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However, about one in five cases of infertility has no clear diagnosed cause.[73] In Britain, male factor infertility accounts for 25% of infertile couples, while 25% remain unexplained. If the sperm are of good quality and the mechanics of the woman's reproductive structures are good (patent fallopian tubes, no adhesions or scarring), a course of ovulation induction maybe used. 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. In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance.

Endometrial biopsy should be performed only in women with suspected pathology (chronic endometritis or neoplasia). It is also important to increase the frequency of intercourse by having well-timed sex regularly to improve fertility. Evaluation of the uterus and fallopian tubes can be performed by hysterosalpingography in women with no risk of obstruction. Cervical stenosis (a narrowed cervix) or the lack of cervical mucus often make it harder for sperm to travel through the cervix into the uterus.

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In current practice, an alternative for patients with more than 5 sizable follicles is to convert the treatment to IVF. It's sometimes done while you're taking meds that help trigger the release of an egg.

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Production of the First Offspring from Oocytes Derived from Fresh and Cryopreserved Pre-antral Follicles of Adult Mice. (PDF, 2 MB) Reproductive BioMedicine Online, 2007. ART techniques generally start with stimulating the ovaries to increase egg production.

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Although many of these can be treated through surgery or hormonal substitutions, some may be indefinite.[59] Infertility associated with viable, but immotile sperm may be caused by primary ciliary dyskinesia. Studies have shown that approximately 70% of miscarriages are due to chromosomal abnormalities. Modifiable and non-modifiable risk factors for poor semen quality: a case-referent study. A Physical Map of the Human Y Chromosome. (PDF, 160 KB) Nature, 2001. Ovarian dysfunction, when a woman’s ovaries are not producing eggs, or egg production has diminished due to hormonal imbalance, age or other factors. CASA measures the following parameters: Curvilinear velocity – The average distance per unit time between successive sperm positions) Straight-line velocity – The speed of forward direction Linearity – The straight-line velocity divided by the curvilinear velocity In addition, the program measures the average path velocity, the amplitude of lateral head displacement, and the flagellar beat frequency, and it is used to evaluate for evidence of hyperactivation. Causes include: Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. 43 Other low-cost methods of monitoring for ovulation, although less effective, include basal body temperature measurements and cervical mucus changes. Vasectomy. (PDF, 5 MB) From the Encyclopedia of Reproduction, 1999.