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3,4  Infertility may arise from male factors, female factors, or a combination of these (Table 15–8). Smoking during pregnancy increases the chance of pregnancy loss. This leads to the final maturation and release of the egg.

Varicocele A varicocele is a swelling of the veins that drain the testicle, which can impact sperm quality. Reversal of Vasectomy and the Treatment of Male Infertility. (PDF, 4 MB) Urologic Clinics of North America, 1981. A dye test may be performed to detect any blockage in the reproductive tract, wherein a dark blue dye is passed up through the cervix and is followed with the laparoscope through its passage out into the fallopian tubes to the ovaries.[1] See also[edit] [edit] External links[edit] Feder, Barnaby J.Infertility is the inability of a person, animal or plant to reproduce by natural means. Sperm density Normal sperm density is greater than 20 million sperm/mL.

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Oocyte Vitrification – Women’s Emancipation Set in Stone. (PDF, 70 KB) Fertility and Sterility, 2008. In women with anovulation, it may be an alternative after 7 - 12 attempted cycles of pituitary feedback regimens (as evidenced by clomifene citrate), since the latter ones are less expensive and more easy to control.[18] In vitro fertilization[edit] The standard procedure of in vitro fertilization includes controlled ovarian hyperstimulation with gonadotropins, but in larger doses, with the intention to induce development of supernumerary follicles. It stimulates the ovaries to mature egg follicles. 8,46 Obesity impairs fertility and the response to fertility treatments, including in vitro fertilization; therefore, it is advisable to counsel patients who are obese to lose weight before conception or infertility treatments. London, United Kingdom: National Institute for Health and Clinical Excellence (NICE); February 2013:1–63. (Clinical guideline no. Also searched were the Cochrane database, the National Guideline Clearinghouse database, Dynamed, and Essential Evidence Plus.

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Factors contributing to the formation of antisperm antibodies in women are disturbance of normal immunoregulatory mechanisms, infection, violation of the integrity of the mucous membranes, rape and unprotected oral or anal sex. A systematic review of tests predicting ovarian reserve and IVF outcome. Outside pregnancy and lactation, women with high levels of prolactin may have irregular ovulation cycles and fertility problems. Women with regular menstrual cycles are likely to be ovulating and should be offered serum progesterone testing at day 21 to confirm ovulation. Patients present with short stature, precocious puberty, small testis, and occasional bilateral testicular rests. Affected individuals displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.[27] Other causes[edit] Factors that can cause male as well as female infertility are: DNA damage DNA damage reduces fertility in female ovocytes, as caused by smoking,[28] other xenobiotic DNA damaging agents (such as radiation or chemotherapy)[29] or accumulation of the oxidative DNA damage 8-hydroxy-deoxyguanosine[30] DNA damage reduces fertility in male sperm, as caused by oxidative DNA damage,[31] smoking,[28] other xenobiotic DNA damaging agents (such as drugs or chemotherapy)[32] or other DNA damaging agents including reactive oxygen species, fever or high testicular temperature.[33] The damaged DNA related to infertility manifests itself by the increased susceptibility to denaturation inducible by heat or acid [34] or by the presence of double-strand breaks that can be detected by the TUNEL assay.[35] General factors Diabetes mellitus,[36][37] thyroid disorders,[38] undiagnosed and untreated coeliac disease,[39][40][41][42] adrenal disease[43] Hypothalamic-pituitary factors Hyperprolactinemia Hypopituitarism The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility with an odds ratio of 1.

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Men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. Cervical surgery can sometimes cause scarring or shortening of the cervix. Surgical procedures for women If the fallopian tubes are blocked or scarred, surgical repair may make it easier for eggs to pass through. In particular, small bowel obstruction poses the most significant problem.[30] The use of surgical humidification therapy during laparoscopic surgery may minimise the incidence of adhesion formation.[32] Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery.[30] Robotic laparoscopic surgery[edit] A laparoscopic robotic surgery machine. Normal Fertilization of Human Oocytes after Testicular Sperm Extraction and Intracytoplasmic Sperm Injection.(PDF, 2 MB) Fertility and Sterility, 1994. The male partner can be evaluated for infertility or subfertility using a variety of clinical interventions, and also from a laboratory evaluation of semen.” (Semen manual, 5th Edition3). Therefore we recommend a fertility evaluation if a couple has been attempting pregnancy for 6 months or more when the woman is 35 years of age or older. Basic Work-up for Infertility Detailed history and physical examination. Semen analysis. Evidence of ovulation. (Day 2-3 gonadotrophins, Day 21 progesterone) Susceptibility to rubella Cervical smear screening Screening for Chlamydia trachomatis Serum prolactin Thyroid function tests 12. Semen analysis: - semen volume: 1. If an endocrinopathy, such as hyperprolactinemia, is diagnosed, the underlying cause should be treated. Medical conditions Some medical conditions can affect fertility. In addition, loss of peripheral visual fields bilaterally may be due to compression of the optic chiasm by the growing pituitary tumor.