What is total fertilization failure after ICSI?

Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg. ICSI is generally performed following an in vitro fertilization procedure to extract one to several oocytes from a woman.

For both patient and doctor, failed fertilization comes as a shock. Although, the fertilization failure after ICSI is less common but considerable chances cannot be ruled out. Generally, fertilization failure after IVF is because of sperm problem. However, fertilization failure after ICSI is rarely because of sperm problem.

Surprisingly, most of the patients are in this notion that failure of ICSI is because of sperm problem. The much known fact that 50 per cent of the DNA comes from the sperm, becomes the reason to believe that fertilization failure after ICSI is because of sperm problems.

Now, ICSI is performed on infertile men with low sperm count or poor sperm motility. Hence, it is logical to conclude that failed fertilization is because of the abnormal sperm DNA in men, which prevents the sperm from fertilizing the eggs. 

The actual truth is that the failed fertilization after ICSI is not because of sperm but the egg. Why? After the sperm is injected inside the egg, most of its work is done. The rest of the fertilization process is driven by energy which is provided by the powerhouses of the cells – the mitochondria, which are present in the cytoplasm of the egg. The sperm has very little role to play after the ICSI has been performed.

Now why the eggs look completely normal? This is because there is no way to distinguish between a normal and an abnormal egg even if the failure has occurred because of eggs. Even if the egg functionally incompetent, it looks normal.

Failure of fertilization after ICSI can only be found out when the embryologist does the fertilization check 16 hours after ICSI. If the eggs do not get fertilized (i.e. it does not have any pronuclei) then fertilization fails.

Rarely, the incubator malfunction can damage the eggs or embryologist can also damage the eggs when doing ICSI. But, remember that failed fertilization after ICSI is usually because of an egg problem. Women, those with poor ovarian reserve and a poor ovarian response encounter these problems.

IVF with ICSI involves the use of specialized micromanipulation tools and equipment and inverted microscopes that enable embryologists to select and pick up individual sperm in a specially designed ICSI needle.

The needle is carefully advanced through the outer shell of the egg and the egg membrane - and the sperm is injected into the inner part (cytoplasm) of the egg. This usually results in normal fertilization in about 75-85% of eggs injected with sperm.

However, first the woman must be stimulated with medications and have an egg retrieval procedure so we can obtain several eggs for in vitro fertilization and ICSI.

Dr Neeraj Pahlajani

Obstetrician & IVF Specialist

(MS, DNB, FMAS, DRM - Germany)

MBBS - Lady Harding Medical College - New Delhi

MS - Obstetrics and Gynecology (PGI - Rohtak)

DNB - Obstetrics and Gynecology

FMAS - World Association of Laparoscopic Surgeons

DRM - Diploma in Reproductive Medicine (Germany)

Fellow in IVF & Embryology – (USA)

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Pahlajani Test Tube Baby Centre

(Mata Laxmi Nursing Home)

Anupam Nagar, Near T.V. Tower, Raipur (Chhattisgarh) India

Phone:  +91- 771- 4052967, +91- 771- 4053285 Mobile:  +91- 9300511044, +91- 9329630455

Email - contact@raipurivf.com, sameerp5000@hotmail.com

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IMSI - will superior selection of sperms improve ICSI success outcome?

Intracytoplasmic morphologically-selected sperm injection (IMSI) is an infertility treatment and is believed by some experts to be the most effective treatment to date for male factor infertility. This is simple a modification of the standard ICSI technique, in which the sperm are magnified even further. The rationale is very logically appealing - let's use higher powered magnification, so we can select the best sperm for ICSI. One would therefore expect that this technique would result in higher pregnancy rates after ICSI. The technique involves selecting the best quality sperm cells from a sample provided by the male partner, and injecting them directly into the eggs retrieved from the female partner, thereby increasing the probability that these sperm cells will fertilize the eggs.

Pahlajani Test Tube Baby Centre is proud to be announced that we have new, advanced IMSI equipment in our laboratory and a team of experienced embryologists who carry out the procedure. IMSI is also known as “Super ICSI”, since it is a technique that improves the results of the sperm injection. Fertility treatment just got better with handpicking the best sperm to be fused with the egg. Experts have improvised on intracytoplasmic sperm injection ICSI which is a method in which a sperm is physically injected into an egg but now come up to more advanced feature with the new technique of intracytoplasmic morphologically selected sperm injection (IMSI). The procedure involves use of powerful microscopes to look at and select the healthiest-looking sperm to improve the success rate of conception.

