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Male Infertility

Sep10
2009 Leave a Comment Written by admin

Causes | Diagnosis | Treatment
Causes

Sperm disorder
Most common cause of male infertility deals with the production and development of sperm. This include azoospermia, a condition which produce no sperm cells and oligospermia, which produce few sperm cells.

Obstruction
This condition of blockage of sperm is caused by various reasons including prior vasectomy, injury, infection or physical anomaly. Any portion of the male reproductive tract, such as the vas deferens that carries sperm from the testicles to the penis or epididymis which stores sperms can be obstructed, preventing normal transport of sperm from the testes to the urethra, where it leaves the body during ejaculation.

Varicoceles
These are dilated scrotal vein or varicose vein in the testicle. It can damage the blood flow to the testes, making sperm production slowed or stopped. Sometimes these veins may be enlarged and twisted enough to be visible in the scrotum. This most correctable cause of infertility is usually discovered on physical examination.

Temperature can be a cause of infertility in men. Conditions that increase the temperature of the testes (where sperm are produced) can greatly reduce the number of sperm and the vigor of sperm movement and can increase the number of abnormal sperm.

Retrograde Ejaculation
This is a condition caused by the failure muscles or nerves of the bladder neck to close during ejaculation allowing the ejaculate to be propelled into the bladder instead of out the penis. Signs of retrograde ejaculation may be diminished or dry ejaculation and cloudy urine after ejaculation.

Others factors that can cause infertility include genetic disease such as cystic fibrosis or a chromosomal abnormality; certain medication such as anabolic steroids which may affect hormone levels and excessive consumption of alcohol can also interfere with sperm production.

Diagnosis

The specialist will analyze a physical examination which includes the medical history, illnesses and disabilities, medications and sexual habits. Other tests like semen analysis, testicle size and hernias test are also preformed.

Semen analysis
In this test, the semen specimen which is obtained by masturbating or in any other way is analyzed in the laboratory for quantity, color and presence of infections or blood. It will also detect the volume, count, concentration and any abnormalities in the shape and movement (motility) of the sperm.

Blood Tests
A blood test is performed to determine the level of testosterone and other hormone levels or the presence of sperm antibodies.

Transrectal Ultrasound (TRUS)
A transrectal ultrasound is the most common test to look at the male pelvic organs, such as the prostate and seminal vesicles. This is an imaging test that places a probe into the rectum to beam high-frequency sound waves to nearby ejaculatory ducts. It can help the physician to determine if the structures are either poorly developed or obstructed with cysts, calcifications or other blockages.

Testicular Biopsy
In this procedure, which performed under general anesthesia, a small piece of tissue is removed from each testicle for microscopic evaluation. This is obtained through a small cut in the scrotum or using a needle inserted through skin over the testicle. A biopsy of testicular tissue can identify the problem with sperm production, abnormal growths, tumors, or incomplete growth or maturation of reproductive organs.

Treatment

Treatment options for infertility, depends upon the cause and may include :

Drug Therapy
This medication treatment is to improve sperm production, treat hormonal dysfunction, cure infections that compromise sperm, and fight sperm antibodies.

Electroejaculation (EEJ)
Electroejaculation or Rectal Electroejaculation (REE) is a treatment in which electric stimulus brings about ejaculation to obtain semen. It is collected and  prepared for use, usually in artificial insemination. This procedure is usually done in men with neurological problems.

Artificial Insemination (AI)
It is performed when the male has a low sperm count or a high number of abnormal sperm or the woman has sperm antibodies present in her cervical mucus.  Sperm is treated in the laboratory to increase the chances of fertilisation. Large numbers of sperm are then inserted directly into the uterus for easy access to the f Fallopian tubes. It procedure is also used when couples are producing sperm and eggs, but have a problem bringing them together. In this situation, the sperm and  eggs are physically placed together in the woman’s womb and then left for nature to run its course. The advanced procedure of artificial insemination is called In- vitro fertilization.

Epididymal and testicular sperm extraction / Surgical Sperm Aspiration
It is the treatment for male containing azoospermia and spermatic cord abnormalities. The treatment technique involves removing sperm from part of the male  reproductive tract such as the epididymis or directly from the testis using a needle and fertilisation is performed by Intracytoplasmic Sperm Injection (ICSI) .  Usually enough sperm can be collected so that samples can be frozen for later use if required.

