FERTILITY AND INFERTILTY

FERTILITY

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<span style="font-size: 16pt; line-height: 24.5333px;">What is human fertility?<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">     H</span><span style="font-size: 21.3333px;">uman fertility is the ability to produce or sustain a numerous progeny, the result of various factors of biological nature (age, health status, functioning of the endocrine system), cultural (prescription about sex and marriage, division of labor, type and rate of occupation), which cause abrupt changes from one situation to another.</span><span style="font-size: 16pt;"> </span><br />
<span style="font-size: 16pt; line-height: 24.5333px;">Human fertility can be affected by different factors, such as age, the onset of diseases, etc. There are several treatments to protect fertility in both men and women. Although it is easier in men than in women.<o:p></o:p></span></div>
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<span style="font-size: 16pt;">     Female fertility has been interpreted by various civilizations as an essential feature. It may be the case that the husband rejects women for infertility, and marriage is annulled. Male fertility has an incidence similar to female infertility, and remained unknown for a long time, attributing all responsibility to women (this is part of patriarchal society).</span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">Human fertility problems:<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">One in four couples of reproductive age have difficulty conceiving. This relates to a number of factors, but age of women is very important.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">It is proved that the age of women has a direct relationship with fertility. From age 35, the chance of a spontaneous pregnancy is 15% each month, and decreases to 10% after 40 years.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">     The woman has 400,000 eggs at birth, but after puberty, women ovulate one egg every 28 days. The problem is the age of the eggs as they have the same woman, therefore, their quality gradually diminishes.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">In man, the situation is different, producing new sperm throughout their lives. Although recent studies have shown that the quality thereof, would also be affected, but to a lesser degree than eggs.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">There are other causes for the deficiency in human fertility, which have to do with both members of the couple, and can be classified into: <o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- tubal obstruction <o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- low sperm concentration <o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- low sperm motility. Or altered sperm morphology. <o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Endometriosis. <o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Ovulatory dysfunction. <o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Immune factor. <o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Unknown cause.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">                          <b>Treatments for human fertility:</b><o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">     There are many cases where human fertility is affected, for example in severe pathological conditions that require aggressive treatments such as radiation or chemotherapy, tissue producers gametes, sperm or eggs are destroyed.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">                          <b>What is human fertility</b><o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">For men there are several simple solutions such as sperm cryopreservation, involving assisted reproduction.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">In women it is more difficult, due to lower production of eggs per cycle and removal difficulties, and complications posed by cryopreservation techniques.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">     There are several options for preserving fertility in women - Cryopreservation of embryos: a woman's eggs are obtained and fertilized in vitro. Then they are frozen for later implant them in the uterus of women.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Ovarian tissue cryopreservation: is removed and frozen ovarian tissue sample of women, and I replanted once it has completed cancer treatment. The process of cryopreservation offers drawbacks. there is also risk of ischemic damage.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Ovarian suppression: are hormonal treatments that protect ovarian tissue through the jamb or radiotherapy.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Transposition of ovaries: ovaries are repositioned using surgery to remove them from the exhibition area.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">- Conservative gynecological surgery: may involve removal of the cervix, by surgery, but keeping the uterus.<o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">                   <b>  The period of fertility in women</b><o:p></o:p></span></div>
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<span style="font-size: 16pt; line-height: 24.5333px;">The period of fertility of women is variable and will produce changes over the years. In addition to calculating the fertile days with ovulation calculator, there are certain natural symptoms of women also possible to determine those dates.<o:p></o:p></span></div>
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fertility FERTILITY

(adsbygoogle = window.adsbygoogle || []).push({}); What is human fertility? Human ferti…