Men with fertility problems do not produce normal, healthy sperms that are capable of swift movement towards the egg. In such cases, ICSI, which stands for intracytoplasmic sperm injection, is the only way to produce an embryo. "But even such procedures fail because sperm we select may not be completely healthy,"

In IMSI, after the microscope magnifies sperm 7,000 times, a computerized semen analysis picks up the best sperm to be fused with the most fertile eggs. Dr Neeraj Pahlajani feels IMSI is superior as it makes the selection process more stringent. After two to five days, the fused egg-sperm is injected into the uterus.

IMSI improves on the successes of ICSI (Intracytoplasmic sperm injection). ICSI, developed in the early 1990s, has itself been found to increase the chances of successful IVF. Male patient who have tried and failed to become fathers through at least two previous IVF attempts were twice likely to succeed through IMSI than through another round of conventional fertility treatment. Unfortunately, this is not true in real life. Not only does IMSI not improve pregnancy rates as compared to ICSI, it can actually decrease them. This is because IMSI takes longer to perform than ICSI. The embryologist has to keep the fragile eggs into which the sperm has to be injected on the micromanipulator for longer while doing IMSI, and since eggs are very sensitive, this extra exposure can cause them to get damaged.

We also know that abnormal embryos are the commonest reason for failed embryo implantation after IVF; and that this is the reason why IVF failure rates increase for older women. Now, since the sperm provide 50% of the genes of the embryo, it is logical to assume that 50% of the time the reason for genetically abnormal embryos and thus failed IVF cycles and recurrent miscarriages would be genetically abnormal sperm.

However, what is logical is not always true.  In reality, studies have shown that there is no correlation between abnormal sperm and failed IVF or miscarriages. Let's look at a very common reason for infertility. This is the problem of abnormal sperm morphology, known medically as teratozoospermia. These are men who have a very large proportion of abnormally shaped sperm - more than 95% abnormal forms. The standard treatment for these men is ICSI, in which a single sperm is injected into an egg to fertilize it.

IMSI versus ICSI versus IVF

In IVF, eggs are harvested from the female partner and left in a dish with sperm cells from the male partner. These sperm cells need to be strong enough having well enough morphological quality to swim to the eggs, penetrate their outer layers and fertilize them. IMSI and ICSI do not rely on the sperm cells' ability to do this - both techniques give the sperm cells a helping hand to reach the inner layer of the egg (the cytoplasm). Where IMSI differs from ICSI, however, is that during IMSI, the embryologist carrying out the procedure uses an extremely high-powered microscope to select the sperm cells with the best morphological quality to be injected into the eggs.

The procedure of IMSI

IMSI begins with standard IVF procedure. The female partner is given ovulation-inducing drugs, and the resulting mature eggs are then harvested from her ovaries and prepared for fertilization in the laboratory. The embryologist will then use the high-powered microscope to examine the male partner's semen sample. He then uses a long, thin, hollow needle to pick up the desired sperm cell. He holds the egg cell in a special pipette, and then uses the needle to push the sperm cell through the outer shell of the egg and into its inner area, where fertilization can take place. The eggs and sperm are then left for 24 hours, during with fertilization is likely to occur. If this is indeed what happens, the now fertilized eggs (embryos) are transferred back to the woman's uterus where hopefully at least one will implant, resulting in a pregnancy.

Risks and drawback

IMSI is significantly more expensive to perform than ICSI, because of the need for specialized training and expensive state-of-the-art equipment. There is also the possibility of a higher risk of multiple pregnancy (twins or triplets) arising from IMSI than from ICSI. But the pregnancy rate among the IMSI couples 35% more success among the couples who used ICSI. Pahlajani Test Tube Baby Centre is eager to provide high quality treatment with high success rates.

Can PCOD be Cured? A Helpline for Infertile Couples

PCOD - Polycystic Ovarian Disease is one of the general causes of infertility. Patients with PCOD have irregular periods, and this can cause considerable distress. The good news is that you can to learn to manage it yourself. PCOD is one of the commoner causes of infertility. It's a chronic disease, which patients need to learn to manage them; sadly, lots of patients with PCOD are very confused. They seem to understand very little about their own problem and I think this is partly because their doctors are very confused themselves and do not take the time and trouble to teach patients about their disease. Patients with PCOD have irregular periods; and they know that their irregular periods also mean that they will be infertile. How the irregular periods cause infertility is something they are not clear about. They also know that they have a "hormonal imbalance" - but are clueless about which hormones are not in balance. Because they miss their periods every month, many of them go to the doctor regularly so that he can prescribe medications for them to take in order to induce a period. While many know that the medicine the doctor prescribes is progesterone, they are very scared to take this for themselves on their own. For one thing, most patients are scared to self-medicate; and they are worried about the side effects of these hormones.

