Infertility

Symptoms: Irregular or no periods, changes in sexual drive, milky white discharge from the nipple, abnormal hair growth in chin, lips, and chest
Causes: Smoking, being overweight or underweight, polycystic ovary syndrome, low sperm count in men
Risk Factors: Women above the age of 35, hormonal imbalance, severe stress, eating disorders, substance abuse 
Severity: Primary and secondary infertility
Which doctor to consult: Obstetrician-Gynecologist, Endocrinologist

Overview:

The condition of not being able to get pregnant or conceive even after having unprotected sexual intercourse for a year or longer is called infertility. 
Infertility is not only a women's problem. Both male and female partners can have infertility. In fact, in most cases, infertility is caused by a combination of men's and women's issues.
The risk of infertility increases with age. Women over 40 or 45 may experience infertility while trying to conceive. However, it is also common among individuals of all reproductive ages.
Infertility does not mean miscarriage or unable to carry a baby for the pregnancy term.
There are different reasons for infertility. Various health conditions may make it difficult for a woman to get pregnant. Pregnancy is not the result of a single step. A woman's body releases eggs that come in contact with the sperm to fertilize. Infertility may result from a problem in any of the steps in the entire process.
The most common symptom of infertility is not being able to get pregnant. The other symptoms that individuals often experience result from different health issues, which make it difficult to get pregnant. Polycystic Ovary Syndrome (PCOS) is a common health problem that causes difficulty among women in getting pregnant.
Infertility can be of two types:
Primary Infertility: This refers to individuals who have not been able to get pregnant after a year of trying. 
Secondary Infertility: This is when individuals have given birth once but are now facing problems getting pregnant.

When to Consult a Doctor?

Individuals who are trying to conceive but are not able to do so can consult a doctor. Women are born with a fixed egg reserve, which reduces drastically after age 35. A fertility specialist can check the egg reserve and guide the individual accordingly.
Women over 35 years of age should see a doctor if they have been trying to get pregnant but do not see any results after six months.
Regardless of gender, an individual should visit a doctor if he/she experiences symptoms of infertility or has underlying health issues.
The common signs of infertility in women include:
Changes in the menstrual cycle; painful periods, no periods or abnormal periods
Back pain or pelvic pain, or painful cramps during period
Changes in physical appearance; dark hair growth on chest, chin and lips, acne on face
Sudden weight gain
Changes in sex drive
Painful sex
Milky white discharge from nipples
Men should not ignore the following symptoms of infertility:
Changes in sex drive
Changes in hair growth
Pain or swelling in the testicle
Difficulty in erections and ejaculation
Small, firm testicles

Diagnosis:

The doctor does not recommend fertility tests right away. Initially, the doctor will understand the couple's sexual habits and health conditions and discuss methods to help them conceive.
After several months, if tested methods do not yield positive results, the doctor may start a diagnosis. The doctor will perform a physical examination which includes a basic gynaecological exam. A pap smear test is often conducted to identify problems. After this, the doctor will suggest different fertility tests.
Different tests conducted at this stage to identify the problem include:

Lab Tests:

Blood Tests: Blood tests are conducted to analyze components in blood and hormone levels. This can reveal other associated problems that may prevent the couple from getting pregnant.

Imaging Tests:

Hysterosalpingogram (HSG): An X-ray procedure detects blockage in the fallopian tubes and checks if the uterine cavity is normal. Individuals may experience mild discomfort during this procedure when the dye is injected into the uterus.
Transvaginal Ultrasound: It is a pelvic ultrasound that is used to check the condition of the uterus, ovaries, tubes, cervix and pelvic area. It can reveal uterine or ovarian diseases. 
Sonohysterogram: This is another procedure to look inside the uterus. It often reveals more details than a transvaginal ultrasound. It is also known as a saline infusion sonogram.
Tests are conducted on males as well to diagnose male fertility problems. The tests include:
Blood Tests: Blood tests are conducted to check abnormalities related to hormones and other components of blood.
Semen Analysis: This is also known as the sperm count test, one of the primary tests to identify male fertility issues. It can identify the characteristics of sperm.
Scrotal Ultrasound: A scrotal ultrasound can show problems in the testicles, epididymis, and scrotum.

