Causes of Poylcystic Ovary Syndrome (PCOS)

The exact cause of PCOS is not known but a hormonal imbalance is the basic problem encountered in a woman suffering from this disease. This can lead to anovulation (lack of ovulation) or irregular ovulation, scanty or irregular periods, and cysts within the ovaries.

Infertility resulting from ovulation problems can occur due to :

• Abnormally high levels of androgen (male hormone).
• Low follicle-stimulating hormone (FSH).
• Insulin resistance.

Falling Pregnant with PCOS

Infertility is a common problem in women with PCOS but pregnancy is still a possibility and women should not lose hope. Many women with PCOS do not know they have this condition until they undergo investigations for infertility. There are various treatment options for infertility and this must be with a gynecologist. Failure of one therapeutic measure to achieve the desired result does not mean that a woman will not fall pregnant.

Fertility medications such as clomiphene citrate or gonadotropin injections may help to stimulate ovulation and increase chances of pregnancy. Clomiphene citrate can achieve ovulation in a large number of cases and can result in a successful pregnancy within a few months. However, one of the main side effects of this drug is having a multiple pregnancy. If positive results are not achieved within 6 months, gonadotropin injections to stimulate the ovaries may be tried.

Other options

• An alternative to ovarian stimulation is ovarian drilling or laparoscopic ovarian diathermy (LOD). Small holes are drilled into the ovary by means of a hot diathermy probe or laser.
• Drugs used to treat diabetes, such as metformin, may help to increase the response to fertility drugs.
• IVF may be tried to achieve pregnancy.
• Losing excess weight with lifestyle changes such as diet and exercise may be helpful.

Causes of Endometriosis

Just as with PCOS, the cause of endometriosis is not clearly understood. Tissues from the endometrial lining of the uterus get implanted in some site other than the uterus, such as the fallopian tubes, ovaries, bladder, abdomen or other abnormal sites and give rise to various symptoms.

Although a many women with endometriosis have no problems with conceiving, the chances of endometriosis causing infertility are relatively high. Infertility may be caused by anatomic factors such as adhesions and scarring caused by endometrial tissues in the pelvis, or hormonal factors which hinder ovulation, fertilization or implantation of the fertilized ovum. Pain during intercourse caused by endometriosis may restrict the act and be a factor in reducing chances of pregnancy.

Falling Pregnant with Endometriosis

Women with mild or moderate endometriosis have a fairly good chance of conceiving, even without any specific treatment. Infertility is more likely to occur in women who have severe endometriosis.

There are various treatment options available for endometriosis which may increase chances of conception. Surgical treatment often gives better results than hormonal or other medical treatments when the aim of treatment is to achieve pregnancy. Assisted reproduction techniques such as intrauterine insemination or in-vitro fertilization (IVF) may provide better results when combined with surgical treatment. Surgery aims to remove any endometrial tissue or adhesions, as well as repair any damage done to organs. Laparoscopic surgery is the method of choice in most cases.

]]> http://www.phaa.com/chances-of-pregnancy-with-pcos-and-endometriosis.htm/feed 0 http://www.phaa.com/fertility-tests-and-procedures.htm http://www.phaa.com/fertility-tests-and-procedures.htm#comments Sat, 21 Nov 2009 19:49:27 +0000 Dr. Peter http://www.phaa.com/?p=225 Fertility tests are done to determine the cause of infertility and whether the problem lies with the male or female partner or both. After proper history taking and physical examination, the following tests and procedures are advised :

• complete blood count
• grouping and Rhesus factor
• German measles (rubella)
• hepatitis B
• HIV
• syphilis

Based on the results of these tests, further special testing and other investigative procedures may be necessary for each partner. The findings will determine the appropriate infertility treatment that should be considered for the individual or couple.

Infertility Tests for Men

• Semen analysis is when a specimen of semen is collected and analyzed in the laboratory, particularly for sperm count, morphology (shape and structure), and motility (movement) of the sperm.
• Hormone testing is a blood test to evaluate the level of testosterone and other male hormones.

Infertility Tests for Women

Fertility Blood Tests

Blood tests are done to evaluate the levels of various hormones affecting the reproductive process. Interpretation of the results depend on the  day of the menstrual cycle when the blood sample was taken. Some of hormones tested may include :

• Follicle stimulating hormone (FSH) which is secreted by the pituitary gland and its level increases as a woman approaches menopause and the ovaries show signs of aging.
• Luteinizing hormone (LH) controls egg development, but consistently high levels of this hormone hinders this process.

