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6 The initial history should cover menstrual history, timing and frequency of intercourse, previous use of contraception, previous pregnancies and outcomes, pelvic infections, medication use, occupational exposures, substance abuse, alcohol intake, tobacco use, and previous surgery on reproductive organs. ARTICLES FROM THE 2000s Evaluation and Treatment of Male Infertility. (PDF, 17 MB) Clinical Obstetrics and Gynecology, 2000. Psychological/Physical/Behavioral Problems: Several sexual problems exist that can affect male fertility.  These problems are most often both psychological and physical in nature:  it is difficult to separate the physiological and physical components. ICSI with Epididymal and Testicular Sperm in Azoospermic Men. (PDF, 2 MB) From Treatment of Infertility: The New Frontiers, 1998.

The farther from the scrotum, and the longer duration that the testicle resides outside the scrotum, the greater the likelihood of infertility. In reproductive medicine, the most common surgical procedures are laparoscopy, hysteroscopy, and abdominal myomectomy (removal of uterine fibroids). Linthicum, Md.: American Urological Association, Inc.; 2010. In humans, infertility is the inability to become pregnant after one year of intercourse without contraception involving a male and female partner.[2] There are many causes of infertility, including some that medical intervention can treat.[3] Estimates from 1997 suggest that worldwide about five percent of all heterosexual couples have an unresolved problem with infertility.

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New Treatment for Infertility Due to Congenital Absence of Vas Deferens. (PDF, 1 MB) The Lancet, 1987. Sperm Granuloma and Reversibility of Vasectomy. (PDF, 11 MB) Lancet, 1977. Those with a varicocele diagnosable only on scrotal ultrasonography have subclinical varicoceles and will likely not benefit from repair. Obese women have a higher rate of recurrent, early miscarriage compared to non-obese women. From that point onwards, there is a progressive decline up to the point when a woman reaches 37 years of age.

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The presence of antibodies in serum or seminal plasma is less prognostic than antibodies bound to sperm. Although 60% of patients have evidence of antisperm antibodies after vasectomy, the clinical significance has not been completely elucidated. Anatomic causes of infertility include acquired and congenital problems.

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Aromatase inhibitors Aromatase inhibitors (letrozole, anastrozole) inhibit the action of the enzyme aromatase, which converts androgens into estrogens by a process called aromatization. Septate uterus The hypothesis that a uterine septum can cause infertility is controversial. Sperm are then collected, washed, and added to the eggs in the dish. Infertility is more likely in men who have had this condition. A small incision is made in the abdomen, and a thin, flexible microscope with a light at the end, called a laparoscope, is inserted through it. The Human Fertilization and Embryology Authority, HFEA website.Summary Infertility means not being able to become pregnant after a year of trying. The Prevention of Acute Tubular Necrosis in Renal Transplantation by Chronic Salt Loading of the Recipient. (PDF, 627 KB) ANZ Journal of Surgery, 1974. Successful Pregnancy after Microsurgical Transplantation of an Intact Ovary. (PDF, 438 KB) The New England Journal of Medicine, 2008. 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. New Concepts in Operative Andrology: A Review. (PDF, 7 MB) International Journal of Andrology, 2000. Fertilizing Capacity of Epididymal and Testicular Sperm using Intracytoplasmic Sperm Injection (ICSI). (PDF, 7 MB)Reproduction, Fertility and Development, 1995. It's rarely reversible – if you do have a sterilisation reversed, you won't necessarily become fertile again. Some diseases: Conditions that are sometimes linked to lower fertility in males are anemia, Cushing's syndrome, diabetes, and thyroid disease. Testicular histology reveals hyalinization of seminiferous tubules.[21] Some men with Klinefelter syndrome may be able to conceive with the help of assisted reproductive techniques. 17 Evaluation of male infertility starts with a history and physical examination focusing on previous fertility, pelvic or inguinal surgeries, systemic diseases, and exposures. Medications, treatments, and drugs Some drugs can affect fertility in a woman. It has been suggested that infertility be classified as a form of disability.[22] Causes[edit] Immune infertility[edit] Antisperm antibodies (ASA) have been considered as infertility cause in around 10–30% of infertile couples.[23] In both men and women, ASA production are directed against surface antigens on sperm, which can interfere with sperm motility and transport through the female reproductive tract, inhibiting capacitation and acrosome reaction, impaired fertilization, influence on the implantation process, and impaired growth and development of the embryo. Mutations in the Cystic Fibrosis Gene in Patients with Congenital Absence of the Vas Deferens. (PDF, 5 MB) New England Journal of Medicine, 1995.