The most common causes of female infertility are ovulatory disorders and anatomical abnormalities such as damaged fallopian tubes. Less frequent causes include, for example, endometriosis and hyperprolactinemia. Causes of male infertility can be divided into three main categories: Sperm production disorders affecting the quality and/or the quantity of sperm; anatomical obstructions; other factors such immunological disorders. Approximately a third of all cases of male infertility can be attributed to immune or endocrine problems, as well as to a failure of the testes to respond to the hormonal stimulation triggering sperm production. However, in a great number of cases of male infertility due to inadequate spermatogenesis (sperm production) or sperm defects, the origin of the problem still remains unexplained.

A routine gynecological examination does not provide information about possible problems which can cause infertility, such as blocked fallopian tubes or ovulatory disorders. You need a systematic infertility workup.

A variety of procedures can be used to diagnose the cause of infertility in a couple; these range from simple blood tests to more complicated analytical methods. In any case, diagnosis is a crucial first step to determine the appropriate therapeutic path that should be followed. In addition to the cause itself, other factors, such as the age of the woman, or problems shared by both partners, might also influence the choice of treatment.

Painful periods do not affect fertility. In fact, for most patients, regular painful periods usually signal ovulatory cycles. However, progressively worsening pain during periods (especially when this is accompanied by pain during sex) may mean you have endometriosis.

As long as the periods are regular, this means ovulation is occurring. Some normal women have menstrual cycle lengths of as long as 40 days. Of course, since they have fewer cycles every year, the number of times they are ‘fertile’ in a year is decreased. Also, they need to monitor their fertile period more closely, since this is delayed (as compared to women with a 30 day cycle).

There is no relation between blood groups and fertility.

In any type of infertility treatment, important factors need to be taken into account when referring to success rates. The age of the woman and the duration of the couple’s infertility are likely to influence the success of treatment. In women, fecundity decreases as age increases, particularly after 40 years of age. When the woman is being treated, her chances of conceiving can be lessened if her partner also has infertility problems (eg poor quality sperm).

Loss of seminal fluid after intercourse is perfectly normal, and most women notice some discharge immediately after sex. Many infertile couples imagine that this is the cause of their problem. If your husband ejaculates inside you, then you can be sure that no matter how much semen leaks out afterwards, enough sperm will reach the cervical mucus. This leakage of semen (which is called effluvium seminis) is not a cause of infertility. In fact, this leakage is a good sign it means your husband is depositing his semen normally in your vagina! Of course, you cannot see what goes in – you can only see what leaks out – but the fact that some is leaking out means enough is going in!

When talking of success rates for any type of infertility treatment, one should bear in mind that the average chance to conceive for a normally fertile couple having regular unprotected intercourse is around 25% during each menstrual cycle. It is estimated that 10% of normally fertile couples fail to conceive within their first year of attempt and 5% after two years. Comparable to normal fertility rates, effective treatments can be expected to have, on an average, up to a 25% success rate per cycle of treatment, and may therefore need to be repeated several times before a pregnancy is achieved. Simple ovulation induction to compensate for hormonal imbalances has a very high success rate; more than 80% of women suffering from such disorders are likely to conceive after several cycles of treatment with drugs such as clomiphene citrate or gonadotropins.

Several options are offered to couples depending on the type of infertility that has been diagnosed. The vast majority of female patients are successfully treated with the administration of drugs such as clomiphene citrate, cabergoline, metformin or gonadotropins. Surgery can also be a means to repair damage to the reproductive organs, such as those caused by endometriosis and infectious diseases. Treatment options for male infertility also include the administration of drugs, surgery and assisted reproductive technologies, such as intracytoplasmic sperm injection (ICSI). Drug therapy and surgery have proved very successful for specific types of male infertility. However, in a great number of cases, the reason why men have fertility problems remains unexplained and the treatment methods applied are empirical. Some patients nevertheless require more complex medical intervention. Assisted reproductive technologies (ART) refer to several different methods designed to overcome barriers to natural fertilization such as anatomical problems (eg blocked fallopian tubes). One of these techniques, in-vitro fertilization (IVF), has now been practiced for more than 30 years. Overall, the estimated number of infertile patients currently treated by ART is around 20%.