INFERTILITY

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<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">                                                                       </span></b><br />
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<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDdNRz-jTWECpJBCDNZ9s1Vg3NE72iAxhmREyE53eC28esaqxsBWbf2fumP5t0ekBO-Rtfxohq9uGTFPYKAiadPP_PdtrfEb1EKD_7A3uR5jQfeUg6WvqJoYEa0f1H9iobBOXvQt_1LCY/s1600/fertility+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDdNRz-jTWECpJBCDNZ9s1Vg3NE72iAxhmREyE53eC28esaqxsBWbf2fumP5t0ekBO-Rtfxohq9uGTFPYKAiadPP_PdtrfEb1EKD_7A3uR5jQfeUg6WvqJoYEa0f1H9iobBOXvQt_1LCY/s1600/fertility+2.jpg" /></a></span></b></div>
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">                                    <o:p></o:p></span></b></div>
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<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">   </span></b><br />
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">  </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">This is defined as a
couple’s inability to achieve pregnancy after 1 year of unprotected
intercourse. Primary infertility refers to a couple who has never had a child.
Secondary infertility means that at least one conception has occuerred, but
currently the couple cannot achieve a pregnancy. In the United States,
infertility affects 6 million couples. It is often a complex physical problem,
and its causes are usually related to azoospermia, anovulation, or tubal
obstruction.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">      Most infertility is really some degree of subfertility and 1
in 7 couples who have conceived before. The WHO (1992) defines subfertility as ‘the
inability of a couple to achieve conception or to bring a pregnancy to term
after a year or more of regular, unprotected intercourse’. <o:p></o:p></span></div>
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Infertility is categorized as primary if there has been no prior
conception and secondary if there has been a previous pregnancy irrespective of
the outcome. Couples now have fewer than two children on average in most
European countries and they tend to postpone reduction in fertility. Under
normal circumstances the chance of a couple conceiving within one menstrual
cycle is 20-25% given that unprotected intercourse occurs at the optimum time,
the female partner is ovulating regularly and the male partner is producing
sperm of sufficient quality. Approximately
one-third of  cases of infertility
involve problems with both partners in one-third of couples the causes of
infertility remain unexplained. The most common causes are ovulation failure
and sperm disorders.<o:p></o:p></span></div>
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<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">INITIAL
MANAGEMENT OF THE INFERTILE COUPLE<o:p></o:p></span></b></div>
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<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Much of the initial
management is via primary care, therefore the preliminary investigation of both
partners and subsequent  referral to
specialist care will be through the general practitioner. Each referral should be
instigated for couples where the female partner is over 35 years and where
there is amenorrhoea or significant pelvic infection.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">                                 <b>CAUSES OF INFERTILITY<o:p></o:p></b></span></div>
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<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">MALE
INFERTILITY<o:p></o:p></span></b></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">ENDOCRINE DISORDERS<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Dysfunction of<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hypothalamus<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Pituitary<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Adrenals<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Thyroid<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Systemic disease<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Diabetes mellitus<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Coelic disease<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Renal failure<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Testicular disorders<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Trauma<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Environmental (high temperature)<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital ( hydrocele, undescended testes)<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Occupational (furnaceman, long distance lorry
driver)<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Acquired ( Varicocele, tight clothing)<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Cancer treatment<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective transport<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Obstruction or absence of seminal ducts:<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital anomalies<o:p></o:p></span></div>
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</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Trauma<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Impaired secretions from prostate or seminal
vesicles:<o:p></o:p></span></div>
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<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l14 level1 lfo5; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Metabolic disorders<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ineffective delivery<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l11 level1 lfo6; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Psychosexual problems (impotence)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l11 level1 lfo6; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Drug-induced (ejaculatory dysfunction)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l11 level1 lfo6; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Physical disability<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l11 level1 lfo6; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Physical anomalies<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hypospadias<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Epispadias<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Retrograde ejaculation (into bladder)<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">FEMALE
