Discover infertility causes and evaluation steps used to guide personalized IVF treatment planning.

Learn about the health risks associated with IVF for the mother (OHSS symptoms) and child (prematurity), and how to manage them.

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Unlocking the Mystery of Infertility

Infertility is often a silent struggle. Couples may feel isolated, frustrated, or even guilty, wondering “Why us?” at every negative pregnancy test. At Liv Hospital, we want to shift the narrative. Infertility is not a failure of character; it is a medical condition of the reproductive system. And like any medical condition, it has specific causes that can be identified and treated.

The first step to a successful pregnancy is a precise diagnosis. In about 40% of cases, the cause lies with the female partner; in 40%, it lies with the male partner; and in 20% of cases, it is a combination of both or remains “unexplained.” Our IVF Causes and Evaluation program is designed to investigate both partners simultaneously, ensuring that no time is wasted treating the wrong problem.

When Should You Seek Help?

The medical definition of infertility is based on time, not just biology. You should schedule a consultation with our fertility specialists if:

  • Under 35: You have been having regular, unprotected intercourse for 12 months without conception.
  • Age 35–40: You have been trying for 6 months. Egg quality declines rapidly in this window, so waiting a year is often inadvisable.
  • Over 40: You should seek evaluation immediately or after 3 months of trying.
  • Known Conditions: If you have a history of irregular periods, PCOS, endometriosis, or if the male partner has a history of testicular surgery/trauma, do not wait. Come in right away.

Female Infertility Factors

For a woman to conceive, a complex sequence of events must occur perfectly: hormones must trigger an egg to mature, the ovary must release it (ovulation), the fallopian tube must catch it, sperm must fertilize it, and the resulting embryo must implant in the uterus. A disruption at any stage causes infertility.

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Ovulation Disorders

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If you don’t ovulate, there is no egg to fertilize.

  • PCOS (Polycystic Ovary Syndrome): A hormonal imbalance where the ovaries contain many small follicles (cysts) that fail to release an egg regularly. 
  • Diminished Ovarian Reserve (DOR): The ovaries have fewer eggs remaining than expected for your age. 
  • Premature Ovarian Failure (POF): Loss of ovarian function before age 40, often due to autoimmune issues or chemotherapy.
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Tubal Factor Infertility

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The fallopian tubes are the “meeting place” for sperm and egg.

  • Blockages: Past infections (like Chlamydia or Gonorrhea) or surgeries can cause scar tissue that blocks the tubes. This prevents the sperm from reaching the egg or, worse, traps a fertilized egg causing an ectopic pregnancy.
  • Hydrosalpinx: A blocked tube that fills with toxic fluid. This fluid can leak back into the uterus and poison a developing embryo, preventing IVF success even if the other tube is open.

Uterine Factors

The “soil” must be healthy for the “seed” to grow.

  • Fibroids (Myomas): Benign muscle tumors in the uterus. While common, fibroids that bulge into the uterine cavity (submucosal) can block implantation.
  • Polyps: Soft, finger-like growths in the uterine lining that act like a natural IUD, preventing pregnancy.
  • Congenital Anomalies: A septate uterus (a wall dividing the uterus) or bicornuate uterus (“heart-shaped”) can increase miscarriage risk.
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Endometriosis

A painful condition where tissue similar to the uterine lining grows outside the uterus (on ovaries, tubes, or bowel).

  • The Impact: It creates a hostile inflammatory environment that damages egg quality and can cause anatomical distortion (scarring) that blocks the tubes.

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Male Infertility Factors

Historically, infertility was seen as a “woman’s problem.” We now know that Male Factor Infertility is the sole cause in 20-30% of cases and a contributing factor in another 20-30%.

Sperm Production Issues

  • Azoospermia: Zero sperm in the ejaculate. This can be obstructive (blockage in the tubes) or non-obstructive (testicular failure).
  • Oligospermia: Low sperm count (less than 15 million/ml). Even with low numbers, pregnancy is possible, but it takes longer.

Sperm Function Issues

  • Motility: The sperm must be strong swimmers to reach the egg. “Asthenospermia” is poor movement.
  • Morphology: The sperm must have a perfect shape (oval head, long tail) to penetrate the egg. “Teratospermia” means many sperm are misshapen (two heads, short tails), making fertilization difficult.

DNA Fragmentation

Sometimes the sperm count looks normal, but the DNA inside the sperm head is damaged (fragmented). High fragmentation is a major cause of Recurrent Miscarriage and “Unexplained Infertility.”

