INFERTILITY AND WOMEN- NEW TECHNIQUE (IUI)

THAT ABORTION THAT ROBBED ME OF MY CHILDREN---[INFERTILITY]
http://www.joasmedicaldiagnostix.8m....ew_post/564736

In my many years of practice of medical ultrasound I have attended to thousands of women suffering from infertility due to many causes including abortion, legal or illegal.

I had this patient, she has being married for over 7 years with no child. She came to me for ultrasound scan test, after the tests, I noticed that the endometrial cavity was thin and fibrosed with evidence of adhesion. I asked her if she had had a miscarriage, she told me that she had never being pregnant since she got married. I now asked her if she had ever being pregnant before she got married, and what happened to her.
That was when she opened up and told me the whole story.
She was a virgin and had this boyfriend, after much pressure from the young man for some closer intimate moments with her, she finally gave in to keep the relationship. They had sex only once, but unfortunately for her she became pregnant.
In an effort to hide it from their parents , since they were not ready to get married yet and were very young, they both agreed to have an abortion.
They went to a clinic [qualified or not we cannot tell], and had the abortion, after that all was well. She separated from the young man , and had never had sex with any other man until she got married.
Now for seven years she could not get pregnant, she thought she was cursed. She had done many tests and all results were normal but no improvement in her situation. Until she came to me and I made my findings.

In this article , I want to assure you that I am not here to talk about pro abortion nor con abortion issues. I am not here to condemn anyone, nor discuss moral issues of abortion. That is not my place. I am only interested in discussing about infertility, the causes, diagnostic tests, treatments especially a simple assisted reproductive technique called Intrauterine Insemination [IUI].

INFERTILITY

Infertility is the inability to conceive after one year of regular, unprotected sexual activity or the inability to carry a pregnancy to term. Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, some which may be bypassed with medical intervention.
Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile during the rest of the menstrual cycle. Fertility awareness methods are used to discern when these changes occur by tracking changes in cervical mucus or basal body temperature. If a woman keeps having miscarriages, it is also called infertility. Lots of couples have infertility problems. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found. Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

A woman’s body must release an egg from one of her ovaries (ovulation).
The egg must go through a fallopian tube toward the uterus (womb).
A man's sperm must join with (fertilize) the egg along the way.
The fertilized egg must attach to the inside of the uterus (implantation).
Infertility can happen if there are problems with any of these steps.

There are strict definitions of infertility used by many doctors. However, there are also similar terms, e.g. subfertility for a more benign condition and fecundity for the natural improbability to conceive. Infertility in a couple can be due to either the woman or the man, not necessarily both.

Infertlity
A couple is considered to be infertile if:
the couple has not conceived after 12 months of contraceptive-free intercourse if the female is under the age of 34
the couple has not conceived after 6 months of contraceptive-free intercourse if the female is over the age of 35 (declining egg quality of females over the age of 35 account for the age-based discrepancy as when to seek medical intervention)
the female is incapable of carrying a pregnancy to term.

Subfertility
A couple that has tried unsuccessfully to have a child for a year or more is said to be subfertile meaning less fertile than a typical couple. The couple's fecundability rate is approximately 3-5%. Many of its causes are the same as those of infertility. Such causes could be endometriosis, or polycystic ovarian syndrome.

Primary vs. secondary infertility
Couples with primary infertility have never been able to conceive, while, on the other hand, secondary infertility is difficulty conceiving after already having conceived (and either carried the pregnancy to term, or had a miscarriage). Technically, secondary infertility is not present if there has been a change of partners.

CAUSES

What causes infertility?Infertility may be due to problems in the female, the male or a combination of both. In some cases, the cause is not known.Some common female factors that may cause or contribute to infertility include:

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Damage to the fallopian tubes following infection or surgery;
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Uterine fibroids;
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High levels of the hormone prolactin;
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Ovulation problems;
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Endometriosis;
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Pelvic inflammatory disease;
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Galactorhoea (milk leaking from the breasts).
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Amennorhoea (absence of periods).
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Hostile cervical mucus. This is a condition in which the cervical mucus creates a thick barrier that sperm cannot penetrate.
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Sexually transmitted diseases such as chlamydia;
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The production of sperm antibodies (when a woman develops antibodies to her partner’s sperm).