Why do women with PCOD have trouble with their menstrual cycle and fertility?

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.

In women with PCOD, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.

Does PCOD change at menopause?

Yes and no. PCOD affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOD, such as heart attack, stroke, and diabetes, increase as a woman gets older.

Some basic principles which every PCOD patient needs to learn 

·         Firstly, you should plan to get 12 periods every year. There's no point in waiting week after week for the period to come on its own - you are just wasting time and adding to your anxiety levels. Every time you miss your period, you are hopeful that you are pregnant at last - and when the pregnancy test comes back as negative, you get depressed and disheartened again. Why break your heart every month - you need to be proactive.

·         Having irregular periods reduces your fertility. It also messes up the quality your life; and it also also impairs your health.

·         Why waste time waiting for the period to come when it's so easy and safe to induce one? Unfortunately, many patients are scared to self-medicate because of ignorance.

·         All you need to do is to take a 5-day course of a natural hormone called progesterone.

·         Many women are scared of hormones. They are worried that these hormones will make them fat or cause side effects. Please remember that this is a natural hormone which you are taking only because your own ovaries are not behaving themselves and producing this important hormone. It's very similar to managing diabetes. Just like a diabetic needs to take insulin to keep his blood sugar under control, you need to take the progesterone every month to induce a period. The good news is that it's not an injection - and you need to take it for only 5 days every month.

·         Every time you miss your period, do a pregnancy test to confirm you are not pregnant. Many doctors routinely prescribe during pregnancy to provide luteal phase hormonal support. Don't forget that progesterone is a natural hormone which is produced during pregnancy and as the name suggests, it supports gestation; If you take it inadvertently during your pregnancy, you will not harm your baby and in fact if you do not get a withdrawal bleed after taking this course of tablets, one possibility your doctor will need to rule out is a pregnancy.

What are the symptoms of PCOD?

The symptoms of PCOD can vary from woman to woman. Some of the symptoms of PCOD include:

·         Infertility (not able to get pregnant) because of not ovulating. In fact, PCOD is the most common cause of female infertility.

·         Infrequent, absent, and/or irregular menstrual periods

·         Increased hair growth on the face, chest, stomach, back, thumbs, or toes

·         Cysts on the ovaries

·         Acne, oily skin, or dandruff

·         Weight gain or obesity, usually with extra weight around the waist

·         Male-pattern baldness or thinning hair

·         Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black

·         Skin tags — excess flaps of skin in the armpits or neck area

·         Pelvic pain

·         Anxiety or depression

·         Sleep apnea — when breathing stops for short periods of time while asleep

How do I know if I have PCOD?

There is no single test to diagnose PCOD. Your doctor will take the following steps to find out if you have PCOD or if something else is causing your symptoms.

·         Medical history: Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

·         Physical exam: Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

·         Pelvic exam: Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.

·         Blood tests: Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.

·         Vaginal ultrasound:  Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium -lining of the womb. This lining may become thicker if your periods are not regular.

How does PCOD affect a woman while pregnant?

Women with PCOD appear to have higher rates of:

·         Miscarriage

·         Gestational diabetes

·         Pregnancy-induced high blood pressure (preeclampsia)

·         Premature delivery

·         Babies born to women with PCOD have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).

Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breast milk. Talk with your doctor about metformin use if you are a nursing mother.

Does PCOD put women at risk for other health problems?

Women with PCOD have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that more than 50 percent of women with PCOD will have diabetes or pre-diabetes before the age of 40.

·         The risk of heart attack is 4 to 7 times higher in women with PCOD than women of the same age without PCOD.

·         Women with PCOD are at greater risk of having high blood pressure.

·         Women with PCOD have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.

·         Women with PCOD can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

·         Women with PCOD may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Women with PCOD are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer. 

I have PCOD. What can I do to prevent complications?

If you have PCOD, get your symptoms under control at an earlier age to help reduce your chances of having complications like diabetes and heart disease. Talk to your doctor about treating all your symptoms, rather than focusing on just one aspect of your PCOD, such as problems getting pregnant. Also, talk to your doctor about getting tested for diabetes regularly. Other steps you can take to lower your chances of health problems include:

·         Eating right

·         Exercising

·         Not smoking

How can I cope with the emotional effects of PCOD?

Having PCOD can be difficult. You may feel

·         Embarrassed by your appearance

·         Worried about being able to get pregnant

·         Depressed

Getting treatment for PCOD can help with these concerns and help boost your self-esteem. You may also want to look for support groups in your area or online to help you deal with the emotional effects of PCOD. You are not alone and there are resources available for women with PCOD.

