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Thursday, April 25, 2024
Tags Posts tagged with "infertility"

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Female doctor talking with patient along coworker in ICU. Man is lying on bed amidst essential workers. Healthcare workers are in protective workwear.

The antimalaria drug hydroxychloroquine has generated significant controversy. A new study suggests that if it is given early, it can reduce mortality in people with severe COVID-19. But our expert points out weaknesses in the study’s design.

Amid an ongoing search for an effective COVID-19 treatment, the debate about the antimalaria drug hydroxychloroquine (HCQ) continues.

There was plenty of hype about the drug during the early months of the pandemic. On March 28, 2020, the Food and Drug Administration (FDA) granted Emergency Use Authorization (EUA), allowing doctors to use HCQ and chloroquine (CQ) products in situations where clinical trials were not an option.

Last month, the FDA withdrew the EUA. The agency explains that it “has determined that CQ and HCQ are unlikely to be effective in treating COVID-19 for the authorized uses in the EUA. Additionally, in light of ongoing serious cardiac adverse events and other serious side effects, the known and potential benefits of CQ and HCQ no longer outweigh the known and potential risks for the authorized use.”

Clinical trials using the drug have shown mixed results and been marred with controversy. After an investigation by The Guardian into the quality of data analysis provided by a company called Surgisphere, the authors of one high-profile study in The Lancet retracted the paper.

Several institutions have since halted their HCQ studies, including the World Health Organization (WHO) and the National Institutes of Health (NIH).

Now, a new study in the International Journal of Infectious Diseases — by researchers from the Henry Ford Health System, in Michigan — reports that treatment with HCQ alone and in combination with the antibiotic azithromycin reduced the number of deaths among people in the hospital with severe COVID-19.

Comparing mortality rates

The corresponding author is Dr. Marcus J. Zervos, an infectious disease specialist at Henry Ford Hospital and the Wayne State University School of Medicine, both in Detroit, MI.

For their study, the team retrospectively reviewed the medical records of 2,541 individuals who received treatment for COVID-19 in Henry Ford Health System hospitals.

The aim of the research was to compare how many people with COVID-19 died while in the hospital after receiving either HCQ, HCQ and azithromycin, azithromycin on its own, or “other treatments for COVID-19,” as the authors explain in their paper.

Treatment with HCQ, azithromycin, or both began within 24 hours of hospital admission in 82% of cases, and within 48 hours of admission in 91% of cases.

Among the 2,541 patients in the study, 460 died, which equates to an overall mortality rate of 18.1%. In the group of 409 patients who received neither HCQ nor azithromycin, 108 died, representing a mortality rate of 26.4%.

A total of 1,202 patients received only HCQ, of whom 162 died, a mortality rate of 13.5%, while out of the 147 patients who received only azithromycin, 33 died, equating to a mortality rate of 22.4%.

Among the 783 patients who received a combination treatment of HCQ and azithromycin, 157 patients died. This reflects a mortality rate of 20.1%.

While these results sound encouraging, Dr. Hanh Le, who is the senior director of medical affairs at Healthline Media, shared her concerns about the study with Medical News Today.

“As an observational study, it would have been good to have insights into what factored into the treatments that the patients received. For example, of the patients who received neither drug, why were most of them 65 or older?” Dr. Le pointed out. “Unfortunately, the study authors did not address that.”

Study limitations

Dr. Le explained that the average age of those who received neither HCQ nor azithromycin was significantly higher than those who received HCQ.

Specifically, the average age in the group who received other COVID-19 treatments was 68.1 years, the median age was 71 years, and 64.1% were over the age of 65. In the HCQ group, on the other hand, the average age was 63.2 years, the mean age was 53 years, and 48.9% were over 65.

Patients in the HCQ group were also significantly more likely to receive steroids in addition to the drug. While 78.9% of patients in this group received steroids, only 35.7% of patients in the other COVID-19 treatment groups did.

“In addition, white race is a risk factor they identified, and it too was unbalanced,” Dr. Le added.

In the group receiving other COVID-19 treatments, 45.5% were white, while in the HCQ group, 27.6% were white.

