Infertility leads to considerable personal suffering and disruption of family life. According to United Nations “Reproductive health is a state of complete physical, mental and social wellbeing and not merely absence of the disease or infirmity in all matters related to the reproductive system and its functions and processes”3. The most comprehensive study of infertility 1, “A WHO study of 5,800 infertile couples seeking help at 33 medical centers in 22 developed and developing countries-found that female causes accounted for between 25 to 37% of infertility worldwide (with larger proportions in sub-Saharan Africa and Southeast Asia), male causes accounted for between 8 to 22%, and both male and female causes accounted for between 21 to 38%.” The 1981 Census data were analyzed to show the pattern of childlessness among ever-married women in India. Around 18.5 percent of the ever-married women in India were reported to be childless. Large percentage of childless women were concentrated in the younger age groups, but the percentage drops rapidly and stabilizes at a lower level above age 35. Present study aims to evaluate the prevalence of male and female infertility in different age groups.

The present study was conducted on 200 couples in Index Medical College and Research Centre and Manipal Ankur Center for infertility CHL hospital Indore. Subjects with the complaint of primary infertility in the child bearing age span had provided the necessary clinical material for this study. In the present study inclusion criteria was, age more than 20 years and less the 50 years, married and living together for more than 1 year and nulliparous women. The patient with  pre-existing cardiovascular, respiratory illness, generalized peritonitis, intestinal ileus or obstruction, abdominal hernia and malignancy were excluded. A detail history was taken and emphasis was given on the age, duration of marriage, menstrual history, drug history, history of contraceptives used and duration it was used for, smoking and alcohol consumption were noted. In the men, attention was paid to sexual and ejaculatory function, history of inguinal surgery, cryptorchidism, mumps, orchitis, testicular torsion, environmental or occupational factors and drug or medication intake. In the women, history of menstrual regularity, abdominal surgery, urinary tract infection, vaginal or nipple discharge, frequency of intercourse, dysparonia and drug or hormone intake, were determined. Past medical and surgical history was recorded, family history especially infertility among other siblings if present was recorded. This was followed by a thorough clinical examination, radiological, routine haematological and biochemical examination.

Table No. 1: Distribution of Males according to age

Table No. 2: Distribution of females according to age

Age alone impacts on fertility (Mosher1997). In the present study maximum number of infertile females (51.13%) belonged to the age group between 20 to 30 with mean age group 31.46 ± 4.99 years which is similar to the other studies. Buyalos, Daneshmand and Brzechiffa (1997) investigated the fertility of women of different ages and observed that a woman reaches her maximum fertility potential at the age of 24 yrs. Fertility potential begins to decline by the age of 30 yrs. In present study mean age of 31.19 ± 5.09 years accounts 54.84% of male cases of primary infertility. Pasqualotto FF, Borges JE, Pasqualotto EB7 in their studies have shown that blood testosterone level decline with age, and the risk of becoming infertile doubled in men who are over 35 years old compared with men who are under 25 years old, and five times longer to conceive at the age of 45.

COMPARISON ON THE BASIS OF AGE GROUP

Female age is the single most important determinant of spontaneous as well as treatment related conception. There is corresponding rise in mean age at which women present with infertility. The researcher’s reveals that, age at marriage > 25 years proved to be a significant risk factor for primary infertility which is comparable with the finding of the study done in Egypt in 20064 and according to National Family Health Survey-3.5 A new term on the ground of infertility is 'voluntary infertility' a typical urban Indian syndrome. Women are educated, independent, career-minded, and defer marriage or childbearing till they can afford all the good things in life. Ninety percent of a woman’s eggs degrade at the end of her 37 th year, by the time she decides to have a baby, her ‘biological clock’ often slows down. She then requires the help of an ART (assisted reproductive technique) specialist to conceive. Deoki Nandan, the director of National Institute of Health and Family Welfare (NIFHW), puts it succinctly: "Now people are not trying till their 30s and even 40s, and because a woman's age brings down fecundity, we are getting a higher incidence of couples struggling for parenthood.

A variety of explanations have been offered like increase in educational levels, employment, career and insecurity. According to a survey conducted by population council, New Delhi, among 50,848 married and unmarried young women and men, 51% of married young women wanted to delay the first pregnancy.9 Prevalence of primary infertility is predominant in female compared to males. The age group affected in both the gender is 20-30years.

1. Cates W, Farley TMM, Rowe PJ. Worldwide patterns of infertility: Is Africa Different? Lancet 1985; 596-598.
2. Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M. Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India. Fertil Steril 1997; 68: 637-643
3. RCOG, The initial investigation and management of the infertile couple , London : RCOG Press;1998
4. Mokhtar S, Hassan HA, Mahdy N, Elkhwsky F, Shehata G. Risk factors for primary and secondary female infertility in Alexandria: a hospital-based case-control study. JMRI 2006; 27: 255–261.
5. International Institute for Population Sciences and ORC Macro, Report of the National Family Health Survey (NFHS-III) 2006; Mumbai: IIPS.
6. Talib W, Ikram M, Maimoona H, Saeed M. Infertile female; laparoscopic evaluation. Professional Med J2007; 14:562-6.
7. Pasqualotto FF, Borges JE, Pasqualotto EB. The male biological clock is ticking: a review of the literature. Sao Paulo Med J. 2008 May 1; 126 (3): 197-201.
8. Rajashekar L, Krishna D, Patil M. Polycystic ovaries and infertility: Our experience, J Hum Reprodsci 2008;1:65-7
9. Shaw textbook of obstetrics and gynecology, 15th edition 2011