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Fertility

How to cope with male infertility

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Infertility is a problem which can have a profound impact on an person and his relationship. Advice is most frequently focused on women, but we concentrate on men’s infertility in this Spotlight section, and include some science-based tips for coping with it.

Male infertility can be a heavy burden to bear.
Male infertility can be a heavy burden to bear.

When the term “infertility” rears its alarming head, the majority of people think first of all of female infertility.

Males, however, are responsible for 20–30 percent of infertility cases and “contribute to total 50 per cent of cases.”

Men and women tend to react differently to the experience of infertility: traditionally , women have assumed that men are easier to deal with the issue, but in fact, men are actually less likely to open up about their emotions.

It can be a painful feeling to discover you are infertile. A man could perhaps feel less male and as if they have failed.

Many people think their identity is wrapped up in their ability to give a child to their partner, and therefore thinking they have lost that ability may generate powerful negative emotions.

What causes male infertility?

Firstly, infertility is worth defining. This is described by the World Health Organization (WHO) as “the inability of a sexually active, non-contraceptive couple to achieve pregnancy in 1 year.”

Male infertility is attributed, in most cases, to an abnormal sperm. There are often small sperm counts, although there are at times none at all. Or, however, the sperm can not be great swimmers, or deformed.

There are a variety of ways such problems can be induced including:

  • testicular infection
  • testicular surgery
  • varicocele, or varicose veins in the scrotum
  • hypogonadism, or testosterone deficiency
  • mumps
  • radiotherapy
  • cystic fibrosis
  • some medications, including anabolic steroids

The list continues. Yet, still, the faulty sperm has no well-defined cause. And in many cases , despite good sperm and no apparent reproductive health problems for the wife, pregnancy remains difficult to achieve.

Crack a window and let some hope in

For certain cases, impregnating a woman is difficult for a man but that is fairly rare. There’s always a chance, in most cases. When you’ve tried for a very long time, it may seem like there’s no hope — but, generally speaking, there is.

If you haven’t seen an infertility doctor yet, you should take that into consideration. They will pin down where there may be a question, and offer general tips and advice. Speaking with an expert can also make you know you ‘re not alone.

There are choices too. Most couples, for instance, now conceive through in vitro fertilization ( IVF). In reality, 1 million IVF babies have been born in the United States over the last 30 years. It’s important to note that when you go through this difficult time, there are other routes to follow.

The remainder of this article includes tips on handling the mental and realistic side of infertility.

1. Get the facts

Above all, find out what’s going on. If you just think you ‘re infertile, or you didn’t make a baby despite a year or so of trying, it’s time to get checked. There’s no point beginning a journey into sorrow without even understanding if it’s justified.

Go to an expert, and check the sperm. Please raise questions. Learn all you can. Understand what your particular problem is, and what this means for your conceptional chances.

2. Make plans

One of the toughest aspects of male infertility care is not understanding how long it will last. Making plans will make you feel like you are still in control, whenever possible.

Set targets and limits. Discuss with your partner what treatments you are able to go through, and what emotional and financial rates you can accommodate both. Pregnancy is always the product of prolonged activity, whether through treatment with natural intercourse or fertility. When you both end up as financially destroyed, dessicated mental husks it will benefit no one.

Include all kinds of choices. Go about all of the options — adoption, IVF, or sperm donor. Understanding and talking about potential avenues will help should you face any setbacks further down the road — and if one thing doesn’t work, you’ll know what you’re trying next.

3. Take control

There are also scientifically validated ways to enhance the consistency of the sperm. Even the simple act of taking back some control will go a long way in helping to cope with infertility; it fights off the overwhelming feeling of helplessness.

Eating right can improve both sperm quality and general well-being.
Eating right can improve both sperm quality and general well-being.

The list below is by no means exhaustive but it includes some basic (and scientifically supported) steps that can be taken to give your sperm the best chance to meet and greet an egg.

Eat right. Lay off meat items in short, and load up on veg. It is difficult to understand the exact impacts of total food consumption, but a diet that includes lean meats, fruits, legumes, and grains tends to enhance sperm motility.