“We attribute our findings that differ from other studies to early treatment, and part of a combination of interventions that were done in supportive care of patients, including careful cardiac monitoring,” Dr. Zervos comments in a press release.

“Our dosing also differed from other studies not showing a benefit of the drug. And other studies are either not peer-reviewed, have limited numbers of patients, different patient populations, or other differences from our patients,” he continued.

The study authors do urge caution in light of their findings:

“Our results should be interpreted with some caution and should not be applied to patients treated outside of hospital settings,” they write in the paper. “Our results also require further confirmation in prospective, randomized controlled trials that rigorously evaluate the safety, and efficacy of [HCQ] therapy for COVID-19 in hospitalized patients.”

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Infertility in women above the age of forty can almost always be contributed to menopause, but if you’re in your twenties and thirties and struggling to conceive, there are a number of other causes.

Menopause can’t be ruled out. Premature menopause, while uncommon, does occur in certain women. This is usually genetic. If close family had premature menopause, that trait is likely to be passed along.

Premature menopause will have all the normal symptoms of menopause such as hot flashes, mood swings and vaginal dryness. Women with premature menopause can no longer conceive with their own eggs, but can still have children using donor eggs. In cases like this, IVF can be used with a donor egg and sperm before being placed into the menopausal woman’s body. This will result in a normal pregnancy. Women interested in this procedure can visit a fertility clinic to learn more about IVF.

The most common cause of infertility is a condition known as anovulation. This means that the ovaries do not release any eggs. This condition is easily treated using ovulation inducing medicine and is often not a serious health concern. Roughly forty percent of infertile women have this condition.

Women who suffer from endometriosis will often suffer from terrible pain during their menstruation and the effects of this condition can lead to infertility as well. Many women aren’t diagnosed with endometriosis because they believe the pain they feel during their menstruation is normal. When left untreated, endometriosis can cause scar tissue and lesions to form outside the uterus, leading to a decrease in fertility and even more pain. It’s best to see a doctor as soon as possible to prevent damage, but most of the effects of endometriosis can be alleviated with surgery.

Another cause of infertility is Polycystic Ovary Syndrome. This is a hormone disorder that hinders the ability of the ovaries to release eggs. This disorder can be treated with medication, but studies have suggested that a healthy lifestyle can work just as well. Overweight women are prone to this disorder due to their unhealthy lifestyles and most fertility doctors would recommend a diet plan and regular exercise before they would resort to prescribing medication.

Another reason for this is the risks involved with being pregnant while overweight. The risks are numerous for mother and child in the case that a heavily overweight woman does manage to conceive.

Still not sure what might be the cause of your infertility? Visit a fertility clinic to be properly diagnosed. In many cases, the problem isn’t with your uterus, but with your partner’s sperm. Most infertility problems can be solved with IVF treatment (with your own egg or with a donor egg). There are treatments or medication available for each of the causes mentioned above and others that were not mentioned. The best way to know what steps you need to take is by talking to a medical health care professional. Don’t attempt to self-diagnose.

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I want to share with readers some of the presentation we made at the recently concluded 22nd world fertility congress of the International Federation of Fertility Societies in New Delhi, India.

I will also be sharing some of the submissions from the 6th Conference of the Association of Fertility and Reproductive Health in Nigeria, held in Port Harcourt last week.

I do this so you can understand the role of preventive medicine  when it comes to fertility challenges.

The first presentation was on sexually transmitted diseases. Through elaborate studies by Prof. Olu Osoba from the 1970s and 1980s; and our recent management of infertility cases from the 1990s till date, it has become clear that STD is one of the major causes of infertility.

You should also know that the main culprits are gonorrhea and chlamydia infections in both males and females.

It is now well established that, next to infection, the environment plays a major role as one of the causes of infertility. This was eloquently presented at a plenary session, titled “Environmental Toxicant and Reproductive Health – A Global Problem Needing a Global Solution” by Linda Gludice, a professor of Obstetrics at the University of California, San Francisco.

