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What is a hernia in women?

Hernia is defined as a protrusion or bulging of any part of the internal organs towards the outside of the body due to muscle weakness. Women may suffer from many different types of hernia as a result of ligaments, muscles and\or tendons weakness.

Why do Women Get Hernia?

For hernia to occur there must be two main factors; muscle weakness and prolonged increase in intra-abdominal pressure. Risk factors for increasing intra-abdominal Pressure: Chronic constipation. Chronic chest diseases causing continuous coughing. Doing exercises in the wrong manner. Continuous weight lifting especially in wrong ways. And on the other side, The main risk factors for muscle weakness: Heavy smoking. Sedentary life, bad health habits and not practicing exercises regularly. Obesity. Recurrent pregnancies especially if labour is by Cesarean section. Abdominal and pelvic surgeries.

How to prevent Hernia in Women?

Prevention is always better than treatment, although hernia in women is an annoying health issue and may progress to severe complications, it’s preventable. Here are some advices to protect against having hernia: ● Exercise routinely, especially walking every day. ● Avoid smoking, fast food and getting overweight. ● Treat any chronic disease cough and constipation. ● Special exercises after labour and abdominal surgeries to enhance muscle strength. ● Be careful while weight lifting and follow the right way to do it.

What Are the 5 Most Common Types of Hernia in Women?

Although hernia is much more famous in men than women, there are 5 main types of hernia that are frequently seen in women of different ages. 1. Inguinal Hernia Inguinal hernia is the most common type of hernia in women, however it generally affects men much more. In inguinal hernia a part of intestine or fats bulge through a small opening in the muscles of pelvis and lower abdomen.There are two main types of inguinal hernia in women: ● The most frequent type that happens in baby girls shortly after birth due to congenital anomaly. ● The second type occurs at any age group and most probably after abdominal surgeries. 2. Femoral Hernia In femoral hernia there is weakness in the muscles of the upper thigh where part of the intestine may bulge through it. This type of hernia is much more frequent in women than men due to anatomical variations. 3. Umbilical Hernia Umbilical hernia is usually associated with recurrent pregnancy and obesity, as these two factors cause marked weakness in the abdominal muscle around the umbilicus. Some parts of fats or intestines protrude outside through the umbilicus. In many cases it may be painless and not dangerous, however in others many complications may occur such as inflammation, strangulation and even gangrene. 4. Incisional Hernia Incisional hernia is considered a silly complication of previous surgical operations especially if the patient is overweight or had muscle weakness. Any part of internal organs can bulge through the incision of a previous operation if the scar is inflamed and failed to complete proper healing. 5. Hiatus Hernia Hiatus hernia occurs due to weakness in the muscles of the diaphragm, resulting in bulging of parts of the stomach through it. It may be difficult in diagnosis as the affected patients experience such vague symptoms as heartburn and uncomfortable sensation in the upper abdominal region.

What is Infertility in Men?

Infertility in men is defined as the decreased man’s ability to conceive a child with unprotected sex. Fertility in men depends on many factors as follows: ● Secretion of sex hormones especially testosterone that stimulate and modulate the production of sperms. ● Production of millions of sperms in both testicles before every ejaculation. ● The produced sperms should be healthy and have the ability to move fast and forward during the ejaculation. ● Patent Vas deferens. ● Proper activity of Prostate gland that produces the seminal fluid which helps transport sperm to the vagina. ● Fertilization occurs when a sperm meets an ovum in the fallopian tube then the produced zygote becomes implanted in the uterus. Impairment of any of those steps will decrease the chance of getting pregnant and leads to infertility.

What are the main causes of infertility in men?

There are many causes of infertility in men and the most 7 important and famous causes are: 1. Sperm Abnormalities Sperm abnormalities are the most common cause of infertility in men and highly affect the male’s ability to conceive a baby. These abnormalities may occur due to genetic factors, congenital anomalies or systemic disorders as in kidney failure. Bad health habits, obesity, alcohol and smoking have a strong effect on sperm health, also some infections during childhood such as Mumps may affect the production process of sperm. The main sperm abnormalities are: ● Decrease sperm count Normal sperm count ranges from 300-400 millions per each 1 ml of the seminal fluid and the lowest sperm count that can conceive a child is 10-20 millions. When sperm count is below normal it is called Oligospermia, while some cases may suffer from complete absence of sperm which is known as Azoospermia. ● Abnormal sperm morphology Abnormalities in the shape of sperm may affect its ability to move till reaching the ovum and complete fertilization. ● Abnormality in sperm movement Abnormal sperm movement may be in speed or the direction of movement. 2. Varicocele In varicocele veins surrounding the testicles get dilated and engorged with blood, and this results in increasing the temperature within the testicles and impair the production of sperm. Varicocele affects 16% of men at different ages; not all cases suffer from infertility; only 40 of 100 cases show infertility issues due to it. 3. Retrograde Ejaculation Normally during ejaculation, sperm move fast and forward from the male genitalia through the vagina to reach the ovum. In retrograde ejaculation the sperm move in wrong directions and fail to get through the vagina. It may happen due to weakness of nerve and muscles of the urinary bladder most probably after surgeries. 4. Obstruction of Male Genital Tract Narrowing or obstruction of any part of the male genital tract prevents sperm from getting out. This may happen due to reccurent inflammation or adhesions after trauma or surgery. 5. Medications Taking some sorts of medications that may have side effects on sperm production and health as in the following medical conditions:

What Are Causes of Fallopian Tube Obstruction?

