Authors: Stacey Chillemi,Dr. Michael Chillemi D. C.
Hormone testing:
A blood test to determine the level of testosterone and other male hormones is common.
Tests for women
Confirmation of ovulation:
A blood test is sometimes performed to determine the levels of hormones involved in successful ovulation.
Hysterosalpingography:
This test evaluates the condition of your uterus and fallopian tubes.
Laparoscopy.
Performed under general anesthesia, this surgical procedure involves inserting a thin viewing device into your abdomen and pelvis to examine your fallopian tubes. Laparoscopy generally is done on an outpatient basis.
Basal body temperature:
Although this test was once a standard, basal body temperature charting is used less often today. Charting a woman's body temperature doesn't give as precise time of ovulation as earlier believed.
Urinary luteinizing hormone (LH) detector kits:
A number of at-home kits are available to test your LH level.
Ovarian reserve testing:
Testing may be done to determine the potential effectiveness of the eggs after ovulation. This approach often begins with hormone testing early in a woman's menstrual cycle.
Unexplained infertility
In some infertile couples, no specific cause is found. Even though infertility is unexplained, the pregnancy rate for these couples is among the highest.
Treatment
Treatment of infertility depends on the cause, how long this has been going on, the age of the people and other factors. Some causes of infertility can't be corrected. However, various means of insemination or embryo transfer may be possible so that a woman can still become pregnant.
Fertility drugs (ovulation induction) include:
Clomiphene citrate (Clomid, Serophene):
This drug is taken orally and stimulates ovulation in women who have PCOS or other ovulatory disorders. It causes the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
Human menopausal gonadotropin or hMG (Repronex, Pergonal):
This injected prescription medication is for women who don't menstruate on their own due to the failure of the pituitary gland to stimulate ovulation. Unlike clomiphene, which stimulates the pituitary gland, hMG and other gonadotropins directly stimulate the ovaries. This drug contains both FSH and LH.
Follicle - stimulating hormone or FSH (Gonal-F, Follistim, Bravelle):
FSH is essentially hMG without the LH. Like hMG, it works by stimulating the ovaries to mature egg follicles.
Human chorionic gonadotropin or HCG (Ovidrel, Pregnyl):
Used in combination with clomiphene, hMG and FSH, this drug stimulates the follicle to release its egg (ovulate).
Gonadotropin-releasing hormone (Gn-RH) analogs:
This treatment is for women with irregular ovulatory cycles or who ovulate prematurely — before the lead follicle is mature enough — during hMG treatment. Gn-RH analogs deliver constant Gn-RH to the pituitary gland, which alters hormone production, so that a physician can induce follicle growth with FSH.
Letrozole (Femara):
This drug is in a class of medications called aromatase inhibitors, which are approved for treatment of advanced breast cancer. Doctors sometimes prescribe letrozole for women who don't ovulate on their own and who haven't responded to treatment with clomiphene citrate. Letrozole is not approved by the U.S. Food and Drug Administration for inducing ovulation. The drug's manufacturer has warned doctors not to use the drug for fertility purposes because of possible adverse health effects. These adverse effects may include birth defects and miscarriage.
Metformin (Glucophage):
This oral drug is taken to boost ovulation. It's used when insulin resistance is known or suspected.
Bromocriptine:
This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.
Surgery
Surgery may be a treatment option for infertility. Blockages or other problems in the fallopian tubes usually can be surgically repaired. Laparoscopy allows delicate operations on the fallopian tubes.
Infertility due to endometriosis often is more difficult to treat. Although hormones such as those found in birth control pills are effective for treating endometriosis and relieving pain, they
have not been useful in treating infertility. If you have endometriosis, your doctor may treat you with ovulation therapy, in which medication is used to stimulate or regulate ovulation, or in vitro fertilization, in which the egg and sperm are joined in the laboratory and transferred to the uterus.
Assisted reproductive technology (ART):
ART has revolutionized the treatment of infertility. Each year thousands of babies are born in the United States as a result of ART. Medical advances have enabled many couples to have their own biological child. An ART health team includes physicians, psychologists, embryologists, laboratory technicians, nurses and allied health professionals who work together to help infertile couples achieve pregnancy.
