one of the leading causes of infertility in India. It occurs when tissue similar to the uterine lining grows outside the uterus — on the ovaries, fallopian tubes, or in the pelvic cavity — causing inflammation, scarring, and altered immune responses that impair fertility. It is frequently underdiagnosed, often for 7–10 years before a definitive diagnosis.
Uterine Abnormalities
- Fibroids — Fibroids are non-cancerous growths in or around the uterus that can distort the uterine cavity or block the fallopian tubes
- Polyps — overgrowths of the uterine lining that interfere with implantation
- Uterine septum or congenital anomalies — structural abnormalities present from birth
- Asherman’s Syndrome — intrauterine scarring, often from prior D&C procedures or infections
Diminished/ Low Ovarian Reserve
Women are born with a finite number of eggs. From the late 20s onwards, egg quantity and quality begin to decline, significantly accelerating after 35. Women with diminished/low ovarian reserve (low AMH, low AFC on ultrasound) may struggle to produce enough eggs for fertilisation, even with ovarian stimulation. Age is the single strongest predictor of female fertility.
What Causes Infertility in Men?
Male infertility is equally common but far less discussed. A semen analysis — a simple test — is the single most important investigation for any infertile couple and should always be the first test done, since it is non-invasive and inexpensive. Common causes of male infertility in India include:
Low Sperm Count (Oligospermia)
A sperm count below 15 million per millilitre is classified as oligospermia. Causes in India include increasing exposure to urban pollution, thermal stress (laptops on laps, hot work environments), varicocele, hormonal imbalances, and poor nutrition. Research shows Indian men’s average sperm counts have declined significantly over the past two decades.
Poor Sperm Motility (Asthenospermia)
Even with an adequate count, if sperm cannot swim effectively (progressively motile), they cannot reach and fertilise the egg. Causes of low/ zero sperm count include oxidative stress, infections, and lifestyle factors, including smoking and alcohol.
Abnormal Sperm Morphology (Teratospermia)
Sperm with an abnormal shape have difficulty penetrating the egg’s outer shell. Defined as fewer than 4% normal forms on strict Kruger criteria, this is frequently seen in Indian men and is treatable with ICSI (Intracytoplasmic Sperm Injection).
Azoospermia
Complete absence of sperm in the ejaculate. Can be obstructive (a blockage preventing sperm from reaching the ejaculate) or non-obstructive (failure of sperm production). Both types have treatment options — surgical sperm retrieval (TESA/PESA) for obstructive cases, and hormonal or microsurgical options for selected non-obstructive cases.
Varicocele
An abnormal enlargement of the veins in the scrotum, raising testicular temperature and impairing sperm production. Varicocele is found in approximately 15% of men overall and up to 40% of men presenting with infertility. Surgical correction (varicocelectomy) can significantly improve sperm parameters.
Hormonal Causes
Low testosterone, elevated FSH (indicating testicular failure), or pituitary disorders can all impair sperm production. These are diagnosed through a blood hormone panel and are often treatable with medication.
What are the Lifestyle and Environmental Causes of Infertility in India?
Beyond medical conditions, several lifestyle and environmental factors significantly affect fertility in both partners, and are particularly relevant in the Indian context:
- Delayed marriage and parenthood — many urban Indian couples now marry in their late 20s or 30s, reducing the window of peak fertility
- Obesity and metabolic syndrome — strongly linked to PCOS in women and hormonal imbalance in men; India has a rapidly growing obesity prevalence
- Stress — chronic stress disrupts the hypothalamic-pituitary-gonadal axis, affecting ovulation in women and sperm quality in men
- Tobacco use — smoking significantly reduces sperm count and motility in men and accelerates ovarian ageing in women
- Alcohol consumption — Alcohol consumption affects hormonal balance in both partners
- Pesticide and chemical exposure — particularly relevant for agricultural workers in rural Bihar, UP, and MP
- Nutritional deficiencies — folate, vitamin D, zinc, and antioxidant deficiencies are common in Indian diets and affect both egg and sperm quality
How Is Infertility Diagnosed? Tests for Women and Men
A thorough fertility evaluation is the essential first step before any treatment decision. At Shradha IVF, we evaluate both partners simultaneously because infertility is a couple’s diagnosis, not an individual one.
What are Infertility Tests for Women?
What are Infertility Tests for Men?
What Are the Treatment Options for Infertility?
Treatment depends entirely on the identified cause, the age of both partners, and how long the couple has been trying. The goal is always the most effective, least invasive option appropriate to the diagnosis.
Ovulation Induction
Medications (Clomiphene, Letrozole, injectable Gonadotropins) stimulate the ovaries to develop and release eggs. Used for women with ovulation disorders, often as a first-line treatment or in preparation for IUI.
