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Author disclosure: No relevant financial affiliations. 35. In women aged under 40 years who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 3 full cycles of IVF, with or without ICSI. Testicular Transplantation and Autotransplantation. (PDF, 8 MB) Chapter 22 of textbook, Extracorporeal and Microvascular Surgery, 1982. Immotility of the sperm can be caused by antibodies against the sperm. Risk factors Risk factors that increase the risk include: Smoking significantly increases your risk of infertility Age: The ability to conceive starts to fall around the age of 32 years.

Damaged tubes may interfere with fertilization of the egg and its transport into the uterine cavity. Programming of Ovarian Stimulation with Norethindrone Acetate in IVF/GIFT Cycles. (PDF, 2 MB) Human Reproduction, 1989.

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Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. In response to FSH stimulation at puberty, germ cells become spermatogonia and undergo an ordered maturation to become spermatozoa. Causes in women Infertility in women can also have a range of causes. Progesterone deficiency can be corrected by the administration of progesterone during the luteal phase, starting 48 hours after ovulation. [204] Patients with hyperprolactinemia need a thorough evaluation to exclude a pituitary microadenoma.

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What Forms of Male Infertility are there left to Cure? (PDF, 2 MB) Human Reproduction, 1995. Both infertility and subfertility are defined as the inability to conceive after a certain period of time (the length of which vary), so often the two terms overlap. Mental stress: Stress can be a factor, especially if it leads to reduced sexual activity. Fertilizing Capacity of Epididymal and Testicular Sperm with ICSI. (PDF, 5 MB) Frontiers in Endocrinology, 1995. A woman with a suspicion of chronic anovulation most probably due to polycystic ovary (PCO) syndrome, as there is a long history of irregular cycles and clinical presentation with hirsutism, her serum levels of testosterone hormone, sex hormone binding globulin (SHBG), dihydroepiandrostenedione (DHEA), dihydroepiandrostenedione-sulfate (DHEAS) and prolactin should be evaluated to prove the provisional diagnosis and to detect the source of excess androgens.

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Causes include: Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. Ovulation problems can be a result of:  polycystic ovary syndrome (PCOS) thyroid problems – both an overactive thyroid gland and an underactive thyroid gland can prevent ovulation premature ovarian failure – where a woman's ovaries stop working before the age of 40 Scarring from surgery Pelvic surgery can damage and scar the fallopian tubes, which link the ovaries to the womb. Full history taking of both partners usually denotes the underlying problem [17-23], (Appendix 1). Other factors that can affect a woman's chances of conceiving include being overweight or underweight,[56] or her age as female fertility declines after the age of 30.[57] Sometimes it can be a combination of factors, and sometimes a clear cause is never established. Microsurgical Aspects of Varicocele. (PDF, 9 MB) Fertility and Sterility, 1979. In a move that dramatically changes the definition of infertility, the WHO will declare that it should no longer be regarded as simply a medical condition. Women presenting with a history of this anomaly should be considered high-risk obstetrical patients. [115] Bicornuate uterus A bicornuate uterus causes only minimal problems with infertility (if any). For example, a woman who has a 33-day cycle one month, a 31-day cycle the next, and a 35-day cycle after that, is probably having “normal” periods. Embryo Development after ICSI Using Testicular, Epididymal and Ejaculated Spermatozoa. (PDF, 2 MB) Frontiers in Endocrinology, 1995. ICSI with Epididymal and Testicular Sperm in Azoospermic Men. (PDF, 2 MB) From Treatment of Infertility: The New Frontiers, 1998. The fertilized egg moves down the fallopian tube towards the uterus.