INFERTILITY<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective ovulation<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Endocrine disorders<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Dysfunction of<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hypothalamus<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Pituitary<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Adrenals<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l2 level1 lfo7; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Thyroid<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Systemic disease<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo8; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Diabetes mellitus<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo8; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Coelic disease<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo8; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Renal failure<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Physical disorders<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l7 level1 lfo9; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Obesity<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l7 level1 lfo9; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Anorexia nervous or strict dieting<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l7 level1 lfo9; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Excessive exercise<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovarian disorders<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l9 level1 lfo10; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hormonal<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l9 level1 lfo10; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovarian cysts or tumours<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l9 level1 lfo10; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Polycystics ovary disease<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l9 level1 lfo10; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovarian endometiosis<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective transport<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo11; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovum<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo11; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Tubal obstruction<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection (gonorrhea, peritonitis, pelvic
inflammatory disease)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Previous tubal surgery<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l8 level1 lfo12; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Fimbrial adhesians<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l8 level1 lfo12; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Previous surgery<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l8 level1 lfo12; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Endometriosis<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Sperm<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Vaginal<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l10 level1 lfo13; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Psychosexual problems (Vaginismus)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l10 level1 lfo13; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection (causing dyspareunia)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l10 level1 lfo13; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital anomaly<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Cervix<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l5 level1 lfo14; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Cervical trauma  or surgery (cone biopsy)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l5 level1 lfo14; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l5 level1 lfo14; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hormonal (hostile mucus)<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l5 level1 lfo14; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Antisperm antibodies in mucus<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Defective implantation<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Hormonal imbalance<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Congenital anomalies<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Fibroids<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Infection<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">ASSISTED
REPRODUCTIVE TECHNIQUES<o:p></o:p></span></b></div>
<div class="MsoListParagraphCxSpMiddle">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">A range of assisted
reproductive techniques is available to treat the infertile couple and it is
important that the appropriate treatment option is offered. Those techniques
include the followings:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">In vitro fertilization (IVF) treatment<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Donor insemination (DI) treatment<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Gamete intrafallopian transfer (GIFT)
where donated sperm or eggs are used in treatment.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo15; text-indent: -.25in;">
<span style="font-family: "symbol"; font-size: 14.0pt; line-height: 115%;">·<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">       
</span></span><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Storage of gametes or embryos<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Each of the techniques
highlighted above will be discussed in details in the next article.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">OVULATION
INDUCTION<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">There are many reasons
for ovulatory failure and although menstruation is strongly suggestive of
ovulation it is not conclusive. Women with amenorrhoea or oliogomenorrhoea can
be treated with ovulation inducing agents provided that the male partner has an
adequate sperm count.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Clomifene is the most
commonly prescribed drug but should be prescribed only when there are no other
factors contributing to infertility and there is access to ovarian ultrasound
feedback that stimulates the release of GnRH; which in turn leads to an
increase in FSH and ovarian follicular growth and can be effective in up to 80%
of appropriately selected women.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Treatment should be limited to six cycles
with the lowest effective dose. The side effect of clomifene include multiple
pregnancy and ovarian hyperstimulation and minority of women may experience
symptoms such as hot flashes, abdominal distention, nausea, vomiting, breast
tenderness, headaches, hair loss and blurred vision.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Women with clomifene  resistant polycystic ovarian syndrome (PCOS)
can be treated with human menopausal gonadotrophin (HMG) and FSH injections.
Cabergoline as  opposed to bromocriptine,
is rapidly becoming the treatment of choice for women suffering from anovulatory
hyperprolactinaemia. This is because latter is associated with the unpleasant
side effects of nausea, headaches, vertigo and drowsiness whereas the former
has significantly fewer side effects.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in;">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">INTRAUTERINE
INSEMINATION (IUI)<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-left: .5in;">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">IUI is indicated where
there are problems such as hostile cervical mucus, antisperm antibodies or male
fertility problems such as low sperm count, premature ejaculation, retrograde
ejaculation, anatomical problems or impotence. It is also useful for cases of
unexplained infertility. The tubal patency of the female partner must be
assured.  In order to increase the
chances of success, ovulation is induced and the sperm prepared to maximize its
fertilizing ability before being inserted high into the uterus.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">   <o:p></o:p></span></b></div>
<br />
<div class="MsoListParagraphCxSpLast">
<br /></div>
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MEDICAL MANAGEMENT OF MALE AND FEMALE FERTILTY

