American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
SPERM DNA FRAGMENTATION
Clinical threshold value of DNA Fragmentation Index is 30%, that means 70% are normal.
Has role in deciding to go for ICSI in patients who have high fragmentation
DIAGNOSTIC CATEGORIES
After evaluation we should be able to segregate the patients into different categories depending on cause and what treatment we can offer.
Broadly we have can segregate into categories:
Medical/ Surgical treatment
Will help
May Help or improve chances of success in ART
Will not help
MEDICAL AND SURGICAL
MANAGEMENT OF
MALE INFERTILITY
MEDICAL THERAPYSPECIFIC
Endocrine Disorders
Ejaculatory Disorders
Genital Tract
Infections
EMPIRICAL THERAPY
Treatments for Idiopathic Male infertility
AROMATASE INHIBITORS
Empirical antioxidant treatment
Vitamin C and E
Carotenoids and Lycopene
Folate
Carnitine and N-acetylcysteine
Selenium
Clomiphene citrate and aromatase inhibitors
Lifestyle complimentary treatments
Environmental exposure prevention
Obesity prevention
Coital Lubricants
Eastern approaches-Acupuncture
Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis
Coital therapy
Immunologic infertility
Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.
COMPLIMENTARY TREATMENTS
Lifestyle complimentary treatments
Environmental exposure prevention
Obesity prevention
Coital Lubricants
Eastern approaches-Acupuncture
Nonsurgical treatments
Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis
Coital therapy
Immunologic infertility
Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.
Ejaculatory Duct obstruction
PESA-Percutaneous Epididymal Sperm Aspiration
Micro-TESE : Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle.
Micro TESE- Surgical Approach
MANAGEMENT
The management of infertility should take place in a dedicated infertility clinic staffed by an appropriately trained professional team of Andrologists with facilities for investigating and managing problems in both partners.
SCI International Hospital
M-4, Greater Kailash-1, New Delhi-110048
www.scihospital.com
SPERM DNA FRAGMENTATION
Clinical threshold value of DNA Fragmentation Index is 30%, that means 70% are normal.
Has role in deciding to go for ICSI in patients who have high fragmentation
DIAGNOSTIC CATEGORIES
After evaluation we should be able to segregate the patients into different categories depending on cause and what treatment we can offer.
Broadly we have can segregate into categories:
Medical/ Surgical treatment
Will help
May Help or improve chances of success in ART
Will not help
MEDICAL AND SURGICAL
MANAGEMENT OF
MALE INFERTILITY
MEDICAL THERAPYSPECIFIC
Endocrine Disorders
Ejaculatory Disorders
Genital Tract
Infections
EMPIRICAL THERAPY
Treatments for Idiopathic Male infertility
AROMATASE INHIBITORS
Empirical antioxidant treatment
Vitamin C and E
Carotenoids and Lycopene
Folate
Carnitine and N-acetylcysteine
Selenium
Clomiphene citrate and aromatase inhibitors
Lifestyle complimentary treatments
Environmental exposure prevention
Obesity prevention
Coital Lubricants
Eastern approaches-Acupuncture
Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis
Coital therapy
Immunologic infertility
Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.
COMPLIMENTARY TREATMENTS
Lifestyle complimentary treatments
Environmental exposure prevention
Obesity prevention
Coital Lubricants
Eastern approaches-Acupuncture
Nonsurgical treatments
Pyospermia: evaluate the patient for sexually transmitted diseases, penile discharge, prostatitis, or epididymitis
Coital therapy
Immunologic infertility
Corticosteroid suppression, sperm washing, IUI, IVF, and ICSI.
Ejaculatory Duct obstruction
PESA-Percutaneous Epididymal Sperm Aspiration
Micro-TESE : Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle.
Micro TESE- Surgical Approach
MANAGEMENT
The management of infertility should take place in a dedicated infertility clinic staffed by an appropriately trained professional team of Andrologists with facilities for investigating and managing problems in both partners.
SCI International Hospital
M-4, Greater Kailash-1, New Delhi-110048
www.scihospital.com
16-Aug-2021-"Gestational trophoblastic disease (GTD) is a spectrum of abnormal growth and proliferation of the trophoblasts of the placenta that continue even beyond the end of pregnancy of the placenta".
