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In addition to stimulation by FSH, Sertoli cell function is modulated by intratesticular testosterone and signals from peritubular myoid cells. Clomiphene citrate (Clomid, Serophene) The chemical formula for clomiphene citrate (CC) is 2-[p -(2-chloro-1,2-difhenylvinyl) phenoxy] triethylamine dihydrogen citrate.

National Collaborating Centre for Women's and Children's Health. Oligospermia is defined as fewer than 20 million sperm/mL, severe oligospermia is less than 5 million/mL, and azoospermia is defined as no sperm present. Further investigations may be requested according to the clinical presentation and the results of preliminary tests.

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Investigations Infertile couples are usually adviced to start their investigations after 12 months of trying to conceive or after 6 months if the female partner is more than 35 years old or immediately if there is an obvious cause for their infertility or subfertility [16]. Blood test: This can assess hormone levels and whether a woman is ovulating. BMI (body mass index) may be a significant factor in fertility, as an increase in BMI in the male by as little as three units can be associated with infertility. Patients who do not ovulate because of a fault in the pituitary gland may receive this drug as an injection. Intra-uterine insemination for male subfertility. The fertilized egg moves down the fallopian tube towards the uterus.

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It is an approach to disseminate the recommended medical care of infertile couple to the practicing clinicians. Today, it is feasible by using a gestational carrier. Ultrasound: This may reveal issues such as ejaculatory duct obstruction or retrograde ejaculation. Luteal phase support. (and cryopreservation choice offered if good quality embryos are available) IVF/ICSI 37. Down-regulation: - to avoid premature LH surge and spontenous ovulation. - either GnRH agonist protocol or GnRH antagonist protocol. - always use GnRH antagonist protocol in women with high risk of OHSS.

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These drugs also can also help you get pregnant by causing your ovaries to release multiple eggs. Have you had any sexually transmitted infections or abnormal pap smears? There is no reliable means to predict whether the use of any treatment option will be successful and after how many attempts. In men who have the necessary reproductive organs to procreate, infertility can be caused by low sperm count due to endocrine problems, drugs, radiation, or infection. Paternal age > or = 40 years: an important risk factor for infertility. 6 The initial history should cover menstrual history, timing and frequency of intercourse, previous use of contraception, previous pregnancies and outcomes, pelvic infections, medication use, occupational exposures, substance abuse, alcohol intake, tobacco use, and previous surgery on reproductive organs. Algorithm for infertility evaluation. (ART = assisted reproductive technology.) Lifestyle Factors Jump to section + All couples should be counseled to abstain from tobacco use, limit alcohol consumption, and aim for a body mass index less than 30 kg per m2 to improve their chances of natural conception or using assisted reproductive technology. The predictable pregnancy rate for this group is about 5% after timed intercourse, 10% after superovulation with intrauterine insemination (IUI), and 15% to 25% after assisted reproduction techniques (ART) [41]. Congenital blockage of the ductal system An increased rate of duct obstruction is observed in children of mothers who were exposed to DES during pregnancy. The normal working of the male reproductive system involves first the production of sufficient numbers of functional sperm cells and then the delivery of these sperm to the ejaculate.