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Erectile dysfunction, vaginismus (painful involuntary spasm of vagina preventing intercourse) and dyspareunia (pain during sexual intercourse) can explain involuntary childlessness in some couples. Hormonal Problems A small percentage of male infertility is caused by hormonal problems.  The hypothalamus-pituitary endocrine system regulates the chain of hormonal events that enables testes to produce and effectively disseminate sperm.  Several things can go wrong with the hypothalamus-pituitary endocrine system: · The brain can fail to release gonadotrophic-releasing hormone (GnRH) properly.  GnRH stimulates   the hormonal pathway that causes testosterone synthesis and sperm production.  A disruption in   GnRH release leads to a lack of testosterone and a cessation in sperm production. · The pituitary can fail to produce enough lutenizing hormone (LH) and follicle stimulating hormone   (FSH) to stimulate the testes and testosterone/sperm production.  LH and FSH are intermediates   in the hormonal pathway responsible for testosterone and sperm production. · The testes� Leydig cells may not produce testosterone in response to LH stimulation. · A male may produce other hormones and chemical compounds which interfere with the   sex-hormone balance. It binds in a part of the brain called the hypothalamus, which is essential in stimulating the ovary to grow and release an egg. It is important to tell a doctor if excessive mental and emotional stress develop. Hysterosalpingogram (HSG) – This test is essential for evaluating fallopian tubal patency, uterine filling defects such as fibroids and polyps, and scarring of the uterine cavity (Asherman syndrome). Any condition that interferes with these events may result in infertility.

2 or more - sperm concentration: 15 million spermatozoa per ml or more - total sperm number: 39 million spermatozoa per ejaculate or more - total motility: 40% or more motile or 32% or more with progressive motility - vitality: 58% or more live spermatozoa - sperm morphology (percentage of normal forms): 4% or more Basic Work-up for Infertility 13. Evidence of ovulation: 1. Alternatively, the patient may bypass surgical treatment and proceed directly to intrauterine insemination or in vitro fertilization, depending on the severity and the female partner's age. About one out of every three cases of infertility is due to the man alone, and we're somehow involved in infertility about half the time.

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Pregnancies after Testicular Sperm Extraction and Intracytoplasmic Sperm Injection in Non-obstructive Azoospermia. (PDF, 3 MB) Human Reproduction, 1995. Conventional IVF vs ICSI (Intra Cytoplasmic Sperm Injection) for Patients Requiring Microsurgical Epididymal Sperm Aspiration (MESA). (PDF, 4 MB) Chapter from textbook, Frontiers in Endocrinology: Perspectives on Assisted Reproduction, 1994. As sperm move from the head to the tail, they mature and acquire fertilization capacity.

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The first phase develops between the second and seventh day after ovulation, and the second phase only occurs if the patient becomes pregnant. If a woman can get pregnant but keeps having miscarriages or stillbirths, that's also called infertility. The more fetuses there are, the higher the risk of premature labor. Blockage of the ejaculatory duct: Sperm can be extracted directly from the testicles and injected into an egg in the laboratory. Testicular histology reveals hyalinization of seminiferous tubules.[21] Some men with Klinefelter syndrome may be able to conceive with the help of assisted reproductive techniques.

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If the correction is not done, it may be harder for the sperm to get to the female's cervix. 6) Surgery – After a thorough history, physical examination, and ultrasound are performed, your doctor may recommend surgery to correct and abnormality. A Modern View of Male Infertility. (PDF, 7 MB) From The Infertile Male: Advanced Assisted Reproductive Technology, 1994. Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body. Egg donation. This can help you if you have ovaries that don't work right but you have a normal uterus. The Relationship of Abnormal Semen Parameters to Male Fertility. (PDF, 4 MB) Human Reproduction, 1989. Endometrial polyps Endometrial polyps are growths found in the uterine cavity. This can happen as a result of: an infection of your testicles testicular cancer  testicular surgery a problem with your testicles you were born with (a congenital defect) when one or both testicles hasn't descended into the scrotum, the loose sac of skin that contains your testicles (undescended testicles) injury to your testicles Sterilisation Some men choose to have a vasectomy if they don't want children or any more children.  It involves cutting and sealing off the tubes that carry sperm out of your testicles (the vas deferens) so your semen will no longer contain any sperm. Placenta Percreta Invading Bladder. (PDF, 2 MB) The Journal of Urology, 1973. A typical adverse effect can be ovarian hyperstimulation. A woman of reproductive age who is using artificial insemination to conceive (with either partner or donor sperm) after 6 failed trials. Consider earlier referral to infertility specialists where: - the woman is aged 36 years or over. - there is a known clinical cause of infertility or a history of predisposing factors for infertility. - treatment is planned that may result in infertility (such as treatment for cancer). - People who are concerned about their fertility and who are known to have chronic viral infections such as hepatitis B, hepatitis C or HIV. NIH: National Institute of Child Health and Human Development Start Here Defining Infertility (American Society for Reproductive Medicine) - PDF Infertility (Mayo Foundation for Medical Education and Research) Also in Spanish Infertility and Fertility (National Institute of Child Health and Human Development) Infertility FAQ's (Centers for Disease Control and Prevention) Optimizing Natural Fertility (American Society for Reproductive Medicine) - PDF Also in Spanish Pregnancy Problems? Normal fertility is observed in three fourths of patients with unilateral mumps orchitis and in one third of patients in bilateral orchitis. The Disappearing Male. (PDF, 1 MB) From Towards Reproductive Certainty, 1999. The prostate gland contributes approximately 10-30% (0.