Cure For Infertility
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The level of ovarian reserve and the age of the female partner are the most important prognostic factors in the fertility workup. Ovarian reserve is most commonly evaluated by checking a cycle day 3 FSH and estradiol level.
Treating Infertility - ACOG
In cases where the patient is 35 years or older, dynamic ovarian reserve testing may be indicated. The most common test used is the clomiphene citrate challenge test CCCT. A serum FSH and estradiol level is drawn on cycle day 3. Clomiphene citrate mg by mouth is administered on cycle days and a serum FSH level is drawn again on day An FSH level greater than 10 is associated with decreased fertility and lower pregnancy rates. One large prospective observational trial suggests that age, AMH, inhibin B, and FSH combined have significant predictor of poor oocyte yield.
However, most of these have not been found to be of adequate sensitivity, specificity, or positive predictive value when applying cutoffs across all age groups for pregnancy. They are predictive of response to ovulation induction medications. Thus, any result must be interpreted within the clinical context of the patient. A serum AMH assay could be used to identify patients with decreasing ovarian reserves and polycystic ovarian insufficiency.
Because thyroid disease and hyperprolactinemia can cause menstrual abnormalities and infertility, a serum TSH and prolactin should always be checked and corrected prior to instituting therapy. The male partner must submit a semen sample for a comprehensive semen analysis. Previous paternity does not guarantee current fertility status.
The comprehensive semen analysis must be performed in a certified andrology laboratory. The semen sample should be collected at the same andrology laboratory that will conduct the test. However, if the sample must be collected at home, it must be collected in a sterile plastic container and delivered to the andrology laboratory at body temperature no later than 30 minutes after ejaculation. Some patients cannot produce a semen sample through masturbation. In these cases, the sample can be collected through intercourse, using a special nonspermicidal condom provided by the andrology laboratory.
To optimize results, the semen sample should be collected after a period of 3 days but no more than 5 days of sexual abstinence. The basic semen analysis assesses sperm concentration, motility, morphology, and viability. The World Health Organization's semen analysis parameters with the variable and the corresponding reference range are as follows [ 98 ] :.
Infertility Natural Treatments & Home Remedies
Morphology has become an important parameter to evaluate the quality of sperm and fertilization capability. Kruger reported a new classification based on strict sperm morphology after fixing and staining the sperm. Specific biochemical analyses relevant to accessory sex gland function can be performed using the semen sample. Sperm agglutination is an indirect indicator of the presence of sperm antibodies. The immunobead test can be performed either directly on the sperm or indirectly on sperm and blood. The antibodies can be specific for the head or for the tail of the sperm. Sperm antibodies are associated with infection ie, orchitis , testicular trauma, and a history of vasectomy.
Spermatogenesis takes approximately 72 days. Abnormal semen analysis results can be attributed to various unknown reasons eg, short period of sexual abstinence, incomplete collection, poor sexual stimulus ; therefore, repeating the semen analysis at least 1 month later is important before a diagnosis is made. The patient should be informed of the normal fluctuation that can occur between semen samples. Azoospermia indicates absence of sperm that could result from congenital absence or bilateral obstruction of the vas deferens or ejaculatory ducts, spermatogenesis arrest, Sertoli cell syndrome, or postvasectomy.
This can be caused by extreme temperatures and delayed analysis after sperm collection. Teratospermia indicates an increased number of abnormal sperm morphology at the head, neck, or tail level. A proliferation of different sperm tests have been developed to evaluate and predict the sperm fecundability, including 1 the acrosome reaction test with fluorescent lectins or antibodies, 2 computer assessment of the sperm head, 3 computer motility assessment, 4 hemizona-binding assay, 5 hamster penetration test, and 6 human sperm-zona penetration assay.
They are subject to variation in interpretation, which render them more of academic interest than of practical therapeutic value.
