Feb 25, 2023 | Common Solutions, Surgeries
What is female infertility?
Female infertility can be discussed when a woman is unable to conceive a pregnancy after trying for at least one year without using any form of contraception. In some cases, female infertility can also refer to a woman’s inability to carry a pregnancy to term, resulting in miscarriages or stillbirths. Other signs of female infertility may include irregular menstrual cycles, hormone imbalances, or other medical conditions that affect fertility.
It is important to note that infertility is not always the result of female factors alone, and that male infertility or a combination of male and female factors may also be involved. Therefore, it is recommended that both partners undergo fertility testing and evaluation to identify the root cause of infertility and determine the best course of treatment.
How is female infertility diagnosed?
Female infertility is diagnosed through a series of medical tests and evaluations. Here are some common diagnostic procedures for female infertility:
1-Medical history: A doctor will take a detailed medical history of the patient and their partner, including information about menstrual cycle, sexual habits, and previous pregnancies.
2-Physical examination: A doctor will perform a physical exam to check for any physical abnormalities such as blocked fallopian tubes or endometriosis.
3-Hormone testing: Blood tests can be done to check hormone levels, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. Hormonal imbalances can affect ovulation and fertility.
4-Ovulation testing: This involves tracking the patient’s menstrual cycle to determine if they are ovulating regularly. This can be done through blood tests or ultrasounds.
5-Hysterosalpingography (HSG): This is an X-ray test that uses dye to determine if the fallopian tubes are open and functioning properly.
6-Laparoscopy: This is a surgical procedure that allows a doctor to view the reproductive organs and look for any abnormalities, such as endometriosis or ovarian cysts.
7-Genetic testing: In rare cases, genetic testing may be recommended to look for any genetic abnormalities that could be causing infertility.
By performing these tests, doctors can often identify the cause of infertility in women and recommend appropriate treatment options.
How we can treat female infertility?
The treatment options for female infertility will depend on the underlying cause. Some common treatment options include:
1-Medications: Medications may be used to regulate ovulation, stimulate the production of eggs, or treat underlying hormonal imbalances that can affect fertility.
2-Surgery: In some cases, surgery may be necessary to correct structural abnormalities that can interfere with fertility, such as blocked fallopian tubes, uterine fibroids, or endometriosis.
3-Intrauterine insemination (IUI): IUI involves placing washed sperm directly into the uterus around the time of ovulation to increase the chances of fertilization.
4-In vitro fertilization (IVF): IVF involves fertilizing eggs with sperm in a laboratory and then transferring the resulting embryo(s) into the uterus.
5-Donor eggs or embryos: If a woman’s own eggs are not viable, she may be able to use donated eggs or embryos to achieve pregnancy.
6-Surrogacy: In some cases, a woman may be unable to carry a pregnancy to term due to a medical condition, in which case surrogacy may be an option.
It is important to consult with a fertility specialist to determine the most appropriate treatment for your individual needs.
Risk factors of female infertility
There are many risk factors associated with female infertility, some of which include:
1-Age: As women age, their fertility declines, with a marked decrease in fertility occurring after the age of 35.
2-Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder that affects up to 10% of women of reproductive age, and can interfere with ovulation.
3-Endometriosis: This condition occurs when the tissue that lines the uterus grows outside of it, potentially causing damage to the reproductive organs.
4-Pelvic Inflammatory Disease (PID): PID is an infection of the female reproductive organs that can lead to scarring and blockages, making it difficult for eggs to travel from the ovaries to the uterus.
5-Hormonal imbalances: Any imbalances in hormones that regulate the menstrual cycle can interfere with ovulation and fertility.
6-Fallopian tube damage: Damage to the fallopian tubes, which transport eggs from the ovaries to the uterus, can be caused by infections, surgeries, or other conditions.
7-Uterine abnormalities: Structural problems with the uterus can interfere with implantation or increase the risk of miscarriage.
8-Lifestyle factors: Smoking, excessive alcohol consumption, and a sedentary lifestyle can all affect fertility.
9-Weight: Being either overweight or underweight can interfere with hormonal balance and ovulation.
It’s important to note that these are just a few examples of risk factors associated with female infertility. If you’re concerned about your fertility, it’s best to speak with a healthcare professional who can help you identify any potential issues and develop a plan to address them.
How to prevent female infertility?
There are several steps that women can take to help prevent infertility:
1-Maintain a healthy weight: Being overweight or underweight can disrupt normal ovulation and hormone production, leading to infertility. Maintaining a healthy weight through a balanced diet and regular exercise can help prevent infertility.
