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This results in normal or enhanced follicular recruitment without the risk of multiple ovulation and ovarian hyperstimulation syndrome. These time intervals would seem to be reversed; this is an area where public policy trumps science. In addition to a careful history, a physical evaluation may also be performed.

Diet: A lack of folic acid, iron, zinc, and vitamin B-12 can affect fertility. This was set up on 1 August 1991 following a detailed commission of enquiry led by Mary Warnock in the 1980s A similar model to the HFEA has been adopted by the rest of the countries in the European Union.

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The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, has been shown to reduce this risk.[27] Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach. According to Ross, “anything that improves quality of health, like adequate sleep and nutrition,” should improve fertility. Preconception lifestyle advice for people with subfertility. Subsequently, Semm submitted a paper on laparoscopic appendectomy to the American Journal of Obstetrics and Gynecology, at first rejected as unacceptable for publication on the grounds that the technique reported on was "unethical," but finally published in the journal Endoscopy.[40] The abstract of his paper on endoscopic appendectomy can be found at here. Treatment of Male-factor Infertility. (PDF, 10 MB) Chapter 9 from Progress in Infertility, 1993.

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Conventional IVF vs ICSI (Intra Cytoplasmic Sperm Injection) for Patients Requiring Microsurgical Epididymal Sperm Aspiration (MESA). (PDF, 4 MB) Chapter from textbook, Frontiers in Endocrinology: Perspectives on Assisted Reproduction, 1994. Infection An increased number of white blood cells in the semen may be observed in patients with infectious or inflammatory processes of the genital tract. Patients with azoospermia should have a postejaculatory urine sample analyzed for sperm, should be evaluated for ejaculatory duct obstruction, and should undergo a hormonal evaluation. Techniques for the Resolution of Testicular Obstruction. (PDF, 8 MB) Chapter 78 from textbook, Reconstructive Urology, 1992. Practice Committee of American Society for Reproductive Medicine. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature.

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If oligospermia or azoospermia is noted, hypogonadism should be suspected. Genetics of Male Infertility: Evolution of the X and Y Chromosome and Transmission of Male Infertility to Future Generations. (PDF, 10 MB) Chapter 5 from Essential IVF, 2004. GIFT (gamete intrafallopian tube transfer) and ZIFT (zygote intrafallopian transfer).  Like IVF, these procedures involve retrieving an egg, combining it with sperm in a lab, and then transferring it back to your body. Hypogonadotropic Hypopituitarism: Low pituitary gland output of LH and FSH.  This condition arrests sperm development and causes the progressive loss of germ cells from the testes and causes the seminiferous tubules and Leydig (testosterone producing) cells to deteriorate.  May be treated with the drug Serophene.  However, if all germ cells are destroyed before treatment commences, the male may be permanently infertile. Studies on Testicular Biopsies from Vasectomized Men. (PDF, 18 MB) Chapter 21 from Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, 1979. Unexplained infertility is not the same thing as having no explanation, but rather reflects the fact that the tests performed have been normal. The volume summarizes the results gained from the study of more than 10,000 infertile couples, who were investigated as part of the WHO's programme to counter the widespread personal distress caused by infertility.