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38,39 Family physicians may choose to attempt ovulation induction in anovulatory women (WHO group II) with clomiphene. Other factors that can affect a woman's chances of conceiving include being overweight or underweight,[56] or her age as female fertility declines after the age of 30.[57] Sometimes it can be a combination of factors, and sometimes a clear cause is never established. The Fate of Non-absorbable Intraureteral Suture. (PDF, 233 KB) The Journal of Urology, 1973. For a woman to conceive, certain things have to happen: vaginal intercourse must take place around the time when an egg is released from her ovary; the system that produces eggs has to be working at optimum levels; and her hormones must be balanced.[54] For women, problems with fertilisation arise mainly from either structural problems in the Fallopian tube or uterus or problems releasing eggs.

FSH stimulates the Sertoli cells to facilitate sperm production, while LH stimulates testosterone release from the Leydig cells. Other causes may include: Genetic factors: A man should have an X and Y chromosome. Infertility in women was ranked the 5th highest serious global disability5&6 (among populations under the age of 60). Fertility Evaluation: Obstetric and Gynecological History The obstetric and gynecological history should include: Reproductive history (children, mode of delivery, prematurity, stillbirth, extrauterine pregnancy, spontaneous and induced abortion, fertility and infertility in earlier relationships). Treatment of the cause: 30. Unexplained infertility: - Ovarian stimulation should not be considered as does not improve pregnancy or birth rates. - Advise to try to conceive for two years of unprotected sexual intercourse before other options. - After two years of failure to conceive, consider IVF/ICSI. Evaluation of the Female Partner: Evidence of Ovulation (Continued) Progesterone test.

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Some suggest that the number of times a couple has intercourse should be reduced to increase sperm supply, but this is unlikely to make a difference. Patients who do not achieve ovulation after three to six cycles should be referred to an infertility specialist for further treatment. Reduced hormones may result, which could potentially translate into trouble conceiving. Duration of Fertility after Fresh and Frozen Ovary Transplantation. (PDF, 606 KB) Fertility and Sterility, 2010.

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Uterine fibroid embolization (UFE) consists of catheterization of the uterine artery and the injection of microbeads of polyvinyl alcohol to selectively occlude the circulation of the fibroid. Laparoscopy for Cryptorchidism. (PDF, 1 MB) The Journal of Urology, 1980.

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High-cost treatments are out of financial reach for some couples. Treatment of Secondary Amenorrhea and Oligo-ovulation Once the diagnosis is established and any other endocrinopathy has been excluded, the ovulation induction agent of choice depends on a functioning hypothalamic-pituitary-ovarian axis. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties, including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery, and urology. Transplantation of a Human Testis for Anorchia. (PDF, 19 MB) Fertility and Sterility, 1978. Female factor Dysfunction of the female reproductive organs is also apparent in around 40% of infertile couples. If a woman can get pregnant but keeps having miscarriages or stillbirths, that's also called infertility. BMI (body mass index) may be a significant factor in fertility, as an increase in BMI in the male by as little as three units can be associated with infertility. Removal of polyps by the minimally invasive procedure hysteroscopy is associated with a doubling of pregnancy rate. 6-Mb Deletion of the Human Y Chromosome Persists Through Balance Between Recurrent Mutation and Haploid Selection. (PDF, 295 KB) Nature Genetics, 2003.