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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. 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. Uterine fibroids Fibroids are noncancerous growths in the uterus. Postcoital testing and antisperm antibody testing are no longer considered useful in this evaluation.

Severe ovarian hyperstimulation syndrome is characterized by easily palpable ovaries, severe ascites, nausea, vomiting, diarrhea, shortness of breath, hydrothorax, peripheral edema, oliguria, hemoconcentration (eg, hematocrit level >48% and hemoglobin level >16 g), and creatinine level greater than 1. Results of Microsurgical Vasoepididymostomy: Role of Epididymis in Sperm Maturation. (PDF, 3 MB) Human Reproduction, 1989. Furthermore, if there is a background of gynaecological or andrological issues in the couple, a study should be carried out as soon as possible. Ejaculatory Incompetence: This rare psychological condition prevents men from ejaculating during sexual intercourse even though they can ejaculate normally through masturbation.  This condition sometimes responds well to behavioral therapy; if this technique does not work, artificial insemination can be employed using an ejaculate from masturbation.Continued Hysteroscopy . In this procedure, your doctor places a hysteroscope into your uterus through your cervix. Many uterine and tubal abnormalities detected by the HSG can be surgically corrected.

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Mental stress: This may affect female ovulation and male sperm production and can lead to reduced sexual activity. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Medications in use for this effect are mainly clomifene citrate and tamoxifen (both being selective estrogen-receptor modulators), as well as letrozole (an aromatase inhibitor.[17] Follicle-stimulating hormone (FSH), directly stimulating the ovaries. Passive smoking has also been linked to lower fertility.

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Debate over whether health insurance companies (e.g. in the US) should be required to cover infertility treatment. Intracytoplasmic Sperm Injection and Infertility. (PDF, 53 KB) Nature Genetics, 2001. In most cases, only 1 follicle is recruited and develops until ovulation.

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Your physician will refer you to a reproductive urologist if appropriate. Ovulation of the egg occurs approximately 2 weeks before the start of the next period. 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). Ultrastructure of Human Sperm in Men with Congenital Absence of the Vas Deferens: Clinical Implications. (PDF, 2 MB) Fertility and Sterility, 1992. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Treatment of Uterine Factors Until in vitro fertilization became available, a patient with congenital absence of the uterus and vagina (Rokitansky-Küster-Hauser syndrome) had no chance to have a biologic child. They can include: Changes in hair growth Changes in sexual desire Pain, lump, or swelling in the testicles Problems with erections and ejaculation Small, firm testicles   When to See the Doctor If you are under 35 and have been trying to get pregnant without success for a year, see your doctor. PDF Articles by Decade: 1970s | 1980s | 1990s | 2000s | 2010s ARTICLES FROM THE 1970s Active Lupus Glomerulitis and Hematoxylin Bodies with Normal Urinalysis. (PDF, 5 MB) The Journal of Urology, 1971. 18  If the semen analysis result is abnormal, further evaluation is indicated (Table 36–8,10,19,20). Fertility treatments for women Fertility drugs might be prescribed to regulate or induce ovulation. A doctor injects sperm directly into the egg in a dish and then places it into your uterus. Causes of Infertility Affecting Both Partners Some causes of infertility, such as psychological causes, may be relevant to both partners. Endometriosis causes infertility by producing inflammation and scarring, which can result in not only pain but also potentially detrimental effects on egg, sperm or embryo. It has been proven useful in overcoming infertility conditions, such as blocked or damaged tubes, endometriosis, repeated IUI failure, unexplained infertility, poor ovarian reserve, poor or even nil sperm count. Fertility treatments for men Treatment will depend on the underlying cause of the infertility. Allied and Complementary Medicine Database (AMED), ... IVF in action Intracytoplasmic sperm injection (ICSI): A single sperm is injected into an egg to achieve fertilization during an IVF procedure.