About humans
Health and wellness
An aspect of Gynecology
Broad for Medical Students
Perfect for teachers
Lucid for the non-medically inclined or the general public
Knowledge based
Result oriented
Contents include:
- Introduction/Definition
- Epidemiology of Infertility
- Anatomy & Physiology
- Factors affecting infertility
- Requirements for infertility
- Causes/Etiology of Infertility
- Evaluation
- Investigations of Infertility
- Treatment of Infertility
- Unexplained infertility
- Assisted Reproductive Technology (ART)
- Psychological support
- Case History
- Summary
Was compiled on 29th June 2014
And was presented on 23rd July, 2014 in the State House Medical Centre, Aso Rock, Abuja - FCT, Nigeria.
The method of ovulation induction selected by the clinician should be based upon the underlying cause of anovulation and the efficacy, costs, risks, burden of treatment, and potential complications associated with each method as they apply to the individual woman. In this presentation I have mentioned every points in detail.
how to investigate infertile couples? there are endless number of tests: How evidence based diagnosis would help us in this issue? this talk try to answer such questions?
presentation on infertility, causes and its management. it gives an idea of the scope of the problem especially in sub Saharan Africa . the challenges in its management.
Female and male infertility Causes & Management by Asar KhanAsar Khan
In this Presentation we have included the male and female infertility their causes and Management. we hope that it will provide you some basic information regarding this issues.
Fertility among males usually requires the normal functioning of the testes, pituitary gland and hypothalamus. Hence, a range of health conditions can lead to infertility.
As an intern doctor in Gyne department , this presentation outlines the steps of assessment of an infertile couple including history taking , examinations and relevant investigations and imagings .
16-Aug-2021-"Gestational trophoblastic disease (GTD) is a spectrum of abnormal growth and proliferation of the trophoblasts of the placenta that continue even beyond the end of pregnancy of the placenta".
About humans
Health and wellness
An aspect of Gynecology
Broad for Medical Students
Perfect for teachers
Lucid for the non-medically inclined or the general public
Knowledge based
Result oriented
Contents include:
- Introduction/Definition
- Epidemiology of Infertility
- Anatomy & Physiology
- Factors affecting infertility
- Requirements for infertility
- Causes/Etiology of Infertility
- Evaluation
- Investigations of Infertility
- Treatment of Infertility
- Unexplained infertility
- Assisted Reproductive Technology (ART)
- Psychological support
- Case History
- Summary
Was compiled on 29th June 2014
And was presented on 23rd July, 2014 in the State House Medical Centre, Aso Rock, Abuja - FCT, Nigeria.
The method of ovulation induction selected by the clinician should be based upon the underlying cause of anovulation and the efficacy, costs, risks, burden of treatment, and potential complications associated with each method as they apply to the individual woman. In this presentation I have mentioned every points in detail.
how to investigate infertile couples? there are endless number of tests: How evidence based diagnosis would help us in this issue? this talk try to answer such questions?
presentation on infertility, causes and its management. it gives an idea of the scope of the problem especially in sub Saharan Africa . the challenges in its management.
Female and male infertility Causes & Management by Asar KhanAsar Khan
In this Presentation we have included the male and female infertility their causes and Management. we hope that it will provide you some basic information regarding this issues.
Fertility among males usually requires the normal functioning of the testes, pituitary gland and hypothalamus. Hence, a range of health conditions can lead to infertility.
As an intern doctor in Gyne department , this presentation outlines the steps of assessment of an infertile couple including history taking , examinations and relevant investigations and imagings .
