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Unlike women, whose fertility significantly declines after the age of 35, men’s fertility doesn’t decline until they are much older. Laparoscopy is an operation performed in the abdomen or pelvis through small incisions, generally no more than a centimeter, with the assistance of a laparoscope attached to a camera which projects to a screen. In 1978, the first baby was born as a result of IVF.

In men who have the necessary reproductive organs to procreate, infertility can be caused by low sperm count due to endocrine problems, drugs, radiation, or infection. Inhibin B levels have been reported to decrease with increasing weight, which results in decreased Sertoli cells and sperm production. The epididymis is a coil-like structure in the testicles which helps store and transport sperm.

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Intracytoplasmic Sperm Injection Today: A Personal Review. (PDF, 5 MB) Human Reproduction, 1998. They include: Clomifene (Clomid, Serophene): This encourages ovulation in those who ovulate either irregularly or not at all, because of PCOS or another disorder. If the woman is aged over 35 years, the couple may wish to see a doctor earlier, because fertility testing can take time, and female fertility starts to drop when a woman is in her 30s. 37,38 The addition of 1,500 to 1,700 mg of metformin (Glucophage) daily may increase ovulation and pregnancy rates, but it does not significantly improve live birth rates over clomiphene alone.

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Laparotomy is indicated in patients with severe pelvic adhesions that compromise the bowel, ovaries, and tubes, with obliteration of the cul-de-sac. [129] The aim of the procedure is to correct what is necessary to allow the normal transport of the gametes; complete restoration of the anatomy is not intended. [130] Lysis of adhesions should be meticulous, using hydrodissection and fine instruments. Hjollund NH, Storgaard L, Ernst E, Bonde JP, Olsen J. Recovery of Spermatogenesis after Testicle Autotransplantation in an Adult Male. (PDF, 2 MB) Fertility and Sterility, 1982. The Relationship of Abnormal Semen Values to Pregnancy Outcome. (PDF, 770 KB) Chapter 10 from textbook, 1992. Full history taking of both partners usually denotes the underlying problem [17-23], (Appendix 1). In vitro fertilization[edit] IVF is the most commonly used ART.

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The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made general surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). 8 If a woman has irregular cycles, the testing should be conducted later in the cycle, starting seven days before presumed onset of menses, and repeated weekly until menses. Female age of 35 years or older: For unclear reasons, egg numbers decrease at a rapid rate as women age. Sperm are then collected, washed, and added to the eggs in the dish. Hormonal Problems A small percentage of male infertility is caused by hormonal problems.  The hypothalamus-pituitary endocrine system regulates the chain of hormonal events that enables testes to produce and effectively disseminate sperm.  Several things can go wrong with the hypothalamus-pituitary endocrine system: · The brain can fail to release gonadotrophic-releasing hormone (GnRH) properly.  GnRH stimulates   the hormonal pathway that causes testosterone synthesis and sperm production.  A disruption in   GnRH release leads to a lack of testosterone and a cessation in sperm production. · The pituitary can fail to produce enough lutenizing hormone (LH) and follicle stimulating hormone   (FSH) to stimulate the testes and testosterone/sperm production.  LH and FSH are intermediates   in the hormonal pathway responsible for testosterone and sperm production. · The testes� Leydig cells may not produce testosterone in response to LH stimulation. · A male may produce other hormones and chemical compounds which interfere with the   sex-hormone balance. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. The Use of Epididymal Sperm in Assisted Reproduction. (PDF, 8 MB) Chapter from textbook, Frontiers in Endocrinology: Perspectives on Assisted Reproduction, 1994. After injection of the sperm, the patient remains in the recumbent position for 10-15 minutes.