2- Don’t smoke: Smoking has been linked to decreased fertility in women. Quitting smoking can improve fertility and overall health.
3-Limit alcohol and caffeine intake: Excessive alcohol and caffeine intake can interfere with normal ovulation and hormone production. Limiting consumption of these substances can help prevent infertility.
4-Manage stress: Chronic stress can disrupt hormone production and ovulation, leading to infertility. Finding healthy ways to manage stress, such as meditation or exercise, can help prevent infertility.
5-Practice safe sex: Sexually transmitted infections (STIs) can cause pelvic inflammatory disease (PID), which can lead to infertility. Practicing safe sex and getting tested regularly for STIs can help prevent infertility.
6-Get regular check-ups: Regular gynecological exams can help detect and treat conditions that may cause infertility, such as polycystic ovary syndrome (PCOS) or endometriosis.
7-Consider fertility preservation options: If you are planning to delay pregnancy, or if you have a medical condition that may affect your fertility, consider fertility preservation options, such as freezing your eggs or embryos, to increase your chances of having a biological child in the future.
It is important to note that infertility can have various causes, and not all cases can be prevented. If you are having difficulty getting pregnant, it is recommended that you speak with a healthcare provider to determine the underlying cause and explore treatment options.
Freezing eggs
Freezing eggs, also known as oocyte cryopreservation, can be a beneficial option for women who are facing infertility due to various reasons. This process involves extracting a woman’s eggs from her ovaries, freezing them, and storing them until she is ready to use them in the future to try and conceive a child.
There are several reasons why a woman may choose to freeze her eggs. One of the most common is to preserve fertility before undergoing treatments that could affect her ability to have children, such as chemotherapy or radiation therapy. Women who are planning to delay childbearing for personal or professional reasons may also choose to freeze their eggs.
It’s important to note that freezing eggs does not guarantee a successful pregnancy in the future, but it does offer the possibility of using these eggs to conceive if natural conception is not possible. The success of egg freezing depends on various factors such as the woman’s age at the time of freezing, the number and quality of eggs retrieved, and the method used for freezing and thawing.
Overall, freezing eggs can be an effective option for women facing infertility, but it’s important to discuss the potential risks and benefits with a healthcare provider to determine if it’s the right choice for individual circumstances.
Jul 23, 2021 | Common Solutions
How is male infertility diagnosed?
Diagnosis starts with a physical examination to evaluate your general state of health and identify any physical problems that may have consequences on your fertility. The doctor required the presence of the two partners and some tests:
Semen Analysis
Semen analysis is a routine lab test that helps to determine:
– Sperm volume, concentration, and count per ejaculation.
– PH of the sperm.
– Velocity: how fast your sperm travels.
– Morphology: Size and shape of your sperm.
– Color.
– Viscosity: liquefaction time of the sperm.
– Motility of the sperm.
– Viability of the sperm.
If the semen test shows low sperm numbers or the total absence of the sperm, it may not mean you are permanently infertile; more testing may be needed.
Transrectal Ultrasound
Your doctor may order a transrectal ultrasound. A probe is inserted in the rectum, and sound waves are delivered to the nearby ejaculatory ducts. This imaging technique can help the doctor to see if some structures such as the ejaculatory duct or seminal vesicles are blocked or present some problems.
Testicular Biopsy
If semen analysis shows oligospermia or azoospermia; you may need a testicular biopsy, which can be done with general or local anesthesia. A small cut is made in the scrotum, and a small piece of tissue from each testicle is removed and evaluated under a microscope. The biopsy helps to find the cause of male infertility; and to collect sperm for use in assisted reproduction (such as in vitro fertilization; IVF).
Hormonal Profile
The health care provider may check your hormones to know how well your testicles make sperm; by evaluating the FSH level (FSH is the pituitary hormone that tells the testicles to make sperm).
Can male infertility be treated?
When the diagnosis of male infertility is confirmed, the curative phase begins to increase the couple’s chance of having a child.
Depending on the cause of infertility, treatments may include:
Medications:
– Hormone therapy to increase the number of sperm, when infertility is caused by high or low levels of certain hormones.
– Treatments for sexual intercourse problems; when certain sexual problems in men cause infertility (premature ejaculation or erectile dysfunction), and in some cases the couple should consult a sexologist.
– Antibiotic treatments if there is an infection.
