Female Infertility

Female Infertility

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.

Facts About Gout

Facts About Gout


What is Gout?

Gout is a form of arthritis that causes sudden attacks of pain, redness, and tenderness in joints; especially the joint at the base of the big toe.
Gout occurs when your body has extra uric acid; so urate crystals accumulate in joints, causing inflammation and intense pain.
A crisis usually develops during the night because the body is inactive and has a low temperature.
Gout can be treated with medications and changes in diet and lifestyle.

Who is affected by Gout?

-Men are more affected by gout than women because they have higher levels of uric acid in their blood.
-Women are affected after menopause because in this period they reach these uric acid levels.
-Obese people.
-Diabetic people.
-People with high blood pressure.
-People with kidney disease.
-People with a family history of gout.
-People with congestive heart failure.
-A person who consumes: a diet high in animal proteins, alcohol, and diuretics.

What causes Gout?

Normally the human body makes uric acid when he breaks down chemicals called purines (substances found in certain food and drinks); the production of uric acid goes through the kidneys and exits the body with urine.
Sometimes the body produces an excessive quantity of uric acid, or the kidneys are not doing a good job to handle the uric acid out of the body, so gout occurs.

What are the symptoms of Gout?

The symptoms of gout always occur suddenly, and often at night (gout attack):

-Intense joint pain especially the large joint of the big toe.
-Inflammation and redness.
-When gout progresses, the patient will not be able to move normally the joints affected.

A gout attack can last a week or two.
Between gout attacks, you may have no symptoms at all.

How often do Gout attacks happen?

Gout attacks can occur frequently or after several years from the last attack.
But if gout isn’t treated, attacks may become more frequent and last longer.
Gout attacks can occur in the same joint or affect different joints.

How to diagnose Gout?

Doctors usually diagnose gout based on the symptoms of the patient and the appearance of the affected joint. Check Babame activity cube.

Other tests that help doctors:
-Imaging test
-Blood test to measure the amount of uric acid in your blood.
Aspiration: by using a needle to draw fluid from your affected joint, and the fluid is examined under the microscope.

How is Gout treated?

1-Some medications are used to treat gout symptoms and to prevent future attacks:
-Nonsteroidal anti-inflammatory drugs ( NSAIDs)

2-Medications to prevent gout complications:
-Medications that block uric acid production.
-Medications that help your kidneys to do a good job and remove uric acid from your body.

3-Changes in diet and lifestyle:
Medications are often the most effective way to treat gout attacks, but some changes in your lifestyle are important:
-Choose healthier beverages and foods:
*Avoid malted barley drinks (diuretic that increases the levels of uric acid in the body), fruit juice drinks with high fructose (because fructose stimulates the body to produce uric acid), coffee (caffeine is a diuretic), alcohol.
*You should drink a lot of water because it helps to remove uric acid from your body.
*Avoid foods high in purines: seafood, tuna, red meat, turkey, spinach, liver…
*Avoid foods high in fat and sugars to prevent obesity and diabetes.
*Types of food that might help gout:
Cherries, whole grains, eggs, cucumber, dark chocolate instead of sweets high in sugar, tomatoes, fat free dairy products.
*Exercise regularly and lose weight.

Kidney disease can lead to Gout?

Kidneys are responsible to filter wastes like uric acid (found in your blood) out of your body. But when you have chronic kidney disease, you will have an excessive quantity of uric acid in your blood because the kidneys cannot filter this waste out of the body; so gout occurs.

Gout may lead to kidney stones?

People with gout could be at a higher risk of developing uric acid kidney stones because they have a higher level of uric acid being excreted by the kidneys, and they have more acidic urine, which makes the uric acid more likely to form stones.


Blood in urine!

Blood in urine!


Seeing blood in urine should never be ignored; because it can be a sign of a serious medical problem.
It is the most common sign of bladder cancer that is usually painless, the urine color might change to orange, bright red, or brown.

What is hematuria?

Hematuria is the presence of blood cells in the urine. We have two types of hematuria:

-Gross hematuria: when the blood present in the urine is visible to the naked eye.

-Microscopic hematuria: when the blood in your urine can only be seen through a microscope.

Hematuria is just a symptom, so you should visit your doctor who will determine the cause by ordering some tests…When the origin of the blood in your urine is defined, the doctor can start the adequate treatment.

Where blood in urine might come from?

Blood in your urine can come from your kidneys, and from several parts of your urinary tract:

– Ureters

– Bladder

– Urethra

What are the causes?

Urinary tract infection (UTI).

– Pyelonephritis or kidney infection.

Kidney stones.

Enlarged prostate – BPH.

– Injury to the urinary tract.

– Kidney disease (when your kidneys aren’t working properly).

– Sickle cell disease:  a hereditary defect of hemoglobin in red blood cells that can cause blood in the urine.

