IHC, FSH Test

The term infertility in females explains a wide range of disorders but in order to simplify things, lets’ just say, infertility in women is a condition in which women are unable to conceive. There are numerous reasons that can be responsible for this situation and although some are preventable or curable, most others have no specific cure or treatment.

Ovulatory Disorders

One of the most common reasons for infertility is an ovulatory disorder. Almost 30 percent of female infertility is caused due to this reason. 70 percent of such infertility is treatable with drugs such as Reprones/Menogan and Clomiphene. Here is a list of causes of failed ovulation-

1. Disruption in the complex hormonal balance.

2. Ovaries fail to produce mature eggs. Polycystic ovarian syndrome is the most common disorder causing this problem. This syndrome has reduced FSH production and increased production of LH, Oestrogen and Testosterone. Suppressed FSH production may cause the partial development of ovarian follicles.

3. Hypothalamus may malfunction thereby causing the pituitary to malfunction, thus losing control over the process or FSH and LH production.

4. Physical damage to the ovaries by multiple surgeries or due to the formation of cysts.

5. A rare case of premature menopause.

6. Problems of the follicle.

7. Poor functioning of fallopian tubes

Diseases or disorders in the tube have been another major reason of infertility in women. Almost 25 percent of women infertility occurs due to this reason. Although treatments exist, success rates of the treatments are as high as 30 percent. The causes of tube damage may be as follows-

1. Infection caused by bacteria or viruses

2. Abdominal diseases like colitis and appendicitis

3. Previous pelvic or abdominal surgeries.

4. A condition called ectopic pregnancy which occurs in the tube, and even if very carefully but successfully overcome, may leave permanent damage.

5. Rare congenital defects in which women may be born with tube anomalies.

Endometriosis

This is the condition where the endometrium expands excessively thereby preventing individuals from getting pregnant. This affects almost 10 percent of the population of infertile women. Almost 40 percent of women with endometriosis are infertile.

Other Factors

Other additional factors may include:

1. Abnormal uterus

2. Congenital diseases

3. Behavioural factors like personal habits, lifestyle and health factors.

4. Exercise and diet- extremely overweight or underweight women may have problems in conceiving.

5. Cigarette smoking reduces the chances of conceiving by one-third.

6. Alcohol increases the chances of birth defects.

Hence, pregnancy is tougher than it might really seem. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Human sexuality is involves biological, erotic, physical, emotional, social, or spiritual feelings and behaviors.

The biological and physical aspects of sexuality largely concern the human reproductive functions, including the human sexual response cycle. Physical and emotional aspects of sexuality include bonds between individuals that is expressed through profound feelings or physical manifestations of love, trust, and care.  

Sexuality also affects and is affected by cultural, political, legal, philosophical, moral, ethical, and religious aspectsInterest in sexualactivity typically increases when an individual reaches puberty. Genetic studies work on In the study of human chromosomes in human sexuality,research has shown that "ten percent of the population has chromosomal variations that do not fit  into the XX-female and XY-male set of categories"

The study of sexualityalso includes human identity within social groups, sexually transmitted infections (STIs/STDs).

Development-

Genderdifferences[edit]Seealso: Sex differences in psychology § Sexualbehaviorother aspects of humansexuality, such as sexual satisfaction, incidence of oral sex, and attitudes toward homosexuality and masturbation, show little to no observed difference between males and females 

Biological and physiological aspects-

 Human reproductive system Like other mammals, humans are primarily grouped into either the male or female sex with a small proportion (around 1%) of intersex individuals, for whom sexual classification may not be as clear.The biological aspects of humans' sexuality deal with the reproductive system, the sexual response cycle, and the factors that affect these aspects. They also deal with the influence of biological factors on other aspects of sexuality, such as organic and neurological responses,[20] heredity, hormonal issues, gender issues, and sexual dysfunction.

Brain

The hypothalamus is the most important part of the brain for sexual functioning. This is a small area at the base of the brain consisting of several groups of nerve cell bodies that receives input from the limbic system. Studies have shown that within lab animals, destruction of certain areas of the hypothalamus causes the elimination of sexual behavior.[ The hypothalamus is important because of its relationship to the pituitary gland, which lies beneath it.The pituitary gland secretes hormones that are produced in the hypothalamus and itself. The four important sexual hormones are oxytocin, prolactin, follicle-stimulating hormone, and luteinizing hormone. Oxytocin, sometimes referred to as the "love hormone, is released in both sexes during sexual intercourse when an orgasm is achieved.[ Oxytocin has been suggested as critical to the thoughts and behaviors required to maintain close relationships. The hormone is also released in women when they give birth or are breastfeeding. Both prolactin and oxytocin stimulate milk production in women ] Follicle-stimulating hormone (FSH) is responsible for ovulation in women, which acts by triggering egg maturity; in men it stimulates sperm production. Luteinizing hormone (LH)triggers ovulation, which is the release of a mature egg.

