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If the sperm do not have the right shape, or they cannot travel rapidly and accurately towards the egg, conception may be difficult. Although many of these can be treated through surgery or hormonal substitutions, some may be indefinite.[59] Infertility associated with viable, but immotile sperm may be caused by primary ciliary dyskinesia. Treatment of tubal obstruction generally requires referral for subspecialty care.

Some causes are more common in some countries than others, such as pelvic inflammatory diseases (PID) and sexually transmitted infections (STI) in Africa [10]. In this procedure, 5–10 mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO 2 from leaking). Infertility rates have increased by 4% since the 1980s, mostly from problems with fecundity due to an increase in age.[72] Fertility problems affect one in seven couples in the UK. If stem cells remain viable after radiation therapy, patients may regain fertility within several years. A specimen is collected by masturbation into a clean, dry, sterile container or during coitus using special condoms (containing no spermicidal lubricants). 0.[44] Environmental factors Toxins such as glues, volatile organic solvents or silicones, physical agents, chemical dusts, and pesticides.[45][46] Tobacco smokers are 60% more likely to be infertile than non-smokers.[47] German scientists have reported that a virus called adeno-associated virus might have a role in male infertility,[48] though it is otherwise not harmful.[49] Other diseases such as chlamydia, and gonorrhea can also cause infertility, due to internal scarring (fallopian tube obstruction).[50][51][52] Alimentary habits[53] Obesity: The obesity epidemic has recently become is a serious issue, particularly in industrialized nations.

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Endometriosis is usually more common in women in their mid-twenties and older, especially when postponed childbirth has taken place.[55] Another major cause of infertility in women may be the inability to ovulate. There may be testicular malformations, hormone imbalance, or blockage of the man's duct system. If a tube is blocked and filled with fluid (called a hydrosalpinx), then minimally invasive surgery (laparoscopy or hysteroscopy) to either remove the tube or block/separate it from the uterus prior to any fertility treatments is recommended. The likelihood of fertilization improves significantly for men with low sperm concentrations.

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Certain medical conditions such as diabetes, thyroid disease and anemia may also affect fertility. Although the sperm count may be slightly decreased by an intercourse frequency of once per day or once every other day, the motility and number of sperm in the healthy male would be sufficient to achieve pregnancy. Checking testosterone levels is advisable because an elevation above the reference range has a negative feedback effect on sperm production.

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The medical industry is forever making advances in this field. Modifiable and non-modifiable risk factors for poor semen quality: a case-referent study. Further investigations 18. Laparoscopy: - Invasive procedure. - to check for pelvic disease; such as endometriosis and to check tubal patency. - therapeutic as in laparoscpic myomectomy and ovarian drilling. Hysteroscopy: - to evaluate uterine cavity. - In case of repeated failed IVF cycles. - therapeutic as in intrauterine septum. Thoracentesis is rarely indicated in cases of pleural effusion. This should be followed by documentation of ovulation via serum progesterone. The treatment of uterine malformations depends on the severity of the problem. Less than 50% motility may significantly affect the ability for sperm to fertilize the egg without therapy; and (4) morphology, or shape – there are three parts of the sperm that are analyzed for morphology: the head, midpeice, and tail. 6 The initial history should cover menstrual history, timing and frequency of intercourse, previous use of contraception, previous pregnancies and outcomes, pelvic infections, medication use, occupational exposures, substance abuse, alcohol intake, tobacco use, and previous surgery on reproductive organs.