Hold proper weight. There are relatively good associations between being overweight and being male infertile.

Reduce stress. No, I’m not joking, although it does sound like a joke. Infertility stresses you out, which in effect may intensify infertility. And unfortunately the proof suggests it’s possibly real. The coping strategy section below offers some information on mitigating the effects of stress … and breathing.

Become involved. While there has been no conclusive proof of the correlation between physical exercise and sperm quality, being physically active can avoid obesity, which is definitely related. Exercising also helps alleviate tension, so it’s worth sweating. Bicycling for only 5 hours a week could do the trick according to one report.

It’s worth mentioning that there are a host of companies selling “magic” pills and supplements to turn your sperm into tiny athletes but, as I’m sure you already know, there’s a lack of evidence for these kinds of products.

There are also other habits to be avoided for enhancing sperm health:

  • smoking,as it lowers sperm count and increases the risk of misshapen sperm
  • alcohol, asitreduces testosterone production — it is therefore sensible to moderate drinking
  • don’t use lubricants during sex, as some may hinder sperm
  • keep your balls cool, ashot testicles, according to some studies, may be less efficient at producing sperm — so avoid hot tubs, tight underwear, and saunas

Speak to a doctor about drugs that may interfere with sperm development, such as blocks of calcium channels, tricyclic antidepressants and anabolic steroids.

4. Talk about it

The men don’t want to talk about their issues according to traditional assumptions. Although this assumption sometimes holds true, this is not the case for all. As cliché and trite as it might sound, “a common problem is a half of the problem.”

Keep communication channels open. You don’t have to transmit it far and wide, but speak to someone: a physician, a nurse, a friend, a counselor, a support group — anybody. It will lighten your burden, and they could offer a new perspective.

If any of the following symptoms occur frequently, it is necessary to speak to an infertility qualified doctor or counselor:

  • abusing drugs or alcohol
  • thoughts about harming yourself or others
  • becoming angry or abusive easily
  • losing interest in things that you once enjoyed
  • insomnia or sleeping much longer than usual

5. Develop healthy coping strategies

It ‘s easy to let stress build up until you crack. Many people are better at managing it than others, but sometimes everyone will let it get their best.

So finding ways to loosen the stopcock every once in a while is important. The coping strategies below will help keep the thinking straight and narrow.

Exercise
Exercise can help to manage infertility physically and mentally.

Keep moving. Everything you do — whether it’s weight lifting, running , swimming or basketball — whatever it’s, get sweaty a couple of times a week. Exercise has been shown consistently to assist with stress reduction. Nothing moving about prices so take advantage of it.

Relax. Men, on the whole, are less likely than women to get a massage, but times change. Even though a massage isn’t something you would normally consider, it’s a very good way to de-stress. Some healthy choices include meditation and yoga.

A major meta-analysis published in JAMA in 2014 for example, concluded that:

“Mindfulness meditation programs had moderate evidence of improved anxiety […] depression  […] and pain.”

Sure, “moderate” doesn’t sound fantastic, but it means a real, statistically relevant impact has been measured in the sense of a JAMA study. So, adding it alongside other coping strategies could really help.

Write. Not everyone is a natural author, and since they were at school, most people didn’t try to write anything substantial. No one tells you though that it has to be written somewhere. The simple act of writing your thoughts can help you work through the way you feel and begin the process of dealing with it.

If you want to write it down and set it on fire immediately or store it away for a future you’ll be learning doesn’t matter. It is the act of writing itself that is important.

And this isn’t just another of those wishy-washy interventions; the actual thing is “writing therapy.” This is not especially commonly used, otherwise known as written disclosure counseling, although there is some evidence to indicate that it can have beneficial effects on psychological well-being and can even reduce blood pressure.

Cry. Yet again, the male stereotype dictates that we will never shed a tear — at least not while looking at others. But nowadays there are plenty of men ready to cry every now and then. So if you’re in private, so know you ‘re not going to be interrupted, open the floodgates. This is a genuine cathartic release.

