Friday, April 15, 2005

Medical Treatment of Varicocele

Last updated / published 4/15/2005


Varicocele and infertility

Varicocele is a finding in men where enlarged or dilated veins occur in the blood vessels of the scrotum. Normally the scrotal veins have valves that regulate the blood flow. However, in some cases, the valves are absent or defective and the blood does not circulate out of the testicles efficiently. This results in swelling of the veins above and behind the testicles. 85% of varicoceles develop in the left testicle.

It is estimated that varicoceles are present in about 20% of the normal male population and up to 40% of an infertile population. It is uncertain how varicoceles may cause infertility. Some evidence points to the increased temperature of the blood raising the temperature of the testes, which then damages the sperm. Heat can damage or destroy sperm. The increased temperature may also impede production of new, healthy sperm. Another theory is that in men with varicocele, the testicular fluid which carries sperm has an increased concentration of chemicals which can damage sperm. The chemicals are called reactive oxygen species or ROS.

Previously, varicoceles have been treated using various types of surgical procedures.

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Friday, April 08, 2005

Smoking reduces IVF Pregnancy Rates

In a study about to be published in the journal Human Reproduction, infertile women who smoke were found to have lower pregnancy rates and higher miscarriage rates during treatment with in vitro fertilization - IVF.

Smoking reduced IVF pregnancy rates

Danish researchers looked at 8,457 women aged 20 to 40 who had had in vitro fertilization treatment. The patients were divided into four groups, depending on the cause of each couple's fertility problems; male fertility disorder, fallopian tube problems, other clinical explanations - such as polycystic ovaries or endometriosis, or unexplained fertility problems.

Overall, the live birth rate for smokers was 28% lower than non-smokers. Among women with unexplained infertility, the live birth rate was a third lower for smokers, at 13% compared to 20% for non-smokers. This is the same effects as would be seen for women who were ten years older. In other words, a 35 year old woman who smokes would have the pregnancy rate a 45 year old.

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Saturday, April 02, 2005

Folic acid does not increase risk for twins

A recent study has disproved the notion that the use of folic acid supplementation increases the risk for twinnning.

Folic Acid prevents birth defects

For some time now, I have been recommending that women who are attempting to become pregnant should take 1000 micrograms of folic acid daily to reduce the risk of having a baby with birth defects. The birth defects are known as neural tube defects and include such problems as spina bifida and anencephaly. Recent data have shown that since these recommendations have gone into effect that the rate of neural tube defects has dropped significantly.

Folic acid, also called folate is a B vitamin found in foods such as spinach and other leafy greens, beans and orange juice. Despite the addition of folic acid to many breakfast cereals, breads and other grains, many women have a difficult time getting the required amound on a daily basis. Thus, prenatal vitamins containing folic acid have been recommended. In the United States, fortifiaction of foods has been required since 1998.

Folic acid and twinning

Some studies have suggested that the rate of twinning has risen since the introduction of fortification. The largest effect was reported in a Swedish study that reported a 45% increase in multiple gestation if a woman use folic acid before pregnancy. However, several studies since 1999 have attributed the increase risk to the greater use of fertility treatments and not from the use of folic acid itself.

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Blood test to predict tubal damage

A recent study published in the journal Fertility and Sterilityindicates that a combination of inexpensive blood tests can predict the presence or absence of tubal damafe from chlamydia infection with fairly good accuracy.

Chlamydia Background information

Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium, Chlamydia trachomatis. Chlamydia infection is extremely common. Chlamydia is the most common sexually transmitted infection in the United States. The Center for Disease Control estimated that 2.8 million Americans are infected with chlamydia each year.

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during childbirth. Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection.

About 75% of infected women and about 50% of infected men have no symptoms of chlaymida infection. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure. Women who do have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods.

Chlamydia can cause infertility

In women, untreated infection can spread into the fallopian tubes and cause the tubes to become blocked at the very ends (distal tubal obstruction). They can also develop scar tissue around the fallopian tubes that makes it more difficult for the tube to "pick up" the egg at the time of ovulation. The problems can lead to infertility and an increased risk for ectopic (tubal) pregnancy.

Distal tubal obstruction can be detected by performing a hysterosalpingogram. Pelvic adhesions, however, can only be detected by undergoing a surgical procedure to look inside of the abdominal cavity. This is usuaully done using a technique called laparoscopy where a fiber optic telescope is inserted through the belly button under general anesthesia. Since laparoscopy is a much more invasive procedure, it is desirable to avoid it whenever possible.

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