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Infertility is defined as the failure to conceive after a year of unprotected and unrestricted intercourse. In women over 35, the period is defined as six months. Primary infertility is when a couple has never had children, whereas secondary infertility refers to couples who have had children together but are at present unable to conceive.
The causes of infertility are equally split between male, female and unknown causes.
Reduction in sperm quality or quantity may be idiopathic, or a result of conditions such as:
Anovulation may be due to many factors, including:
In men, testing starts with semen analysis, and hormonal assays if indicated, as when sperm counts are very low.
In women, ovulation is tested for, either at home, using means such as basal body temperature or cervical mucus tests, or in hospital, with an ultrasound or blood tests.
If ovulation is present, tests may be performed to rule out tubal or uterine blockages and assure normal uterine anatomy.
If ovulation is absent, hormonal levels are checked, as well as metabolic parameters.
Treatment is based on:
ART is costly, time-consuming and carries a relatively higher risk of certain birth defects, such as heart, digestive and cleft lip/palate problems.
More modern choices include the use of a surrogate mother or a gestational carrier.