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Archive for the month “April, 2012”

How does ovulation occur normally ?


Normal ovulation

Normally, one of the ovaries releases a single mature egg every month, and this is called ovulation. Women may notice pain or abdominal discomfort at the time of ovulation and occasionally have some slight vaginal bleeding. The presence of regular periods, premenstrual tension and dysmenorrhoea (period pains) usually indicate that the menstrual cycles are ovulatory.

Eggs are stored in the ovaries in follicles. Follicles exist in two major categories – growing and non-growing ( primordial ). Eggs in the primordial follicle are in a very immature form. In this state they are not capable of being fertilized by a sperm until they undergo a maturing process which culminates in their release from the ovary at the time of ovulation.

Egg maturation and ovulation is stimulated by two hormones secreted by the pituitary – follicle stimulating hormone (FSH) and luteinizing hormone (LH) . These two hormones must be produced in appropriate amounts throughout the monthly cycle for normal ovulation to occur.

Every month, at the start of the menstrual cycle, in response to the FSH produced by the pituitary gland, about 30-40 primordial follicles start to grow. Of these, only one matures to form a large fluid-filled structure, called a Graafian follicle which contains a mature egg, while the others die ( a process called atresia). The mature egg is released from the follicle when the follicle ruptures in response to a surge of LH produced by the pituitary.

After ovulation has occurred, the follicle from which the egg has been released forms a cystic structure called the corpus luteum. This is responsible for progesterone production in the second half of the cycle.

You can see an excellent animation ( which will open in a new browser window) of the hormonal changes which occur during a normal menstrual cycle at Serono Fertility Lifecycle.

Most women who have regular periods have ovulatory cycles. Women who fail to ovulate or who have abnormal ovulation usually have a disturbance of their menstrual pattern. This may take the form of complete lack of periods (amenorrhoea), irregular or delayed periods (oligomenorrhoea) or occasionally a shortened cycle due to a defect in the second part (luteal phase) of the cycle.

 

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Fig 2. The hormonal changes which occur during a normal ovulatory cycle, if pregnancy occurs. The purple line marks the point when the embryo implants.

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What will happen if woman take Viagra? Does it work on women, and is it dangerous to try?


ImageViagra was developed to help men with erectile dysfunction. It works by allowing increased blood flow to the penis, which causes an erection. And, judging by the billions of dollars in sales, Viagra (and similar drugs) is the greatest invention since the wheel — if you happen to be a man who can’t get it up.

However, the studies done to test its effectiveness on women have yielded less-than-stellar results, probably because men and women are fundamentally different when it comes to desire and arousal. Though the increased blood flow down below has caused some women who’ve tried the drug to experience physical arousal, it’s had little effect on desire.

Should you try Viagra? No, absolutely not!

For starters, the Food and Drug Administration has approved it only for men (even though some doctors still prescribe it to their female patients, but that’s a whole other issue).

And there has been little research on what kinds of side effects it might have on women.

The most common reactions that men experience include headaches, indigestion, diarrhea, flushed skin, and dizziness. It’s even been known to cause heart attacks and strokes, especially when taken with certain other medications (including recreational drugs like cocaine or ecstasy).

Plus, you shouldn’t be thinking about taking any prescription medicine unless it’s been prescribed for you by your physician!

There are plenty of other ways to heat up your sack sessions. (Take a look through the Carnal Counselor archives for some suggestions.) So, do yourself a favor and try to get creative in bed the old-fashioned way — by relying on your brain, not a little blue pill.

 

5 S_x Myths to Bed for Girl.


woman in bra on top of man in his underwear in bed

Who knows how rumors get started. The point is, there is a lot of misinformation going around about what gets guys off between the sheets that could possibly be keeping you and your guy from reaching ultimate pleasure.

“When you operate under false assumptions, you are not able to give your mate what he truly wants and needs,” says sex therapist Brenda Schaeffer, PhD, author of Is It Love or Is It Addiction?

Well, it’s time to set the record straight.

Here, real guys — and some sexperts — debunk

five of the most common sex mistakes.

Myth 1: Guys Like Kisses with Tons of Tongue

Fact: You might think that all guys are into full-on Frenching all the time, but it turns out that many men prefer soft, gentle kisses to tonsil hockey.

In fact, William Cane, author of The Art of Kissing, has actual proof. He surveyed 50,000 men and found there are 30 different kinds of smooching moves guys love that don’t involve jamming their tongues into your mouth or jamming yours into his.

“One of the favorites is the sliding kiss,” says Cane. “Start by kissing your guy gently around the perimeter of his lips, then brush your mouth across his cheek, before moving down and nibbling his jaw line.” Jonathan,* 25, prefers what Cane calls the lip-o-suction. “I suck on her top lip while she sucks on my bottom lip,” he explains. “Then we switch off. There’s something kind of innocent about it, which is pretty hot.”

Myth 2: Men Think Manual Action Is BoringFact: Most men love hand jobs. After all, when you think about it, it’s how they give themselves pleasure. What men don’t love are bad hand jobs. To perfect your manual MO, take your cue from the master, i.e., your guy. “The single best way to learn how to give a good hand job is to watch him masturbate, since he’s ultimately the real expert of his own body,” explains sex therapist Sandor Gardos, PhD, founder of mypleasure.com

But if he’s a little shy about giving you a do-it-himself demo, here’s a manhandling move that can’t miss: Put a dab of water-based lube on your palm and rub your hands together to warm it up. (Make sure you keep him well lubed throughout the act.) Then wrap one hand around his nerve-packed head and work your hand up and down his shaft. Begin slowly and increase your speed and the amount of pressure you apply as he starts to harden.

