The infertility problem must be approached in a systematic way; this approach provides a flawless relationship and communication between the couple and their specialized gynecologist who must provide both partners with full and reliable information on the impact of the problem, the available solutions, and the possibility of success for each applicable method.  The key point to this approach is the complete individualization of each case so that each couple receives the best possible treatment. Thus one should take into consideration the results of the infertility causes’ investigation, the partners’ age, the duration of the problem, any previous unsuccessful assisted reproduction attempts, and the couple’s psychological status. Let us see in detail the causal treatment of certain conditions leading to infertility:

• Couples where the man has serious sperm disorders (severe oligospermia or asthenospermia): application of in vitro fertilization with intracytoplasmic sperm injection
  
  
• Couples where the man has azoospermia (lack of spermatozoa into the semen): if the man’s clinical and endocrine investigation suggests a possibility of sperm retrieval from the testicles or the epididymis (a place of spermatozoa accumulation in the male reproductive system), microsurgical sperm retrieval can be attempted followed by the application of in vitro fertilization. In the case of lack of such possibility, the suggested solution is use of donor sperm which is injected after preparation into the uterus (heterologous intrauterine insemination)
  
  
• Couples where the man has a slight or moderate sperm disorder: application of homologous intrauterine insemination (IUI), i.e. the sperm is inseminated into the uterus after being properly prepared. After 3 or 4 unsuccessful IUIs, the application of in vitro fertilization is suggested. In case that the abovementioned disorders are related to the presence of varicocele, the surgical treatment of the latter may bring some improvement in the long run (debatable)
  
  
• Couples where the woman suffers from obstruction of both fallopian tubes: application of in vitro fertilization. If the tubes are both obstructed and dilated and filled with fluid (hydrosalpinx) then the suggested solution is their laparoscopic removal or at least their ligation before applying in vitro fertilization. This is because the results of IVF are negatively affected if the hydrosalpinx remains into the woman’s pelvis.
  
  
• Couples where the woman demonstrates ovulation disorders: the suggested solution is ovulation induction with the use of fertility drugs under close observation followed by scheduled sexual intercourse or application of intrauterine insemination
  
  
• Couples where the woman presents clinical features of endometriosis: a diagnostic and/or operative laparoscopy is suggested for the best possible treatment of the disease. Subsequently, according to the occasion, efforts for natural conception (after an additional pharmaceutical treatment or not), or assistance by performing intrauterine insemination, or application of in vitro fertilization are suggested
  
  
• Couples where the woman has endometrial polyps, sub-mucous fibroids, or uterine septa: a hysteroscopic treatment is suggested. Subsequently, according to the occasion, efforts for natural conception or a faster application of some assistance method are suggested
  
  
• Couples in which the abovementioned infertility factors investigation does not demonstrate the presence of some specific cause (unexplained infertility): the performance of sperm injections is suggested at a first stage of treatment. After 3 or 4 unsuccessful sperm injections one should proceed to application of in vitro fertilization.

It should be noted once again that the treatment of each couple must be fully individualized, given that more than one infertility factors may exist at the same time, but also that particular social or demographic factors (the woman’s age for example) may require modifications in the applied treatment.