peterhutch asked:


le may be infertile during their reproductive years. They may be unaware of this because they are not seeking to create a pregnancy. On any one occasion, the chance of pregnancy is just one percent. About one in seven couples in the United States are infertile. Age, lifestyle and physical problems can all contribute to infertility.

Infertility Cancer and its treatment may sometimes put female survivors at risk for infertility. Infertility means not being able to get pregnant or maintain a pregnancy, usually after you have been trying for over a year. There are many different causes for infertility in cancer survivors. While it’s best to discuss your risk for infertility before treatment begins, there are still options for cancer survivors who may experience infertility as a result of cancer or its treatment.

Infertility affects approximately 10% of the population. Since infertility strikes diverse groups-affecting people from all socioeconomic levels and cutting across all racial, ethnic and religious lines- chances are great that a friend, relative, neighbor or perhaps you are attempting to cope with the medical and emotional aspects of infertility.

If you’ve been trying to conceive for more than a year, there’s a chance that something may be interfering with your efforts to have a child. Infertility may be due to a single cause in either you or your partner, or a combination of factors that may prevent a pregnancy from occurring or continuing.

Infertility or possible infertility may affect you emotionally. If you want to have children, it’s perfectly understandable if thinking about being infertile makes you feel sad or upset. This document outlines the physical causes of infertility and options for survivors who may have difficulty having children. It does not explain how infertility can affect you emotionally, which is something you may want to discuss with a mental health professional.

Causes of infertility can be found in about 90% of infertility cases but, despite extensive tests, about 10% of couples will never know why they cannot conceive. Between 10 – 30% of cases of infertility have more than one cause. Male or female infertility each account for about 30 – 40% of cases. In men, ***** defects (their quality and quantity) are usually responsible. Female infertility is more complex.

Roughly one-third of infertility cases can be attributed to male factors and another one-third to factors that affect women. For the remaining infertile couples, infertility is caused by a combination of problems in both partners (about 13%) or is unexplained (about 10%). The most common causes of male infertility include azoospermia (no ***** cells are produced) and oligospermia (few ***** cells are produced). Sometimes, ***** cells are malformed or they die before they can reach the egg. In rare cases, male infertility is caused by a genetic disease such as cystic fibrosis or a chromosomal abnormality.

Infertility affects men and women equally. About one-third of the cases are due to a male factor, one-third to the female and the remaining to the combination of both partners. Causes of infertility include a wide range of physical as well as emotional factors. For a woman to be fertile, her reproductive organs must be healthy and functional. To conceive a child, the ovaries must release healthy eggs regularly and her reproductive tract must allow the eggs and ***** to pass into her fallopian tubes for a possible union.

Doris

Dr. Lester De Silva asked:


Background

Definition of unexplained infertility: Infertility cases in which the standard infertility testing has not found a cause for the failure to conceive.

The definition of what “standard testing” consists of is not agreed upon by all experts. Unexplained infertility is also referred to as idiopathic infertility. Medical studies have reported that 0-26% of infertile couples have unexplained infertility. The most commonly reported figures are between 10-20% of infertile couples. However, those percentages are from studies in which all the women had laparoscopy surgery to investigate the no longer done as part of the routine fertility workup. Therefore, we are not finding all of the causes of infertility that we used to – leaving more couples in the unexplained category. The current rate of unexplained infertility is probably about 50% for couples with a female partner under age 35 and about 80% by age 40 (see discussion below about female age issues).

In reality, there are probably hundreds of “causes” of infertility. What this means is that there are a lot of things that have to happen perfectly in order to conceive and have a baby. As a simplified example:

The hormones that stimulate egg development must be made in the brain and pituitary and be released properly The egg must be of sufficient quality and be chromosomally normal The egg must develop to maturity The brain must release a sufficient surge of the LH hormone to stimulate final maturation of the egg The follicle must rupture and release the follicular fluid and the egg The tube must “pick up” the egg The ***** must survive their brief visit in the vagina, enter the cervical mucous, swim to the fallopian tube and “find” the egg The ***** must be able to get through the cumulus cells around the egg and bind the shell (zona pellucida) of the egg The ***** must undergo a biochemical reaction and release their DNA package (23 chromosomes) into the egg The fertilized egg must be able to divide   The early embryo must continue to divide and develop normally After 3 days, the tube should have transported the embryo into the uterus The embryo must continue to develop into a blastocyst The blastocyst must hatch from its shell The endometrial lining of the uterus must be properly developed and receptive  The hatched blastocyst must attach to the endometrial lining and “implant” Many more miracles in early embryonic and fetal development must then follow…

