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Hypospadias

Definition:
Hypospadias is a birth defect found in boys in which the penile meatus is not at the tip of the penis. The meatus is the term for the opening of the penis through which urine normally exits the bladder. The incidence is reported to be 1 in 300 live male births. There is some family risk of hypospadias, as familial tendencies have been noted. Up to 14% of male siblings are affected.

Hypospadias is usually classified according to the location of the opening. As the defect increases in severity, the opening to the penis will be found further back on the penis. The most severe types can have openings at the region of the scrotum and even in the perineum (the region between the anus and scrotum).

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In some men with hypospadias, there’s another abnormality called chordee, in which the penis curves downwards and the foreskin only covers the front of it.In the most severe forms of hypospadias, the urethral opening is so far back it’s almost in the scrotum. The scrotum itself may be small and the testes may not have descended (that is, they’re still deep in the abdomen). When babies are born like this, it can be difficult to work out which sex they are without further tests.

click tom see the picture

Both hypospadias and chordee must be repaired so that a child can have normal urinary and reproductive health.

Symptoms:
Hypospadias is a structural abnormality that doesn’t progress or put the man at risk of any other serious illness. However, as with any abnormalities of the urinary system, there may be an increased risk of urinary infection in more severe cases.

Hypospadias may cause emotional turmoil when a boy realises he’s different from his friends. It can also cause practical problems with passing urine (those with the condition usually have to sit down to pee) and later with sexual intercourse, which may be embarrassing or difficult to cope with. Hypospadias may cause general worries about sexuality and fertility.

Signs and symptoms of hypospadias may include:

*Opening of the urethra at a location other than the tip of the penis
*Downward curve of the penis (chordee)
*Hooded appearance of the penis because only the top half of the penis is covered by foreskin
*Abnormal spraying during urination

Causes:
Hypospadias is present at birth (congenital). The exact reason this defect occurs is unknown. Sometimes hypospadias is inherited.

As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.

As a boy is developing in utero, the penis begins to form in the sixth week of fetal life. Two folds of tissue join each other in the middle and a hollow tube is formed in the middle of the future penis. This tube is the urethra and its opening is called the penile meatus. As the skin folds develop to form the penis, any interruption in this process leads to the meatus being located in a location further from the end of the penis. The exact etiology for this premature cessation of urethral formation is poorly understood. In addition, the etiology of the often-associated abnormal downward curvature (chordee) is also poorly understood.

Risk Factors:
This condition is more common in infants with a family history of hypospadias.

Some research suggests that there may be an increased risk of hypospadias in infant males born to women of an advanced age or those who used in vitro fertilization (IVF) to conceive. The connection to IVF may be due to the mother’s exposure to progesterone, a natural hormone, or to progestin, a synthetic form of progesterone, administered during the IVF process. Other research, however, hasn’t confirmed a link between IVF and hypospadias, but did find an association between a mother’s exposure to pesticides and hypospadias.

Diagnosis:
A physical examination can diagnose this condition. Imaging tests may be needed to look for other congenital defects.

Treatment
The treatment of hypospadias is always surgical. Initially when the child is born and hypospadias is identified, it is important to delay any thoughts of circumcision until seen by a urologist. This is because the foreskin can provide essential additional skin needed to reconstruct the urethra.

Hypospadias is often repaired  before a child is one year of age. This way, the boy is in diapers and management of dressings are made easier. However, the exact age of repair can vary according to the size of the penis and severity of the defect. It can be repaired in most of the  cases with a single operation, but on occasion, a second operation may be needed. The operation is performed under general anesthesia with the child completely asleep. Most of the boys will have a small tube exiting the tip of their new meatus. This “stent” will protect the new urethra and allow for adequate healing. Most patients leave the hospital the same day or the following day. However, more complex repairs for the more severe types of hypospadias can require longer hospital stays due to the need for bedrest and immobilization in the immediate post-operative setting.


Click for the picture

The exact type of operation employed varies according to the severity of the defect. For the more distal defects that have openings closer to the normal position at the end of the penis, a new tube can be created from the surrounding skin. This creation of a tube is known as a Thiersch-Duplay repair. For more severe defects, the options range. Additional hairless skin is often needed to recreate the urethral tube when longer defects are seen. Here, the subdermal skin of the foreskin can be used. For the most severe defects, we can remove mucosal skin from the inside of the cheek or use subdermal skin from other hairless parts of the body. It is important to use hairless skin as future hair growth in the neourethra can present multiple problems.

