Obmed32.files.wordpress.com



InfertilityDefinition failure to conceive after one year of unprotected intercourse Risk Factors Age : women above 32 years old , men below 40 years oldSmoking ; also a great risk of miscarrageAlcohol consumption Obese or overweight Eating disorderVeganOver-exercisingSedentary life styleSexually transmitted infections ; eg Clamedyia Exposure to chemicals : eg pesticidesMental stressCauses of infertility in women Ovulation disorders (most common cause of infertility in women)Premature ovarian failure ; women ovaries stops working after 40sPCOS (polycystic ovary syndrome) woman's ovaries function abnormally. Hyperprolactinemia Poor egg quality ; the older a woman is the higher the risk.HyperthyroidismHypothyroidismChronic conditions : eg ;AIDS, CancerProblems in the Uterus or Fallopian tubes :Surgery : pelvic or cervical surgeries Submucosal fibroid Endometriosis Previous sterilization treatmentMedication NSAIDs eg : long term use of aspirin or ibuprofen ChemotherapyRadiotherapyIllegal drugs eg ; cocaine or marijuanaCauses of Infertility in men Sperm related causes :Abnormal sperm (75% of all cases of male infertility)Low sperm count : normal count = 20 million sperm per ml of semen , under 10 million (subfertility)Azoospermia (no sperm)Low sperm mobilityAbnormal Semen related causes :Testicular: infection, cancer, surgery or overheating.Ejaculation disordersVaricoceleUndescended testis HypoguandisimGenetic abnormality – eg (Klinefelter's syndrome) Mumps Hypospedias Cystic fibrosis - Males with cystic fibrosis commonly have a missing or obstructed vas deferensRadiotherapy Some diseases - eg: Anemia, Cushing's syndrome, Diabetes, Thyroid diseasesMedications eg-Sulfasalazine Anabolic steroids Chemotherapy Illegal drugs - eg marijuana or cocaine Diagnosis :Most people will visit their GP if there is no pregnancy after 12 months of trying. For anybody who is concerned about fertility, especially if they are older (women over 35), it might be a good idea to see a doctor earlierA GP can give the patient advice and carry out some preliminary assessments. As it takes two to make a baby it is better for both the male and female to see the doctor together; Before undergoing testing for fertility it is important that the couple be committed. Infertility tests for menGeneral physical exam - including history, medications, and sexual habits. The physician will also carry out an examination of his genitals. The testicles will be checked for lumps or deformities, while the shape and structure of the penis will be examined for any abnormalities. Semen analysis - for concentration, motility, color, quality, infections and whether any blood is present. Blood test - including the man's level of testosterone and other male hormones. Ultrasound - determining whether there is any ejaculatory duct obstruction, retrograde ejaculation, or other abnormality. Chlamydia test Infertility tests for womenGeneral physical exam - including history, medications, menstruation cycle, and sexual habits. She will also undergo a gynecological examination.Blood test - several things will be checked, for example, whether hormone levels are correct and whether the woman is ovulating (progesterone test).Hysterosalpingography - fluid is injected into the woman's uterus which shows up in X-ray pictures. X-rays are taken to determine whether the fluid travels properly out of the uterus and into the fallopian tubes. If the doctor identifies any problems, such as a blockage, surgery may need to be performed.Laparoscopy - a thin, flexible tube with a camera at the end (laparoscope) is inserted into the abdomen and pelvis to look at the fallopian tubes, uterus and ovaries. A small incision is made below the belly button and a needle is inserted into the abdominal cavity; carbon dioxide is injected to create a space for the laparoscope. The doctor will be able to detect endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.Ovarian reserve testing Genetic testing Pelvic ultrasound Chlamydia test Thyroid function testTreatments for infertilityFrequency of intercourse : The couple may be advised to have sexual intercourse more often. Sex two to three times per week may improve fertility if the frequency was less than this. Fertility treatments for menErectile dysfunction or premature ejaculation - medication and/or behavioral approaches can help men with general sexual problems, resulting in possibly improved fertility. Varicocele - if there is a varicose vein in the scrotum, it can be surgically removed. Blockage of the ejaculatory duct - sperm can be extracted directly from the testicles and injected into an egg in the laboratory. Retrograde ejaculation - sperm can be taken directly from the bladder and injected into an egg in the laboratory. Surgery for epididymal blockage - if the epididymis is blocked it can be surgically repaired. The epididymis is a coil-like structure in the testicles which helps store and transport sperm. If the epididymis is blocked sperm may not be ejaculated properly. Fertility treatments for womenOvulation disorders - if the woman has an ovulation disorder she will probably be prescribed fertility drugs which regulate or induce ovulation. These include: Clomifene (Clomid, Serophene) - this medication helps encourage ovulation in females who do not ovulate regularly, or who do not ovulate at all, because of polycystic ovary syndrome (PCOS) or some other disorder. It makes the pituitary gland release more FSH and LH Metformin (Glucophage) - women who have not responded to Clomifene may have to take this medication. It is especially effective for women with PCOS, especially when linked to insulin resistance. Human menopausal gonadotropin, or hMG, (Repronex) - this medication contains both FSH and LH. It is an injection and is used for patients who don't ovulate on their own because of a fault in their pituitary gland. Follicle-stimulating hormone (Gonal-F, Bravelle) - this is a hormone produced by the pituitary gland that controls estrogen production by the ovaries. It stimulates the ovaries to mature egg follicles. Human chorionic gonadotropin (Ovidrel, Pregnyl) - this medication is used together with clomiphene, hMG and FSH. It stimulates the follicle to