Infertility is defined as not conceiving after twelve months of regular, unprotected intercourse — or six months if the woman is 35 or older. It is not a single disease but a symptom with many possible causes. Crucially, those causes are split almost evenly between the two partners, which is why evaluating only one is a common and costly mistake.
Broadly, the causes fall into four groups. Female factors account for around 40% of cases and include ovulation disorders (most commonly PCOS), blocked or damaged fallopian tubes, endometriosis, uterine abnormalities such as fibroids and polyps, and reduced ovarian reserve. Male factors are involved in roughly 40–50% of cases and include low sperm count, poor motility, abnormal morphology, complete absence of sperm (azoospermia), and high sperm DNA fragmentation. In a significant proportion of couples both partners contribute, and in about 10–15% the cause remains unexplained even after a complete workup — which does not mean untreatable.
The Most Important Fact on This PageInfertility is not primarily “a woman’s problem.” A male factor is involved in roughly 40–50% of couples. This is why, at Wellspring, both partners are always evaluated from the start — a semen analysis for him is as routine and essential as ovarian-reserve testing for her. Diagnosing one partner and treating blindly is how months and money are wasted.
When couples struggle to conceive, the instinct is to focus on the woman. Scans are arranged for her. Blood tests are ordered for her. Months pass. This is the single most common and most costly mistake in fertility medicine:
What this means for you: There is a 65% chance that the male partner is the sole or contributing cause of your difficulty conceiving. A semen analysis costs a fraction of any female fertility investigation — and can be completed in under an hour. At Wellspring IVF, we investigate both partners from Day 1.
Infertility has a cause. Sometimes it is female. Sometimes it is male. Often it is both. Select the path most relevant to your situation — each section contains complete diagnostic and treatment information:
Difficulty conceiving, irregular periods, hormonal issues, previous diagnosis, or unexplained failure after IVF — start here.
Semen analysis result, low count, zero sperm, motility concerns — or never been tested at all. Start here.
| What You've Noticed | Most Likely Investigation | Go To |
|---|---|---|
| Irregular or absent periods, weight gain, acne | Hormonal panel, TVS for PCOS | PCOD/PCOS → |
| Severe period pain, pain during sex | Laparoscopy for Endometriosis | Endometriosis → |
| Heavy bleeding, painful periods, bulky uterus | TVS/MRI for Adenomyosis or Fibroids | Adenomyosis → |
| No symptoms + history of infection, TB, or prior surgery | HSG / Hysteroscopy for Blocked Tubes | Blocked Tubes → |
| Age >35 or short cycles, prior ovarian surgery | AMH test + AFC scan | Low AMH → |
| 2+ miscarriages, recurrent IVF failure | Thrombophilia panel, uterine cavity assessment | Recurrent Miscarriage → |
| Semen analysis: low count or zero sperm | WHO semen analysis, hormonal panel, Doppler | Male Infertility → |
| Normal semen analysis but repeated IVF failure | Sperm DNA Fragmentation (DFI) test | Sperm DNA → |
| Both partners tested — all results normal | Unexplained infertility workup, ERA test | Contact Dr. Shah → |
Our fertility specialists are committed to providing personalized, compassionate care with
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Why Time Matters More Than Most Couples Realise
| Situation | When to Consult a Fertility Specialist |
|---|---|
| Under 35, regular cycles, no known issues | After 12 months of unprotected regular intercourse without conception |
| 35–37 years of age | After 6 months of trying — do not wait 12 months |
| Over 38 years of age | Start investigation immediately — even before trying for 3 months |
| Irregular or absent periods (PCOS, thyroid) | Seek evaluation before starting to try — do not delay |
| Known endometriosis, fibroids, or prior surgery | Consult before trying — pre-treatment may improve chances significantly |
| Known male factor (previous semen report) | Seek specialist evaluation immediately — time matters |
| 2 or more pregnancy losses (any gestation) | Investigation after 2 losses — do not wait for a third |
| Any prior IVF failure | Seek a second opinion with full cycle review — do not repeat blindly |
The single most important difference in Dr. Pranay Shah’s approach is the one that couples feel from their very first appointment: both partners are investigated at the same time.
This sounds obvious. In practice, it rarely happens. Across India, fertility workups are still initiated almost exclusively on the female partner. The male partner enters the picture — often only for a semen test — weeks or months into the process. By this time, the couple has already undergone scans, blood tests, and sometimes procedures, without knowing whether the primary factor is male.