How to Manage your PCOD

It is important that a broad approach be used to treat and manage PCOD.

Lifestyle changes and Healthy eating

The good news is that PCOD can generally be treated with lifestyle changes that lead to good health. Studies show, that improving food and eating patterns, increasing exercise and losing some weight if necessary, can reduce insulin resistance, improve PCOD symptoms, help prevent long-term problems and reduce the use of medications. The main aims are to reduce both insulin resistance and insulin secretion and avoid excessive energy intake where weight is a concern. Food is an important part of culture, lifestyle and celebrations. Healthy eating is an essential part of PCOD management but this doesn’t mean following strict diets. Instead try small, sustainable changes that become a part of a normal lifestyle. What you can do

1. Eat regular meals

Spreading food more evenly over the day helps to prevent large swings in blood sugar, insulin and hunger levels. Eat regular meals and snacks when you need them over the day and avoid overeating later in the day. Eating more often doesn’t mean eating too much though.

2. Have a healthy variety of foods each day. This includes:

·         Eat plenty of fruits, salads and vegetables

·         These foods are high in fiber and vitamins and not too high in kilojoules. They should make up about half your plate at a main meal and be one of the first choices for snacks. Be careful with juices though as they can be high in sugar and kilojoules.

·         Wholegrain cereals

·         Choose wholegrain breads and breakfast cereals and keep serving sizes of rice and pasta to about one cup cooked at a time. Avoid too many extra biscuits, muffins and cakes so your intake of energy from starch and sugars (carbohydrate) is not too high.

·         The Glycemic Index is a ranking of foods with carbohydrate (sugar and starch) based on their effect on blood sugar (glucose) levels. Low G.I. foods have a number of benefits for PCOD. To find out more consult a dietitian.

·         Avoid large quantities of carbohydrate at any one meal, even from low GI foods (e.g. large serves of pasta or rice) – moderation is the key!

·         Include a moderate protein intake

·         Lean protein choices include meat, chicken, fish, eggs, dairy, nuts, legumes or soy foods and are an important part of the day’s nutrition as they contain minerals like iron, zinc and calcium. Protein also adds to the feeling of fullness when eating which may help with weight loss.

·         Healthy fats in small amounts

·         The type of fat eaten is important so choose monounsaturated fats and omega 3 essential fatty acids in moderation and avoid saturated fats. To do this, use small amounts of olive oil or canola oil in cooking and monounsaturated spreads instead of butter, use low fat dairy foods and include fish regularly. Check the labels on food for saturated fat levels.

3. Limit high fat, high sugar foods

Foods containing a lot of fat and sugar produce excess kilojoules (calories), contribute to weight gain and higher insulin levels and often don’t contain much nutrition. However, low fat, low sugar does not mean any fat, no sugar; The best approach is commonsense moderation and avoiding extremes in intake of any foods.

4. Pay attention to eating habits, not just food

People eat for many reasons such as pleasure, boredom, loneliness, stress or simply out of habit. This eating can be a concern if it leads to a less healthy food intake than needed. Rather than dieting, reducing this ‘non hungry’ eating is the best way to maintain a healthy weight. Serving sizes of food have also generally increased in recent years leading to many people becoming used to eating too much at a time. In this case experiment with smaller serving sizes and be careful not to overeat when eating out socially.

Physical Exercise and PCOD

Exercise is an essential part of managing PCOD. Regular physical activity can reduce insulin levels, increase the metabolic rate of the body, improve mood and energy levels and help maintain a healthy weight. Research has shown that people who exercise regularly, even if they are overweight or have a family history of diabetes, have less risk of developing diabetes or cardiovascular disease. Be active every day and then at least three to four times a week aim for 30 to 45 minutes of more vigorous exercise. A balanced mix of activities that include aerobic, resistance and flexibility/stretching exercises will give the best results. Variety is also important – if you are getting bored, it is time to try something new

·         Aiming for about 10,000 steps a day is an easy way to measure and assess general physical activity.

·         Put a limit to time watching television or in front of a computer. If you have a job where you sit for much of the day, get up and move around regularly.

·         Keep walking faster or further so your fitness keeps improving

·         Use the stairs instead of taking the lift, or park the car a bit further from the shops rather than the closest spot

·         Make time to take up a sport again you have enjoyed in the past

·         Make sure you have the right shoes and clothes

How can thyroid affect fertility, conceiving and pregnancy ?

Concerned your thyroid is having an impact on your fertility? Solving thyroid problems before conceiving is more important than you think! The thyroid is an important gland for fertility. Hormonal imbalance can act as a trigger for thyroid problems. Before we begin to learn different ways thyroid issues may affect your fertility, it is important to know how the thyroid functions.