No. The incidence of infertility in men and women is almost identical. Infertility is exclusively a female problem in 30-40% of the cases and exclusively a male problem in 10-30% of the cases. Problems common to both partners are diagnosed in 15-30% of infertile couples. After thorough medical investigations, the causes of the fertility problem remain unexplained in only a minority of infertile couples (5-10%).

You need to remember that its not possible to determine the reason for your infertility until you undergo tests to find out if your husbands sperm count is normal if your fallopian tubes and uterus are normal and if you are producing eggs. Only after undergoing these tests will your doctor be able to tell you why you are not conceiving. While testing does cause considerable anxiety, its far better to intelligently identify the problem so that we can look for the best solution.

Age
Smoking
Excess alcohol use
Stress
Poor diet
Athletic training
Being overweight or underweight
Sexually transmitted infections (STIs)
Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency.

Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

A mans sperm can be changed by his overall health and lifestyle. Some things that may reduce the health or number of sperm include—
Heavy alcohol use
Drugs
Smoking cigarettes
Age
Environmental toxins, including pesticides and lead
Health problems such as mumps, serious conditions like kidney disease, or hormone problems
Medicines
Radiation treatment and chemotherapy for cancer

Infertility in men is most often caused by
A problem called varicocele. This happens when the veins on a man’s testicle(s) are too large. This heats the testicles. The heat can affect the number or shape of the sperm. Other factors that cause a man to make too few sperm or none at all.
Movement of the sperm. This may be caused by the shape of the sperm. Sometimes injuries or other damage to the reproductive system block the sperm. Sometimes a man is born with the problems that affect his sperm. Other times problems start later in life due to illness or injury. For example, cystic fibrosis often causes infertility in men.

Common methods of ART include:
In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a womans fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the mans sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the womans uterus.
Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the womans fallopian tube. So fertilization occurs in the womans body. Few practices offer GIFT as an option.
Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.

Some common medicines used to treat infertility in women include:
Clomiphene citrate (Clomid®): This medicine causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by orally.
Human menopausal gonadotropin or hMG (Repronex®, Pergonal®): This medicine is often used for women who dont ovulate due to problems with their pituitary gland—hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
Follicle-stimulating hormone or FSH (Gonal-F®, Follistim®): FSH works much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
Gonadotropin-releasing hormone (Gn-RH) analog: These medicines are often used for women who dont ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray. Metformin (Glucophage®): Doctors use this medicine for women who have insulin resistance and/or PCOS . This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
Bromocriptine (Parlodel®): This medicine is used for women with ovulation problems due to high levels of prolactin. Prolactin is a hormone that causes milk production.
Many fertility drugs increase a womans chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born too early (prematurely). Premature babies are at a higher risk of health and developmental problems.

Infertility can be treated with medicine, surgery, artificial insemination, or assisted reproductive technology. Many times these treatments are combined. In most cases infertility is treated with drugs or surgery. Doctors recommend specific treatments for infertility based on Test results
How long the couple has been trying to get pregnant
The age of both the man and woman
The overall health of the partners
Preference of the partners
Doctors often treat infertility in men in the following ways :
Sexual problems:
Doctors can help men deal with impotence or premature ejaculation. Behavioral therapy and/or medicines can be used in these cases.
Too few sperm:
Sometimes surgery can correct the cause of the problem. In other cases, doctors surgically remove sperm directly from the male reproductive tract. Antibiotics can also be used to clear up infections affecting sperm count.
Sperm movement:
Sometimes semen has no sperm because of a block in the man’s system. In some cases, surgery can correct the problem. In women, some physical problems can also be corrected with surgery. A number of fertility medicines are used to treat women with ovulation problems. It is important to talk with your doctor about the pros and cons of these medicines. You should understand the possible dangers, benefits, and side effects.

Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35. So age is a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems.
Aging decreases a womans chances of having a baby in the following ways: Her ovaries become less able to release eggs
She has a smaller number of eggs left
Her eggs are not as healthy
She is more likely to have health conditions that can cause fertility problems
She is more likely to have a miscarriage.

Most experts suggest at least one year. Women aged 35 years or older should see their doctors after six months of trying. A womans chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, women should talk to their doctors if they have— Irregular periods or no menstrual periods
Very painful periods
Endometriosis
Pelvic inflammatory disease
More than one miscarriage
It is a good idea for any woman to talk to a doctor before trying to get pregnant. Doctors can help you get your body ready for a healthy baby. They can also answer questions on fertility and give tips on conceiving.

Doctors will do an infertility checkup. This involves a physical exam. The doctor will also ask for both partners’ health and sexual histories. Sometimes this can find the problem. However, most of the time, the doctor will need to do more tests.
In men, doctors usually begin by testing the semen. They look at the number, shape, and movement of the sperm. Sometimes doctors also suggest testing the level of a mans hormones. In women, the first step is to find out if she is ovulating each month. There are a few ways to do this. A woman can track her ovulation at home by— Writing down changes in her morning body temperature for several months
Writing down how her cervical mucus looks for several months
Using a home ovulation test kit (available at drug or grocery stores)
Doctors can also check ovulation with blood tests. Or they can do an ultrasound of the ovaries. If ovulation is normal, there are other fertility tests available. Some common tests of fertility in women include
Hysterosalpingography: This is an X-ray of the uterus and fallopian tubes. Doctors inject a special dye into the uterus through the vagina. This dye shows up in the X-ray. Doctors can then watch to see if the dye moves freely through the uterus and fallopian tubes. This can help them find physical blocks that may be causing infertility. Blocks in the system can keep the egg from moving from the fallopian tube to the uterus. A block could also keep the sperm from reaching the egg.
Laparoscopy: A minor surgery to see inside the abdomen. The doctor does this with a small tool with a light called a laparoscope (LAP-uh-roh-skohp). She or he makes a small cut in the lower abdomen and inserts the laparoscope. With the laparoscope, the doctor can check the ovaries, fallopian tubes, and uterus for disease and physical problems. Doctors can usually find scarring and endometriosis by laparoscopy.
Finding the cause of infertility can be a long and emotional process. It may take time to complete all the needed tests. So dont worry if the problem is not found right away.

Along with their intended benefits, drugs used to treat infertility may on occasion cause side effects. In ovulation induction, close monitoring of follicular growth is crucial to ensuring successful treatment. Monitoring techniques (such as ultrasound scan and blood tests) and adequate use of treatment protocols help the physician to avoid ovarian hyper stimulation syndrome (OHSS) and minimize the risk of multiple pregnancy. Current treatment protocols have been designed to reduce the risk of multiple births and OHSS. My grandmother says that if I just pray and have faith, I will definitely conceive. How far is this true? Believing in god can help you to maintain a positive outlook, but sheer will and blind faith wont overcome a physical problem like blocked tubes or absent sperms.

Ovarian Hyper Stimulation Syndrome (OHSS) is a side-effect that can occur during infertility treatment with ovulation inducing drugs. Symptoms of this syndrome may include ovarian enlargement, accumulation of fluid in the abdomen and gastrointestinal disorders (nausea, vomiting, and diarrhea). Severe cases of OHSS are however very rare (1-2% of cases). My husband refuses to get his semen tested. He says the fact that it is thick and voluminous means it must be normal. Is that true? Semen consists mainly of seminal fluid, secreted by the seminal vesicles and the prostate. The volume and consistency of the semen is not related to its fertility potential, which depends upon the sperm count. This can only be assessed by microscopic examination.

