Infertility is the inability to beget a child after one year of unprotected sexual intercourse. Either or both partners may be responsible. 1 in 10 couples face this problem.

The basics of the natural process of conception deserve a mention. In a normal menstrual cycle around the 14th day, usually one egg (ovum) is produced from one of the two ovaries. This is termed ovulation. The egg is sucked into the fallopian tube. The man produces millions of highly motile sperms in his testes. These are deposited in the vagina during intercourse, the timing of which is important. The sperms travel upwards through the uterus to the fallopian tube. Only one among them succeeds in uniting with the ovum i.e. fertilization. The fertilized ovum then travels down the fallopian tube to reach the uterus roughly 5 - 7 days later. It gets implanted in the uterus. The embryo then develops and grows for 37 - 40 weeks, to a term fetus.

From the above it is not difficult to comprehend procreation as an orchestrated sequence of events where each organ plays a pivotal role. It is provided with some fine-tuning from other organ systems in the body (endocrine - pituitary, thyroid, and the nervous system). Hence to arrive at the cause of infertility, the couple needs to go through a meticulous evaluation. It is of essence to the doctor to start from the basics of acquiring information, proceed through a detailed systemic examination and investigations, culminating in treatment.

Two factors hinder the pursuit to fertility in a couple considered infertile. One is the fact that couples seek specialist guidance and treatment after they have been through an armory of remedies, medical and mystical. When equated in terms of menstrual/ovulatory cycles lost, it is a lot! Timely referral to a specialist and a commitment to subsequent visits would certainly go a long way in achieving the desired result. This is also less taxing on the patient in more ways than one. Secondly, fertility regulation is not a one-time command. The couple needs to be aware of the fact that infertility treatment can be a long-drawn process or a short one, depending on the cause. Finally it should be emphasized that no other area of medicine demands such a close and sometimes lengthy cooperation between the doctor and the patient, in order to achieve success. The family/society should also contribute to the latter by supporting the couple in their decisions.

Fetal medicine

The center stage in the play of procreation is currently occupied by a 5mm entity - the fetus. Its call for attention to develop and grow into a normal being is finally being heeded to in the area of fetal medicine.

The last three decades has witnessed the growth of fetal medicine from a controversial experimental procedure to a routine component of obstetric care. The fetal framework in terms of physical structure, bodily functions and behavior, inherited components (from the parents) i.e. the genes, as well as its abode - the amniotic fluid, have all been made accessible to observation, assessment and treatment, and revolve within the sphere of fetal medicine.

Precision in the diagnosis of fetal abnormalities at the gross and subtle level is as a result of the advances in cytogenetics, molecular biology and ultrasonography. In other words, the fetus can be seen on an ultrasound scan, its cells obtained from the amniotic fluid or the fetal blood/skin can be studied at the cellular and molecular level. This is what is commonly referred to as prenatal diagnosis. Fetal therapy logically follows, and thanks to the concerted efforts of research teams worldwide, it has successfully made an inroad into the field of obstetric care.

The rationale for providing fetal therapy is as follows:

It is obvious that fetal medicine involves a multi-disciplinary approach with a sonologist, a geneticist, a specialized obstetrician and a perinatologist working in tandem. Fetal medicine should be practiced only in committed centers with the requisite infrastructure. It is pertinent to point out that all the resources of diagnosis and therapy are intended for that case in point where something is amiss. Its very presence does not call for its indiscriminate use.