At Wellspring IVF, the first consultation ends with investigation orders for both partners. The semen analysis result is available the same day. The female hormonal panel returns within 24–48 hours. By the second consultation, we have a complete picture — and a real plan.
What Happens at Your First Consultation at Wellspring IVF
“The first question almost every couple asks me is ‘whose fault is it?’ — and it is the wrong question. Infertility is a shared medical condition with a cause we can usually identify, and a male factor is involved about as often as a female one. My job at the first consultation is to find that cause in both partners, explain it in plain language, and tell you honestly what it means. Once we know the cause, the right treatment is usually obvious — and it is far more often something straightforward than the worst-case scenario couples have imagined while waiting. Understanding is the first treatment.” — Dr. Pranay Shah, MS (ObGy), Director & Chief Fertility Consultant, Wellspring IVF & Women’s Hospital, Ahmedabad |
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You find out by testing both of you — simultaneously. At Wellspring IVF, the first consultation ends with investigation orders for both partners. The semen analysis is available the same day. The female hormonal panel within 24–48 hours. Within one week of your first appointment, Dr. Shah typically has enough information to identify the primary factor — whether it is female, male, or both.
If you are under 35, the standard guideline is 12 months before seeking help. However, there are important exceptions: if you have irregular periods, known PCOS, any prior pelvic surgery, or any history of infection — do not wait 12 months. And if you are over 35, 6 months is the threshold. There is no harm in consulting earlier — a good specialist will simply reassure you and monitor, not rush you into treatment.
This is ‘unexplained infertility’ — affecting approximately 10–15% of couples. Standard tests are genuinely normal. The next step is advanced investigation: sperm DNA fragmentation, ERA (endometrial receptivity), hysteroscopy, and a thrombophilia panel. In the majority of unexplained cases, one of these advanced tests reveals the answer.
Not necessarily. IVF is one treatment among several, and at Wellspring it is never the automatic first step. Depending on your diagnosis, the right treatment may be ovulation induction, a hysteroscopic correction, or IUI — IVF is recommended only when the clinical picture clearly supports it (for example, blocked tubes, severe male factor, or failed simpler treatments). Your diagnosis determines the treatment; for the full range of options, see our Fertility Treatments hub.
No — and in many cases, it is not even the first option. IVF is indicated for specific diagnoses: blocked tubes, severe male factor, IUI failure, advanced age with time constraints, or complex combined factors. For many other diagnoses — mild PCOS, mild male factor, ovulation disorders, correctable uterine issues — treatment with medication, lifestyle change, or IUI is appropriate first. Dr. Shah’s approach is to use the minimum necessary intervention for each specific diagnosis.
For female fertility — yes, significantly. A woman is born with her entire lifetime supply of eggs. Egg number (ovarian reserve) and egg quality both decline with age — the decline accelerates meaningfully after 35 and sharply after 38. For men, age also matters, but the decline is more gradual. This is why we recommend earlier consultation for women over 35, and why we always check AMH (Anti-Müllerian Hormone) at the first appointment — it gives an accurate, age-independent measure of ovarian reserve.
Not necessarily. A standard semen analysis checks the basic metrics: sperm count, motility (movement), and morphology (shape). However, it does not look inside the sperm’s genetic material. Many couples diagnosed with “unexplained infertility” actually have high Sperm DNA Fragmentation (DFI)—meaning the sperm looks perfectly healthy under a regular microscope, but carries microscopic DNA damage that prevents successful fertilization or causes early miscarriage. If you have normal routine reports but are still facing unexplained delays or recurrent IVF failures, Dr. Pranay Shah recommends advanced testing like Sperm DNA Fragmentation (DFI) to uncover these hidden factors.
In most cases, yes. The majority of infertility causes are identifiable and treatable, often with simpler measures than couples expect — ovulation medication, a minor corrective surgery, or IUI — with IVF reserved for cases that genuinely need it. Even “unexplained” infertility is frequently treatable. The first step is always an accurate diagnosis; once the cause is known, an effective treatment plan can almost always be made.
Lifestyle factors can contribute to, but are rarely the sole cause of, infertility. Smoking, significant excess or very low body weight, excessive alcohol, and certain occupational exposures can reduce fertility in both partners, and these are worth addressing. Stress, while it does not by itself usually cause infertility, is a very real part of the experience and deserves support. A proper evaluation distinguishes a genuine medical cause from contributing factors — which is why self-diagnosing from internet searches is rarely accurate.
