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Some uterine and tubal abnormalities, such as adhesions, uterine septum, or fibromyoma, may be corrected by surgical procedures. The FAST study: fertility assessment and advice targeting lifestyle choices and behaviours: a pilot study. The Male-specific Region of the Human Y Chromsome is a Mosaic of Discrete Sequence Classes. (PDF, 754 KB) Nature, 2003. Linthicum, Md.: American Urological Association, Inc.; 2010. High-cost treatments are out of financial reach for some couples. Polycystic ovary syndrome (PCOS): The ovaries function abnormally and ovulation may not occur.

However, it is important to note that they are not necessarily all displayed simultaneously. Diagnostic evaluation of the infertile female: a committee opinion.

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Previously, metformin was recommended as treatment for anovulation in polycystic ovary syndrome, but in the largest trial to date, comparing clomiphene with metformin, clomiphene was more effective than metformin alone.[21] Following this study, the ESHRE/ASRM-sponsored Consensus workshop do not recommend metformin for ovulation stimulation.[22] Subsequent randomized studies have confirmed the lack of evidence for adding metformin to clomiphene. Ideally, using strict morphology criteria, a minimum of 5 – 15% normal forms leads to a better ability for sperm to fertilize the egg. Less common factors The following other factors may also be responsible for infertility in a smaller proportion of cases: • Genetic abnormalities within eggs, sperm or both • An abnormal uterine cavity, including the presence of fibroids or polyps • Immunological infertility, whereby either the male or female partner produces anti-bodies against sperm cells or implantation of an embryo • Abnormal cervical mucus which hinders the passage of sperm to the uterus and fallopian tubes Unexplained infertility Even when investigations have been extensive, some couples will have no reason with which to explain their infertility. It can also help if a man has severe erectile dysfunction. PID can damage and scar the fallopian tubes, making it virtually impossible for an egg to travel down into the womb. Treatment of tubal obstruction generally requires referral for subspecialty care.

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Evaluating the Infertile Male – Part 1. (PDF, 5 MB) Contemporary OB/GYN, 2004. If the response is exaggerated, with more than 5 sizable follicles (18 mm in diameter), and the E2 level is greater than 2500 pc/mL, cancelling the ovulation is better to avoid the risk of ovarian hyperstimulation syndrome and a high order of multiple pregnancy. 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.

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Options include intrauterine insemination (also known as IUI) or IVF with intracytoplasmic sperm injection (also known as ICSI). Other medical techniques are e.g. tuboplasty, assisted hatching, and preimplantation genetic diagnosis. For conception, sperm must reach the cervix, penetrate the cervical mucus, migrate up the uterus to the fallopian tube, undergo capacitation and the acrosome reaction to digest the zona pellucida of the oocyte, attach to the inner membrane, and release its genetic contents within the egg. Ovarian hyperstimulation syndrome (OHSS) usually results from taking medications to stimulate the ovaries, such as clomifene and gonadotrophins. 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. More than 60% of sperm should be normal, and less than 2-3% should be immature. 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). Only active, undamaged sperm are chosen for injections. As well as generally causing pelvic and menstrual pain, it is estimated that around 40% of women faced with difficulties getting pregnant have endometriosis. It is more successful in women who have previously been pregnant. Abnormal sperm: The sperm may have an unusual shape, making it harder to move and fertilize an egg. Successful Autotransplantation of an Intra-abdominal Testis to the Scrotum by Microvascular Technique. (PDF, 11 MB) The Journal of Urology, 1976. Refinements in the Methodology of Injection for Transvaginal Gamete Intra-Fallopian Transfer. (PDF, 2 MB) Human Reproduction, 1994.