Treatments for Infertility
A consultation once the evaluation has been completed is imperative. A treatment plan should be generated according to the diagnosis, duration of infertility, and the woman's age. Chronic cervicitis may be treated with antibiotics. Reduced secretion of cervical mucus due to destruction of the endocervical glands by previous cervical conization, freezing, or laser vaporization responds poorly to low-dose estrogen therapy.
The easiest and most successful treatment is intrauterine insemination IUI. Artificial insemination can be performed by depositing the sperm at the cervical level cervical insemination [ ] or inside the endometrial cavity intrauterine insemination. Cervical insemination has almost been abandoned because of its low success and has been relegated only to cases in which the sperm count is normal, such as in artificial insemination using donor sperm or if the sample has elevated white cells.
For intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection procedures, the removal of certain components of the ejaculate ie, seminal fluid, excess cellular debris, leukocytes, morphologically abnormal sperm with the retention of the motile fraction of sperm is desirable. For most specimens, the greatest recovery of the motile portion results from separation via centrifugal filtration through a discontinuous density gradient system.
However, for certain very poor specimens with low original concentrations of motile sperm, the use of the gradient system results in such a negligible recovery as to render it useless. The recourse for these specimens is to remove the seminal fluid by successive media washes.
A small number of specimens have acceptable original concentrations of motile sperm but poor recoveries with the gradient system. These specimens benefit most from layering a washed pellet of sperm with nutrient media and allowing the motile fraction to swim up into the media before being separated. After sperm preparation, the spermatozoa are enhanced in motility and become activated and ready to fertilize an oocyte.
Intrauterine insemination is performed during a natural cycle or after ovulation induction with CC or gonadotropins. The procedure is performed hours after the spontaneous LH surge or 36 hours after the administration of 10, U of hCG human chorionic gonadotropin. After injection of the sperm, the patient remains in the recumbent position for minutes. Homologous insemination refers to the use of sperm from the patient's partner.
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Heterologous or therapeutic insemination, formerly called artificial insemination by donor sperm, refers to the use of frozen sperm that has been quarantined for at least 6 months. Today, it is feasible by using a gestational carrier. Once patients desire to have children, they proceed with stimulation of the ovaries, oocyte aspiration, and in vitro fertilization, but the embryos are transferred to a gestational carrier see In Vitro Fertilization.
The treatment of uterine malformations depends on the severity of the problem. Fertility is not an issue for some patients affected by DES, and they remain undiagnosed until they have an abnormal Papanicolaou test result.
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Those who do have fertility problems are treated according to the following guidelines: [ , , ]. A unicornuate uterus remains undetected unless fertility is compromised.
Patients with this type of uterus can have a normal term pregnancy. Most problems are related to premature labor and pregnancy loss. Thus, an intravenous pyelogram must be performed once this diagnosis is made. Whether interventions before conception or early in pregnancy, such as resection of the rudimentary horn and prophylactic cervical cerclage, decidedly improve obstetrical outcomes is uncertain; however, current practice suggests that such interventions may be helpful.
Infertility: Symptoms, Treatment, Diagnosis
Women presenting with a history of this anomaly should be considered high-risk obstetrical patients. A bicornuate uterus causes only minimal problems with infertility if any. A bicornuate uterus can be associated with a history of recurrent miscarriages, and its repair is indicated only if other etiologies for the miscarriage have been excluded see Surgical intervention below.
In general, an arcuate uterus does not cause infertility. Whether it should be corrected in cases of primary infertility is controversial. The hypothesis that a uterine septum can cause infertility is controversial. Advising surgery in cases of primary infertility is difficult. The avascular nature of the septum is theorized to interfere with implantation and maintenance of the embryo. Uterine anomalies can be corrected through operative hysteroscopy under general anesthesia or conscious sedation.
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Furthermore, laparoscopy assists in the differential diagnosis between a septate and a bicornuate uterus. A bicornuate uterus is characterized by the presence of an indentation at the fundus. The 2 techniques are the Strassman metroplasty and the Jones metroplasty. The Strassman metroplasty consists of performing an incision at the fundus of the uterus between both cornual areas and closing the defect with an anteroposterior suture.