There are many factors that would cause fallopian tube obstruction or adhesions such as: ● Endometriosis Cases with endometrial cells in the fallopian tubes would suffer from recurrent bleeding and inflammation that leads to obstruction of the tubes. Also endometriosis of other pelvic organs can cause adhesions that can obstruct the tubes. ● Pelvic inflammatory disease Pelvic inflammatory disease is inflammation of the female pelvic organs such as ovaries, fallopian tubes, uterus and cervix caused by infections. Many bacterial, fungal or viral organisms can cause pelvic inflammatory disease and one of its common complications is fallopian tube obstruction. ● Specific Sexual Transmitted Infections (STI) Certain infections that are transmitted by intercourse such as Chlamydia and Gonorrhea can cause fallopian tube severe inflammation and obstruction. ● Previous Ectopic Pregnancy Ectopic pregnancy is pregnancy outside the uterus, if you have a misdiagnosed ectopic pregnancy within a fallopian tube it can be complicated and cause obstruction or even rupture of the tube. ● Fibroid Fibroids when grown to a large size can attach to the uterus causing blockage of the fallopian tubes. ● Surgery Adhesion formation is one of most common complications after surgeries. Risk of fallopian tube adhesions is highly increased especially when the surgery is within the tube itself. Fallopian Tube Obstruction and Infertility Fallopian tube plays an important role in the process of fertilization and blockage of it is a common reason for infertility. Within days of ovulation the ovum stays for a few days in the upper portion of the fallopian tube waiting for the sperm to fertilize it. Fertility is highly affected according the degree of obstruction of the fallopian tube as follows: ● Definite infertility would occur in cases of complete obstruction of both fallopian tubes, and for getting pregnant IVF\ICSI procedures are recommended. ● In cases with partial obstruction of fallopian tubes, the incidence of ectopic pregnancy would increase. ● If obstruction occurs in one tube and the other one is normal and patent, fertility wouldn't be affected and the chance of pregnancy is within normal.

How is Fallopian Tube Obstruction Diagnosed?

When fallopian tube obstruction is suspected, there 2 main methods that help in diagnosis: 1. Hysterosalpingography (HSG) Hysterosalpingography is one of X-ray techniques, the doctor injects a specific dye through the vagina to visualize the lumen of all the reproductive system. Hysterosalpingography is a beneficial procedure in diagnosing fallopian tube adhesions, however, in some cases it can’t reach an accurate diagnosis. 2. Laparoscopy In some cases advanced interventional procedures such as laparoscopy is needed to diagnose fallopian tube adhesions. Laparoscopy is also considered a treatment for some cases when adhesions are recent and partial.

What are the main complications of adhesions in the fallopian tubes?

The main complication of Fallopian tube obstruction are: ● The risk of ectopic pregnancy is highly increased with undiagnosed fallopian tube adhesions. ● Infertility as adhesions blocks the way and forms a barrier against the ovum and sperms. However Fallopian tube adhesions can cause infertility in many cases still it can be treated at early partial adhesions and some cases can get pregnant normally. On the other side, in severe forms of adhesions IVF\ICSI become the golden standard to have a baby.

What is androgen insensitivity syndrome and how does it occur?

Androgen insensitivity syndrome is a relatively rare disease in which mutations occur in the genes on chromosome X in the baby during intrauterine development. Chromosome X carries specific genes that determine the sex of the baby and direct the body to develop testes or ovaries and uterus. Then testicles and ovaries secrete other sex hormones that regulate the development of the other sex organs, sexual features and muscles as well. If those genes show mutations sex determination fails and a baby with XY is born as agirl with no testicles and only external features of a female with no female internal organs.

What are the main types and symptoms of androgen allergy syndrome?

