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About one-third of infertility cases are caused by fertility problems in men and another one-third of fertility problems are due to fertility problems in women. The chance of a multiple birth is lower with an oral fertility drug. In a third of cases, the reason lies only with the man; in another third, it is because of the woman; and in the rest of the cases, it is a combination of both, or the cause is unknown.

A combination of these factors leads to infertility 20 to 30 percent of the time. The woman may be given a low dose of ovary stimulating hormones. Ovarian Transplantation between Monozygotic Twins Discordant for Premature Ovarian Failure. (PDF, 315 KB) The New England Journal of Medicine, 2005. In some cases, the egg may have matured properly, but the follicle may have failed to burst (or the follicle may have burst without releasing the egg).

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Afterward, radiographs are taken and the contrast material can be seen in the abdominal cavity if the tubes are pervious. Those with a varicocele diagnosable only on scrotal ultrasonography have subclinical varicoceles and will likely not benefit from repair. Endocrine tests to check concentrations of the hormones testosterone, FSH and LH. For intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection procedures, the removal of certain components of the ejaculate (ie, seminal fluid, excess cellular debris, leukocytes, morphologically abnormal sperm) with the retention of the motile fraction of sperm is desirable. Epididymal and Testicular Spermatozoa and Intracytoplasmic Sperm Injection. (PDF, 7 MB) Assisted Reproduction Reviews, 1996. The likelihood of fertilization improves significantly for men with low sperm concentrations.

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Ejaculation disorders: If the ejaculatory ducts are blocked, semen may be ejaculated into the bladder Hormonal imbalance: Hypogonadism, for example, can lead to a testosterone deficiency. Mittelschmerz and premenstrual symptoms tend to be absent or reduced when a woman is anovulatory. Live Birth Following Day Surgery Reversal of Female Sterilisation in Women Older then 40 Year: A Realistic Option in Australia? (PDF, 156 KB) Medical Journal of Australia, 2007. This situation can be related to the presence of other endocrine disorders such as hyperprolactinemia, congenital adrenal hyperplasia, adrenal tumors, Cushing syndrome, thyroid dysfunction, and extreme obesity. However, there are various scenarios where one may be advised to seek help earlier.

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It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). Tubal occlusion is a cause of infertility because an ovulated egg is unable to be fertilized by sperm or to reach the endometrial cavity. The rate increases to 10-12% after CC ovulation induction and to 12-15% per cycle after hMG/hCG ovulation induction. Such tissue growth and its surgical removal can cause scarring and prevent fertilization.  Uterine and cervical causes  Problems in the uterus or cervix may also affect fertility. For those interested, we offer a free class entitled, “The Couple’s Guide to IVF”, that meets twice monthly and is open to the public. The rod-lens based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 µm typically, dependant on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. A combination of these factors leads to infertility 20 to 30 percent of the time.