By Dr Abha Majumdar
Often, couples and doctors use the words subfertility and infertility interchangeably, but it is imperative to realise that both the terms are quite different. In fact, the prognosis and treatment for both these conditions also differ. This is an important aspect to consider when couples seek infertility counselling. The fertility counsellor analyses the health condition of the couple, their conception issues and investigate whether it is subfertility or infertility.
What does each term describe?
When the conception takes longer than the average, but the woman and the man can conceive a child, is best described as subfertility. In this condition, couples have reduced fertility or experience delay in fertility, but the possibility of conceiving naturally still exists, even though they may take longer time to conceive than what their expectations may be.
On the other hand, infertility deals with inability to conceive naturally. There are various types and causes of infertility in both men and women. In some cases of infertility, a woman may not produce eggs at all either due to hormonal imbalance or absence of eggs in the ovary. Similarly, infertility among men deals with either complete lack of sperm creation or the absence of the entire delivery system or route for sperms to pass into semen, even though sperm production is sufficient.
Factors that affect fertility negatively:
Various factors in women like hormonal problems affecting ovulation, or functional issues like obstruction in the fallopian tube or in the cavity of uterus which are severe enough and do not let pregnancy happen naturally, lead to infertility. Similarly, in men complete absence or severe deficiency of sperms in semen leads to infertility. However, if these problems are mild and only require more time or minimal assistance in the form of lifestyle modification and good sexual practices for a pregnancy to happen, then these are categorised as subfertility. For example, Polycystic Ovary Syndrome (PCOS) is quite common among women affecting ovulation and may cause irregular ovulation among women leading to subfertility. On the other hand, conditions like reduced ovarian reserve and premature menopause due to aging or pre-existing medical conditions can also affect fertility leading to infertility among women.
However, in most of the couples, the factors remain the same that lead to subfertility or infertility. It is the severity of the cause which defines the conditions. Subfertility and infertility affect both men and women and sometimes even both together.
How treatment differs
The treatment for both, subfertility and infertility, will depend on the cause found after examination and investigations, for the couple’s inability to conceive. The fertility evaluation will involve tests for both the man and woman.
After a thorough analysis, the fertility expert will advise treatment options for them, depending on the results of the analysis. The expert might suggest simple treatment options like lifestyle changes for example, reducing alcohol and caffeine consumption, maintaining healthy weight and adequate physical and sexual activity for most sub-fertile couples. On the other hand, one may need to resort to medical or surgical treatment or even advanced treatment options such as use of assisted reproduction techniques like IVF depending on the severity of the problem found.
Therefore, to summarise, some of the medical treatment options for men include surgery for opening the blockage in the sperm delivery system or medications for sufficient sperm production in the ejaculate. For women, some of the treatment options would include fertility enhancing drugs comprising ovulation inducing agents, surgery to restore tubal patency or In-Vitro Fertilisation (IVF).
It is important to speak to your doctor/fertility expert first for any queries and advice on difficulty in conceiving and fertility options possible and available.
(The writer is Director, Centre of Human Reproduction & IVF, Sir Gangaram Hospital)