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The patients are prepared in a similar way to in-vitro fertilization, firstly with ovarian stimulation and follicle puncture. Definition “A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility” NICE guideline, CG156 Primary infertility; couple have failed to conceive before. Secondary infertility; woman has previously been pregnant regardless of the outcome of the pregnancy and now unable to conceive.

Diagnosis is based on history, physical examination, biochemical evaluation, ultrasonography, and laparotomy. The elevated temperature hinders the maturation process of sperm, which develop best in an environment that is slightly cooler than body temperature. For women, being underweight and having extremely low amounts of body fat are associated with ovarian dysfunction and infertility and they have a higher risk for preterm birth. Histologic endometrial dating is not considered reliable nor is it predictive of fertility. About 92 out of 100 couples who are trying to get pregnant do so within two years.[citation needed] Women become less fertile as they get older.

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A specimen is collected by masturbation into a clean, dry, sterile container or during coitus using special condoms (containing no spermicidal lubricants). Smoking during pregnancy increases the chance of pregnancy loss.

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Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis.(PDF, 958 KB) Reproductive BioMedicine Online, 2010. The use of Epididymal and Testicular Sperm for ICSI. (PDF, 1 MB) From IX World Congress on In Vitro Fertilization and Alternated Assisted Reproduction, 1995.

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Irregular menstrual cycle The length of a menstrual cycle varies between individuals and over time. However, it is widely acknowledged by doctors that it is usually very difficult for PCOS patients to lose weight. Ovulation of the egg occurs approximately 2 weeks before the start of the next period. Affected individuals displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.[27] Other causes[edit] Factors that can cause male as well as female infertility are: DNA damage DNA damage reduces fertility in female ovocytes, as caused by smoking,[28] other xenobiotic DNA damaging agents (such as radiation or chemotherapy)[29] or accumulation of the oxidative DNA damage 8-hydroxy-deoxyguanosine[30] DNA damage reduces fertility in male sperm, as caused by oxidative DNA damage,[31] smoking,[28] other xenobiotic DNA damaging agents (such as drugs or chemotherapy)[32] or other DNA damaging agents including reactive oxygen species, fever or high testicular temperature.[33] The damaged DNA related to infertility manifests itself by the increased susceptibility to denaturation inducible by heat or acid [34] or by the presence of double-strand breaks that can be detected by the TUNEL assay.[35] General factors Diabetes mellitus,[36][37] thyroid disorders,[38] undiagnosed and untreated coeliac disease,[39][40][41][42] adrenal disease[43] Hypothalamic-pituitary factors Hyperprolactinemia Hypopituitarism The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility with an odds ratio of 1. Hystersalpingography (HSG): Further investigations 17. Investigation of suspected tubal and uterine abnormalities: 2. Sherman Silber: Be Fruitful and Multiply. (PDF, 6 MB) Lifestyles Magazine, 1999. At least one open tube is required for IUI, and the sperm abnormality cannot be severe otherwise the sperm will not be able to swim to and fertilize the egg. The following is a list of hormonal disorders which can disrupt male infertility: Hyperprolactinemia: Elevated prolactin--a hormone associated with nursing mothers, is found in 10 to 40 percent of infertile males.  Mild elevation of prolactin levels produces no symptoms, but greater elevations of the hormone reduces sperm production, reduces libido and may cause impotence.  This condition responds well to the drug Parlodel (bromocriptine). Embryo Development after ICSI Using Testicular, Epididymal and Ejaculated Spermatozoa. (PDF, 2 MB) Frontiers in Endocrinology, 1995.