There are 3 main types of Androgen insensitivity syndrome with specific symptoms and features for each. 1. Complete Androgen Insensitivity Syndrome (CAIS) This type is considered the most hard one as its diagnosis is usually missed at labour, however the baby is born with chromosomes XY he appears and is treated as a girl. The external genitalia resembles a girl but there are no developed uterus or ovaries. Many babies born like that may suffer from undescended tescticles that are hanging inside the abdomen and may cause complications. Symptoms and signs usually appear at the puberty (around age of 11 or 12 years) such as: ● No development of secondary sexual characteristics as pubic and axillary hair. ● Breasts are small in size with no development of breast buds. ● No menstrual cycle. ● Very narrow and small vagina. Girls with complete androgen insensitivity have definite infertility as there are no developed uterus and ovaries. 2. Partial Androgen Insensitivity Syndrome Symptoms and signs of Partial Androgen Insensitivity Syndrome vary in patients as some affected babies are treated as boys and others as girls. Baby boys suffer from: ● Small penis. ● Hypospadias in which the opening of the urethra is abnormally on the lower surface of the penis. ● Partial undescended testes. ● Enlarged breast buds. On the other side, baby girls with this type of syndrome show the same symptoms and complications as the complete type mentioned above. Unfortunately, both affected boys and girls will suffer infertility. 3. Mild or Simple Androgen Insensitivity Syndrome Simple Androgen Insensitivity Syndrome is considered the most benign type, as the affected boy is with normal and complete external male genitalia and the secondary sexual features develop normally. Some affected males may suffer from decreased sperm count that may affect their fertility, but it can be treated by hormonal therapy and even IVF\ICSI procedures. Other rare symptoms are muscle weakness and relative increase in breast size.

How is Androgen Insensitivity Syndrome diagnosed?

Most cases with partial Androgen insensitivity type are diagnosed since birth as the external genitalia are clearly abnormal. While other cases with complete Androgen insensitivity type are missed at birth and treated as women and symptoms appear at puberty. Many investigations may be ordered for diagnosis such as: ● Chromosomal examination. ● Abdominal and pelvic ultrasound and MRI. ● Testecles biopsy for examination. ● Total hormonal profile. So Androgen insensitivity syndrome is a serious disorder with many types and varies in severity according to the type. However it may be missed in many cases, in others it could be discovered and controlled by specific treatment protocols.

What Causes Anemia with Pregnancy?

Anemia is defined as the decrease of number or function of red blood cells so oxygen supply to the brain and other organs is impaired. There are many types of anemia that may affect pregnant women, the most common types are: ● Iron deficiency anemia It is the most famous and common type of anemia with pregnancy in which there is insufficient iron. Iron is used in the body to form hemoglobin within the red blood cells which is an important protein that carries oxygen to the whole body organs. If you are pregnant and the iron storage in the body is depleted or iron supplementation is low, you are at high risk of getting anemia. ● Folate deficiency anemia Folate is an important vitamin that has a role in formation of normal blood cells and its deficiency causes anemia and causes neuronal defects in the baby. ● Vitamin B12 deficiency anemia It is an important vitamin available in many foods and its deficiency leads to multiple birth defects. 5 Most Obvious Symptoms of Anemia with Pregnancy Anemia is the most common health hazard that faces all pregnant women around the world. Awareness of the most common symptoms of anemia is important to get medical advice as fast as possible. These symptoms are: 1. Feeling dizzy and black outs without effort. 2. Headache. 3. Decrease concentration. 4. Pale lips and skin. 5. Fast breathing and rapid heartbeats.

What are the high risks of developing anaemia during pregnancy?

All pregnant women are at risk of having anemia with pregnancy but there are many factors that increase the risk of getting severe anemia or having it at early pregnancy. Risks such as: ● Having anemia before getting pregnant. ● Pregnancy in more than one baby. ● Recurrent pregnancies with small periods in between. ● Severe vomiting during pregnancy. ● Getting pregnant very young. ● Not eating food and drinks sufficient in iron.

What are the serious complications of anaemia during pregnancy?

When anemia becomes severe and untreated many serious complications may occur such as: ● Impairment of the mental and physical development of the baby. ● Blood transfusion to get rapid correction of anemia. ● Baby is born anemic as the mothers blood supplies iron to the baby to form its hemoglobin so if the mom has anemia the baby will be born with anemia. ● Increase risk of preterm labour. ● Depression after labour.

How to get Protected Against Anemia with Pregnancy?

Protection tips against anemia are very important to prevent having all those risks and complications. These tips will help you to provide your body with all nutrients important for protection against anemia: ● Vitamins before getting pregnant Taking multivitamins 2 to 3 months before getting pregnancy, especially folic acid, is very important in protection against developing anemia with pregnancy. ● Supplement Iron Intake Iron supplements are usually prescribed by doctors to pregnant women and the dose is according to the severity of anemia. Taking vitamin C with it will improve the absorption of iron. ● Healthy Diet Increased dietary intake of nutrients rich in essential minerals and iron will keep your body healthy and protect against several disorders. Diet rich in minerals such as: fish, nuts, seeds, eggs, poultry, beans, leafy green and fruits. Food rich in vitamin C like lemon. Guava, oranges, strawberries, kiwis and tomatoes.

What are the ways to help develop congenital toxoplasmosis?

