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The enzyme aromatase is responsible for this conversion, and is found primarily in adipose tissue. This combination of laboratory test results may indicate ovarian insufficiency or diminished ovarian reserve. CC has been in clinical use since the early 1960s.

The quality of the cervical mucus can be improved with the administration of a small dose of estrogens, or the problem can be bypassed by intrauterine insemination. [163, 209] If the follicle is smaller than 23-24 mm at the time of ovulation, a better size can be obtained by starting the CC therapy on the menstrual cycle day 2. To prevent further polyp development associated with anovulation, the patient should have withdrawal bleeding at least every 6 weeks. Are Sequence Family Variants Useful for Identifying Deletions in the Human Y Chromosome? (PDF, 377 KB) The American Journal of Human Genetics, 2004.

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Factors affecting Fertility Frequency/Timing of sexual intercourse: - Every 2 to 3 days optimises the chance of pregnancy Obesity: - Women who have BMI of over 30 should be informed that they are likely to take longer to conceive and will affect treatment success rates. Treatment of the cause: 24. Ovulation disorders: (Group I) - Weight gain if BMI less than 19. - pulsatile administration of gonadotrophin-releasing hormone or gonadotrophins with luteinising hormone activity to induce ovulation. To reach timely ovulations, ovulation triggers are combined with chorionic gonadotropin (beta-HCG). By the end of this step, most of healthcare professionals will be able to sketch out their provisional diagnosis.

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The fertilized embryo is then transferred to womb. They compete with endogenous GnRH molecules for the pituitary receptors and provoke a massive release of gonadotropins into circulation. RE: The Impalpable Testis: A Rational Approach to Management. (PDF, 389 KB) The Journal of Urology, 1979.

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A failure of GnRH neurons to migrate to the proper location in the hypothalamus has been implicated. IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies, premature birth, and a host of health problems. The Intra-abdominal Testes: Microvascular Autotransplantation. (PDF, 4 MB) The Journal of Urology, 1981. Men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. Sperm or egg donation: If necessary, sperm or eggs can be received from a donor. Several studies have demonstrated that an increase in BMI is correlated with a decrease in sperm concentration, a decrease in motility and an increase DNA damage in sperm. If the sperm do not have the right shape, or they cannot travel rapidly and accurately towards the egg, conception may be difficult. Surgical ablation: - In minimal or mild endometriosis; surgical ablation or resection of endometriosis plus laparoscopic adhesiolysis improves the chance of pregnancy. - Laparoscopic resection of endometriomas may be beneficial, however recent RCTs suggest intervention only in endometriomas > 4cm. - In moderate or sever endometriosis; surgical treatment should be offered. (Debatable) - Post-operative medical treatment does not improve pregnancy rates. Bhaskar Dutta/Photoshare Clinical definitions Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”… (WHO-ICMART glossary1). “Infertility is the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year. Diagnosis Male infertility is usually diagnosed by a semen analysis. Hysterosalpingo-contrast-ultrasonography - TVS scan during which air and saline or a solution of D-galactose is infused into the uterine cavity and observed to flow along the fallopian tubes. - Requires more expertise. - Less invasive. CC has been in clinical use since the early 1960s.