In males with hepatitis B, The Practice Committee of the American Society for Reproductive Medicine advises that sperm washing is not necessary in IVF to prevent transmission, unless the female partner has not been effectively vaccinated.[37][38] In females with hepatitis B, the risk of vertical transmission during IVF is no different from the risk in spontaneous conception.[38] However, there is not enough evidence to say that ICSI procedures are safe in females with hepatitis B in regard to vertical transmission to the offspring.[38]

A 2013 review and meta analysis of randomised controlled trials of acupuncture as an adjuvant therapy in IVF found no overall benefit, and concluded that an apparent benefit detected in a subset of published trials where the control group (those not using acupuncture) experienced a lower than average rate of pregnancy requires further study, due to the possibility of publication bias and other factors.[34]

Sometimes problems getting pregnant for a second or subsequent time are related to a complication that occurred in a prior pregnancy or prior to delivery (damage to the uterus, for instance). But most often, secondary infertility is caused by the same factors that would cause primary infertility — issues like advanced age, obesity, ovulation problems and so on.
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