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Background: Infertility affects up to one in seven couples and carries a heavy psychosocial burden, particularly in societies where childbearing is closely tied to social identity. Conventional evaluation focuses on ovulatory, tubal, uterine and male factors, and treatment ranges from ovulation induction to in vitro fertilisation, which remains costly and inaccessible for many couples. Ayurveda discusses female infertility under the term Vandhyatva and offers a structured account of the factors necessary for conception. Objective: To review the classical Ayurvedic understanding of Vandhyatva, its causes and classification, to correlate these with current biomedical categories of female infertility, and to summarise the published clinical evidence for Ayurvedic management strategies. Methods: Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya and Kashyapa Samhita were reviewed for concepts of conception and infertility. PubMed was searched up to October 2026 for reviews, guidelines, clinical trials, protocols and case reports on female infertility, Ayurveda, polycystic ovary syndrome, tubal blockage and Uttara basti. Each cited record was verified against PubMed and findings were synthesised narratively. Results: The classical requirement of four factors for conception, namely Ritu (fertile period), Kshetra (reproductive tract), Ambu (nourishment) and Beeja (ovum and sperm), provides a framework that maps closely onto ovulatory, uterine, tubal and male causes of infertility. Published evidence for Ayurvedic management consists mainly of small single-arm or open-label studies and case reports, covering anovulation and polycystic ovary syndrome, thin endometrium and tubal blockage, together with one registered randomised trial protocol comparing an Ayurvedic regimen with letrozole. Reported ovulation, tubal patency and conception rates are encouraging but are drawn from uncontrolled or small samples. Conclusion: The Ayurvedic model of Vandhyatva is coherent and clinically usable alongside modern infertility evaluation. Rigorous randomised trials with live birth as the primary outcome are needed before Ayurvedic regimens can be recommended as alternatives to established fertility treatments.