Abnormalities of Reproductive Anatomy Encountered in Infertility and Its Effect on Treatment Outcome - Essay Example

It is known that about 15% of married couples are infertile and can't have children. About 60% of infertility causes are connected with inadequate ovulation, cervical factors and/or blocked fallopian tubes. About 42% of infertility is connected with male problems such as bad sperm functioning, abnormal structure of sperm and inadequate sperm counts. But there are more serious reproductive abnormalities which can lead to infertility and than to long period of treatment. Unfortunately the IVF success is not very high, because many of reproductive problems significantly decrease the chances to have the child. It is rather difficult to absolutely recover from serious abnormalities whereas some abnormalities are inherited and/or incurable. The guideline of the paper is to describe reproductive abnormalities of males and females and to evaluate IVF success. Infertility: Abnormalities of Reproductive Anatomy Introduction: abnormalities and their affect on treatment It is known that general reproductive abnormalities fall the following categories such as gonadal, chromosomal, hermaphroditism, external genitalia, tract abnormalities, gonadal dysfunction, gonadal descent. It is mentioned that some reproductive abnormalities are connected with gonad development that can affect the later sexual development either of man or woman. Gonad development can lead to infertility. Other reproductive abnormalities are connected with external genitalia and the tract which can also be caused by gonadal abnormality. (Carlsen 1992) Abnormalities do make the treatment process more complication and log-lasting, because it is necessary to cure abnormality firstly and only then start curing infertility. Abnormalities do slow the process of recovery. The success of treatment depends absolutely on the professionalism of doctors and the patient as well. Reproductive abnormalities and infertility It is necessary to point out that infertility is inability to have children for men and to become pregnant for women or to carry pregnancy. Normal healthy couples are said to have about 25% chance to have a child each month. It is reported that 95% of normal couples achieve pregnancy within a year. It is more difficult for women from 30-35 to become pregnant and the possibility considerable decreases from 35 years. It is known that about 15% of married couples are infertile and can't have children. About 60% of infertility causes are connected with inadequate ovulation, cervical factors and/or blocked fallopian tubes. About 42% of infertility is connected with male problems such as bad sperm functioning, abnormal structure of sperm and inadequate sperm counts. But there are more serious reproductive abnormalities which can lead to infertility and than to long period of treatment. (Holbrook 1990) Unfortunately the IVF success is not very high, because many of reproductive problems significantly decrease the chances to have the child. It is rather difficult to absolutely recover from serious abnormalities whereas some abnormalities are inherited and/or incurable. (Carlsen 1992) Female infertility is told to account one-third of infertility cases. The infertility rate is about 15% whereas some cases are unexplained infertility. A couple is considered to be infertile if: 1. If they haven't conceived a child after a year of unprotected sexual relations or after half a year in case if woman is over 35. The rapid decline of fertility for women is after 35. 2. If woman is incapable to carry a child to the set term. Male infertility: reproductive abnormalities The risk of men's infertility can be increased by such factors as drug use, alcoholic drinks, tobacco smoking, health problems, medicines, age, radiation treatment, environmental toxins (lead and pesticides). (Goldstein 1999) Male reproductive abnormalities may lead to lower chances to have a child. It means that for example dysfunctional activity of sperm can result in diminished ability to impregnate the ovum. It is necessary to mention that chromosomal abnormalities play significant role in fertility. Chromosomal abnormalities in males involve abnormalities of testicular development and abnormalities connected with ejaculatory tract. The main reproductive abnormalities are described below: (Goldstein 1999) Poor sperm production Doctors note that about 90% of male infertility resulted from poor sperm production. Such abnormality occurs when sperm is not produced in enough qualities or is not produced at all. It is obvious that the more sperm there are the more chance to impregnate the ovum. Doctors admit that when total account of sperm is less than 5million per ml it doesn't mean that man is infertile if the sperm is healthy, mobile and well-formed. During last years the sperm count had been steadily declining. The main reason is that obese, fatness and unhealthy nutrition. Healthy formation of sperm requires steady supply of nutrients (fruits, vegetables, vitamins). Other possible reasons are increased temperature in scrotum, environmental factors such as air pollution and high levels of heavy metals, variciceles, etc. (Goldstein 1999) Varicocele It is noticed that "a varicose vein around one of the two spermatic cords can cause blood to pool in the testes; this, in turn, causes the temperature to increase in this area.". (Goldstein 1999) In the result higher temperature significantly