10:07 Unknown 0

<div class="MsoNormal">
<div class="MsoNormal">
                                                                               <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2__yXE9fm4uWtdSFQFw6UrLrEuu8m3LmDT3rBtlEvnWDqChopr2XJ76omrsiYgk3A5WTOb4UOP9RnNnjtBqEeYNjtYtFXtXgNrGbIEIDJtqXNY7py21FTqM21cSahmiBT5JyIkfPaDCI/s1600/fertility+3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2__yXE9fm4uWtdSFQFw6UrLrEuu8m3LmDT3rBtlEvnWDqChopr2XJ76omrsiYgk3A5WTOb4UOP9RnNnjtBqEeYNjtYtFXtXgNrGbIEIDJtqXNY7py21FTqM21cSahmiBT5JyIkfPaDCI/s1600/fertility+3.jpg" /></a></div>
</div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     </span><br />
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">The
treatment of infertility is complex and often requires advanced technology. The
specific type of treatment depends on the cause of the problem, if it can be
identified. Many infertile couples have normal test results for ovulation ,
sperm production and fallopian tube patency.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">PHARMACOLOGIC
THERAPY<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">    
Pharmacologically induced ovulation is undertaken when women do not
ovulate on their own or ovulate irregularly. Women older than 37 years are less
likely to be fertile. These couples are often treated with clomiphene to
stimulate ovulation. Gonadotropn treatment may also be used if conception does
not occur. Various other medications are used, depending on the primary cause
of infertility.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Blood
tests and ultrasounds are used to monitor ovulation. Multiple pregnancies (i.e,
twins, triplets or more) may occur with use of these medications. Ovarian
hperstimulation syndrome (OHSS) may also occur. This condition is characterized
by enlarged multicystic ovaries and is complicated by a shift of fluid from the
intravascular space into theabdominal cavity. The fluid shift can result in
ascites, pleual effusion, and edema; hypovolemia may also occur. Risk factors
include younger age, history of polycystic ovarian syndrome, high serum
estradiol levels, a larger number of follicles and pregnancy.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">ARTIFICIAL
INSEMINATION<o:p></o:p></span></b></div>
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<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">    
Artificial insemination is the deposit of semen into the female genital
tract by artificial means. If sperm cannot penetrate the cervical canal
normally, artificial insemination using 
partner’s or husband’s semen or that of a donor may be considered. When
the  sperm of the woman’s partner is
defective or absent (azoospermia) or when there is a risk of transmitting a
genetic disease, donor sperm may be used. Safeguards are put in place to
address legal, ethical, emotional, and religious issues.Written consent is
obtained to protects all paties involved, including the woman, the donor and
the resulting child. The donor’s semen is frozen, and the donor is evaluated to
ensure that he is free of genetic disorders and STDs, including HIV infection.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Certain
conditions must be met before semen is transferred to the vaginal or uterus.
The woman must have no abnormalities of the genital system, the fallopian tubes
must be patent, and oval must be available. In the male, sperm need to be
normal in shape, amount, motility, and endurance. The time of ovulation should
be determined as accurately as possible so that the two or three days of which
fertilization is possible each month can be targeted for treatment.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">   
Ultrasonography and blood studies of varying hormone levels are used to
pinpoint the best time for insemination and to monitor for OHSS. Fertilization
seldom occurs from a single insemination. Usually, insemination is attempted
between days 10 and 17 of the cycle; three different attempts may be made
during one cycle. The woman may have received clomiphene or other medications
to stimulate ovulation before insemination. The recipient is placed in
lithotomy position on the examination table, a speculum is inserted, and the
vaginal and cervix are swabbed with cotton-tipped applicator to remove any
excess secretions. The sperm are washed before insertion to remove biochemical and
to select the most active sperm. Semen is drawn into a sterile syringe, and a
cannula is attached. The semen is then directed to the external os. In IUI,
semen is placed into the uterine cavity.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">IN
VITRO FERTILIZATION<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     In vitro
fertilization (IVF) involves ovarian stimulation, egg retrieval, fertilization,
and embryo transfer. This procedure is accomplished by first stimulating the
ovary to produce multiple eggs or ova, usually with medications, because success
rates are greater with more than one embryo. Many different protocols exist for
inducing ovulation with one or more agents. Patients are carefully selected and
evaluated, and cycles are carefully monitored using ultrasound and monitoring
hormone levels. At the appropriate time, the ova are recovered by transvaginal
retrieval. Sperm and eggs are coincubated for up to36 hours, and the embryos
are transferred about 48 hours after retrieval. Implantation should occur in 3
to 5 days.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">GAMETE
INTRAFALLOPIAN TRANSFER<o:p></o:p></span></b></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     </span></b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Gamete intrafallopian
transfer (GIFT), a variation of IVF, is the treatment of choice for patients
with ovarian failure. GIFT is considered in unexplained infertility and when
there is religion-based discomfort with IVF. The most common indications for
IVF and GIFT are irreparable tubal damage, endometriosis, unexplained
infertility, inadequate sperm, and exposure to DES. Success rates for GIFT vary
from 20% to 30%.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">OTHER
ASSISTED REPRODUCTIVE TECHNOLOGIES<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     In
intracytoplasmic sperm injection (ICSI), an ovum is collected as explained before, and one  sperm is introduced  through
the egg membrane, </span><span style="font-family: "times new roman" , serif; font-size: 18.6667px;">through the zona pellucida,</span><span style="font-family: "times new roman" , serif; font-size: 14pt;"> and into the cytoplasm of the oocyte. The  egg </span><span style="font-family: "times new roman" , serif; font-size: 18.6667px;">fertilized</span><span style="font-family: "times new roman" , serif; font-size: 14pt;"> is  transferred back to  donor. ICSI  treatment  is of choice in severe
male factor infertility.</span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Women who
cannot produce their eggs (ie, premature ovarian failure) have option of using
the eggs of a donor after stimulation of the donor;s ovaries. The recipient
also receives hormones in preparation for these procedures. Couples may also
choose this modality if the female partner has a genetic disorder that may be
passed on to children.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     <o:p></o:p></span></b></div>
<br />
<div class="MsoNormal">
<br /></div>
</div>
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PATHOPHYSIOLOGY OF FACTORS AFFECTING FERTILITY

