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Medical conditions Some medical conditions can affect fertility. The following problems are possible: Low sperm count: The man ejaculates a low number of sperm. This abnormality is usually surgically corrected in infancy.

For example, treatment for Hodgkin disease has been estimated to lead to infertility in as many as 80-100% of patients. Many more couples, however, experience involuntary childlessness for at least one year: estimates range from 12% to 28%.[4] Male infertility is responsible for 20–30% of infertility cases, while 20–35% are due to female infertility, and 25–40% are due to combined problems in both parts.[2][5] In 10–20% of cases, no cause is found.[5] The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent menstrual periods.[6] Male infertility is most commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.[7] Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the menstrual cycle.

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Image: “Bilateral multilocular cystic masses in a patient with ovarian hyperstimulation syndrome in a spontaneous pregnancy with invasive mole” by openi. Previously, metformin was recommended as treatment for anovulation in polycystic ovary syndrome, but in the largest trial to date, comparing clomiphene with metformin, clomiphene was more effective than metformin alone.[21] Following this study, the ESHRE/ASRM-sponsored Consensus workshop do not recommend metformin for ovulation stimulation.[22] Subsequent randomized studies have confirmed the lack of evidence for adding metformin to clomiphene. Fertility treatments for women Fertility drugs might be prescribed to regulate or induce ovulation. Ultrastructure of Human Sperm in Men with Congenital Absence of the Vas Deferens: Clinical Implications. (PDF, 2 MB) Fertility and Sterility, 1992. Patients with azoospermia should have a postejaculatory urine sample analyzed for sperm, should be evaluated for ejaculatory duct obstruction, and should undergo a hormonal evaluation.

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Once a follicle containing an egg reaches a mature size, another hormone injection called HCG is often given to mimic the natural LH surge that occurs at the time of ovulation. The gonadotropins in these formulations are FSH, and in some cases, a combination of FSH and LH (luteinizing hormone). Etiologies include cysts (midline and eccentric), ductal calcification and stones, postinfectious, and postoperative. This should be followed by documentation of ovulation via serum progesterone. Intracytoplasmic Sperm Injection. (PDF, 4 MB) Chapter 47 from textbook Current Therapy in Equine Reproduction, 2006.

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Mental stress: This may affect female ovulation and male sperm production and can lead to reduced sexual activity. But few areas achieve this, with rationing deepening across the NHS amid financial pressures. The content of counselling may differ depending on the concerned couple and the existing treatment options. Treatment of Female Infertility: Assisted Reproductive Technology (ART) Assisted Reproductive Technology (ART) is a term used to collectively describe a number of noncoital methods of conception that treat causes of infertility not responsive to conventional methods. Castration of the affected testis may allow the other testis to regain its ability to produce sperm, but the prognosis is guarded. Only 5-10% of these couples eventually achieve a pregnancy within 5 years. Semen analysis – The semen analysis is the main test to evaluate the male partner. Intravenous fluids (ie, isotonic sodium chloride solution) must be administered until hemodilution is achieved. Options include intrauterine insemination (also known as IUI) or IVF with intracytoplasmic sperm injection (also known as ICSI).