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A combination of these factors leads to infertility 20 to 30 percent of the time. Male and female factors can exist in isolation or combination and fertility investigations, diagnoses and treatment should always be considered in the context of the couple.       Male factor Sperm problems will contribute to about 40% of infertility cases.

47 Motivational interviewing techniques for modifiable risk factors, such as obesity, tobacco, illicit drugs, and alcohol, can decrease the targeted risk factor. Treatment Treatment will depend on many factors, including the age of the person who wishes to conceive, how long the infertility has lasted, personal preferences, and their general state of health. Hofherr SE, Wiktor AE, Kipp BR, Dawson DB, Van Dyke DL. This may be used if IVF has not been effective, if there has been poor embryo growth rate, and if the woman is older. At this point, pouring the semen drop by drop should be possible. For this reason, it is less likely to adversely affect the endometrium and cervical mucus.

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Prolactin stimulates milk production during breastfeeding. Infertility may be caused by blockage of the Fallopian tube due to malformations, infections such as chlamydia or scar tissue. Large submucosal uterine fibroids may make the uterus' cavity bigger, increasing the distance the sperm has to travel.

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If he has two X chromosomes and one Y chromosome, as in Klinefelter's syndrome, the testicles will develop abnormally and there will be low testosterone and a low sperm count or no sperm. No consensus exists as to whether the medical treatment should precede surgery or vice versa. [154, 155, 156] Those who prefer medical treatment first argue that the size of the endometriosis decreases; therefore, surgery will be easier and shorter. 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. Thus it is essential to evaluate both the man and the woman. 8 A high serum FSH level (greater than 30 to 40 mIU per mL [30 to 40 IU per L]) with a low estradiol level can distinguish ovarian failure from hypothalamic pituitary failure, which typically reveals a low or normal FSH level (less than 10 mIU per mL [10 IU per L]) and a low estradiol level.

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Also, polymorphisms in folate pathway genes could be one reason for fertility complications in some women with unexplained infertility.[62] However, a growing body of evidence suggests that epigenetic modifications in sperm may be partially responsible.[63][64] Diagnosis[edit] If both partners are young and healthy and have been trying to conceive for one year without success, a visit to a physician or women's health nurse practitioner (WHNP) could help to highlight potential medical problems earlier rather than later. Instruments can be introduced through the hysteroscope, allowing the surgeon to remove or correct any anatomic abnormalities. Infection and Disease: Mumps, tuberculosis, brucellosis, gonorrhea, typhoid, influenza, smallpox, and syphilis can cause testicular atrophy.  A low sperm count and low sperm motility are indicators of this condition.  Also, elevated FSH levels and other hormonal problems are indicative of testicular damage.  Some STDs like gonorrhea and chlamydia can cause infertility by blocking the epididimis or tubes.  These conditions are usually treated by hormonal replacement therapy and surgery in the case of tubular blockage. However, hormones are not the main problem in 97% of infertile men. Women in group III can conceive only with oocyte donation and in vitro fertilization. Although 60% of patients have evidence of antisperm antibodies after vasectomy, the clinical significance has not been completely elucidated. Estrogen excess may be seen in patients with Sertoli cell tumors, Leydig tumors, liver failure, or severe obesity. Exposure to some chemicals: Some pesticides, herbicides, metals, such as lead, and solvents have been linked to fertility problems in both men and women. Demographic definitions of infertility An inability of those of reproductive age (15-49 years) to become or remain pregnant within five years of exposure to pregnancy. (DHS2) An inability to become pregnant with a live birth, within five years of exposure based upon a consistent union status, lack of contraceptive use, non-lactating and maintaining a desire for a child. (Trends in prevalence4).