There are 5 main ways through which we can pick up the infection with toxoplasmosis: 1. Eating undercooked meat containing the parasite. 2. Infected cat can transmit toxoplasmosis through its feces, so if you eat or drink water contaminated with that feces you would get infected. 3. Blood transfusion from an infected person. 4. From maternal blood to the fetus through placenta (congenital toxoplasmosis). 5. Organ transplantation from an infected person. But till now the most common modes of infection are swallowing of the parasite and congenital transmission.

What Are Symptoms of Congenital Toxoplasmosis?

Many cases of toxoplasmosis show very mild symptoms just like that of common cold but if you are pregnant your doctor may suspect you are infected if: ● You have a history of recurrent abortion in the first 3 months of pregnancy. ● Cold flu-like symptoms with eye inflammation or generalized lymphadenopathy.

How does Congenital Toxoplasmosis Affect the Baby?

The incidence of transmitting the infection to the baby is higher in the third trimester than the first and second trimesters. In fact complications of congenital toxoplasmosis vary in between cases, some babies are born normally and symptoms appear later on and others show complications since birth. The most common health hazards and complications are: ● Preterm labour. ● Low maturity of the baby. ● Jaundice due to premature liver functions. ● Breastfeeding difficulties. ● Anemia. ● Tendency to bleed. ● Enlarged spleen, liver and other lymph nodes. ● Abnormal head sizes are either large (macrocephaly) or small (microcephaly). ● Sensori-neural hearing loss. ● Eye problems with vision loss or even eye damage. ● Global motor and mental developmental delay. ● Convulsions. ● Hydrocephalus.

How Can I Know If My Baby Gets The Infection?

If your doctor suspects that you have been infected with toxoplasmosis he would ask for a blood test first to confirm the diagnosis. There are some investigations to be done to know if your unborn baby has got the infection from your blood or not such as: ● The usual ultrasound or 3 dimensional US to rule out any congenital anomalies. ● Amniotic fluid examination and PCR. ● Blood testing of the baby. After delivery there are much more variable tests to diagnose congenital toxoplasmosis: ● Antibodies testing from the baby’s CSF and blood. ● Eye examination. ● MRI brain. ● Full neurologic examination.

How to Get Protected Against infection?

Fortunately congenital toxoplasmosis can be prevented by some tips you should follow especially if you expecting pregnancy: ● Eat well cooked food especially meat. ● Continuous hand wash. ● Proper wash of fruits and vegetables before handling and eating. ● Gloves are worn while dealing with pets or during gardening to avoid getting contaminated with cat feces.

How is Congenital Toxoplasmosis Treated?

When toxoplasmosis is diagnosed during pregnancy there are many medications that are used in treatment such as: ● Mixture of antibiotics to prevent transmission of the infection to the baby. ● Folic acid supplementation to avoid congenital neurological anomalies. ● Steroids to protect the baby’s vision and hearing.

How Can Diabetes Affect Your Baby?

Uncontrolled diabetes highly affects the baby during intrauterine development and also after birth and may cause many health problems as: ● Late Intrauterine Fetal Death The incidence of fetal death at late pregnancy months highly increases by 5 times in diabetic women than in non-diabetics. Also preterm labour increases by 6 times than in non- diabetic women. ● Macrosomia Macrosomia means that the baby is overweight (above 4 Kgm) at the time of labour, this occurs as the baby’s body deals with high blood sugar level by converting it into fat cells to be stored. This leads to increase in body fats and highly increases the body weight which causes obstructed labour and cesarean section. Generally obstructed labour has many hazards on the baby and several birth injuries such as hypoxia, brain injuries and limbs dislocation. ● Baby Hypoglycemia When maternal blood glucose level increases especially at the 3 rd trimester and just before labour, insulin production increases in the baby’s body which affects the baby with hypoglycemia. Severe hypoglycemia affects the baby’s brain and may be life threatening. ● Congenital anomalies Babies born to diabetic moms are at high risk of developing many major congenital anomalies such as: 1. Heart malformations as cardiac transposition of the great arteries, ventricular septal defect and atrial septal defect. 2. Brain and nerves malformations as anencephaly, microcephaly and isolated hydrocephalus. 3. Gastrointestinal such as duodenal atresia and anorectal atresia. 4. Muscles and bone anomalies as talipes and arthrogryposis disorders. 5. Urinary tract abnormalities such as polycystic kidney, renal dysgenesis and hydronephrosis. 6. Cleft lips and palate anomalies. ● High blood bilirubin levels and jaundice due to breaking of red blood cells, anemia and low calcium blood levels.

What advice do we give to women with diabetes who plan to get pregnant?

1. Close follow up with blood sugar testing several months before getting pregnant and keep on contraception until achieving accurate control of blood glucose. 2. Stick to a daily dose of 5 mg of Folic acid before getting pregnant and up to the first 3 months of pregnancy. 3. Physical examination and treat any other health problem. 4. Lifestyle modifications such as doing exercises regularly, stop eating sugars and fast food. 5. Keep the body weight within normal and follow a healthy diet regimen rich in vitamins and proteins.

