Balaji Horizon Women’s Hospital · Ahmedabad
Female Infertility — Causes, Diagnosis & Treatment in Ahmedabad
Female infertility affects approximately 1 in 6 couples globally. A structured, evidence-based evaluation — not guesswork — is the foundation of effective fertility care. Dr. Priyadatt Patel provides comprehensive investigation and individualized treatment planning.
Understanding Female Infertility
Infertility is defined as the inability to conceive after 12 months of regular unprotected intercourse (or 6 months for women over 35). Female factors account for approximately 35–40% of infertility cases, male factors for another 30–35%, and the remainder involve combined or unexplained causes.
Effective management begins with a complete, systematic evaluation — not empirical treatment. Identifying the underlying cause determines the optimal treatment pathway, the likely prognosis, and whether medical, surgical, or assisted reproductive technology (ART) approaches are appropriate.
A concurrent male factor evaluation is essential from the outset, as combined factors are common and influence treatment decisions significantly.
Common Causes of Female Infertility
Ovulatory Disorders
PCOS is the most common cause of anovulatory infertility. Other causes include hypothalamic dysfunction, hyperprolactinaemia, thyroid disorders, and premature ovarian insufficiency (POI).
Tubal Factor
Blocked or damaged fallopian tubes — most commonly from pelvic inflammatory disease (PID), prior ectopic pregnancy, or endometriosis — prevent sperm-egg interaction.
Endometriosis
Present in 30–50% of infertile women. Impairs fertilisation through peritoneal inflammation, ovarian damage from endometriomas, and adhesion-related tubal dysfunction.
Uterine Factors
Submucous fibroids, endometrial polyps, intrauterine adhesions (Asherman syndrome), and uterine septum can impair implantation and are correctable causes of infertility.
Diminished Ovarian Reserve
Low AMH and reduced antral follicle count (AFC) indicate diminished egg supply. Causes include age, prior ovarian surgery, endometriomas, and genetic factors (e.g. Fragile X premutation).
Unexplained Infertility
Standard investigations are normal in approximately 10–15% of infertile couples. This diagnosis requires full evaluation — including laparoscopy in selected cases — before acceptance.
Diagnostic Workup
A structured fertility evaluation includes:
Ovarian Reserve Assessment
AMH (anti-Müllerian hormone), antral follicle count (AFC) on Day 2/3 ultrasound, FSH, LH, and oestradiol. These determine the quantity of eggs remaining and guide protocol selection.
Ovulation Assessment
Mid-luteal progesterone, LH tracking, and serial ultrasound for folliculometry. Thyroid function, prolactin, and androgens assessed as indicated.
Tubal Patency
Hysterosalpingography (HSG) or HyCoSy (hysterosalpingo-contrast-sonography). Diagnostic laparoscopy and dye test in cases with clinical suspicion of endometriosis or prior PID.
Uterine Cavity Assessment
Saline infusion sonohysterography (SIS) or hysteroscopy to identify polyps, fibroids, septa, and adhesions. 3D ultrasound is valuable for uterine anomalies.
Partner Semen Analysis
WHO criteria-based semen analysis is mandatory early in evaluation. DNA fragmentation index (DFI) in selected cases of unexplained or recurrent failure.
Treatment Options
Ovulation Induction
Letrozole or clomiphene for anovulatory infertility (primarily PCOS). Monitored with ultrasound. Simple, effective, and first-line in appropriate cases.
IUI (Intrauterine Insemination)
Timed intrauterine insemination with processed sperm — appropriate for mild male factor, unexplained infertility with patent tubes, or cervical factor. Success rates are modest per cycle.
IVF / ICSI
The most effective intervention for tubal factor, endometriosis-related infertility, diminished ovarian reserve, and significant male factor. Offers the highest per-cycle success rates.
Operative Laparoscopy
Surgical correction of endometriosis, myomectomy for submucous fibroids, adhesiolysis, and tubal microsurgery in selected cases where surgical correction improves natural or ART conception chances.
Hysteroscopic Surgery
Polypectomy, myomectomy (submucous fibroids), adhesiolysis, and septal resection — all correctable intrauterine causes of implantation failure addressed with operative hysteroscopy.
Hormonal Optimisation
Thyroid normalisation, prolactin management, insulin sensitisation in PCOS, and androgen suppression as appropriate — often overlooked but impactful on fertility outcomes.
Your Specialist
Dr. Priyadatt D. Patel
Senior Gynecologist · IVF Specialist · Advanced Laparoscopic Surgeon · Endometriosis Expert
Balaji Horizon Women’s Hospital, Ahmedabad
Frequently Asked Questions
When should a fertility evaluation begin?
After 12 months of unprotected intercourse without conception (6 months for women over 35, or sooner if there is a known risk factor such as irregular cycles, endometriosis, or prior pelvic surgery). Both partners should be evaluated simultaneously.
Is PCOS the most common cause of infertility?
PCOS is the most common cause of anovulatory infertility. Many women with PCOS conceive with first-line ovulation induction. However, the diagnosis of PCOS does not automatically mean severe infertility — outcomes are generally good with appropriate management.
Can unexplained infertility be treated?
Yes. Empirical treatment (IUI, then IVF if needed) is effective in most cases. However, a thorough evaluation should be completed first — some “unexplained” cases harbour undetected endometriosis or subtle male factor that changes management.
Does age significantly affect female fertility?
Yes significantly. Fertility declines with age — accelerating after 35 — due to reduction in both egg quantity (ovarian reserve) and quality. AMH testing provides a measurable assessment of reserve. Age is the single strongest predictor of IVF success.
Begin Your Fertility Investigation Today
A structured evaluation is the first and most important step. Dr. Priyadatt Patel provides thorough, evidence-based fertility assessment with an individualized treatment plan — not a generic protocol.
Balaji Horizon Women’s Hospital · Science City Road, Ahmedabad 380060 · +91 9723431544