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All about infertility causes of male infertility causes of female infertility causes of infertility infertility tests female fertility tests male fertility tests infertility treatment assisted reproductive technology (ART) treatments for female infertility female infertility drugs treatments for male infertility infertility prevention in vitro fertilization (IVF) intrauterine insemination (IUI) gamete intrafallopian transfer (GIFT) intracytoplasmic sperm injection (ICSI) zygote intrafallopian transfer (ZIFT)

What infertility tests are available?

In the male, sperm examination and sperm count is commonly done. As male factors contribute to more than a third of infertility problems, a semen analysis is necessary as part of the evaluation. A specimen of semen is examined microscopically in the laboratory, to determine the number of sperms as well as their size, shape, and motility. If the sample proves normal, no further tests may be necessary for the male. If there are less than 60 million sperm per cubic centimetre, less than 60 percent normal forms, or less than 60 percent actively moving sperm, or any other abnormalities in the sperm, further evaluation is indicated. Examination of the reproductive tract and genital organs may be necessary.

In females, the basal body temperature is recorded each morning over several months to find any ovulatory disorders. Other methods to confirm ovulation include a blood test to measure progesterone blood level after ovulation and a biopsy of the lining of the uterus. Blockages of the tubes or abnormalities in the uterine lining, may require a hysterosalpingogram (HSG). A dye is injected through the cervix into the uterine cavity and tubes, and an X ray photograph is taken. The outline of the lining of the uterus is examined to confirm that the tubes are normal and open. A postcoital test (PCT) may be done shortly after intercourse to evaluate the cervical mucus and its interaction with the sperm. Laparoscopy may be done to visualise the abdominal and pelvic cavity to see the uterus, fallopian tubes and ovaries, to detect pelvic adhesions, scarring, endometriosis or other relevant pathology.

Because fecundity (the ability to conceive) naturally decreases as people grow older, making it more difficult to conceive no matter how infertile one or both of the partners is, it is very important to begin diagnosis and treatment for infertility as early as possible. This is especially true for women who are older than 35 years old, since it’s around that age that natural fecundity drops dramatically.

Women who are older than 35 (as well as couples who have been unsuccessful for several years) should have a CCCT (clomiphene citrate challenge test) performed so that their physicians can evaluate their ability to become pregnant on the basis of the number and quality of their remaining eggs. Almost without exception, women who experience regular, predictable menstrual cycles are ovulating normally. Women who are experiencing any sort of abnormal bleeding may, on the other hand, be ovulating erratically or not at all. Anovulation – the absence of ovulation - accounts for approximately 25% of all female infertility cases.

Several hormone levels (e.g., PL, TSH, LH, FSH, progesterone) are routinely checked when investigating the cause of infertility. Anovulation is usually diagnosed by measuring the level of luteinizing hormone (LH) in a woman's urine with a LH predictor kit. A lower than normal LH level indicates that the woman is not ovulating, which partially explains her inability to conceive. The level of progesterone is tested 6 to 8 days after the LH surge that precedes ovulation. Lower than normal progesterone levels also indicate anovulation.

Blocked tubes and uterine abnormalities account for about 35% of all female infertility cases, thus it’s essential that the tubes and uterus be examined during the workup, especially if anovulation doesn’t appear to be the problem. The medical history often provides helpful clues about whether the tubes or uterus are involved. The patient’s health care provider will likely ask her if she has any history of STDs or pelvic inflammatory disease, abdominal or pelvic surgery, ectopic pregnancy, endometriosis, or uterine abnormalities, all of which can lead to infertility.

Diagnosing uterine or tubal infertility factors usually involves an HSG as the first step and, depending on the results, could require a hysteroscopy or laparoscopy. Large fibroids in the uterus usually preclude a laparotomy.

More information on infertility

What is infertility? - Infertility is the inability to achieve and/or maintain pregnancy. Infertility may due to a variety of causes, including abnormal hormonal levels, low sperm production and scarring of the fallopian tubes.
What causes infertility in men? - The most common male infertility factors include azoospermia and oligospermia. In rare cases, infertility in men is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.
What causes infertility in women? - The most common female infertility factor is an ovulation disorder. Other causes of female infertility include blocked fallopian tubes. Inability of the fertilized egg to implant in the uterus will lead to female infertility.
What causes infertility? - Causes of infertility include a wide range of physical as well as emotional factors. Infertility can be caused by any interruption in the usual process of fertilization, pregnancy, and birth.
How is infertility diagnosed? - In the male, sperm examination and sperm count is commonly done. In females, the basal body temperature is recorded each morning over several months to find any ovulatory disorders.
What female fertility tests are available? - Blood tests that measure the levels of various hormones. The doctor may want to measure the man's testosterone levels to see if they are high enough. Basal body temperature (BBT) can be measured at home using a special thermometer to help predict the most fertile days.
What male tertility tests are available? - A semen analysis is the most common testing procedure for determining if there is a male infertility factor. Semen analysis is the mainstay of male testing.
What treatments are available to cure infertility? - The ultimate goal of infertility treatment is a healthy pregnancy and the birth of one healthy infant. There are various treatments for infertility, depending what the problem is.
What is assisted reproductive technology (ART)? - Assisted reproductive technologies are medical treatments to overcome infertility. The most common type of ART is in vitro fertilization.
What are the treatments for female infertility? - Assisted reproductive technology (ART) combines the use of fertility drugs - hormonal therapy with artificial insemination using any of a group of techniques. Acupuncture may also be helpful.
What medicines treat female infertility? - Clomiphene triggers the release of FSH and LH, boosting egg growth and helping the ovaries release a monthly egg. Bromocriptine suppresses a hormone called prolactin. LH-RH drugs are used when the pituitary or hypothalamus gland is not producing hormones.
What are the treatments for male infertility? - Low sperm counts can be treated by collecting and concentrating healthy sperm for insemination or assisted reproductive technology (ART) treatment.
How to prevent infertility? - Most types of infertility cannot be prevented. Smoking has been linked to low sperm counts. Alcohol affects the fertility of both men and women. Excessive exercise can lead to menstrual disorders in women and affect sperm production in men.
What is in vitro fertilization (IVF)? - In vitro fertilization (IVF) is the process used to conceive a child outside the body. In vitro fertilization is a method of assisted reproduction that involves removing eggs from a woman's ovary, combining the egg with sperm in a dish and replacing the resulting embryos in the woman's uterus.
What is intrauterine insemination (IUI)? - Intrauterine insemination is a procedure in which a fine catheter is inserted through the cervix into the uterus to deposit a sperm sample directly into the uterus.
What is gamete intrafallopian transfer (GIFT)? - Gamete intrafallopian transfer (GIFT) is an infertility treatment in which eggs are removed from a woman's ovaries, and placed in one of the fallopian tubes, along with the man's sperm.
What is intracytoplasmic sperm injection (ICSI)? - Intracytoplasmic sperm injection (ICSI) is an in vitro fertilisation procedure in which a single sperm is injected directly into an egg.
What is zygote intrafallopian transfer (ZIFT)? - Zygote intrafallopian transfer (ZIFT) is technique in which a woman's egg is fertilized outside the body, then implanted in one of her fallopian tubes.
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