The thyroid is a small butterfly shaped gland. It is located just below the larynx, in the lower part of the neck. The purpose of the thyroid gland is to take iodine from foods we consume and convert them into thyroid hormones: thyroxin (T4) and triiodothyronine (T3). Thyroid cells are the only cells in the body which can absorb iodine. The thyroid combines iodine and the amino acid tyrosine to make T4 and T3. T4 and T3 once released into the blood stream control our metabolism. The thyroid is also responsible for proper growth, development and repair of the body. It is extremely important for the development of the central nervous system. The metabolism of every single cell in our body is dependent on thyroid hormones. The thyroid produces about 80% T4 and 20% T3, but T3 has four times the strength of T4.

The thyroid is controlled by the pituitary gland. The pituitary gland is controlled by the hypothalamus. When thyroid hormones drop too low, the pituitary gland releases Thyroid Stimulation Hormone (TSH). The release of TSH stimulates the thyroid to release more T3 and T4. Healthy regulatory release T3 & T4 signal the pituitary to decrease the release of TSH. The hypothalamus stimulates the pituitary gland to release TSH through the release of TSH Releasing Hormone (TRH). All of this can be confusing. To break it down into simpler terms, imagine it like this: The hypothalamus is like you, a person who can control the thermostat in your home. The thermostat is the pituitary, and the heat is thyroid hormones. As the heat rises (thyroid hormones) it signals the thermostat (pituitary) to shut off. As the heat decreases, it signals the thermostat to run again. The control person (hypothalamus) sets the thermostat (pituitary) to regulate the heat (thyroid).

Thyroid Disease, Pregnancy and Fertility

Thyroid disease is not common during pregnancy. This is because the immune system, which plays a role in thyroid disease, is suppressed during pregnancy in order to protect the developing fetus. As a result of the loss of this protective effect at the end of pregnancy, there is a tendency for thyroid disease to occur after delivery in those women who have had previous thyroid disease or who are at risk for developing thyroid disease. Silent autoimmune thyroiditis is particularly common after pregnancy. This "post partum thyroiditis" tends to get better after a few weeks although recurrence in subsequent pregnancies and progression to permanent hypothyroidism is possible. It is important to recognize thyroid disorders during pregnancy as untreated hypothyroidism may impair full and normal development of the fetus, to some degree, and may increase maternal complications. Iodine intake should be increased during pregnancy and breastfeeding of 150 micrograms to 250 micrograms per day, but should not exceed 500 micrograms per day.

Infertility

Patients with either hyper or hypothyroidism can have fertility problems although it is certainly possible to have these diseases and still get pregnant. Once the diseases have been treated, it is important to recommence birth control (if desired), since fertility is restored quickly once the patient’s thyroid function is normal. Sub-clinical hypothyroidism can sometimes cause infertility and miscarriages and is, thus, usually treated in women of childbearing age that desire to become pregnant.

In addition, both men and women with untreated thyroid disease often have decreased sexual desire (libido). Hyper- or hypothyroidism is also a cause for male infertility since sperm development requires normal thyroid hormone levels.

Preferably, Graves’ disease should be treated with radioactive iodine or by surgery before pregnancy to avoid the use of ant thyroid medication during pregnancy. It is generally recommended to wait six months after radioactive iodine treatment before becoming pregnant. One other cause of infertility in patients with thyroid disease is the uncommon condition of primary ovary failure. This is an autoimmune disorder, like Graves’ disease caused by proteins and white cells in the blood that attack proteins in the patient’s ovaries. This leads to the decreased size of the ovaries, the failure to ovulate, premature menopause, and infertility.

Menstruation

Menstruation tends to be increased in hypothyroidism and decreased in hyperthyroidism. The effects of thyroid hormones on menstrual periods, ovarian function and the endocrine system in general are complicated but important. With too much or too little thyroid hormone a variety of effects on the reproductive system can occur. Girls who become hyper- or hypothyroid during puberty may have delayed menstrual function.

Thyroxine Treatment in Pregnancy

There is no contra-indication to taking thyroxine throughout pregnancy. If hypothyroidism has been diagnosed before pregnancy The Endocrine Society recommends to adjust the dose to reach a TSH not higher than 2.5 mIU/L before pregnancy. It has been observed that thyroxine requirements increase during the pregnancy so most women with thyroid diseases need dose adjustment and monitoring. The baby’s thyroid becomes functional at approximately 12 weeks of gestation. Thyroid hormones play an important role in fetal brain development, so the thyroid hormones provided by the mother during the first trimester of pregnancy are especially important. Thyroxine treatment is adjusted to obtain TSH levels specific to each trimester (less than 2.5 mIU/L in the first trimester or 3 mIU/L during the second and third trimester).