 A weak link anywhere in chain can this cause failure to conceive

The above list is very oversimplified, but the point is made. There are literally hundreds of molecular and biochemical events that have to function properly in order to have a pregnancy develop. The standard tests for infertility barely scratch the surface and are really only looking for very obvious factors, such as blocked tubes, abnormal ***** counts, ovulation regularity, etc. These tests do not address the molecular issues at all. That is still for the future…2

The subtle causes of sub fertility that have been proposed as underlying unexplained infertility are as follows3

Ovarian and endocrine factors

 Abnormal follicle growth

Luteinized unruptured follicles and ovarian cysts

Hyper secretion of LH

Hypersecretion of prolactin in the presence of ovulation

Reduced growth hormone secretion /sensitivity

Cytological abnormalities in oocytes

Genetic abnormalities in oocytes

Antibodies to zona pellucida

  Peritoneal factors

 Altered macrophage and immune activity

Mild endometriosis

Antichlaydial Ab

  Tubal factors

 Abnormal peristalsis or cilliac activity

Altered macrophage and immune activity

  Endometrial factors

 Abnormal secretion of endometrial proteins

Abnormal intergrin/adhesion molecules

Abnormal t cell and natural killer cell activity

Secretion of embryo toxic factors

Abnormalities in uterine perfusion

 Cervical factors

 Altered cervical mucous

Increased immunogenicity

General immune factors

Altered cell mediated immunity

  Male factors

 Reduction in motility, acrosome reaction, oocyte  binding ,and zona penetration

Ultrasructural abnormalities of head morphology

  Embryological factors

 Poor quality embryos

Reduced progression to blastocyst

Abnormal chromosomal complement-increased miscarriage rate

Unexplained infertility and female age

Women are born with certain number of eggs and when they attain menarche they start releasing these eggs cyclically. As the woman ages they run out of there eggs and quality of eggs will become poorer too. Therefore the likelihood of a diagnosis of unexplained infertility is increased substantially in women 35 and over – and greatly increased in women over 38. Since we do not have a “standard category” called egg factor infertility, these couples sometimes get lumped in to the “unexplained” infertility category. Most women over 40 who try to get pregnant will have difficulty, and fertility over age 44 is rare – even in women who are ovulating regularly every month. The point is that the older the female partner, the more likely that there is an egg related issue causing the fertility problem. Unfortunately, there is currently no specific test for “egg quality”.2

Unexplained infertility and Mild endometriosis

It is not quite clear whether mild endometriosis causes infertility and treating mild endometriosis improve the fertility rates. Some recent studies has shown surgical treatment for mild endometriosis increases the fertility. Some experts would also consider infertility associated with mild endometriosis to be in the “unexplained” category. This is because a cause and effect relationship has not been definitely established between mild endometriosis and fertility problems.

Chance for getting pregnant on own – without fertility treatment – for couples with unexplained infertility

The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. After 5 years of infertility, a couple with unexplained infertility has less than a 10% chance for success on their own.

One study showed that for couples with unexplained infertility and over 3 years of trying on their own, the cumulative pregnancy rate after 24 months of attempting conception without any treatment was 28%. This number was found to be reduced by 10% for each year that the female is over 31.4

Treatment options for unexplained infertility

Ovarian stimulation and/or intrauterine insemination (IUI)

Intrauterine insemination vs. timed *********** – no medications involved

Studies have been shown that chances of pregnancy is increased with intrauterine insemination  compared to timed ***********.

Clomid and timed intercourse

Glazener et al .treated 100women,43% of whom were porous ,with either clomid 100mg from days 2-6 and placebo in a randomized cross over study. Overall there was a 50% increase in pregnancy rates after 3 cycles of treatment. Benefit was seen in after 3 years of infertility and more so in parous women.The same study showed that there were no conception in women over 35 years.5 This suggest that these women are not suitable candidates for clomid treatment and should be treated vigorously with assisted conception methods.

