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3) Tubal occlusion (blockage): As discussed previously, a history of sexually transmitted infections including chlamydia, gonorrhea, or pelvic inflammatory disease can predispose a woman to having blocked fallopian tubes. She records this temperature on a sheet of graph paper.

They can be blocked due to numerous causes, including infections,  trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions. Gracia CR, Sammel MD, Coutifaris C, Guzick DS, Barnhart KT. For example; a woman who has no history suggestive of previous pelvic inflammatory disease or endometriosis, there is no justification to request a laparoscopy especially after normal hysterosalpingography study [33].

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17 Evaluation of male infertility starts with a history and physical examination focusing on previous fertility, pelvic or inguinal surgeries, systemic diseases, and exposures. Fimbrioplasty for fimbria agglutination or phimosis without destruction of the cilial epithelium is equally successful. In reproductive medicine, the most common surgical procedures are laparoscopy, hysteroscopy, and abdominal myomectomy (removal of uterine fibroids). This can happen as a result of: an infection of your testicles testicular cancer  testicular surgery a problem with your testicles you were born with (a congenital defect) when one or both testicles hasn't descended into the scrotum, the loose sac of skin that contains your testicles (undescended testicles) injury to your testicles Sterilisation Some men choose to have a vasectomy if they don't want children or any more children.  It involves cutting and sealing off the tubes that carry sperm out of your testicles (the vas deferens) so your semen will no longer contain any sperm. 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. Causes include: Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes.

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Female and male factors are equally responsible for infertility. ICSI can be performed when sperm counts are extremely low or abnormal.

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Patients present with short stature, precocious puberty, small testis, and occasional bilateral testicular rests. Microsurgery and Andrology. (PDF, 5 MB) Chapter from textbook, 1991. Then, generally one or two embryos, which have demonstrated appropriate development, are carefully and gently transferred into the uterine cavity. Metformin (Glucophage): If Clomifene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance. Noonan syndrome (46, XY) Patients with Noonan syndrome, also known as male Turner syndrome, have physical characteristics similar to that of women with Turner syndrome (45, X). Endometriosis can only be confirmed by surgery, usually laparoscopy. There may be testicular malformations, hormone imbalance, or blockage of the man's duct system. A specific portion of the androgen receptor gene, exon 1, has been studied in infertile males and a meta-analysis that involved males with idiopathic infertility and fertile controls found that infertility was directly correlated with the length of CAG repeats in this exon.[23] Y chromosome microdeletion syndrome The long arm of the Y chromosome (Yq) is considered critical for fertility, especially Yq11. If ovulation does not occur with the 50-mg dose, the CC dose must be increased in subsequent cycles to 100 mg for 5 days. Isodicentric Y Chromosomes and Sex Disorders as Byproducts of Homologous Recombination that Maintains Palindromes. (PDF, 1 MB) Cell, 2009.