What are the complications of diabetes in pregnant women?

Failure of controlling diabetes during pregnancy causes many health risks and life threatening complications such as: ● Cesarean section increases by 44% than in non-diabetic women with some complications after surgery as poor healing of the wound. ● High incidence of pre-eclampsia by 12% more than normal women, where blood pressure is highly elevated with dangerous insults to other body organs especially liver and kidneys. ● Chronic hypertension with kidney affection highly increases in diabetic women during pregnancy. ● Maternal death 0.6% ● The incidence of eye complications also increases during pregnancy due to other hormonal and metabolic imbalances. Diabetes forms a very challenging situation for doctors and mothers as well, the key point is close follow up and accurate control of blood glucose levels to avoid all risk hazards to mom and her baby.

What is Endometriosis?

Endometrium is a layer of specific cells that strictly form the inner lining of the uterus and is affected by the action of certain hormones which causes menstrual bleeding. When this endometrial layer grows on other pelvic organs outside the uterus it’s called Endometriosis. During the menstrual cycle, estrogen and progesterone act on all endometrial cells inside and outside the uterus as well. As we know, menstrual bleeding occurs from the shedding of the endometrial layer lining the uterus, but what about the endometrial cells on other organs? In fact, the changes of endometrial cells on other organs will cause inflammation, pain and some adhesions as the blood has no way to go outside the body.

What Causes Endometriosis?

Unfortunately, doctors can’t find a definite explanation for endometriosis, but there are some opinions about that such as: ● Retrograde menstruation; some physicians think that during menstruation some blood with endometrial cells move backwards through the fallopian tube and cells stick in different sites. ● Genes also may have a rule as many females in the same family may be affected.

How does Endometriosis Lead to Infertility in Women?

Endometriosis causes delay in getting pregnancy in many affected women as it highly affects female fertility. As monthly bleeding and inflammation inside the pelvis cause lesions and scars, it may affect fallopian tubes and prevent sperm from reaching the ova so fertilization wouldn’t happen. Also severe menstrual bleeding in many cases would affect the health of the endometrial layers, adhesions may occur in the uterus and form barriers against implantation. So many women with endometriosis suffer from infertility and would need medical intervention either by surgical removal of the endometrial cells outside the uterus or by IVF\ ICSI procedures to get pregnant.

What Are Types of Endometriosis?

Endometriosis has 3 main types according to the site of the lesion: 1. Superficial Peritoneal Superficial peritoneal lesion is the most common type, where lesions are distributed over the peritoneum (the thin lining layer that surrounds abdominal and pelvic organs). 2. Ovarian Lesions Ovarian lesions are also known as chocolate cysts, these cysts are filled with blood deep in the ovaries. This type of endometriosis can damage the ovaries and usually need surgical intervention. 3. Deep Infiltrative Endometriosis This type presents in around 4% of cases, while endometrial tissue is deposited in different organs such as bladder or intestines.

What are the most common signs of migratory endometriosis?

In the start symptoms may be vague and misleading, but if persist you should seek medical advice for early diagnosis. Pain is a mark of endometriosis as affected women show variable degrees of pain in different body parts but it may be very severe during menstruation. 9 of most early and common symptoms of Endometriosis: 1. Severe back pain and cramps during menstrual period. 2. Changes in menstrual bleeding such as heavy bleeding not as usual or irregular periods. 3. Pain during or after intercourse. 4. Bleeding or severe pain during urination or micturition. 5. Delay in getting pregnant. 6. Severe attacks of Migraine. 7. Bleeding from vagina in days away from the regular menstrual periods. 8. Nausea, allergies and easy fatigue. 9. Constipation or Diarrhea.

How is endometriosis diagnosed?

Diagnosis of Endometriosis is achieved by several steps: ● Full history. ● Pelvic examination. ● Ultrasound either abdominal or vaginal, in many cases US can’t diagnose the site of the lesion accurately. ● MRI of the abdomen and pelvis. ● Laparoscopy for diagnosis and treatment as well according to the site and the degree of lesion.

When IVF and ICSI techniques should be done?

Infertility occurs as a result of several health issues that may affect husband or wife separately or both of them at the same time. Also, infertility may occur without a specific cause which is known as “Unexplained infertility”. IVF and ICSI is one of the recent popular medical techniques that help in solving the problem of infertility, obs\ gyn physicians recommend the appropriate protocol for each couple according to their complaints. Here are the most common Indications of IVF and ICSI: ● Polycystic Ovarian Syndrome (PCO) PCO is the most common medical condition that affects women and may be diagnosed in very young girls. PCO causes imbalance in many hormones that influence ovulation and fertility. ● Endometriosis Endometriosis is a common health problem that faces women at different age groups. In this condition, endometrial tissue spreads on other pelvic organs as ovaries and intestine causing pain, adhesions and hormonal disturbances. ● Fallopian Tube adhesions It is one of the most common causes of infertility that usually occurs as a complication of a previous surgical operation. ● Uterine Fibroids or masses Any type of uterine fibroids or masses can cause infertility. ● Unexplained infertility Unexplained infertility is diagnosed after all medical causes of infertility are excluded by precise investigations and examination. ● Early menopause Many women may experience early menopause when ovulation stops and hormonal disturbances occur. ● Congenital anomalies Presence of congenital anomalies within any part of female reproductive organs may cause infertility. ● Age above 35 By aging the efficiency of ovulation decreases and the possibility of infertility becomes higher.