Screening during Pregnancy for Thyroid Disorders

Screening guidelines for thyroid disease differ among the various associations and expert groups. The Endocrine Society recommends screening for thyroid disorders in women at high risk; Women with prior thyroid disease or surgery, goitre, family history, positive thyroid antibodies, other autoimmune diseases, symptoms or signs suggestive of thyroid dysfunction, previous head and neck irradiation for other disease. Screening is performed by measuring the TSH level.

Hyperthyroidism

Hypothyroidism an underactive thyroid is a frequent cause of infertility. If the thyroid in underactive, the hypothalamus and pituitary gland can sense this and try to kick things back to normal by increasing levels of the hormones TRH (thyroid-releasing hormone) and TSH (thyroid-stimulating hormone) in your body. TRH produced by the hypothalamus, prompts the pituitary to release TSH, which in turn stimulates the thyroid to do its job. However, TRH also prompts the pituitary to release more of the hormone Prolactin. Elevations of Prolactin can interfere with ovulation by suppressing release of the hormones LH and FSH, which stimulate the ovary. Low levels of thyroid hormone can also interfere with the rate at which your body metabolizes sex hormones, which can also cause ovulatory disorders.

Excess thyroid hormone resulting either from an overactive thyroid gland or from taking too much thyroid hormone can also cause problems. Thyroid hormone can block the effect of estrogen at various points in the body. That means the estrogen will not be as effective at getting its job done. This can make the endometrium (uterine lining) unstable and cause abnormal uterine bleeding.

Fertility Signs and Symptoms of Hyperthyroidism for Women

·         Loss of libido

·         Amenorrhea (Absent Period)

·         Postpartum thyroiditis, occurs in 7% of women within the first year after childbirth

Hypothyroidism

This is when the thyroid is not producing enough thyroid hormones. This commonly happens when there is iodine deficiency. Hypothyroidism happens in women more often than men.

Fertility Signs and Symptoms of Hypothyroidism for Women

Early signs:

·         Female infertility

·         Any type of problem with the menstrual cycle

·         Hyper-Prolactenimia (elevated Prolactin hormone)

·         Galactorrhea (flow of milk in the absence of pregnancy or childbirth)

Late signs:

·         Abnormal menstrual cycles

·         Low Basal Body Temperature (BBT)

Untreated or poorly treated hypothyroidism may cause serious complications for pregnancy, in both the mother and the baby. Because Hashimoto’s thyroiditis may lead to hypothyroidism, these risks for complications fall under that thyroid problem as well.

Complications for the mother:

·         Anemia (iron deficiency)

·         Miscarriage

·         Preeclampsia

·         Placental abruption (placenta detaches from wall of uterus pre-term)

·         Postpartum hemorrhage

Thyroid function must be controlled before you get pregnant!

It is important to treat thyroid problems right away if you want to have a baby. Preconception planning is essential to a healthy pregnancy for women with thyroid problems. Women with untreated or neglected thyroid problems may affect their baby’s growth and brain development. Untreated thyroid problems may also lead to infertility, miscarriage, or a baby born with birth defects. It is important to see a doctor about thyroid issues. Make a plan with your doctor. If you desire natural treatments it is important to speak with your doctor to see if that is a possibility for you. Below are some ways to supplement and support proper thyroid function. If you are interested in any of these, talk to your doctor about the possibility of adding them to your natural health plan. If you already take medications and are wondering if any of these supplements are safe for use with your medication, please speak with your doctor first, prior to using them.

Iodine Rich Food Sources

A diet rich in whole foods should always be the first way to support overall health, including thyroid health. Poor diet and nutritional deficiency is one of the top reasons for thyroid problems. Choose organic foods when possible, as the thyroid is very sensitive to environmental toxins. Too much iodine can also cause goiter, so do not go overboard. More is not always better, it is about balance. It is important to get a balanced amount of iodine in the diet. People with hypothyroidism due to iodine deficiency may benefit from increasing the recommended daily allowance of iodine rich foods.

Supplementation for Thyroid Support

There are key nutrients to support the thyroid including vitamins, minerals and herbs. Thyroid hormones are made from iodine and tyrosine.

·         Zinc, with vitamins E and A function together in the manufacture of thyroid hormone.

·         Selected B vitamins and Vitamin C are also necessary for normal thyroid hormone manufacture.

·         Zinc, copper and selenium are required co-factors for normal blood levels of thyroid hormones and normalization of thyroid activity.