Treatment:

Infertility treatment depends on health conditions, age, and how long the individual has been infertile. Most individuals require at least two or three types of treatment to become pregnant successfully.
Home Care: Women trying to conceive can follow simple steps at home to help them with fertility. 
Diet and Supplements: A diet rich in healthy fats and greens should be ideal for women trying to conceive. Iron deficiency is common in women, so an iron-rich diet is recommended. Including of leafy green vegetables, flax seeds, nuts, sesame and legumes in daily diet becomes a must.
Get Enough Rest: Rest is vital for men and women because stress can affect sexual drive, influencing the chances of getting pregnant. 
Medication: Medication is the primary treatment for individuals experiencing infertility. Fertility drugs are administered to influence hormone levels and induce ovulation. There are different options for fertility drugs available for patients. The most common include clomiphene citrate, metformin and gonadotropin.
Medication can increase testosterone levels and treat erectile dysfunction and other related fertility problems for men.
Surgical Treatment: Sometimes, surgery is needed to correct structural issues. For instance, surgery can remove uterine fibroids, treat endometriosis, or remove the blockage of fallopian tubes.
Laparoscopic surgery is also common for pelvic adhesions and removing large fibroids.
Assisted Conception: There are several options for conceiving if a women fail to get pregnant through natural sexual intercourse. Some of these options include:
Intrauterine Insemination (IUI): This is an artificial insemination process where a healthy sperm is inserted into the womb through the cervix. A long, thin tube is used to insert the sperm into the uterus.
In Vitro Fertilisation (IVF): This is an intensive process that helps with childbirth. The process involves different steps which go on for several weeks. Matured eggs are collected in this process, fertilized in the lab, and then transferred to the uterus.
 

Alternative Management:

Alternative treatment options are not popular for infertility because hormone levels play the most critical factor in getting pregnant. But yoga, meditation, or a light workout can help individuals.
Yoga or meditation can help with work-related anxiety or life stress. This can balance all health factors which can help to get pregnant.

Risks & Complications if Left Untreated

Infertile individuals can adopt other measures to conceive. While they experience complications during natural conceiving, there is no risk associated if they do not treat their condition.
However, there are exceptions. If underlying health issues like PCOS, hypo or hyperthyroidism prevent individuals from getting pregnant, severe complications may arise if left untreated. 

Additional Information

Risk Factors for Infertility
Women experiencing the following issues are at risk of infertility:
Women of age 35 or older and have been trying to conceive for six months or longer
Women with irregular or absent periods
Women with painful periods
Women diagnosed with endometriosis or pelvic inflammatory disease
Women with multiple miscarriages
Women who underwent treatment for cancer
Men can experience infertility if they have the following:
Low sperm count
A family history of prostate or sexual problems
Undergone treatment for cancer
Swelling or other noticeable changes in the scrotum
A family history of infertility problems

Cause of Infertility

There are different causes of infertility in couples. Some of the common causes include:
Uterine or Cervical Abnormalities: Abnormalities like uterine fibroids or leiomyomas, or myomas are non-cancerous growth that appears in the uterus. This prevents the women from getting pregnant.
Endometriosis: This is a condition where cells similar to the lining of the uterus, called the endometrium, start growing outside the uterus.
Sexually Transmitted Disease: Sexually transmitted infection (STI) causes upper female genital tract infection, creating severe pregnancy issues.
The causes of infertility in men include the following:
Abnormal Sperm Production: Certain health conditions like disease or infections, can cause problems in sperm production. Premature ejaculation is also responsible for infertility.
Cancer, particularly reproductive cancer, is another problem affecting fertility in women and men. Treatments related to cancer like radiation therapy or chemotherapy also affect the process.