In Vitro Fertilization (IVF):
It is occasionally used for men with oligospermia. IVF, is the most effective form of ART, refers to the fertilization taking place outside the body in a laboratory. The procedure involves retrieving mature eggs from a  woman, fertilizing them with a man’s sperm in a dish under controlled conditions in a laboratory and implanting the embryos into the woman’s uterus (womb) three  to five days after fertilization. IVF treatment commonly known as ‘test tube baby’ is used to treat infertility blockages of the fallopian tubes, endometriosis, abnormal  sperm, and some cases of unexplained infertility.

Intracytoplasmic Sperm Injection (ICSI):
This consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg with a microscopic needle to achieve  fertilization.
ICSI is usually done in people with poor semen quality or lack of sperm in the semen which is caused by an obstruction or testicular failure. In some cases, sperm  may be surgically extracted from the testis or epididymis.

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Female Infertility Treatment

Sep10
2009 Leave a Comment Written by admin

Treatment options depends on the cause, duration of infertility and the age. Most infertility cases can be treated with drug therapies (fertility drugs) or hormone therapy to promote ovulation. Depending on the problem and diagnosis, surgery and assisted reproductive technologies may be used.

Fertility drugs
Fertility drugs are the primary treatment for women who are infertile due to ovulation disorders. These drugs can be used to regulate or induce ovulation. Injectable fertility drugs significantly increase the chance of multiple births. The use of these drugs requires careful monitoring with a combination of blood tests of hormones and ultrasound measurement of ovarian follicle size.

Surgery
Depending on the cause, surgery may be a treatment option for infertility. Blockages or other problems in the fallopian tubes usually can be surgically repaired.

Assisted reproductive technology (ART)
Improvements in fertility treatment have made it possible for many women whose male partner is infertile, to become pregnant. ART has revolutionized the treatment of infertility. The most common forms of ART include:

Artificial Insemination (AI): It is performed when the male has a low sperm count or a high number of abnormal sperm or the woman has sperm antibodies present in her cervical mucus.  Sperm is treated in the laboratory to increase the chances of fertilisation. Large numbers of sperm are then inserted directly into the uterus for easy access to the f Fallopian tubes. It procedure is also used when couples are producing sperm and eggs, but have a problem bringing them together. In this situation, the sperm and  eggs are physically placed together in the woman’s womb and then left for nature to run its course. The advanced procedure of artificial insemination is called In- vitro fertilization.

In Vitro Fertilization (IVF): IVF, is the most effective form of ART, refers to the fertilization taking place outside the body in a laboratory. The procedure involves retrieving mature eggs from a  woman, fertilizing them with a man’s sperm in a dish under controlled conditions in a laboratory and implanting the embryos into the woman’s uterus (womb) three  to five days after fertilization. IVF treatment commonly known as ‘test tube baby’ is used to treat infertility blockages of the fallopian tubes, endometriosis, abnormal  sperm, and some cases of unexplained infertility.

Intracytoplasmic Sperm Injection (ICSI):This consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg with a microscopic needle to achieve  fertilization.
The fertilised eggs can be transferred to the fallopian tubes of the woman or grown in the laboratory for a couple of days and then transferred to the  uterus of the female partner. Eggs are obtained the same way as for IVF.

Gamete Intra-Fallopian Transfer (GIFT): GIFT is suitable for women with no abnormalities in the fallopian tubes. This procedure is the same as that for IVF except that fertilisation takes place inside the body of the woman. The eggs and sperm (gametes) are collected and placed directly into the fallopian tubes for fertilisation.

Zygote Intra-Fallopian Transfer (ZIFT): ZIFT involves the same procedure as IVF except that the very early embryo (zygote) is placed directly into the fallopian tube. This procedure is undertaken when there are abnormal sperm or problems with the ability of the sperm to fertilise the eggs.

Complications of treatment include Multiple pregnancy, bleeding, infection, low birth weight, birth defects and ovarian hyperstimulation syndrome in which the woman’s ovaries may enlarge and cause discomfort.

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Female Infertility Diagnosis

Sep10
2009 Leave a Comment Written by admin

Infertility is usually diagnosed through medical interviews and physical examinations of both partners. A fertility specialist usually an obstetrician-gynecologist may analyse the health history, menstrual cycle, and sexual habits.