Analyzing the Works about Causes and Factors of InfertilityYogeshIJTSRD
Infertility is the inability to become pregnant after one year of intercourse without contraception involving a male and female partner. The frequency of the female factor is 62-75 , and that of the male factor is 28-45 . Moreover, impaired reproductive function in both partners is observed in every third infertile couple. primary infertility the absence of pregnancy in the anamnesis, and secondary infertility established in the presence of pregnancy in the past. If possible, the onset of pregnancy is characterized by absolute and relative infertility. They say about absolute infertility when the possibility of pregnancy is completely excluded there is no uterus, ovaries, or there are severe anomalies in the development of the genitals. By relative infertility is meant the preservation of fertility, but the inability to have children in the particular marriage in question for example, male infertility . Magzumova N. M. | Gadoeva D. A. | Musaeva A. F "Analyzing the Works about Causes and Factors of Infertility" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Special Issue | Innovative Development on Academic Research and Development during Covid 19 , May 2021, URL: https://www.ijtsrd.com/papers/ijtsrd41274.pdf Paper URL : https://www.ijtsrd.com/medicine/other/41274/analyzing-the-works-about-causes-and-factors-of-infertility/magzumova-n-m
There are many possible causes of infertility. It's important to understand the possible causes so that you can find the right solution. Learn more here.
it describes in detail about causes, investigations and management of female infertility.in the end of presentation, it includes a video demonstration to describe the management options of assisted conception.
drugs safety in pregnancy medications medication in pregnancy treatment during pregnancy healthy pregnancy teratogen teratogenecity teratogenic drugs in pregnancy drugs and congenital malformation
Infertility means not being able to become pregnant after a year of trying. If a woman can get pregnant but keeps having miscarriages or stillbirths, that's also called infertility. Infertility is fairly common. After one year of having unprotected sex, about 15 percent of couples are unable to get pregnant.
Dấu hiệu, nguyên nhân của mãn kinh sớm và cách điều trị | Venus GlobalVENUS
Trong những năm gần đây, mãn kinh sớm đang là một vấn đề khiến nhiều chị em lo lắng. Có rất nhiều nguyên nhân gây ra tình trạng mãn kinh sớm nó có thể do thói quen ăn uống, sinh hoạt ảnh hưởng đến nội tiết tố nữ và tứ đó gây ra mãn kinh. Trong bài viết này Venus sẽ cung cấp cho bạn toàn bộ thông tin về nguyên nhân, biểu hiện gây ra căn bệnh này để bạn đọc có cách phòng tránh cũng như điều trị kịp thời.
Nguồn: Trích https://venusglobal.com.vn/man-kinh-som/
#mãn_kinh_sớm
#dấu_hiệu_mãn_kinh_sớm
#cách_trị_mãn_kinh_sớm
#dấu_hiệu_của_mãn_kinh_sớm
#dau_hieu_cua_man_kinh_som
Prevalence of infertility gravitates to increase due to different factors. Causes of male infertility could be varicocele, idiopathic infertility, testicular insufficiency, obstruction, ejaculation disorder, medicineradiation effect, undescended testis, immunological mechanisms, endocrine dysfunction such as diabetes, excessive taking of alcohol, smoking and environmental toxins such as pesticides, mercury and lead. It is furthermore understood that person, obesity, be deficient in of nutrition and habits of utilizing time for example too much use of, laptop, mobile phones, computers and sauna, etc., as for women, age, smoking, too much consumption of alcohol, having a skinny or overweight body and having been exposed to physical or mental stress fruition in amenorrhea might be the causes of infertility. The progress in infertility prevalence draws attention to the effects of factors such as lifestyle, dietetic habits and environmental factors. Male infertility originates from mostly as a result of the association between oxidative stress and antioxidants. A review of these areas will provide researchers with a more noteworthy understanding of the compulsory participation of these nutrients in male reproductive processes. This review also caustic out gaps in recent studies which will require further investigations.
