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National Collaborating Centre for Women's and Children's Health. In-vitro fertilization (IVF): Sperm are placed with unfertilized eggs in a petri dish, where fertilization can take place. The results of these tests help determine the best fertility treatment.

Options include intrauterine insemination (also known as IUI) or IVF with intracytoplasmic sperm injection (also known as ICSI). The problem is getting the sperm where they need to go. This can reveal signs of endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes. Ovarian Transplantation between Monozygotic Twins Discordant for Premature Ovarian Failure. (PDF, 315 KB) The New England Journal of Medicine, 2005.

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There are different studies, for both women and men.[69] Spermatogonial stem cells trasplant: it takes places in the seminiferous tubule. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. The impact of fibroids located elsewhere in the uterus are controversial and do not always require surgery. Gonadotropins can trigger ovulation when Clomid or Serophene don't work.

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If the sperm are of good quality and the mechanics of the woman's reproductive structures are good (patent fallopian tubes, no adhesions or scarring), a course of ovulation induction maybe used. One-third of couples will discover fertility problems in both partners or will have their infertility remain unexplained. Suspect antisperm antibodies when semen analysis reveals abnormal clumping, agglutination, unexplained decreased motility, or an abnormal postcoital test result. If sperm appears, these men should be offered cryopreservation.

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Laboratory studies have suggested that long-term acetaminophen use during pregnancy may affect fertility in males by lowering testosterone production. One type of ovulation problem, polycystic ovarian syndrome, is effectively treated with medications. Many infertile couples have had some previous assessment for their infertility and this data should be cautiously reviewed. As new technology becomes available, fertility treatment is now accessible to more people, and success rates and safety are improving all the time. As the major causes of infertility are sperm abnormalities, ovulation dysfunction, and fallopian tube obstruction, the preliminary adviced investigations for the infertile couple should be focused on semen analysis (to be compared with the WHO reference values [27]), detection of ovarian function by hormonal assay (early follicular FSH and LH levels, and mid-luteal progesterone), and evaluation of tubal patency by hysterosalpingography (HSG) [17-32], (Appendix 3). Most couples skip the invasive laparoscopic surgery and do treatments with intrauterine inseminations and then IVF if inseminations are not successful. Legal, cultural and religious inquiries have limited the available choices in some countries, such as the use of donor sperms or oocytes. Delayed conception and active and passive smoking. Worldwide, 8 to 12 percent of couples experience fertility problems. Women in group III can conceive only with oocyte donation and in vitro fertilization. Pregnancy with Sperm Aspiration from the Proximal Head of the Epididymis: A New Treatment for Congenital Absence of the Vas Deferens. (PDF, 2 MB) Fertility and Sterility, 1988. Other causes include Y chromosome microdeletion, a depletion of chromosome material that impedes or severely decreases spermatozoa production. A review of records from other fertility doctors that you have seen is also important. WHO categorizes ovulatory disorders into three groups: group I is caused by hypothalamic pituitary failure (10%), group II results from dysfunction of hypothalamic-pituitary-ovarian axis (85%), and group III is caused by ovarian failure (5%). Intracytoplasmic Sperm Injection and Infertility. (PDF, 53 KB) Nature Genetics, 2001.