Management Of Infertility

Infertility is the inability of a couple to procreate or bear children after one year of regular unprocteted sexual intercourse. The rate of infertility has been on the rise of late which is brought about by a wide range of physical and emotional factors.

 History Taking

It is important to take the history of both Males and Females together or separately. This should include developmental history including immunisation, milestones, e.g. puberty
, past medical and surgical history, frequency of coitus and mode of coitus. It should also include types of jobs of husband and wife and whether they live together or separately.

Specific questions must be asked from both males and females of any past infections, vaginal or urethral discharge or lower abdominal pains. Specific questions of past history of mumps should be asked in the males. Both partners should also be questioned for past history of diabetes or hypertension or drug abuse.

Physical Examination 

Both male and female should be examined for any congenital abnormality including undescended tests in the male, imperforate hymen or any other disability in the females, should also be screened for evidence of fibroids and all other factors that may be responsible for infertility.

Counselling

Physical examination is followed by counselling of the couple. This should include the physical aspect of sexual relationship, sex, education and detecting any sexual dysfunction.

During the first counselling, some very important points are stressed. These include:

1. That fertile sperms should enter the vaginal at the time of ovulation.

2. Good secretion (i.e. egg white) from the cervix are required for sperms to enter the uterus.

3. The tubes have to be open.

4. The lining of the uterus must be in the right condition for the egg to implant and pregnancy to start.

It should be stressed during counselling that getting pregnant is a function of both males and females. The mind of the male should be disabused about the fact that fertility is only a function of the female, i.e. referring to fruit of the womb. The man has to first deposit viable spermatozoa before pregnancy can be achieved. Both partner should therefore be encouraged to take joint responsibility for achieving their aim of having a child.

One of the methods is the use of the Ondo Chart. Both Parties are encouraged to look at the chart together. Other methods include recording it on a chart. The most reliable method is however the Billings Method of Ovulation and the filling of the Ondo Chart.

It is important to reassure the couple and continue to encourage them to use the natural methods for about a year unless gross abnormalities have been discovered during physical examination. If these however fail, it is necessary to proceed to investigation.

Investigation of an Infertile Couple

The investigation should involve those for the husband and wife. The couple should be made to understand that both of them have to go through the medical tests together.

It is also better to start from the non-invasive tests before proceeding to the invasive tests. The non-invasive tests are those that would not disturb the physiology of the body.

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Causes Of Male Infertility

1. Sexually transmitted Diseases:  Many sexually transmitted diseases cause only minor symptoms, many infected men do not get the necessary treatment. As a result a large number of men suffer the effects of sexually transmitted diseases induced infertility.


2. Retrograde Ejaculation: This occurs when semen which would normally be ejaculated via urethra is redirected to the urinary bladder. When the bladder sphincter does not function properly,
retrograde ejaculation may occur. Retrograde ejaculation is sometimes referred to as a "Dry Orgasm". 

3. Low sperm Count: Low sperm count is the leading cause of infertility in men. Men with low sperm count find it difficult to impregnate their wives
. A sperm count of less than 20 million/ml is considered low sperm. Sperm count varies widely over time, and temporary low sperm count are common.


4. Smoking/Drinking: when you smoke, your blood circulation decreases. when blood circulation decrease, sperm count also decrease. Smoking impairs sperm count, sperm motility, reduces sperm lifespan, and may cause generic changes that affect the offspring.


5. Retrograde Ejaculation: This occurs when semen which would normally be ejaculated via urethra is redirected to the urinary bladder. When the bladder sphincter does not function properly, retrograde ejaculation may occur. Retrograde ejaculation is sometimes referred to as a "Dry Orgasm".


6. Testicular Cancer: Testicular cancer is cancer that starts in the testicles, the male reproductive glands located in the scrotum. The exact cause of testicular cancer is unknown. There is no link between vasectomy and testicular cancer. Testicular cancer is the most common form of cancer in en between the ages of 15 and 35. It can occur in older men, and rarely in younger boys. 

7. Structural Chromosome Abnormalities: This occur when there is a change in the structure or component of a chromosome. The total number of chromosomes is usually normal (46 total per cell). Structural chromosome abnormalities occur when part of a chromosome is missing, a part of a chromosome is extra

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common problems associated

Fibroid Symptoms
*          Long menstrual period:

            Period may last more than seven days and menstrual flow may be very heavy. Heavy menstrual flow can sometimes lead to anaemia.

*          Pressure on other organs: Large fibroids may press on organs in the pelvic
         
            - A basin-shaped cavity in the lower abdomen, containing the bladder, bowel, and reproductive organs.


            - If fibroid press on the bladder: A woman may feel the urge to urinate frequently. She may pass only small amounts of urine and she may feel as though she has not completely emptied her bladder.
         
            - If fibroid press on the bowel, she may feel constipated suffering from difficult, painful, or infrequent movement of the bowels, or full after eating only a small amount of food.

         - If fibroid press on one or both ureters (the tubes connecting the kidneys to the bladder). They may partially block the flow of urine. A woman may not be aware of this, because it often isn’t painful. Over time, however, this kind of blockage can lead to kidney infections or other serious kidney damage.

*         Pelvic Pain

            The pressure of large fibroids on other organs may cause pain in the pelvic. Sometimes, if fibroid do not get the blood flow they need to sustain themselves, they degenerate or die. This may cause severe pain lasting for days or weeks. Pain may also occur if the stalk of a fibroid twists, cutting off blood supply to the fibroid. Rarely, a fibroid may become infected and cause pain.

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how to test male fertility

Tests for Male Fertility


1. Seminal Fluid Analysis: This involves obtaining the semen immediately after intercourse or through the process of Masturbation. The semen is then subject to test in the laboratory and results obtained. The normal count should be 20 – 200 million.