If you really want to make his brain fog, add this twist, suggests Dave, 25. “Wrap both hands around the penis and twist them in opposite directions up and down the shaft. It’s amazing.” A word of caution: “As he reaches the point of no return, avoid touching the supersensitive tip,” warns Gardos. “And don’t stop or slow down until about 10 seconds after he ejaculates.” This gives him a chance to come down, so you don’t inadvertently cut him off too soon.

Myth 3: He Wants You to Get Him Off ASAPFact: Guys know that the longer they wait to orgasm, the better the payoff, because building the momentum results in a more intense climax.

The problem? It’s a whole lot easier said than done. “When a man is fully aroused, he might have a hard time holding back,” says psychologist Debra Mandel, PhD, author of Healing the Sensitive Heart.
“But women wrongly assume that his escalating excitement means he wants to ejaculate as soon as sex begins.”So how do you prolong his — and your — pleasure? For Devin, 31, it’s all about taking a time-out. “If I keep going at it with the same intensity for too long, I’m a goner,” he says. “So my girlfriend and I do the stop-start thing. We’ll have sex for a while, and then when I start to get really excited, I’ll pull out — way before I’m about to climax. Then we’ll take a breather for a couple of minutes and we’ll make out or I’ll go down on her for a while or whatever. Afterward we’ll get back to intercourse. We’ll do this off and on until I just can’t hold off one more second, and the orgasms are unbelievable.”

Another hold-him-back trick: Try the squeeze technique. To do it, have him pull out, place your thumb and pointer below the tip of his penis and squeeze firmly. This will cool him down stat.

Myth 4: He Doesn’t Want Your Teeth Near His MemberFact: While no guy wants you gnawing on him, little love nibbles are pretty damn fantastic. “The problem with using teeth arises only when they scratch his skin or you bite down too hard,” says Gardos. One big fan is Thomas, 25. “My girlfriend has this awesome move where she gently grazes me with her teeth,” he says. “It’s such a completely unique sensation. And there’s also the fear that at any moment, she might cause pain, which makes it that much more exciting.”

His testicles are also prime territory for some light dental work, but make sure you tread with caution. “It’s enough to simply hold a testicle in your mouth without actually biting down on it,” says Gardos. But be warned: The only spot that should always remain a teeth-free zone is the frenulum, the nerve-centric section of skin that runs along the underside of the penis.

Myth 5: If You Get Too Kinky, He Won’t Want to Take You Home to MomFact: The old Madonna-whore complex is more dated than dial-up modems. Seriously, any quasi-evolved man who’s worth your time knows full well that a woman who’s willing to push her bedroom boundaries a little bit (er, hell, even a lot) is worth more than box seats for him and all of his buddies at the Super Bowl. “Today, men want passion with an emotional connection. Most men love when a woman feels comfortable enough with him to explore her sexual desires,” says Schaeffer. “And they also know that sex is better when there’s deeper feelings involved.”

That’s what Bob, 33, found out when he met his current girlfriend, Chelsea. “In the past, I had either great sex with random chicks or so-so sex with serious girlfriends,” he recalls. “But Chelsea is totally different. Not only is she someone I’m proud to bring home to my parents, but she also blows my mind in bed. She’ll play dress up, try lots of positions and have sex in different places. Her willingness to experiment doesn’t make me think less of her; it’s actually made me love her more.”

Accidental Turn-onsSometimes men’s pleasure triggers shock even us. Here, five guys reveal the surprising things that fire them up in the sack.

“My inner thighs are my weakness. When a woman licks me there, it drives me insane. A lot of guys don’t have any hair in that area. I think it’s nature’s way of clearing a path for her tongue.”
—Sam, 24

“I once caught my girlfriend masturbating when she thought I was out of the house. It was the sexiest thing I’ve ever seen in my entire life.”
—Dan, 30

“A back massage is good, but a nice, firm butt massage — that’s even better. I really love it when a woman firmly kneads my cheeks with her knuckles and really digs in there.”
—Oliver, 27

“I dated this girl who liked to suck on my toes. At first I thought it was freaky, but it feels damn good.”
—John, 24

“I’m not sure why, but I absolutely love when my girlfriend pulls my hair right as I’m climaxing. It’s like an extra rush.”
—Thomas, 29

Is there any connection between a low sperm count and sexual performance ?


The major cause of male infertility usually is a sperm problem. However, do remember that this is no reflection on your libido or sexual prowess. Sometimes men with testicular failure find this difficult to understand (but doctor, I have sex twice a day! How can my sperm count be zero?). The reason for this is that the testis has two compartments. One compartment, the seminiferous tubules, produces sperms. The other compartment, the “interstitium” or the tissue in between the tubules (where the Leydig cells are) produces the male sex hormone, testosterone, which causes the male sexual drive. Now while the tubules can be easily damaged, the Leydig cells are much more resistant to damage, and will continue functioning normally in most patients with testicular failure.

This is why the diagnosis of a low sperm count can be such a blow to one’s ego — it is so totally unexpected, because it is not associated with other symptoms or signs. Men react differently – but common feelings include anger with the wife and the doctor; resentfulness about having to participate in infertility testing and treatment since they feel having babies is the woman’s “job”; loss of self-esteem; and temporary sexual dysfunction such as loss of desire and poor erections. Many men also feel very guilty that because of “their” medical problem, they are depriving their wife the pleasures of experiencing motherhood. Unfortunately, social support for the infertile man is practically non-existent, and he is forced to put up a brave front and show that he doesn’t care. Since he is a man, he is not allowed to display his emotions. He is expected to provide a shoulder for his wife to cry on – but he needs to learn to cry alone. However, remember that the urge for fatherhood can be biologically as strong as the urge for motherhood – and we should stop treating infertile men as second class citizens.

