FERTILITY AND INFERTILTY: female

MEDICAL MANAGEMENT OF MALE AND FEMALE FERTILTY

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<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>
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<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>
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<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>
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<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>
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<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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<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>
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<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>
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<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>
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<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>
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<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>
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<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>
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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%;">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>
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<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>
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<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>
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<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>
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<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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The treatment of infertility is complex a...

INFERTILITY AND WOMEN

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<b><span style="font-size: 14.0pt; line-height: 115%;">What is infertility?<o:p></o:p></span></b></div>
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<span style="font-size: 14.0pt; line-height: 115%;">     Infertility
is the inability of a sexually active couple who are not using contraception
get pregnant after trying for one year.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">For
pregnancy to occur, several things must happen:<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">It should
develop an egg in one of the ovaries of women.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">The ovary to
release an egg each month (ovulation). The egg must then be picked up by one of
the fallopian tubes.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">A man's
sperm must travel through the uterus to the fallopian tubes to join the egg and
fertilize it.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">The
fertilized egg must travel through the fallopian tubes and adhering (implanted)
to  the uterus lining.<o:p></o:p></span></div>
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<span style="font-size: 14pt;">Approximately
35 to 40 percent of infertility cases are due to female infertility, but a
similar number of cases are due to male infertility. Therefore, before taking
many tests and treatments, your partner should have a semen analysis to ensure
that his semen is normal. Even if abnormal, there are many treatments
available.</span></div>
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<b><span style="font-size: 14.0pt; line-height: 115%;">What causes female infertility?<o:p></o:p></span></b></div>
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<span style="font-size: 14.0pt; line-height: 115%;">     Approximately
25 percent of women with infertility ovulate rarely or never. These women often
have irregular periods or not have them at all. Ovulation can be altered due to
changes in the way the pituitary gland (a gland at the base of the brain)
releases certain hormones. These hormones, luteinizing hormone (LH) and
follicle-stimulating hormone (HFS), send a signal to the egg develops and the
ovary releases it.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">Among the
problems that interfere with the normal release of LH and HFS are<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">lesions in
the hypothalamus (part of the brain that works with the pituitary gland)<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">pituitary
tumors<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">having too
low or high weight<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">too much
exercise<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">extreme
stress<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">Other
hormonal disorders that interfere with ovulation or affect fertility are<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">Polycystic
ovary syndrome (PCOS)<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">hyperthyroidism
or hypothyroidism<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">diabetes<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">early
menopause<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">sometimes,
Cushing syndrome (a disorder that causes a very high level of cortisol,
sometimes called "the stress hormone")<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">The ability
to get pregnant also can be affected by age, since the number and quality of
eggs gradually decreases from approximately 35 years. Other factors include<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">reproductive
tract problems.</span></div>
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<b><span style="font-size: 14.0pt; line-height: 115%;">How is infertility diagnosed?<o:p></o:p></span></b></div>
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<span style="font-size: 14.0pt; line-height: 115%;">     Your doctor
will begin with a medical history about your menstrual cycle, past illnesses,
sexually, transmission surgeries and any medications you are taking.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">Step two is pelvic examination to confirm your reproductive tract (vagina,
uterus and ovaries) is normal and blood tests to measure your hormone levels.
In addition, it will take a medical history of your partner and will do a semen
analysis. According to the results of these tests, your doctor may make them
more tests, including one to ensure that the fallopian tubes of women are not
blocked.<o:p></o:p></span></div>
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<b><span style="font-size: 14.0pt; line-height: 115%;">What is the treatment for
infertility?<o:p></o:p></span></b></div>
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<span style="font-size: 14.0pt; line-height: 115%;">     Treatment for infertility depends on the cause
and age. There are two main categories: one contributes to fertility drugs or
surgery, and the other techniques used in assisted reproduction.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">Fertility
drugs (clomiphene pills, and injections of the hormone HFS and HL) are the main
treatment for women with ovulation disorders. It is possible that women without
a clear cause of infertility also use these drugs. Doctors sometimes combine
drug treatment with intrauterine insemination (IUI), in which sperm are
released into the uterus with a catheter (a thinflexible tube) is inserted into
the vagina. IUI is made attime of ovulation.<o:p></o:p></span></div>
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<span style="font-size: 14.0pt; line-height: 115%;">Assisted
reproductive technology uses techniques such as mixing sperm with an egg
outside the body (in vitro fertilization or IVF) or injecting a single sperm
into an egg and transferring the resulting embryo into the uterus. Some women
who are left with very few eggs in the ovaries opt for IVF using a donor egg.<o:p></o:p></span></div>
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female infertility women INFERTILITY AND WOMEN

What is infertility? Infertility is the inability of a sexually active couple who are not using contraception get pregnant af...

FERTILITY AND INFERTILTY

MEDICAL MANAGEMENT OF MALE AND FEMALE FERTILTY

INFERTILITY AND WOMEN

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