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In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles. There may be testicular malformations, hormone imbalance, or blockage of the man's duct system. In addition to a careful history, a physical evaluation may also be performed. Any abnormality in the tubes can affect or impede conception: hydrosalpinx, tubal occlusion or salpingitis. The fertilized embryo is then transferred to womb. Surprisingly, most patients have normal libido, erections, and orgasms, so testosterone therapy has only a limited role; exogenous testosterone may also suppress any underlying sperm production.

7 million women reported impaired ability to get pregnant or carry a baby to term. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Several studies have reported different causes of infertility [7-9]. The average pregnancy rate achieved after a natural-cycle intrauterine insemination is 8%.

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This combination of laboratory test results may indicate ovarian insufficiency or diminished ovarian reserve. Classic Klinefelter syndrome has a 47, XXY karyotype and is caused by a nondisjunction during the first meiotic division, more commonly of maternal origin; mosaic forms are due to nondisjunction following fertilization. Hyperprolactinemia: If prolactin levels are high, and the woman is not pregnant or breastfeeding, it may affect ovulation and fertility.

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In closed social groups, a degree of rejection (or a sense of being rejected by the couple) may cause considerable anxiety and disappointment. Full history taking of both partners usually denotes the underlying problem [17-23], (Appendix 1).

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1) Advancing maternal age: Historically before the latter 20th century, women were conceiving in their teens and twenties, when age-related abnormalities with the egg were not evident. They can be blocked due to numerous causes, including infections,  trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions. Microsurgery of the Male Genitalia for Infertility. (PDF, 8 MB) Chapter 59 from Reconstructive Urologic Surgery, 1994. The woman may be given a low dose of ovary stimulating hormones. With this condition, boys are born with a different chromosomal make-up, generating an absence of spermatozoa production or minimum generation of sperm that ceases at an early age. A low testosterone level with a low FSH level signals a secondary cause. Congenital Absence of the Vas Deferens: The Fertilizing Capacity of Human Epididymal Sperm. (PDF, 3 MB) New England Journal of Medicine, 1990. Excess alcohol consumption: This may lower male fertility. Fibroids Non-cancerous growths called fibroids in or around the womb can affect fertility.