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If a woman needs an HCG injection to activate ovulation and ultrasound scans show that too many follicles have developed, it is possible to withhold the HCG injection. The more fetuses there are, the higher the risk of premature labor. Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%.[4] Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts.[2][5] In 10–20% of cases, no cause is found.[5] The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent menstrual periods.[6] Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.[7] Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the menstrual cycle.

Causes of infertility include male factors, ovulatory dysfunction, uterine abnormalities, tubal obstruction, peritoneal factors, or cervical factors. It is often defined as not conceiving after 12 months of regular sexual intercourse without the use of birth control. Sexually transmitted infections (STIs): Chlamydia can damage the fallopian tubes in a woman and cause inflammation in a man's scrotum.

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25 Women with no clear risk of tubal obstruction should be offered hysterosalpingography to screen for tubal occlusion and structural uterine abnormalities. Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. Female and male factors are equally responsible for infertility. Congenital Absence of the Vas Deferens: The Fertilizing Capacity of Human Epididymal Sperm. (PDF, 3 MB) New England Journal of Medicine, 1990.

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Some women have bilateral tubal occlusion, which is when both tubes are blocked. Fertility is not an issue for some patients affected by DES, and they remain undiagnosed until they have an abnormal Papanicolaou test result. An evaluation by a physician is the only way to sort it out.

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For example, polycystic ovarian syndrome is when the eggs only partially developed within the ovary and there is an excess of male hormones. The best candidates for tubal reanastomosis are patients who had tubal ligation by the method of fallopian ring, Filshie clip, or Pomeroy. [144] The pregnancy rate following a tubal reanastomosis performed by a skilled surgeon fluctuates from 70-80%. For a woman to be fertile, the ovaries must release healthy eggs regularly. Edwards; the physiologist who developed the treatment, was awarded the Nobel Prize in Medicine in 2010. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). Preliminary Tests of a New Reversible Male Contraceptive in Bush Dog, Speothos Venaticus: Open-ended Vasectomy and Microscopic Reversal. (PDF, 106 KB) Journal of Zoo and Wildlife, 2006. The only known risk factor for Klinefelter syndrome is advanced maternal age. Follicle-stimulating hormone (Gonal-F, Bravelle): This hormone is produced by the pituitary gland that controls estrogen production by the ovaries. Intrauterine insemination (IUI.)At the time of ovulation, sperm are injected directly up into the uterus. Success rates reported by various practices that offer ICSI range from 15% to 30% per egg retrieval. Other causes of ovulation disorders include ovarian insufficiency and hypothalamic amenorrhea. Fertility Evaluation: General and Sexual History A detailed history includes: General history  This includes occupation and background, use of tobacco, alcohol and drugs, earlier diseases, history of abdominal surgery and earlier infections.