The main cause of infertility today is most likely natural ageing. Couples are most fertile in their late teens and early 30s, and from there fertility rates fall with age. We notice that, in countries around the world, fertility rates fall when the average age of marriage rises.

Compare, for instance, the median age of first marriage of women and the corresponding total fertility rate (the number of children produced per woman): in 2010, the median age was 27.6 years and the total fertility rate 1.22, whereas in 1970 the median age was 23.1 years and the total fertility rate 3.07.

Putting aside the influence of population control programs of the past and the easy availability of contraceptives today, we find that getting married later means starting a family later: say in the late 20s. Unfortunately this is the time that problems such as endometriosis, fibroids and hormonal problems start to show up for women.

For men - who statistically tend to be two to three years older than their brides - recent studies show that sperm quality continuously decreases with age. Some possible causes for poor sperm quality include pollution, exposure to toxins (such as food additives) and substance abuse (such as smoking or excessive drinking of alcohol).

Thankfully, with recent advances in the technology, treatment is available for most fertility problems. The invention of smaller, higher-quality camera optics, for instance, has allowed doctors to make smaller entry wounds when performing keyhole surgery - from 12-10mm in the early 2000s to 5-3mm today - without loss in resolution, precision or efficiency.

The value of ultrasonography of the endometrium, and direct inspection of the cavity by hysteroscopy, has been recently realised and are now integral parts of investigation. Prior to this, we used to miss diagnosing problems in the uterine cavity and endometrium, areas where one of the most important steps of reproduction occurs: implantation. When detected, these problems were easily treated; another advance which has helped us push the success rate of IVF cycles to nearly 40 percent.

Laboratory techniques for IVF have also been constantly improving. Improvements in Intracytoplasmic Sperm Injection (ICSI) and vitrification techniques has enabled the fertilisation of a larger promotion of eggs and raised the survival rate of frozen embryos and eggs respectively. More accurate embryo transfers are now also possible due to advances in ultrasound guidance technology.

One must also not forget the advances that society has made on a cultural and sociological level. Only over this past decade has the message that age is detrimental to childbearing been assimilated by the public. More couples are stepping forward at an earlier age for help, and the Ministry of Health drove home the point by licensing centres to do IVF only for women up to the age of 45 years: the rationale being that hardly any women above the age of 44 were successful in achieving a full term pregnancy from IVF.