IUI (Intrauterine Insemination)
Carefully prepared sperm are placed directly into the uterus at the time of ovulation, increasing the number of sperm that reach the egg. IUI is recommended for mild male factor infertility, unexplained infertility, or cervical factor infertility.
IVF (In Vitro Fertilisation)
Eggs are retrieved from the ovaries, fertilised with sperm in the embryology laboratory, and the resulting embryo is transferred to the uterus. IVF is the most effective fertility treatment available and is recommended for blocked tubes, severe male factor, failed IUI cycles, diminished ovarian reserve, or when a couple has been trying for several years without success.
ICSI (Intracytoplasmic Sperm Injection)
A single sperm is injected directly into an egg using a microscopic needle. ICSI is performed within the IVF process and is recommended for severe male factor infertility, azoospermia with surgical sperm retrieval, or previous fertilisation failure with conventional IVF.
Surgical Treatments
- Laparoscopy to treat endometriosis, remove adhesions, or unblock tubes
- Hysteroscopy to remove fibroids, polyps, or intrauterine adhesions
- Varicocelectomy for male varicocele
- Surgical sperm retrieval (TESA, PESA, micro-TESE) for azoospermia
Donor Programs
When neither partner’s own eggs nor sperm can produce a healthy embryo, donor eggs or sperm allow couples to achieve pregnancy using a third party’s gametes. All donor programs at Shradha IVF comply fully with ICMR guidelines and the ART (Regulation) Act 2021.
Infertility in Bihar — What Couples Should Know
Bihar has specific infertility risk factors that are underrecognised in national conversations:
- Reproductive tract infections (RTIs) — often untreated for years in rural areas, leading to tubal damage in women
- PCOS underdiagnosis — many women in Bihar are told their irregular periods are “normal” without investigation, delaying diagnosis by years
- Social stigma — infertility is still frequently blamed on women, even when the male factor is the cause, delaying proper bilateral investigation
- Agricultural chemical exposure — pesticide exposure in farming communities can impair sperm quality in men
- Nutritional deficiencies — folate, vitamin D, and zinc deficiencies are common in Bihar’s dietary patterns and affect both egg and sperm quality
Shradha IVF & Maternity in Patna exists specifically to address these challenges — bringing MRCOG-qualified specialist care, advanced embryology, and compassionate counselling to couples across Bihar, without the need to travel to Delhi or Mumbai.
When Should You See a Fertility Specialist?
How Shradha IVF & Maternity Supports Couples in Patna
Shradha IVF & Maternity is Bihar’s dedicated fertility and reproductive medicine centre, led by Dr. Shradha Chakhaiyar — a specialist with an MRCOG qualification from London and over two decades of fertility experience in Patna.
- Complete couple evaluation — both partners assessed simultaneously, with results explained clearly
- Advanced embryology laboratory — time-lapse incubators, precision sperm handling, and ICSI capability in Patna
- Transparent pricing — itemised cost estimates of IVF treatment before any procedure begins
- IVF on EMI — structured payment plans for couples who need flexibility
- Free IVF camps — periodic subsidised consultation events for couples across Bihar
- Compassionate counselling — every consultation includes time for questions, without pressure or urgency
FAQs Related to Infertility
Infertility is the inability to achieve a clinical pregnancy after 12 months of regular, unprotected intercourse. For women over 35, this threshold is 6 months. It can affect either or both partners and is a medical condition, not a personal failing. It is treatable in the majority of cases.
Yes. According to WHO data, 15–20% of couples in India experience infertility — approximately 27.5 million couples. Bihar, UP, and MP have higher clinical prevalence than the national average, partly due to delayed care-seeking and higher rates of untreated reproductive infections.
The most common causes are PCOS (affecting 1 in 5 Indian women), blocked or damaged fallopian tubes (often from untreated infections), ovulation disorders (including thyroid problems), endometriosis, uterine abnormalities (fibroids, polyps), and age-related decline in ovarian reserve. PCOS is the most treatable and most commonly underdiagnosed cause in India.
Yes, in many cases. Depending on the cause, treatment may involve ovulation induction medications, IUI (intrauterine insemination), surgical correction of blocked tubes or varicocele, hormonal treatment for thyroid or PCOS, or lifestyle changes. IVF is recommended when simpler treatments are unlikely to succeed or when the cause specifically warrants it.
For women: AMH, Day 2/3 FSH, AFC ultrasound, TSH, HSG (fallopian tube test), pelvic ultrasound. For men: semen analysis (the most important first test), scrotal ultrasound, hormonal profile. Both partners are evaluated simultaneously at Shradha IVF, since infertility is a couple's diagnosis.
