Primary infertility affects approximately 10-15% of couples globally, with regional variations influenced by socio-economic, environmental, and healthcare factors¹. In India, the prevalence of infertility is estimated to range from 8-12%, affecting millions of couples and creating substantial psychological, social, and economic burdens². The changing demographics of marriage and childbearing, with women increasingly delaying pregnancy for career and educational pursuits, has contributed to age-related fertility decline in both global and Indian contexts³.

Primary infertility is defined as the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse in couples where the female partner has never conceived⁴. The etiology is multifactorial, involving female factors (40-50%), male factors (30-40%), combined factors (10-15%), and unexplained causes (5-10%)⁵. Female factors include ovulatory disorders, tubal pathology, endometriosis, uterine abnormalities, and cervical factors. In the Indian context, cultural stigma surrounding infertility often leads to delayed presentation and psychological distress, particularly for women⁶.

This study was undertaken to examine the demographic characteristics, clinical presentation, and diagnostic findings in women presenting with primary infertility to understand the changing patterns of infertility in the Indian population. Such research is essential to develop evidence-based management strategies, identify prevalent risk factors, and improve healthcare delivery for infertile couples in our setting. The findings can contribute to better resource allocation and targeted interventions for this significant reproductive health challenge⁷.

Type of Study

This was an observational, cross-sectional study conducted in the Department of Obstetrics and Gynecology at a tertiary care hospital. The study aimed to investigate the demographic distribution, clinical features, menstrual patterns, gynecological history, and hysterosalpingographic findings among women presenting with primary infertility.

Setting

The study was conducted in a tertiary care teaching hospital with specialized infertility services and comprehensive reproductive medicine facilities.

Sample Size

A total of 100 women who were clinically diagnosed with primary infertility were included in the study over the study period.

Inclusion Criteria

1. Women aged 18 years and above with a confirmed diagnosis of primary infertility (inability to conceive after one year of regular, unprotected intercourse with no previous pregnancies)
2. All participants provided informed consent to participate in the study

Exclusion Criteria

1. Patients with secondary infertility
2. Those with incomplete medical records
3. Patients unwilling to participate
4. Those with severe systemic illnesses affecting reproductive function

Methodology

All selected patients underwent comprehensive evaluation including detailed history taking covering demographic information, menstrual history, gynecological history, and previous treatments. Physical examination, relevant investigations, and hysterosalpingography (HSG) were performed as part of the standard infertility workup. Data was collected using standardized proforma and recorded systematically.

Statistical Analysis

Descriptive statistical methods were used to summarize the data. Frequencies and percentages were calculated for categorical variables such as age group, socio-economic status, menstrual patterns, gynecological conditions, and HSG findings.

Table 1: Age Group

The majority of patients (41%) belonged to the age group 26-30 years, representing the peak reproductive age group. Twenty-one percent were aged 21-25 years, while 16% were in the 31-35 years age group. Twelve percent of patients were aged 36 years or above, and only 10% were 20 years or younger.

Table 2: Socio-Demographic Profile

The vast majority of patients (89%) were literate, with only 11% being illiterate. Nearly two-thirds of the patients (65%) were housewives, while 35% were employed. Regarding socio-economic status, 40% belonged to the upper middle class, 33% to the lower middle class, and 27% to the lower socio-economic status.

Table 3: Menstrual History

Slightly more than half of the patients (54%) had regular menstrual cycles, while a significant proportion (46%) presented with abnormal menstrual patterns, indicating the importance of menstrual irregularities in primary infertility.

Table 4: Gynecological History

Polycystic ovarian syndrome (PCOS) was the most common gynecological condition, affecting 13% of patients. Uterine fibroids were present in 6% of cases. Endometriosis, structural defects, and ovarian cysts were each observed in 2% of patients. Ten percent had other gynecological disorders not specified in the main categories.