10:01 Unknown 0

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<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">                                                                        </span></b><br />
<div class="separator" style="clear: both; text-align: center;">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2BdZLcxx1nmL5CJYH1WPttPHsvLAezWgCYhtAajDc2iWQL1cfxOgdC4JtsnwWSJRwE34lTwAYCXyB6o8bgIySOZu9bwH_lWoot8zM-pAym0zRuNdwxmWXXGWErTTSOmu_mz26b5gPnEg/s1600/fertility+4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj2BdZLcxx1nmL5CJYH1WPttPHsvLAezWgCYhtAajDc2iWQL1cfxOgdC4JtsnwWSJRwE34lTwAYCXyB6o8bgIySOZu9bwH_lWoot8zM-pAym0zRuNdwxmWXXGWErTTSOmu_mz26b5gPnEg/s1600/fertility+4.jpg" /></a></span></b></div>
<br />
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Ovarian
and Ovulation Factors<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">    
Diagnostics studies performed to determine if ovulation is regular and
whether the progestational endometrium is adequate for implantation may include
a serum progesterone level and an ovulation index. The ovulation index involves
a urine- stick tests to determine whether the surge in LH that precedes
follicular rupture occurred. Ovulatory dysfunction is complex, but many women
with ovulation disorders have prolycystic ovary syndrome, and may be treated
with clomiphene to induce ovulation or insulin sensitizing agents. Once insulin
levels are normalized, ovulation often occurs. Some women have high prolacting
levels, which inhibit ovulation, and they are treated with dopaminergic drugs
after a pituitary adenoma is ruled out by MRI. If a woman has premature ovarian
failure, oocyte donation may be considered.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Tubal
and Uterine Factors<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     HSG is
used to rule out uterine or tubal abnormalities. A contrast substance introduced into uterus via the cervix gives an identity of the shape of the uterine
cavity and the patency of the tubes. This process sometimes removes mucus or
tissue that is lodged in the tubes. Laparoscopy permits direct visualization of
the tubes and other pelvic structures and can assist in identifying conditions
that may interfere with fertility (e.g endometriosis).<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Fibroids,
polyps, and congenital malformations are possible causative factors affecting
the uterus. Their presence may be determined by pelvic examination,
hysteroscopy, saline sonogram ( a variation of a sonogram), and HSG.
Endometriosis, even if mild, is associated with reduced fertility.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">MALE
FACTORS<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     An
analysis of semen provides information about the number of percentage of moving forms, </span><span style="font-family: "times new roman" , serif; font-size: 18.6667px;">sperm (density),</span><span style="font-family: "times new roman" , serif; font-size: 14pt;">  and morphology (shape and form) </span><span style="font-family: "times new roman" , serif; font-size: 18.6667px;">quality of forward movement (forward progression),</span><span style="font-family: "times new roman" , serif; font-size: 14pt;">. From 2 to 6 mL of watery alkaline semen is
normal. A normal count has 60 to 100 million sperm/mL. However, the incidence
of impregnation is lessened only when the count decreases to less than 20
million sperm/mL.</span></div>
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<br />
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Men may
also be affected by varicoceles, which
decrease semen quality by increasing testicular temperature and </span><span style="font-family: "times new roman" , serif; font-size: 18.6667px;">varicose veins around the testicle,</span><span style="font-family: "times new roman" , serif; font-size: 14pt;">. Retrograde
ejaculation or ejaculation into the bladder is assessed by urinalysis after
ejaculation. In  male partners testing of blood may include the measuring of testosterone; LH and FSH ( which are involved in maintaining testicular function);
and prolactin levels.</span></div>
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factors fertility male ovulation uterine PATHOPHYSIOLOGY OF FACTORS AFFECTING FERTILITY