Clomid plus IUI

Treatment with Clomid tablets plus IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. This pregnancy rate holds up for about 3 tries and the success rate is considerably lower after that.

Deaton et al carried out a randomized study between timed *********** or clomid with IUI, and showed that monthly fecundity was 9.5% in clomid plus IUI group compared to control group- a significant difference.6  In the same study it has been showed that there was no difference in number of follicles between conception and non conception cycles, suggesting that the insemination component have a more important influence than the Clomid does on outcome- but success rates are higher when both are used together.

Collating all studies together a recent systematic review, Hughes et al. reported that treatment with clomid is superior to no treatment or placebo (95% CI 1.5-4.65).7

Injectable gonadotropins plus intercourse

This is less extensively studied. However a study by Mascarenhas et al demonstrated that super ovulation with gonadotrophins significantly increased the pregnancy rates in unexplained infertility.8

Injectable gonadotropins (shots of FSH hormone) plus IUI

Several studies showed improved pregnancy success rates with injectable FSH plus IUI treatment as compared to no treatment. A meta-analysis by Hughes9 indicated that FSH plus IUI increases the pregnancy rate by 2.3 times than compared to FSH plus timed ***********.

It is most likely that super ovulation and IUI  both independently increase fertility potential, with relatively more fertility benefit coming from the IUI component.

Assisted reproductive technologies

IVF

In vitro fertilization (IVF) has high success in young women with normal ovarian reserve (normal FSH levels) and unexplained infertility. Most couples with unexplained infertility with a female partner under age of 35 could try about 3 artificial inseminations and if fail to pregnant  it is sensible to have IVF. On the other hand women over 35 years should have been offered IVF as a first line treatment.

GIFT

Gamate intrafallopian transfer goes one step further than superovulation/IUI as it involves the collection of oocytes and ***** into fallopian tubes. The main disadvantage compared to IUI is the need of laparoscopy and more complicated ovarian stimulation regimes. Compared with GIFT the main advantages of IVF are, that being able to study the fertilization, gives the opportunity to transfer best quality embryos to the uterus, and it also gives couple with surplus fertilized oocytes which can be cryo preserved for future use.

A large multi-center randomized study performed by European Society of Human Reproductive and Emryology to compare five treatments for unexplained fertility .The study concluded that there was no significant difference in outcome between them.(super ovulation 15% per cycle, super ovulation 27%,superovulation/IUI 27%,GIFT28%,IVF26%.10

 In summary, strategic management of unexplained infertility should focus on the efficacy of the method ,cost effectiveness and invasiveness of the procedures involved. Evidence suggest that there would be little or no benefit if treatment start in  a woman less than 35 years. Therefore it is worth considering superovulation and/or IUI for 3 cycles after 3 years of infertility, and if not successful go for IVF. However for older women (over 35) to consider IVF straight away.

References

1. Hull MGR, Glazener CMA, Kelly NJ et al.(1985), Population study of causes,

2. Unexplained Infertility

http ;//www.advancedfertility.com/unexplain.ntm( accessed 11/03/2008).

3. Adam, H.B. & Howard, S.J, (2003), Infertility In Practice, Churchill Livingstone, London.

4. Collings JA ( 1989), Natural course of unexplained infertility, Proceedings of the Serono symposium on unexplained infertility : basic and clinical aspects. Serono Aries Publishers, Rome.

5. Glazener CMA, Coulson C, Lambert PA et al, ( 1990), Clomiphene treatement for women with unexplained infertility : placebo-controlled study of hormonal responses and conception rates. Gynecol Endocrinol 4: 75-83

6. Deaton JL, Gibson M, Blackmer KM, Nakajima ST, Badger GJ & Brumsted JR, (1990), A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 54 : 1083- 1088.

7. Hughes E, Collins J, & Vandekerchhove P (2002),Clomiphene citrate for unexplaine subfertility in women. Cochrane Database of systematic Reviews, Issue 1, 2002.