Men seeking to become a dad should have sex each day for a week before their partner ovulates to improve the genetic quality of their sperm, new Australian research suggests.


Daily sex urged for budding dads

 

sex after babyIncrease your chances of conception

Men seeking to become a dad should have sex each day for a week before their partner ovulates to improve the genetic quality of their sperm, new Australian research suggests.

Until now fertility specialists have debated whether refraining from sex in the days before attempting to conceive with their partner could increase a man’s chances of fathering a child.

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A study by David Greening, a specialist in reproductive endocrinology and infertility at Sydney IVF, has found that ejaculating daily substantially improves the genetic quality of sperm, without lowering sperm counts enough to impair fertility.

At the annual meeting of the European Society of Human Reproduction and Embryology in Amsterdam this week, Dr Greening said the findings could have important implications for couples trying to conceive spontaneously and those undergoing assisted reproduction.

“These results may mean that men play a greater role in infertility than previously suspected, and that ejaculatory frequency is important for improving sperm quality, especially as men age and during assisted reproduction cycles,” he said.

Men are usually advised to abstain from ejaculation so sperm count has time to recover before the woman’s most fertile period or egg retrieval in the case of IVF.

Dr Greening studied 118 men with above-average sperm DNA damage and found their sperm quality increased significantly after they were told to ejaculate daily for seven days, compared to three days abstinence.

On average, their DNA fragmentation index – a measure of sperm damage – fell from 34 per cent (poor quality) to 26 per cent (fair). Ninety-six men recorded about 12 per cent decrease in sperm DNA damage, putting them in the good range.

Dr Greening said it was likely frequent ejaculation improved the quality of sperm by reducing the length of time they were exposed to potentially damaging molecules called reactive oxygen species in the testicular ducts and epididymis.

However, 22 men recorded an increase in damage of 10 per cent on average and Dr Greening said these men may have a different explanation for their sperm DNA damage.

Couples with relatively normal semen parameters should have sex daily for up to a week before ovulation, he said

I have answered your questions on a variety of infertility topics.


Hello everyone and welcome to the latest Infertility Blog.

Today I have answered your questions on a variety of infertility topics.

IUI

What if your estrogen is lower than expected after you take fertility drugs? Estrogen alone is not the most important factor in your fertility drug treatment and is not the best predictor of pregnancy. The ultrasound is more helpful. If say you have 3 eggs growing, we may expect you estrogen to be 240-500, but levels in the 100’s could work out just fine.

 

IUI vs. timed intercourse. With normal sperm, logic says intercourse should be just as good, but the studies show that there is a slight improvement in pregnancy rates with iui. 1% of the sperm makes it from the vagina to the uterus during intercourse and 1% of that make it to the tubes. For women easily conceiving, the numbers mean nothing. When someone is having trouble conceiving, every little bit helps.

 

Ovulation after the hCG injection take place approximately 36 hours later. The time will only be shorter if you have started to ovulate on your own before the shot.

 

Sperm

Treatment for low morphology. If you suspect a problem with the sperm it is best to consult with a top fertility urologist. Overall, we do not believe that morphology means much. Many cases of low morphology are really normal morphology. What I mean here is that we may not know what a normal sperm looks like, and the shape we see may mean nothing. Of course there are exceptions.

 

Luteal Support

Progesterone support for clomid or femara? Some doctors always prescribe progesterone and some never do. Most studies show no benefit, unless in an IVF cycle. If your period comes much earlier than expected, you may be more of a candidate for progesterone. However, just because you get your period early does not mean that you were unable to get pregnant. It is most likely that if you had a good pregnancy going, the period would not come at all.

 

Clomid

Vision problems with clomid. Almost always temporary and some doctors don’t take patients off clomid who have such issues. I have women switch.

 

Stress and Clomid. Fifteen percent of women have side effects from clomid which are mostly mental. Depression is a top contender. If you are taking clomid and now you feel way more stressed than before, talk to your doctor about an alternative medication.

 

40 years old doing Clomid. It’s fine as long as you are informed of the actual pregnancy rate per try, and you are told about the pregnancy rates of injections and IVF. I do not like to use Clomid in women in their 40s because the pregnancy rate is low and time is slipping away. But if you are informed and you are ok with your choice, than that’s the best treatment for you. I do not use estradiol with Clomid.

In cases of no response to clomid, we have used the extended clomid protocol. This just means if ovulation does not start, you can start the clomid within a few days again instead of waiting for another provera period.

 

IVF

Not starting IVf due to a high progesterone. Few of us measure progesterone on day 2 or day 3. Currently we do not think it is important. Very low levels are hard to measure accurately. For example, a lab may report a level of 2.1, which some consider ovulation, but your levels may really be 0.9, no ovulation.

 

What is the theory behind estrogen prime? Most women who are recommended for E2m (estrogen) prime are poor responders, many of whom have elevated FSH levels.The theory is this. FSH is the same compound that is in the fertility injections, so f there is extra FSH floating around (high FSH levels) before the fertility drugs are given, the injected FSH may not make much of a difference. Estrogen lowers the amount of natural FSH floating around. If we can lower the natural FSH, the injected FSH will be more of a shock to the ovaries and get them to jump into action. Just a theory.

 

IVF works just as well if your ovaries are retriperitoneal. The ovaries are usually in a similar place as a normal ovary, but they are just covered with a layer if internal skin that has formed as a result of all of the chronic inflammation caused by the endometriosis.