Surgical treatment :
For example, a varicocele can often be surgically corrected or an obstructed vas deferens repaired. Prior vasectomies can be reversed. When there is no sperm in the ejaculation, sperm can often be retrieved directly from the testicles or epididymis using sperm retrieval techniques.
– Assisted reproductive technology (ART): in ART sperm can be obtained through normal ejaculation, surgical extraction, or donor individuals, depending on your specific case and wishes. The sperm is then inserted into the female genital tract or used to perform in vitro fertilization or intracytoplasmic sperm injection (ICSI).
In IVF, the egg and sperm (of which there are many) fertilize on their own in the laboratory. In ICSI, the selected sperm is directly injected into the egg.
What about Fertility Preservation?
When you have medical and sexual issues that affect your fertility; freezing your sperm is the best method to preserve your fertility and increase the chance of having a child.
WHO IS A CANDIDATE FOR FERTILITY PRESERVATION?
Fertility preservation is an option when a man:
– Is diagnosed with cancer at a young age.
– Has sexual dysfunctions.
– Expects to have surgery especially a vasectomy.
– Has an autoimmune, hormone, or genetic disorder.
– Experienced trauma.
– Hopes to have children later in life.
– Has high-risk occupations.
– Have low sperm counts for no known reason.
Jul 23, 2021 | Common Solutions
Male Infertility
Nearly 1 in 7 couples is infertile, which means there is no pregnancy even though they’ve had frequent, unprotected sexual intercourse for a year or longer.
The male factor can be the cause of infertility, and this can lead to a stressful relationship.
When to see a doctor?
If no pregnancy after a year of regular unprotected intercourse, and if there is:
– Erection or ejaculation problems, low sex drive, or other sexual problems.
– Pain or swelling in the testicle area.
– Testicular or sexual problems.
– A groin, testicle, penis, or scrotum procedure.
– A partner over age 35.
What are the causes of male infertility?
– Sperm Disorders.
– Varicoceles.
– Retrograde Ejaculation.
– Immunologic Infertility.
– Obstruction.
– Hormones.
– Medications.
Sperm Disorders
The most common problem is with the production and maturation of sperm. Sperm may:
– Not grow enough.
– Have a strange form.
– Not move the right way.
– We can have oligospermia (low number of sperm) or azoospermia (absence of sperm completely).
Sperm problems can be congenital; but sometimes a toxic lifestyle can reduce sperm count: smoking, drinking alcohol, and taking certain medications.
Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections, or hormonal testosterone disorder.
Damage to the reproductive system can cause low sperm numbers or the total absence of it ; which can cause the obstruction of the tubes that the sperm travel through.
Varicoceles
Varicoceles are overinflated veins located in the scrotum; they are more common in infertile men (40 out of 100). They stop the growth of sperm by blocking blood drainage and lead blood to flow back into your scrotum from your belly; the testicles are then too distended and hot to touch for making sperm, which can cause low sperm number.
Retrograde Ejaculation
Retrograde ejaculation is when semen goes into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don’t close during orgasm; it can be caused by some procedures, medications, or health problems of the nervous system; signs are turbid urine after ejaculation and dry ejaculation.
Immunologic Infertility
Sometimes a man’s body makes antibodies that attack his own sperm because of a certain surgery or infection. Antibodies prevent sperm from moving and working normally in order to fertilize the egg.
Obstruction
Sometimes the tubes which sperm travel through can be blocked; some infections and surgeries (such as vasectomy) can cause blockage. Any part of the male reproductive tract can be blocked, which can lead to infertility because the sperm from the testicles can’t leave the body during ejaculation.
Hormones
A very low pituitary hormone level causes poor sperm growth.
Chromosomes defects
Hereditary disorders such as Klinefelter’s syndrome; in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) cause abnormal development of the male reproductive organs.
Medication
Certain medications have side effects on sperm production, function, and delivery. These medications help to treat:
– arthritis
– depression
– digestive problems
– infections
– high blood pressure
– cancer
Risk factors
Several factors can increase the risk of male infertility:
– Smoking.
– Abusing illegal drugs.
– Drinking alcohol.
– Don’t maintain a healthy weight.
– Being exposed to toxins.
– Overheating the testicles.
– Having a history of undescended testicles.
– Having genetic disorders.
– Having testicular injuries.
– Testicular cancer and treatment.
What are the complications of male infertility?
– Stress and relationship problems.
– Expensive and involved reproductive techniques.
– High risk of testicular and prostate cancer.
Prevention
Some measures must be taken into consideration to prevent infertility:
– Don’t smoke.
– Don’t drink alcohol.