She gave the detailed mechanisms on how these reproductive toxicants, which include pesticides, petrochemicals, plastics products and other groups, may affect fertility. More worrisome is how the consequences of exposure to these toxicants can manifest in subsequent generations.

She provided evidence indicating that a grandmother’s lifestyle or exposures can have serious consequences on the reproductive ability of her granddaughters yet unborn.

Her presentation was followed by that of Dr. Atinuke Adeyi from Martlife Detox Clinic in Lagos, Nigeria. She also gave a list of similar reproductive toxicants and how they can be eliminated in the body. The plenary presentation was the result of a joint study between Martlife Detox Clinic and Medical art Centre.

They looked at 111 patients attending Medical Art Centre for infertility treatment from 2014 to 2016. These are those  who had opted to undergo a supervised modern Mayr type of detoxification at the Mart-Life Detox Clinic before further assisted reproductive technology treatment. The supervised Mayr type of detoxification consists of five major components:

  • . Resting – The patients are made to rest and reduce external contact with sources of stress – such as cell phone calls – and work for a specified period
  • Simplified diet -This is taking the recommended minimal daily food allowance and in such simple forms as to be readily digested.
  • Cleansing of the intestinal system using Martlife protocols.
  • The use of new equipment such as physiotherm, hypoxicator, sea oxygen, high-powered hydrotherapy baths and massage, deep body wraps and immersion, colon irrigator and hydrotherapy, piroche ultrasonics, radio scan and body detox.
  • Abdominal treatment and the use of Orthomolecular supplements, which consist of anti-oxidants and cell-repairing co-factors.

Sixty-seven patients had a history of repeated IVF failures (60.4%), 89 had BMI ≥27mg/Kg (80 per cent) and nine were poor responders (8.1%).

Twelve patients had never attempted IVF before the programme (11%). Improvement in their fertility outcomes and other laboratory parameters were assessed in subsequent cycles after detoxification.

The results show that more than 80 per cent of patients achieved significant weight reduction and improvement in BMI. Uniform increase in oocyte yield was noted across board but this was particularly significant in previous poor responders (three-fold increase).

Most participants found this aspect of the result very interesting as it may indicate that whatever had been removed by the Mayr-type detoxification programme might have been compromising egg production in the body.

Thirty eight per cent of the patients tested positive for beta HCG following detoxification while 51.6 per cent of the subset of patients who had a history of repeated IVF failure tested positive for beta HCG after detox. Approximately 50 per cent either have ongoing pregnancies or have carried babies to term.

The increase in oocyte yield was found to have a direct relationship with fertilisation and pregnancy rate following the detoxification programme. This was also observed in previous poor responders. The data suggest that supervised modern Mayr type of detoxification may positively impact fertility indices in infertile couples who undergo ART.

The participants at both conferences agreed with authors that there is the need for further studies on larger populations to further establish pattern of response. This was the first time that a study on Mayr will be presented at an international meeting and it was highly commended.

The implication of the study is that the work of Prof. Gludice shed greater weight on our earlier warning that our environment is a clear and present danger to our reproductive ability.

The WHO department of the Reproductive Health and Research confirms this danger and expresses the need for public education. We have noticed such trend in the reproductive capacity of those working or living in the oil-producing areas.

It is recommended that people who work in areas that have high levels of industrial pollutants may need to check the level of such toxins in their body regularly, especially if they are planning to have babies.

One should also recognise that toxins, apart from their deleterious effects on reproductive health, may also be carcinogenic.

Finally, our government should make our environmental protection agencies monitor and ensure low-level emission into our environment even from old automobiles with bad mufflers, diesel emissions, oil fossils, aviation fuel, plastics, fish containing heavy metals and industrial wastes, to mention a few of such toxin we have found to create havoc in our environment.

PUNCH.

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What is male infertility?

Reproduction (or making a baby) is a simple and natural experience for most couples. However, for some couples it is very difficult to conceive.

A man’s fertility generally relies on the quantity and quality of his sperm. If the number of sperm a man ejaculates is low or if the sperm are of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy.

Male infertility is diagnosed when, after testing both partners, reproductive problems have been found in the male.

How common is male infertility?