When should I do ICSI with IVF?

Recent scientific researches recommend performing ICSI technique with IVF in all cases of infertility especially in cases with male infertility. Here is a list of the most common causes of male fertility: ● Low sperm count. ● High percentage of sperm abnormalities. ● Retrograde ejaculation. ● Compelte absence of sperms ``Azoospermia”. ● Vas deferens blockage. ● Different syndromes causing hormonal disturbances. ● Congenital anomalies within male reproductive system.

Is there a difference between IVF and ICSI?

The ICSI technique is a recent technique that has been added to the IVF process, so ICSI is considered one of IVF steps. However, IVF may be performed separately without microscopic injection (ICSI). Recent scientific research has shown that adding ICSI to IVF greatly increases the success rate of the procedure and increases the chances of getting pregnant, especially in cases of male infertility. Now we will simply explain the difference between IVF and ICSI: ● IVF process IVF process is performed by extracting a number of ova from the ovaries and placing them in an incubation media outside the uterus with a large number of sperms, then the fertilization process is left to take place normally. ● ICSI technique During ICSI technique after extracting the ova, the doctor chooses the most healthy sperm and performs insemination under microscopic observation. Most doctors advise to perform ICSI with IVF to increase the chance of getting pregnant, and guarantee a healthy pregnancy. Scientific statistics revealed that the success rates of performing IVF and ICSI together ranges from 70% to 85% which is much higher than doing IVF alone.

What are the cases that need to perform ICSI with IVF?

ICSI is a relatively recent technique added to IVF, doctors recommend performing ICSI with almost all cases of infertility. However, it becomes a highly recommended step especially in such cases with infertility: ● Infertility due to male factors such as: Low sperm count, Increase the percentage of sperm deformity, Retrograde ejaculation and Azoospermia; which is the complete absence of sperm. ● Genetic diseases in males or females so by ICSI we can select the best healthy sperm and ovum before fertilization. Other common causes of infertility in women that indicate IVF and ICSI: ● Infertility of unknown cause. ● Endometriosis. ● Polycystic ovarian syndrome. ● Fallopian tube adhesions. ● Uterine fibroid and polyps. ● Early ovarian failure and menopause. ● Female genitalia congenital anomalies.

What are the factors that affect the success rates of IVF and ICSI?

IVf has a high success rate and adding ICSI technique elevates the success rate to over 95%. Preparing for IVF and ICSI takes many steps and seems to be a complicated procedure that may cause stress and anxiety. There are 6 important factors and tips that affect the success rates and should be followed before and while performing such procedure: 1. Be confident with your physician and stick to the follow up schedule and take medications on the precise plan. 2. Be calm and avoid anxiety, being over stressed, caffeine and cigarette smoke. 3. Follow the instructions after implantation; like complete rest for at least 2 weeks and taking the prescriped medications. 4. Perfect age for getting pregnant is from 24 to 35 while the ova are very healthy and efficient for fertilization. 5. Healthy uterus; uterus without inflammations, masses or polyps to ensure a good media for implantation. 6. Autoimmune disorders may cause recurrent abortion during early pregnancy, in such cases doctors may prescribe specific drugs to control the immune reaction.

Does ICSI affect a child's IQ?

Some rumors are published about ICSI affection on Baby’s IQ, physical and mental development. Researches revealed that the incidence of genetic malformations in normal pregnancy ranges from 1.5 - 3% only, and this is the same percentage in IVF and ICSI procedure.

What are the possible complications of IVF and ICSI?

Generally speaking, IVF and ICSI procedure is a very safe operation but there are very limited and relatively rare complications that may happen such as: ● Hyperovulation Hyperovulation is not a common complication; it happens in only 10% of women undergoing IVF. It’s considered a side effect of the ovulation stimulation stage and in some cases may be a life threatening condition that needs hospitalization. ● Multiple pregnancy Getting pregnant in more than one baby is common in IVF and ICSI procedure, but the more the babies the more the risk of abortion or premature labour. ● Injury during implantation Some rare complications may happen during returning the fertilized ova to the uterus. These complications such as: trauma of urinary bladder or intestines, pelvic inflammation and formation of small blood clots. ● Premature labour incidence increases in pregnancy with IVF and ICSI procedure rather than normal pregnancies. Regardless of the causes of infertility, IVF and ICSI procedure is the perfect and safe solution with the most accurate and high success rates. However some rare complications may happen but still sticking to instructions and follow up regularly is the guarantee to get a normal and healthy pregnancy.

