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Small or firm testicles that feel "tight" may be another sign of hormone issues. On Regenerating the Ovary and Generating Controversy. (PDF, 37 KB) Cell, 2005. According to the literature survey, the most common causes of infertility are: male factor [5,7-9,13-15] such as sperm abnormalities [9,13,15], female factor [7-9,14-16] such as ovulation dysfunction [7,8] and tubal pathology [7-9], combined male and female factors [7,9,14,15] and unexplained infertility; where no obvious cause could be detected [7-9].

Algorithm for infertility evaluation. (ART = assisted reproductive technology.) Lifestyle Factors Jump to section + All couples should be counseled to abstain from tobacco use, limit alcohol consumption, and aim for a body mass index less than 30 kg per m2 to improve their chances of natural conception or using assisted reproductive technology. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. Other tests include: ovarian reserve testing, to find out how effective the eggs are after ovulation genetic testing, to see if a genetic abnormality is interfering with fertility pelvic ultrasound, to produce an image of the uterus, fallopian tubes, and ovaries Chlamydia test, which may indicate the need for antibiotic treatment thyroid function test, as this may affect the hormonal balance Complications Some complications can result from infertility and its treatment.

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The pathophysiology of the disease is not well understood, but a massive extravascular accumulation of fluid occurs that is associated with a severe depletion of the intravascular volume responsible for dehydration, hemoconcentration, and electrolyte imbalance (ie, hyponatremia, hyperkalemia). [193] Ovarian hyperstimulation syndrome can be mild, moderate, or severe. [194] Mild ovarian hyperstimulation syndrome is characterized by ovarian enlargement (up to 5-12 cm in diameter), minimal ascites, and weight gain of less than 10 lb. Negative tests with immotile sperm in the cervical mucus suggest rare immunological causes of sterility. As new technology becomes available, fertility treatment is now accessible to more people, and success rates and safety are improving all the time. Surprisingly, the complete absence of sperm in the semen (a condition known as azoospermia), can be a good thing.

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Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body. This applies to the ability to conceive with her eggs, but not with donor eggs. Obesity can increase the risk for other conditions that may impact a man's fertility such as sperm quality and sexual dysfunction. If the egg does not travel, it can be harder to conceive naturally. The reduced release of gonadotropin is often triggered by stress, physical strain such as high-performance sports, and anorexia nervosa.

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Microscopic Vasoepididymostomy: Specific Microanastomosis to the Epididymal Tubule. (PDF, 15 MB) Fertility and Sterility, 1978. Grading is as follows: Grade 0 – No movement Grade 1 – Sluggish movement Grade 2 – Slow movement in a poorly defined direction Grade 3 – Slow or curved forward movement Grade 4 – Fast movement straight forward  Patients with abnormal sperm motility should be evaluated for the following: Pyospermia Antisperm antibodies Varicocele Sperm ultrastructural abnormalities Partial ductal obstruction Sperm morphology The head, acrosome, mid piece, and tail of individual spermatozoa are analyzed with phase-contrast microscopy after fixation with Papanicolaou stain. Luttjeboer F, Harada T, Hughes E, Johnson N, Lilford R, Mol BW. A couple should see a healthcare provider if they have not been able to become pregnant after 12 months of having sex regularly without birth control. Microscopic Technique for Reversal of Vasectomy. (PDF, 3 MB) Surgery, gynecology & obstetrics, 1976. When anatomic variance or obstruction is suspected, referral for surgical evaluation and treatment is appropriate. Then, generally one or two embryos, which have demonstrated appropriate development, are carefully and gently transferred into the uterine cavity. For the past 20 years, hMG and its derivatives have been the first choice for controlled ovarian hyperstimulation in assisted reproductive technologies. Another requirement for male fertility is a normal ductal system. If you’ve been diagnosed with infertility, or fear you may have trouble conceiving in the future, you’re not alone.