Dr. Judith Orloff, a psychiatrist with 20 years of clinical experience at the University of California, Los Angeles, writes, “Typically, after crying, our breathing and heart rate decrease, and we enter into a calmer biological and emotional state.”

Laugh. You can’t push it, and it may feel like the last thing you want to do on earth — but it does help. At the same time, it acts as both exercise and stress relief. Put on a movie you know is going to tickle you, or hang out for a while with your buddies. Should not cover yourself in a darkened corner.

The last word

Infertility affects people in a variety of ways – physically and emotionally alike. This is important to note, though, that you are not alone, and that there is support available. Keep it active, speak and handle your body and mind well.

Fertility

All you need to know about IVF

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IVF is the most frequent and effective type of assisted reproductive technology for assisting people in becoming pregnant. When other treatments have failed, IVF can help you get pregnant.

An egg is fertilized outside the body, in a laboratory dish, and then implanted in a person’s uterus.

The most frequent and effective type of assisted reproductive technology is in vitro fertilization (IVF) (ART). ART is used to conceive roughly 2.1 percent of kids born in the United States each year, according to the Centers for Disease Control and Prevention (CDC). With IVF, there’s also a higher risk of multiple births.

The IVF procedure is discussed in this article. It covers everything from success rates to expenses to screenings and everything in between.

What is IVF

Overview of IVF

Louise Brown, the first baby born through IVF, was born in 1978. IVF is credited to Robert Edwards and Patrick Steptoe, who worked together on the treatment.

An egg grows and matures in the ovary during a normal pregnancy. The ovary releases the egg during ovulation.

The sperm go via the uterus and into the fallopian tube in search of the egg, which they pierce and fertilize. After that, the fertilized egg, or embryo, adheres to the uterus wall and begins to develop into a baby.

IVF, on the other hand, may be a viable alternative for the following reasons:

  • male factor infertititly or abnormal sperm parameters
  • a person’s fallopian tubes are blocked
  • a person is unable to get pregnant naturally
  • a person or couple is diagnosed with unexplained infertility

The IVF process

One IVF treatment cycle might take 3–6 weeks, according to the Human Fertilization and Embryology Authority in the United Kingdom. However, depending on their risk factors and the treatment’s effectiveness rate, a person may require more than one round.

Depending on the clinic, several techniques may be used. IVF, on the other hand, usually entails the following steps:

1. Superovulation

Controlled ovarian hyperstimulation is another name for superovulation. Luteinizing hormone or follicle-stimulating hormone are both found in fertility treatments. The ovaries create more eggs than usual as a result of these hormones. Transvaginal ultrasound scans can be used to track the ovaries’ growth and development.

A person can also use donated or frozen eggs as an option.

2. Retrieving the eggs

To extract eggs, doctors use a minor surgical technique known as “follicular aspiration” or “egg retrieval.”

A tiny needle is injected through the vaginal wall and into an ovary under ultrasound supervision. The needle is connected to a suction device that suctions out the follicular secretions and eggs. This procedure is carried out by doctors for each ovary.

3. Insemination, fertilization, and embryo culture

The obtained eggs are mixed with sperm and maintained in a temperature-controlled facility. The sperm should penetrate the egg after a few hours.

The sperm is sometimes put straight into the egg. Intracytoplasmic sperm injection is the term for this procedure (ICSI). Frozen sperm obtained via testicular biopsy could be used.

The fertilized egg divides into two and develops into an embryo. Many fertility clinics offer preimplantation genetic testing once the embryos have reached the blastocyst stage (PGT). An embryo is screened for chromosomal abnormalities or aneuploidies using this approach.

One or two of the best embryos are used in the transfer. The uterine lining is then prepared for the embryo’s implantation using hormones and other drugs.

4. Embryo transfer

The womb may receive more than one embryo at a time. It’s important to talk to your doctor about the amount of embryos you’ve transferred.

Typically, the doctor will only transfer one embryo at a time. Several risk considerations must be considered before deciding to transfer more than one embryo, which should be discussed with a clinician.

