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This procedure is performed in the doctor’s office without anesthesia. Basic Work-up for Infertility Detailed history and physical examination. Semen analysis. Evidence of ovulation. (Day 2-3 gonadotrophins, Day 21 progesterone) Susceptibility to rubella Cervical smear screening Screening for Chlamydia trachomatis Serum prolactin Thyroid function tests 12. Semen analysis: - semen volume: 1. Fertility Evaluation: General and Sexual History A detailed history includes: General history  This includes occupation and background, use of tobacco, alcohol and drugs, earlier diseases, history of abdominal surgery and earlier infections. Surgical procedures for women If the fallopian tubes are blocked or scarred, surgical repair may make it easier for eggs to pass through.

This can be made laparoscopically as well as sonographically. If this is unsuccessful, the dosage may be increased to 100 mg daily. The impact of fibroids located elsewhere in the uterus are controversial and do not always require surgery. Human menopausal gonadotropins Crowe discovered that the gonads were under the control of the anterior hypophysis. [175] Zondek and Aschheim discovered that FSH and LH were responsible for the development of the gonads in immature animals and confirmed Crowe's work. [135, 136] In the 1930s, ovulation induction was attempted by using gonadotropins from a mare, but its use was discontinued because of the development of antibodies. [176, 177] Borth et al demonstrated the effect of FSH and LH extracted from menopausal urine. [178, 179] Gemzell reported the first ovulation induction using human pituitary gonadotropin in 1958, and the first pregnancy was reported in 1960. [180, 181] Lunenfeld reported preliminary results using hMG; however, in 1963, it was definitely established as a real ovulation induction agent. [182, 183, 184] Human menopausal gonadotropin (hMG [eg, Repronex, Menopur]) contains 75 U of FSH and 75 U of LH per mL, although the concentration may vary among batches (ranges from FSH at 60-90 U and LH at 60-120 U). Medical conditions Some medical conditions can affect fertility. A review of records from other fertility doctors that you have seen is also important.

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Today, many patients do not receive the recommended medical care that based on the best available evidence [5]. The World Health Organization (WHO) published reference ranges for semen testing in 2010. [45] These include “lower reference limits” representing the 5th percentiles for semen characteristics. [46] Note that the lower reference limits do not serve as a cut-point between “fertile” and “infertile.” Volume Normal ejaculate volume is 1. This results in negative feedback stimulation of the hypothalamic-pituitary axis, causing an increase release of gonadotropins and testosterone. European Association of Urology guidelines on male infertility: the 2012 update. 8–16 One retrospective case-control study of 650 men with infertility and 698 control participants questioned the role of environmental risk; no association could be determined after assessing for multiple factors including shift work, stress, and pesticides.

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Treatment Possibilities: Male Infertility Surgical treatment may be successful in some cases, such as varicocele. Effects[edit] Psychological[edit] The consequences of infertility are manifold and can include societal repercussions and personal suffering. Key to the diagnosis of male infertility is a semen analysis, which assesses primarily sperm numbers, sperm movement and sperm form. Surgeons must use tools to interact with tissue rather than manipulate it directly with their hands. 6,8 It is important for primary care physicians to be familiar with the workup and prognosis for infertile couples. These include: Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.[11][12] Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.[12][13][14] Less pain, leading to less pain medication needed.[15][14] Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.[13][16] Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.[6] There are more indications for laparoscopic surgery in gastrointestinal emergencies as the field develops.[17] Although laparoscopy in adult age group is widely accepted, its advantages in pediatric age group is questioned.[18][19] Benefits of laparoscopy appears to recede with younger age.

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Microscopic Vasoepididymostomy: Specific Microanastomosis to the Epididymal Tubule. (PDF, 15 MB) Fertility and Sterility, 1978. About one out of every three cases of infertility is due to the man alone, and we're somehow involved in infertility about half the time. Ejaculatory Duct Obstruction. (PDF, 3 MB) The Journal of Urology, 1980. World Health Organization[edit] The World Health Organization defines infertility as follows:[10] United States[edit] One definition of infertility that is frequently used in the United States by reproductive endocrinologists, doctors who specialize in infertility, to consider a couple eligible for treatment is: a woman under 35 has not conceived after 12 months of contraceptive-free intercourse. Primary vs. secondary infertility[edit] Primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months, during which they have not used any contraceptives.[14] The World Health Organisation also adds that 'women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility'.[15] Secondary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months since their last live birth, during which they did not use any contraceptives.[15] Thus the distinguishing feature is whether or not the couple have ever had a pregnancy which led to a live birth. Without an erection, it is difficult for a man to release sperm inside the vagina—and, therefore, difficult to get a woman pregnant. Duration of Fertility after Fresh and Frozen Ovary Transplantation. (PDF, 606 KB) Fertility and Sterility, 2010. The effect of age upon men's fertility is less clear.[citation needed] In people going forward for IVF in the UK, roughly half of fertility problems with a diagnosed cause are due to problems with the man, and about half due to problems with the woman. Compensatory and Obligatory Renal Growth in Rats. (PDF, 1 MB) American Journal of Physiology, 1974. IVF and related techniques (ICSI, ZIFT, GIFT) are called assisted reproductive technology (ART) techniques. Human chorionic gonadotropin (Ovidrel, Pregnyl): Used together with clomiphene, hMG, and FSH, this can stimulate the follicle to ovulate. Bensdorp AJ, Cohlen BJ, Heineman MJ, Vandekerckhove P.