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This is called the fulcrum effect.[22] Some surgeries (carpal tunnel for instance) generally turn out better for the patient when the area can be opened up, allowing the surgeon to see "the whole picture" surrounding physiology, to better address the issue at hand. Also searched were the Cochrane database, the National Guideline Clearinghouse database, Dynamed, and Essential Evidence Plus. Thus it is essential to evaluate both the man and the woman. Medication. If you have ovulation problems, you may be prescribed drugs such as clomiphene citrate (Clomid, Serophene), gonadotropins (such as Gonal-F, Follistim, Humegon and Pregnyl), or letrozole. Any abnormality in the tubes can affect or impede conception: hydrosalpinx, tubal occlusion or salpingitis. Coutifaris C, Myers ER, Guzick DS, et al.; NICHD National Cooperative Reproductive Medicine Network.

Role of Semen Analysis in Subfertile Couples. (PDF, 250 KB) Fertility and Sterility, 2010. Diagnosis requires a physical examination and semen analysis What is infertility? Growth of Baby Kidneys Transplanted into Adults. (PDF, 1 MB) Archives of Surgery, 1976. A uterus capable of developing and sustaining the conceptus to maturity. A lower concentration may lead to a lower chance for conception without treatment; 3) sperm motility or movement – a normal motility should be at least 50%.

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Thyroid problems: An overactive or underactive thyroid gland can lead to a hormonal imbalance. In those with azoospermia and a varicocele, sperm may appear after repair in up to one third, but most of these men return to an azoospermic state within a few months. And as aging occurs, egg quality, or the likelihood of an egg being genetically normal, decreases as well. Vasectomy Reversal. (PDF, 733 KB) The New England Journal of Medicine, 1977. Preconception lifestyle advice for people with subfertility. When anatomic variance or obstruction is suspected, referral for surgical evaluation and treatment is appropriate.

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The patient's electrolyte levels must be checked to consider the need for diuretics. Diet: A lack of folic acid, iron, zinc, and vitamin B-12 can affect fertility. Basal body temperatures are no longer considered a reliable indicator of ovulation, and are not recommended for evaluating ovulation. Chemotherapy: Some chemotherapy drugs can result in ovarian failure. Many countries have special frameworks for dealing with the ethical and social issues around fertility treatment.

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A variety of disorders ranging from hormonal disturbances to physical problems, to psychological problems can cause male infertility.  Although many treatment options are now available, in many cases treatment will not work.  In many instances, male infertility is caused by testicular damage resulting in an inability of the testicle to produce sperm.  Once damaged, the testicle will not usually regain its sperm-making capabilities; this aspect of male infertility is analogous to menopause (though not natural like menopause) for women and cannot usually be treated.  Despite medicine�s limited ability to treat male infertility, many successful treatment options are available for its many causes.  Besides testicular damage, the main causes of male infertility are low sperm production and poor sperm quality.   The Causes of Male Infertility Male infertility has many causes--from hormonal imbalances, to physical problems, to psychological and/or behavioral problems.  Moreover, fertility reflects a man�s �overall� health.  Men who live a healthy lifestyle are more likely to produce healthy sperm.  The following list highlights some lifestyle choices that negatively impact male fertility--it is not all-inclusive: · Smoking--significantly decreases both sperm count and sperm cell motility. · Prolonged use of marijuana and other recreational drugs. · Chronic alcohol abuse. · Anabolic steroid use--causes testicular shrinkage and infertility. · Overly intense exercise--produces high levels of adrenal steroid hormones which cause a    testosterone deficiency resulting in infertility. · Inadequate vitamin C and Zinc in the diet. · Tight underwear--increases scrotal temperature which results in decreased sperm production. · Exposure to environmental hazards and toxins such as pesticides, lead, paint, radiation, radioactive   substances, mercury,  benzene, boron, and heavy metals · Malnutrition and anemia. · Excessive stress! Normal Intrauterine Pregnancy After Reversal of Tubal Sterilization in the Wife and Vasectomy in the Husband.(PDF, 1 MB) Fertility and Sterility, 1978. Ultrastructure of Human Sperm in Men with Congenital Absence of the Vas Deferens: Clinical Implications. (PDF, 2 MB) Fertility and Sterility, 1992. Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%.[4] Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts.[2][5] In 10–20% of cases, no cause is found.[5] The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent menstrual periods.[6] Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.[7] Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the menstrual cycle. Because sperm generation time is just over two months, it is recommended to wait three months before repeat sampling. Enzymatic Digestion of Testicular Tissue May Rescue the Intracytoplasmic Sperm Injection Cycle in Some Patients with Non-obstructive Azoospermia. (PDF, 66 KB) Human Reproduction, 1998. Infertility may be caused by blockage of the Fallopian tube due to malformations, infections such as chlamydia or scar tissue. This allows for the diagnosis and treatment of conditions such as endometriosis with one procedure. If a woman has an ovulation disorder, she may ovulate infrequently or not all. Prevalence of Premature Ovarian Failure in Monozygotic and Dizygotic Twins. (PDF, 90 KB) Human Reproduction, 2007. ART techniques generally start with stimulating the ovaries to increase egg production.