The embryo is transferred using a thin tube or catheter around 3–5 days after conception. It enters the uterus via the vaginal canal. A pregnancy begins when the embryo adheres to the uterine lining, a process known as implantation, and embryo growth proceeds.

IVF success rates

According to the CDC, the percentage of planned egg retrievals that resulted in live birth deliveries in 2019 was:

  • 52.7% among people aged under 35 years
  • 38% among people aged between 35–37 years
  • 24.4% among people aged between 38–40 years
  • 7.9% among people over the age of 40

These figures differ depending on where the procedure is performed.

Other considerations

The most important risk factor affecting the success rate of IVF is age.

However, there are a number of other elements that can influence your chances of success, including:

  • the cause of infertility
  • ovarian reserve test results
  • whether or not pregnancy or a live birth has occurred before
  • the strategy that will be used

IVF costs

In the United States, the average cost of an IVF cycle ranges from $10,000 to $15,000. Some insurance companies, however, fund infertility treatments like IVF. As a result, a person with health insurance may be able to save money on IVF treatment.

Coverage will be determined by the health insurance company and the state in which the individual resides. Currently, 17 states in the United States have laws requiring insurance companies to cover or offer coverage for infertility treatment.

Due date calculator for IVF

A due date calculator can be used to calculate an estimate of a person’s due date.

Many websites, including Flo Health, have a calculator that may be used to determine a person’s due date based on information such the embryo transfer date and the type of transfer they had. The calculators include the following:

  • Day 3 embryo transfer
  • Day 5 embryo transfer
  • IVF with own eggs
  • IVF with fresh donor eggs cycle
  • Fresh donor embryos cycle

Screenings

To establish the sex of the embryo and to rule out any genetic anomalies, screening and testing are available.

Preimplantation genetic testing (PGT) was originally a process used by clinicians to discover genetic diseases in the DNA of an embryo. These could cause a birth defect or a developmental problem.

Doctors are now using this approach to determine the sex of an embryo before it is implanted during IVF. Doctors can examine the embryo’s chromosomal make-up to predict whether it will be male or female.

Preimplantation testing is available at about 72 percent of contacted ART facilities, according to a 2018 survey.

IUI vs. IVF

Intrauterine insemination (IUI), commonly known as artificial insemination, is a method in which sperm is delivered directly to the uterine cavity via a catheter. This method shortens the time and distance that the sperm must travel to fertilize the egg.

This differs from IVF, which involves combining eggs and sperm outside of the body in a controlled setting.

IUI is typically used to treat couples with unexplained infertility and mild male factor infertility. In addition to IUI, a woman may be given medicine to help her ovulate. During the ovulation time, a doctor will inject the sperm into the uterus.

In comparison to IVF, IUI is a quick treatment that takes about 5–10 minutes. IUI is also less expensive than IVF. Without insurance, IUI costs between $300 and $1,000 on average.

IUI, on the other hand, is less successful than IVF.

The body’s natural processes will take over once the sperm is put into the uterus by doctors. Doctors can use IVF to check if an egg has been fertilized and choose the best embryo (s).

IUI has a success rate that is roughly a third of that of IVF.

In addition, IUI may not be an appropriate reproductive treatment in the following situations:

  • is in their late 30s or over 40
  • has low-quality eggs
  • has a low number of eggs
  • has blocked fallopian tubes
  • has severe endometriosis

If the reason for infertility treatment is severe male factor infertility, this treatment is equally ineffective.

Insemination vs. ICSI

ICSI is a fertilization procedure that involves injecting a single sperm into an egg.

ICSI is a frequent treatment for male factor infertility in couples. It may also boost the chances of fertilization in people who have had previous IVF failures. It’s also for preimplantation genetic testing-enabled cycles.

ICSI is linked to a slightly greater risk of birth abnormalities, according to the American College of Obstetricians and Gynecologists, including:

Side effects

During IVF, many people will have few to no adverse effects. Some people, however, may develop negative side effects. These may include the following:

  • irritability
  • nausea
  • headaches
  • fatigue
  • abdominal pain
  • sore breasts

These symptoms are most common during the IVF ovarian stimulation phase. The following side effects may occur in a small percentage of people:

  • vomiting or abdominal pain that requires hospital admission
  • dehydration
  • shortness of breath

Some people may have changes in mood as well.