Complications:
The usual risks of surgery are present at the time of performing  hypospadias repairs. Risk of infection is controlled with use of antibiotics with the surgery and in the post-operative setting. Bleeding is well controlled by using a penile tourniquet during the operation. This limits the blood loss to a very minimal amount, while allowing for good visualization of the tissues for the surgeon.

By using good surgical techniques   the longer-term complications of the surgery are minimised. The most common problems that present are fistula and stricture. A fistula occurs if a hole develops along the pathway of the repair proximal to the tip of the penis. In other words, a hole can develop along the underside of the penis allowing for leakage of urine. Additionally, a stricture is a scar that can form causing a narrowing in the urethra. If either of these complications occur, an additional repair will be needed usually 6 months later

Prognosis:
Results after surgery are typically good. In some cases, more surgery is needed to correct fistulas or a return of the abnormal penis curve.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/hypospadias.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/001286.htm
http://www.mayoclinic.com/health/hypospadias/DS00884
http://www.cornellurology.com/pediatrics/hypospadias.shtml

http://www.medindia.net/patients/paediatrics/Hypospadias.htm

http://www.surgeryencyclopedia.com/Fi-La/Hypospadias-Repair.html

http://www.adhb.govt.nz/newborn/Guidelines/Anomalies/Hypospadias.htm

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BPA may be Responsible for Women Infertility

Bisphenol A (BPA), which is a chemical used to harden plastic and line food containers, may be harming women’s eggs.
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Evidence links exposure to the chemical to a lower quality among eggs retrieved for in vitro fertilization. A study found that as blood levels of BPA in the women studied doubled, the percentage of eggs fertilized normally declined by 50 percent.

UPI reports:

“The researchers noted BPA — found in the urine of nearly everyone tested in a 2004 U.S. analysis — is an endocrine disruptor that either mimics or blocks body hormones.”

Resources:
AnnArbor.com December 16, 2010
UPI December 19, 2010
Fertility and Sterility December 4, 2010

Posted  By Dr. Marcola.Jan.3.2011

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The Common Causes of Female Infertility

Trying For a Baby?

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What happens when you see your doctor?

See your GP in the first instance, if you have any reason for concern.

Your doctor will want to know about your development as a teenager and your periods. You’ll be asked when they started, how regular they are, whether you’ve ever been pregnant before or whether you’ve ever had a pelvic infection or sexually transmitted infection.

You can use our ovulation calendar to help identify when your most fertile days are.

It’s also important to mention any other illnesses you’ve had and any medication you may be taking.

Your doctor will examine you, including an internal examination, and send you for blood tests to check your blood count and hormone levels.

Your doctor may ask your partner about his development too, check his medical history for problems such as mumps, examine him and give him instructions to collect a semen sample for testing.

You may then be referred to a specialist clinic to a specialist clinic for further tests and advice. This is usually done once you’ve been trying to get pregnant for at least 18 months, but may be sooner if you’re in your mid-30s or older.

What can specialists do?
Once referred to a fertility specialist (a reproductive medicine specialist), the cause of your infertility will be investigated.

The treatment will depend on the cause. It can range from hormone treatments and the use of donor sperm, to assisted conception techniques such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

IVF and ICSI
IVF involves removing eggs from the woman’s ovaries and mixing them with either her partner’s or a donor’s sperm in a laboratory. If the eggs are fertilised successfully, they may then be placed back in the womb……….CLICK & SEE

This is a demanding treatment for the couple and only about one in three women will become pregnant after a single IVF/ICSI cycle. Some of these pregnancies will be lost in the early stages. Many cycles may be required before achieving successful pregnancy, and these treatments are not successful for everyone, no matter how many times they’re attempted.

ICSI is sometimes recommended to couples who’ve had no success with IVF. It involves injecting a single sperm into the egg. If a healthy embryo develops, it’s then placed back in the womb as in IVF………..CLICK & SEE

Access to IVF is limited on the NHS. Guidelines from the National Institute for Health & Clinical Excellence (NICE) say women aged 23 to 39 who have an identified cause of infertility or have had unexplained infertility for at least three years should be entitled to three cycles of IVF.

The Government has suggested that each primary care trust starts by offering couples one cycle, working up to three when possible. Access to NHS treatment varies, however, and it can depend on where you live, and what other local conditions are placed on you, such as your age.