diminish production of sperm and may lead to infertility. But such problem is easily cured by surgery intervention. And after certain time period the couple's IVF success is very high. But there is a question: what is varicocele and how is it caused All men have structure which contains veins, arteries, tubes and actually nerves. And the structure is called spermatic cord that provides interconnection and is responsible for blood circulation to and from testicles. Veins are known to carry the blood that flows from the body back towards the heart. Vein valves keep the blood "one way and stop it from flowing backward". To say in other words, the mentioned vein valves are responsible for regulation the blood flow of a person and they endure the right flowing of the body. Unfortunately, these valves can fail and blood can flow in opposite direction. And what is the result The reversed blood flow may collect in pools in the veins and lead to venous congestion called varicocele. (Dowshen 2004) A man in some cases may not be aware that he has problems with reproduction, because varicocele may have no symptoms at all. However if symptoms are present they occur predominantly in hot weather, during heavy exercise and long sitting or standing. The main symptoms are the following: Feeling of dragging in the scrotum Dull ache in testicles Discomfort in the testicles Dilated veins make the testicle smaller because of different blood flow There is no way to prevent such abnormality and it usually doesn't need special treatment or surgery intervention. Such disease is usually harmless and can be treated. In most cases varicocele doesn't affect men's ability for reproduction, but in hard cases varicocele can damage the testicle and in such a way can significantly decrease production of sperm. In hard cases surgery is recommended. (Dowshen 2004) Infections It is known that 27-72% of male infertility is caused by infections of reproductive organs. For example, antibodies are able to destroy the sperm and they are indicators of infection. The most serious infection is chlamydia trachomastis, because it damages the epidermis. The disease is commonly sexually transmitted and is treated with antibiotics. After recovery from infection males are able to have children and IVF success is high as well. (Goldstein 1999) Ejaculatory disorders Main ejaculatory disorders are: Delayed ejaculation Premature ejaculation Painful ejaculation Duct obstruction Ejaculation disorders are separated into those that concerns premature ejaculation and delayed ejaculation. Premature ejaculation can be also called uncontrolled ejaculation or "persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it". Premature ejaculation is inability to delay the ejaculation and to allow woman to reach orgasm. Such abnormality is common among 50% of couples encountered in sexual relations. The first thing to handle with premature ejaculation is to accurately diagnose the patient, because the consequences can be different. Premature ejaculation may affect the ability to have a child, although such disorder is not too serious or dangerous. (Goldstein 1999) Delayed ejaculation is called retarded ejaculation. According to some sources delayed ejaculation occurs in 4% of males with sexual dysfunctions. Retarded ejaculation is inability to reach ejaculation despite strong sexual desire, erection and sexual stimulation. Delayed ejaculation also affects the reproductive function and has to be treated. Delayed ejaculation can be caused by prostatitis as the side effect. Painful ejaculation means ejaculating physically normal without pleasure and/or with painful feelings. Doctors say that "because the issue of diminished sexual desire cannot currently be defined on a hormonal level, a serum testosterone level should be obtained in all patients". The testicles failure is more frequent in older men than in younger. Men may complain of scrotal and perineal pain after ejaculation. It is a matter of fact that such pains may result in diminished chances of reproduction. Such condition can be inflammatory, physiological or obstructive and usually occur with epididymitis, urethritis or prostatitis after vasectomy. (Goldstein 1999) Men that have less sexual desire are not physiologically disturbed in some cases. The main problems connected with loss of sexuality are probably chronic illnesses, traumas, thyroid disorders, congenital abnormalities, pituitary disorders, etc. such disorders represent little psychological difficulty, but it has be treated anyway. Duct obstruction It means that spermatic tunes are blocked or damaged. Such abnormality is usually caused by sexually transmitted disease, congenital abnormalities and different infections of reproductive organs. Duct obstruction in hard cases can lead to male's infertility and chances to have a child may significantly decrease. Duct obstruction can be caused by the following: Stones in the duct Prostate or other serious infections Congenital cysts Congenital abnormalities of the vas Urological surgery while treating prostate (Goldstein 1999) Pseudo duct obstruction occurs when the semen are going back into the bladder. Such disorder is caused by weak musculature of the bladder that serves as sphincter while ejaculating. Such disorder is called retrograde ejaculation and is usually caused by urological surgery via the prostate. Doctors note that "the prostatic pressure against a constricted external sphincter preferentially