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Hystersalpingography (HSG): - usually after failed successive cycles of ovulation induction, and in some centres after failed IUI. - good predictive but requires expertise. This is where no cause can be identified in either the woman or man. The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, has been shown to reduce this risk.[27] Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach.

The interstitium between the seminiferous tubules contains the Leydig cells, fibroblasts, lymphatics, blood vessels, and macrophages. Additionally, because insulin-like growth factor (IGF) has been shown to have an effect on semen quality, its role in varicocele pathology has been studied.[25] One study showed that IGF levels significantly increased after a varicocelectomy to levels that were no different than fertile controls, suggesting that varicocele-related infertility may involve IGF.[26] Varicoceles lead to an increased incidence of sperm immaturity, apoptosis, and necrosis with severe disturbances in meiotic segregation compared to fertile men without varicoceles, and these parameters generally improve after repair. Other hormones including inhibin B and leptin, may also be affected by obesity. The acrosome should be 40-70% of the size of the head, and no mid piece or tail abnormalities should be present. The woman may be given a low dose of ovary stimulating hormones. The Effect of Female Age and Ovarian Reserve on Pregnancy Rate in Male Infertility: Treatment of Azoospermia with Sperm Retrieval and Intracytoplasmic Sperm Injection. (PDF, 66 KB) Human Reproduction, 1997.

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When used in the early follicular phase, letrozole inhibits estrogen synthesis, thereby causing enhanced GnRH pulsatility and consequent FSH and inhibin stimulation. The most common identifiable causes of female fertility problems are outlined below: • Ovulatory dysfunction, (or anovulation) where an egg is not released from the ovary every month, is the single most common cause of female infertility. Fertilizing Capacity of Epididymal and Testicular Sperm with ICSI. (PDF, 5 MB) Frontiers in Endocrinology, 1995. Treatment of Male-factor Infertility. (PDF, 10 MB) Chapter 9 from Progress in Infertility, 1993. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails.

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Are Sequence Family Variants Useful for Identifying Deletions in the Human Y Chromosome? (PDF, 377 KB) The American Journal of Human Genetics, 2004. If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done, as well as other tests. If the correction is not done, it may be harder for the sperm to get to the female's cervix.

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Transmission of Male Infertility to Future Generations: Lessons from the Y Chromosome. (PDF, 303 KB) Human Reproduction Update, 2002. Debate: Are Spermatid Injections of any Clinical Value? (PDF, 6 MB) Human Reproduction, 1998. The likelihood of fertilization improves significantly for men with low sperm concentrations. Simultaneous Treatment of the Wife in Infertile Couples with Oligospermia. (PDF, 4 MB) Fertility and Sterility, 1983. Bromocriptine and cabergoline are dopamine agonists used to suppress prolactin levels. If endometriosis is found, it can be surgically removed by various methods, and its removal may lead to a decrease in pain as well as improvement in the ability to conceive naturally. Often, varicoceles or past infections such as mumps orchitis are the cause of sterility. Outcome of Intracytoplasmic Sperm Injection with Testicular Spermatozoa in Obstructive and Non-obstructive Azoospermia. (PDF, 426 KB) Human Reproduction, 1996. For this reason, a call for low-cost ART protocols have been attempt to reduce the overall current cost of IVF through limiting the rquired laboratory investigations, modifying the stimulation regimen and purchasing low-priced pre-used machines and instruments [35].