Missing information about reproductive processes is an important barrier
to conception and live birth among infertile couples. In vitro and
genetic techniques have been informative, but not enough is known
about potential defects in fertilization, implantation and early embryo
development to define explicit infertility diagnoses and direct specific
treatment. Study of gamete quality is needed because endocrine and
ultrasound measurements in the female cannot determine oocyte quality
and semen analysis in the male is a limited predictor of fertilizing
ability. Also, more study would help in understanding the conditions
in the Fallopian tube and elsewhere that fos¬ter fertilization
and embryo development. Research in related subjects is also needed:
after many years of enquiry, there exists little or no evidence to
determine how and if endometriosis causes subfertility. In contrast,
the recently described impact of smoking in males is large, clinically
important and possibly reversible. Missing information limits the
choice of specific treatment, puts a ceiling on the overall prognosis,
increases the likelihood of persistent infertility and forms a barrier
to understanding the broader meanings of success in the management
of infertility.
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