diverts the ejaculate into the bladder, when the bladder neck is weakened". Duct obstruction may have no symptoms like varicocele or the symptoms may be dramatic. For example, a guy can notice less sperm production or the expulsion of semen is less forceful. In some cases men may see no semen at all during ejaculation. The most common symptoms are pains in testicles and groin pains. In some cases guys feel pain in the upper inner thigh. It is recommended not to think about sexual relations, because sex and thoughts about it can increase pain and discomfort. (Goldstein 1999) There are several possible ways how to treat duct obstruction: 1. Resection of ducts 2. Amplification of the ducts 3. Washing out of the ducts 4. Prostatic massages The chances to improve semen quality are rather high - 50-80%. If the quality of semen is improved, the probability of pregnancy is about 50%. During the surgery treatment the risk of infection and bleeding is not high - about 1%. There are practically no complaints concerning the procedure. (Daniels 1993) Other possible reasons of male infertility are: Abnormal development of tests caused by inflammation Disorder connected with coital Undescended testicles Chromosomal abnormality Disorder of glands Female infertility: reproductive abnormalities Firstly it is necessary to say the infertility is more frequent in women than in men. Infertility causes not only health problems, but also psychological stresses, because in some cases IVF success is very low or even impossible. Women suffer greatly from infertility, because their predestination is to become mothers. Infertility is caused in many cases by reproductive abnormalities and diseases. (Daniels 1993) The risk of women's infertility can be increased by such factors as constant psychological stresses, age, hard athletic training, poor diets, weight: overweight and underweight, smoking, drinking alcohol, sexually transmitted diseases, health problems and hormonal changes. Polycystic ovarian disease Such disease is usually caused by ovulation disorders and is characterized by "by the presence of many minute cysts in the ovaries, by excess production of androgens, and by infrequent periods (obliomenorrhoea) or absent periods (amenorrhoea)". (Inhorn 2002) Doctors say that inability to ovulate is the most spread reason of women infertility mostly resulted from psychological stresses, different disorders and diseases of reproductive organs, hormonal imbalance, etc. (Carlsen 1992) Pelvic Inflammation Such disease may lead to infertility caused by blockage and/or damaging of fallopian tubes. The inflammation is usually caused by transmitted sexually diseases, early abortions, intrauterine device, birth of child and miscarriages. Pelvic inflammation is caused by infection in the upper reproductive tract: uterus, ovaries or fallopian tubes. Such infection is also sexually transmitted that can develop without obvious causes. Pelvic inflammations can be either chronic or acute. Such disorder is common in sexually active and young women. If not treated pelvic infection can lead to damage of the fallopian tubes and in such a way to infertility. Nevertheless the infection is not quickly spread. The main symptoms of the inflammation are: (Carlsen 1992) Abdominal painful feelings Strong pains during menstruation: vomiting, nausea Painful urinations Cervical discharges Abnormal vaginal discharges Ovulatory dysfunction The mentioned problem occurs when female's ovaries don't produce ovum or produce less eggs than earlier. The possible reasons are age, inflammations, infections, hormonal imbalance, etc. (Carlsen 1992) Serious abnormality is considered to be immunological infertility, when female's system produces "anti-sperm antibodies which destroy her partner's sperm". (Inhorn 2002) There are many factors that can prevent the process of ovulation. Some factors are easily detected and treated, other are not. Nevertheless, such abnormality can be overcome in most cases. It is the hormonal dysfunction that causes infertility: hypothalamic, pituitary, thyroid. Hypothalamic is told to be the "master gland of reproduction". The hypothalamus secrets stimulate the release of the gonadotropin. It is necessary to say that abnormalities of the secrets can affect the menstrual cycle and can lead to female's infertility. The possible reasons are drugs, loss of weight, tumors and psychological stresses. The most spread pituitary problem is connected with adenoma or tumor. Such abnormality causes menstrual problems and slows down the secretion from hypothalamus. Hormonal imbalances can affect significantly the female's menstrual cycle and dysfunction of thyroid ("butterfly-shaped organ in the front of the neck"). Thyroid dysfunction can cause infertility and menstrual abnormalities. (Carlsen 1992) An under-active thyroid can cause mainly menstrual abnormality and irregularity, less sexual desire, diminished chances to have children. In other words thyroid problems can lead to infertility if not treated. The common symptoms are constipations, significant weight gains, increased fatigue, decreased sexuality, and decreased heart rates. An over-active thyroid affects women's fertility, because women suffer from menstrual dysfunctions, heart palpitations, irritation, constant loss of weight, increased perspiration. The increased pregnancy loss is reported in women with anti-thyroid antibodies. (Carlsen 1992) Endometriosis Such abnormality may occur when "the tissue