Infertility: Causes, Symptoms and Types Explained

Introduction

For many couples, trying to conceive happens alongside busy workdays, running a business and managing family responsibilities. When pregnancy does not happen as expected, worry and pressure can quietly build, often affecting peace of mind and daily focus. Questions from relatives and uncertainty about what is going wrong can make the situation more stressful.

Infertility is common and not a personal failure. It is defined as the inability to conceive after 12 months of regular, unprotected intercourse or six months if the woman is above 35. In India, about 10 to 15 percent of couples face infertility.

This guide explains what causes infertility, symptoms and types of infertility in clear terms, helping you understand when to seek medical advice and how to take informed next steps with confidence.

What Causes Infertility in Women?

Infertility in women can result from problems with ovulation, structural abnormalities in the reproductive organs, conditions like endometriosis, or age-related decline in egg quality and quantity.

• Ovulation Disorders: Ovulation disorders account for about 20 percent of infertility cases in India. Pregnancy cannot occur if eggs are not released regularly. Polycystic Ovary Syndrome affects around 20 percent of Indian women of reproductive age and is a leading cause. Thyroid disorders also disrupt ovulation by affecting hormonal balance.
• Structural Issues: Structural problems can block fertilisation or implantation. Damaged or blocked fallopian tubes, often caused by pelvic inflammatory disease, previous surgery, endometriosis, or genital tuberculosis, prevent sperm and egg from meeting. Uterine fibroids, polyps, or congenital abnormalities may reduce implantation.
• Endometriosis: Endometriosis involves uterine-like tissue growing outside the uterus. It causes inflammation, scarring, and anatomical distortion, interfering with fertilisation and implantation.
• Age: After 35, egg quality and quantity decline. By 40, the chance of natural conception per cycle falls to about 5 percent.

How Do You Know If You Have Infertility Issues?

The main sign of infertility is the inability to conceive after 12 months of regular, unprotected intercourse or after six months if the woman is over 35. In many cases, infertility has no obvious symptoms, but certain signs can indicate underlying problems that affect fertility.

In women, irregular or absent periods are a key warning sign. Very heavy or painful periods may suggest conditions such as endometriosis or fibroids. Pain during intercourse, unusual vaginal discharge or a history of pelvic infections can indicate structural problems or damage to the reproductive organs.

Some women may also notice significant weight changes, excessive facial or body hair growth associated with PCOS, darkening of skin in body folds or symptoms of thyroid dysfunction such as fatigue, mood changes or unexplained weight gain or loss. Women with a history of reproductive tract infections, tuberculosis or pelvic surgery may have fertility issues even without clear symptoms.

In men, symptoms are often subtle. Changes in sexual function, including difficulty maintaining an erection, reduced libido or ejaculation problems, may point to hormonal or physical issues. Pain, swelling or lumps in the testicles and a noticeable reduction in facial or body hair can also indicate fertility-related problems.

What Are the Different Types of Infertility?

Infertility is classified into two main types based on whether a couple has previously conceived: primary infertility and secondary infertility.

• Primary Infertility: Primary infertility refers to couples who have never been able to conceive despite regular, unprotected intercourse for at least one year. It accounts for a significant proportion of infertility cases in India, especially among couples who delay childbearing.
• Secondary Infertility: Secondary infertility occurs when a couple is unable to conceive after previously having a successful pregnancy and childbirth. It is more common in India than primary infertility and may result from age-related fertility decline, new medical conditions, complications from earlier pregnancies or deliveries or infections acquired after the first child.

When Should You See a Doctor About Infertility?

Couples should consult a doctor after 12 months of trying to conceive if the woman is under 35, or after six months if she is between 35 and 40. If the woman is above 40 or if either partner has known fertility risk factors, medical consultation should be sought immediately. Delaying evaluation can reduce treatment options, as fertility declines with age.

Men should also see a doctor regardless of how long they have been trying if they have a history of testicular injury or surgery, mumps after puberty, sexual dysfunction or previous cancer treatment. Early assessment helps identify treatable causes and avoids unnecessary delays in care.

What Medical Conditions Are Linked to Infertility?

Several medical conditions can significantly increase the risk of infertility by affecting hormones, reproductive organs or sperm and egg function. Common conditions include PCOS, endometriosis, thyroid disorders, diabetes, tuberculosis, sexually transmitted infections and hyperprolactinemia.

PCOS disrupts normal ovulation due to hormonal imbalance and is a leading cause of infertility in India. Thyroid disorders interfere with the hormones needed for ovulation and for maintaining pregnancy.

Diabetes can cause hormonal disturbances and damage to reproductive organs in both men and women. Tuberculosis, particularly genital tuberculosis, is an important but often overlooked cause of infertility due to inflammation and scarring.

Sexually transmitted infections such as chlamydia and gonorrhoea may lead to pelvic inflammatory disease in women and epididymitis in men, resulting in scarring and blockages that affect fertility.

Endometriosis causes inflammation and scarring that can damage eggs, sperm and embryos, as well as create physical blockages. Hyperprolactinemia, or elevated prolactin levels, interferes with ovulation but is a common and treatable cause of infertility among Indian women.

Conclusion

Infertility is a medical condition with multiple causes and affects millions of couples across India. It may result from ovulation disorders, sperm-related problems, structural abnormalities, lifestyle factors or infections such as tuberculosis. It is not a personal failing but a health issue that requires timely medical evaluation and support.

Understanding the causes of infertility is the first step toward effective treatment. Today, modern diagnostic methods and treatment options offer many paths to parenthood.

If you are struggling to conceive, do not delay care or let stigma prevent you from seeking help. Consulting a qualified fertility specialist can provide clarity, appropriate treatment and the support needed to move forward with confidence.