Keywords: Nutrition; spermatogenesis, oligospermia, infertility, antioxidants, reproductive
Polycystic ovary syndrome PCOS is a common endocrine and metabolic disorder in premenopausal women. Heterogeneous by its nature, PCOS is defined as combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The etiology of the syndrome remains unknown, but evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. It affects 8 to 13 of reproductive aged women. Polycystic ovary syndrome PCOS is associated with hormonal, biochemical disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health related quality of life HRQoL . The most recent international guidelines set lifestyle management as the cornerstone of the PCOS treatment. Hridyanshi | R. K. Patil | Lovish Kansal "Polycystic Ovary Syndrome: A Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd41134.pdf Paper URL: https://www.ijtsrd.commedicine/gynecology/41134/polycystic-ovary-syndrome-a-review/hridyanshi
A Retrospective Study on Evaluation of Patients with Uterine Fibroid in a Ter...ijtsrd
Uterine fibroids are a major cause of morbidity in women of reproductive age. Hence it is important to evaluate the occurrence of fibroid. An observational retrospective study was carried out in Obstetric and Gynecology Department over a period of 2 months. Each of the cases was scrutinized for sociodemographic, clinical profile and other necessary information. In this study, Fibroid was found to be predominant in premenopausal women. .Parity and number of abortions had no much significance with fibroid diagnosed. The primary management of obese patients were found as weight reduction and diet control. Hysterectomy was done based on large fibroid size. Anju Mam Thomas | Blessy Rachal Boban | Jiya Ann Mathew "A Retrospective Study on Evaluation of Patients with Uterine Fibroid in a Tertiary Care Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-2 , February 2019, URL: https://www.ijtsrd.com/papers/ijtsrd20311.pdf
Paper URL: https://www.ijtsrd.com/pharmacy/pharmacy-practice/20311/a-retrospective-study-on-evaluation-of-patients-with-uterine-fibroid-in-a-tertiary-care-hospital/anju-mam-thomas
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
Message: @Pi_vendor_247 on telegram if u want to sell PI COINS.
1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
What website can I sell pi coins securely.DOT TECH
Currently there are no website or exchange that allow buying or selling of pi coins..
But you can still easily sell pi coins, by reselling it to exchanges/crypto whales interested in holding thousands of pi coins before the mainnet launch.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and resell to these crypto whales and holders of pi..
This is because pi network is not doing any pre-sale. The only way exchanges can get pi is by buying from miners and pi merchants stands in between the miners and the exchanges.
How can I sell my pi coins?
Selling pi coins is really easy, but first you need to migrate to mainnet wallet before you can do that. I will leave the telegram contact of my personal pi merchant to trade with.
Tele-gram.
@Pi_vendor_247
what is the best method to sell pi coins in 2024DOT TECH
The best way to sell your pi coins safely is trading with an exchange..but since pi is not launched in any exchange, and second option is through a VERIFIED pi merchant.
Who is a pi merchant?
A pi merchant is someone who buys pi coins from miners and pioneers and resell them to Investors looking forward to hold massive amounts before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade pi coins with.
@Pi_vendor_247
If you are looking for a pi coin investor. Then look no further because I have the right one he is a pi vendor (he buy and resell to whales in China). I met him on a crypto conference and ever since I and my friends have sold more than 10k pi coins to him And he bought all and still want more. I will drop his telegram handle below just send him a message.
@Pi_vendor_247
how to sell pi coins in all Africa Countries.DOT TECH
Yes. You can sell your pi network for other cryptocurrencies like Bitcoin, usdt , Ethereum and other currencies And this is done easily with the help from a pi merchant.
What is a pi merchant ?
Since pi is not launched yet in any exchange. The only way you can sell right now is through merchants.
A verified Pi merchant is someone who buys pi network coins from miners and resell them to investors looking forward to hold massive quantities of pi coins before mainnet launch in 2026.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
how to sell pi coins on Bitmart crypto exchangeDOT TECH
Yes. Pi network coins can be exchanged but not on bitmart exchange. Because pi network is still in the enclosed mainnet. The only way pioneers are able to trade pi coins is by reselling the pi coins to pi verified merchants.
A verified merchant is someone who buys pi network coins and resell it to exchanges looking forward to hold till mainnet launch.
I will leave the telegram contact of my personal pi merchant to trade with.
@Pi_vendor_247
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
how can i use my minded pi coins I need some funds.DOT TECH
If you are interested in selling your pi coins, i have a verified pi merchant, who buys pi coins and resell them to exchanges looking forward to hold till mainnet launch.
Because the core team has announced that pi network will not be doing any pre-sale. The only way exchanges like huobi, bitmart and hotbit can get pi is by buying from miners.
Now a merchant stands in between these exchanges and the miners. As a link to make transactions smooth. Because right now in the enclosed mainnet you can't sell pi coins your self. You need the help of a merchant,
i will leave the telegram contact of my personal pi merchant below. 👇 I and my friends has traded more than 3000pi coins with him successfully.
@Pi_vendor_247
how to sell pi coins at high rate quickly.DOT TECH
Where can I sell my pi coins at a high rate.