·         Ashwagandha and rhodiola are two key herbs that may support the thyroid gland, as well as the rest of the endocrine system.

Does masturbating affect sperm count and fertility? Some Myths and Facts

Frequent male masturbation doesn't reduce sperm count. Male masturbation also doesn't affect your ability to achieve an erection. Actually, not having an orgasm (ejaculating) for several days or more may lower your fertility. This is because it may lower the number of sperm with normal shape (morphology) and ability to move (motility). Both normal morphology and motility affect your sperm's ability to get to and fertilize your partner's egg. Having sexual intercourse with ejaculation several times a week will maximize your chances of getting your partner pregnant, whether you masturbate or not. Male masturbation refers to sexual stimulation of a man's own genitals, usually to the point of orgasm. Ejaculation usually takes place during male masturbation. When a couple is trying to get pregnant, the male who masturbates, however, may need to limit his masturbation and conserve the sperm stores for the fertilization of the egg.

Male Masturbation and Fertility Male masturbation is stimulation of the male genitals for the purpose of advancing sexual arousal and having an orgasm usually with ejaculation. Most people masturbate until they have an orgasm and when men masturbate and have an orgasm they ejaculate. Masturbation is a part of normal human sexuality. When a couple is trying to get pregnant, the male who masturbates, however, may need to limit his masturbation and conserve the sperm stores for the fertilization of the egg.

Myths:  A man who masturbates frequently will have less sperm available to make a woman pregnant.

Truth: Masturbating doesn't lower sperm count. As long as the couple continues to have regular intercourse, particularly while the woman is ovulating, the frequency of masturbation (by either person) should have no effect on their ability to conceive. However, heavy drinking, smoking, genetics, environmental pollutants, and certain medications are all factors that can reduce sperm count.

Myths:  I ejaculate, so I am fertile

Truth:  There is a difference between 'semen' and 'sperm'. The semen consists of the seminal vesicle fluid, produced by the seminal vesicles tubular glands placed below the bladder, the in vitro fertilisation specialist fluid produced by the prostate and the sperms produced by the testicles. The seminal vesicle fluid helps in motility, while the function of the prostatic fluid is not fully understood in sperm motility. So unless your ejaculate is tested in a lab, it's difficult to say how healthy the sperms are. A normal count is considered to be 20 million sperms per milliliter. So even if you ejaculate normally, but have genetic, hormonal or lifestyle issues, you may have low or no sperm count and bad sperm health.

Myths: I am physically fit, so I have healthy sperms

Truth:  You may have a healthy heart rate, your cholesterol and blood pressure is under control, but it is not necessarily an indicator of healthy sperms too. You may have hurt your testicles while exercising without a scrotum supporter or you may be skipping antioxidants, which prevent your sperms from falling victim to excessive oxidation. Strawberries, cranberries and blackberries are rich sources of anti-oxidants. Or if you are a vegan and in perfect health, you may be missing a crucial chemical element called selenium which helps healthy sperm production. Some selenium rich foods include eggs, meat, chicken and fish.

Myths:  I can't have a baby if I have low sperm count

Truth:  Low sperm count is not bad news. Most guys suffer from self-esteem issues for this reason; but they need to understand that they may still conceive normally. Low sperm count could be an indication of other treatable problems. For example, you may be leading an unhealthy lifestyle and require changes like quitting smoking and alcohol, exercising and eating right. In many cases, the sperm count has returned to normal after certain lifestyle changes. With the right advice from a fertility expert or a specialist, you will be able to conceive.

Myths:  Sperm count is the same every time it is examined

Truth:  If you have been diagnosed with a sperm count of 10 million per ml, it may not necessarily mean that you have low sperm count. The count varies over a period of days. Variation in the temperature, for instance, can affect a man's sperm count. So if you take a test after days of taking very hot showers, your sperm count is likely to be low because heat is bad for sperm health. If you stop the hot baths and have another test after a break, your sperm count may come back to normal. 

Myths:  Bicycling, wearing tight pants causes’ infertility

Truth:  Riding a bicycle for hours raises the temperature in your scrotum and so does wearing tight pants and underwear. Operating laptops placed on your groin might also have the same effect. But all these things do not make you infertile and only lower the sperm count because of the heat. Take off your underwear before going to sleep to allow your scrotum to cool down and help the production of healthy sperms.

Myths:  Masturbation causes LOW or NO sperm count

Truth:  It takes six weeks for your testicles to produce new sperms. Neither masturbation nor sex affects the sperm count. Your body is designed to produce sperms throughout your life. In fact, masturbating or having sexual intercourse several times a week will maximize your chances of getting your partner pregnant, because you are allowing your body to produce fresh sperms at a good rate.

