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Assisted conception The following methods are currently available for assisted conception. Hormonal Problems A small percentage of male infertility is caused by hormonal problems.  The hypothalamus-pituitary endocrine system regulates the chain of hormonal events that enables testes to produce and effectively disseminate sperm.  Several things can go wrong with the hypothalamus-pituitary endocrine system: · The brain can fail to release gonadotrophic-releasing hormone (GnRH) properly.  GnRH stimulates   the hormonal pathway that causes testosterone synthesis and sperm production.  A disruption in   GnRH release leads to a lack of testosterone and a cessation in sperm production. · The pituitary can fail to produce enough lutenizing hormone (LH) and follicle stimulating hormone   (FSH) to stimulate the testes and testosterone/sperm production.  LH and FSH are intermediates   in the hormonal pathway responsible for testosterone and sperm production. · The testes� Leydig cells may not produce testosterone in response to LH stimulation. · A male may produce other hormones and chemical compounds which interfere with the   sex-hormone balance.

Blockage of the ejaculatory duct: Sperm can be extracted directly from the testicles and injected into an egg in the laboratory. IVF was a major breakthrough because it allowed for successful pregnancies in women that were previous deemed permanently infertile, such as when the fallopian tubes are both markedly damaged. Infertility is caused by primary testicular failure, and most patients are azoospermic. Several studies have demonstrated that an increase in BMI is correlated with a decrease in sperm concentration, a decrease in motility and an increase DNA damage in sperm. Idiopathic Hypercalciuria. (PDF, 1 MB) New England Journal of Medicine, 1971. Birth after Preimplantation Diagnosis of the Cystic Fibrosis F508 Mutation by Polymerase Chain Reaction in Human Embryos Resulting from Intracytoplasmic Sperm Injection with Epididymal Sperm. (PDF, 2 MB) The Journal of the American Medical Association, 1994.

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In those with azoospermia and a varicocele, sperm may appear after repair in up to one third, but most of these men return to an azoospermic state within a few months. Summary Infertility is a significant medical and social problem affecting couple worldwide. It is a sensitive issue that should be handled with great care with continuous professional counselling. Most young couples will conceive naturally within 2 years. Evaluation of both partners for causes is essential. Treatment depends on the cause, and varies from medical treatment to surgery to ART. Egg donation. This can help you if you have ovaries that don't work right but you have a normal uterus. ART includes all fertility treatments in which both eggs and sperm are manipulated. Role of Semen Analysis in Subfertile Couples. (PDF, 250 KB) Fertility and Sterility, 2010. Vasectomy and its Microsurgical Reversal. (PDF, 17 MB) Urologic Clinics of North America, 1978.

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A small ejaculate volume may be observed in patients with retrograde ejaculation, absence of the vas deferens or seminal vesicles, ductal obstruction, hypogonadotropism, or poor sympathetic response. The facilities available and the skills of personnel are the major determining factors for the success rate. A varicocele is like a varicose vein that can appear in the leg. Medical conditions Some medical conditions can affect fertility. Sherman Silber: Be Fruitful and Multiply. (PDF, 6 MB) Lifestyles Magazine, 1999.

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Blood, urine, and imaging tests can be done to discover why you are having trouble getting pregnant. Role of Epididymis in Sperm Maturation. (PDF, 3 MB) Urology, 1989. Radiation therapy: This can impair sperm production. Gonadotropin releasing hormone analogs (GnRH-a) are synthetic peptides whose structure is similar to the natural GnRH. The application of artificial insemination usually is made after previous medicamentous treatment. Problems in the uterus or fallopian tubes can prevent the egg from traveling from the ovary to the uterus, or womb. Surgical sperm aspiration: The sperm is removed from part of the male reproductive tract, such as the vas deferens, testicle, or epididymis. Motility, adhesions and focusses of endometriosis can precisely be assessed by laparoscopy with blue instillation. Several studies have demonstrated that an increase in BMI is correlated with a decrease in sperm concentration, a decrease in motility and an increase DNA damage in sperm. Povey AC, Clyma JA, McNamee R, et al.; Participating Centres of Chaps-UK.