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For a woman to conceive, certain things have to happen: vaginal intercourse must take place around the time when an egg is released from her ovary; the system that produces eggs has to be working at optimum levels; and her hormones must be balanced.[54] For women, problems with fertilisation arise mainly from either structural problems in the Fallopian tube or uterus or problems releasing eggs. Hypospadias: The urethral opening is under the penis, instead of its tip. Some causes are more common in some countries than others, such as pelvic inflammatory diseases (PID) and sexually transmitted infections (STI) in Africa [10]. Women who have a body weight 10% to 15% below normal may have reduced fertility. Tubal occlusion A tubal occlusion means there is a blockage in the fallopian tube. A bicornuate uterus is characterized by the presence of an indentation at the fundus.

Intrauterine insemination is performed during a natural cycle or after ovulation induction with CC or gonadotropins. Male and female factors can exist in isolation or combination and fertility investigations, diagnoses and treatment should always be considered in the context of the couple.       Male factor Sperm problems will contribute to about 40% of infertility cases.

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6 Accuracy may be improved by use on midday or evening urine specimens, which correlate better with the peak in serum luteinizing hormone levels. Sperm can survive inside the female for up to 5 days, while an egg can be fertilized for up to 1 day after ovulation. As new technology becomes available, fertility treatment is now accessible to more people, and success rates and safety are improving all the time. The ovaries can stop working in about 5% of cases. Hormone changes Signs of hormonal changes can be nonspecific, and a person may not notice them or know the underlying cause. Unexplained Even after a full fertility work-up, for one in five couples an exact cause of infertility cannot be determined.

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Erectile dysfunction or premature ejaculation: Medication, behavioral approaches, or both may help improve fertility. The treating doctor may feel inadequacy and the trust between the doctor and patient breaks down [43]. Sterility is the inability to conceive after two years of regular intercourse. Theoretically, with this therapy, we can get artificial gamets in vitro. Checking the woman’s fallopian tubes to make sure they are not blocked.

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For in-vitro fertilization, a 100,000 of sperm are necessary and, for the intracytoplasmatic sperm injection, only a few sperms are required. Tubal microsurgery and laparoscopic tubal surgery: - May be more effective than no treatment. - No strong evidence. (e.g.: fimbrial end dilatation) 2. There is a consistent association of Mycoplasma genitalium infection and female reproductive tract syndromes. If a blockage is present, surgery may be necessary. The resulting embryos are then transferred into the uterus of the future mother, known as the recipient. Men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. 8) Unexplained/other: Sometimes a full evaluation does not reveal the cause of infertility. Post-testicular causes of infertility Post-testicular causes of infertility include problems with sperm transportation through the ductal system, either congenital or acquired.