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Primary vs. secondary infertility[edit] Primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months, during which they have not used any contraceptives.[14] The World Health Organisation also adds that 'women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility'.[15] Secondary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months since their last live birth, during which they did not use any contraceptives.[15] Thus the distinguishing feature is whether or not the couple have ever had a pregnancy which led to a live birth. Other considerations include preconception screening and vaccination for preventable diseases such as rubella and varicella, sexually transmitted infections, and cervical cancer, based on appropriate guidelines and risk. If both tubes are blocked, then in vitro fertilization (IVF) is required. The procedure is performed in an outpatient setting in the vast majority of cases, and recovery time can be as little as a few days. Guidelines and recommendations were retrieved from the best evidence reviews at the American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Canadian Fertility and Andrology Society (CFAS), European Society of Human Reproduction and Embryology (ESHRE), Human Fertilisation and Embryology Authority (HFEA), Royal College of Obstetricians and Gynaecologists (RCOG), and the World Health Organization (WHO).

Large submucosal uterine fibroids may make the uterus' cavity bigger, increasing the distance the sperm has to travel. Analyses of the CFTR Gene in 67 Patients. (PDF, 4 MB) The American Journal of Human Genetics, 1995. Vasectomy. (PDF, 5 MB) From the Encyclopedia of Reproduction, 1999. Women attempting pregnancy at age 40 or older have a 50% decreased fertility rate and a two-fold to three-fold increased risk of spontaneous abortion compared with younger women.

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Ovarian Transplantation between Monozygotic Twins Discordant for Premature Ovarian Failure. (PDF, 315 KB) The New England Journal of Medicine, 2005. Congenital Absence of the Vas Deferens: The Fertilizing Capacity of Human Epididymal Sperm. (PDF, 3 MB) New England Journal of Medicine, 1990.

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The elevated temperature hinders the maturation process of sperm, which develop best in an environment that is slightly cooler than body temperature. Society and culture[edit] Perhaps except for infertility in science fiction, films and other fiction depicting emotional struggles of assisted reproductive technology have had an upswing first in the latter part of the 2000s decade, although the techniques have been available for decades.[76] Yet, the number of people that can relate to it by personal experience in one way or another is ever growing, and the variety of trials and struggles is huge.[76] Pixar's Up contains a depiction of infertility in an extended life montage that lasts the first few minutes of the film.[77] Other individual examples are referred to individual subarticles of assisted reproductive technology Ethics[edit] There are several ethical issues associated with infertility and its treatment. Its treatment depends on the etiologic factor, but, in many instances, the underlying cause remains unknown. About 10% to 15% of couples will not be able to achieve pregnancy after one year of unprotected intercourse. Laparotomy is indicated in patients with severe pelvic adhesions that compromise the bowel, ovaries, and tubes, with obliteration of the cul-de-sac. [129] The aim of the procedure is to correct what is necessary to allow the normal transport of the gametes; complete restoration of the anatomy is not intended. [130] Lysis of adhesions should be meticulous, using hydrodissection and fine instruments. Paternal age > or = 40 years: an important risk factor for infertility.

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This can make it difficult for the embryo to implant. In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment. One of the requirements for this procedure is that a woman should have at least 1 undamaged fallopian tube. The procedure is performed 30-34 hours after the spontaneous LH surge or 36 hours after the administration of 10,000 U of hCG (human chorionic gonadotropin). [110] The sperm is delivered into the endometrial cavity using an intrauterine insemination catheter. A doctor may diagnose infertility if a woman has not become pregnant after 1 year of trying. Diagnosis and Management of Hypogonadism, Infertility, and Impotence. (PDF, 13 MB) Chapter 22 of textbook,Male Reproductive Dysfunction, 1986. It makes the pituitary gland release more follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Further investigations may be requested according to the clinical presentation and the results of preliminary tests.