FERTILITY AND INFERTILTY: male

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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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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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The treatment of infertility is complex a...

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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%;">Ovarian
and Ovulation Factors<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%;">    
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>
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<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>
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<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>
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<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>
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<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>
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<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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<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

Ovarian and Ovulation Factors Diagnostics studie...

FERTILITY AND INFERTILTY

MEDICAL MANAGEMENT OF MALE AND FEMALE FERTILTY

PATHOPHYSIOLOGY OF FACTORS AFFECTING FERTILITY

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