8. Mascarenhas L, Khastgir G, Davies WAR & Lee S, ( 1994),Superovulation and timed intercourse: can it provide a reasonable alternative  for those unable to afford assisted conception ? Hum Reprod  9: 67 -70

9. Hughes EG (1997), The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility : a meta-analysis. Hum Reprod 12 : 1865-1872

10. Crosignani PG, Walters DE & Soliani A, (1991), ESHERE multicentre trail on the treatment of unexplained infertility : a preliminary report. Hum Reprod 6: 953-958.



Alice

Low Jeremy asked:


The uncovering of problems in infertility requires both participants are examined in parallel procedures so as to give equal treatment for them. This may in the end, reveal where the fault lies. In infertility treatment programs, both participant are vital units for examination from which the parameters of the procedures are largely founded.

Why is this procedure vital? Only because male factors and female factors along with the shared factors have equal standing in infertility.

But let us focus our discussion on male infertility.

The cornerstone of all male infertility cases is laid on the comprehensive examination and detailing of the history of the condition. The latter though may not implicitly deal on infertility or fertility alone, rather on the conditions and diseases that may have probably led to the unwanted towards infertile.

Certain childhood conditions such as mumps, injuries on the genitals, testicular trauma and exposure to adverse environments may contribute largely on the development of the condition.

Advanced puberty may be a good indication of the development of the adrenal:genital syndrome. On the other hand, delayed puberty may be indicative of Klinefelter’s syndrome, both of which are contributors to infertility which can develop later in the male’s life.

Other details should also be gathered to discover what really have caused the condition. Say for example the exposure of the person towards harmful environmental substances such as radiation, excessive heat and environmental toxins.

Cancer patients are definitely one of those people that stand as possible patients of infertility. As we have earlier noted, too much heat may cause infertility since it exposes the sperms to temperatures they were not accustomed to. Since ***** cells are the vehicle to form fertilization and since they are very sensitive to extreme changes in temperature, they may loose potency and may not serve their primary functions since they will most likely meet premature death inside the testes.

History of medications that the male participant has previously undergone must also be elicited. Some medications like cimetidine and anabolic steroids are potent in diminishing the motility of the ***** cells. Others may in general, affect the male reproductive system itself.

Surgeries may also compromise male infertility. Bladder neck operations for example, create damaging effects on the emission of the ***** cells. If the person is diabetic and have undergone treatments, he may probably developed impotency or poor ejaculation.

Although male infertility may be attributed to a number of conditions, we can still find that some issues are more prevalent than others. Here are some of them, in no particular order:

Blockage of Sperm: the possibility that the passages carrying the sperms towards their destination is high. This may be due to vasectomy, physical anomaly, infection or injury. For a male to be infertile, he must be capable of successfully delivering sperms cells towards the female by means of these passages (e.g. vas deferens). Natural fertilization occurs when nothing impedes the ***** cells from flowing to their proper points.

Erectile Dysfunction (ED): the problem comes when a man is incapacitated for ********. Without this, it would be almost impossible to deliver ***** cells out from the male’s body. This condition may be attributed to a number of chronic diseases which include heart problems and hypertension. Too much alcohol in the body may also lead to erectile dysfunction. And to say the obvious, paralysis may largely contribute to ED.

Infections: these may arise from conditions that were recently incurred or those that may have manifested during childhood. Infections may cause low ***** count and sterility.

Failure to Produce Sperm: a condition is also known as azoospermia. Temperature is the leading cause why this condition appears. Since ***** cells are by nature extra sensitive, the slightest heat may cause them to die and eventual cessation of the production of cells may result.

However, other conditions may pop:up such as abnormal cells or lessened ***** movements. Any phenomenon that may raise the normal body heat during a long period of time may affect the condition of the ***** cells. This can be anything from prolonged fever, exposure to too much heat due to chemotherapy, varicocele or the presence of varicose veins in the testes and undescended testes.

Nonetheless, genetic disorders and certain hormonal abnormalities may intrude with the normal and healthy production of ***** cells. Such may include hypothyroidism, hyperprolactinemia, hypogonadism, adrenal gland disorders (the organ responsible for the secretion of testosterone a number of other hormones), and abnormality of the pituitary gland (which controls the release of the testosterone).