Multiple births occur more frequently after infertility treatment than in the normal population. About 80% of pregnancies achieved following simple ovulation induction with gonadotropins result in single births, the remaining 20% being multiple pregnancies, mostly twin pregnancies. New treatment regimens carefully adapted to the patients response help to decrease the risk of a multiple pregnancy. After IVF, one pregnancy out of four is multiple (20% twin pregnancies and 3-4% triplets). In IVF centers, physicians now frequently choose to replace a maximum of three embryos after fertilization, to further reduce the chance of multiple births.

If your mother, grandmother or sister has had difficulty becoming pregnant, this does not necessarily mean you will have the same problem! Most infertility problems are not hereditary, and you need a complete evaluation.

Ovarian cancer is a rare disease; the chance of a young woman developing an ovarian malignancy during her lifetime is lower than 1.5%. A number of factors have been found to increase the risk of ovarian cancer, including genetic predisposition and dietary habits. Scientific studies carried out in the last few decades have demonstrated that infertility itself is a risk factor for ovarian cancer. There is evidence that each pregnancy reduces the risk of a woman contracting ovarian cancer (this risk could be reduced by more than 25% by a first pregnancy). No epidemiological study has ever established a causal link between ovulation promoting drugs and ovarian cancer. An extensive study on this issue, reporting on more than 2,600 women treated between 1964 and 1974 and followed for an average of twelve years, found no association between ovulation inducing drugs and ovarian cancer.

Sperm remain alive and active in woman’s cervical mucus for 48-72 hours following sexual intercourse; therefore, it isn’t necessary to plan your lovemaking on a rigid schedule.

Regarding children born following treatment with ovulation promoting drugs, the incidence of birth defects has never been found to be higher than that in the normal population.

Although having sexual intercourse near the time of ovulation is important, no single day is critical. So, don’t be concerned if intercourse is not possible or practical on the day of ovulation.

The physician helps the infertile couple find the most appropriate therapeutic path to overcome barriers to conception, but, before a treatment is started, patients need to be aware of all its aspects, including its constraints. Beyond the medical expertise, infertile couples are also looking for counseling and support. From a psychological point of view, infertility is often a hard condition to cope with. During treatment and before a pregnancy is achieved, feelings of frustration or loss of control usually experienced by the infertile couple are likely to be exacerbated. Management of infertility includes both the physical and emotional care of the couple. Therefore, support from physicians, nurses and all people involved in treating the infertile couple is essential to help them cope with the various aspects of their condition. Offering counseling and contact with other infertile couples and patient associations can provide help outside the medical environment. My sister-in-law is advising me to keep a pillow under my hips during and after intercourse. Will this increase my chances of conceiving? Sperm are already swimming in cervical mucus as sexual intercourse is completed and will continue to travel up the cervix to the fallopian tube for the next 48 to 72 hours. The position of the hips really doesn’t matter.

One complete IVF or ICSI cycle takes approximately 15 to 16 days. From Day 1 or 2 of menses the stimulation of the ovaries start by muscular or subcutaneous injections of hormones. The mean stimulation period is 12 days, depending on the reaction of the ovaries. The ovum pick up takes place within two days after stopping the stimulation (usually on day 13). Now the real IVF or ICSI follows in the laboratory. When fertilization occurs, embryos are transferred into the uterus (usually on day 15) and drugs supporting the uterus are given. After approximately 13 days a pregnancy test will show whether the IVF treatment has been successful or not.

If pregnancy has not occurred after a year, chances are there is a medical condition causing infertility. There is no evidence that stress causes infertility. Remember, all infertile patients are under stress: its not the stress which causes infertility, its the infertility which causes the stress !

