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Problems with sexual intercourse These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex. This elevates the abdominal wall above the internal organs to create a working and viewing space. Linthicum, Md.: American Urological Association, Inc.; 2010. One type of ovulation problem, polycystic ovarian syndrome, is effectively treated with medications.

Intrauterine insemination (IUI.)At the time of ovulation, sperm are injected directly up into the uterus. Pregnancy with Sperm Aspiration from the Proximal Head of the Epididymis: A New Treatment for Congenital Absence of the Vas Deferens. (PDF, 2 MB) Fertility and Sterility, 1988. Furthermore, an immunological cause in the cervical mucus is possible. Intracytoplasmic Sperm Injection. (PDF, 4 MB) Chapter 47 from textbook Current Therapy in Equine Reproduction, 2006. MESA or TESA? (PDF, 115 KB) Human Reproduction, 1996.

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Gonadotrophins for idiopathic male factor subfertility. If they are blocked, it indicates the site of the block.

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Studies have shown that psychological issues contribute to reducing the sperm quality. 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. In some couples who have been unable to reproduce, tests fail to find the cause of infertility. For example, treatment for Hodgkin disease has been estimated to lead to infertility in as many as 80-100% of patients.

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Poor egg quality: Eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy. An obstruction can occur anywhere in the plumbing between the testicles and the penis. In women whose ovulation is suppressed by hyperprolactinemia (high blood levels of the pituitary hormone prolactin), ovulation may be induced with prolactin-suppressing drugs. The production of anti-sperm antibodies by the woman’s immune system can interfere with fertilization. But as it turns out, we men don't get off that easily. Scrotal surgery, including vasectomy, hydrocelectomy (5-6%), and spermatocelectomy (up to 17%), may lead to epididymal injury and subsequent obstruction.[30] Antisperm antibodies Antisperm antibodies bind to sperm, impair motility, and lead to clumping, impairing movement through the female reproductive tract and interaction with the oocyte. As a result, infertility has come to be defined as the inability to conceive within 12 months. For women, being underweight and having extremely low amounts of body fat are associated with ovarian dysfunction and infertility and they have a higher risk for preterm birth. Signs of infertility in women In women, signs of infertility may include: Pain during sex Pain during sex, or dyspareunia, can be a sign of an underlying health problem that may influence a woman's fertility.