Is it painful?

Although some people may suffer moderate discomfort throughout the IVF process, it is usually not painful.

There may be mild bruising and pain at the injection site because IVF involves the infusion of fertility drugs. Abdominal cramps, which can be unpleasant, is another possibility.

Because pain medication is provided before the procedure, the egg retrieval technique is usually painless.

Embryo transfer is frequently painless as well.

Risks with IVF

The following are some of the hazards connected with IVF:

Medication side effects

Some people may experience side effects from the drugs used during treatment.

The following are some of the probable negative effects of IVF drugs:

  • hot flashes
  • enlargement of the ovaries
  • difficulty sleeping
  • abdominal pain
  • nausea and vomiting
  • difficulty breathing
  • irritability

Ovarian hyperstimulation syndrome (OHSS)

The drugs used to stimulate the ovaries to generate eggs can cause OHSS in rare cases. This occurs when a person’s body overreacts to the prescriptions they’re taking, causing their hormone levels to rise.

OHSS people have a large number of developing follicles as well as high estrogen levels. This causes fluid to cause into the belly, causing bloating, nausea, and abdominal swelling.

The following symptoms may occur in people with severe OHSS:

  • dehydration
  • vomiting
  • blood clots
  • shortness of breath

Pregnancy loss

An abnormal number of chromosomes, known as chromosomal aneuploidy, is the major cause of pregnancy loss, whether in IVF or spontaneous conception.

An embryo is tested with PGT to look for aneuploidy.

Multiple births

When more than one embryo is transferred to the uterus, the chances of conceiving twins, triplets, or more infants increase.

Pregnancies with multiple fetuses can lead to:

  • significant increase in the mother’s blood pressure
  • double the mother’s risk of developing diabetes
  • preterm birth or low birth weight

In people who have a higher likelihood of conceiving twins, the doctor may prescribe that only one embryo be transferred.

Sources:

  • https://medlineplus.gov/assistedreproductivetechnology.html
  • https://www.cdc.gov/art/index.html
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5904054/
  • https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-020-09347-w
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035132/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087828/
  • https://www.medicalnewstoday.com/articles/262798
  • https://www.hfea.gov.uk/treatments/explore-all-treatments/in-vitro-fertilisation-ivf/
  • https://www.cdc.gov/reproductivehealth/infertility/
  • https://www.pfcla.com/blog/intrauterine-insemination-success-rates
  • https://www.nhs.uk/conditions/ivf/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171154/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4467930/
  • https://www.sciencedirect.com/science/article/pii/S2590161319300985
  • https://www.ncsl.org/research/health/insurance-coverage-for-infertility-laws.aspx
  • https://www.nature.com/articles/nrg.2016.97
  • https://www.plannedparenthood.org/learn/pregnancy/fertility-treatments/what-ivf

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Endocrinology

Irregular periods: Things you need to know

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The normal length of the menstrual cycle of a woman is 28 days, but between individuals, this varies. When the length of the cycle is longer than 35 days, or if the duration varies, irregular menstruation occurs.

The part of the menstrual cycle in which the endometrium is shed, which is the lining of the uterus, is a period or menstruation. This appears as bleeding that is released through the vagina from the womb.

Periods usually start between 10 and 16 years of age during puberty and continue until menopause, when a woman is 45- to 55-year-old.

If there is a change in the method of contraception, a hormone imbalance, hormonal changes around the time of menopause, and endurance workouts, irregular periods, also called oligomenorrhea, can occur.

Treatment for irregular periods during puberty and around menopause is not usually necessary, but medical advice may be needed if irregular periods occur during the reproductive years.

Causes

In regular menstruation, a woman’s cycle follows a predictable pattern.
In regular menstruation, a woman’s cycle follows a predictable pattern.

The chance of irregular menstruation is enhanced by a number of factors. Most are related to the production of hormones. Estrogen and progesterone are the two hormones that affect menstruation. These are the cycle-regulating hormones.

