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Polycystic ovarian syndrome is the most frequent indication for ovulation induction. These are agents that support the follicular maturation and the secretion of gonadotropins. 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). If endometriosis is found, it can be surgically removed by various methods, and its removal may lead to a decrease in pain as well as improvement in the ability to conceive naturally. The fluid comes from the prostate gland, the seminal vesicle, and other sex glands.

The presence of antibodies in serum or seminal plasma is less prognostic than antibodies bound to sperm. Clomiphene citrate for unexplained subfertility in women. Lifestyle and environmental factors such as smoking, alcohol and drugs, poor eating habits, exposure to increases in testicular temperature (for example, in professions where the worker spends many hours sitting down) and exposure to toxins are factors that compromise semen quality. In the United States, around 10 percent of women aged 15 to 44 years are estimated to have difficulty conceiving or staying pregnant. Other causes may include: Genetic factors: A man should have an X and Y chromosome. Exogenous testosterone should never be administered in an attempt to boost sperm production because it actually decreases intratesticular testosterone levels owing to feedback inhibition of GnRH release.

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Mental stress: Stress can be a factor, especially if it leads to reduced sexual activity. About 10% to 15% of couples will not be able to achieve pregnancy after one year of unprotected intercourse. A Series of Monozygotic Twins Discordant for Ovarian Failure: Ovary Transplantation (Cortical versus Microvascular) and Crypreservation. (PDF, 791 KB) Human Reproduction, 2008.

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They include: Clomifene (Clomid, Serophene): This encourages ovulation in those who ovulate either irregularly or not at all, because of PCOS or another disorder. Hjollund NH, Storgaard L, Ernst E, Bonde JP, Olsen J. 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. 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. Prior to Mühe, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation. Typical characteristics are ascites and cyst formation of the ovaries.

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In other cases, the cause is suspected to be immunological or genetic; it may be that each partner is independently fertile but the couple cannot conceive together without assistance. Gonadotrophins for idiopathic male factor subfertility. IVF and other fertility treatments have resulted in an increase in multiple births, provoking ethical analysis because of the link between multiple pregnancies, premature birth, and a host of health problems. B.: - GnRHa should not be offered with ovulation induction for risk of OHSS. - No evidence for the role of adjuvant growth hormones. At least one open tube is required for IUI, and the sperm abnormality cannot be severe otherwise the sperm will not be able to swim to and fertilize the egg. The severity usually depends on how near to the testicles the radiation was aimed. Testis Biopsy and the Infertile Male. (PDF, 20 MB) Chapter 15 from textbook Office Andrology, 2005. Treatment is with exogenous gonadotropins and iron-chelating therapy. Causes include: Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. VITRIKAS, MD, David Grant Medical Center Family Medicine Residency, Travis Air Force Base, California Am Fam Physician. 2015 Mar 1;91(5):308-314.   Patient information: See related handout on infertility, written by the authors of this article.   Related letter: Natural Procreative Technology for Treating Infertility This clinical content conforms to AAFP criteria for continuing medical education (CME).