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Low sperm mobility (motility): The sperm cannot "swim" as well as they should to reach the egg. This can reveal signs of endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes. Patients are often short, with small firm testis and gynecomastia, but they have a normal-sized penis. Men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. It is increasingly recognized that egg quality is of critical importance and women of advanced maternal age have eggs of reduced capacity for normal and successful fertilization.

Aetiology of Congenital Absence of Vas Deferens: Genetic Study of Three Generations. (PDF, 4 MB) Human Reproduction, 1993. Castration of the affected testis may allow the other testis to regain its ability to produce sperm, but the prognosis is guarded.

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Endometriosis: Cells that normally occur within the lining of the uterus start growing elsewhere in the body. Afterward, radiographs are taken and the contrast material can be seen in the abdominal cavity if the tubes are pervious.

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Some causes, such as hyperprolactinemia, are reversible with proper treatment. 6,8 It is important for primary care physicians to be familiar with the workup and prognosis for infertile couples. United Kingdom[edit] In the UK, previous NICE guidelines defined infertility as failure to conceive after regular unprotected sexual intercourse for two years in the absence of known reproductive pathology.[11] Updated NICE guidelines do not include a specific definition, but recommend that "A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner, with earlier referral to a specialist if the woman is over 36 years of age."[12] Other definitions[edit] Researchers commonly base demographic studies on infertility prevalence on a five-year period.[13] Practical measurement problems, however, exist for any definition, because it is difficult to measure continuous exposure to the risk of pregnancy over a period of years. Some methods may be used in concert with other methods. In some cases, laparoscopy for infertility will be indicated to look for pelvic scarring or endometriosis As in vitro fertilization success rates have improved dramatically over the past 20 years, laparoscopy for infertility is being done much less than before. 8) Unexplained/other: Sometimes a full evaluation does not reveal the cause of infertility.

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Mumps: If this occurs after puberty, inflammation of the testicles may affect sperm production. 50% are female causes with 25% being due to anovulation and 25% tubal problems/other.[74] In Sweden, approximately 10% of couples wanting children are infertile.[75] In approximately one third of these cases the man is the factor, in one third the woman is the factor, and in the remaining third the infertility is a product of factors on both parts. Clomiphene citrate for unexplained subfertility in women. 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. Diagnosis of Sterility An important part of the diagnosis is a detailed anamnesis and the routine gynecologic examination. The vast majority of anovulation patients belong to the WHO2 group and demonstrate very heterogeneous symptoms ranging from anovulation, obesity, biochemical or clinical hyperandrogenism and insulin resistance.[14] Treatments[edit] Anovulation can potentially be reversed by lifestyle changes.[15] Lifestyle changes[edit] In women with polycystic ovary syndrome with anovulation, weight loss generally results in improved menstrual regularity, ovulation, and pregnancy rates.[16] In otherwise healthy women with anovulation, avulatory disorders may be favorably influenced by a healthy diet such as a higher consumption of monounsaturated fats rather than trans fats, vegetable rather than animal protein sources, high fat dairy, multivitamins, and iron from plants and supplements.[15] Ovulation induction[edit] The main alternatives for ovulation induction medications are: Antiestrogen, causing an inhibition of the negative feedback of estrogen on the pituitary gland, resulting in an increase in secretion of follicle-stimulating hormone. Sterility is an emotional journey for the couple trying to become pregnant, and feelings of anger, guilt, and depression are not uncommon.