which lines the uterus (the endometrium) grows into growths or lesions outside of the uterus". Mainly the growth is on the fallopian tubes, ovaries, ligaments supporting the woman's uterus. Like menstrual cycle the tissue is building up, breaking down and shedding every month. Unfortunately it is impossible to remove it from the body. Endometriosis results in internal bleeding, breakdown of tissues and internal inflammation accompanied by constant pains and infertility. Doctors say that the cause of such disorder is still unknown. (Bellina 1986) Pelvic adhesions are mainly caused by surgery, infections and occur when scar tissue is formed between two internal organs. Pelvic adhesions can lead to infertility, because this tissue will strongly affect fallopian tubes and ovaries. Prenatal exposure to DES is connected with high risk for reproductive tract abnormalities, tract cancer, menstrual problems, and repeated miscarriages. It is necessary to mention uterine fibroids, because they occur in 40% of females and they can affect in vitro fertilization and fetal growth. (Infertility 2006) The quality of ovum begins to diminish after 30 years and it is apparently difficult for women to become pregnant and to carry fetus during nine months. If woman is older than 30 years of age her ovum is likely to have chromosomal abnormalities. It is seen that age is also affecting the possibility to have a child. Female infertility can be also caused by general factors involving adrenal disease, diabetes mellitus, kidney or liver disease, different psychological factors. Unexplained infertility Doctors say that approximately in 15% of cases there are no abnormalities, although the couple is not able to have a child. Abnormalities do present, but they can't be detected by current methods used in infertility investigations. The problems can be the following: Ovum isn't released at the time necessary for fertilization Ovum may not enter the fallopian tubes Sperm isn't able to reach the ovum Fertilization can't take place Transportation of zygote may be disturbed Implantation fails (Infertility 2006) The critical importance for women is ovum quality. Infertility can be caused by the fact the female's ovum is of reduced capacity for successful fertilization. There are cases when both woman and man are infertile or sub-fertile. The infertility of the couple is told to arise from the combination of such conditions. There are cases when infertility is genetic or immunological. It means that woman and man are fertile, but together they can't conceive a child without medical assistance. (Infertility 2006) Conclusion: treatment and IVF success In conclusion it is important to admit that success depends on qualified medical help and in some cases surgery. The possible ways of treatment are: 1. Fertility drugs used to stimulate ovulation. Women should be aware that fertility drugs are painful, because they are usually injected into the muscle and are difficultly administered without any help. Fertility drugs are useful as they increase possibility of IVF up to 50%. Fertility drugs stimulate the ovaries and release ovum. (Infertility 2006) 2. Intravenous insemination is the case when sperm is injected into the uterus of woman. Such procedure means that woman is artificially inseminated with the male's sperm. 3. Surgery in order to restore fallopian tubes obstruction. IVF (in vitro fertilization): During in vitro fertilization the female's ovum is removed, fertilized and than again is placed into the uterus. In vitro fertilization bypasses the fallopian tubes. There are some variations of the IVF: (Infertility 2006) Using ovum or sperm of donors in IVF. It happens when sperm or ovum is unusable or with the purpose to avoid genetic diseases. Intracytoplasmic sperm injection is used to inject single sperm into the ovum and then fertilized egg is placed in wome's uterus. Zygote intrafallopian transfer is used to to remove ovum from female, to fertilize it and to place it into fallopian tubes. Gamete intrafallopian transfer is used to remove ovum from female and then to place it into fallopian tube along with male's sperm. Such procedure allows fertilization to occur in female's body. Assisted hatching, fertility preservation, freezing of ovum or sperm, transfer of frozen embryo. (Infertility 2006) Alternative treatment involves acupuncture (increase the IVF success by as much as 60%; effective in treatment anovular infertility in women); healthy diet and supplements, healthy lifestyle. Such method is commonly used when couple has reproductive abnormalities and in some cases IVF is the only way to become pregnant and to have a child. But IVF is not absolutely successful, because everything depends on the female's organism. Surgical operations provide only 50% of success. IVF success rates vary and they depend on many factors. The factors affecting the IVF success include: Age of both partners Reasons for infertility If the ovum is fresh or not The success rates for fertility clinics: About 37% in females under 35 About 30% in females of 35-37 About 20% in females of 37-40 About 10% in females over 40 (Infertility 2006) References Battersby, Christine. (1994). Gender and Genius: Towards a Feminist Aesthetics. London: The Women's Press. Beck, Ulrich. (1992). 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Stress, coping, and social support processes: Where are we What next Journal of Health and Social Behavior (Extra Issue), 53-79. Read More