Pi is not launched yet on any exchange. But one can easily sell his or her pi coins to investors who want to hold pi till mainnet launch.
This means crypto whales want to hold pi. And you can get a good rate for selling pi to them. I will leave the telegram contact of my personal pi vendor below.
A vendor is someone who buys from a miner and resell it to a holder or crypto whale.
Here is the telegram contact of my vendor:
@Pi_vendor_247
Introduction to Indian Financial System ()Avanish Goel
The financial system of a country is an important tool for economic development of the country, as it helps in creation of wealth by linking savings with investments.
It facilitates the flow of funds form the households (savers) to business firms (investors) to aid in wealth creation and development of both the parties
What price will pi network be listed on exchangesDOT TECH
The rate at which pi will be listed is practically unknown. But due to speculations surrounding it the predicted rate is tends to be from 30$ — 50$.
So if you are interested in selling your pi network coins at a high rate tho. Or you can't wait till the mainnet launch in 2026. You can easily trade your pi coins with a merchant.
A merchant is someone who buys pi coins from miners and resell them to Investors looking forward to hold massive quantities till mainnet launch.
I will leave the telegram contact of my personal pi vendor to trade with.
@Pi_vendor_247
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...Quotidiano Piemontese
Turin Startup Ecosystem 2024
Una ricerca de il Club degli Investitori, in collaborazione con ToTeM Torino Tech Map e con il supporto della ESCP Business School e di Growth Capital
Turin Startup Ecosystem 2024 - Ricerca sulle Startup e il Sistema dell'Innov...
A340106.pdf
1. American Journal of Multidisciplinary Research & Development (AJMRD)
Volume 3, Issue 04 (April- 2021), PP 01-06
ISSN: 2360-821X
www.ajmrd.com
Multidisciplinary Journal www.ajmrd.com Page | 1
Research Paper Open Access
BEHAVIOR TO BE TAKEN BEFORE AN INFERTIOUS
COUPLE WITH A VIEW TO MEDICALLY ASSISTED
PROCREATION
Hicham Chemsi 1, α
, Samir Ibenmoussa 1
, Naima Khlil 1
1
Biochemistry Laboratory, LC-BENS Research Laboratory, Casablanca FMPC Faculty of Medicine and
Pharmacy, Hassan II University, Casablanca, Morocco
α
Biochemistry Laboratory, LC-BENS Research Laboratory, Ibn Rochd Hospital University Of Casablanca,
FMPC, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
Abstract : In recent years, infertility disorders have continued to increase. One in six couples (16%) consult for an
infertility problem and almost two-thirds will conceive spontaneously, or thanks to medical treatment. Infertility is
a real public health problem, since around 14% of couples see a doctor at least once for an infertility problem. In
about 33% of cases, a purely female cause is found, in 21% of cases a uniquely male cause, in 39% of cases both a
female and male cause and 7% of cases no cause is found (unexplained infertility). AMP techniques have
advanced a lot in recent years as well as their field of application. These techniques have a constant success rate.
I. Introduction
Infertility is the complete inability of a man, woman or couple to conceive at any given time. This
incapacity can be temporary and reversible, or permanent and irreversible. We speak of primary female
infertility when the woman has never been pregnant. Fertility is the ability to conceive. In practice, subfertility
results in a longer conception period.The objective of this paper is to address the main causes of infertility in
men and women, as well as the exploration of the infertile couple, in addition to the various techniques of
medically assisted procreation.
II. Fertility disorders
General factors influencing the fertility of the couple
Age: Female fertility peaks between 20 and 30 years, with an effective of 25%. This fertility drops from age 31,
worsening more sharply from age 35 to exceed 50% from age 40, while the rate of spontaneous abortions is two
to three times higher [1]. Male fertility, assessed on the characteristics of the sperm (count, mobility,
morphology) reaches a maximum around 30, then signs of aging begin to appear on the testes.
Tobacco: Twice the risk of being infertile, decreased ovarian reserve, lower anti-Müllerian hormone (AMH)
levels, short and irregular cycles and dysmenorrhea are also found in smokers (2). Studies have shown that
smoking in men and women leads to a 40% decrease in the chances of AMP, and a three-fold higher ICSI failure
rate in smokers [2].
