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Diagnosis Most people will visit a physician if there is no pregnancy after 12 months of trying. Surgical ablation: - In minimal or mild endometriosis; surgical ablation or resection of endometriosis plus laparoscopic adhesiolysis improves the chance of pregnancy. - Laparoscopic resection of endometriomas may be beneficial, however recent RCTs suggest intervention only in endometriomas > 4cm. - In moderate or sever endometriosis; surgical treatment should be offered. (Debatable) - Post-operative medical treatment does not improve pregnancy rates. Metformin (Glucophage): If Clomifene is not effective, metformin may help women with PCOS, especially when linked to insulin resistance.

In some cases, the reproductive urologist can improve semen function by recommending certain lifestyle changes, by hormonal treatments, or by surgery. After repair, 40-70% of patients have improved semen parameters, while 40% are able to impregnate their partner without other interventions. Apparent Fertility of Human Spermatozoa from the Caput Epididymidis. (PDF, 4 MB) Journal of Andrology, 1989.

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Reducing the risk of multiple pregnancies Injectable fertility drugs can sometimes result in multiple births, for example, twins or triplets. First Fallopian Tube-Ovary Transplant Carried Out. (PDF, 2 MB) Welcome Trends in Ob/Gyn, 1985.

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Eating disorders: If an eating disorder leads to serious weight loss, fertility problems may arise. Intracytoplasmic sperm injection is a process by which semen is washed and prepared for direct injection of one sperm into each egg collected during the IVF process.

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1) Advancing maternal age: Historically before the latter 20th century, women were conceiving in their teens and twenties, when age-related abnormalities with the egg were not evident. 8 Women in group I typically present with amenorrhea and low gonadotropin levels, most commonly from low body weight or excessive exercise. Outcome of Intracytoplasmic Sperm Injection with Testicular Spermatozoa in Obstructive and Non-obstructive Azoospermia. (PDF, 426 KB) Human Reproduction, 1996. Exposure to some chemicals: Some pesticides, herbicides, metals, such as lead, and solvents have been linked to fertility problems in both men and women. Erectile dysfunction Erectile dysfunction is when a man cannot get or keep an erection (get hard) for sex. Causes include: Surgery: Pelvic surgery can sometimes cause scarring or damage to the fallopian tubes. ED may be the consequence of the conversion of androgens to estradiol. You take gonadotropins that trigger the development of more than one egg.