Progesterone is required for the success of early pregnancy. In a natural cycle progesterone is made by the corpus luteum (CL). If the CL is removed during the first 5 weeks after conception, the pregnancy will miscarry. By about 9 weeks’ gestation, the luteal-placental shift takes place: the trophoblast itself makes sufficient progesterone, and the pregnancy is no longer dependent on the CL. There are 2 reasons for giving extra progesterone after an IVF. The first is that the CLs in IVF were all disturbed by the IVF needle during egg pick-up. The CLs start as follicles containing eggs. At the retrieval, the needle is placed inside the follicle, the egg is removed; and other cells may also be removed. The follicle is mostly fluid, but it also contains tons of cells that make up the follicle and surround the egg. These are called the granulosa cells; and these are the cells that convert to CL cells after ovulation. So if the needle removes some of these cells, as is usually the case, the CL would not work as well, and less progesterone is produced. The second is to do with IVF medication. In a natural cycle, the hormone LH is secreted by the pituitary in small doses after ovulation, as this LH helps the CL to produce progesterone. However, during an IVF cycle, most women are given Lupride, Gonapeptyl or Ovurelix to suppress a premature LH surge at ovulation. In a natural cycle or IUI, surges are fine, they cause ovulation. In IVF, we need to time the retrieval to the hour, so that a surge at the wrong time ruins everything. So we give medicines to stop LH; but this means LH is no longer available to help the CL with progesterone production as well.

Oral preparations – Oral supplementation is not recommended because although some studies have not found a difference in efficacy between oral and other routes of administration, a few studies did report lower implantation rates, lower pregnancy rates, and /or higher miscarriage rates in women receiving oral compared with IM or vaginal progesterone. Intramuscular progesterone : The main downside of IM progesterone is local skin inflammation at the site of injection. At times, this reaction can be quite painful and can lead to induration that may persist for weeks after the injections are complete. Vaginal preparations : Because the progesterone is first absorbed locally, intrauterine concentrations are high despite serum levels that are lower than with IM progesterone. Vaginal progesterone may be administered using compounded suppositories, tablets or 8% gel. The main side effects with vaginal preparations are vaginal irritation, discharge and dyspareunia. The principal advantage of the vaginal preparations is that they are less painful than IM injections. IM injections may be difficult for a patient to administer herself, whereas vaginal preparations can be self-administered. However, vaginal preparations must be used 2-3 times per day, whereas IM progesterone is administered once daily .

In the beginning In Vitro Fertilization (IVF) was developed for patients facing infertility due to damaged fallopian tubes. Later on the indications to perform IVF were broadened, for example, unexplained infertility and male infertility. Nowadays tubal damage still accounts for a large number of all IVF treatments. The main cause is abdominal infection. This is mostly due to sexually transmitted diseases (for example chlamydia or gonorrhea) but complicated appendicitis or Pelvic Inflammatory Disease (PID) can also cause damaged tubes. Other causes are abdominal operations (gynecological operations, Cesarean section, sterilization or other) and internal diseases like Crohn’s disease. Affected patients can have fertility problems and are at risk for having a pregnancy located in the tubes (ectopic or tubal pregnancy).

Men who have cystic fibrosis often have a congenital anomaly in the male genital tract. The vas deferens, the tube connecting the testicle and epididymis to the ejaculatory duct, is congenitally absent. This makes it impossible for the sperms to pass through the penis. Using testicular sperm aspiration, the urologist can obtain sufficient sperm to allow excellent success with IVF and ICSI (intra cytoplasmic sperm injection). Insufficient numbers of sperm are obtained to make intrauterine insemination an effective option. As cystic fibrosis is a recessive genetic disorder, abnormal gene contributions from both parents are necessary for this disorder to be present. Both copies of the gene are abnormal in men with CF. While persons carrying a single copy of an abnormal gene do not have this condition, when paired with a partner with CF, they have a 50% chance of CF in their offspring. This makes testing the female partner advisable. If the woman tests normal, the children will be carriers for an abnormal gene and although they will not likely have CF, it is advised that their spouses be checked for CF gene abnormalities.

There is no connection between sexual pleasure and fertility. Don’t forget that even a woman who gets raped can get pregnant! And don’t forget that the commonest reason women do not enjoy sex is because their husbands are unskilled lovers! Maybe you should improve your sexual technique, and spend more time in foreplay and in pleasuring your wife!