 

Nice embryos on day 3, very bad on day 5. I whole-heartedly believe in day 5 transfers, but the individual patient cannot be ignored. If the embryos look super on day 3 and terrible on day 5, I sometimes go back to the day 3. In my practice I see this in about once every 200 patients.

 

Can you biopsy a frozen blastocyst? Yes. Sometimes the embryo needs to be refrozen while waiting for the results, and sometimes refreezing is not necessary.

 

Day 5 morulas can result in a normal pregnancy. However the odds are lower than of the embryos have reached a more advanced stage.

 

 

Frozens

Can a frozen cycle be better than a fresh cycle. Some say yes for a couple of reasons. First, the estrogen level is usually higher in a fresh cycle and there are some theories, mostly unproven, that higher estrogens are better for implantation. The other reason has to do with these small rises in progesterone that occur before the hcg injection in a fresh cycle. This is also unproven, however the field in general is starting to pay more attention to this issue. More research is coming. Right now, almost every clinic prefers a fresh cycle.

 

Natural cycle Frozen Embryo Transfers (FET). I d not usually perform the natural FET. The reason is that the cycle is more likely to be cancelled for uncertainty of the surge timing, or known premature ovulation. Otherwise it’s an ok option.

 

 

Uterine Adhesions: Ashmermans

The unstuck type of Ashermans. I have never heard this term before, but completely understand what you are saying as I have seen some cases of this. I am assuming the term means the uterine cavity is open and the HSG shows a normal shaped cavity with no scar. However, for some reason, probably due to scarring that takes place just under the lining, the lining is very thin. Something has damaged the part of the uterus that makes the gland cells. Some gland cells are made, but not enough to let the lining grow to the expected levels. This is a tough situation because not much can be done to make the lining thicker. However, many women do get pregnant with very thin linings.

 

Septums

If you had a septum and you are still notpregnant, you may need to have another hsg to be sure the septum was fully removed. This is a common issue. Once that is done, certainly there may be other issues for your infertility, sometimes discovered and sometimes not. If you are not pregnant post septum correction, you may need to follow the regular infertility treatment paths.

 

 

FSH Levels

Day 21 measurements of FSH are not helpful unless that are very high.Very high anytime is bad, very low anytime is not helpful. When low it has to be days 2-4 and an estrogen must be measures with the FSH. If the Estrogen is high, the FSH is not valid and both need to be repeated.

 

An FSH of 17 on day 2 is not good. It may be a mistake, it may need a repeat, but it needs to be investigated further.

 

PCO

Alternatives to clomid with PCO or anovulation. Certainly all of the complimentary treatments can be tried. If weight is a possible problem, tackle that and good results should follow. Don’t forget about the nutritionist as there may be many subtle non-calorie issues that need adjusting.

 

PCO with a spike in FSH from 5 to 9? There is some variation in FSH levels form month to month. If you really have PCO I would not worry about the level of 9, it may just be a blip. If your resting follicle count is not in the PCO range, the level may indeed be accurate.

 

First treatment for those who have PCO and do not ovulate. There are options. The quickest way to get a chance at pregnancy is to make an attempt with clomid. There are other very good options. Weight loss, or at least diet adjustment, is a great startbut ovulation may not return right away, if ever. This is a discussion you need to have with your doctor. If you would rather start with Injections or IVF, that’s ok too.

 

Endometriosis

Can fertility drugs exacerbate endometriosis? Yes, however usually not to a large degree. Overall fertility drugs will increase pregnancy rates in women with endometriosis, not lower rates.I do not believe in “freshening up the ovary” by removing an endometriosis cyst pre IVF, but every case is different and you need discuss this with your doctor. One problem is that removing cysts, no matter how careful your doctor is, will result in removing some eggs. Many women with endometriosis have damaged ovaries with reduced egg numbers, therefore losing even more eggs with the cyst may not be good.

 

Should everyone get checked for endometriosis? Yes, but the details may differ. Everyone should have an ultrasound. If the ultrasound shows endometriosis, there is your answerer. If the ultrasound is normal and the exam is normal and there is no history of pain, and the hsg is normal, the odds of endometriosis being a factor are really low. Is a laparoscopy to double check indicated? It may be, depending on the history and the motivations of the patient, In general, laparoscopies are not performed in such cases.

 

 

Polyps and Fibroids

Small polyps probably do not cause miscarriage. In many cases polpys can be seen during your ultrasounds for fertility monitoring. It’s easier to see them as the follicle size and estrogen levels increase. It’s harder to see them post-ovulation.

 

Fibriods and infertility. I tend to be conservative with fibroids and in many cases I do not recommend surgery. However, two 6 centimeter fibroids could be a problem, you need a second opinion. Letrazol will probably not increase the size of a fibroid by much.

 

Thyroid

Hypothyroidism and thyroid antibodies. The general feeling across the country is that the TSH needs to be lower than 2-3.5 to improve fertility and prevent miscarriage. NYU preformed a large studying showing this is not the case and that there is no relationship, providing the hypothyroidism is treated.Many doctors are over treating basically normal women with thyroid hormone. Of course discuss the problem with your doctor.

 

Letrazol

I am not aware of any large studies showing letrazol reduces miscarriages.

 

I am unaware of legs cramps with letrazol

 

Miscellaneous

RH antibodies can be measured, so your doctor can easily test you for this.

 

Exercise can weaken or remove ovulation, but the amount of exercise needs to be extreme, i.e running 25+ miles per week. There may be some variation there, but 5 hours in a gym per week is probably not enough to make a difference.

 

28 years old and no pregnancy despite 8years of unprotected intercourse? Testing is required. Not necessarily a lot of testing, just start with the hsg, semen analysis and day 3 FSH testing.

 

 

Thanks for reading.

Can hormone imbalance cause male infertility ?


ImageUnlike the woman, hormone imbalances in the man are not a common cause of fertility problems . These problems can stem from organs as far apart as the brain or the testicles, and can show up in blood tests. They can arise because of:

  • Head injury
  • A tumour in the pituitary gland at the base of your brain
  • A tumor in the adrenal gland, above the kidneys.
  • Malfunctioning of the pituitary gland
  • Cirrhosis of the liver
  • Conditions present from birth, such as and Klinefelter’s syndrome (47, XXY syndrome)
  • A thyroid problem

Medication

Certain diseases require treatment via drugs that may affect levels of male hormone. Prostate cancers are treated with anti-androgen drugs such as cyproterone and flutamide. These androgen suppressants can cause feminizing effects such as gynecomastia, or enlarged breasts.

Other drugs that can cause side effects due to their influence on male hormone levels include efavirenz, used in the treatment of AIDS, tricyclic antidepressants, cimetidine and other ulcer drugs, heart medications and chemotherapy, according to the Mayo Clinic.

Tumors

Some tumors that affect a gland can cause an increase in hormone production. Others can decrease hormone production. Hormonally active tumors can contribute to gynecomastia and other feminizing results. Tumors that affect the hypothalamus or the pituitary gland, for example, can result in lowered levels of testosterone. Impotence and loss of body hair and muscle can result.

Diet

Stanford University notes that a diet that is overly high in iodine can cause hypothyroidism. Thyroid hormones affect the quality of semen that is produced by the testicles. When iodine intake is excessive, low sperm count can result and the man may experience infertility.

Genetic Disorders

Chromosomal abnormalities can lead to an imbalance in male hormones. Klinefelter syndrome is an example of a genetically induced male hormonal disorder. Men with Klinefelter syndrome have an extra Y chromosome that they inherited from one of their parents. The symptoms of Klinefelter syndrome typically manifest during puberty, and include enlarged breasts, decreased muscle mass and sparse facial or body hair. Sterility and learning disabilities are sometimes a result of Klinefelter syndrome.

The University of Maryland Medical Center states that a rare disorder called Kallman syndrome is another genetic cause of male hormonal imbalance. It causes a condition known as hypogonadotrophic hypogonadism, which can prevent the onset of puberty and result in infertility.

Hormone Transfer Through Skin Contact

The use of transdermal patches to deliver progesterone through the skin is a boon to women who have progesterone deficiencies, but it can be a bane for the men who are intimate with these women. Skin contact can cause these hormones to be transferred from women to their male partners, who then absorb them into their system, according to Rocky Mountain Analytical Laboratories. Accumulation of progesterone in men due to skin transfer can cause testosterone deficiency.

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One problem is that of hyperprolactinaemia (a high prolactin level). This is usually caused by a pituitary malfunction or tumour; and can be detected by a blood test. Patients with hyperprolactinemia often also have decreased libido and may be impotent. Treatment with bromocryptine to suppress the high prolactin levels is highly successful in achieving pregnancy.

Another problem is that of hypogonadotropic hypogonadism (poor function of the testes because of inadequate stimulation of the testes by the gonadotropic hormones, FSH and LH produced by the pituitary). Most hypogonadotropic patients are hypogonadal – that is, they have low levels of the male hormone, testosterone. This means they have poorly developed secondary sexual characters ; an effeminate appearance; scanty hair; decreased libido , and small flabby testes. This can be confirmed by blood tests which show low levels of FSH and LH. This can be treated by replacement therapy with the gonadotropin hormones – HCG and HMG. These are expensive injections and a fairly long course of treatment is needed for them to work , but they are effective in enhancing sperm production in these men.

What is retrograde ejaculation ?


Retrograde ejaculation

This means that the semen goes backwards into the bladder instead of coming out of the penis, so that very little or no semen is ejaculated at the time of orgasm, and the urine looks cloudy after having sex. This occurs when the bladder sphincter muscle does not contract properly during orgasm, as a result of which the semen leaks back from the urethra into the bladder. This could be caused by prostate surgery, a spinal injury, diabetes, high blood pressure medication and congenital problems.

A simple way to diagnose retrograde ejaculation is to examine a man’s urine after he ejaculates. If there are sperm in the urine, this confirms the diagnosis.

Self-help includes trying to have sex with a full bladder and while standing up, because this makes the muscle around the opening of the bladder more likely to stay closed . Some medications like decongestants can also help the sphincter muscle to close. Surgery can also be performed on the opening of the bladder to prevent it from misbehaving , but this is not very successful.

An effective treatment option is to collect the sperm and use it for artificial insemination . After passing urine, the man alkalinizes his urine by drinking sodium bicarbonate; and then urinates immediately after ejaculation. The recovered sperm in the urine are processed and used for insemination. Pregnancy rates with insemination are usually low because the recovered sperm are often of poor quality , and sometimes IVF needs to be done with these sperm to give a reasonable chance of pregnancy.

What additional tests can be done for a man with an abnormal semen analysis report?


  1. Antisperm Antibodies Test
  2. Semen Culture Test
  3. Postcoital Test (PCT)
  4. Bovine Cervical Mucus Test
  5. Sperm Viability or Sperm Survival Test
  6. Sperm Penetration Assay (SPA, Hamster Assay)

Antisperm Antibodies Test

The role of antisperm antibodies in causing male infertility is controversial, since no one is sure how common or how serious this problem is. However, some men (or their wives) will possess antibodies against the sperm, which immobilize or kill them and prevent them from swimming up towards the egg. The presence of these antibodies can be tested in the blood of both partners, in the cervical mucus, and in the seminal fluid. However, there is little correlation between circulating antibodies (in the blood) and sperm-bound antibodies (in the semen).

There are many methods of performing this test, which can be quite difficult to standardize, as a result of which there is a lot of variability between the result reports of different laboratories. The older methods of testing used agglutination methods on slides and in test tubes.

Perhaps, the best method available today is one such uses immunobeads, which allow determination of the location of the antibodies on the sperm surface. If they are present on the sperm head they can interfere with the sperm’s ability to penetrate the egg; if they are present on the tail they can retard sperm motility. Of course, if the test is negative, this is reassuring; the problem really arises when the test is positive! What this signifies and what to do about it are highly vexatious issues in medicine today, and doctors are even more confused about this aspect than the patients.

Semen Culture Test

In the semen culture test, the semen sample is tested for the presence of bacteria, and , if present, their sensitivity to antibiotics is determined. Interpreting this test can also be problematic! It is normal to find some bacterial in normal semen samples – and the question which must be answered is : are these bacteria disease- causing or not?

Tests which assess the sperm’s ability ” to perform” include the following sperm function tests.

Postcoital Test (PCT)

The postcoital test is the easiest test of sperm function, since it is performed in vivo. It is done when the wife is in the ” fertile” period, during which time the cervical mucus is profuse and clear. The gynecologist examines a small sample of the cervical mucus, under the microscope, a few hours after intercourse. (This can be embarrassing and awkward for the patient, but it is not painful at all). Finding 5-10 motile sperm per high power microscopic field means that the test is normal. A normal test implies normal sperm function and can be very reassuring.

An abnormal test needs to be repeated and, if the problem is persistent, one needs to determine if the defect lies in the sperm or in the mucus, by cross-testing with the husband’s sperm, donor sperm, wife’s mucus and donor mucus.

 

 

 

Bovine Cervical Mucus Test

The bovine cervical mucus test is another form of testing for the ability of the sperm to penetrate and swim through cervical mucus, with the difference that in this case, the mucus used is that of a cow (since this is commercially available abroad in a test kit.) The sperm are placed in a column of cervical mucus and how far the sperm can swim forward through the column in a given amount of time is checked with the help of a microscope.

 

 

 

 

 

 

Sperm Viability or Sperm Survival Test

This is a simple test, which provides crude (but useful!) information on the functional potential of the sperm. The sperm are washed using the same method which is used for IVF (either a Percoll spin or sperm swim up) and the washed sperm are then kept in a culture medium in the laboratory incubator for 24 hours. After 24 hours, the sperm are checked under the microscope. If the sperm are still swimming actively, this means that they have the ability to “survive” in vitro for this period- and this is reassuring. If, however, none of the sperm are alive after 24 hours, this suggest that they may be functionally incompetent.

 

 

 

 

 

Sperm Penetration Assay (SPA, Hamster Assay)

Since the basic function of a sperm is to fertilize an egg, scientists were very excited when they found that normal sperm could penetrate a denuded (zona-free) hamster egg. A zona-free hamster egg is obtained from hamsters egg. A zona-free hamster egg is obtained from hamsters and the covering (the zone) removed by using special chemicals. The egg are then incubated with the sperm in an incubator in the laboratory. After 24 hours, the eggs are checked to ascertain how many sperm have been able to penetrate the egg. The result gives a penetration score, which gives an index of the sperm’s fertilizing potential. This is a very delicate technique and is not available in India. In any case, nowadays scientists the world over are quite disenchanted with the test, since the correlation between IVF results (the ability to fertilize human eggs) and the SPA (the ability to penetrate zona-free hamster eggs) is quite poor.

  • Testing for acrosomal status
  • HOS test – hypo-osmotic swelling test-which tests for the integrity of the sperm membrane
  • CASA – computer-assisted sperm analysis
  • Hemizona assay
  • Electron microscopy of sperm

A test which has recently become very fashionable is the Sperm Chromatin Structure Assay (SCSA) and the sperm DNA Fragmentation assay. These test the integrity of the DNA in the sperm nucleus, and thus the ability of the sperm to fertilise the egg. While they seem very attractive, the major problem with these tests is that they provide information which is applicable only to groups of patients. Thus, we know that men with a higher degree of DNA fragmentation have a higher chance of being infertile. However, they do not provide any information for the individual patient, which means their utility in clinical practise is very limited.

The aforementioned tests are highly sophisticated and are not easily available. Another drawback is that these tests are often not standardized adequately, so that interpreting their results can be quite difficult. This is why we do not do any of these tests in our own practise, because we feel they do not provide any clinically useful information.

The ultimate sperm function test is IVF, since this directly assesses whether or not the husbands” sperm can fertilize the wife’s eggs. The best way to perform this test is to culture some of the eggs with the husband’s sperm and the others with donor sperm of proven fertility, at the same time. If the donor sperm can fertilize the eggs, and the husband’s sperm fail to do so, then the diagnosis of sperm inability to fertilize the egg is confirmed. However, even this test is not infallible, since it has been shown that about 5% of sperm samples which fail to fertilize an egg in the first IVF attempt, can do so in a second attempt at IVF. In any case, it is obviously not practicable or feasible to use IVF as a test for sperm function in clinical practice

What is obstructive azoospermia ?


Duct blockage

If the passage (reproductive tract) between the penis and testes is blocked there will be no sperm in the semen – azoospermia. If the reason for the azoospermia is a duct blockage, this is called obstructive azoospermia. Blockages can be caused by infection (gonorrhea, chlamydia, filarisias, or TB); or by surgery done to repair hernias or hydroceles.

What surgery can be done to treat obstructive azoospermia ?

If the passage is blocked, surgical repair can be attempted by performing a long and complicated 2 to 3 hour micro surgery called a vasoepididymal anastomosis (VEA) . This is highly specialised surgery which is best done by an experienced microsurgeon, since the tubes involved are so fine and delicate.

This is technically difficult and intricate surgery because it needs to be done under high magnification . The surgeon tries to bypass the block, so that the sperm can reach the penis .

Surgical results can be poor for the following reasons:

  • Technical difficulty, because of the minute size of the tubes; Often patency cannot be restored, and the sperm count remains zero. The anatomic patency rate is about 50 % for most patients (which means that sperm can be found in the semen after surgery).
  • These sperm are often poor in quality and are successful in giving rise to a pregnancy in only about 25% of patients, as the sperm that make their may out may not be mature or motile since they have not spent enough time in the epididymis, which functions to mature the sperms in the body.
  • Secondary damage to the epididymis and duct system may have occurred because they have been subjected to high pressure for a long time, causing multiple leaks and blocks, making surgery less successful.
  • Damage to the functional lining of the epididymis, either as a result of the infection which caused the block or as a result of the high pressure, so that it no longer works effectively and sperms cannot mature here properly.

The best chance of success is with the first surgical attempt – repeat surgery has a dismal success rate and is rarely worthwhile.

One of the uncommon causes of obstructive azoospermia is an ejaculatory duct obstruction. These men have low semen volume, no fructose in the semen; and an acidic semen, because their seminal vesicles are blocked. Sometimes, this is because of an ejaculatory duct cyst, which can be diagnosed by TRUS ( transrectal ultrasound). This can sometimes by treated by a TURED ( transurethral resection of the ejaculatory duct) procedure, which is performed by passing an endoscope into the urinary bladder, but the results of surgical repair are often very poor.

Whether the sperms are moving well or not (sperm motility)


Image

The quality of the sperm  is often more significant than the count. Sperm  motility is the ability to move. Sperm are of 2 types – those which swim, and those which don’t. Remember that only those sperm which move forward fast are able to swim up to the egg and fertilise it – the others are of little use.

Motility is graded from a to d, according to the World Health Organisation (WHO) Manual criteria, as follows.

  • Grade a (fast progressive)

sperms are those which swim forward fast in a straight line – like guided missiles.

  • Grade b (slow progressive)

sperms swim forward, but either in a curved or crooked line, or slowly (slow linear or non linear motility).

  • Grade c (nonprogressive)

sperms move their tails, but do not move forward (local motility only).

  • Grade d (immotile )

sperms do not move at all.

Sperms of grade c and d are considered poor. If motility is poor
(this is called asthenospermia), this suggests that the testis is producing poor quality sperm and is not functioning properly – and this may mean that even the apparently motile sperm may not be able to fertilise the egg.

This is why we worry when the motility is only 20% (when it should be at least 50% ?) Many men with a low sperm count ask is – ” But doctor, I just need a single sperm to fertilise my wife’s egg. If my count is 10 million and motility is 20%, this means I have 2 million motile sperm in my ejaculate – why can’t I get her pregnant ? ” The problem is that the sperm in infertile men with a low sperm count are often not functionally competent – they cannot fertilise the egg. The fact that only 20% of the sperm are motile means that 80% are immotile – and if so many sperm cannot even swim, one worries about the functional ability of the remaining sperm. After all, if 80% of the television sets produced in a factory are defective, no one is going to buy one of the remaining 20% – even if they seem to look normal.

What is premature ejaculation?


What is premature ejaculation?

Premature ejaculation is uncontrolled ejaculation either before or shortly after sexual penetration, with minimal sexual stimulation and before the person wishes. It may result in an unsatisfactory sexual experience for both partners. This can increase the anxiety that may contribute to the problem. Premature ejaculation is one of the most common forms of male sexual dysfunction and has probably affected every man at some point in his life. Premature ejaculation (PE) is the most common sexual dysfunction for men. PE affects 25% to 40% of men in the India.

At the 2006 Congress of the European Society for Sexual Medicine, an American research paper reported:

  • the average lasting time of men with PE was 1.8 minutes
  • ‘normal’ men lasted an average of 7.3 minutes.

What causes premature ejaculation?

Most cases of premature ejaculation do not have a clear cause. With sexual experience and age, men often learn to delay orgasm. Premature ejaculation may occur with a new partner, only in certain sexual situations, or if it has been a long time since the last ejaculation. premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy.

temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence.

Psychological factors such as anxiety, guilt, or depression can cause premature ejaculation.

In some cases, premature ejaculation may be related to an underlying medical cause such as hormonal problems, injury, or a side effect of certain medicines.

What are the symptoms?

Premature ejaculation is characterized by a lack of voluntary control over ejaculation that interferes with optimal sexual or psychological well-being in either partner. Also referred to as rapid ejaculation, premature ejaculation typically occurs before or shortly after penetration during sexual intercourse. The main symptom of premature ejaculation is an uncontrolled ejaculation either before or shortly after intercourse begins. Ejaculation occurs before the person wishes it, with minimal sexual stimulation.

How is premature ejaculation diagnosed?

Your doctor will discuss your medical and sexual history with you and conduct a thorough physical examination. Your doctor may want to talk to your partner also. Because premature ejaculation can have many causes, your doctor may order laboratory tests to rule out any other medical problem.

