Friday, October 9, 2009

By: Sunita Kulshrestha, MD, FACOGSometimes, men and women who conceived one or more children without medical

By: Sunita Kulshrestha, MD, FACOGSometimes, men and women who conceived one or more children without medical assistance are surprised to discover that they are having difficulty conceiving again. This type of infertility is called secondary infertility, defined as the inability to get pregnant after having had a previous pregnancy. The previous pregnancy (ies) may have ended in abortion and miscarriage, or a woman delivery.A which is under the age of thirtyfive years should see a specialist if he fails to conceive within the first twelve months of trying to conceive. If more than thirtyfive or if she needed fertility treatment to her first pregnancy, you should seek help if you have not conceived in the first 6 months, or sooner if you or your partner have a known fertility infertility is problem.Secondary often inexplicable. Sometimes, all the historical factors and tests are normal and there is no identifiable cause of infertility. Although a previous pregnancy implies that in a moment in time, egg quality, sperm quality, ovulation, when egg sperm exposure, factors, and the state of the uterine tubes (with at least one open tube ) were normal, these factors may change. A new partner may have a fertility problem or the woman may have had prior tubal ligation or the male may have had a vasectomy.As a woman ages, the quality of your eggs decline. This decline accelerated after the age of thirtyfive years and becomes even faster after age forty. Older women also have eggs that are more likely to have chromosomal abnormalities. Both factors can reduce the chances of achieving pregnancy and increase the chances of the first miscarriage.Ovulatory models may change over time. Ovulation can be affected by extreme stress, weight, diet and exercise. Other hormonal abnormalities may develop, including abnormalities of the thyroid gland, an overproduction of the hormone prolactin and the exacerbation of polycystic ovary syndrome.With time, some women develop fibroids (benign smooth muscle nodules in the uterus) or enlarge existing fibroids. Women may also have endometrial polyps. Fibroids or polyps can affect fertility if they involve the uterine cavity. If a woman has had any instrumentation or surgery on the uterus (including dilation and curettage for a miscarriage or an abortion), or a complicated delivery, may develop intrauterine adhesions (scar tissue) inside the uterus. The possibility of developing scars in the uterus of any of these procedures, however, is quite low.Fallopian tubes can be blocked if any inflammatory process involving the pelvis. This occurs primarily in the context of a pelvic infection (most often chlamydia, gonorrhea or PID (pelvic inflammatory disease). Any surgical procedure in the abdomen or pelvis (such as appendectomy, myomectomy (removal of fibroids) and tubal surgery can cause pelvic adhesions (scarring), and these adhesions can cause obstruction of the tubes. Some women have endometriosis, a progressive disease that can also cause pelvis.At new accessions in the same age, man has an equivalent decrease in sperm quality. However, some men can develop with age varicocele (dilation of blood vessels in the scrotum). This can affect sperm quality. In addition, the semen is much more sensitive than eggs are environmental factors and these factors may have changed. spermatozoa may be negatively affected by certain medications, medical problems, fever, viral diseases, excessive alcohol consumption and exposure to the woman he thinks he has heat.A secondary infertility should consult a doctor who is an expert in fertility. Given this situation, the doctor may order tests to include an assessment of ovarian reserve (egg quality), a semen analysis, hormonal evaluation and an assessment of anatomy (uterus or fallopian tubes). The treatment is based on first identifying the cause and try to correct it. Possible treatments can be as simple as lifestyle changes (adequate weight loss, reduce excessive consumption Alcohol, smoking cessation and / or stress management). If tests show a hormonal problem, oral medications can be taken to help restore normal hormone balance and to induce ovulation. If a woman is in advanced reproductive age or has diminished ovarian reserve (problems with egg quality or response to drugs), which could be aggressive and IVF (if possible) or use donated eggs and embryos have been transferred to your account uterus. insemination in vitro using donor eggs is an effective tool to avoid the problem of ovarian aging.If a woman has tubal disease or have had a tubal ligation in the past, IVF skips the need for open tubes. The role of the probe is to collect and fertilize eggs. In IVF, eggs are collected in a procedure called egg retrieval and fertilization occurs in a laboratory dish. surgical correction of diseases tubes may also be an option in selected cases. fibroids, polyps, intrauterine adhesions can be managed surgically.For unexplained infertility, the goal is to improve the efficiency of the design process. This can be achieved through: 1) Superovulation, a technique that allow the release of more than one egg, 2) intrauterine insemination, in which a higher concentration of sperm is delivered closer to the egg, and 3) in vitro fertilization (IVF), which normally fertilized eggs (embryos) be replaced directly to a receptive uterus. Of all these techniques, IVF offers the best success rates.Conversely, if a problem is identified with sperm, the modalities may include a urologic evaluation and intrauterine insemination (IUI) in the case of a mild problem or fertilization in vitro with intracytoplasmic sperm injection (IVF / ICSI) with moderate to severe problems. If man had a vasectomy after IVF / ICSI can be performed with an NSA (nonsurgical testicular sperm aspiration). In IVF / ICSI, only normal sperm is needed for each egg. br br