Others are

male associated infertility
age-related factors
uterine problems
previous tubal ligation
previous vasectomy
unexplained infertility
Tuberculosis (TB)

Recent research suggests that psychological issues, such as anxiety resulting from a lack of emotional support, can lead to hormonal problems that affect a woman’s fertility.
Male infertility is often caused by a low sperm count or an anatomical abnormality, such as a palpable dilation of veins in the scrotal area known as varicocoele. Other contributing factors can be attributed to how the sperm move (motility), or an abnormal sperm type. A few reasons for low sperm count include prolonged fever or a recent severe illness, excessive alcohol consumption, endocrine disorders, testicular injury and exposure to toxins, radiation or high heat.

Infertility Caused By Abortion

There is a risk of becoming infertile after an abortion, arising from various complications. If you have had a first trimester abortion (in the first 13 weeks) this is done by vacuum suction which can cause perforation of the womb. This is when the womb ruptures and causes internal bleeding. It is life threatening and the surgeon would be required to do additional surgery to repair the damage. Sometimes after this has occurred, the damage to the womb prevents another embryo from attaching. Rupture happens in about 1% of cases, so if 100 women had an abortion, one of them would have this problem.
The main abortion complications that could cause infertility:
90% of abortions are done in the first trimester. However, a late abortion frequently requires a material called laminaria to dilate the cervix. This makes the passage large enough to allow a suction tube to be inserted. The laminaria could weaken the cervix and conceivably cause infertility.
If the physician scrapes too hard, the lower lining of the uterus can be removed. This is extremely rare.
An untreated infection can scar the uterus and cause later fertility problems. The infection rate for first trimester abortions is less than 1%. Most women monitor their body temperature after an abortion to detect if an infection has occurred. Early detection should prevent any problems.
A woman who already have gonorrhea or chlamydia are very likely to suffer pelvic inflammatory disease which causes infertility. They are particularly susceptible to damage from PID after an abortion. This can be avoided by obtaining a STD test before the abortion.
The suction tube can perforate both the uterus and a large blood vessel or intestine. If the latter happens, then surgery may be required. The surgery can cause infertility. Perforation of the uterus is also quite rare. 2
It would seem that if the physician is competent, and the woman monitors her body temperature after the procedure, that the chances of an abortion causing later infertility is quite remote.

DIAGNOSTIC TESTS

[1] Ultrasound Scan

Ultrasound scan is a simple and easy outpatient procedure to examine the internal reproductive organs. It can clearly show the position and size of uterus, endometrial lining and the ovaries. Certain abnormal conditions such as fibroid, double uterus and ovarian cyst can be diagnosed through ultrasound scan alone. In addition, ultrasound scan can be used for the diagnosis of ovulation.
Ultrasound scan appears as a routine practice in the management of infertility, from the initial stages of diagnosis of the cause of infertility, to the eventual confirmation of pregnancy, including routine monitoring of early pregnancy. Ultrasound scan is probably the most important test in investigation of infertility. A well-preformed and detailed ultrasound scan of the female pelvis will give more information than any other single test.

[a] Transvaginal Scan for Uterine and Ovarian function
[b] Folliculometry [Follicular tracking]
[c] Sonohysterography [SonoHSG]

[2] HSG [X-Ray] Study to evaluate the uterine cavity and fallopian tubes

[3] Semen analysis
[4] Post-coital cervix test
[5] Sperm migration tests
[6] Ovulation tests
[7] Cervical mucus tests
[8] Hormone blood tests
[9] Uterus examination tests
[9] Fallopian tube examination tests
[10] Laparoscopy
[11] Laparotomy

Typically, couples are seen together when diagnosing infertility. The doctor will take a note of the couples' full medical histories and this will be followed by an examination. They will also be asked about the use of prescribed or illegal drugs, alcohol and tobacco, and whether there is a family history of infertility or genetic disorders.
Women can expect questions about their menstrual history, including the age of onset and any difficulties with menstruation. They also will be asked whether they have noticed milk leaking from their breasts.
Women may have to undergo a genital examination, as well as a cervical smear. Blood tests are taken to measure prolactin levels and thyroid function and sometimes to test for certain hormone levels, such as progesterone and oestradiol. A post-coital test, which is similar to a cervical smear, may be required to see if the sperm can penetrate the cervical mucus. Sometimes an ultrasound scan of the pelvis is taken to check for fibroids in the uterine cavity. A laparoscopy also may be performed, in which a lighted camera is passed through a hole in the abdomen to look at the pelvic structures. Occasionally, a hysteroscopy is required, in which a thin, lighted tube is passed into the uterus to directly examine it.
Men will be required to provide a semen analysis. They must abstain from sexual intercourse for three days before providing the sample. If the initial sample is abnormal, another will be required. The volume of semen, the sperm count, how the sperm move (motility), as well as the presence of immature sperm are checked. If the second sample is abnormal, your doctor may advise the man to have a genetic blood test is performed to make sure that there are no chromosomal abnormalities or defective genes that could be passed on to potential offspring. Blood tests also may be taken to determine levels of testosterone.

