A 27 yo woman fails to conceive for 6 months . She has normal menstrual cycle, and no significant medical or surgical history. Her BMI is 23.5 kg /m2 . Her partner is 30yo with BMI 24 kg/m2. No significant medical or surgical history . There is no history suggestive of sexual dysfunction. What would be the first line of management ?

Following fertility investigations, a man is found to have idiopathic oligozoospermia. He enquires if there is any treatment he can take to improve his sperm count . What would you recommend?

•According to the current WHO criteria , what is the reference limit for the total number of spermatozoa in an ejaculate ?

The GP has referred a 26 year old woman to the infertility  clinic who has been trying to conceive for the last 2 years . Her pelvic ultrasound is normal. Her husband has fathered a child from his previous relationship . His semen analysis is as follows with the referral form. Which one of the following parameters is an abnormal result ?

A 38yo Asian woman has been referred to the infertility clinic. She has been trying to conceive for the last 14months . Her recent HSG reveals a normal uterine cavity & tubes. A day 21 serum progesterone level is reported to be 31 ng/mL. Her husband’s semen analysis results are reported as follows:

•Percentage of abnormal forms : 85%

•Progressive motility : 35%

•Ph 7.22

•Total sperm number 40 million

•Semen volume 2 mL

•How should she be managed regarding her subfertility?

A 39 year old male presents to a fertility clinic following a repeat semen analysis for oligoasthenoteratozoospermia. The semen analysis results show semen volume 1.0mL , sperm concentration 2x $$10^6$$   , total motility 10% , normal forms 1%, and vitality 10% .•What is the next appropriate  next step in management?

•A male patient presents with history of anosmia , azoospermia , bilateral small testes  and gynaecomastia .

•What is the best treatment modality ?

Microdeletion seen in one or more gene of the long arm of Y chromosome is seen what % of men with azoospermia .

•29yo woman for subfertility . Investigation reveals mid cycle progesterone 65 , normal FSH , LH , normal HSG / thyroid and prolactin normal. USG normal,semen analysis shows Azoospermia, all of the following can cause azoospermia except :

•A couple were investigated for infertility . The man was found to be oligozoospermic and the women had blocked tubes and irregular ovulation. They were therefore offered ICSI with superovulation. They are anxious about the effects of the procedure on the resulting children. Which complications listed below are related to ICSI ?

•A 24 yo P0+0 lady attends the clinic with history of failure to conceive for about 26months despite having regular unprotected SI . She has no medical prob and regular menses. Her partner is a 36year old man who is generally healthy, smoke 20 cigarettes/day and drinks >12units alcohol/week. He has history of mumps when he was 16yo. His semen analysis has shown absence of any sperm that has been confirmed by repeat test.  His serum FSH & LH raised , serum testosterone is low. He has normal karyotype . Best management plan is: