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During ejaculation, the ejaculate is propelled forward by the rhythmic contractions of the smooth muscle that surrounds the ducts and by the bulbourethral muscles and other pelvic muscles. 8 Women in group I typically present with amenorrhea and low gonadotropin levels, most commonly from low body weight or excessive exercise. Eating disorders: If an eating disorder leads to serious weight loss, fertility problems may arise.

Linthicum, Md.: American Urological Association, Inc.; 2010. Obese women have a higher rate of recurrent, early miscarriage compared to non-obese women. These may be purchased over the counter and allow couples to predict the most fertile days in the cycle.

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Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis, varicocele, infections, prostatitis, testicular cancer, failure of immunosuppression and unprotected receptive anal or oral sex with men.[23][24] Sexually transmitted infections[edit] Infections with the following sexually transmitted pathogens have a negative effect on fertility: Chlamydia trachomatis and Neisseria gonorrhoeae. The surgeon can remove implants and scar tissue, and this may reduce pain and aid fertility. In addition to the components already listed, semen is also composed of secretions from the bulbourethral (Cowper) glands and the (periurethral) glands of Litre, each producing 2-5% of the ejaculate volume, serving mainly to lubricate the urethra and to buffer the acidity of the residual urine. These include: non-steroidal anti-inflammatory drugs (NSAIDs) – long-term use or a high dosage of NSAIDs, such as ibuprofen or aspirin, can make it more difficult to conceive chemotherapy – medicines used for chemotherapy can sometimes cause ovarian failure, which means your ovaries will no longer be able to function properly neuroleptic medicines – antipsychotic medicines often used to treat psychosis; they can sometimes cause missed periods or infertility spironolactone – a type of medicine used to treat fluid retention (oedema); fertility should recover around 2 months after you stop taking spironolactone Illegal drugs, such as marijuana and cocaine, can seriously affect fertility and make ovulation more difficult. 41 Treatment of Unexplained Infertility Jump to section + Couples who have no identified cause of infertility should be counseled on timing of intercourse for the most fertile period (i.e., the six days preceding ovulation). Metformin (Glucophage) is another type of medication that may help you ovulate normally if you have insulin resistance or PCOS (polycystic ovarian syndrome).

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Castration of the affected testis may allow the other testis to regain its ability to produce sperm, but the prognosis is guarded. Additional risk factors may include smoking, alcohol use, obesity, and older age; however, the data are hampered by a lack of pregnancy-related outcomes. M. genitalium infection is associated with increased risk of infertility.[25][26] Genetic[edit] A Robertsonian translocation in either partner may cause recurrent spontaneous abortions or complete infertility.[citation needed] Mutations to NR5A1 gene encoding Steroidogenic Factor-1 (SF-1) have been found in a small subset of men with non-obstructive male factor infertility where the cause is unknown. For example, endometriosis can cause infertility with the growth of endometrial tissue in the Fallopian tubes or around the ovaries.

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A review of systems and physical examination of the endocrine and gynecologic systems should be performed. Abnormalities of the uterus like the uterus bicornis, uterus septa or hypoplasia of the uterus less frequently result in contraceptional barriers but can cause miscarriages. Some diseases: Conditions that are sometimes linked to lower fertility in males are anemia, Cushing's syndrome, diabetes, and thyroid disease. Cortical deficiency may be seen in patients with adrenal failure due to infection, infarction, or congenital adrenal hyperplasia (CAH). 6 Women with risk factors for tubal obstruction, such as endometriosis, previous pelvic infections, or ectopic pregnancy, should instead be offered hysteroscopy or laparoscopy with dye to assess for other pelvic pathology.