The most common forms of ART include:
In vitro fertilization (IVF):
This is the most effective ART technique. IVF involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization. IVF often is recommended as a first-line therapy and is the treatment of choice if both fallopian tubes are blocked. It has also widely used for a number of other conditions, such as endometriosis, unexplained infertility, cervical factor infertility, male factor infertility and ovulation disorders.
Electroejaculation:
Electric stimulus brings about ejaculation to obtain semen. This procedure can be used in men with a spinal cord injury who cannot otherwise achieve ejaculation.
Surgical sperm aspiration:
This technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if blockage is present.
Intracytoplasmic sperm injection (ICSI):
This technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilization.
Assisted hatching:
This technique attempts to assist the implantation of the embryo into the lining of the uterus.
ART works best when the woman has a healthy uterus, responds well to fertility drugs, and ovulates naturally or uses donor eggs. The man should have healthy sperm, or donor sperm should be available. The success rate of ART gradually diminishes after age 32.
Certain complications exist with the treatment of infertility. These include:
Multiple pregnancies:
Although the most common complication of ART is multiple pregnancies, ART isn't the direct cause of a number of the extreme cases of septuplets or octuplets reported in the media. The number of quality embryos kept and matured to fetuses and birth ultimately is a decision made by the couple. If too many babies are conceived, the removal of one or more fetuses (multifetal pregnancy reduction) is possible to improve survival odds for the other fetuses.
Ovarian hyperstimulation syndrome (OHSS):
If over stimulated, a woman's ovaries may enlarge and cause pain and bloating. Mild to moderate symptoms often resolve without treatment, although pregnancy may delay recovery. Rarely, fluid accumulates in the abdominal cavity and chest, causing abdominal swelling and shortness of breath. This accumulation of fluid can deplete blood volume and lower blood pressure. Severe cases require emergency treatment. Younger women and those who have polycystic ovary syndrome have a higher risk of developing OHSS than do other women.
Bleeding or infection:
As with any invasive procedure, there is a risk of bleeding or infection.
Low birth weight:
The greatest risk for low birth weight is a multiple pregnancy. In single live births, there may be a greater chance of low birth weight associated with ART.
Birth defects:
Significant concern exists regarding the possible relationship between ART and birth defects. More research is necessary to confirm these findings. Weigh this factor if you're considering whether to take advantage of this treatment. ART is the most successful fertility-enhancing therapy to date.
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With so many things going on in our daily lives, it is normal to forget things. Everyone forgets things. How many times have you misplaced something? How many times have you put something in a safe place and forgot where the safe place was at? Forgetfulness tends to increase with age, but there is a big difference between normal memory-loss and the type of memory loss associated with a medical condition
Normal that is age-related does not prevent you from living a happy, healthy, and productive life. You just need more time to remember a name or the task you had set out to do. You are aware that you're forgetful and may even crack a joke about it and laugh with your friends about being forgetful.
Causes
Taking too much of a medication (overmedication). Overuse of medications may be the single biggest cause of memory loss or confusion in older adults.
Alcohol and medication interactions: This is a problem, especially for older adults, who may take many medications at the same time.
Misusing or abusing a medication or alcohol.
Drug intoxication or the effects of withdrawal
A head injury
Decreased or blocked blood flow to the brain.
A seizure disorder
Brain tumors
Medical Conditions
Memory loss that begins suddenly or that significantly interferes with your ability to function in daily life may indicate a more serious problem.
Dementia
is a slow decline in memory, problem-solving ability, learning ability, and judgment that may occur over several weeks to several months. Many health conditions can cause dementia or symptoms similar to dementia. In some cases, dementia may be reversible. This is the most common cause of dementia in people older than age 65.
Dirium
is a sudden change in how well a person's brain is working (mental status). Delirium can cause confusion, disruption of the sleep-wake cycles, and unusual behavior. Delirium can have many causes, such as withdrawal from alcohol or drugs or medications, or the development or worsening of an infection or other health problem.