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Efficacy of laparoscopy is inferior to open surgery in certain conditions such as pyloromyotomy for Infantile hypertrophic pyloric stenosis. Although the sperm count may be slightly decreased by an intercourse frequency of once per day or once every other day, the motility and number of sperm in the healthy male would be sufficient to achieve pregnancy.

Povey AC, Clyma JA, McNamee R, et al.; Participating Centres of Chaps-UK. However, early referral of infertile couples to a dedicated specialist infertility clinic may be indicated to increase their chance of pregnancy (Table ). Abnormalities of sperm may be treated with gonadotropin therapy, intrauterine insemination, or in vitro fertilization. Aetiology of Congenital Absence of Vas Deferens: Genetic Study of Three Generations. (PDF, 4 MB) Human Reproduction, 1993. Combined infertility[edit] In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions. Environmental vs Genetic Sex Determination: A Possible Factor in Dinosaur Extinction? (PDF, 307 KB) Fertility and Sterility, 2004.

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Surprisingly, the complete absence of sperm in the semen (a condition known as azoospermia), can be a good thing. However, its value has been questioned because some studies have found no correlation between the presence or absence of viable sperm in the mucus and subsequent fertility. Legal, cultural and religious inquiries have limited the available choices in some countries, such as the use of donor sperms or oocytes.

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Hypothyroidism has no effect on male libido or semen quality. Further investigations 18. Laparoscopy: - Invasive procedure. - to check for pelvic disease; such as endometriosis and to check tubal patency. - therapeutic as in laparoscpic myomectomy and ovarian drilling. Hysteroscopy: - to evaluate uterine cavity. - In case of repeated failed IVF cycles. - therapeutic as in intrauterine septum. Evaluation of cervical mucus is unreliable; therefore, investigation is not helpful with the management of infertility.

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To prevent thromboembolism, a sufficient intake of fluids is necessary; also, ascites and pleural effusions should not lead to the wrong track and lead to a restriction of fluids. Poor egg quality: Eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. The embryos are placed within the tip of the transfer catheter and then injected within the uterine cavity once the catheter is placed through the cervical canal to the ideal spot within the uterus. Abdominal myomectomy is a surgical procedure performed through a very low horizontal abdominal incision allowing access to the uterus for removal of fibroids. 8 Patients should be counseled that 50% of couples who have not conceived in the first year of trying will conceive in the second year. Hormonal Problems A small percentage of male infertility is caused by hormonal problems.  The hypothalamus-pituitary endocrine system regulates the chain of hormonal events that enables testes to produce and effectively disseminate sperm.  Several things can go wrong with the hypothalamus-pituitary endocrine system: · The brain can fail to release gonadotrophic-releasing hormone (GnRH) properly.  GnRH stimulates   the hormonal pathway that causes testosterone synthesis and sperm production.  A disruption in   GnRH release leads to a lack of testosterone and a cessation in sperm production. · The pituitary can fail to produce enough lutenizing hormone (LH) and follicle stimulating hormone   (FSH) to stimulate the testes and testosterone/sperm production.  LH and FSH are intermediates   in the hormonal pathway responsible for testosterone and sperm production. · The testes� Leydig cells may not produce testosterone in response to LH stimulation. · A male may produce other hormones and chemical compounds which interfere with the   sex-hormone balance. Clean, Intermittent Self-catheterization in the Treatment of Urinary Tract Disease. (PDF, 2 MB) The Journal of Urology, 1972. The drugs are indicated for diseases like corpus luteum insufficiency, anovulational cycles, and normogonadotropic amenorrhea. Practice Committee of the American Society for Reproductive Medicine.