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When the Tests are "Normal"

In about 15-20% of couples, all standard tests come back normal. The sperm is good, tubes are open, and ovulation is regular. This is called Unexplained Infertility.

  • What it really means: It doesn’t mean “nothing is wrong.” It usually means the problem is subtle—perhaps the sperm can’t penetrate the egg shell, or the embryo stops developing after day 3.
  • The Good News: IVF is often highly successful for unexplained infertility because it bypasses these microscopic hurdles (using ICSI) and allows us to visualize the embryo quality directly.

When the Tests are "Normal"

In about 15-20% of couples, all standard tests come back normal. The sperm is good, tubes are open, and ovulation is regular. This is called Unexplained Infertility.

  • What it really means: It doesn’t mean “nothing is wrong.” It usually means the problem is subtle—perhaps the sperm can’t penetrate the egg shell, or the embryo stops developing after day 3.
  • The Good News: IVF is often highly successful for unexplained infertility because it bypasses these microscopic hurdles (using ICSI) and allows us to visualize the embryo quality directly.

The Diagnostic Journey at Liv: Step-by-Step

When you arrive at Liv Hospital for your initial evaluation, we perform a “360-degree” assessment. We recommend both partners attend the first visit.

For the Female Partner:

  1. AMH (Anti-Mullerian Hormone) Test: A simple blood test that gives us a snapshot of your “Ovarian Reserve” (how many eggs you have left). Unlike FSH, it can be done on any day of your cycle.
    • High AMH: Suggests PCOS.
    • Low AMH: Suggests diminished reserve (time is critical).
  2. Transvaginal Ultrasound: We count the “Antral Follicles” (sleeping eggs) in your ovaries to confirm the AMH results. We also check the uterus for fibroids or polyps.
  3. HSG (Hysterosalpingogram): The “dye test.” We inject a contrast liquid into the uterus and take X-rays. It shows if the fallopian tubes are open and if the uterine cavity has a normal shape. It causes mild cramping but is over in 5 minutes.
  4. Hormone Panel (Day 2-3): Measuring FSH, LH, Estradiol, Prolactin, and TSH (Thyroid) to check for hormonal imbalances affecting ovulation.

For the Male Partner:

  1. Semen Analysis (Spermiogram): The most critical test.
    • Requirement: You must abstain from ejaculation for 2–5 days before the test.
    • What we measure: Volume, Count, Motility, and Morphology.
  2. Sperm DNA Fragmentation Test: If there is a history of miscarriage or failed IVF elsewhere, we check the DNA integrity.
  3. Scrotal Ultrasound: To check for Varicoceles (swollen veins in the scrotum) which can heat up the testicles and damage sperm.

Advanced Genetic Evaluation (Karyotyping)

If a couple has had recurrent miscarriages or failed IVF cycles, we perform a Karyotype blood test on both parents.

  • Why? Sometimes a parent carries a “Balanced Translocation”—a rearrangement of chromosomes. They are healthy, but their eggs/sperm have unbalanced chromosomes, leading to embryos that cannot survive. If found, we recommend PGT-A (Preimplantation Genetic Testing).

Preparing for Your First Appointment

To make the most of your consultation at Liv Hospital, please bring:

  • Any previous medical records (HSG films, old blood tests, surgery reports).
  • A list of medications you are currently taking.
  • Dates of your last 3 menstrual periods.
  • (For men) Results of any previous sperm analyses.

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FREQUENTLY ASKED QUESTIONS

Is the HSG (dye test) painful?

Most women experience moderate cramping, similar to menstrual cramps, when the dye is injected. This lasts for only a few minutes. We recommend taking a mild painkiller (like Ibuprofen) 1 hour before the procedure.

Sometimes. If the cause is a hormonal imbalance, medication (like Clomid) can boost sperm count. If it is a varicocele, surgery might help. However, for severe counts, IVF with ICSI is the fastest and most effective route to pregnancy.

Stress doesn’t block tubes or kill sperm directly, but extreme stress can disrupt the brain signals (GnRH) that trigger ovulation or sperm production. It can also lower libido. We treat stress as a contributing factor, not a primary cause.

This refers to the 3rd day of your menstrual period (Day 1 is the first day of full flow). This is the baseline when your hormones are “quiet,” giving us the most accurate reading of your ovarian function (FSH/E2).

You can do the ultrasound and AMH test while on the pill, but you cannot do the Day 3 hormone panel (FSH/LH) because the pill suppresses these hormones. You will need to stop the pill for one cycle to get accurate baseline blood work.

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