How Far Can Obesity Affect Fertility in Women?

Many women suffer from obesity especially in the middle age period (20- 35 years old) which is known as the golden age of fertility. In Fact, Obesity has a great effect on fertility in women and as the American Society of Reproductive Medicine indicated that more than 6% of infertility cases in women are due to obesity. In addition, all medical statistics revealed that obese women are more susceptible to infertility more than other women with average normal body weight. Mainly, Obesity affects fertility in women by causing disturbances in hormonal balance such as estrogen which in turn affects endometrium and impairs ovulation. Obesity and Ovulation.. When ovaries functions are impaired Ovulation occurs within the ovaries and is controlled by many hormones secreted from the Anterior Pituitary gland and the ovaries as well. Obesity and increase body fat lead to the following hormonal disturbances: ● Insulin resistance and increase in blood sugar level that may cause Diabetes mellitus. ● Elevate secretion of Leptin. ● Decrease in excretion of Growth hormone, SHBG and IGFBP. All these hormonal disturbances impair the ability of ovaries to produce mature and healthy ova which cause Infertlity and recurrent abortion.

What is the relationship between obesity and PCOS?

PCO has a high prevalence rate in women and may be diagnosed at the age of 18. Indeed not all patients with PCO are obese, however there is a tight relation between obesity and the pathological process of PCO. As obese patients suffer from high body fat mass the susceptability to develope insuline resistance is elevated, and it leads to more androgen secretion. High androgen levels in the body cause different signs and symptoms such as menstrual disturbances and ovarian hypofunction which lead to infertility.

Does Obesity affect the success rates of IVF and ICSI?

IVF and ICSI procedure is the best recent solution for infertility no matter the cause, it also has very high success rates that exceed 90%. However, Obese women have issues while preparing for IVF and ICSI that may decrease the success rates as: ● Endometrial changes due to hormonal imbalance may impair the ability of the early fertilized zygote to implant within the uterus. ● Decreased the efficiency of the ova that may also increase the risk of genetic malformations. ● High rates of recurrent abortion especially in the early pregnancy. ● High susceptibility of mother affection with Diabetes mellitus that increases the risk of premature labour.

Can Obesity Cause Infertility in Men?

No doubt that obesity can cause infertility in men also, as many medical research revealed that obesity highly affects sperm production and performance. Obese men suffer from many general health problems, however the most improtant problems that affect fertility are: ● Increased Insulin resistance that may lead to Diabetes which impairs the production of Testosterone and causes weak erection. ● General impairment in sperm production process appears as decrease in number of sperms, abnormal mobility and high deformity percentage. ● Hypertension and increased blood cholesterol level impair erection and ejaculation. In addition to the general health hazards of obesity in men and women, obesity can highly affect the fertility in both sexes that may even lead to infertility.

What is the ruling on the ovaries in the ovulation process?

Ovaries are important organs within the female genital system, they are responsible for production of 2 important hormones: 1. Estrogen that develops the female sexual features and organizes puberty with other physiological processes. 2. Progesterone that acts with estrogen in regulation of the menstrual cycles, and has an important rule in maturation of the ova before ovulation. The ovulation process is relatively complex and starts within the intrauterine life as follows: ● In girls, all ova are produced within the ovaries during the intrauterine life and are kept till age of puberty. ● At the age of puberty, the hormonal cycle of estrogen and progesterone stimulates and increases the maturation of many ova every 28 days which is called ovulation. ● Ovulation occurs every month by production of one mature ovum from one ovary then the other ovary acts on the next month. ● Also there are many changes in the uterus every month preparing for getting pregnant. ● If no pregnancy occurs, drop of the hormonal levels causes shedding of the uterine wall and menstrual bleeding starts.

What is Polycystic Ovarian Syndrome (PCO)?

Polycystic ovarian syndrome is a disorder of unknown cause that has variable effects on many body systems: ● Metabolic process. ● Physiological processes of the genital organs. ● Cardiovascular system. ● Endocrine system. Scientists can’t exactly explain the cause of this syndrome, however there are many theories that may give explanation for it such as: ● The genetic theory as they found that the syndrome runs in certain families. ● High insulin resistance causes increase in its level, blood glucose levels and androgen which all affect ovulation. ● Obesity also is associated with high insulin levels that affects ovulation and predispose to PCO. Polycystic ovarian syndrome is famous for the triad of: 1. Irregular menstruation Normal menstrual cycle happens every (26- 30 days) with bleeding for an average of 5 days. Disturbances in the menstrual period may occur in many forms as a decrease in the amount of blood or stop of menstruation for several months. 2. Increase Androgen levels: Androgen is normally found in females with very low levels, but when its level elevates in PCO it causes abnormal hair distribution in the face and other body parts. 3. Formation of cysts in the ovaries, but this feature isn’t found in all cases. Having only two of those features is enough for getting diagnosed with polycystic ovarian syndrome.