The two tests above are done on the third day of the menstrual cycle. A second hormone evaluation may be done one or two days before ovulation, when FSH and LH levels are measured again. High levels of FSH and LH may be a sign of ovarian problems, while low levels may indicate a pituitary or hypothalamic disorders.

Other tests may monitor or test the following :

• Estradiol level in the blood often detects a decrease in egg quantity and quality even though the day 3 FSH level is normal.

• Clomiphene challenge test can detect poor ovarian reserve even when the day 3 FSH level is normal. This test is done by noting the day 3 FSH and estradiol levels, taking 2 tablets of clomiphene (100 mg) on days 5 to 9 of the menstrual cycle, and repeating FSH level on day 10. The result is taken as normal if FSH and estradiol levels are low on day 3 and FSH level is also low on day 10.

• Prolactin levels if high inhibits release of FSH and LH, preventing ovulation.

• Thyroid function tests to exclude thyroid disease as the cause of infertility.

• Progesterone test is done around day 21 of the menstrual cycle and a high level of progesterone confirms ovulation.

Fertility Procedures

Other diagnostic procedures may also be conducted to verify other factors that may contribute to infertility in women.

• Pelvic ultrasound is done to determine size and structure of the uterus and ovaries and detect conditions such as uterine fibroid.

• Hysterosalpingogram is an x-ray test to see the inside of the tubes and uterus to detect tubal blockage or any other abnormality in the tubes or uterus.

• Laparoscopy is when a tiny incision near the umbilicus allows a thin lighted tube to be put inside the abdomen to view the woman’s pelvic organs. Possible causes of infertility such as adhesions, cysts, fibroid, and endometriosis can be diagnosed.

• Endometrial biopsy is when a small sample of uterine tissue is used to check if normal changes are taking place in the endometrium during the menstrual cycle.

• Karyotype or Genetic tests.  Karyotyping may be necessary to look for problems in the genetic material (chromosomes) of the cells and genetic tests may help to find the cause of infertility or frequent abortions.

Infertility Treatment for Women

Drugs

Fertility drugs help by inducing or regulating ovulation in women who are infertile due to ovarian dysfunction. These drugs include :

1. Clomiphene which is taken orally and helps to stimulate ovulation in women. It is particularly useful in cases of polycystic ovary syndrome (PCOS) and other ovulation disorders and works by acting on the pituitary gland.
2. Human menopausal gonadotropin (hMG) is given in as an injection and directly stimulates the ovaries in case of pituitary gland failure.
3. Follicle stimulating hormone (FSH) stimulates the ovaries to mature egg follicles.
4. Human chorionic gonadotropin HCG).
5. Metformin is used when insulin resistance is the cause of infertility.
6. Bromocriptine inhibits prolactin secretion and is helpful in cases of hyperprolactinemia causing infertility.

The main side effect of fertility drugs is the possibility of multiple pregnancies.

Surgery

Surgical intervention may be considered in the following cases :

1. Blockage in the fallopian tube.
2. Genetic defects in the reproductive system.
3. Endometriosis.
4. Uterine fibroid.
5. Ovarian cysts

Assisted reproductive technology (ART)

This form of treatment for infertility allows couples to have their own biological baby, and chances of success are more in a woman with a healthy uterus, with a good response to fertility drugs, who ovulates normally or uses eggs from a donor. Healthy sperm from the male partner or a donor is necessary. The various forms of ART include :

1. Artificial insemination where a concentrated amount of healthy sperm from the partner or a donor is introduced into the uterus by means of a catheter.
2. In vitro fertilization (IVF) where mature eggs are fertilized with sperm  in a laboratory dish, and is then implanted into the uterus three to five days after fertilization.
3. Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF but the embryo is transferred to the fallopian tube instead of the uterus.
4. Gamete intrafallopian transfer (GIFT) when eggs and sperms are transferred to the fallopian tube so that fertilization occurs inside the woman’s body.
5. Intracytoplasmic sperm injection (ICSI) is the method where a single sperm is injected into a mature egg to obtain fertilization and is especially helpful in men with low sperm count.
6. Embryo donation is where an embryo or egg from a donor is fertilized with sperm and implanted into the uterus.
7. Surrogacy is when a couple’s embryo or a donor embryo is carried by a surrogate mother.