While we have discussed the biological reasons for the decrease in the production of ***** cells (and the lack thereof), we must still take into account other conditions that can cause abnormalities in the testes. These may include previous diseases and ailments, excessive use of drugs and exposure to environmental toxins.

More serious cases may be attributed to lack of seminal vesicles, missing or blocked vas deferens, and obstruction in the ejaculatory ducts and serious injuries of the testes.



Gina

Cindy Heller asked:


Female and male infertility is fairly common nowadays. If you feel that there is a problem with you and your partner in having a child, you need to understand the causes of female and male infertility.

The Causes of Female and Male Infertility

Infertility in the male is caused by a few different factors. It is essential to have healthy ***** production for conception to happen. This ***** needs to be strong enough to reach the egg. It will need good motility. If the ***** count is below optimum or the sperms are of poor quality, pregnancy will rarely occur. The problem could also be that the ***** is not formed properly or they die prematurely before they can reach the egg.



Women need to have both healthy eggs and blockage free fallopian tubes to allow for conception. Female infertility is often caused by ovulation disorder. Correct cycles of ovulation are necessary for the healthy eggs to descend into place for the ***** to reach it. Polycystic ovary syndrome is one of the more common problems in female infertility. Female and male infertility problems can also be due to birth defects or genetics that causes damage to the reproductive systems.

Female and male infertility is treated in different ways and by different types of medical doctors. A gynecologist often is the first consultation for female infertility and men need to see an urologist. Once the cause of the female and male infertility is determined, the proper treatment can then begin.

Some Facts about Male Infertility

Many people would think of infertility as a woman problem. The fact is that up to half of all infertility cases are exacerbated or caused by male infertility. Hence, it is important for any infertility test to include an investigation of both male infertility as well as the female problems.

Causal Factors of Male Infertility

The infertility may be caused by zero ***** production. Such a condition is known as azoospermia. Another condition called oligiospermia is where there are very few ***** present in the *****. This will greatly reduce the chances of conception. It can also be a problem of ***** motility. The ***** are present, but cannot move effectively enough to effect fertilization. Finally, there can be problems with the form and structure of the ***** that can also inhibit fertilization.

Male Infertility Testing

It is important for couple to understand that infertility affects both men and women. The problem may not lie with the woman. It is important for the male to take a male infertility test to determine the source of the problem.

A male infertility test is conducted with a ***** sample provided by the man through ************. The same way that ***** donation is collected. This is normally done in the privacy of his own home and delivered within a specified time. Or it is collected in the fertility clinic. After the ***** sample is collected, the doctor will conduct male infertility test to determine the quantity and quality of the *****.

Treatment Options for Male Infertility

The male infertility test can show whether the man has a low ***** count or if his ***** are irregular. For diagnosis, a test will be conducted to get the exact ***** count. The solutions available for this condition are not wearing tight clothing, reducing weight, stop the smoking and generally avoiding extreme temperature in the lower body region. Sometimes fertility drugs can be used to help improve the ***** count so that he can successfully impregnate his mate.

Male infertility may be a result of problems with the ***** and seminal fluid, or with the reproductive organs. Varicoele is one common cause of male infertility. Enlarged varicose veins that are present in the spermatic travel route cause this condition. The first sign of varicoele is the appearance of large dilated veins on the *******. The second sign is a large painless bulge or swollen area on the *******. In some cases, there are no symptoms at all. The treatment for this problem is simply to remove the blockages and allow normal blood flow. Surgery is used to tie off the affected veins. The male fertility solutions for these problems are generally effective.

Sometimes the treatment for male infertility can simply be a few behavioral changes such as adequate rest. Your doctor may recommend less frequent *********** for the problem of low ***** count. This is help build up a better concentration of *****. If hormones are the culprits, medication can be used to remedy the problem. Another effective treatment for male infertility is artificial insemination, where fertilization takes place outside the womb. This can be a very effective treatment for certain condition such as low ***** counts since a single ***** is placed inside an egg.

The good news is that there are many options for male infertility treatments. The cost is getting cheaper too. If you have been trying to conceive for a year or more, consult your doctor today about possible female or male infertility diagnosis and treatment.



Shane