Click For more information of   infertility :

Source
: BBC Health.22nd. July.2010

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What You Eat or Drink May Help You Get Pregnant

What goes inside a body may have a significant effect in improving female fertility, suggests a study.
…………………………………Pregnant_woman

Dr. Emma Derbyshire and her team, from Manchester Metropolitan University, has found that controlled diet may enhance the chances of getting a positive pregnancy test, even to the point of being as effective as IVF treatment.

The researchers observed that while intrauterine insemination and ovarian stimulation showed a success rate of 33% in conception, dietary advice was virtually as effective, giving a 32% success rate, reports Times Online.

They suggest that some efforts that may help increase a woman’s chances of becoming pregnant, and delivering a healthy baby.

These included restrictive methods like abstaining from alcohol, cutting down on caffeine levels or switching to decaffeinated versions.

Emphasis was also put on the inclusion of plenty of fruit and vegetables in daily diet, which could help to put off the reproductive years.

Source:
The Times Of India

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In Vitro Fertilization (IVF)

Definition:
In vitro fertilization (IVF) is a process by which egg cells are fertilized by sperm outside the womb, in vitro. IVF is a major treatment in infertility when other methods of assisted reproductive technology have failed. The process involves hormonally controlling the ovulatory process, removing ova (eggs) from the woman’s ovaries and letting sperm fertilise them in a fluid medium. The fertilised egg (zygote) is then transferred to the patient’s uterus with the intent to establish a successful pregnancy. The first “test tube baby”, Louise Brown, was born in 1978.

……Oocyte granulosa cells……….naked egg

In vitro fertilization (IVF) is a procedure in which eggs (ova) from a woman’s ovary are removed. They are fertilized with sperm in a laboratory procedure, and then the fertilized egg (embryo) is returned to the woman’s uterus.

ivf1_large..ivf2_large..ivf3_large

The term in vitro, from the [Latin] root meaning within the glass, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Today, the term in vitro is used to refer to any biological procedure that is performed outside the organism it would normally be occurring in, to distinguish it from an in vivo procedure, where the tissue remains inside the living organism within which it is normally found. A colloquial term for babies conceived as the result of IVF, test tube babies, refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry labs and biology labs. However, in vitro fertilisation is usually performed in the shallower containers called Petri dishes. (Petri-dishes may also be made of plastic resins.) However, the IVF method of Autologous Endometrial Coculture is actually performed on organic material, but is yet called in vitro. This is used when parents are having infertility problems or they want to have multiple births.

IVF has been used successfully since 1978, when the first child to be conceived by this method was born in England. Over the past 20 years, thousands of couples have used this method of ART or similar procedures to conceive.

Other types of assisted reproductive technologies might be used to achieve pregnancy. A procedure called intracytoplasmic sperm injection (ICSI) uses a manipulation technique that must be performed using a microscope to inject a single sperm into each egg. The fertilized eggs can then be returned to the uterus as in IVF. In gamete intrafallopian tube transfer (GIFT) the eggs and sperm are mixed in a narrow tube and then deposited in the fallopian tube, where fertilization normally takes place. Another variation on IVF is zygote intrafallopian tube transfer (ZIFT). As in IVF, the fertilization of the eggs occurs in a laboratory dish. And, similar to GIFT, the embryos are placed in the fallopian tube (rather than the uterus as with IVF).

Purpose
IVF is one of several assisted reproductive techniques (ART) used to help infertile couples to conceive a child. If after one year of having sexual intercourse without the use of birth control a woman is unable to get pregnant, infertility is suspected. Some of the reasons for infertility are damaged or blocked fallopian tubes, hormonal imbalance, or endometriosis in the woman. In the man, low sperm count or poor quality sperm can cause infertility.

IVF is one of several possible methods to increase the chances for an infertile couple to become pregnant. Its use depends on the reason for infertility. IVF may be an option if there is a blockage in the fallopian tube or endometriosis in the woman, or low sperm count or poor quality sperm in the man. There are other possible treatments for these conditions, such as surgery for blocked tubes or endometriosis, which may be attempted before IVF.

IVF will not work for a woman who is incapable of ovulating or with a man who is not able to produce at least a few healthy sperm.

Diagnosis/Preparation

Once a woman is determined to be a good candidate for in vitro fertilization, she will generally be given fertility drugs to stimulate ovulation and the development of multiple eggs. These drugs may include gonadotropin-releasing hormone agonists (GnRHa), Pergonal, Clomid, or human chorionic gonadotropin (hcg). The maturation of the eggs is then monitored with ultrasound tests and frequent blood tests. If enough eggs mature, a physician will perform the procedure to remove them. The woman may be given a sedative prior to the procedure. A local anesthetic agent may also be used to reduce discomfort during the procedure.

