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VITRIKAS, MD, David Grant Medical Center Family Medicine Residency, Travis Air Force Base, California Am Fam Physician. 2015 Mar 1;91(5):308-314.   Patient information: See related handout on infertility, written by the authors of this article.   Related letter: Natural Procreative Technology for Treating Infertility This clinical content conforms to AAFP criteria for continuing medical education (CME). Diagnostic evaluation of the infertile female: a committee opinion.

Thalassemia Patients with thalassemia have ineffective erythropoiesis and undergo multiple blood transfusions. ICSI with Epididymal and Testicular Sperm Retrieval. (PDF, 1 MB) Male Sterility and Motility Disorders: Etiological Factors and Treatment, 1998. It is better for a couple to see the doctor together. Endometrial biopsy should be performed only in women with suspected pathology (chronic endometritis or neoplasia). Microscopic Technique for Reversal of Vasectomy. (PDF, 3 MB) Surgery, gynecology & obstetrics, 1976.

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For example; a woman who has no history suggestive of previous pelvic inflammatory disease or endometriosis, there is no justification to request a laparoscopy especially after normal hysterosalpingography study [33]. Patients have eunuchoidal body habitus, large testis, and a low ejaculatory volume.

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Similarly, there is no need for testing tubal patency for couples who will require IVF or ICSI procedure. If oligospermia or azoospermia is noted, hypogonadism should be suspected. Prolactin stimulates milk production during breastfeeding. This means it’s more difficult to become pregnant and the chance of miscarriage is higher.  Unexplained infertility  Sometimes, doctors are unable to find the reason for infertility, despite running the required fertility tests. 7 million women reported impaired ability to get pregnant or carry a baby to term.

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8–16 One retrospective case-control study of 650 men with infertility and 698 control participants questioned the role of environmental risk; no association could be determined after assessing for multiple factors including shift work, stress, and pesticides. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles. The National Institute for Health and Care Excellence (NICE) recommends that women with unexplained infertility who haven't conceived after 2 years of having regular unprotected sex should be offered IVF treatment. Semen and sperm Sometimes the sperm cannot travel effectively to meet the egg. Kallmann syndrome has been described in both familial (X-linked and autosomal) and sporadic forms, and its incidence is estimated as 1 case per 10,000-60,000 births. Whether it should be corrected in cases of primary infertility is controversial. The sperm is washed in a fluid and the best specimens are selected. 29 When the semen analysis is abnormal, referral to a male fertility specialist or reproductive endocrinologist is warranted. The progestins that can be used and the doses are as follows: Medroxyprogesterone acetate (eg, Depo-SubQ Provera 104; administer 104 mg SC q3mo or q12-14wk) Megestrol acetate (eg, Megace 20-40 mg PO qd for up to 2 months) Norethindrone acetate (eg, Aygestin 15 mg PO qd for 6-9 months) [145, 146, 147, 148, 149, 150] The androgens used are 17-ethinyl testosterone derivatives (eg, danazol 400-800 mg PO divided BID; not to exceed 9 months) [151, 152, 153] The GnRH agonists used are as follows: Leuprolide acetate (eg, Lupron 3. In cases of poor sperm quality, intrauterine insemination can be performed.