Infertility is a widespread problem. For about one in five infertile couples the problem lies solely in the male partner.

It is estimated that one in 20 men has some kind of fertility problem with low numbers of sperm in his ejaculate. However, only about one in every 100 men has no sperm in his ejaculate.

What are the symptoms of male infertility?

In most cases, there are no obvious signs of infertility. Intercourse, erections and ejaculation will usually happen without difficulty. The quantity and appearance of the ejaculated semen generally appears normal to the naked eye.

Medical tests are needed to find out if a man is infertile.

What causes male infertility?

Male infertility is usually caused by problems that affect either sperm production or sperm transport. Through medical testing, the doctor may be able to find the cause of the problem.

About two-thirds of infertile men have a problem with making sperm in the testes. Either low numbers of sperm are made and/or the sperm that are made do not work properly.

Sperm transport problems are found in about one in every five infertile men, including men who have had a vasectomy but now wish to have more children. Blockages (often referred to as obstructions) in the tubes leading sperm away from the testes to the penis can cause a complete lack of sperm in the ejaculated semen.

Other less common causes of infertility include: sexual problems that affect whether semen is able to enter the woman’s vagina for fertilisation to take place (one in 100 infertile couples); low levels of hormones made in the pituitary gland that act on the testes (one in 100 infertile men); and sperm antibodies (found in one in 16 infertile men). In most men sperm antibodies will not affect the chance of a pregnancy but in some men sperm antibodies reduce fertility.

Known causes of male infertility

Sperm production problems • Chromosomal or genetic causes
• Undescended testes (failure of
the testes to descend at birth)
• Infections
• Torsion (twisting of the testis in scrotum)
• Varicocele (varicose veins of the testes)
• Medicines and chemicals
• Radiation damage
• Unknown cause
Blockage of sperm transport • Infections
• Prostate-related problems
• Absence of vas deferens
• Vasectomy
Sexual problems
(erection and ejaculation problems)		 • Retrograde and premature ejaculation
• Failure of ejaculation
• Erectile dysfunction
• Infrequent intercourse
• Spinal cord injury
• Prostate surgery
• Damage to nerves
• Some medicines
Hormonal problems • Pituitary tumours
• Congenital lack of LH/FSH (pituitary problem from birth)
• Anabolic (androgenic) steroid abuse
Sperm antibodies • Vasectomy
• Injury or infection in the epididymis
• Unknown cause

The male reproductive system

The male reproductive system is made up of the testes, a system of ducts (tubes) and other glands that open into the ducts. The brain plays an important part in the control of the male reproductive system.

A side view showing the main parts of the male reproductive system

A side view showing the main parts of the male reproductive system

The pituitary gland and the hypothalamus, located at the base of the brain, control the production of male hormones and sperm. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) are the two important messenger hormones made by the pituitary gland that act on the testes.

The brain connection

Two messenger hormones act on the testes

The testes (testis: singular) are a pair of egg-shaped glands that sit in the scrotum next to the base of the penis on the outside of the body. The testes make sperm and the male sex hormone testosterone. It takes about 70 days for sperm to become mature and able to fertilise an egg.

When released from the testes, the sperm spend two to 10 days passing through the epididymis where they gain the vital ability to swim strongly (become ‘motile’), and to attach to and penetrate (get into) the egg.

At orgasm, waves of muscle contractions transport the sperm, with a small amount of fluid, from the testes through to the vas deferens. The seminal vesicles and prostate contribute extra fluid to protect the sperm. This mixture of sperm and fluid (the semen) travels along the urethra to the tip of the penis where it is ejaculated (released).

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If you have been unsuccessfully trying to get pregnant for more than six months, before you embark on invasive medical procedures and spend thousands of naira for assisted reproductive technology, ensure that you rule out any thyroid problem.

Many women do not realise that a good thyroid function is necessary for fertility, the ability to conceive and to maintain a pregnancy.  A low or hyper functioning thyroid gland can prevent you from achieving that much desired pregnancy. While there are many and varied reasons for infertility, suboptimal thyroid function may be that “missing link” especially for those with no specific reproductive problems.