The screening procedures and treatments for infertility can become a long, expensive, and, sometimes, disappointing process. Each IVF attempt takes at least an entire menstrual cycle and can cost $5,000–10,000, which may or may not be covered by health insurance. The anxiety of dealing with infertility can challenge both individuals and their relationship. The added stress and expense of multiple clinic visits, testing, treatments, and surgical procedures can become overwhelming. Couples may want to receive counseling and support through the process.

Aftercare
After the IVF procedure is performed, the woman can resume normal activities. A pregnancy test can be done approximately 12–14 days after the procedure to determine if it was successful.

Risks Factors and Complications
The risks associated with in vitro fertilization include the possibility of multiple pregnancy (since several embryos may be implanted) and ectopic pregnancy (an embryo that implants in the fallopian tube or in the abdominal cavity outside the uterus). There is a slight risk of ovarian rupture, bleeding, infections, and complications of anesthesia. If the procedure is successful and pregnancy.

……………IVF

Forin vitrofertilization, hormones are administered to the patient, and then eggs are harvested from her ovaries (A). The eggs are fertilized by sperm donated by the father (B). Once the cells begin to divide, one or more embryos are placed into the woman’s uterus to develop (C). (Illustration by GGS Inc.)

is achieved, the pregnancy carries the same risks as any pregnancy achieved without assisted technology.

The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity, and neonatal morbidity with the potential for long term damage. Strict limits on the number of embryos that may be transferred have been enacted in some countries (e.g., England) to reduce the risk of high-order multiples (triplets or more), but are not universally followed or accepted. Spontaneous splitting of embryos in the womb after transfer can occur, but this is rare and would lead to identical twins. A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of < 2500 g.[6] However recent evidence suggest that singleton offspring after IVF is at higher risk for lower birth weight for unknown reasons.

Another risk of ovarian stimulation is the development of ovarian hyperstimulation syndrome.

If the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early to examine that male offspring is at higher risk for sperm abnormalities.

Birth defects
The issue of birth defects has been a controversial topic in IVF. Many studies do not show a significant increase after use of IVF, and some studies suggest higher rates for ICSI, whereas others do not support this finding. In 2008, an analysis of the data of the National Birth Defects Study in the US found that certain birth defects were significantly more common in infants conceived with IVF, notably septal heart defects, cleft lip with or without cleft palate, esophageal atresia, and anorectal atresia; the mechanism of causality is unclear.[8]

Japan’s government prohibited the use of in vitro fertilisation procedures for couples in which both partners are infected with HIV. Despite the fact that the ethics committees previously allowed the Ogikubo Hospital, located in Tokyo, to use in vitro fertilisation for couples with HIV, the Health, Labour and Welfare Ministry of Japan decided to block the practice. Hideji Hanabusa, the vice president of the Ogikubo Hospital, states that together with his colleagues, he managed to develop a method through which scientists are able to remove the AIDS virus from sperm.

Normal Results:
Success rates vary widely among clinics and among physicians performing the procedure. A couple has about a 10% chance of becoming pregnant each time the procedure is performed. Therefore, the procedure may have to be repeated more than once to achieve pregnancy.

Abnormal results include ectopic or multiple pregnancy that may abort spontaneously or that may require termination if the health of the mother is at risk.

Morbidity and Mortality Rates:
The most common cause of morbidity is ecotopic pregnancy. Pain is associated with most components of the procedure. Mortality as a result of IVF is extremely rare.

Alternatives
Other types of assisted reproductive technologies might be used to achieve pregnancy. A procedure called intracytoplasmic sperm injection (ICSI) utilizes a manipulation technique that must be performed using a microscope to inject a single sperm into each egg. The fertilized eggs can then be returned to the uterus, as in IVF. In gamete intrafallopian tube transfer (GIFT), the eggs and sperm are mixed in a narrow tube, and then deposited in the fallopian tube, where fertilization normally takes place. Another variation on IVF is zygote intrafallopian tube transfer (ZIFT). As in IVF, the fertilization of the eggs occurs in a laboratory dish. And, similar to GIFT, the embryos are placed in the fallopian tube, rather than in the uterus as with IVF

You may click to see->

Intrauterine Insemination (IUI)

Manbir  Online

Digitable Builder

Three-parent embryo formed in lab

Resources:
http://en.wikipedia.org/wiki/In_vitro_fertilisation
http://www.answers.com/topic/in-vitro-fertilisation

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