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Intrauterine insemination (IUI): At the time of ovulation, a fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. Normal Fertilization of Human Oocytes after Testicular Sperm Extraction and Intracytoplasmic Sperm Injection.(PDF, 2 MB) Fertility and Sterility, 1994. Use of clomiphene citrate in infertile women: a committee opinion.

8–16 One retrospective case-control study of 650 men with infertility and 698 control participants questioned the role of environmental risk; no association could be determined after assessing for multiple factors including shift work, stress, and pesticides. These injections are taken nightly, typically for 5 – 10 days, and act directly on the cells of the ovary to stimulate egg development. Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. The initial dosage of clomiphene is 50 mg daily for five days starting on day 3 to 5 of the menstrual cycle. Possible problems could be that the egg is not released at the optimum time for fertilization, that it may not enter the fallopian tube, sperm may not be able to reach the egg, fertilization may fail to occur, transport of the zygote may be disturbed, or implantation fails.

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There may be testicular malformations, hormone imbalance, or blockage of the man's duct system. Sexually transmitted infections (STIs): Chlamydia can damage the fallopian tubes in a woman and cause inflammation in a man's scrotum. Just before those eggs would otherwise be ovulated, they are retrieved under mild anesthesia in an operating room. In this case synthetic FSH by injection or Clomid (Clomiphene citrate) via a pill can be given to stimulate follicles to mature in the ovaries. Embryo Development after ICSI Using Testicular, Epididymal and Ejaculated Spermatozoa. (PDF, 2 MB) Frontiers in Endocrinology, 1995. Abnormal semen may not be able to carry the sperm effectively.

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El Uso de las Espermátides en la Azoospermia. (PDF, 12 MB) Chapter 42 from Reproducción Humana, 2002. Using these criteria, he reported a clinically significant threshold of 14% normal forms as an excellent predictor of IVF success. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization. After stimulation, the physician surgically extracts one or more eggs from the ovary, and unites them with sperm in a laboratory setting, with the intent of producing one or more embryos. When anatomic variance or obstruction is suspected, referral for surgical evaluation and treatment is appropriate.

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Risk factors for the formation of antisperm antibodies in men include the breakdown of the blood‑testis barrier, trauma and surgery, orchitis, varicocele, infections, prostatitis, testicular cancer, failure of immunosuppression and unprotected receptive anal or oral sex with men.[23][24] Sexually transmitted infections[edit] Infections with the following sexually transmitted pathogens have a negative effect on fertility: Chlamydia trachomatis and Neisseria gonorrhoeae. The easiest and most successful treatment is intrauterine insemination (IUI). [104] Similar treatments apply when oligospermia, hypospermia, and ejaculatory disorders such as impotence, hypospadias, or retrograde ejaculation are present. [105, 106, 107] Patients with azoospermia that is not amenable to in vitro fertilization/intracytoplasmic sperm injection treatment benefit from artificial insemination (AI) with donor sperm. [108] Artificial insemination can be performed by depositing the sperm at the cervical level (cervical insemination) [106] or inside the endometrial cavity (intrauterine insemination). Endometriosis (especially if chronic), uterine fibroids (myomas), or an abnormally-shaped uterus might interfere with conception as well.  Age  As women grow older, it usually becomes more challenging for them to conceive. Women older than 35 years or couples with known risk factors for infertility may warrant evaluation at six months. The Varicocele Dilemma. (PDF, 139 KB) Human Reproduction, 2001.