Myths:  The longer I abstain, better the quality of my sperms

Truth:  By abstaining from masturbation or sex for a week or two, the quality of sperm may not be optimal. More and more sperms are being produced and packed in your scrotum every day. Storage in a packed space for a long time may result in DNA damage. On the other hand, abstinence for one or two days can produce the best quality sperm. So, frequent sex is good.

Myths:  Masturbation causes blindness, acne, hair loss, chronic fatigue, hairy palms or cancer.

Truth:  Not true. In fact, doctors say masturbation has medical benefits, wrote Seventeen.com. It can relieve stress, insomnia, headaches, PMS and menstrual cramps.

What Happens During Masturbation?

Truth:  Every time a man masturbates to completion, he has an orgasm an ejaculates. The ejaculation of semen lowers the sperm count available to fertilize the egg. The male body needs to produce more sperm in order to refill the fertilization tank, so to speak and that takes time. For the man who masturbates more than once a day, the stores will consistently be lower than the man who does not masturbate. In order to keep sperm counts higher, men need to conserve the ejaculations for intercourse. When the man allows the sperm to build up in the semen rather than constantly depleting those stores, increased fertility can result. Female masturbation may also play a role in infertility. When the female orgasm takes place, the cervix dips down to touch the end of the vagina. This dip is the bodies’ way of naturally increasing fertility. When the female masturbates during intercourse, if she achieves orgasm before the male, the acids of the vagina may enter the cervix and decrease the amount of sperm remaining viable for fertilization of the egg.

Maintaining a Higher Sperm Count

There are other ways for men to keep sperm counts high. These include wearing loose fitting under garments, refraining from over indulging in alcohol and quitting smoking. The higher the sperm count in the body, the higher the chances that one of the sperm will make it to the egg to fertilize it before it absorbs into the lining of the uterus.

Tests for Sperm Count Levels

If the male feels they may have a lower than normal sperm count and this low sperm count is causing the infertility, a sperm count test can be done to find out if there are any problems in the male reproductive system. The sperm count test requires a sample of the semen given at a clinic with the results being given, usually by mail, at a later date.

Alternative Methods to Increasing Sperm Count

When it comes to increasing the amount of sperm and the mobility of the sperm, there are natural methods that can greatly affect sperm quality and quantity. The first line of defense is the diet. Maintaining a healthy diet and taking a daily vitamin and mineral supplement can help increase the overall health of the body and thus the sperm.

In recent studies, zinc supplementation when paired with folic acid can increase the quality of sperm produced. Doctors have long known the positive effects of folic acid on the fetus, but until lately have not known of a direct link between folic acid and sperm production.

Maintaining healthy sperm and a high sperm count can mean the difference in fertility. With the cost of fertility treatments reaching the thousands of dollars, it is sometimes best to examine the natural ways to increase sperm quality and quantity. Masturbating less often and eating a healthy diet rich in zinc and folic acid are great steps toward achieving parenthood without any outside intervention.

Studies are assorted

There have been many studies done on the effects of male masturbation and fertility. Some of these studies have come back with mixed results, and there is data on both sides of the fence. Some of these studies say that male masturbation depletes the sperm count, making it harder for the woman to get pregnant from sexual intercourse. These studies suggest that men refrain from masturbating to help improve fertility and that you try to get your man to stop masturbating altogether when you are trying to have a baby. However, these studies are few and far between. Most studies do not agree that masturbation is harmful to fertility at all.

No direct connection

Most experts and researchers agree that there is no direct correlation between male masturbation and decreased sperm count or fertility problems. The fact of the matter is, the male body produces sperm at a staggering rate, so it is relatively easy for the body to replenish its sperm supply. Of course, you can’t get pregnant through masturbation, so it might be a better idea to engage in sexual intercourse when you are ovulating instead of masturbating so you will have a chance to get pregnant at all. The studies that we have seen show little to no effect on fertility or sperm count, so don’t stress out about it. If you are truly worried that your man masturbating will inhibit your ability to get pregnant, try to have him refrain from masturbating for a few days before you ovulate, so he will have a larger supply of sperm when you do have intercourse.

Don’t be anxious

There really is no reason to worry though, about masturbation and fertility. That is just something else to worry about, and we all know that stress and anxiety can have a negative effect on your fertility. Just keep in mind that the male body is able to make up for that lost sperm very quickly. There should be no reason why your man’s body will not be able to compensate for any sperm lost during masturbation, and you should be still having the same chances of getting pregnant whether or not your man masturbates.