Infertility Treatment for Men

Difficulty in conceiving may lie with the male partner and may require similar procedures as for women. The main approach to treating infertility in men includes :

• Treating sexual problems such as impotence or premature ejaculation by medicines or counseling.

• Hormone treatment, surgery, or assisted reproductive technology (ART) can help treat infertility in men, depending upon the cause.

Sometimes the cause of infertility isn’t known and research has shown that both men and women suffer from problems known to cause infertility, with sometimes multiple factors playing a part in the cause. There are numerous reasons the woman can be infertile such as hormone imbalances, problems with the fallopian tubes, endometriosis and problems with the reproductive organs.

In men the cause of infertility is due to the number of sperm they produce or blocked spermatic cords. The infertility could be caused by any one of these reasons or by a mixture of them, with sometimes the reason being unclear.

Infertility problems in the woman

Ovulation problems

In order for the release and growth of an egg to take place a balance must be struck between the oestrogen, progesterone, follicle stimulating hormone and the luteinising hormones. When one or more of these becomes imbalanced then ovulation disorders can occur these disorders are the number one reason for infertility in a woman.

Damage to the fallopian tubes

Fertilization of the egg takes place in the fallopian tubes and occasionally there can be either a full or partial blockage of the fallopian tubes this will then prevent fertilization from being successful. The fallopian tubes can also become damaged due to bacterial infection, some sexually transmitted diseases and complications which can arise from surgery.

Uterus and cervical disorders

Fibroids or polyps which are benign growths can grow on the uterus walls, they can them interfere with the embryo successfully attaching to the wall of the uterus. Sometimes the shape and texture of the cervix mucus can change this will then make it very hard for the sperm to successfully penetrate the egg.

Endometriosis

This is a condition where the lining of the uterus forms outside of the reproductive system; this can then block the fallopian tubes and cause problems with conception.

Polycystic ovaries

The woman’s ovaries can contain lots of small cysts which will make the ovary larger than normal, women suffering from this condition might have trouble with their periods and may not ovulate resulting in infertility.

Ovarian failure

This problem is associated with medical treatments for problems such as ovarian tumours. Ovarian failure is often the result of chemotherapy and radiotherapy for pelvic for cancer in other parts of the body.

Age

Age often plays a critical role in infertility as the reproductive function declines from the age of 35 onwards; woman can only produce a certain amount of eggs unlike the man who can produce unlimited sperm. The older a woman gets the less eggs she has left and the quality of the eggs also declines the older the woman gets older. Aging can also have an affect on the reproductive organs and the increase of miscarriage also gets higher.

Fibroids are a condition in which growths are found in the women’s reproductive system; while many women will not ever know they are there some women will experience symptoms ranging from heavy bleeding and pain to infertility problems and incontinence.

What exactly are fibroids?

Fibroids are growths or benign tumours that grow in the reproductive system, more commonly the womb; they are made up of muscle fibre and range in size from that of a pea to as big as a water melon. Experts think that around 30 to 50% of all women will suffer from this condition at some time in their lives though the condition is seen more in women around the age of 30 and very rarely in women under the age of 20.

What causes fibroids?

The exact cause of fibroids is unknown though oestrogen does seem to have some influence on them, recent studies have also shown that fibroids appear in black women more than they do in white but the reason for this is unknown. They also appear in women who are overweight more than women of correct weight for their height.

The different types of fibroids

Fibroids are generally categorised by where they are actually growing in the womb and these types are:

• Intramural – the fibroids in this category grow in the wall of the womb and these are the most common type of fibroid.
• Subserous – these are located in the outer layer of the womb and are sometimes found to grow on stalks, this type of fibroid can grow to be very large.
• Submucous – these develop in the muscles underneath the lining of the womb, they can also grow into the womb and grow on stalks, if they grow long enough they can even reach through the cervix.
• Cervical – these grow in the neck of the womb and are the most difficult ones to remove.

How you can prevent fibroids

As doctors don’t really know what causes fibroids in the first place it is difficult to say for sure how you can prevent them but studies have suggested that there are some things you could do which might help to prevent them, these are:

• Keep to the correct weight for your height.
• Eat plenty of green vegetables and fresh fruit, avoiding red meat if possible, a recent study in Italy showed that women who didn’t eat a lot of meat but ate lots of fruit and vegetables were less likely to develop fibroids.