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Women older than 35 years or couples with known risk factors for infertility may warrant evaluation at six months. Spermiogenic defects may also be a cause of sterility. Testicular histology reveals hyalinization of seminiferous tubules.[21] Some men with Klinefelter syndrome may be able to conceive with the help of assisted reproductive techniques. 6,28 Additionally, postcoital testing of cervical mucus is no longer recommended because it does not affect clinical management or predict the inability to conceive. These numbers are comparable to those of other industrialized nations.

Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%.[4] Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts.[2][5] In 10–20% of cases, no cause is found.[5] The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent menstrual periods.[6] Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.[7] Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the menstrual cycle. 42 However, none of these methods has been proven to increase pregnancy rates when used to predict timing of intercourse. Outside pregnancy and lactation, women with high levels of prolactin may have irregular ovulation cycles and fertility problems. 24 Other tests of ovarian reserve, such as the clomiphene (Clomid) challenge test, antral follicle count, and antimüllerian hormone level, are also generally performed to predict response to ovarian stimulation with exogenous gonadotropins and assisted reproductive technology.

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A typical infection is particularly the adnexitis from Chlamydia, but also infections from Trepona pallidum (lues) and Neisseria gonorrhoea should be kept in mind. Low weight: Obesity is not the only way in which weight can impact fertility. This process bypasses the normal fertilization process, which may be compromised due to poor sperm function.

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Microsurgery for Vasectomy Reversal and Vasoepididymostomy. (PDF, 13 MB) Urology, 1984. A systematic review of tests predicting ovarian reserve and IVF outcome.

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Even with the testis shielded, radiation therapy below the diaphragm may lead to infertility due to the release of reactive oxygen free radicals. A smaller amount may suggest a structural or hormonal problem leading to deficient semen production; 2) sperm concentration – normal concentration should be at least 20 million sperm per 1 ml of semen. There may be testicular malformations, hormone imbalance, or blockage of the man's duct system. Ovulation often can be detected by keeping a menstrual calendar or using an ovulation predictor kit. Source : (1).pptx Evaluation of Fertility: A Cornerstone to Improved ... An estimated 34 million women, predominantly from developing countries, have infertility which resulted from maternal sepsis and unsafe abortion (long term maternal morbidity resulting in a disability). Environmental toxins, including pesticides and lead. The AZFc Region of the Y Chromosome Features Massive Palindromes and Uniform Recurrent Deletions in Infertile Men. (PDF, 5 MB) Nature Genetics, 2001.