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Problems with sexual intercourse These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex. Laparotomy is indicated in patients with severe pelvic adhesions that compromise the bowel, ovaries, and tubes, with obliteration of the cul-de-sac. [129] The aim of the procedure is to correct what is necessary to allow the normal transport of the gametes; complete restoration of the anatomy is not intended. [130] Lysis of adhesions should be meticulous, using hydrodissection and fine instruments. Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body.

549 KB Effect of Age on Male Fertility. (PDF, 5 MB) Chapter from textbook, Seminars in Reproductive Endocrinology, 1991. If stem cells remain viable after radiation therapy, patients may regain fertility within several years. Breeding with a proven fertile male must occur at the optimal time for the female. Blood tests Depending on the individual couple's situation, various blood tests on either the female or the male may be needed.

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When anatomic variance or obstruction is suspected, referral for surgical evaluation and treatment is appropriate. It is better for a couple to see the doctor together. However, these tests have only poor to moderate predictive value despite widespread use. A low testosterone level with a low FSH level signals a secondary cause.

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Women presenting with a history of this anomaly should be considered high-risk obstetrical patients. [115] Bicornuate uterus A bicornuate uterus causes only minimal problems with infertility (if any). Delayed conception and active and passive smoking. It has not been shown to improve patient outcomes but, rather, is helpful for research purposes. 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. If there is a history of recurrent miscarriages (2 or more) a lupus anticoagulant (LAC) and anti-cardiolipin antibody (ACL) are often done, as well as other tests.

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Further investigations may be requested according to the clinical presentation and the results of preliminary tests. 44 Therefore, a simple recommendation is for vaginal intercourse every two to three days to optimize the chance of pregnancy. Exposure to some chemicals: Some pesticides, herbicides, metals, such as lead, and solvents have been linked to fertility problems in both men and women. Unfortunately, there are some forms of male infertility that are not treatable. To examine the sperm motility in the cervical mucus, the postcoital test is made. 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. Contents Definition[edit] "Demographers tend to define infertility as childlessness in a population of women of reproductive age," whereas "the epidemiological definition refers to "trying for" or "time to" a pregnancy, generally in a population of women exposed to" a probability of conception.[8] Currently, female fertility normally peaks at age 24 and diminishes after 30, with pregnancy occurring rarely after age 50.[9] A female is most fertile within 24 hours of ovulation.[9] Male fertility peaks usually at age 25 and declines after age 40.[9] The time needed to pass (during which the couple tries to conceive) for that couple to be diagnosed with infertility differs between different jurisdictions. 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.