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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. Microsurgery of the Male Genitalia for Infertility. (PDF, 8 MB) Chapter 59 from Reconstructive Urologic Surgery, 1994. As the duration of treatment prolonged, psychological suffering is likely to increase [6].

8 Couples with unexplained infertility may want to consider another year of intercourse before moving to more costly and invasive therapies, such as assisted reproductive technology. In 1985, Erich Mühe performed the first laparoscopic cholecystectomy. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis.(PDF, 958 KB) Reproductive BioMedicine Online, 2010.

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Uterine fibroid embolization (UFE) consists of catheterization of the uterine artery and the injection of microbeads of polyvinyl alcohol to selectively occlude the circulation of the fibroid. Bromocriptine (Parlodel): This drug inhibits prolactin production. Semen and sperm Sometimes the sperm cannot travel effectively to meet the egg. Factors like stress or heavy workouts can cause your period to temporarily disappear.

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Several studies have demonstrated that an increase in BMI is correlated with a decrease in sperm concentration, a decrease in motility and an increase DNA damage in sperm. Female age of 35 years or older: For unclear reasons, egg numbers decrease at a rapid rate as women age. Surgical ablation: - In minimal or mild endometriosis; surgical ablation or resection of endometriosis plus laparoscopic adhesiolysis improves the chance of pregnancy. - Laparoscopic resection of endometriomas may be beneficial, however recent RCTs suggest intervention only in endometriomas > 4cm. - In moderate or sever endometriosis; surgical treatment should be offered. (Debatable) - Post-operative medical treatment does not improve pregnancy rates. Testis Biopsy and the Infertile Male. (PDF, 20 MB) Chapter 15 from textbook Office Andrology, 2005.

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6 Women with risk factors for tubal obstruction, such as endometriosis, previous pelvic infections, or ectopic pregnancy, should instead be offered hysteroscopy or laparoscopy with dye to assess for other pelvic pathology. Placenta Percreta Invading Bladder. (PDF, 2 MB) The Journal of Urology, 1973. In certain advanced laparoscopic procedures, where the size of the specimen being removed would be too large to pull out through a trocar site (as would be done with a gallbladder), an incision larger than 10 mm must be made. Donor semen should be free from any STI-producing organisms, including HIV. A high serum estradiol level (greater than 60 to 80 pg per mL [220 to 294 pmol per L]) in conjunction with a normal FSH level has also been associated with lower pregnancy rates. Long-term Economic Benefits Attributed to IVF-conceived Children: A Lifetime Tax Calculation. (PDF, 225 KB) The American Journal of Managed Care, 2008. Severe ovarian hyperstimulation syndrome is characterized by easily palpable ovaries, severe ascites, nausea, vomiting, diarrhea, shortness of breath, hydrothorax, peripheral edema, oliguria, hemoconcentration (eg, hematocrit level >48% and hemoglobin level >16 g), and creatinine level greater than 1. Microsurgery and Andrology. (PDF, 5 MB) Chapter from textbook, 1991. Histologic endometrial dating is not considered reliable nor is it predictive of fertility. It is often defined as not conceiving after 12 months of regular sexual intercourse without the use of birth control. Endometriosis may be treated through laparoscopic surgery.