How is it treated?

In many cases premature ejaculation resolves on its own over time without the need for medical treatment. Practicing relaxation techniques or using distraction methods may help you delay ejaculation. For some men, stopping or cutting down on the use of alcohol, tobacco, or illegal drugs may improve their ability to control ejaculation.

Your doctor may recommend that you and your partner practice specific techniques to help delay ejaculation. These techniques may involve identifying and controlling the sensations that lead up to ejaculation and communicating to slow or stop stimulation. If premature ejaculation is occurring for psychological reasons, a doctor may suggest the squeeze technique. When one feels that they are about to ejaculate, asking your partner to gently squeeze the end of the penis just below the head for a few moments until the urge goes away may help. Wait at least 30 seconds before continuing foreplay. When reaching the point of ejaculation, ask your partner to perform the squeeze technique again. Keep doing this until you feel that you can enter your partner without immediately ejaculating. Other options include using a condom to reduce sensation to the penis or trying a different position (such as lying on your back) during intercourse. Counseling or behavioral therapy may help reduce anxiety related to premature ejaculation.

Certain antidepressant medicines called selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft), are sometimes used to treat premature ejaculation. These medicines are used because a side effect of SSRIs is inhibited orgasm, which helps delay ejaculation. The use of SSRIs for the treatment of premature ejaculation is not related to depression and is considered an “off-label” use.

Learn to Make Healthy Choices and Improve Your Sperm Count


Sometime male infertility can be overcome with a few healthy lifestyle changes. Making healthy choices can increase the fertility of sperm and help to increase low sperm counts. Read the list below to gain a better understanding of how your choices can affect sperm production:

  • Age: Sperm production drops after age 40.
  • Alcohol: Too much alcohol lowers the production of the male hormone testosterone. Drink less alcohol to prevent infertility.
  • Caffeine: Drink less coffee to prevent or cure infertility. Coffee and medications with caffeine appear to make sperm sluggish.
  • Cimetidine: If you are taking this drug and you are trying to conceive at the same time, try to reduce the dosage or take it at another time. This drug is used to treat ulcers but decreases testosterone levels and may affect sperm production.
  • Clothing: Wearing tight trousers or underwear has not been proven to overheat sperm-producing cells in testicles, and lower sperm count. But it doesn’t hurt to wear loose underwear and clothing just in case.
  • Hot tubs: Only use the hot tubs once in a blue moon. Frequent use can lower sperm count by overheating sperm-production cells, especially at high temperatures for over 15 minutes.
  • Infection: All sexually transmitted diseases can have an adverse effect on fertility. Get tested for STD’s and HIV to prevent this problem.
  • Recreational Drugs: Marijuana and other drugs may decrease testosterone levels. Stay away from drugs.
  • Smoking: Lowers sperm count and slows sperm mobility. Do not smoke to prevent infertility.
  • Steroids: Do not use anabolic steroids or other “miracle drugs”. These may have fertility side effects.
  • Stress: Try to decrease the stress in your life. Try alternative therapies to increase your well-being such as acupuncture, chiropractic care, yoga or massage therapy.
  • Weight: Maintain a healthy weight for optimal fertility.

What are the differences between male infertility, impotence or erectile dysfunction, and premature ejaculation?


Infertility is defined as the inability to establish a pregnancy after trying to conceive for 1 year.

Impotence or erectile dysfunction is the inability of a man to achieve or maintain an erection.

Premature ejaculation is more difficult to define but is generally described as recurrent ejaculation with minimal stimulation before the person wishes.

These conditions may be related in some patients or may occur independent of each other.

Men experiencing fertility problems may be potent and men with erectile dysfunction may be fertile.

now you make choice, Want BOY o GIRL as baby


To Get A Boy (According to Shettles):

  • Time intercourse as close to ovulation as possible: The idea is that since the Y-chromosome sperm are faster than the X-chromosome sperm, there will be more Y-chromosome sperm who reach the egg, making it more likely that a Y-chromosome carrying sperm will fertilize the egg.
  • Abstain from intercourse for four to five days prior to ovulation. Have intercourse only just at the time of ovulation and just before.
  • Have intercourse that allows for deep penetration. Shettles recommends rear-entry (aka, “doggy-style”). The idea is that the sperm will be deposited closer to the cervix where cervical fluid is most friendly to the Y-chromosome sperm and where the “boy sperm” are more likely to survive since there is less distance to travel.
  • Men avoid tight clothes: heat kills off both types of sperm, but will kill off the less protected, smaller Y-chromosome sperm faster, according to Shettles.
  • Women have an orgasm: According to Shettles, female orgasm increases the alkaline secretions in the vagina that are favorable to the Y-chromosome carrying sperm. Shettles recommends having an orgasm before or at the same time as the male partner.

To Get a Girl (According to Shettles):

  • Have intercourse 2-3 days before ovulation and avoid intercourse just before ovulation until 2 days after ovulation and when you have peak cervical fluid: The idea is that when you have sex a few days before ovulation, only the X-chromosome “girl sperm” will be left in the female reproductive tract waiting to fertilize the egg when it is released.
  • Have intercourse with shallow penetration: Shettles recommends “missionary position”or any position that will deposit the sperm slightly away from the cervix, giving advantage to the longer living, but slower X-chromosome-carrying sperm.
  • Women avoid orgasm: Shettles suggests women avoid orgasm because it makes the vaginal environment more alkaline, and less acidic and is disadvantageous to the X-chromosome “girl sperm”.

If you are taking longer than expected to conceive, it is generally not recommended to attempt any kind of sex selection as it can increase the time it takes to conceive.

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