Cannabis: Regular consumption of cannabis over 5 years results in decreased sperm volume, number of sperm,
morphology and mobility with overactive sperm and decreased fertility [2].
Drugs: These are certain antihypertensives, chemotherapy, radiotherapy, treatments for neuropsychiatric
conditions (antidepressants), or stomach ulcers [2].
Lifestyle: Oxidative stress occurs in about half of cases in infertile men. This stress targets, among other things,
the DNA of gametes. Mineral and vitamin supplements may be offered to reduce the effect of oxidative stress
[3].
Environmental and occupational pollutants: Recently the deleterious effects of heavy metals and ionizing
radiations have been highlighted. Studies highlight the relationship between the exposure of certain professions
(farmers, smelters, horticulturalists, soldiers, hairdressers, housekeeper, nurse) ; and the fertility problems that
certain couples encounter [2].
Obesity: A real public health problem, plays a major role in female reproduction. The presence of obesity in
adolescence is associated with a higher lifetime risk of nulliparity compared to women with a normal BMI.
Main causes of infertility in men
2. BEHAVIOR TO BE TAKEN BEFORE AN INFERTIOUS COUPLE WITH A …
Multidisciplinary Journal www.ajmrd.com Page | 2
Azoospermia: Is characterized by the absence of sperm in the ejaculate. This diagnosis is made after three
successive spermograms taken three months apart. A distinction is made between secretory or non-obstructive
azoospermia and excretory or obstructive azoospermia.
Teratospermia: The presence of an abnormally high level of abnormal sperm. These abnormalities can affect all
parts of the sperm (head, flagellum) and are usually due to dysfunction of spermiogenesis [3].
Oligospermia: Insufficient number of sperm. It’s the most common case of male infertility [4].
Asthenospermia: Lack of mobility of sperm. There is normally 40% motile sperm in semen.
Necrospermia: It’s characterized by a high percentage of dead sperm (> 50%). Often due to infections. (Table
1)
Table 1: Main sperm abnormalities (1)
Volume
Hypospersmia
Hyeprspermia
Aspermia
Volume < 2ml
Volume > 7ml
Absence of ejaculate
Concentration
Polyspermia
Oligospermia
Cryptospermia
Azoospermia
> 200× 106
/ml
< 20 × 106
/ml
Rare spermatozoa requiring
Absence of sperm
Mobility Asthenospermia
Akinetospermia
Mobility < 40%
Absence of motile sperm
Morphology Tératospermia < 30% Typical shapes
Vitality Necrospermia < 50% live sperm
Main causes of infertility in women
Ovulation disorders (anovulation, dysovulation): They affect 30% of female infertility. Ovulation disorders
can be caused by dysfunction of the ovaries or the structures in the brain that control their activity. The possible
etiologies are: hyperprolactinemia, hypothalamic-pituitary dysfunction, micro-polycystic ovarian dystrophy,
ovarian failure.
Endometriosis:Is the presence of endometrial tissue outside the uterine cavity. It’s a common disease affecting
6-10% of the general population. In women followed for infertility, the frequency is significantly higher (30 to
40%) [5].
Micro-polycystic ovaries: Polycystic ovary syndrome is defined by the presence of at least two of the following
three criteria: oligo and/or anovulation; clinical and/or biological hyperandrogenism; the presence on pelvic
ultrasound of at least 12 follicles per ovary, 2 to 9 mm in diameter and/or an increase in ovarian volume.
Micropolycystic ovarian dystrophy is the most common cause of ovulation disorders.
Hyperprolactinemia: is found in 30% of women suffering from cycle disorders and in 20% of secondary
amenorrhea of high origin. It is characterized by an increase in the level of circulating prolactin.
Hyperprolactinemia in women when their level is greater than 30 µg/L [5].
Genetic etiology: In anovulations of hypothalamic-pituitary origin, several genes have been identified: FGFR1,
the prokineticin receptor and prokineticin, FGF8 and CHD7. In hypogonadotrophic hypogonadisms without
anosmia, mutations of the GnRH receptor, GPR54, TAC3 and its receptor have been identified. In premature
ovarian failure, there may be an abnormality in the number or structure of the X chromosome, deletions or
translocations between the X and the autosomes.
