Subfertility : Everything you need to know


Most couples desire to have children. The inability to do so is an extremely distressing situation. Very rarely can a couple be labeled infertile. (i.e. incapable of having a pregnancy). About 1 in 7 couples however have difficulty in conceiving and therefore can be considered as subfertile. The aim of this article is to help you understand the causes of subfertility and the treatment options.

What is subfertility?

The difficulty of a couple to conceive a child after a minimum period of one year of unprotected (without using any form of contraception) regular sexual intercourse, (minimum 2 or 3 times per week) with due attention to the fertile period.

Causes for subfertility

Subfertility can be due to female factors in 30% of couples and also it’s observed that male factors have affected 40% of couples with subfertility.  Sometimes 30% – 40% can be due to other reasons without involving the factors of the partners. 40% – 60% of couples have affected due to both male and female factors.

Conditions of Male Genital Tract

Most male factors are unknown.
Reasons that are known to cause subfertility are given below.

  • Smoking
  • Stress
  • Varicocele (knotting of the veins of the genital tract)
  • Undescended testes by birth

Diseases of the female genital tract

Altered egg maturation in conditions like Poly Cystic Ovarian Syndrome (PCOS), inflammation of the fallopian tubes and endometriosis like conditions increase the risk for subfertility among women.

Problems related to coitus

Some women get pain during intercourse ( dyspareunia) and also muscle spasms (vaginismus). Impotence or erectile dysfunction hinders the ability of males to perform intercourse to release sperms to the female genital tract. Ultimately due to these problems, subfertility will arise among reproductive-age couples.

When to get pregnant?

The optimum age for pregnancy is between 25 – 30 years. Up to 35 years quality of eggs is satisfactory. It is advisable to complete the family (have the desired number of children) before 35 years of age.

pregnant, m, mom-2640994.jpg

To get pregnant easily

Maintain body weight within the normal range (weight according to height). Follow good habits such as avoiding smoking and not consuming other recreational drugs. Pay your attention to hygiene; especially of the genital
area. Also, manage your stress which might lead you to a healthier living. It’s important to have regular unprotected intercourse throughout the month (without contraception) at least 2 or 3 times per week, with attention to the fertile period. If you have abnormal persistent bleeding, discharges,
associated with soreness in both males and females should be reported.

Things to remember when planning for a pregnancy

  • The pregnancy should be wanted by both partners.
  • Make sure to take Rubella vaccination prior to getting pregnant/
  • Have regular unprotected sexual intercourse.
  • Awareness about the fertile period.
  • Control other diseases as much as possible eg: diabetes, hypertension etc.
  • If further clarification is needed talk to a health care professional (public health mid wife, nurse, doctor)
  • Starting Folic Acid 1mg daily prior to the pregnancy helps the normal formation of the unborn baby.

When to seek help?

  • At the time of the marriage- for general marital counselling after 6 months to 12 months- basic information and check-up.
  • Seek help at 12 months.
  • For a woman over 35 years of age — seek help after a period of 6 months
  • If risk factors for infertility are present, conception is delayed following a previous pregnancy, investigations should be done after 6 months of trying.

Management process of the couple

  • First, both you and your partner will be examined by the doctor for possible reasons affecting fertility.
  • Reason for childlessness will be analyzed and a basic set of investigations will be done which include,
Tests for Males
Tests for Females
Seminal Fluid Analysis(SFA) -tests your semen quality and quantity
Temperature chart - to check the ovulation (2-3 cycles)
Depending on SFA report Ultrasound Scan of the Genital tract/ hormonal tests, testosterone/FSH will be offered.
Ultra Sound Scan of the genital tract -To check whether you have mature ova (egg cells), abnormality in the uterus and fallopian tubes
To check the shape of the uterus and patency of the tubes- HSG
Laparoscopic dye test

Management options

  • Medicines to mature eggs and induce ovulation when indicated.
  • IUI- Intra Uterine Insemination
    The best quality sperms are obtained to be deposited in your womb
  • Assisted fertilization
    Eggs are taken out of the body and are fertilized with your partners/donor’s sperms by;
    1. IVF- natural fertilization of the eggs by added sperms.
    2. ICSI – One selected sperm is introduced into. one egg. The resulting embryo is replaced in the womb for the natural development of the baby. (Eggs and sperms may be obtained by donors as well).

Where and by whom can you get help?

  • Subfertility Clinics at Government Hospitals
  • Subfertility Clinic at the Family Health Bureau (FHB)
  • Centre for Family Health Clinic at FPA Sri Lanka
  • Specialists at Private Hospitals
  • Family Doctor
  • Government Subfertility Clinics

Yomal Amarathunge



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Sanath Nandana
Sanath Nandana
9 months ago

Very Useful