When a pregnancy is not located in the uterus it is called an Extra Uterine Pregnancy (EUP) or ectopic pregnancy. The most common place for an EUP is the fallopian tube but sometimes the ectopic pregnancy is located elsewhere, such as in the cervix, the ovary or in the abdomen. EUP is a rare disease and occurs in 1% of all pregnancies. With IVF treatment the risk can increase. Risk factors for EUP are a history of infection of the tubes (salpingitis), chlamydia infection, Pelvic Inflammatory Disease (PID), former EUP, operation on the tubes or in the lower abdomen, endometriosis and appendicitis. The symptoms of ectopic pregnancy are often similar to those of a normal miscarriage and may include a positive pregnancy test together with or without vaginal bleeding and abdominal pain. Although it is not common, the possibility of EUP has to be considered in patients with the symptoms and one (or more) of the risk factors for EUP. Diagnosis is made by questioning the patient on the risk factors, physical examination, vaginal ultrasound and laboratory findings. Depending on the size and the location of the EUP, different treatments can be given. Mostly the ectopic pregnancy will be removed surgically but occasionally medical treatment or expectant treatment is offered when the pregnancy is very small and thorough control of the patient is possible. I just had a HSG (X-ray of the uterus and tubes) done, and this shows my tubes are blocked. Ive never had symptoms of a pelvic infection, so how could my tubes get blocked? Many pelvic infections have no symptoms at all, but can cause damage, sometimes irreversibly, to the tubes.

To increase the chance of getting pregnant spontaneously, timed sexual intercourse is recommended. This means that sexual intercourse, or coitus, has to be taken place around the time of ovulation, which is the most fertile period of a woman. To detect the approximate time of ovulation a temperature curve of several menstrual cycles can be made. The woman takes her body temperature each morning before getting out of bed, starting on the first day of the menstruation until the start of a new period. The body temperature rises around 0.5 degree Celsius after the ovulation. This is mostly about 14 days after the first day of the period and when no pregnancy occurs the temperature drops to normal again; with pregnancy the temperature stays high. One can also use urine or saliva tests to detect the ovulation. The time of ovulation can sometimes vary a few days each month, even in a regular menstrual cycle. Also, if the circumstances are right, sperm can live inside the women for a few days and sperm quality can decrease with high sexual activity. Therefore it is best to have intercourse 3-4 days before the expected ovulation and every other day until 2-3 days after the expected ovulation with no necessity for higher frequency. When tests are used to detect ovulation it is advised to have sexual intercourse on the day of a positive test. My doctor has advised me to take fertility drugs. I dont want to take them because I am scared that if I do, then Ill have a multiple birth. Although fertility drugs do increase the chance of having a multiple pregnancy (because they stimulate the ovaries to produce several eggs) the majority of women taking them have singleton births.

Women with no or not properly working ovaries can, in some cases, get pregnant through egg donation. In this procedure another woman will be the egg donor. This woman will have an IVF stimulation and ovum pick-up. After the ovum pick-up the collected eggs will be fertilized with sperm of the partner of the recipient woman ie donor acceptor. The embryos are then transferred into the uterus of the recipient. If a pregnancy occurs the recipient and her partner will have a child which is biologically only half their own.

Even a normal (fertile) mans sperm count can vary considerably from week to week. Sperm count and motility can be affected by many factors, including time between ejaculations, illness, and medications. There are other factors which affect the sperm count as well, all of which we do not understand.

There is no correlation between male fertility and virility. Men with totally normal sex drives may have no sperms at all.