Hormonal influences

Puberty, menopause, pregnancy and childbirth, and breastfeeding are life cycle changes that influence hormonal balance.

The body undergoes major changes during puberty. Ostrogen and progesterone can take several years to achieve a balance, and at this time, irregular periods are common.

Women often have irregular periods prior to menopause, and the amount of blood shed may vary. Menopause happens when 12 months have passed since the last menstrual period for a woman. A woman will have no more periods after menopause.

Menstruation ceases during pregnancy, and most women do not have periods while they are breast-feeding.

Irregular bleeding can be caused by contraceptives. Heavy bleeding can be caused by an intrauterine device (IUD), whereas the contraceptive pill can cause spotting between periods.

She can experience small bleeds that are usually shorter and lighter than normal periods when a woman first uses the contraceptive pill. These usually disappear after a couple of months.

Other changes which are linked to irregular periods include:

  • extreme weight loss
  • extreme weight gain
  • emotional stress
  • eating disorders, such as anorexia or bulimia
  • endurance exercise, for example, marathon running.

Missed or irregular menstruation is also connected to a number of disorders.

Symptoms

A menstrual cycle lasts around 28 days, but, depending on the individual, it can vary from 24 days to 35 days.

Each year, most females have between 11 and 13 menstrual periods. Bleeding generally takes about 5 days, but it can vary from 2 to 7 days, too.

It can take up to 2 years to establish a regular cycle when menstruation first starts. Most women’s menstruation is routine after puberty. Similar is the length of time between each period.

However the time between periods and the quantity of blood shed varies considerably for some women. This is referred to as irregular menstruation.

When the cycle is longer than 35 days, or if it varies in length, the main symptom of irregular menstruation is

This is also considered irregular if there are changes in blood flow, or if clots appear that are over 2.5 centimeters in diameter.

Complications

Sometimes, irregular periods can indicate a health problem, and some of these can lead to further problems, such as fertility problems.

Polycystic ovarian syndrome (PCOS) is a condition in which the ovaries develop a number of small, fluid-filled sacs known as cysts.

There is no ovulation for a woman with PCOS and she does not release an egg every month. Irregular or no periods, obesity, acne, and excess hair growth are symptoms.

Male sex hormone, androgen, or testosterone levels are unusually high for women with PCOS.

PCOS affects between 10 percent and 20 women of reproductive age, or up to 5 million American women, according to the Office on Women’s Health at the United States Department of Health and Human Services. PCOS has been diagnosed in girls as young as 11 years old.

Cancer of the uterus
Cancer of the uterus or the cervix can cause unusual bleeding.

Irregular periods may be caused by a thyroid disorder. The thyroid gland generates hormones that control the metabolism of the body.

In rare cases, cervical or uterine cancer, or womb cancer, can cause bleeding between periods or during sexual intercourse.

Endometriosis is a disease in which cells, called endometrial cells, that are usually located within the uterus develop outside the uterus. In other words, outside of it the lining of the inside of the uterus is located.

Endometrial cells are the cells that menstruate every month, so during their childbearing years, endometriosis is more likely to affect women.

The cellular formation involved in endometriosis is not cancerous. No symptoms can occur, but it can be painful and may lead to other problems. It may damage the tissue if the released blood gets trapped in the surrounding tissue, causing extreme pain, irregular cycles, and infertility.

A female reproductive system infection is a pelvic inflammatory disease (PID). Among women, apart from AIDS, it is the most prevalent and severe complication of sexually transmitted infections (STIs).

It can be treated with antibiotics if it is diagnosed early, but if it spreads, it can affect the fallopian tubes and the uterus, causing chronic or long-term pain. There are several signs, including bleeding after sex and between periods.

Home remedies

It may help to reduce the risk of some of the causes of irregular periods by maintaining a healthy lifestyle.

This includes:

  • exercising regularly to maintain a healthy weight and reduce stress
  • following a healthful diet

Some herbal remedies are all said to help, such as black cohosh, chasteberry, licorice root, and turmeric, but their effectiveness has not been proven by studies, and they may have adverse effects. It is better to speak to a doctor first.

