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The main causes of tubal infertility are pelvic infections caused by bacteria such as chlamydia, previous abdominal disease or surgery and ectopic pregnancy. • Endometriosis is characterised by excessive growth of the lining of the uterus. Microscopic Vasoepididymostomy: Specific Microanastomosis to the Epididymal Tubule. (PDF, 15 MB) Fertility and Sterility, 1978. Some suggest that the number of times a couple has intercourse should be reduced to increase sperm supply, but this is unlikely to make a difference. It is often prescribed for Crohn's disease or rheumatoid arthritis. Varicocele The veins in a man’s scrotum (sac) can become too large.

This seems to result in a significant improvement in fertility, although some studies disagree. 50% are female causes with 25% being due to anovulation and 25% tubal problems/other.[74] In Sweden, approximately 10% of couples wanting children are infertile.[75] In approximately one third of these cases the man is the factor, in one third the woman is the factor, and in the remaining third the infertility is a product of factors on both parts. In-vitro fertilization and donor insemination are major procedures involved. Men should undergo evaluation with a semen analysis.

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Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. Fertilizing Capacity of Epididymal and Testicular Sperm using Intracytoplasmic Sperm Injection (ICSI). (PDF, 7 MB)Reproduction, Fertility and Development, 1995.

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The Relationship of Abnormal Semen Parameters to Male Fertility. (PDF, 4 MB) Human Reproduction, 1989. It also shows if there are any abnormalities in the uterine cavity, such as polyps or submucous fibroids; or abnormalities of the tubes, such as evidence of salpingitis. The use of aromatase inhibitors for ovulation induction in premenopausal women is controversial due to the possibility of fetal toxicity and fetal malformations raised by one abstract. [172] However, 2 subsequent publications have shown no evidence of fetal malformations with the letrozole and no difference in birthweight compared with spontaneous conceptions. [173, 174] Furthermore, based on the half-life of each drug, administration in the early follicular phase should result in clearance of the aromatase inhibitors before implantation takes place. Transmission of Male Infertility to Future Generations: Lessons from the Y Chromosome. (PDF, 303 KB) Human Reproduction Update, 2002.

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For some women, these devices do not detect the LH surge, or high levels of LH are a poor predictor of ovulation; this is particularly common in women with PCOS. However, if you haven’t had your period in months, it might be a good idea to seek medical advice.  Heavy and/or painful periods: Periods that hamper your daily activity may be a symptom of fibroids in the uterus or endometriosis. Normal Fertilization of Human Oocytes after Testicular Sperm Extraction and Intracytoplasmic Sperm Injection.(PDF, 2 MB) Fertility and Sterility, 1994. A Modern View of Male Infertility. (PDF, 7 MB) From The Infertile Male: Advanced Assisted Reproductive Technology, 1994. MESA or TESA? (PDF, 115 KB) Human Reproduction, 1996. Known male factor semen abnormalities: If a male partner has a history of infertility with a prior partner, or if there are abnormalities on his semen analysis, then we advise earlier fertility evaluation, ideally within 6 months of attempting pregnancy. Difficulties getting pregnant increase from 35 years of age. Pulsatile GnRH and HCG have been used but result in only 20% achieving complete spermatogenesis. Drugs used for both women and men[67] include clomiphene citrate, human menopausal gonadotropin (hMG), follicle-stimulating hormone (FSH), human chorionic gonadotropin (hCG), gonadotropin-releasing hormone (GnRH) analogues, aromatase inhibitors, and metformin. Microsurgery Successful in Vasectomy Reversals. (PDF, 156 KB) The New York Times, 1975.