The basal body temperature (BBT) is recorded each morning over several months using a special thermometer to find any ovulatory disorders. A blood test is performed to determine the levels of various hormones, such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL), estradiol and progesterone which aid greatly in determining the cause of infertility.

The doctor will perform several specific fertility tests to evaluate the entire reproductive system and these may include :

Hysterosalpingography (HSG) : This is an imaging study of the uterus and fallopian tubes. A radio opaque dye is injected through the cervix and the outline of the lining of the uterus is examined to confirm that the tubes are normal and open. The X-ray image can help to diagnose fibroid tumors, an unusually shaped uterus, scar tissue or blockages in the fallopian tubes. Hysterosalpingography is usually performed before ovulation so the dye does not disrupt an egg or developing embryo.

Hysteroscopy : In this method, a thin telescope called hysteroscope is passed through the cervix into the uterus to look inside directly to detect the presence of endometriosis, fibroids, polyps, pelvic scar tissue, and blockage at the ends of the fallopian tubes.

Laparoscopy : This is a surgical procedure performed under general anesthesia. A small incision is made beneath the navel and a laparoscope which is an illuminated, fiber-optic telescope is inserted through the abdominal cavity to examine the fallopian tubes, ovaries and uterus. A small amount of gas (usually carbon dioxide) is inserted to create space for entry of the laparoscope. At the end of the procedure, the gas and laparoscope are drawn out and the incision is closed. Laparoscopy may be done to visualise the abdominal and pelvic cavity, to see the uterus, fallopian tubes and ovaries, to detect pelvic adhesions, scarring, endometriosis or other relevant pathology.

Post-Coital Test (PCT) : This test is to evaluate the cervical mucus and its interaction with the sperm. It may be done the day of ovulation and several hours after intercourse. In PCT a small amount of cervical mucus is removed and examined under a microscope.

Endometrial Biopsy : It is performed to check if the endometrium (tissue lining the inside of the uterus) can support implantation and growth of a fertilized egg. The test is usually done three days before the period starts. In endometrial biopsy, a sample of endometrium is removed and studied under a microscope. Problems with the endometrium are called luteal phase defect.

Clomiphene Citrate Challenge Test (CCCT) : This test is usually performed in women older than 35 years to evaluate the ability to become pregnant on the basis of the number and quality of remaining eggs.

Pelvic exam : This is performed to feel the uterus for detectable masses and to view the cervix.

Ultrasound scan : This is the standard imaging technique which uses sound waves to produce an image of the organs. It is done to detect uterine fibroids, endometrial polyps, ovarian cysts, and other abnormalities in the pelvis.

Magnetic resonance imaging (MRI) : This is another imaging procedure similar to an x-ray that uses magnetic waves to create images of the internal organs.

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Female Infertility

Sep09
2009 Leave a Comment Written by admin

Causes

Most women have no obvious signs of infertility until they try to become pregnant and are not successful after one year. Infertility may sometimes be signaled by heavy, irregular or absent menstrual periods or associated with conditions that cause pain during menstruation or intercourse. Other signs that may point to fertility problems include obesity, facial hair and fluid that leaks from the breasts.

Infertility problem may occur by various reasons. The most common cause of female infertility include ovulation disorders, polycystic ovarian syndrome, fallopian tube damage or blockage, endometriosis, ovarian cysts, fibroids, pelvic infection and early menopause. It may also be caused by sexually transmitted diseases, poor nutrition
, hormone imbalance, tumor, uterine factors and egg quality.

Ovulation disorders
Ovulation problems result when one part of the system that controls reproductive function malfunctions. The failure to ovulate is the most common cause of female infertility. Without ovulation, eggs are not available to be fertilized. Ovulation problems can be caused by various things such as excessive weight loss, stress, thyroid problems or slight irregularities in hormone imbalances. Disruption in the part of the brain that regulates ovulation (hypothalamic-pituitary axis) can cause deficiencies in luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Signs of problems with ovulation include irregular menstrual periods or no periods.

