Women under the age of 35 are usually advised to try for 12 months before consulting a physician. A couple that knows of adverse medical conditions, such as irregular menstrual cycles or a history of tubal infections, should consider a basic examination sooner. Doctors usually advise women over age 35 to have an initial examination after only six months of trying, while those over 40 may begin fertility tests immediately. Couples should have sexual relations 3 to 4 times a week during the week before ovulation. The egg (oocyte) only survives for 24 hours after ovulation, so good timing is essential.

Each couple's condition and response to infertility treatment is unique. The answer is difficult to calculate, because it depends on several factors: the woman's body, the man's body, the clinic's success rate, and luck. Physiological factors that affect success include the age of the woman, uterine abnormalities, and whether both partners have infertility factors.

Most gynecologists have ample training to handle the basic infertility workup, although some refer patients to a specialist immediately. Usually, the OB/GYN begins the testing process and appropriate treatments, then refers the couple to a fertility specialist if simple treatments are not successful

The endometrium is the lining of the uterus. Endometriosis a condition that can occur if endometrial tissue spreads outside the uterus. Most often, these small pieces of misplaced tissue--sometimes called endometrial lesions or implants--attach to the ovaries, fallopian tubes, the outer surface of the uterus, the lining of the pelvic cavity, or elsewhere in the lower abdomen.Endometrial tissue changes with the hormones of a woman's monthly cycle--the tissue builds up, breaks down, and bleeds. But while menstruation gets rid of the uterine tissue and fluids, the tissue from endometriosis has no place to go. Thus, the area around the endometrial implants can become inflamed and form scar tissue. Other complications may also occur.

Symptoms of endometriosis include pain, infertility, and abnormal menstrual bleeding. Pain can be severe and usually occurs before and during menstrual periods or at ovulation. Some women don't have pain. Pelvic or ultrasound examinations may suggest endometriosis, but direct inspection via a laparoscopy is the only way to be certain. In a laparoscopy, the surgeon makes a small surgical incision just below the navel, inflates the abdomen with carbon dioxide gas (to improve the ability to see the organs), and inserts a long, thin, lighted, flexible, telescope like instrument--the laparoscope. The surgeon can then view and treat, if necessary, endometriosis or other pelvic conditions

Pain from endometriosis can be treated with a variety of medications. For mild or moderate pain, nonprescription pain relievers, such as aspirin, acetaminophen, or ibuprofen, may be helpful. If these don't provide relief or if pain is severe, a prescription pain medication may be needed. Some women have found additional relief using acupuncture, biofeedback, meditation, and exercise.

Treatment of the disease itself may include hormone therapy, surgery, or both. Hormone therapy includes the use of oral contraceptives (estrogen, progestins, or both), danazol, or a newer class of agents called GnRH agonists. Hormone therapy works by stopping ovulation temporarily. This can help the endometrial lesions to shrink and stops the development of new implants. But hormone therapy does not cure endometriosis--the disease recurs in most women when hormone therapy stops.

Surgical treatment removes endometrial implants and scar tissue by cutting away, cauterizing (burning), or vaporizing with a laser. This can usually be done during the inspection by laparoscopy. If endometriosis is severe or if the implants cannot be reached easily with the laparoscope, you may need a more extensive surgery, called a laparotomy. Laparotomy involves a larger incision, usually about four to five inches.

Hormone therapy and/or surgery to remove endometrial implants may help to relieve symptoms temporarily and may make it possible to conceive. Some women with severe endometriosis may consider hysterectomy and removal of the ovaries

Male Infertility is one of the largest causes of sub fertility. There is a declining trend for seminal parameters throughout the world. The stress associated in this highly competitive world ,environmental pollutants, smoking, Varicocoele and sexually transmitted diseases are the causative factors. Lack of exercise, prolonged rides in motorbike, tight jeans and undergarments are also attributed as causatuve factors for male infertility.

The reasons of female infertility may be due to failure to ovulate, obstruction to fallopian tube, infections such as pelvic inflammatory disease due to tuberculosis or sexually transmitted diseases. In Kerala there is a high incidence of endometriosis. In a study conducted at our Fertility Centre for past 4 years Endometriosis has been found to be cause in 28% of female causes of infertility. The cause of high incidence of endometriosis is not clear but may be due to environmental pollutants like Dioxin caused by burning plastic materials.

Laparoscopic Surgery (Key hole surgery) which is minimally invasive surgery is the appropriate method of treatment. Centres equipped with most modern gadgets required for key hole surgery. The patient can be discharged within 24 hours and can try for conception immediately. The other advantage is the time taken to resume normal activities is less than 2 weeks when compared to 4-6 weeks rest advised in Laparotomy (Open Surgery). The cost of laparoscopic surgery is equal to open method.

Roughly one-third of infertility cases can be attributed to male factors and another one-third to factors that affect women. For the remaining infertile couples, infertility is caused by a combination of problems in both partners (about 13%) or is unexplained (about 10%). The most common causes of male infertility include azoospermia (no sperm cells are produced) and oligospermia (few sperm cells are produced). Sometimes, sperm cells are malformed or they die before they can reach the egg. In rare cases, male infertility is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality. The most common cause of female infertility is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes, polycystic ovary syndrome (PCOS) and endometriosis. Repeated miscarriages may be caused by congenital anomalies (birth defects) involving the structure of the uterus and uterine fibroids.

Couples are generally advised to seek medical help if they are unable to achieve pregnancy after a year of unprotected intercourse. The doctor conducts a physical examination of both partners to determine their general state of health and to evaluate physical factors that may be causing infertility. Usually both partners are interviewed about their sexual habits in order to determine whether intercourse is taking place for conception. If the physician cannot find a cause for infertility at this point, more specific tests may be recommended. For women, these include an analysis of body temperature and ovulation (by charting the basal body temperature), an x-ray of the fallopian tubes and uterus, and laparoscopy. For men, initial tests focus on semen analysis