A full thyroid evaluation is essential, and should be done as soon as possible for any woman who wants to get pregnant, especially if she has been trying to get pregnant for more than six months, had two or more miscarriages, has irregular menstrual cycle or a family history of thyroid problems.

Also, in general for both male and female, low libido, erectile dysfunction, lethargy, fatigue and consistent weight gain may also suggest the need for thyroid evaluation.

What does the thyroid gland do?

The thyroid gland is located near the front of the throat, just below the voice box and just above the collar bones. Every cell in the body depends upon thyroid hormones for regulation of the body’s metabolism, blood calcium levels, energy production, fat metabolism, oxygen utilisation, balance of other hormones and weight maintenance. If the pituitary gland is the headmaster of all endocrine glands that produce all hormones, the thyroid gland is like the deputy headmaster.

Hormones involved with thyroid function include Thyroid Releasing Hormone released from the hypothalamus in the brain, which stimulates the pituitary gland at the base of the brain to release Thyroid Stimulating Hormone, which in turn stimulates the thyroid gland to produce Thyroxine and Triiodothyronine.

Much of T4 is converted to T3 (the active form) in the liver.  Thyroid hormones are synthesised from iodine and the amino acid Tyrosine (from protein), and the conversion to the active form is reliant on the trace mineral Selenium.

A healthy thyroid function can be affected by exposure to environmental toxins – electromagnetic radiation, genes, stress, diet and auto-immune disorders.

How does hypothyroidism affect fertility?

Anovulatory cycles

Hypothyroidism can make a woman experience her menstrual cycle without ovulating (she is not releasing any egg). This makes pregnancy impossible.

Luteal phase problems – A person with a short second half of the menstrual cycle who gets a fertilised egg after intercourse will discover that such fertilised egg cannot implant securely and ends up leaving the body at the same time that menstruation would occur (very early miscarriage). This is often mistaken as a regular period.

Other problems associated with hypothyroidism include high prolactin levels; low production of sex hormone binding globulin, estrogen dominance, progesterone deficiency, all of which interfere with proper reproductive hormone balance.

A new study supports the notion that thyroid disorders can cause significant reproductive problems for women. The authors of the report believe that testing for thyroid disease should be considered for women who have fertility problems and repeated early pregnancy loss.

The study co-author and researcher at the Bristol Centre for Reproductive Medicine at Southmead Hospital, Bristol, England, Amanda Jefferys , found that 2.3 per cent of women with fertility problems had an overactive thyroid (hyperthyroidism), compared with 1.5 per cent of those in the general population. The condition is also linked with menstrual irregularity, the researchers said.

She said, “Abnormalities in thyroid function can have an adverse effect on reproductive health and result in reduced rates of conception, increased miscarriage risk and adverse pregnancy and neonatal outcomes,”

We have noticed a strong link between hypo-and hyperthyroidism and infertility as well as their adverse effect on pregnancy and neonatal outcomes for over two decades.

Consequently, routine screening of the general population for thyroid dysfunction at the start of pregnancy, especially when seeking fertility treatment or struggling with miscarriages is highly recommended by experts.

The thyroid produces hormones that play key roles in growth and development. According to the British researchers, changes in thyroid function can have a major effect on reproductive function before, during and after conception.

Hypothyroidism (underactive thyroid) affects about 0.5 per cent of women of reproductive age. In children and teens, the condition is associated with a delay in reaching sexual maturity, according to published reports.

In adult women, hypothyroidism is linked with menstrual problems and a lack of ovulation in some cases. The researchers in the study also noted that thyroid disease is associated with an increased risk of problems during pregnancy, including miscarriages, preeclampsia, poor fetal growth, premature birth and stillbirth.

The thyroid evaluation can be done in any good laboratory and then interpreted by a doctor or better still an endocrinologist. There are also new techniques using bio-energetic testing to determine whether the thyroid gland is stressed or weak at the pre-clinical state before it becomes pathological.

Finally, a good diet with iodide salt and good multivitamin supplement can provide a protection for the thyroid function.

PUNCH.

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