It is no secret that a newlywed couple hopes for a healthy infant. After the marriage about 90% of couples conceive. There are also miscarriages. The balance 10% is sub fertile. Therefore you should not be worried about subfertility until one year after marriage if you are less than 35 years of age.

Miscarriages are not always due to some diseases. In some couples, there is no cause for this.  

What are the causes for subfertility?  
To conceive, germ cells (Ovum and Sperm) from both partners should fertilize. Any cause that prevents fertilization could be a cause of subfertility.  

1. Not having ovulation or infrequent ovulation. (Infrequent menstruation is a feature in those patients.  

2. Defects of Sperms (Reduced number, activity or abnormal - shaped sperms)   
3. Blockage of fallopian tubes (these are common after sexually transmitting diseases or pelvic infections)  

4. Endometriosis (endometrial cells are usually situated within the uterine inner layer. But in some cases these cells are found outside the uterus and these cells grow and bleed with each menstruation causing problems.  

5. Defects of cervix of uterus (Infections or endometriosis of cervix may destroy sperms at cervical level preventing conception)   
6. Defects in intercourse (partial impotence, premature ejaculation)  

What are the tests in subfertility?  
Seminal fluid analysis (SFA) is the first test to be done. If it is normal, the female partner should be investigated. Ovulation is tested with blood test.   

If there are other conditions (thyroid diseases, polycystic ovarian diseases) hormones should be tested. Alternatively ,we can scan ovaries to confirm poly cystic ovarian disease. 

If there is a history of pelvic infections or miscarriages, fallopian tubes should be tested for patency as a first line investigation. This is done by an X-ray test (HSG) or by laparoscopy and dye test which needs hospitalization.  

What are the treatments?  
If the cause is anovulation (not forming egg cells) we have to induce egg formation with medicines ( Clomiphene Citrate, Letrozole)   

If the cause is sperm defects, we have to correct that with medication. And if is in tubes, corrective surgery is the treatment.