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Primary vs. secondary infertility[edit] Primary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months, during which they have not used any contraceptives.[14] The World Health Organisation also adds that 'women whose pregnancy spontaneously miscarries, or whose pregnancy results in a still born child, without ever having had a live birth would present with primarily infertility'.[15] Secondary infertility is defined as the absence of a live birth for women who desire a child and have been in a union for at least 12 months since their last live birth, during which they did not use any contraceptives.[15] Thus the distinguishing feature is whether or not the couple have ever had a pregnancy which led to a live birth. Female factor Dysfunction of the female reproductive organs is also apparent in around 40% of infertile couples. Ultrasound: This may reveal issues such as ejaculatory duct obstruction or retrograde ejaculation. A doctor injects sperm directly into the egg in a dish and then places it into your uterus. Damaged Sperm Ducts: Seven percent of infertile men cannot transport sperm from their testicles to out of their penis.  This pathway may be blocked by a number of conditions: · A genetic or developmental mistake may block or cause the absence of one or both tubes (which   transport the sperm from the testes to the penis). · Scarring from tuberculosis or some STDs may block the epididymis or tubes. · An elective or accidental vasectomy may interrupt tube continuity. Having an irregular cycle, including missing periods, can contribute to infertility, as it means a woman may not be regularly ovulating.

Intrauterine insemination (IUI.)At the time of ovulation, sperm are injected directly up into the uterus. The chance of a live birth following treatment is nearly 50% [25]. If the obstruction is caused by salpingitis isthmica nodosa or fibrosis, the best results are achieved through IVF. [142] Surgical preparation for IVF While the surgeon should be as conservative as possible, he or she should consider that the patient is better served with a single well-functioning fallopian tube than with 2 defective tubes, which elicits an increased risk for ectopic pregnancy or recurrence of pelvic adhesions. Further investigations may be requested according to the clinical presentation and the results of preliminary tests. According to ESHRE recommendations, couples with an estimated live birth rate of 40% or higher per year are encouraged to continue aiming for a spontaneous pregnancy.[66] Treatment methods for infertility may be grouped as medical or complementary and alternative treatments.

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Infection and Disease: Mumps, tuberculosis, brucellosis, gonorrhea, typhoid, influenza, smallpox, and syphilis can cause testicular atrophy.  A low sperm count and low sperm motility are indicators of this condition.  Also, elevated FSH levels and other hormonal problems are indicative of testicular damage.  Some STDs like gonorrhea and chlamydia can cause infertility by blocking the epididimis or tubes.  These conditions are usually treated by hormonal replacement therapy and surgery in the case of tubular blockage. Sperm count often returns to normal after stopping the medication.

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For conception, sperm must reach the cervix, penetrate the cervical mucus, migrate up the uterus to the fallopian tube, undergo capacitation and the acrosome reaction to digest the zona pellucida of the oocyte, attach to the inner membrane, and release its genetic contents within the egg. In order to accomplish this, the semen is washed with a solution safe to sperm and eggs, and then centrifuged to separate motile sperm from immotile sperm and other cells.

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Ovary Transplantation for Fertility Preservation in Cancer Patients: Fresh and Frozen. (PDF, 1 MB) Chapter 42 from textbook Clinial Infertility, 2010. Obese women have a higher rate of recurrent, early miscarriage compared to non-obese women. The National Institute for Health and Care Excellence (NICE) recommends that women with unexplained infertility who haven't conceived after 2 years of having regular unprotected sex should be offered IVF treatment. Theoretically, with this therapy, we can get artificial gamets in vitro. Diagnosis Most people will visit a physician if there is no pregnancy after 12 months of trying. Before performing a tubocornual anastomosis, the patient should have a diagnostic laparoscopy associated with tubal cannulation by hysteroscopy. [139, 140, 141] If one tube remains open, anastomosis is not needed because pregnancy can be achieved in 50% of cases. Human chorionic gonadotropin (Ovidrel, Pregnyl): Used together with clomiphene, hMG, and FSH, this can stimulate the follicle to ovulate. Worldwide, 8 to 12 percent of couples experience fertility problems. About 92 out of 100 couples who are trying to get pregnant do so within two years.[citation needed] Women become less fertile as they get older.