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ENVIRONMENTAL FACTORS THAT HINDERS HUMAN FERTILITY

09:56 Unknown 1

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<div class="separator" style="clear: both; text-align: center;">
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<br />
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">  <b>SMOKING<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">In terms of fertility, in women smoking can induce
early menopause and menstrual problems, in men it can cause abnormalities in
sperm morphology and motility. During fertility, there is an increased risk of
spontaneous abortion, preterm delivery, low birth weight and perinatal
mortality because of antepartum haemorrhage and placental abruption. New
evidence also shows that women who smoke are infertile and if by chance they
are fertile during pregnancy pass harmful carcinogens to their baby.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">    
Nutritional status tends to be compromised in smokers, characterized by
higher intake of energy, total fats, saturated fat, cholesterol and alcohol and
lower intakes of most micronutrients and antioxidant vitamins.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     More
children and matured adults give themselves to smoking, the dominance of such aged groups has increased in England from 8% in 1988 to 26%
in 2015. Over this period the proportion of  matured young girls that smoke often has increased  drastically from  one in five to one in three.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     The
addictive nature of smoking makes it very difficult for woman to stop even when
she knows it may affect her fertility and may harm her baby.<o:p></o:p></span></div>
<div class="MsoNormal">
<b><span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     ALCOHOL<o:p></o:p></span></b></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Alcohol when drunk occasionally or in moderation is
a very acceptable social activity, but when consumed in large quantities it can
become problematics, reduce appetite and affect nutritional status. High
alcohol intakes in women have been associated with menstrual disorders and
decreased fertility, even among women who had five or fewer drinks a week.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Alcohol
is a tetratogen and fetal alcohol syndrome (FAS) is used to describe the congenital
malformations associated with excessive maternal alcohol intake during
fertility. Although there is general agreement that women should not drink when
in search of fertility or child and not drink excessively during pregnancy
there is no consensus opinion as to what is safe amount.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     <b>WORKPLACE HAZARDS AND NOXIOUS SUBSTANCES<o:p></o:p></b></span></div>
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Human are
exposed to many environmental agents that may be hazardous to their
reproductive capacity and much of this exposure may occur in the workplace.
Exposure to solvents ionizing radiation and anaesthetics gases is known to be
toxic and associated with central nervous system defects, microcephaly and an
increased risk of infertility and if conceived there is likelihood of
miscarriage.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     There has
been concern about working with visual display units (VDUs) during pregnancy
and there are reports of the risks of miscarriages and child defects. However,
to date the scientific studies that have been carried out and taken as a whole
do not show any link.<o:p></o:p></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     <o:p></o:p></span></div>
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alcohol enviromental factors fertility smoking ENVIRONMENTAL FACTORS THAT HINDERS HUMAN FERTILITY

