1. Quackery & Media coverage on infertility :

In India, there is absolutely no control on media like television with the result in the guise of alternate system of medicine all and sundry appear on television. They hire slots at enormous cost which in turn is passed on to the infertile couple coming for treatment.
These ‘Quacks’ promises attractive options for cure in every case of infertility male and female to impress the gullible public. Very often, by the time the couple had gone through wasting years on inappropriate infertility treatments and their funds exhausted they would find it difficult to afford for advanced ART, treatment with ICSI.

2. Extraneous stress on the couple :

Married couple face extrinsic pressure from their in-laws, relatives and well-wishers. This factor increases stress on the husband and wife and to some extent even for the treating physicians. It is not uncommon for mother-in-law or father-in-law to question the masculinity of the husband for Infertility in the couple.

3. Unconsummated marriage :

Many Indian couple even though married for years does not have sexual relationship. ‘Unconsummated marriages’ are so common in India. Only careful history taking and clinical examination would reveal such problems.

4. Sperm count and pregnancy :

Some men wonder why in spite of adequate sexual intercourse they could not father a child. Sexual adequacy and lack of sperms are two different issues. One may feel that he ejaculates semen in adequate quantity. However, they are shocked to find their Semen analysis reported as ‘no sperms’ (Azoospermia).
With the invention of ICSI there are very few cases of Male Infertility which are unable to be treated. Sperm count may vary between different occasions on the same individual. It is therefore necessary to repeat the count in all cases where there are ‘no sperms’ or ‘Low sperm count’. Very rarely pregnancies occur in counts less than one million with normal Morphology. Some times ‘Normal sperm count’ don’t fertilize the eggs well. The biochemical defect in the sperm is not always reflected when we see the sperms under the microscope.

5. Semen Analysis - ‘Pyospermia vs Immature Sperm Cells :

The sperm precursors mimic pus cells, since both of them are rounded in shape. They could be differentiated only by special staining techniques. Many laboratories unaware of this information report all the round cells in ejaculate as ‘pus cells’. Based on such false information the treating physicians prescribe unnecessary antibiotics.

6. Varicocele over-diagnosed & over treated even
by Urologists :

Varicocele – occurrence of plexus of veins in the scrotum of men, by itself is not justification for surgery. There is a misconception among treating physicians that ‘Subclinical Varicocele’ detected with Scrotal Doppler should all be treated. Hardly any urologist ignores the finding of Varicocele and majority of these man are advised surgical correction.
It has been observed in cases of men with ‘low count’ varicocele is attributed to be the cause and operated upon. Besides unnecessary surgery, secondary hydrocele and even testicular atrophy has been reported following varicocele surgery.

7. Medical treatment in male infertility :

The Couple with Male Infertility (OAT / AZOOSPERMIA) waste lot of money and time on Medical Management. It is well known that in cases of men with ‘no sperms’ or very few sperms natural conception is unlikely. Yet many general physicians and even some ‘Urologists’ treat such cases with all sort of drugs widely advertised by the pharma-companies. Ultimately to find out such treatment methods are useless.

8. Intrauterine Insemination (IUI) basic facts :

IUI has been abused in Infertility treatment. At Chennai, a metropolitan city in India, there is some laboratories who only prepare the sperm for IUI. The couple travel long distances to get IUI done by the treating Gynecologists who schedule IUI in between their busy consultations. This is a routine meant to be condemned.
How do you expect the sperms prepared for IUI to be alive and kicking all through the transport? If only the doctor prior to depositing the sperms into the uterus could look at the sperms under Microscope just before IUI, she would find most of them are already dead or non motile. Who is to be blamed for failed IUI? - The anxious couple, unscrupulous laboratories, or the ignorance of treating doctor !

9. Do not interpret Semen analysis without clincal
examination of male :

Semen analysis even though gives relevant information on Male fertility, there are men whose sperm parameters are normal. They may have erectile or ejaculatory dysfunction at coitus, deviated ejaculation due to Hypospadius or chronic balanoposthitis with unrecognized Phimosis requiring circumcision.

Many gynecologists interpret the male infertility based only on Semen Analysis report without any clinical examination of the male partner, Scrotal ultrasound is not a substitute for careful clinical examination.

10. Cost factor in ART :

Unlike some countries in the west, Infertility treatment is not covered by the Insurance companies in India with the result the Infertile couple find Assisted Reproduction Treatment(ART) expensive and unaffordable.

11. Age of Fertility :

In todays society age related Infertility is becoming more common. Approximately 20% of woman wait until the age of 30 or more, because of following reasons.

• Contraceptive practices
• More of working women.
• Late Marriages.
• Delay pregnancy for financial reasons

Fertility begins to decline by late 20’s and 30’s . Even healthy woman after 35 have age related decline in fertility.

• Genetic abnormalities are known to occur in children born to older women
• There is increased risk of miscarriage in older women
• In older women any form of Assisted Reproduction IUI – IVF affects chances of pregnancy
• Older women after 40 may require egg donation & so also for women with Premature Ovarian Failure (POF)

Do's and Dont's in infertility practice:

Do's	Don't
Regular exercise	Avoid smoking, alcohol consumption
Maintain optimal body weight / Body Mass Index	Avoid high calorie diet
Should get basic information regarding normal conception , fertile period, egg development, abnormal menstruation, pathological conditions and the risk factors for infertility etc.	Avoid taking drugs interfering with fertility (eg:Opioids,Anabolic sterioids ,Cimetidine, Ketoconozole )
You should know when should you consult a doctor for help for your fertility issues .	Avoid stress and opt for relaxation techniques when it is required .
Its your duty to get full information regarding your fertility issues from your treating doctor and always try to get all the treatment options available for you and chose the treatment according to your likes.	Do not hesitate to take fertility treatment when you have irregular menstrual periods, blocked tubes or decreased or absent sperm count
Look for scientific evidences when you go for that particular fertility treatment	Do not hesitate to come for fertility treatment when your duration of married life is longer than 1 year with regular attempts for conception and if the age of female partner is >35 years consult the infertility specialist after 6 months of failed attempts
Fertility treatments are not free of complications so it is your duty to get all the information regarding your treatment from your treating doctor	Do not take drugs like clomiphene citrate or Letrozole 12 cycles in your life time
	Do not hesitate for to ask your doctor regarding the relevant fertility issues involved in your case and also ask them to educate you regarding how to go about it
	Do not discontinue or skip follow up without doctor’s instruction while when you are under fertility treatment
	Do not follow unnecessary information and stop getting worried for unwanted matters.
	Do not hesitate to go for fertility treatment for unknown reasons when your medical condition demands it