What is pcos/pcod?

 Polycystic ovarian syndrome (pcos) or polycystic ovarian disease (pcod) is a very common issue affecting about 10-20% of young women of child bearing age group. It consists of development of cystic structure or multiple cavities containing fluid within the ovaries. Because of multiple cysts in ovaries give rise to various problems related to hormonal imbalance.

 Who are prone to get pcos?

 Though not clear, there are various risk factors that can be associated with increased risk of pcos. These include obesity (body mass index >30), family history, some genetic issues, taking various medications like antiepileptics (used for seizures), stressful life and physical inactivity.

 What are signs and symptoms of pcod?

 You must look for following symptoms and consult a physician if you are getting these:-

•  Irregular and longer periods
• Increase in weight
• Unable to become pregnant (infertility)
• Pimples
• Growing hairs over body
• Increased urination, thirst
• Depression

How pcos is diagnosed?

•  Doctor will look for all the symptoms of pcos mentioned above and may ask you to do various laboratory tests like:-
• Transvaginal sonography (to see for multiple cysts in one or both ovaries)
• Hormonal blood tests (tsh, antimullerian hormone, fsh, lh, androgen levels)
• Urine examination
• Blood glucose levels
• Hysterosalpingography (hsg) if infertility is a problem. Hsg will tell whether fallopian tubes are patent or is there any block that is causing infertility.

 
What lifestyle changes are helpful in pcos?

 Pcos is a growing problem and many a times associated modern lifestyle that causes weight gain and increased chances of getting pcos. Mainstay of management of pcos is having healthy lifestyle habits. A patient of pcos should try these lifestyle modifications to prevent harmful effects of pcos.

•  Regular exercise (walking, jogging, roping)
• Yoga and meditation
• Avoid oily, frozen foods
• Avoid alcohol and smoking
• Avoid stress and worries as possible
   

What are treatment modalities available for pcos?
After diagnosing pcos, physician may first tell patient to have healthy lifestyle and diet modifications. There are many ways to treat a patient of pcos.

 Oral contraceptive pills- regularize your menstrual periods and prevent growth of excessive hairs over body. Oc pill may not be advised to women who are trying to conceive and undergoing treatment of infertility.
Metformin- is a medication generally used in diabetes mellitus is also useful in treating pcos as it treat insulin resistance (a common issue in pcos patients that lead to diabetes). Metformin also help women reducing weight.

Treatment of infertility: In pcos infertility is a common issue and most often may resolve after treatment. There is problem in ovulation in pcos, hence physician may prescribe medicines that enhance your ovulation. Clomiphene 50mg starting dose from day 2 to day 7 of menstrual cycle is very commonly used medication to induce ovulation. Ovulation monitoring by sonography or by using ovulation kits is performed to check whether ovulation is occurring or not. Fsh may also be used for maturation of follicles that leads to ovulation. In-vitro fertilisation (ivf) is used when other medical treatment for infertility and lifestyle modification failed to work. Surgery to drill multiple abnormal cysts may be performed rarely. Acupuncture may be useful but no any clear-cut evidence.
 
So, if you are having any symptom of pcos, consult your physician at earliest and get it treated. Always remember to have stress-free and healthy lifestyle habits which is of utmost important in managing and preventing pcos.

Male hypogonadism is clinical condition of insufficient male hormone i.e. testosterone in blood circulation of men.

Testosterone is hormone secreted by testes under the influence of pituitary gland. Testosterone hormone is responsible for sexual development of boys when they enter adulthood. This hormone is also responsible for male type physical development, sexual health and male fertility. 

Symptoms of Male Hypogonadism 

Symptoms of male hypogonadism depend on the age when this problem occurs. Hypogonadism early in childhood causes late or poor development of male genitalia, moustaches and beard, and sexual dysfunction. Adults with hypogonadism can have specific symptoms like very low sexual desire, erectile dysfunction, infertility and loss of beard and moustaches. 