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PRE-EXISTING MEDICAL CONDITIONS AND DRUGS THAT HINDERS FERTILITY

09:52 Unknown 0

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<span style="font-family: "times new roman" , serif; font-size: 14pt;">                                                                          </span><br />
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<span style="font-family: "times new roman" , serif; font-size: 14pt;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitkdA9eMyAC06NLMndsFdCty6NbHXs2LrlDgKDCBspFcl77QsUDy2k9ZBo6uGxVhxYtws8UZiFiBZNnvKvygMNrPzcr6X-74kHmnrvV0pywr18GYMydke-1M9oLxca3_DYOZUF78IaBhA/s1600/fertilty+6.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitkdA9eMyAC06NLMndsFdCty6NbHXs2LrlDgKDCBspFcl77QsUDy2k9ZBo6uGxVhxYtws8UZiFiBZNnvKvygMNrPzcr6X-74kHmnrvV0pywr18GYMydke-1M9oLxca3_DYOZUF78IaBhA/s1600/fertilty+6.jpg" /></a></span></div>
<span style="font-family: "times new roman" , serif; font-size: 14pt;">           </span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"><b><br /></b></span>
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"><b>DIABETES</b><o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     Diabetes
mellitus is the most prevalent chronic medical disease in the fertility
population. Infants of insulin-dependent diabetics have 10 times the general
population risk of congenital malformation and five times the stillbirth rate. <o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">Diabetics complications such as retinopathy and
nephropathy may worsen during fertility search, particularly   if associated with hypertension. Women who
have severe neuropathy or cardiovascular disease may even be advised against
pregnancy. In this respect, fertility counseling and family planning advice
should be an important aspect of their diabetic management.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     The aim
of fertility care is to achieve normoglycaemic both pre- and periconception as
many of the problems seen in the insulin-dependent diabetic mother are a direct
result of hyperglycaemia. However, about one-third of diabetic women attend for
fertility care.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     The
safety of currently available oral hypoglycaemic agents in pregnancy is not
well established, therefore women with type 11 diabetes who are taking such
treatments should be switched to insulin therapy both for the fertility or
pre-conception period and for pregnancy.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"><b>PHENYLKETONURIA (PKV)</b><o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">    
Phenylketonuria is an inborn error of metabolism some women with PKV
discontinue treatment during middle childhood. However, unless they resume
careful dietary control around the time of conception the toxic effect of
phenylalanine (Phe) on the developing embryo/fetus results in a high rate of
microcephaly,  mental retardation and
congenital heart defects. Even through  dietary control, it is not easy for some women
to attain the recommended Phe levels of 120-360 micromol per litre, but when
dietary levels are achieved before conception or 8-10 weeks of pregnancy the
occurrence of congenital heart disease is significantly reduced.  Clearly, the woman with PKV needs  specialist help and support throughout for
preserving fertility which will eventually leads to the birth of a baby.<o:p></o:p></span></div>
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;"><b>ORAL CONTRACEPTION</b><o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">     This
should be stopped at least 3 months and preferably 6 months prior to planning a
pregnancy to allow for the resumption of natural hormone regulation and
ovulation. Also the oral contraceptive pill is associated with vitamin and
mineral imbalances that may need correcting. Copper levels are raised whilst
zinc levels are reduced which results in a deficiency of the latter minerals.
Vitamin metabolism is also affected, which may lead to deficiencies of folate,
B complex and vitamin C and an increase in vitamin A, which can be tetratogenic
at high levels.<o:p></o:p></span></div>
<br />
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<span style="font-family: "times new roman" , "serif"; font-size: 14.0pt; line-height: 115%;">      <o:p></o:p></span></div>
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PRE-EXISTING MEDICAL CONDITIONS AND DRUGS THAT HINDERS FERTILITY

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