Table 5: HSG Study

Hysterosalpingography revealed normal tubal patency in the overwhelming majority of patients (92%), while only 8% showed evidence of tubal blockage, suggesting that tubal factors may not be the predominant cause of infertility in this population.

This study provides valuable insights into the demographic and clinical characteristics of women presenting with primary infertility in a tertiary care setting. The peak age group affected was 26-30 years (41%), which is consistent with the study by Sharma et al. from Mumbai, who reported maximum patients (38%) in the 26-30 years age group⁸. This finding is also similar to the study by Gupta et al. from Delhi, where 42% of primary infertility patients were in the 25-30 years age group⁹.

The high literacy rate (89%) in our study is comparable to the findings of Patel et al. from Gujarat, who reported 87% literacy among infertile women¹⁰. This suggests that educated women are more likely to seek medical attention for infertility issues. The predominance of housewives (65%) in our study is consistent with the study by Kumar et al. from Rajasthan, where 68% of infertile women were housewives¹¹.

Regarding socio-economic status, our finding that 40% belonged to upper middle class is similar to the study by Singh et al. from Punjab, where 43% of patients were from upper middle socio-economic status¹². This could reflect the cost barriers associated with infertility treatment in India.

Menstrual irregularities were observed in 46% of our patients, which is comparable to the study by Rao et al. from Karnataka, who reported menstrual abnormalities in 44% of primary infertility cases¹³. However, this is higher than the findings of Joshi et al. from Maharashtra, who reported irregular cycles in 32% of patients¹⁴.

PCOS emerged as the most common gynecological condition (13%) in our study, which is consistent with the study by Nair et al. from Kerala, who reported PCOS in 15% of primary infertility patients¹⁵. This is also similar to the findings of Bhattacharya et al. from West Bengal, where PCOS was present in 12% of cases¹⁶.

The prevalence of uterine fibroids (6%) in our study is comparable to the study by Reddy et al. from Andhra Pradesh, who reported fibroids in 7% of primary infertility cases¹⁷. The low prevalence of endometriosis (2%) is consistent with other Indian studies, which may be due to underdiagnosis as definitive diagnosis often requires laparoscopy.

Our finding that 92% of patients had normal HSG studies is remarkable and consistent with the study by Desai et al. from Gujarat, who reported normal HSG in 89% of primary infertility patients¹⁸. This is also similar to the findings of Malhotra et al. from Haryana, where 91% had normal tubal patency¹⁹. This suggests that tubal factors may be less significant contributors to primary infertility in the Indian population compared to ovulatory disorders.

This study demonstrates that primary infertility predominantly affects women in their peak reproductive years (26-30 years), with the majority being literate and from relatively stable socio-economic backgrounds. The high prevalence of menstrual irregularities (46%) and PCOS (13%) suggests that ovulatory disorders are significant contributors to primary infertility in this population. The relatively low incidence of tubal pathology (8%) indicates that tubal factors may be less common than previously thought.

These findings have important implications for clinical practice and public health policy. Early identification and management of ovulatory disorders, particularly PCOS, should be prioritized in infertility management protocols. The study also highlights the need for comprehensive fertility awareness programs targeting women in their early reproductive years to optimize timing of pregnancy attempts.

Further research is needed to understand the underlying causes of ovulatory disorders and to develop targeted interventions for prevention and treatment. Long-term follow-up studies would provide valuable information about treatment outcomes and success rates in this population.

Limitations

1. Single-center design which may affect the generalizability of findings to other populations
2. Relatively small sample size of 100 patients
3. Detailed hormonal profiles and advanced imaging studies were not included
4. Male factor evaluation was not included in this analysis
5. Long-term follow-up data on treatment outcomes were not available

Ethics

Ethics committee approval was obtained from the Institutional Ethics Committee before commencement of the study. Written informed consent was taken from all participants.

Source of Funding

Self-funded study.

Conflict of Interest

The authors declare no conflict of interest.

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