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Previous sterilization treatment: In women who have chosen to have their fallopian tubes blocked, the process can be reversed, but the chances of becoming fertile again are not high. 8 Intrauterine insemination and ovulation induction do not result in increased pregnancy rates in women with unexplained infertility. The average incidence of infertility is about 15%.

Coital frequency is positively correlated with pregnancy rates. This mucus mainly affects the lungs, but males may also have a missing or obstructed vas deferens.

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The impact of small or single polyps is more controversial. Testosterone and estradiol function as feedback inhibitors of gonadotropin release. The more fetuses there are, the higher the risk of premature labor.

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Up to 25% of infertile men have idiopathic infertility. Release of GnRH is stimulated by melatonin from the pineal gland and inhibited by testosterone, inhibin, corticotropin-releasing hormone, opiates, illness, and stress. Ovulation problems can be a result of:  polycystic ovary syndrome (PCOS) thyroid problems – both an overactive thyroid gland and an underactive thyroid gland can prevent ovulation premature ovarian failure – where a woman's ovaries stop working before the age of 40 Scarring from surgery Pelvic surgery can damage and scar the fallopian tubes, which link the ovaries to the womb. Panhypopituitafism: Complete pituitary gland failure--lowers growth hormone, thyroid-stimulating hormone, and LH and FSH levels.  Symptoms include:  lethargy, impotence, decreased libido, loss of secondary sex characteristics, and normal or undersized testicles.  Supplementing the missing pituitary hormones may restore vigor and a hormone called hCG may stimulate testosterone and sperm production.

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Immunological testing has not been proven to have any value in infertility patients without a history of 2 or more miscarriages. Around 1/3 of infertility cases are caused by fertility problems in men4 1/3 of infertility cases are caused by fertility problems in women4 1/3 of infertility cases are caused by a mixture of male and female problems, or by problems that cannot be determined4 Infertility doesn’t necessarily mean that you won’t ever have children, but you may need the help of fertility treatment to conceive. Factors affecting Fertility Low body weight - Women with BMI less than 19 and irregular menstruation should be counselled to gain weight. Smoking - Strong association between smoking and fertility in both partners. - Affects success rates of ARTs. Radiation therapy: If this is aimed near the reproductive organs, it can increase the risk of fertility problems. Patients with azoospermia or severe oligospermia seeking assisted reproductive techniques should be screened. Acquired anestrus may result from previous oophorectomy, exogenous hormonal treatment (including glucocorticoids), profound hypothyroidism, or ovarian disease (cysts or neoplasia). This abnormality is usually surgically corrected in infancy. In such circumstances, it is recommended not to prescribe any medication until all basic investigations are done and its results received. Androgen receptor dysfunction Because the androgen receptor is essential for the process of spermatogenesis, dysfunctions in this receptor can cause infertility. Other testing may be needed based on circumstances, including testicular biopsy, genetic testing, and imaging (Table 36–8,10,19,20). It's used to remove polyps and fibroid tumors, divide scar tissue, and open up blocked tubes. No consensus exists as to whether the medical treatment should precede surgery or vice versa. [154, 155, 156] Those who prefer medical treatment first argue that the size of the endometriosis decreases; therefore, surgery will be easier and shorter. It stimulates the ovaries to mature egg follicles. Clinical Asst Professor, Obstetrics and Gynecology. Primary testicular causes of infertility Primary testicular problems may be chromosomal or nonchromosomal in nature. Treatment of Tubal and Peritoneal Factors The treatment of tubal-factor infertility underwent major changes, especially during the last quarter of the century when microsurgery became available. [126, 127] Tubal reconstruction was the only hope for those patients before assisted reproductive therapy became available. Partners may become more anxious to conceive, increasing sexual dysfunction.[17] Marital discord often develops, especially when they are under pressure to make medical decisions.