III. Infertile couple exploration
First consultation
A couple is infertile if they remain childless after two years of intercourse without any contraception. In more
than a third of cases, the origin of infertility is mixed. The first consultation must therefore be taken care of by
the couple. During this consultation, an interview and a clinical examination of each partner will help to establish
a strategy for the additional examinations to be prescribed. The exploration of an infertile couple must therefore
be carried out in parallel in both partners.
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Figure 1: What to do during the first consultation [1]
Interrogation
For couple: relates to the date of cohabitation, with or without contraception, regular and physiological sexual
intercourse, scheduled preovulatory or not, the frequency of sexual intercourse (regular or episodic), previous or
current treatments and explorations previously carried out.
For woman: the woman is questioned about her current treatments, sports activity, diet, the operative reports of
the gynecological and obstetric interventions, blood group, serological status: rubella, toxoplasmosis,
Chlamydiae trachomatis. In terms of medical (diabetes, arterial hypertension, thyroid pathology, phlebitis,
psychiatric pathology…), in terms of surgical (abdomino-pelvic surgery), gyneco-obstetrics (age of first
menstruation, regularity of cycles, dysmenorrhea, dyspareunia, premenstrual syndrome, taking contraception and
type, pelvic infection, pregnancies and progress, pathology of the cervix. The questioning must be methodical
and meticulous, because it often alone allows to identify a diagnostic orientation.
For men: The evaluation should include a complete medical and reproductive history, a physical examination
and at least two semen measurements. The systematic questioning aims to find the reproductive history with the
duration of infertility and the previous fertility of the both partners, age of the partner, childhood pathologies,
diabetes, previous surgeries, sexually transmitted infections, exposure to deleterious factors (heat), family
reproductive history and treatments (current and previous) [6].
Clinical examination
In women: This exam assesses actual age and physiology. He also looks for height and weight, hair growth,
blood pressure, appearance of the skin (acne). Breast exam is essential. Also assessed are vaginal trophicity,
uterus, ovaries, presence and quality of cervical mucus, apparent condition of cervix, presence of uterine
fibromyomas.
In men: The general physical examination is an integral part of the assessment of an infertile man. Hairiness,
weight, size, blood pressure, examination of the penis, palpation of the testicles and their size, presence and
consistency of epididymis, detection of varicocele, evaluation of secondary sexual characteristics with
distribution of hair, distribution of fat, detection of gynecomastia, digital rectal examination is strongly
recommended [6].
Woman's infertility assessment
a. Hormonal assessment
Follicle Stimulating Hormone (FSH): The increase usually reflects ovarian failure, in association with
increased estrogen levels and decreased ovarian reserve on ultrasound. The decrease usually reflects damage to
the pituitary gland.
Luteinizing Hormone (LH): An increase early in the cycle is usually indicative of microcystic ovary syndrome.
In this case, there’s an increase in testosterone.
Estrogen: Estradiol levels> 80 pg/mL on day 3 of the cycle are indicative of decreased ovarian reserve. But this
marker is mainly used to correctly assess the basal FSH because a high plasma estradiol level (> 70 pg/mL) can
artificially normalize FSH by negative feedback effect [6].
Prolactin: A value> 200ng/mL indicates the presence of an adenoma. Factors can increase it : stress,
postprandial period, estrogen therapy, pregnancy, thyroid insufficiency, kidney failure and medications
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(antidepressants, antiemetics, antihypertensives…) [7]. It’s therefore necessary to perform the dosage at the start
of the cycle, in the morning at rest, on an empty stomach and after interruption of all therapy.
