The likelihood of spontaneous conception is affected by the age of the female partner, previous pregnancy, duration of subfertility, frequency of sexual intercourse, timing of intercourse during the natural cycle, extremes of body mass index or weight, smoking and if there is any pathology present. The single most important factor in determining fertility is the age of the female partner, with fertility reducing rapidly in women over the age of 35 years of age.

In order for a normal pregnancy to occur, an egg must be produced from the female ovary, adequate sperm must be released from the male testes, the sperm must reach the egg, fertilisation must occur and the fertilised egg must implant in the womb. If there is a problem in any of these steps, subfertility occurs.

Problems contributing to subfertility can broadly be due to defective egg release(ovulation problems),including Polycystic Ovarian Syndrome, defective sperm(male problems), tubal problems(sperm cannot meet egg), unexplained, implantation problems, endometriosis, fibroids, cervical and coital problems. The proportion of each type of subfertility varies in different populations. In 40% of couples, a problem will be found in both partners.

If you and your partner are experiencing some difficulty, you may wish to have an infertility assessment to uncover the cause of the problem. The basic evaluation can be completed within a few menstrual cycles in most cases and includes:

• Medical history and physical examination
• Ultrasound and hysterosalpingography
• Semen analysis
• Ovulation assessment
• Laparoscopy may be used to diagnose and treat endometriosis, pelvic adhesions or ovarian cysts. The patency of the fallopian tubes can also be assessed.

Based on the results of these tests, treatments like ovulation induction, surgery to remove growths (polyps or fibroids) or adhesions, intra-uterine insemination (IUI) or in vitro fertilization (IVF Pregnancy) can be recommended.