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When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. Varicocele A varicocele is a swelling of the veins that drain the testicle, which can impact sperm quality. The use of CC is contraindicated in cases of ovarian cyst, pregnancy, and liver disease. Causes include: Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Examples of such health issues include infections, endometriosis, and fibroids.

41 Treatment of Unexplained Infertility Jump to section + Couples who have no identified cause of infertility should be counseled on timing of intercourse for the most fertile period (i.e., the six days preceding ovulation). If no improvement occurs, depending on the amount of functional sperm recovery after the sperm wash, the decision must be made to proceed with either intrauterine insemination or in vitro fertilization. Environmental vs Genetic Sex Determination: A Possible Factor in Dinosaur Extinction? (PDF, 307 KB) Fertility and Sterility, 2004. Some respond by actively avoiding the issue altogether; middle-class men are the most likely to respond in this way.[21] In the United States some treatments for infertility, including diagnostic tests, surgery and therapy for depression, can qualify one for Family and Medical Leave Act leave. The quality and quantity of eggs begin to decline by the early 30s and drop even further as a woman approaches the age of 40. Patients who are suffering from Stein-Leventhal syndrome (also referred to as polycystic ovary syndrome, or PCOS) can also suffer from anovulation.[3] Up to 90% of cases of anovulation are caused by PCOS; this syndrome is usually hereditary.[4][5] Weight loss or anorexia can also cause hormonal imbalance, leading to irregular ovulation (dysovulation).

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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. After ruling out female infertility concerns, tests for male infertility may be needed.

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Therefore, we recommend an evaluation if menstrual cycles are infrequent or irregular in a couple attempting pregnancy. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance. WHAT'S THE DIFFERENCE BETWEEN PRIMARY AND SECONDARY INFERTILITY? These abnormalities can also cause irregular bleeding between menstrual cycles.

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Primary sterility exists when the couple has never fallen pregnant and secondary sterility when the issue arises following one successful pregnancy but no further pregnancies. Regrettably, this often leads to untruly high expectations of assisted reproduction techniques (ART) [40]. Ovulation should be documented by serum progesterone level measurement at cycle day 21. They can also carry out some basic tests on both partners to see if there is an identifiable reason for not having achieved a pregnancy.