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A small ejaculate volume may be observed in patients with retrograde ejaculation, absence of the vas deferens or seminal vesicles, ductal obstruction, hypogonadotropism, or poor sympathetic response. Structural abnormalities in the uterus: these can affect the cervix or the uterine corpus.  Anomalies can be anatomical (septate uterus, T-shaped uterus, etc.) or pathologies that generate embryo implantation issues or issues with how the pregnancy progresses: polyps, endometritis, Asherman's syndrome - synechiae or adherences of the walls of the uterine cavity - or myomas, a benign tumour that generates anatomical distortion and makes getting pregnant complicated (this is one of the most common pathologies but does not necessarily cause fertility issues).

Apparent Fertility of Human Spermatozoa from the Caput Epididymidis. (PDF, 4 MB) Journal of Andrology, 1989. A diagnosis of male infertility can be one of the hardest challenges a man can face. Understanding the normal reproductive process is essential in knowing when to seek help. The seminal vesicles provide 40-80% of the semen volume, which includes fructose for sperm nutrition, prostaglandins and other coagulating substances, and bicarbonate to buffer the acidic vaginal vault. Analyses of the CFTR Gene in 67 Patients. (PDF, 4 MB) The American Journal of Human Genetics, 1995. In vitro fertilization (IVF). In this technique, your doctor places into your uterus that were fertilized in a dish.

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For patients wishing to conceive, the medical approach is not indicated, as it delays treatment for infertility. A defect in any of these sperm structures may result in infertility that will not be detected by semen analysis.[60] Antisperm antibodies cause immune infertility.[23][24] Cystic fibrosis can lead to infertility in men.

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Drugs, assisted reproductive technology, and surgery are common treatments. 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. Cortical deficiency may be seen in patients with adrenal failure due to infection, infarction, or congenital adrenal hyperplasia (CAH). Other tests include: ovarian reserve testing, to find out how effective the eggs are after ovulation genetic testing, to see if a genetic abnormality is interfering with fertility pelvic ultrasound, to produce an image of the uterus, fallopian tubes, and ovaries Chlamydia test, which may indicate the need for antibiotic treatment thyroid function test, as this may affect the hormonal balance Complications Some complications can result from infertility and its treatment. The pulsatile nature of GnRH is essential to normal gonadotropin release; a continuous stimulation inhibits their secretion. 17 Evaluation of male infertility starts with a history and physical examination focusing on previous fertility, pelvic or inguinal surgeries, systemic diseases, and exposures.

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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). Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Fertilizing Capacity of Epididymal and Testicular Sperm using Intracytoplasmic Sperm Injection (ICSI). (PDF, 7 MB)Reproduction, Fertility and Development, 1995. Another requirement for male fertility is a normal ductal system. In these methods, fertilization occurs inside the body. In order to accomplish this, the semen is washed with a solution safe to sperm and eggs, and then centrifuged to separate motile sperm from immotile sperm and other cells. Pelvic ultrasonography can be used once a week until the dominant follicle is detected; once this occurs, ultrasonography can be used more frequently until ovulation occurs. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. Apparent Fertility of Human Spermatozoa from the Caput Epididymidis. (PDF, 4 MB) Journal of Andrology, 1989. For patients wishing to conceive, the medical approach is not indicated, as it delays treatment for infertility. Endometriosis Endometriosis is a condition where small pieces of the womb lining (the endometrium) start growing in other places, such as the ovaries.