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Less common factors The following other factors may also be responsible for infertility in a smaller proportion of cases: • Genetic abnormalities within eggs, sperm or both • An abnormal uterine cavity, including the presence of fibroids or polyps • Immunological infertility, whereby either the male or female partner produces anti-bodies against sperm cells or implantation of an embryo • Abnormal cervical mucus which hinders the passage of sperm to the uterus and fallopian tubes Unexplained infertility Even when investigations have been extensive, some couples will have no reason with which to explain their infertility. Medical management: - Men with hypogonadotrophic hypogonadism should be offered gonadotrophin drugs. - Men with idiopathic semen abnormalities should not be offered anti-oestrogens, gonadotrophins, androgens, bromocriptine or kinin-enhancing drugs. Women trying to conceive often have depression rates similar to women who have heart disease or cancer.[18] Emotional stress and marital difficulties are greater in couples where the infertility lies with the man.[19] Older people with adult children appear to live longer.[20] Why this is the case is unclear and may dependent in part on those who have children adopting a healthier lifestyle, support from children, or the circumstances that led to not having children.[20] [edit] In many cultures, inability to conceive bears a stigma. 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. For unknown reasons, as women age, egg numbers decrease at a rapid rate.

However, for women with moderate to severe endometriosis, surgical treatment then assisted reproductive therapy can be offered. Refinements in the Methodology of Injection for Transvaginal Gamete Intra-Fallopian Transfer. (PDF, 2 MB) Human Reproduction, 1994. Microscopic Vasectomy Reversal. (PDF, 31 MB) Fertility and Sterility, 1977. Treatment of Cervical Factors Chronic cervicitis may be treated with antibiotics. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

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Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. The uterine cavity is distended with a gas or liquid, and the hysteroscope is introduced into the uterine cavity which can then be carefully inspected. Symptoms If a couple doesn't get pregnant after a year of unprotected intercourse, both the man and woman should be evaluated. If a severe sperm defect is discovered, the testing on the female partner should be modified, and therapy can be immediately directed to the sperm problem. 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. There may be testicular malformations, hormone imbalance, or blockage of the man's duct system.

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These include: age smoking tobacco or marijuana drinking alcohol history of sexually transmitted infections stress poor diet When to see a doctor Anyone experiencing signs of infertility and who has been trying to conceive for more than a year (or 6 months if older than 35 years of age) may want to speak to a doctor for a thorough diagnosis. It is more successful in women who have previously been pregnant. Once patients desire to have children, they proceed with stimulation of the ovaries, oocyte aspiration, and in vitro fertilization, but the embryos are transferred to a gestational carrier (see In Vitro Fertilization). Congenital Absence of the Vas Deferens: The Fertilizing Capacity of Human Epididymal Sperm. (PDF, 3 MB) New England Journal of Medicine, 1990.

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The average pregnancy rate achieved after a natural-cycle intrauterine insemination is 8%. Sperm or egg donation: If necessary, sperm or eggs can be received from a donor. This improves the chances that the embryo will implant at, or attach to, the wall of the uterus. Opinion: Microsurgical TESE and the Distribution of Spermatogenesis in Non-obstructive Azoospermia. (PDF, 5 MB)Human Reproduction, 2000. Intracytoplasmic Sperm Injection Today: A Personal Review. (PDF, 5 MB) Human Reproduction, 1998. Testicular Sperm Extraction (TESE) and Intracytoplasmic Sperm Injection (ICSI) for Non-obstructive Azoospermia.(PDF, 1 MB) 10th World Congress on In Vitro Fertilization and Assisted Reproduction, 1997. Apparent Fertility of Human Spermatozoa from the Caput Epididymidis. (PDF, 4 MB) Journal of Andrology, 1989. The man is advised not to ejaculate for 2 to 3 days before giving the semen sample for evaluation. Once confirmed, the male partner is referred to a reproductive urologist, especially if the abnormality is severe. Gonadotropin-releasing hormone (Gn-RH) analogs: These can help women who ovulate too early—before the lead follicle is mature—during hmG treatment.