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However, given that fertility in women is known to decline steadily with age, some providers evaluate and treat women aged ≥35 years after 6 months of intercourse without the use of contraception (1). Approximately 10% of cases are unexplained, where no definitive cause can be identified. And about 15% of infertile men have normal semen and plenty of normal sperm. In such circumstances, it is recommended not to prescribe any medication until all basic investigations are done and its results received. This situation can be related to the presence of other endocrine disorders such as hyperprolactinemia, congenital adrenal hyperplasia, adrenal tumors, Cushing syndrome, thyroid dysfunction, and extreme obesity. 549 KB Effect of Age on Male Fertility. (PDF, 5 MB) Chapter from textbook, Seminars in Reproductive Endocrinology, 1991.

In this treatment, millions of healthy sperm are injected into the woman’s uterus at the time of ovulation.  IVF: The most effective assisted reproductive treatment is in vitro fertilization or IVF. Klinefelter�s Syndrome: Is a genetic condition in which each cell in the human body has an additional X chromosome--men with Klinefelter�s Syndrome have one Y and two X chromosomes.  Physical symptoms include peanut-sized testicles and enlarged breasts.  A chromosome analysis is used to confirm this analysis.  If this condition is treated in its early stages (with the drug hCG), sperm production may commence and/or improve.  However, Klinefelter�s Syndrome eventually causes all active testicular structures to atrophy.  Once testicular failure has occurred, improving fertility is impossible.

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Once the follicles (fluid filled sacs containing the eggs) reach a mature size, an HCG injection is administered which leads to final development and maturation of the eggs. Spermiogenic defects may also be a cause of sterility. An ultrasonography unit and an endocrine laboratory capable of performing daily determinations of E2, FSH, and LH are necessary. [186, 187, 188, 189] Multiple adverse effects and complications may occur during the use of the gonadotropins, including (1) multiple pregnancy (24-33%), (2) ectopic pregnancy (5-8%), (3) miscarriages (15-21%), (4) ovarian torsion and rupture, and (5) ovarian hyperstimulation syndrome, which is the most severe. [190, 191] Whittemore et al, using a large combined data set derived from case-controlled studies in the United States, showed that the increase of ovarian cancer associated with infertility might be due to the use of fertility drugs. [192] Ovarian hyperstimulation syndrome is an iatrogenic condition that occurs in patients undergoing ovulation induction with hMG or controlled ovarian hyperstimulation (COH) for assisted reproductive technologies. As the rate of getting spontaneous pregnancy among infertile or subfertile couples is lower than that among normal fertile population, it is recommended to carry out the following diagnostic, evidence-based, work-up to detect any hidden treatable cause.

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Affected individuals displayed more severe forms of infertility such as azoospermia and severe oligozoospermia.[27] Other causes[edit] Factors that can cause male as well as female infertility are: DNA damage DNA damage reduces fertility in female ovocytes, as caused by smoking,[28] other xenobiotic DNA damaging agents (such as radiation or chemotherapy)[29] or accumulation of the oxidative DNA damage 8-hydroxy-deoxyguanosine[30] DNA damage reduces fertility in male sperm, as caused by oxidative DNA damage,[31] smoking,[28] other xenobiotic DNA damaging agents (such as drugs or chemotherapy)[32] or other DNA damaging agents including reactive oxygen species, fever or high testicular temperature.[33] The damaged DNA related to infertility manifests itself by the increased susceptibility to denaturation inducible by heat or acid [34] or by the presence of double-strand breaks that can be detected by the TUNEL assay.[35] General factors Diabetes mellitus,[36][37] thyroid disorders,[38] undiagnosed and untreated coeliac disease,[39][40][41][42] adrenal disease[43] Hypothalamic-pituitary factors Hyperprolactinemia Hypopituitarism The presence of anti-thyroid antibodies is associated with an increased risk of unexplained subfertility with an odds ratio of 1. Often, but not always, submucosal fibroids can cause heavy periods, or bleeding between periods. Aromatase inhibitors are available for clinical use and FDA approved for treatment of postmenopausal breast cancer, but not for ovulation induction. Chances of conception People who are concerned about their fertility should be informed that over 80% of couples in the general population will conceive within 1 year if: - the woman is aged under 40 years - they do not use contraception and have regular sexual intercourse. Half of those who do not conceive in the first year will do so in the second year (cumulative pregnancy rate over 90%)(cumulative pregnancy rate over 90%) 5. Combined infertility[edit] In some cases, both the man and woman may be infertile or sub-fertile, and the couple's infertility arises from the combination of these conditions.

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The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood.[16] Infertility may have psychological effects. Epididymal and Testicular Spermatozoa and Intracytoplasmic Sperm Injection. (PDF, 7 MB) Assisted Reproduction Reviews, 1996. National Collaborating Centre for Women's and Children's Health. The University of Georgia School of Veterinary Medicine[9] and Colorado State University's School of Veterinary Medicine[10] are two of the main centers where veterinary laparoscopy got started and have excellent training programs for veterinarians interested in getting started in MIS. Some causes can be easily detected and treated, whereas others cannot. Prolonged diestrus can result from luteal cysts in the ovary. The risk of ovarian hyperstimulation syndrome and multiple pregnancy is heightened; therefore, hMG should be started at the minimal dose (75 IU SC qd for 7 days). In many instances, sterility may be unexplained, but fertility treatments will be able to help. 8 If a woman has irregular cycles, the testing should be conducted later in the cycle, starting seven days before presumed onset of menses, and repeated weekly until menses. If a weight gain greater than 2 lb occurs, the patient should be evaluated to determine if hospitalization is required. 4) In Vitro Fertilization (IVF): In vitro means “outside the body.” IVF is a process whereby eggs are collected and then fertilized by sperm outside the body, in an embryology laboratory. Painful or heavy periods Most women experience cramps with their periods. If you’re having trouble conceiving, you are certainly not alone.