Anti-Mullerian hormone (AMH): This hormone is secreted by granulosa cells. AMH is currently considered to
be the best marker of ovarian reserve, especially the quantity and activity of antral follicles. It has the advantage
of non-variability during the menstrual cycle, making its dosage more credible, uniform and reproducible [8].
b. Ultrasound of the uterus and ovaries
It provides information on the uterine morphology, the ovaries (cysts), the existence of latero-uterine masses
(hydrosalpinx). By endovaginal route, it allows to evaluate the count of the antral follicles which is considered a
good marker of ovarian reserve, and the best for predicting a poor response to stimulation [7].
c. Hysterosalpingography
Hysterosalpingography is an essential examination for the exploration of the uterus and especially the tubes. It
helps to appreciate the uterine cavity and tubal permeability.
d. Laparoscopy
Laparoscopy is the examination of the abdominal cavity. It plays an essential role in the diagnosis and treatment
of female sterility of organic origin and also functional sterility by allowing direct control of the ovaries and
ovulation.
e. Temperature curve
Ovulation is accompanied by a body rise of 0.4 to 0.5 ° C. Establishing this curve helps assess the quality of
ovulation. The temperature curve or menothermal curve (Figure 2) should be performed over at least two cycles.
Hyperthermia of the luteal phase is caused by the action of a progesterone metabolite (pregnandiol) on the bulbar
thermoregulation center.
Figure 2: Normal menothermal curve [7]
Assessment of infertility in men
a. Spermogram
Fundamental examination in male, its realization is systematic. The three essentials parameters are:
concentration, mobility and morphology of the spermatozoa. Differents parameters are studied: volume,
viscosity, pH, count, presence of round cells, agglutinates, vitality, mobility, morphological appearance
(spermocytogram).
b. Hormonal blood test
Allows the evaluation of endocrine function, it is performed in case of abnormal spermogram with concentration
less than 10 M/mL, sexual disorders or presence of other clinical symptoms suggesting endocrinopathy [6]. The
minimum assessment involves testing for FSH and testosterone. Hyperprolactinemia should be investigated for
iatrogenic origin, hypothyroidism, pituitary tumor [9].
c. Spermoculture
This is to check for the presence of possible infectious agents. The search for chlamydia and mycoplasma is done
by culture on special media.
d. Survival migration test (TMS)
Consists of assessing the quantity and quality of motile sperm that can be extracted from the ejaculate. Their
survival is evaluated after storage for 24 hours at room temperature. This test is used in the context of AMP
where it can play an essential role in the therapeutic indications. The total number of motile spermatozoa
available in the final preparation, their morphology and their survival influence the treatment decision [10].
Medical assistance for procreation
Artificial insemination
Artificial insemination involves the instrumental introduction of spermatozoa into the female genital tract,
possibly at the level of the cervix, but mainly into the uterine cavity to promote the meeting of male and female
gametes [10]. The preliminary sperm assessment includes the performance of a spermogram, a sperm culture.
The study of sperm movement allows an objective assessment, quantitative (% of mobile form) and qualitative
(type of movement). The techniques select for “normal” spermatozoa either by upward migration (sedimentation
migration) in a culture medium (swin-up from seminal plasma or after washing), or by filtration after passage
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through a density gradient [11]. Intrauterine insemination in a spontaneous cycle has only been shown to be
effective in two mechanical indications: isolated cervical sterility or the impossibility of having complete sexual
intercourse.
In vitro fertilization IVF
IVF involves collecting the couple's gametes for extracorporeal fertilization, then transferring the resulting
embryos into the uterus. The clinical part therefore mainly concerns women, and includes three essential steps:
stimulation, oocyte puncture and embryo transfer [10]. The main indications for IVF are: tubal infertility,
endometriosis, "idiopathic" sterility, second-line ovulation disorders, artificiels inseminations failures.
Intracytoplasmic sperm injection ICSI
ISCI uses only a single sperm which is introduced into the ovular cytoplasm using a micropipette. ICSI can be
used after failure of in vitro fertilization (lack of short fertilization). The main indication for ICSI is male
infertility, especially in severe oligo-astheno-teratospermias, secretory and in most excretory azoospermias. ICSI
may also be preferable when female and male factors are combined: poor response to ovarian stimulation (<5
matures oocytes) and sperm alterations reducing the chances of fertilization [12].
Figure 3 General diagram of the management of the infertile couple
IV. Conclusion
Medically assisted procreation is responsible for 20000 births per year, this trend is expected to increase with
increasingly late childbearing and the resulting decline in fertility. When a curable cause of infertility is detected,
the medical team will refer the couple to the most appropriate AMP technique.
Conflict of interest
The authors declare no conflicts of interest
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