ovulate. Gn-RH (gonadotropin-releasing hormone) analogs - for women who ovulate prematurely, before the lead follicle is mature enough during hmG treatment. This medication delivers a constant supply of Gn-RH to the pituitary gland, which alters the production of hormone, allowing the doctor to induce follicle growth with FSH. Bromocriptine (Parlodel) - this drug inhibits prolactin production. Prolactin stimulates milk production in breast feeding mothers. If non-pregnant, non-breast feeding women have high levels of prolactin they may have irregular ovulation cycles and have fertility problems. Risk of multiple pregnanciesInjectable fertility drugs can sometimes be the victims of their own success and cause multiple births Oral fertility drugs also raise the risk of multiple pregnancies, but much less so than injectable ones. It is important to monitor the patient carefully during treatment and pregnancy. The more babies the mother carries inside her the higher is her risk of premature labor. If a woman needs an HCG injection to activate ovulation and ultrasound scans show that too many follicles have developed, it is possible to withhold the HCG injection. Couples may decide to go ahead regardless if the desire to become pregnant is very strong. Multifetal pregnancy reduction is possible if too many babies are conceived - one or more of the fetuses is removed. Couples will have to consider the ethical and emotional aspects of this procedure. Surgical procedures for womenFallopian tube surgery - if the fallopian tubes are blocked or scarred surgery may repair them, making it easier for eggs to pass through them. Laparoscopic surgery - a small incision is made in the woman's abdomen. A thin, flexible microscope with a light at the end (laparoscope) is inserted through the incision. The doctor can then look at internal organs, take samples and perform small operations. For women with endometriosis, laparoscopy removes implants and scar tissue, reducing pain and often aiding fertility. Assisted conceptionThe following methods are currently available for assisted conception. IUI (intrauterine insemination)A fine catheter is inserted through the cervix into the uterus to place a sperm sample directly into the uterus. The sperm is washed in a fluid and the best specimens are selected. This procedure must be done when ovulation occurs. The woman may be given a low dose of ovary stimulating hormones. IUI is more commonly done when the man has a low sperm count, decreased sperm motility, or when infertility does not have an identifiable cause. The procedure is also helpful for males suffering from severe erectile dysfunction. IVF (in vitro fertilization)Sperm are placed with unfertilized eggs in a Petri dish; the aim is fertilization of the eggs. The embryo is then placed in the uterus to begin a pregnancy. Sometimes the embryo is frozen for future use (cryopreserved). ICSI (Intracytoplasmic sperm injection)A single sperm is injected into an egg to achieve fertilization during an IVF procedure. The likelihood of fertilization improves significantly for men with low sperm concentrations. Donation of sperm or eggIf there is either no sperm or egg in one of the partners it is possible to receive sperm or eggs from a donor. Fertility treatment with donor eggs is usually done using IVF. In the UK and a growing number of countries the egg donor can no longer remain anonymous - the offspring can legally trace his/her biological parent when reaching the age of 18. Assisted hatchingThis improves the chances of the embryo's implantation; attaching to the wall of the uterus. The embryologist opens a small hole in the outer membrane of the embryo, known as the zona pellucid. The opening improves the ability of the embryo to leave its shell and implant into the uterine lining. Patients who benefit from assistant hatching include women with previous IVF failure, poor embryo growth rate, and older women. In some women, particularly older women, the membrane is hardened, making it difficult for the embryo to hatch and implant. Electric or vibratory stimulation to achieve ejaculationEjaculation is acheived with electric or vibratory stimulation. This procedure is useful for men who cannot ejaculate normally, such as those with a spinal cord injury. Surgical sperm aspirationThe sperm is removed from part of the male reproductive tract, such as the vas deference, testicle or epididymis. Complications of infertility treatmentOvarian hyperstimulation syndromeThe ovaries become very swollen, leaking excess fluid into the body. The ovaries produce too many follicles (small fluid sacs in which an egg develops). OHSS usually occurs as a result of taking medications to stimulate the ovaries, such as clomifene and gonadtrophins, and can also develop after IVF. Symptoms can include: BloatingConstipationDark urineDiarrheaNauseaPain in the abdomenVomiting.In most cases symptoms are mild and easy to treat. On very rare occasions the patient may develop a blood clot (thrombosis) in an artery or vein, liver or kidney problems, and respiratory distress. In very severe cases OHSS can be potentially fatal. Ectopic pregnancyThis is a pregnancy when the fertilized egg does not implant in the womb - in most cases the fertilized egg grows in the fallopian tube. If it stays in the fallopian tube the mother will usually miscarry before complications develop, such as the rupture of the fallopian tube. Women receiving fertility treatment have a slightly higher risk of having an ectopic pregnancy. An ultrasound scan can detect an ectopic pregnancy. Coping mentallyAs it is impossible to know how long treatment will go on for and how successful it will be, coping and persevering can be stressful. The emotional toll on both partners might be considerable and can have an impact on their relationship. Some people find that joining a support group helps - being able to talk to others who share similar problems, aspirations and anxieties can be uplifting. It is important to tell your doctor if you are suffering mentally and/or emotionally. Most fertility doctors have access to counselors, as well as other people and professionals who can offer helpful support. Resource : ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download