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For men, a visual inspection of sexual characteristics can identify such endocrinopathies as hypogonadism (a condition resulting in atrophy or deficient development of secondary sexual characteristics) or Klinefelter’s syndrome (a genetic anomaly often associated with infertility). For example, polycystic ovarian syndrome is when the eggs only partially developed within the ovary and there is an excess of male hormones. Less common factors The following other factors may also be responsible for infertility in a smaller proportion of cases: • Genetic abnormalities within eggs, sperm or both • An abnormal uterine cavity, including the presence of fibroids or polyps • Immunological infertility, whereby either the male or female partner produces anti-bodies against sperm cells or implantation of an embryo • Abnormal cervical mucus which hinders the passage of sperm to the uterus and fallopian tubes Unexplained infertility Even when investigations have been extensive, some couples will have no reason with which to explain their infertility. Thus 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. (Trends in prevalence4). Ovary Transplantation for Fertility Preservation in Cancer Patients: Fresh and Frozen. (PDF, 1 MB) Chapter 42 from textbook Clinial Infertility, 2010.

Issues with ejaculation Similarly, an inability to ejaculate is a sign that it might be time to visit a doctor. 6) Male factors affecting sperm function: Male factor infertility has been associated as a contributing factor causing infertility in 40-50% percent of cases, and as the sole cause for infertility in 15-20% percent of cases. Endometriosis can be treated with hormones that suppress the displaced endometrial tissue or the tissue can be removed by a surgical procedure. Recombination Between Palindromes P5 and P1 on the HUman Y Chromosome Causes Massive Deletions and Spermatogenic Failure. (PDF, 786 KB) The American Journal of Human Genetics, 2002.

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Several methods are available to detect antisperm antibodies, such as radioimmunoassay and enzyme-linked immunosorbent assay, but the most specific test is the immunobead test. A karyotype test and a Y chromosome test for microdeletions are indicated in patients with nonobstructive azoospermia or severe oligospermia (< 5 million sperm/mL), although indications are expanding.[20] Klinefelter syndrome Klinefelter syndrome is the most common chromosomal cause of male infertility, estimated to be present in 1 per 500-1000 male births.

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Unexpected resilience of species with temperature-dependent sex determination at the Cretaceous–Palaeogene boundary. (PDF, 238 KB) Biology Letters, 2010. The eggs may never be released or they may only be released in some cycles.

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37,38 The addition of 1,500 to 1,700 mg of metformin (Glucophage) daily may increase ovulation and pregnancy rates, but it does not significantly improve live birth rates over clomiphene alone. 48 However, there is no firm evidence that preconception counseling leads to increased live birth rates, in part because no studies on this topic have been performed. The hypothalamus acts on the false information that the estrogen level in circulation is low, increasing production of FSH and LH, thus stimulating follicular growth. However, about one in five cases of infertility has no clear diagnosed cause.[73] In Britain, male factor infertility accounts for 25% of infertile couples, while 25% remain unexplained. The Disappearing Y Chromosome – “I Told You So!” (PDF, 266 KB) Human Reproduction, 1997. Gerrits T, Shaw M (2010). "Biomedical infertility care in sub-Saharan Africa: a social science review of current practices, experiences and view points". Couples who do not conceive after treatment for six cycles with documented ovulation should also consider referral to an infertility specialist.