Polycystic Ovarian Syndrome (PCOS)
Polycystic ovarian syndrome is a condition characterised by the presence of many minute cysts in the ovaries which is caused by excess production of hormone called androgen. This will prevent the follicles of the ovaries from producing a mature egg. Without egg production, the follicles swell with fluid and form into cysts. Every time an egg is trapped within the follicle, another cyst forms, so the ovary swells, sometimes reaching the size of a grapefruit. PCOS can be diagnosed through a series of blood tests and some symptoms of this condition include weight gain, acne, irregular or absent periods.

Fallopian tube damage or blockage
This condition usually results from inflammation of the fallopian tube (salpingitis). If they are blocked, the egg cannot move from the ovary to the uterus. This condition can happen as a result of pelvic inflammatory disease, endometriosis, pelvis surgery, ruptured appendix or mislocated (ectopic) pregnancy. Structural disorders, like birth defects of the uterus and fallopian tubes, fibroids in the uterus, and bands of scar tissue can also block the fallopian tubes.

Endometriosis
This is a condition when the tissue that makes up the lining of the uterus (endometrium) grows into growths or lesions outside of the uterus usually on the ovaries or the lining of the abdomen near the uterus and fallopian tubes. In sync with the menstrual cycle, this tissue builds up, breaks down and sheds each month; but it has no way of leaving the body. As a result it causes internal bleeding, breakdown of blood which can lead to scarring and inflammation.
Pelvic pain and infertility are common in women with endometriosis. It can be detected during laparoscopy. If you experience pain while having sex, have very painful menstrual cramps, or experience heavy bleeding during your period or unusual spotting, you may have endometriosis.

Ovarian Cysts (Endometriomas)
Ovarian cysts may indicate advanced endometriosis and often is associated with reduced fertility. An ovarian cyst is a small fluid-filled sac that grows in the ovary. Endometriomas can be treated with surgery.

Uterine Fibroids
Uterine fibroids or leiomymomas are benign tumors usually located on the outside surface or within the muscular wall of the uterus. They are not associated with the reproductive system but may cause infertility by interfering with the contour of the uterine cavity, blocking the fallopian tubes. It can also interfere with embryo implantation or fetal growth. Though the causes of these tumors are unknown, evidence suggest that estrogen and progesterone contribute to the growth of fibroids. It is most often diagnosed in women between the ages of 30 and 40. Common symptoms of fibroids is pelvic pressure, along with irregular bleeding and the effective treatment option is hysterectomy.

Premature Ovarian Failure (POF) or Early Menopause
Early menopause is the absence of menstruation and the early depletion of ovarian follicles before age 40. Though the cause is often unknown, the condition is associated with autoimmune disease, pelvic surgery, tobacco smoking, genetic factors, radiation or chemotherapy. Treatment option for POF is In Vitro Fertilization (IVF).

Pelvic Inflammatory Disease (PID)
PID is an infection of the pelvis or organs of the reproductive tract, including the ovaries, the fallopian tubes, the cervix or the uterus. It can lead to blocked or damaged fallopian tubes and is usually caused by sexually transmitted diseases, miscarriages, abortions, childbirth, or an intrauterine device.

Pelvic Adhesions
Pelvic adhesions are bands of scar tissue formed between two or more internal organs after pelvic infection, appendicitis or abdominal or pelvic surgery. This condition is usually caused by surgery or infection and can affect the functioning of the ovaries and fallopian tubes resulting in infertility.

Age is also a risk factor of infertility. A woman’s peak fertility occurs in her early 20s. The ability for ovaries to produce eggs declines with age, especially after age 35. As a woman ages beyond 35 (and particularly after age 40), the likelihood of conceiving diminishes to less than 10% per month. The risk of miscarriage also increases with a woman’s age. Tobacco smoking, alcohol consumption, extremes in body mass either too high or too low are all risk factors of infertility.

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Infertility

Sep09
2009 Leave a Comment Written by admin

Infertility is a condition of the reproductive system that impairs the ability to achieve pregnancy. Primary infertility is the inability to conceive a child after regular intercourse for at least 1 year. Secondary infertility occurs in couples who have previously been pregnant at least once, but are unable to achieve another pregnancy.

Infertility affects men and women equally. About one-third of the cases are due to a male factor, one-third to the female and the remaining to the combination of both partners. Causes of infertility include a wide range of physical as well as emotional factors.

For a woman to be fertile, her reproductive organs must be healthy and functional. To conceive a child, the ovaries must release healthy eggs regularly and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes for a possible union.

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