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Metformin (Glucophage): If Clomifene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance. Microsurgery for the Undescended Testicle. (PDF, 5 MB) Urologic Clinics of North America, 1982. 40. Luteal phase support: - Should be offer luteal phase support with progesterone till 8 weeks of gestation. - Different form of progesterone with different routes of administration are available, RCT are taking place comparing efficacy of different forms. Generally, success rates lie between 40% and 60% per cycle. 8 Involvement in group counseling and exercise is more effective than weight loss advice alone. 34 Although intrauterine insemination has been shown to be equally effective as timed intercourse in unstimulated cycles, there is a modest increase in live birth rates when combined with ovarian stimulation. As new technology becomes available, fertility treatment is now accessible to more people, and success rates and safety are improving all the time.

In cats, infectious causes of infertility include toxoplasmosis, feline leukemia virus infection, feline infectious peritonitis, and feline viral rhinotracheitis. Estrogen excess may be seen in patients with Sertoli cell tumors, Leydig tumors, liver failure, or severe obesity.

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For women aged 35, about 94% who have regular unprotected sexual intercourse get pregnant after three years of trying. Women with regular menstrual cycles are likely to be ovulating and should be offered serum progesterone testing at day 21 to confirm ovulation.

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Generally, they occur in 50-100% of all abdominal surgeries,[29] with the risk of developing adhesions being the same for both procedures.[30][31] Complications of adhesions include chronic pelvic pain, bowel obstruction, and female infertility. The main causes of tubal infertility are pelvic infections caused by bacteria such as chlamydia, previous abdominal disease or surgery and ectopic pregnancy. • Endometriosis is characterised by excessive growth of the lining of the uterus. This diagnosis is therefore shared by 15% of couples attempting to conceive.

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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. 2 or more - sperm concentration: 15 million spermatozoa per ml or more - total sperm number: 39 million spermatozoa per ejaculate or more - total motility: 40% or more motile or 32% or more with progressive motility - vitality: 58% or more live spermatozoa - sperm morphology (percentage of normal forms): 4% or more Basic Work-up for Infertility 13. Evidence of ovulation: 1. Most couples (about 84%) who have regular sexual intercourse (that is, every two to three days) and who do not use contraception get pregnant within a year. Of the successful pregnancies, 85% are achieved within the first 4 cycles of intrauterine inseminations. Often, in vitro fertilization (IVF) can reveal abnormalities in egg quality, sperm function, or embryo development that would not have been determined from standard testing. Infertility FAQs Male Infertility Best Practice Policy Committee of the American Urological Association & Practice Committee of the American Society of Reproductive Medicine. (2006). Usually no more than 1 – 2 embryos are transferred, and therefore additional embryos can be frozen, or cryopreserved, for future use; 3) embryo donation – a process where a fully developed embryo from another person in combination w/donor sperm, or couple who underwent IVF, are donated to another woman, the future intended mother, for transfer into her uterus; and 4) gestational surrogacy – a process where another woman will undergo an embryo transfer and carry the pregnancy for another person. Semen that is not initially a coagulum is often an indication of an ejaculatory duct obstruction or the absence of seminal vesicles. Coital frequency is positively correlated with pregnancy rates. 6) Male factors affecting sperm function: Male factor infertility has been associated as a contributing factor causing infertility in 40-50% percent of cases, and as the sole cause for infertility in 15-20% percent of cases. Microsurgical Epididymal Sperm Aspiration and Assisted Reproductive Techniques. (PDF, 4 MB) Frontiers in Human Reproduction, 1991.