– Cancer: kidney cancer, bladder cancer, or prostate cancer.

– Medications: the anti-cancer drug cyclophosphamide and penicillin, and anticoagulants can cause urinary bleeding.

What are the symptoms?

Some patients suffer from:

– Frequent, painful, or urgent urination.

– Nausea, vomiting, fever, or pain in the abdomen.

But bloody urine often occurs without other signs or symptoms; so when you see blood in your urine you should directly book an appointment with the doctor.

You should note that urine can also change colors due to food choices.

What are the risk factors of hematuria?

– Age: Many men older than 50 have a high risk of hematuria due to an enlarged prostate gland.

– Patients with existing diseases that are known to cause hematuria.

– Patient who has a family history of kidney disease or kidney stones.

– Certain medications: overuse of pain medications, anticoagulants like Aspirin, and the anti-cancer drug cyclophosphamide and penicillin.

– Smoking.

How is hematuria diagnosed?

The doctor’s goal is to find the cause of hematuria by ordering several tests, and a physical exam which includes a discussion of your medical history.

– Urine analysis and urine culture are required.

– Urine cytology: a urine test that can determine the presence of any abnormal cells.

– Imaging tests: an imaging test is required to find the cause of hematuria; your doctor will recommend a CT or MRI scan or an ultrasound exam.

Cystoscopy: A test that uses a device called a cystoscope to examine the bladder and urethra.

How is hematuria treated?

The treatment of hematuria depends on the cause of blood in  urine. The information collected from the medical history, physical exam, urine tests, and imaging tests will be used to determine the best treatment option; for example, when the cause is a UTI, the best treatment is the use of antibiotics.







Facts about bladder prolapse in Lebanon

Facts about bladder prolapse in Lebanon


Bladder Prolapse

What’s bladder prolapse?

A cystocele or a prolapsed bladder occurs when ligaments that hold your bladder up and the muscle between a woman’s vagina and bladder are weak; for this reason, the bladder will fall into the vagina.

There are three grades of cystocele:

– Grade 1: The bladder falls only a short way into the vagina.

– Grade 2: The bladder falls to the opening of the vagina.

– Grade 3: The bladder comes out of the opening of the vagina; it’s a severe grade.

Causes and Risk factors

There are several causes and risk factors:

– Pregnancy and childbirth: Women who have had a vaginal delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse; because the pregnancy and the delivery may involve straining the muscles of the floor of the pelvis.

– Age:  especially after menopause, when the production of estrogen decreases; so the muscles around the vagina are not strong anymore.

– Hysterectomy.

– Family history or genetic factor (some women are born with weak connective tissues).

– Obesity: Women who are obese are at higher risk of anterior prolapse.

– Constipation.

– Chronic coughing.

– Lifting heavy objects.

– Smoking.

What are the symptoms of a cystocele?

– Seeing something bloating through the vaginal opening.

– Difficulty to urinate.

– Feeling the need to urinate frequently.

– Frequent urinary tract infections.

– Pain in the pelvic area or lower back.

– Painful sex.

– Difficulty to insert tampons or applicators.

How is bladder prolapse diagnosed?

Prolapsed Bladder can be diagnosed with a clinical history and a pelvic exam. The exam may be done while you are lying down, straining or pushing, or standing; the doctor may measure the severity of the prolapsed bladder by seeing in which part of the vagina the bladder has fallen.

Other tests and imaging studies may also be done to check the pelvic floor, and confirm the diagnosis of a prolapsed bladder:

– Cystoscopy: a long tube is passed through the urethra to examine the bladder.

– Urodynamics: to measure the capacity of the bladder to hold and release urine.

– X-rays

– Ultrasound


How to treat the prolapsed bladder?

1- No treatment if the prolapse is:

– Not causing you problems.

– Not blocking your urine flow.

 2- Behavior therapy

– Kegel exercises (which help the muscles of the pelvic floor to be strong).

– Pelvic floor physical therapy.

– Pessary: a vaginal support device to hold the bladder in place.

3- Estrogen replacement therapy

4- Weight loss

5- Surgery:

A moderate or severe prolapsed bladder may require reconstructive surgery to move the bladder into a normal position; and it can be performed through the vagina or the abdomen, under a spinal or general anesthetic.

The surgical treatment is the best therapy for bladder prolapse; but if a woman is planning for a pregnancy, surgery is contraindicated.

The patient usually goes home the day of the surgery, and the recovery time typically takes four to six weeks.

Follow the link for more information about bladder prolapse treatment.

How can a cystocele be prevented?

– Maintain a healthy weight.

– Avoid lifting heavy objects.

– Treat constipation.

– Stop smoking.



Male Infertility

Male Infertility

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:


– 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.


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.




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 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.


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.


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.


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.


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