2. Seminal fluid for microscopy, culture and sensitivity: This is to detect if any infections is present in the genital system. The results would tell us about the presence of any infection and suggest the drugs to be used for treatment.



3. Testicular Biopsy: This involves taking sample of the tests and examining under the microscope. This is to observe the developmental stages of the spermatozoa and detect any abnormalities.


4. Blood samples should be also be obtained for a full set of thyroid functions and level of hormones or when genetic abnormalities are suspected, the blood should be taken to a genetic laboratory.

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Female Infertility Test

Tests for Female Fertility

As stated earlier in Management Of Infertility, it is better to start with the non-invasive tests before proceeding to tests that would alter the physiology of the body. This is because the invasive tests could be painful.

1. Detection of ovulation can be done through the Billings Ovulation Method and the filling of the Ondo Chart.

2. The women can also visit the hospital for follicular monitoring to follow the development of the follicles to determine the exact day of ovulation.

3. Other tests for detecting ovulation include:

Recording the basal body temperature,

Examination of the cervical mucus under the microscope,

Carrying out the tests on the vaginal wall (Vaginal Cytology),

Carrying out an endometrial biopsy and;

Carrying out a uterine motility tests by measuring the pressure within uterus, this can only be done in a specialised centre.

4. Hysteroscopy: This involves passing a small camera into the abdomen of the woman through a small incision in the abdomen. The genital organs are then viewed through the camera.

5. Hysterosalpingography: This involves passing a dye into the uterus and tubes through a canula inserted in the cervix. The movement of the dye is then followed by x-rays to determine the scale of the womb and the potency of the tubes.

6. Tubal Insufflations: This involves passing a gas into the uterus and tubes to determine the potency at correcting the abnormalities detected during investigations.

   

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How To Boost Fertility In Women

WOMEN  MUST KNOW THIS

Fertility is the natural capability of giving life. If a woman is fertile, then there is a good chance that she would become pregnant. Pregnancy may not happen right away unless both a man and a woman are fertile.

For increase chances of a woman to become pregnant, there are certain dietary and behavioural changes she must do that may boost her Fertility.

WHAT FERTILITY SPECIALISTS RECOMMENDED FOR BOOST OF FERTILITY IN WOMEN

REGULAR EXERCISE

Moderate exercise can be a good natural fertility treatment. Exercising with a balanced and nutritious diet can help maintaining a healthy body weight.
Exercise helps to burn off excess body fat allowing hormones level to return to normal.

STAY AWAY FROM COFFEE AND ALCOHOL

Drinking too much coffee or alcohol can impair a woman’s fertility and reduce the ability to conceive and having a healthy pregnancy.

Alcohol is a toxin that can kill the sperm generating cells in the testicle. A sperm takes at least three months to develop and high level of alcohol is likely affect the growth of the sperms.

REGULATE YOUR WEIGHT

Too much fat in the body can lead to an over production of certain hormones that disrupt ovulation. Cycles may be less regular and affect ovulation by lowering chances of getting pregnant. Higher body mass indexes always increase the chances of erectile problems and impotence.

TIMING

Certain tools have been developed for calculating the days when a woman would be more fertile. This can be done by observing menstrual cycle for a few months and then arriving at the days when the woman is likely to conceive. Ovulation occurs about 14 days before the menstrual period is due.

CONCLUSION

It is never too late to adopt a healthy lifestyle to increase the chances of conception whenever a woman is ready to start having baby.

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Fibroid Causes

Fibroid Causes

Fibroid are growth of tissue that are usually found in the wall of the uterus, or womb. They are made of a mixture of muscle tissue from the uterus and threadlike fibers of connective tissue. Although they are called tumours, fibroid are not cancerous.

Fibroid are very common. They occur in 2 or 3 out of every 10 women over age 35.

They occur most often in women between ages 30 and 50, although women in their 20s sometimes have them. It is common to have more than one fibroid. Some women may have as many as a hundred. Fibroid can be as small as a pinpoint or as large as a basketball. They are usually round or oval in shape, like a ball or an egg. Their texture is firm like an unripe peach.

Fibroid can grow in different parts of the uterus. They are named according to which part of the uterus they are found.

Fibroid that grow inside the wall of the uterus are called INTRAMURAL FIBROID. They are the most common type of fibroid.

Fibroid that grow outward from the wall of the uterus into the abdominal cavity are called SUBSEROUS or SUBSEROSAL FIBROIDS.

Fibroid that grow inward from the uterine wall, taking up space within the cavity of the uterus, are called SUBMUCOUS or SUBMUCOSAL FIBROID.

A fibroid that is attached to the uterus by a thin stalk is called a PEDUNCULATED FIBROID.

WHAT CAUSES FIBROID

A fibroid starts as a single muscle cell in the uterus. For reasons that are not known, this cell changes into a fibroid tumour cell and starts to grow and multiply. Heredity may be a factor. It is thought that a muscle cell in the uterus may be “PROGRAMMED” from birth to develop into a fibroid sometime-perhaps many years-after puberty (the start of menstrual periods).

After puberty, the ovaries produce more hormones, especially oestrogen. Higher levels of these hormones may help fibroids to grow, although exactly how this might happen is not understood.

SYMPTOMS OF FIBROID

For many women, fibroid cause no problems. More than half of women with fibroids do not know they have them until their doctor tells them so.

DIET:

Stay away from caffeine. A high fiber diet is good for taking the excess estrogen from your body through the colon, if not it will re-enter your bloodstream. Stay away from conventionally processed meals, beef especially. Eat organic meat.

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