TREATMENT
Increasing your chances naturallyIf you have been having trouble conceiving do not give up hope, as spontaneous pregnancy may occur on its own. In many cases, couples are simply not having enough sex at the right time to conceive. To increase the chance of getting pregnant, intercourse should take place around the time of ovulation.
For women with a regular 28-day cycle, ovulation occurs around day 13-15. Women with irregular periods will find it more difficult to pinpoint their most fertile time. Some over-the-counter tests can help you determine the best time to conceive, although no products are guaranteed to be 100% accurate. Indications for ovulation include a rise in body temperature and a thinning of the cervical mucus. A female egg lives only twelve hours, however sperm can survive in the female genitals for close to 72 hours. Sperm that are waiting in the female genitals can immediately fertilise the eggs once ovulation begins so you will increase your chances by having regular sex for a few days before ovulation. Lubricants that contain spermicides, such as K-Y Jelly, should be avoided.
In situations where a woman develops antibodies to her partner’s sperm, the use of a condom for thirty days may allow time for the antibodies to decrease and intercourse should then take place during ovulation.
Infertility drugsIf timing intercourse around ovulation does not work, a general physician may then prescribe various courses of treatment, such as stimulating ovulation with a drug called Clomiphene. Side effects include hot flushes, vaginal dryness and ovarian cyst formation. The number of eggs that you release cannot be controlled precisely so there is a chance that several eggs could be released at once thereby increasing your risk of multiple pregnancyOther drug treatments include the use of either Bromocriptine or Cabergoline, which act to reduce the levels of prolactin. Check with your general physician about possible side effects of any drug prescribed.
What about assisted reproduction techniques?
There are several ways of bringing sperm and egg together to achieve fertilisation.
The most commonly performed procedures areIUI [Intrauterine Insemination], IVF (In vitro fertilisation) and ICSI (Intra cytoplasmic sperm injection).

INTRAUTERINE INSEMINATION
If you're having trouble getting pregnant, your doctor may recommend an intrauterine insemination (IUI) -- a relatively noninvasive and inexpensive way to boost your chances of conceiving.
With an IUI, your partner provides a sperm sample at home or in the doctor's office on the same day of the insemination. Then, his sperm are "washed" -- that is, the sperm are separated from the semen and concentrated; the washing also cleanses the sperm of potentially hazardous chemicals that could harm the uterus. The resulting liquid is placed in a thin soft tube and injected high into your uterus. This positions the sperm much closer to the fallopian tubes, where it will have to be for one of them to fertilize an egg.

If you don't have a male partner, or if your partner is unable to produce viable sperm, you can undergo the same procedure using frozen sperm purchased from a sperm bank.
The procedure takes only a few minutes. You may experience mild cramping, but it's usually brief and you can resume your activities immediately afterward.
Am I a good candidate for IUI?
The procedure works well for many women under 45 with certain fertility problems (whose partners have viable sperm), and for those in the same age group without male partners who are trying to get pregnant using donated sperm. Some infertility groups say it is less likely to work if women are over 42 or even 40. It's a common treatment for women who have ovulation problems or unexplained infertility, or whose partners have low sperm counts, poorly shaped sperm, or problems with sperm motility (ability to travel).
IUI is particularly appropriate when the woman has been prescribed clomiphene citrate (Clomid or Serophene) to stimulate ovulation, since this medication can result in cervical mucous that is thick and difficult for the sperm to swim through.
Fertility specialists don't usually advise women who have blocked fallopian tubes, severe tubal damage, or very poor egg quality to try IUI. They are also unlikely to suggest this treatment if a man has more than a mild problem with his sperm quality. It's standard to have a thorough fertility workup, including an evaluation for hormonal imbalances, infections, or blockages, before trying IUI.
Single women, couples where the man has no viable sperm, and couples using donor sperm are also good candidates for intrauterine insemination. Because donor sperm is often frozen and a woman's chances of getting pregnant are reduced using frozen -- as opposed to fresh -- sperm, IUI is a relatively easy way to boost the odds. It's more effective, say doctors, than using a plastic syringe to position the sperm on the cervix, a procedure known as intracervical insemination (ICI) that women generally do at home.
Will I need to take fertility drugs?
IUI is timed to occur in the most fertile period of your cycle, or ovulation. In some cases, women receive intrauterine inseminations without having to take drugs. Although there's no universal agreement, many fertility specialists feel women have a better chance of getting pregnant if they combine IUI with a drug that stimulates the ovaries to produce mature eggs. If you are having ovulation problems, your doctor may have you take an ovulation-stimulating drug, such as clomiphene, for several weeks before doing the IUI.
If you are injected with ovarian stimulation drugs, your doctor will need to monitor you carefully with blood tests and ultrasounds beginning on the sixth day of your cycle. Women taking these drugs are at risk of ovarian hyperstimulation syndrome (OHSS), a rare but potentially life-threatening condition marked by abnormal swelling of the ovaries and fluid collection in the abdomen.
What are the other risks of IUI?
Complications of IUI are infrequent, according to fertility experts. Besides the risks of combined IUI and fertility drug treatment, they include infection and the possibility of venereal disease. To lessen the risk of disease, fertility clinics should quarantine all frozen specimens of sperm for 180 days and retest the donor for HIV before releasing the sperm, according to the American Society of Reproductive Medicine. Although some fertility clinics offer fresh donor sperm, the society recommends against its use.
How long will it take to get pregnant?
Specialists recommend from three to six cycles of IUI before you consider moving to a more invasive or expensive treatment, such as in vitro fertilization (IVF).

IVF is only considered in special cases and is not suitable for everyone. In vitro candidates are women who have experienced pelvic disease, endometriosis or unexplained infertility. The process involves an intensive programme of hormonal treatments and harvesting of the eggs. The eggs are then mixed with sperm in a laboratory, (typically 1000,000 sperm to one egg to allow one or more embryos to form) after which the embryo is transferred to the uterus. The success rate varies, although the average is about 20-30%.

ICSI is often done if the sperm count is low or if sperm are unable to fertilise an egg. One sperm is injected directly into the centre (nucleus) of one egg using a very fine needle. In some circumstances if sperm cannot be obtained from semen they can be taken straight out of the testicles under an anaesthetic. This procedure is known as TESA (testicular sperm aspiration). ICSI has an average success rate of 35-40%.

GIFT (Gamete Intra-fallopian transfer) is less commonly used but is sometimes performed if there are cervical barriers to conception. IUI (Inta uterine insemination) where the sperm are flushed into the uterus via the cervix by means of a fine catheter is also occasionally done.

Can complementary therapies help?
Herbs that may enhance sexual functioning in men include damiana, ginseng, sarsaparilla and saw palmetto. Damiana, dong quai, ginseng, gotu kola and wild yam root may enhance sexual function in women. Most of these herbs are available in tablet form from health food shops but you should consult a qualified herbalist and check with your GP before taking them.

As anxiety may contribute to infertility, incorporate stress management techniques into your daily routine.
The importance of preconceptual careIf you are trying to get pregnant, regardless of the method, you should drink only in moderation, do not smoke and avoid any drugs other than those prescribed by your physician. Exercise only lightly and avoid hot tubs and saunas, as they may lead to a lowered sperm count or changes in ovulation. Be sure to get plenty of fresh fruit and vegetables into your daily diet, as they contain folic acid, which helps prevent neural tube defects in the baby. Maintain an appropriate body weight, as being over- or underweight can affect fertility. Also, make sure you receive a rubella vaccination if you have not already had one. It is important to note that pregnancy should be avoided for three months after a rubella immunisation.

JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria, offer comprehensive infertility screening tests for both couples like Transvaginal Scan for uterine and ovarian functions,Ovulation/follicular tracking, HSG to evaluate the fallopian tubes, blood tests for hormone check, semen analysis etc. We also offer a simple assisted reproductive procedure like INTRAUTERINE INSEMINATION [IUI].
For accurate assessment of your fertility situation, contact us at JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria.

Regards
Dr. Victor Efughi
Consultant Clinical Specialist Sonographer

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