Assisted Reproductive Therapy (ART) has caused an increase in multiple pregnancies. This situation is especially seen in ovulation induction and Intra Uterine Insemination. In order to prevent the risk of severe premature birth and handicaps as well as risks for the mother, embryo reduction is sometimes performed. The number of embryos in the uterus is reduced and the remaining pregnancy has a better chance of normal development and delivery. Of course this is not an easy decision for either the patients or the doctor. With careful guidance of the patient during treatment and good counseling when the patient is at risk for a large multiple pregnancy, many triplets or higher order pregnancies may be avoided. I don’t think infertility treatment should be offered in India, because there are too many babies in this country already. Why should we exacerbate the population problem by producing more? In any case, IVF treatment is too expensive for India to be able to afford it. The right to have children is a fundamental right of every human being and a very basic biological urge. Just because a neighbor has too many children should not deprive the infertile couple of their right to have their own. IVF and related technologies are undoubtedly expensive, but, then, so is heart surgery. Yet, no one objects when over Rs 1 lakh are spent to try to salvage the heart of a 70-year-old man (whose life expectancy in any case is only about 5 years and is not extended by the surgery). Why then should medical technology not be used to help couples in their thirties (with their whole lives ahead of them) have their own baby? In fact, IVF is a much more cost-effective use of medical resources than a number of other accepted surgical procedures (such as joint replacement surgery or kidney transplants).

Masturbation is a normal activity which most boys and men indulge in. It does not affect the sperm count. You cannot run out of sperms, because these are constantly being produced in the testes.

Cryopreservation means preserving in a frozen condition. The best known cryopreservation is of semen. This is mostly done in case of cancer of the testicles before treatment of the cancer. Furthermore cryopreserved semen is used in donor insemination. It is also possible to freeze fertilized eggs after IVF or ICSI. If more embryos are left after an IVF or ICSI procedure they can be frozen and transferred another time. In this way there is another chance of a pregnancy while only one IVF or ICSI cycle is performed. For human oocytes cryopreservation is much more difficult. Only in very few experiments this is done successfully. The attention of researchers now is on developing a way to freeze ovarian tissue and after thawing, to obtain the oocytes in it. This procedure is not yet fully refined but when it is it can offer great opportunities in the future.

TESE (Testicular Sperm Extraction):
Sperm collected out of the testicles after operation.
MESA (Microsurgical Epididymal Sperm Aspiration):
Sperm collected out of the epididymis after operation.
TESE or MESA is a technique developed for patients with no sperm cells in their sperm due to an undeveloped or obstructed spermatic cord. The cause of obstruction can be a former sterilization or an infection of the epididymis. When the testicles make no sperm cells at all, of course TESE or MESA is not possible. If sperm cells are obtained, an ICSI procedure (Intra Cytoplasmic Sperm Injection) will follow. ICSI is like IVF; only now one sperm cell is injected into each egg to fertilize it and make an embryo.

Tissue histologically identical to the endometrium (the inner lining of the uterine wall) outside the uterine cavity. Usually, endometriosis is confined to the pelvic and lower abdominal cavity; however, it has occasionally been reported in other areas as well. Endometriosis is one of the most common problems that gynecologists currently face. It is one of the most complex and least understood diseases in our field and, despite many theories; we still do not have a clear understanding of the cause or of its relationship to infertility. Since this disorder is primarily a human disease and rare in other animal species, accumulation of the facts has been slow. Although endometriosis has been considered a pathological or separate disease entity, it may not be a disease at all. It may actually be the clinical manifestation of a more basic underlying disorder, such as a basic chemical or physiological abnormality that affects the tubal motility or immune system which could be responsible for the initiation or progression of endometriosis in patients with retrograde menstrual flow. By the same token, endometriosis may not be the cause of infertility, but the result of it. Further technological developments may be necessary in order for us to fully understand this problem.

Spermatozoa are ejaculated in the seminal fluid during intercourse or masturbation. During assisted reproduction the spermatozoa are extracted from the semen by a series of processes – centrifugation and washing, layering (to select the active sperm and leave the immotile or dead sperm behind) or selecting the best sperm by making them swim through a denser medium and using those that succeed.

Reproductive surgery is a subspecialty that treats anatomical abnormalities interfering with normal reproductive function. Advanced reproductive surgery requires meticulous surgical technique for optimal results, including rapid patient recovery and avoiding the need for routine hospitalization. Reproductive surgeons treat tubal obstruction, endometriosis, uterine fibroids, scarring of the ovaries or other pelvic structures resulting from pelvic inflammatory disease (PID) in the female, and varicocele and vas obstruction in the male as well as other abnormalities.