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If conservative medical treatments fail to achieve a full term pregnancy, the physician or WHNP may suggest the patient undergo in vitro fertilization (IVF). In patients with varicocele, there is insufficient evidence to suggest corrective surgery will increase live birth rates, despite improvement in semen analysis results.

Male and female factors can exist in isolation or combination and fertility investigations, diagnoses and treatment should always be considered in the context of the couple.       Male factor Sperm problems will contribute to about 40% of infertility cases. These medicines are listed below: sulfasalazine – an anti-inflammatory medicine used to treat conditions such as Crohn's disease and rheumatoid arthritis; sulfasalazine can decrease the number of sperm, but its effects are temporary and your sperm count should return to normal when you stop taking it anabolic steroids – are often used illegally to build muscle and improve athletic performance; long-term abuse of anabolic steroids can reduce sperm count and sperm mobility chemotherapy – medicines used in chemotherapy can sometimes severely reduce sperm production herbal remedies – some herbal remedies, such as root extracts of the Chinese herb Tripterygium wilfordii, can affect the production of sperm or reduce the size of your testicles Illegal drugs, such as marijuana and cocaine, can also affect semen quality. Celiac disease A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. A combination of all of these conditions is accordingly termed oligoasthenoteratozoospermia or short OAT syndrome.

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8,45 Figure 1 provides an algorithmic approach to the evaluation of infertility.   Enlarge      Print Infertility Evaluation Figure 1. It usually involves treatment implication counselling, emotional support counselling, and therapeutic counselling [38,39]. Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Reproductive Endocrinology and Infertility. This elevates the abdominal wall above the internal organs to create a working and viewing space. 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. Intracytoplasmic Sperm Injection and Infertility. (PDF, 53 KB) Nature Genetics, 2001.

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Treatment of Female Infertility: Assisted Reproductive Technology (ART) Assisted Reproductive Technology (ART) is a term used to collectively describe a number of noncoital methods of conception that treat causes of infertility not responsive to conventional methods. Adding recombinant human FSH to HCG has been shown to be effective in achieving spermatogenesis in most patients.[18] Select patients with adult-onset idiopathic hypogonadotropic hypogonadism may respond to clomiphene citrate therapy.[19] Prader-Willi syndrome Patients have characteristic obesity, mental retardation, small hands and feet, and hypogonadotropic hypogonadism due to a GnRH deficiency.

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Non-steroidal anti-inflammatory drugs (NSAIDs): Long-term use of aspirin or ibuprofen may make it harder to conceive. Studies on Testicular Biopsies from Vasectomized Men. (PDF, 18 MB) Chapter 21 from Vasectomy: Immunologic and Pathophysiologic Effects in Animals and Man, 1979. Use of clomiphene citrate in infertile women: a committee opinion. Microsurgery of the Male Genitalia for Infertility. (PDF, 8 MB) Chapter 59 from Reconstructive Urologic Surgery, 1994. Theoretically, with this therapy, we can get artificial gamets in vitro. The quality of the cervical mucus can be improved with the administration of a small dose of estrogens, or the problem can be bypassed by intrauterine insemination. [163, 209] If the follicle is smaller than 23-24 mm at the time of ovulation, a better size can be obtained by starting the CC therapy on the menstrual cycle day 2. Not getting pregnant The primary sign of infertility is not getting pregnant after trying for a certain length of time. 18  If the semen analysis result is abnormal, further evaluation is indicated (Table 36–8,10,19,20). The Strassman metroplasty consists of performing an incision at the fundus of the uterus between both cornual areas and closing the defect with an anteroposterior suture. However, varicoceles may lead to impaired testicular spermatogenesis and steroidogenesis, potentially due to an increased intratesticular temperature, reflux of toxic metabolites, and/or germ cell hypoxia as potential causes of these changes, and this appears to be progressive over time.