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Meticulous hemostasis is imperative. [131, 132, 133] Operative laparoscopy was reintroduced into the surgical armamentarium in the 1950s; however, in the 1970s, Semm developed different procedures and operative instruments that currently allow for the outpatient laparoscopic surgical treatment of multiple tuboperitoneal pathologies, [91] electrocautery, endocoagulation, lasers, and ultrasonography scalpels facilitate the performance of operations that otherwise used to require a laparotomy. Fallopian tubes that are patent and will function to permit the sperm and ovum to meet and allow migration of the conceptus to the uterus.

Ovarian hyperstimulation syndrome (OHSS) usually results from taking medications to stimulate the ovaries, such as clomifene and gonadotrophins. In a recent meta-analysis, letrozole was found to be as effective as other methods of ovulation induction. [169] The usual dose for letrozole ovulation induction is 2. Sherman Silber: Be Fruitful and Multiply. (PDF, 6 MB) Lifestyles Magazine, 1999. Algorithm for infertility evaluation. (ART = assisted reproductive technology.) Infertility Evaluation Figure 1.

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A typical adverse effect can be ovarian hyperstimulation. However, future pregnancy is possible with the other ovary and tube. Vasectomy. (PDF, 5 MB) From the Encyclopedia of Reproduction, 1999.

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8–16 One retrospective case-control study of 650 men with infertility and 698 control participants questioned the role of environmental risk; no association could be determined after assessing for multiple factors including shift work, stress, and pesticides. However, early referral of infertile couples to a dedicated specialist infertility clinic may be indicated to increase their chance of pregnancy (Table ). In contrast, anovulation usually manifests itself as irregularity of menstrual periods, that is, unpredictable variability of intervals, duration, or bleeding. Once the fluid containing the eggs is removed from the follicles into the vials, they are handed to the embryologist who finds the eggs, places them in tiny droplets on a Petri dish, and then fertilizes the eggs using their partner’s or donor sperm. Your doctor will determine if you are at risk of having endometriosis based on a careful history, physical exam, and ultrasound. The resulting embryos are then transferred into the uterus of the future mother, known as the recipient.

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Suspect antisperm antibodies when semen analysis reveals abnormal clumping, agglutination, unexplained decreased motility, or an abnormal postcoital test result. GnRH analog ([GnRHa], leuprolide acetate, nafarelin acetate, goserelin acetate) causes down-regulation of the pituitary, inducing chemical menopause after injections of 3. Several methods are available to detect antisperm antibodies, such as radioimmunoassay and enzyme-linked immunosorbent assay, but the most specific test is the immunobead test. 8,46 Obesity impairs fertility and the response to fertility treatments, including in vitro fertilization; therefore, it is advisable to counsel patients who are obese to lose weight before conception or infertility treatments. Ongoing Pregnancies and Birth after Intracytoplasmic Sperm Injection with Frozen-thawed Epididymal Spermatozoa. (PDF, 442 KB) Human Reproduction, 1995. Radiation treatment and/or chemotherapy for cancer. Your physician will discuss these approaches to having a baby if appropriate to your particular case. Diverse Spermatogenic Defects in Humans Caused by Y Chromosome Deletions Encompassing a Novel RNA-binding Protein Gene. (PDF, 2 MB) Human Reproduction, 1996. Other considerations include preconception screening and vaccination for preventable diseases such as rubella and varicella, sexually transmitted infections, and cervical cancer, based on appropriate guidelines and risk.