Way forward

Infertility or subfertility across all borders and societies is perceived as an emotional grief that impends individual, familial, marital, financial, and social strength of subfertile couples affecting their partnership. In developing countries, the rate of infertility and childlessness is quite high and is frequently considered a misfortune and a curse for the subfertile couple, which affects their personal lives as well the entire family. Where poor hygienic conditions precipitate chronic health issues, little is known about fertility, and the occurrence of misconceptions and myths aggravates the problem further. The impact of lifestyle behaviors, such as smoking, alcohol intake, food habits, physical activity, and environmental influences, impairs the key players of fertility (sperms and eggs). Health-seeking behavior includes alternative medicine and faith healers that may even worsen the case. Fertility awareness thus assumes a primary role to empower the couple to deal with the perspective on life, their own feelings, and relationship with others. Support comes from different sources such as family, friends, healthcare providers, and lastly, infertility specialists and minimize stress and strengthen their partnership. To improve the process of natural fertility as well as to augment the success of treatments, it is important to promptly ascertain the cause of infertility and its effect on the emotional and mental health of the couple. It is therefore important that healthcare professionals at the primary-care level review each subfertile couple as an individual “CASE, " where a detailed history, screening, and baseline investigations of both partners are offered and emotional stress is managed through counseling and fertility awareness sessions. Once the couple is diagnosed to be infertile, prompt referral to infertility clinics for active management is indicated. The decision to use advanced reproductive techniques (ARTs) should be based on female age, ovarian reserve, sperm count, and more importantly willingness of the couple. Treatment may be medical or surgical intervention depending on the cause of subfertility, but a meaningful outcome will depend not only on the interventions but also on lifestyle modifications, emotional and mental well-being, support from family, and counseling from counselors.