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Ovulation usually occurs within the 32-40 hours after the indicative color change. Grading is as follows: Grade 0 – No movement Grade 1 – Sluggish movement Grade 2 – Slow movement in a poorly defined direction Grade 3 – Slow or curved forward movement Grade 4 – Fast movement straight forward  Patients with abnormal sperm motility should be evaluated for the following: Pyospermia Antisperm antibodies Varicocele Sperm ultrastructural abnormalities Partial ductal obstruction Sperm morphology The head, acrosome, mid piece, and tail of individual spermatozoa are analyzed with phase-contrast microscopy after fixation with Papanicolaou stain. Many infertile couples have had some previous assessment for their infertility and this data should be cautiously reviewed. Hysterosalpingogram (HSG) – This test is essential for evaluating fallopian tubal patency, uterine filling defects such as fibroids and polyps, and scarring of the uterine cavity (Asherman syndrome). If no improvement occurs, depending on the amount of functional sperm recovery after the sperm wash, the decision must be made to proceed with either intrauterine insemination or in vitro fertilization.

The medicalization of infertility has unwittingly led to a disregard for the emotional responses that couples experience, which include distress, loss of control, stigmatization, and a disruption in the developmental trajectory of adulthood.[16] Infertility may have psychological effects. Vasectomy and its Microsurgical Reversal. (PDF, 17 MB) Urologic Clinics of North America, 1978.

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Reducing the risk of multiple pregnancies Injectable fertility drugs can sometimes result in multiple births, for example, twins or triplets. The severity usually depends on how near to the testicles the radiation was aimed. Men should undergo evaluation with a semen analysis. A doctor may diagnose infertility if a woman has not become pregnant after 1 year of trying. 8,45 Figure 1 provides an algorithmic approach to the evaluation of infertility.   Enlarge      Print Infertility Evaluation Figure 1.

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Trauma Testicular trauma is the second most common acquired cause of infertility. Sterility is classified into two groups, primary and secondary.

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Temporal relationship and reliability of the clinical, hormonal, and ultrasonographic indices of ovulation in infertile women. The urine specimen must be centrifuged immediately. After one year of having unprotected sex, about 15 percent of couples are unable to get pregnant. Exercise: Both too much and too little exercise can lead to fertility problems. A couple which is unable to conceive is not the same as a couple which often conceives without difficulties but which then sadly finds that the pregnancy does not go full term. The likelihood of fertilization improves significantly for men with low sperm concentrations. Trauma Testicular trauma is the second most common acquired cause of infertility. Legal, cultural and religious inquiries have limited the available choices in some countries, such as the use of donor sperms or oocytes. Congenital blockage of the ductal system An increased rate of duct obstruction is observed in children of mothers who were exposed to DES during pregnancy.