What are the common symptoms and signs of PCOS?

Polycystic ovarian syndrome may occur at a very young age, so awareness of various symptoms and signs may help in early diagnosis and proper control of it. Here is a list of 7 most common symptoms and signs: 1. Marked increase in body weight and even obesity in almost 40% of cases. 2. Menstrual period disturbances are shown in 90% of cases and may cause infertility in 70% of them. 3. High androgen level with abnormal increase of thick hair in face, chin and other parts of the body. 4. More acne formation (in 45% of cases) with hot, painful spots deep in the skin. 5. Insulin resistance that may cause diabetes in many cases especially with obesity. 6. Thick wall ovaries with multiple thick walled cysts filled with fluids. 7. High cholesterol blood levels that cause thickening in the small blood vessels which has a dangerous impact on heart and other organ perfusion.

What is The Preimplantation genetic diagnosis (PGD) Technique?

Preimplantation genetic diagnosis is considered one of the most recent techniques that are added to IVF and ICSI according to the case and the willingness of the parents. By adding Preimplantation genetic diagnosis technique, doctors can examine the genetic material of sperms and ova then select the best of them for fertilization. Doctors can identify the affected sperm or ovum and exclude them, also they can select the sex of the baby accurately with almost 100% success rate. All recent scientific research revealed that preimplantation genetic diagnosis highly increases the success rates of IVF and ICSI.

How does sex determination occur during conception?

Basically it is known that all the ova carry chromosome (X) and on the other hand some of the sperms carry chromosome (X) and others carry chromosome (Y). Conception occurs when a sperm meets an ovum and fertilizes it, sex determination depends on the sex chromosome of that sperm. If a sperm with (X) fertilizes an ovum then the produced zygote carries (XX) will be a Girl, and if a sperm with (Y) fertilizes an ovum the produced zygote (XY) is a Boy.

What about Other Ways for Sex Selection?

Lots of people post many traditional methods, herbal recipes and advices about sex selection without any scientific bases. There is no evidence based on the safety and the accuracy of those methods, so you should seek medical advice before experiencing any of these ways. There are also some widespread theories about sex selection as: ● Shettles Theory Around 1960 in the USA this theory was published by doctor Landrum B. Shettles. Dr. Shettles examined sperms and many other aspects that may affect fertilization such as intercourse positions, timing and physical aspects of vaginal fluids like pH. Then he observed that sperms with X chromosomes are heavier and can survive longer in the womb, so intercourse days before ovulation promote having a Girl. While sperms with chromosome Y are faster, so intercousre at the day of ovulation increases the chance of having a Boy. However till now, there are many debates about the efficiency of this theory and still the success rates are low against PGD. ● Changing Vaginal pH Many researches focus on the effect of the vaginal fluid pH on sperm viability and mobility. They found that sperms with Y chromosomes prefer alkaline media, so applying an alkaline vaginal douche just before intercourse increases chances of having a baby Boy. But be carefull, the overuse of vaginal douches kill the normal bacterial flora and cause recurrent inflammation and ulcers.

What are the steps of Preimplantation Genetic Diagnosis (PGD)?

As mentioned before the preimplantation genetic diagnosis is one of the steps of IVF and ICSI procedure: ● Ovarian Stimulation then extraction of the mature ova. ● Microscopic precise examination of ova and sperms to exclude any genetic malformations, mutations and chromosomal syndromes. ● Choose the most healthy sperms and ova for fertilization and select the specific sperm carring X or Y chromosome to determine the baby’s sex. ● In vitro (outside the body) incubation of the selected sperm and ovum then intra cytoplasmic sperm injection (ICSI) is performed. ● Return the fertilized zygote into the uterus to complete pregnancy. Finally the PGD is a highly advanced technique that allows accurate examination of sperms and ova during IVF and ICSI, so we can guarantee a healthy pregnancy and select the sex of the baby if needed.

Why does Premenstrual Syndrome happen?

Premenstrual syndrome happens due to hormonal imbalance that occurs on certain days every month before the menstrual bleeding. Researchers explained that as estrogen and progesterone levels change over the months affecting other hormones and causing mood swings, sleep disorders and changes in physical activity. There are other chemicals in the brain that are affected also as Serotonin that has an effect on mood, feelings and psychological state. Some women are more reliable to premenstrual syndrome than others due to some risk factors such as: ● Positive family history of Premenstrual syndrome. ● Previous history of mood swings, depression attacks, bipolar disorder or postpartum depression (depression after labour). ● Past experience of emotional or physical traumas. ● Have other neuropsychological disorders such as: Generalized anxiety disorder, Schizophrenia, Major depressive disorder.

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