– Steer clear of illicit drugs.
– Avoid being overweight.
– Don’t get a vasectomy.
– Avoid things that overheat the testicles.
– Reduce stress.
Diagnosis and Treatment
Feb 24, 2022 | Sexual Health
Varicoceles
What are varicoceles?
Varicoceles are when veins called pampiniform plexus become enlarged inside your scrotum (the sac that protects and holds the testicles). About ten to fifteen males out of one hundred have varicocele; it is like getting a varicose vein in your leg.
This condition is most common in young men; and affects the left side of the scrotum more than the right side, because the male anatomy is not the same on both sides.
Varicoceles can be on both sides at the same time, but this is rare.
Causes
Your spermatic cord (each testicle is holding up by a spermatic cord) transfers blood to and from your testicles.
It’s not certain what causes varicoceles; but the principal cause could be a problem with blood flow in the spermatic cord.
Many experts believe a varicocele forms when the valves inside the veins in the cord prevent your blood from flowing properly; which leads the veins to dilate. This might cause damage to the testicle and lead to infertility.
When varicocele occurs in puberty, it’s often because of the immediate growth they undergo during puberty. The testicles need more blood than normal as they develop, and any problem in the veins can keep the blood from getting where it needs to go.
What are the symptoms of varicoceles?
Varicoceles often don’t present symptoms; but sometimes you may notice:
• Dull testicular pain or scrotal aching; which often gets better when you lie down, and get worse while doing certain activities.
• Inflamed testicle or scrotum.
• Male infertility.
• Sensation of a mass above the affected testicle.
• Enlarged veins that are quite noticeable.
Complications
• Testicular atrophy: The majority of the testicle comprises sperm-producing tubules. When damaged, as from varicocele, the testicle contracts and softens. We can’t explain why the testicle shrinks, but the malfunctioning valves allow blood to pool in the veins, which can result in increased pressure in the veins and exposure to toxins in the blood that may cause testicular damage.
• Infertility: Temperature changes inside the scrotum due to blood accumulation in veins; this higher temperature may affect sperm formation, movement (motility), and function.
Diagnosis
In the physical exam, the doctor can feel above your enlarged testicle a mass that does not trigger discomfort upon palpation.
If you have a large varicocele, your doctor might ask you to stand, take a deep breath and hold it while you bear down (Valsalva maneuver); this helps your doctor detect abnormal amplification of the veins.
Sometimes the physical exam is inconvincing, so your doctor might order a scrotal ultrasound (a test that uses high-frequency sound waves to create precise images of the male’s testicles and surrounding tissues). In certain cases, other imaging might be recommended to rule out other causes for the varicocele, such as a tumor compressing the spermatic vein.
The size of the mass in your testicle helps your doctor classify your varicocele on a grading scale of 0-3.
A Grade 0 is the smallest, and can be diagnosed only with the help of an ultrasound.
Grade 3 is the largest, and means your varicocele is big enough that it changes the shape of your scrotum and can be diagnosed with the physical exam.
Treatment
Varicoceles require treatment only if:
• You have pain
• You have problems with your fertility
• Your right testicle is growing more than the left
There are no medicines to prevent or treat varicoceles.
If you do need treatment, the goal will be to remove the veins that supply blood to your spermatic cord. You might have:
Varicocelectomy: This surgery is performed to remove enlarged veins in your scrotum; and to restore proper blood flow to your reproductive organs, under local or general anesthesia through a small cut into your scrotum.
Laparoscopic surgery: The doctor makes a small incision in your abdomen and passes a tiny instrument through the incision to see and repair the varicocele; this procedure requires general anesthesia.
After those two surgical treatments, you may notice:
• Varicoceles don’t go away, or come back
• Hydrocele
• Your testicular artery gets injured
Percutaneous embolization: A radiologist inserts a tube into a vein in your groin or neck through which instruments can be passed; the radiologist inserts a coil by using X-rays, to deflect blood away from the enlarged vein in your scrotum, under general anesthesia.
Risks that can follow this procedure include:
• Varicoceles don’t go away, or comes back
• The coil moves
• An infection
Recovery
After embolization, you can return to work after two days, and begin exercising after seven to 10 days.
If you have the procedure to help with fertility, the doctor will test you in 3-4 months; that’s how long it takes for new sperm to grow. You’ll probably see improvements in 6 months, but it could take a year.
A little more than half of the infertile men who have the procedure benefit from it. Surgery is also successful for most teens who have it to fix slow testicular growth.
May 14, 2021
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