Non-specific symptoms of testosterone deficiency are feeling tired and fatigue, low mood, poor concentration, poor muscle strength, weak bones which can break easily etc. 

Causes of Hypogonadism

Low testosterone can be due to defects either in pituitary gland or testes. Diseases of pituitary gland which can cause testosterone deficiency are genetic disorders, tumours, infections, head injury, brain surgery/radiation etc. 

Similarly, genetic disorders of testes, tumours, trauma, infections of testes also can cause testosterone deficiency. 

Also, many other systemic illness and many drugs can cause hypogonadism. Diagnosis simple blood tests are enough to diagnose low testosterone. Depending on it's cause imaging tests like MRI scan of pituitary gland or ultrasound scan of testes may be required. Patients should also be investigated for other hormonal problems which can coexist with testosterone deficiency. 

Treatment 

Treatment of hypogonadism with testosterone replacement improve symptoms of erectile dysfunction, poor muscle strength, fatigue, weak bones etc. Testosterone is available in the form of injection and gel. 

Infertility, if caused by pituitary diseases, can be treated with injection of HCG with FSH. Infertility, if caused, by testicular diseases can be treated with artificial reproductive techniques. If you wish to discuss any specific problem, you can consult an endocrinologist.

The concept of egg quality of a woman is derived from the belief that the embryo implantation probability is powerfully related to the age and ovarian reserve of the woman. Thus, it is regarded that the quality of the egg is almost synonymous with the chances of embryo implantation. Its quality cannot be assessed merely by looking at the egg or measuring its ability to receive the fertilization by sperm or simply observing the initial embryo division.

There are a few important factors that contribute to the success or failure of the embryo implantation and some of them are:

1. Diminished ovarian reserve: A woman with an increased FSH level on the third day of the menses is regarded as having diminished reserve of ovary. This implies that her ovary is not competent in sending feedback signals to the pituitary gland and the body responds by producing an increased amount of FSH for stimulating the ovary. For more than 10 years, it has been found that in over thousands of fertility treatment cycles, women with an increased FSH level have a lower egg quality.
2. Advanced age of maternity: Even though the FSH level is normal, the age of the mother who provides the eggs plays an important role to determine the quality of the egg. Quite like women with increased FSH levels, eggs obtained from women aged more than 40 years can have some problems at a later stage of fertilization. Normal FSH levels are not considered a reassuring factor, owing to the lower implantation rate in females aged over 45 years.
3. Diminished quality of egg: With an increase in age, the capacity of the mitochondria in producing energy slowly decreases. The egg is linked to the circulation before ovulation, and it is linked again after the embryo implantation. But during the one week time ranging from ovulation to implantation, the egg and the resulting embryo are contained in the zona pellucida and function on the basis of mitochondrial energy supply. The older age of the woman doesn’t cause any problem at the initial stage of ovulation. Its fertilization and embryonic development are also normal. But soon, it runs out of energy and stops dividing before reaching the stage of implantation.

Therefore, it is important to have the eggs tested to find out any sort of chromosomal abnormality. In case the mother is deficient of producing high-quality eggs, the best option is to have donor eggs.

Mitochondrial Concept:

Mitochondrial replacement (MRT, sometimes called mitochondrial donation) is a special form of in vitro fertilisation in which the future baby's mitochondrial DNA comes from a third party. This technique is used in cases when mothers carry genes for mitochondrial diseases. The two most common techniques in mitochondrial donation are pronuclear transfer and maternal spindle transfer.

Cells are the tiniest part of any organism including the human body, but has various parts within, which have specific functions. The mitochondria, for instance, are the batteries of the cells and produce energy for all functions, including cellular movement and adequate cellular function.

The egg, being a single cell, also is highly dependent on the mitochondria for its optimal function. For an egg to be healthy, it should have optimal energy, and that comes only when the mitochondria is functioning at its best. This determines the overall quality of the egg too. Poor eggs, it is well established, is one of the major cause of infertility, as it cannot implant itself and sustain the entire term of pregnancy.
Studies have confirmed that eggs have more mitochondria than normal cells, as their energy requirements are higher.

The ovaries have cells called precursor cells, which eventually can become eggs and get fertilized. Studies have shown that when mitochondria from these precursor cells are infused into the fertilized egg, the overall quality of the egg improves and therefore improves chances of fertilization.

Mitochondrial transfer is the new technique which is being developed and has resulted in a baby but involves third party IVF and hence is in a ethical debate. If you wish to discuss about any specific problem, you can consult a IVF Specialist.