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ICSI with Epididymal and Testicular Sperm in Azoospermic Men. (PDF, 2 MB) From Treatment of Infertility: The New Frontiers, 1998. Gracia CR, Sammel MD, Coutifaris C, Guzick DS, Barnhart KT. Conventional In-vitro Fertilization vs Intracytoplasmic Sperm Injection for Patients Requiring Microsurgical Sperm Aspiration. (PDF, 3 MB) Human Reproduction, 1994. If you and your partner agree, extra embryos can be frozen and saved to use later. Lifestyle and environmental factors such as smoking, alcohol and drugs, poor eating habits, exposure to increases in testicular temperature (for example, in professions where the worker spends many hours sitting down) and exposure to toxins are factors that compromise semen quality. Women in group III can conceive only with oocyte donation and in vitro fertilization.

To examine the sperm motility in the cervical mucus, the postcoital test is made. Medications, treatments, and drugs Some drugs can affect fertility in a woman. A low testosterone level with a low FSH level signals a secondary cause.

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6) Male factors affecting sperm function: Male factor infertility has been associated as a contributing factor causing infertility in 40-50% percent of cases, and as the sole cause for infertility in 15-20% percent of cases. An ultrasonography unit and an endocrine laboratory capable of performing daily determinations of E2, FSH, and LH are necessary. [186, 187, 188, 189] Multiple adverse effects and complications may occur during the use of the gonadotropins, including (1) multiple pregnancy (24-33%), (2) ectopic pregnancy (5-8%), (3) miscarriages (15-21%), (4) ovarian torsion and rupture, and (5) ovarian hyperstimulation syndrome, which is the most severe. [190, 191] Whittemore et al, using a large combined data set derived from case-controlled studies in the United States, showed that the increase of ovarian cancer associated with infertility might be due to the use of fertility drugs. [192] Ovarian hyperstimulation syndrome is an iatrogenic condition that occurs in patients undergoing ovulation induction with hMG or controlled ovarian hyperstimulation (COH) for assisted reproductive technologies. As in the case of sterility, the process will get under way right away in those cases where there is a background of reproduction issues. There are also a number of sperm production problems that can contribute to infertility, including: Scrotal varicose veins (varicoceles)  Scrotal varicose veins (varicoceles) are swollen veins causing your testicles to get hotter and affect the production of sperm  These are treated with surgery  Testicular injury   Serious trauma to the testicles such as becoming twisted (torsion) can affect sperm production  Damage from playing sports or an accident can rupture the vessels that supply blood to the testicles  Previous injuries can’t be treated, but an ART treatment may help you to conceive Undescended testicles  In the uterus, baby boys’ testicles form in their abdomen and descend into their scrotum shortly before birth  Some men’s testicles don’t descend before they are born (cryptorchidism), although in these cases they usually drop in the first six months after birth  If left untreated, undescended testicles can affect fertility Testicular cancer  This happens when a malignant tumour in the testicle destroys testicular tissue  If undetected, testicular cancer can spread to other parts of the body  This is treated either by surgery, medication, radiotherapy or chemotherapy  However, cancer therapy can also damage sperm production  Genetic defects  Sometimes, genetic information on the Y chromosome (which is only present in men) is deleted (micro-deletions),6 which can reduce the production of sperm  Depending on where the micro-deletion is on the chromosome, this may be treated by surgically extracting sperm from part of your reproductive tract  However, some couples may need to consider using a donor sperm to conceive Mumps Contracting mumps (or mumps-related orchitis) after puberty may damage the sperm-producing cells in your testicles,  causing infertility or subfertility7 Usually, only one testicle is affected and if you have one functioning testicle you may not need treatment  However, some couples may need to use a sperm donor in order to conceive Anti-sperm antibodies  Anti-sperm antibodies are large proteins in your blood that are hostile to sperm  They can cause sperm to clump together and prevent them from swimming, or they may mistake sperm cells for an infection and try to destroy them  This can be treated using an ART treatment   Lifestyle   Sperm production can be affected by a range of lifestyle factors, including smoking, drinking, drugs, stress, overweight and unhealthy food Environmental factors can also affect your sperm quality, including overheating of your testicles, some sexual lubricants, the chemicals involved in certain manufacturing, painting or printing jobs   These factors are treated by making lifestyle changes, such as wearing loose clothing to avoid overheating Hormonal problems  Hormonal problems are rarely the cause of male infertility problems  However, some men have a natural deficiency in follicle-stimulating hormone (FSH) and luteinising hormone (LH), which prevents the testicles from producing testosterone or developing healthy sperm  Hormonal problems can usually be treated with medication Obstruction problems Blocked sperm ducts  Occasionally, male sperm ducts (epididymis and vas deferens) can become blocked, meaning that your semen doesn’t contain any sperm  This can be treated with surgery, or sperm may be surgically extracted from part of your reproductive tract  Vasectomy  Some men have had a previous vasectomy to stop them being able to conceive  This can sometimes be reversed using surgery  The procedure’s success depends on how long ago your vasectomy was performed  Previous infections  Infections can cause scarring or adhesions (organs sticking together) in your sperm ducts  This can usually be treated with surgery  Does age affect male fertility?

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The Disappearing Male. (PDF, 1 MB) From Towards Reproductive Certainty, 1999. Chemotherapy: Some types may significantly reduce sperm count. Checking testosterone levels is advisable because an elevation above the reference range has a negative feedback effect on sperm production. IVF in action Intracytoplasmic sperm injection (ICSI): A single sperm is injected into an egg to achieve fertilization during an IVF procedure. Ejaculation disorders: If the ejaculatory ducts are blocked, semen may be ejaculated into the bladder Hormonal imbalance: Hypogonadism, for example, can lead to a testosterone deficiency.

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The corollary to this is that, by definition, failure to conceive in women under 35 isn't regarded with the same urgency as it is in those over 35. Immediate surgery is needed and, sadly, the tube on that side will be lost. Most couples skip the invasive laparoscopic surgery and do treatments with intrauterine inseminations and then IVF if inseminations are not successful. The Male-specific Region of the Human Y Chromsome is a Mosaic of Discrete Sequence Classes. (PDF, 754 KB) Nature, 2003. Semen and sperm Sometimes the sperm cannot travel effectively to meet the egg. Limits were placed on language and human race as well. Gracia CR, Sammel MD, Coutifaris C, Guzick DS, Barnhart KT. Uterine surgery: - Women with amenorrhoea who are found to have intrauterine adhesions should be offered hysteroscopic adhesiolysis because this is likely to restore menstruation and improve the chance of pregnancy. Between 45 and 50 percent of cases are thought to stem from factors that affect the man. New Treatment for Infertility Due to Congenital Absence of Vas Deferens. (PDF, 1 MB) The Lancet, 1987. Ovarian Hyperstimulation Syndrome (OHSS) The syndrome occurs due to treatment with medicamentous ovulation inductors. Tubal microsurgery and laparoscopic tubal surgery: - May be more effective than no treatment. - No strong evidence. (e.g.: fimbrial end dilatation) 2. Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body. Due to the relative high cost of the equipment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices. Counseling about options should be offered to couples who are not physically able to conceive (i.e., same-sex couples or persons lacking reproductive organs).