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Chlamydia test: Chlamydia can affect fertility, but antibiotics can treat it. It delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH. Other testing may be needed based on circumstances, including testicular biopsy, genetic testing, and imaging (Table 36–8,10,19,20). Radiation therapy: If this is aimed near the reproductive organs, it can increase the risk of fertility problems.

41 Treatment of Unexplained Infertility Jump to section + Couples who have no identified cause of infertility should be counseled on timing of intercourse for the most fertile period (i.e., the six days preceding ovulation). In humans, infertility is the inability to become pregnant after one year of intercourse without contraception involving a male and female partner.[2] There are many causes of infertility, including some that medical intervention can treat.[3] Estimates from 1997 suggest that worldwide about five percent of all heterosexual couples have an unresolved problem with infertility. Microsurgery of the Male Genitalia for Infertility. (PDF, 8 MB) Chapter 59 from Reconstructive Urologic Surgery, 1994. In women, both smoking and alcohol use are associated with lower rates of conception and increased rates of spontaneous abortion. For in-vitro fertilization, a 100,000 of sperm are necessary and, for the intracytoplasmatic sperm injection, only a few sperms are required.

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At least one open tube is required for IUI, and any sperm abnormality cannot be severe, otherwise the sperm will not be able to swim to and fertilize the egg. Hormone imbalances Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. The doctor or WHNP may also be able to suggest lifestyle changes to increase the chances of conceiving.[65] Women over the age of 35 should see their physician or WHNP after six months as fertility tests can take some time to complete, and age may affect the treatment options that are open in that case. In some cases, the reproductive urologist can improve semen function by recommending certain lifestyle changes, by hormonal treatments, or by surgery. Vasectomy Reversal. (PDF, 733 KB) The New England Journal of Medicine, 1977.

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Once the follicular diameter reaches 18 mm and the E2 level is below 2000 pc/mL, ovulation is triggered by the administration of hCG (10,000 IU IM). The couple should make sure to have sex during the three days before ovulation. Once the fluid containing the eggs is removed from the follicles into the vials, they are handed to the embryologist who finds the eggs, places them in tiny droplets on a Petri dish, and then fertilizes the eggs using their partner’s or donor sperm. Female factor Dysfunction of the female reproductive organs is also apparent in around 40% of infertile couples. 6-Mb Deletion of the Human Y Chromosome Persists Through Balance Between Recurrent Mutation and Haploid Selection. (PDF, 295 KB) Nature Genetics, 2003. A doctor or WHNP takes a medical history and gives a physical examination.

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Exposure to chemicals: Pesticides, for example, may increase the risk. Testicular Transplantation and Autotransplantation. (PDF, 8 MB) Chapter 22 of textbook, Extracorporeal and Microvascular Surgery, 1982. Patients who do not achieve ovulation after three to six cycles should be referred to an infertility specialist for further treatment. Postcoital testing and antisperm antibody testing are no longer considered useful in this evaluation. It is possible that this mechanism evolved to protect the mother’s health. In the body, testosterone circulates 2% in the free form, 44% bound to sex hormone–binding globulin (SHBG), and 54% bound to albumin. Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Poor egg quality: Eggs that are damaged or develop genetic abnormalities cannot sustain a pregnancy.