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For information about the SORT evidence rating system, go to https://org/afpsort A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.For information about the SORT evidence rating system, go to https://org/afpsort Source: For more information on the Choosing Wisely Campaign, see Abnormalities of sperm may be treated with gonadotropin therapy, intrauterine insemination, or in vitro fertilization.Ovulation should be documented by serum progesterone level measurement at cycle day 21.A decreased testosterone level with an increased FSH level points to primary hypogonadism.A low testosterone level with a low FSH level signals a secondary cause.Women with anovulation may be treated in the primary care setting with clomiphene to induce ovulation.
Because sperm generation time is just over two months, it is recommended to wait three months before repeat sampling.8 A normal sample according to the 2010 World Health Organization (WHO) guidelines is described in .
Evaluation may be initiated sooner in patients who have risk factors for infertility or if the female partner is older than 35 years.
Causes of infertility include male factors, ovulatory dysfunction, uterine abnormalities, tubal obstruction, peritoneal factors, or cervical factors.
Evaluation of the uterus and fallopian tubes can be performed by hysterosalpingography in women with no risk of obstruction.
For patients with a history of endometriosis, pelvic infections, or ectopic pregnancy, evaluation with hysteroscopy or laparoscopy is recommended.
Unexplained infertility in women or men may be managed with another year of unprotected intercourse, or may proceed to assisted reproductive technologies, such as intrauterine insemination or in vitro fertilization.