Infertility
Infertility means not achieving a pregnancy after 12 months or more of regular unprotected sexual intercourse. It may be described as primary infertility when pregnancy has never occurred, or secondary infertility when someone has previously had a pregnancy but is now having difficulty conceiving. Fertility problems can involve either partner, both partners, or remain unexplained after testing. They are not automatically "the woman's fault."
Infertility is common, affecting about 1 in 6 people of reproductive age worldwide during their lifetime. It can cause considerable emotional, social and financial stress, but several causes are treatable and different options may help people achieve pregnancy.
Symptoms
The main sign is not becoming pregnant despite regular unprotected sex. Infertility itself may cause no other symptoms, but possible clues to an underlying cause include:
In women or people who ovulate:
Irregular, very infrequent or absent periods
Very painful periods or persistent pelvic pain
Pain during sex
Bleeding between periods or after sex
Symptoms suggesting a hormone problem, such as increased facial hair, acne, unexplained weight change or nipple discharge
Previous pelvic infection, sexually transmitted infection, ectopic pregnancy or pelvic surgery
Previous cancer treatment or early menopause
Possible causes include ovulation disorders, polycystic ovary syndrome, thyroid problems, endometriosis, fibroids, reduced ovarian function and blocked or damaged fallopian tubes.
In men:
Difficulty getting or maintaining an erection
Difficulty ejaculating
Reduced sexual desire
Pain, swelling or a lump in a testicle
Previous testicular injury, infection or surgery
A history of undescended testicles
Previous cancer treatment
Male-factor infertility may involve a low sperm count, no sperm, reduced sperm movement, abnormal sperm shape or problems with semen being released.
Red flags
Infertility itself is not usually an emergency, but seek urgent medical care if there is:
A positive pregnancy test with severe or one-sided lower abdominal pain, shoulder-tip pain, vaginal bleeding, dizziness or fainting, as this may indicate an ectopic pregnancy
Sudden severe testicular pain or swelling
A new hard lump or persistent swelling in a testicle
Severe pelvic pain with fever, vomiting, abnormal vaginal discharge or marked illness
Very heavy vaginal bleeding, fainting or severe weakness
Severe emotional distress, thoughts of self-harm or feeling unsafe
Arrange earlier fertility assessment rather than waiting 12 months if:
The woman or person trying to become pregnant is aged 36 or older
Periods are absent or very irregular
There is known endometriosis, pelvic inflammatory disease, previous ectopic pregnancy or pelvic surgery
Either partner has had cancer treatment
There is a known testicular, sexual or ejaculation problem
Either partner has another reason to be concerned about fertility
Fertility generally declines with age, particularly from the mid-30s, so delaying assessment may reduce the available options.
Self-care
Infertility cannot always be corrected through lifestyle changes, and people should not blame themselves when pregnancy does not occur. However, the following measures can support general reproductive health while arranging assessment:
Have unprotected sex every 2 to 3 days throughout the menstrual cycle rather than relying only on predicted ovulation days.
Avoid smoking, vaping and recreational drugs.
Keep alcohol intake low or avoid alcohol while trying to conceive.
Aim for a healthy, sustainable body weight; being significantly underweight or overweight can affect ovulation and sperm health.
Eat a varied, balanced diet and remain physically active.
Take a preconception folic-acid supplement as recommended by a qualified health professional.
Review regular medicines, supplements, herbal products and gym or bodybuilding products with a clinician.
Avoid anabolic steroids or testosterone products unless specifically prescribed, because they can markedly reduce sperm production.
Reduce excessive heat exposure around the testicles where practical.
Seek testing and treatment for possible sexually transmitted infections.
Support each other emotionally and avoid blaming either partner.
Do not take fertility hormones, herbal remedies or medicines advertised online without specialist assessment. Unmonitored treatment can cause side effects, multiple pregnancy or delay investigation of the actual cause. Complementary treatments have not been proven to treat infertility.
Treatment
Both partners should usually be assessed, because fertility problems may involve either or both. Initial assessment may include the duration and frequency of trying to conceive, menstrual and pregnancy history, sexual difficulties, previous infections or surgery, medicines, lifestyle and existing illnesses.
Tests may include:
Semen analysis to assess sperm number, movement and shape
Blood tests to check ovulation and relevant hormones
Ultrasound examination of the womb and ovaries
Tests for sexually transmitted infections
Tests to check whether the fallopian tubes are open
Examination of the pelvis, penis or testicles where appropriate
Additional hormone, genetic or imaging tests when clinically indicated
A normal result in one partner does not remove the need to assess the other. Sometimes no definite cause is found, which is called unexplained infertility.
Treatment depends on the cause, age, duration of infertility, test results, previous pregnancies, personal preferences, cost and locally available services. Options may include:
Treatment of thyroid disease, infection or another underlying condition
Medicines to help ovulation in selected people
Surgery for certain cases of blocked tubes, endometriosis, fibroids or reproductive-tract obstruction
Treatment of erection or ejaculation difficulties
Intrauterine insemination (IUI), where prepared sperm is placed inside the womb
In vitro fertilisation (IVF), where eggs are fertilised in a laboratory before an embryo is placed in the womb
Intracytoplasmic sperm injection (ICSI), where a single sperm is injected into an egg in selected cases
Use of donated eggs or sperm where appropriate and legally available
Emotional counselling or psychological support throughout assessment and treatment
No fertility treatment can guarantee pregnancy. Clinics should explain the realistic likelihood of success, possible complications, total cost, medicines, tests, storage fees and number of treatment cycles before treatment begins.
In Nepal, fertility investigations and assisted-reproduction services are mainly concentrated in larger cities and are often paid for privately. Before starting IUI or IVF, confirm that the clinic uses appropriately qualified specialists, provides clear consent procedures, explains success rates by age, and gives a written breakdown of all expected costs. Avoid clinics that promise guaranteed pregnancy or recommend expensive procedures before completing basic assessment of both partners. Access to affordable and properly regulated fertility care remains a challenge in many lower- and middle-income countries.
Questions to ask your doctor
When should we begin fertility investigations?
Should both partners be tested at the same time?
Am I ovulating regularly?
Is semen analysis needed, and how should the sample be collected?
Could an infection, endometriosis, PCOS, thyroid problem or blocked tube be contributing?
Which medicines or supplements might be affecting fertility?
What additional tests are genuinely necessary?
Is there a treatable underlying cause?
What are our chances of conceiving naturally?
Which treatment options are appropriate before considering IVF?
What are the success rates and risks for someone of my age and circumstances?
What will the full treatment cost include?
What emotional or counselling support is available?
Nepal pathway
In Nepal, start with your nearest health post, primary health care centre, clinic, or hospital if symptoms are worrying, severe, worsening, or not improving. Take previous prescriptions, test reports, allergy information, and current medicines with you. Seek urgent care immediately if there are red flag symptoms.
Disclaimer
This is general health information only and does not replace medical advice, diagnosis, treatment, or emergency care.
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