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5 IU q5d) until follicle development is detectable based on an elevation of the E2 levels and the presence of follicle development on sonograms. A defect in any of these sperm structures may result in infertility that will not be detected by semen analysis.[60] Antisperm antibodies cause immune infertility.[23][24] Cystic fibrosis can lead to infertility in men. Evaluation of cervical mucus is unreliable; therefore, investigation is not helpful with the management of infertility. Polycystic ovary syndrome (PCOS): The ovaries function abnormally and ovulation may not occur.

With the fast progression in reproductive medicine and the experiences gained through infertility management, a wider range of treatment options have become available to infertile couples [17-19,21-26,31,36], (Appendix 4). ART techniques generally start with stimulating the ovaries to increase egg production.

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Physical Problems A variety of physical problems can cause male infertility.  These problems either interfere with the sperm production process or disrupt the pathway down which sperm travel from the testes to the tip of the penis.  These problems are usually characterized by a low sperm count and/or abnormal sperm morphology.  The following is a list of the most common physical problems that cause male infertility: Variocoele: A varicocele is an enlargement of the internal spermatic veins that drain blood from the testicle to the abdomen (back to the heart) and are present in 15% of the general male population and 40% of infertile men.  These images show what a variocoele looks like externally and internally.  A varicocele develops when the one way valves in these spermatic veins are damaged causing an abnormal back flow of blood from the abdomen into the scrotum creating a hostile environment for sperm development.  Varicocoeles may cause reduced sperm count and abnormal sperm morphology which cause infertility.  Variococles can usually be diagnosed by a physical examination of the scrotum which can be aided by the Doppler stethoscope and scrotal ultrasound.  Varicocoele can be treated in many ways (see treatment section), but the most successful treatments involve corrective surgery. Cystic fibrosis CF is the most common genetic disorder in whites. ART: Gamete Intrafallopian Transfer (GIFT) GIFT is a procedure that involves ovarian stimulation, egg retrieval, and placing a mixture of sperm and eggs directly into the woman’s fallopian tube to foster fertilization inside the female body. Thus one of the requirements is normal spermatogenesis – normal sperm count, motility and biologic structure and function.

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ICSI with Epididymal and Testicular Sperm in Azoospermic Men. (PDF, 2 MB) From Treatment of Infertility: The New Frontiers, 1998. The use of Epididymal and Testicular Sperm for ICSI. (PDF, 1 MB) From IX World Congress on In Vitro Fertilization and Alternated Assisted Reproduction, 1995.

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Instruments can be introduced through the hysteroscope, allowing the surgeon to remove or correct any anatomic abnormalities. The vast majority of anovulation patients belong to the WHO2 group and demonstrate very heterogeneous symptoms ranging from anovulation, obesity, biochemical or clinical hyperandrogenism and insulin resistance.[14] Treatments[edit] Anovulation can potentially be reversed by lifestyle changes.[15] Lifestyle changes[edit] In women with polycystic ovary syndrome with anovulation, weight loss generally results in improved menstrual regularity, ovulation, and pregnancy rates.[16] In otherwise healthy women with anovulation, avulatory disorders may be favorably influenced by a healthy diet such as a higher consumption of monounsaturated fats rather than trans fats, vegetable rather than animal protein sources, high fat dairy, multivitamins, and iron from plants and supplements.[15] Ovulation induction[edit] The main alternatives for ovulation induction medications are: Antiestrogen, causing an inhibition of the negative feedback of estrogen on the pituitary gland, resulting in an increase in secretion of follicle-stimulating hormone. Gonadotropins can trigger ovulation when Clomid or Serophene don't work. Causes of this kind of infertility include: Retrograde ejaculation. Ovulation induction agents increase the risk of multiple pregnancy, ovarian hyperstimulation syndrome, and thrombosis, and they may increase the risk of ovarian cancer in women who remain nulliparous. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. It's used to remove polyps and fibroid tumors, divide scar tissue, and open up blocked tubes. Intracytoplasmic sperm injection[edit] ICSI technique is used in case of poor semen quality, low sperm count or failed fertilization attempts during prior IVF cycles. Assisted hatching: The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. Up to 2 percent of men are thought to have suboptimal sperm. Recombination Between Palindromes P5 and P1 on the HUman Y Chromosome Causes Massive Deletions and Spermatogenic Failure. (PDF, 786 KB) The American Journal of Human Genetics, 2002.