Treatment

Therapy, if necessary, will depend on the cause.

Puberty and menopause: Treatment is usually not necessary for irregular periods that occur during puberty or as a woman approaches menopause.

Birth control: If irregular bleeding is caused by contraception and continues for several months, the woman should discuss other options with a health care professional.

PCOS and obesity: Overweight or weight-loss obesity may help stabilize menstruation in cases of PCOS. A lower weight means that so much insulin does not need to be produced by the body. This results in lower levels of testosterone and a better chance of ovulating.

Thyroid Problems: Treatment is likely to be prescribed for the underlying problem. Medication, radioactive iodine therapy or surgery may include this.

Stress and eating disorders: Psychological therapy may help if irregular periods have been triggered by emotional stress, an eating disorder, or sudden weight loss. This may include techniques for relaxation, management of stress, and talking to a therapist.

Medication

Metformin, an insulin-lowering oral drug for type 2 diabetes, may be prescribed by a doctor to help ensure ovulation and regular periods.

A low-dose birth control pill that contains a mixture of progesterone and estrogen may help. This will reduce the production of androgen and will help to correct abnormal bleeding.

Alternatively, it is likely that periods will be controlled by taking progesterone for 10 to 14 days each month.

Pregnancy

Irregular periods can indicate a fertility problem, but that is not always the case. There may be ovulation, even while menstruation is irregular.

Here are some things you can do to track ovulation:

  • Mark any periods on a calendar, and look for patterns.
  • Check for changes in cervical mucus. As ovulation approaches, the mucus will be more plentiful, slippery, clear, and stretchy.
  • Take your temperature each day and note when it spikes. This can indicate that ovulation is occurring.

These records will help a doctor reach a diagnosis if irregular periods are linked to fertility issues.

Medical advice should be sought by anyone concerned about irregular menstruation.

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Endocrinology

Androgen insensitivity syndrome: What to know

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The disease of androgen insensitivity is an unusual genetic condition in which male hormones do not respond to a male fetus.

The disorder affects the growth of the genitals and the reproductive system.

It is also known as Reifenstein syndrome, Rosewater syndrome, incomplete testicular feminization, or Type 1 familial incomplete male pseudohermaphroditism.

A newborn with androgen insensitivity syndrome (AIS) tends to be female, although it is rare to have reproductive characteristics. The scale of the vagina and the lack of ovaries , fallopian tubes, or the womb can be abnormal. The testicles can stay in the abdomen or inguinal canal.

AIS impacts between 2 and 5 of every 100,000 people in the United States (U.S.).

Individuals with AIS have a normal life span but will need clinical support and hormone therapy.

Important facts about androgen insensitivity syndrome

  • Androgen insensitivity syndrome (AIS) causes the development of abnormal sexual organs.
  • The condition is genetic and affects the Y chromosome that shapes male sexual development.
  • AIS can be graded on a scale from one to 7. One is very mild, and 7 refers to complete AIS.
  • Gender identity is an extremely important concern for people with AIS, as their genitals may be male at an internal level but female in appearance. Counselling can assist with this.
  • Undescended testicles can be released or removed by surgical means, and hormone therapy may be used to nurture a person with AIS towards their preferred gender.

What are sex chromosomes?

Androgen insensitivity syndrome
Androgen insensitivity syndrome is caused by a mutation to the Y chromosome that programs male sexual development.

Sex chromosomes are a pair of molecules of DNA, called X or Y, that determine the sexual development of an individual.

  • A female has two X chromosomes known as XX
  • A male has one X and one Y chromosome, or XY

The Y chromosome induces the testes to develop and prevents the growth of the female ovaries. The female reproductive system and genitals grow spontaneously because there is no Y chromosome.

Male genitals and reproductive organs should be produced by an child born with XY chromosomes. The male reproductive organs that contain androgens, or male hormones, are the testes, or testicles. These hormones allow male traits and sex organs, such as the penis, to develop.

Causes

Both male and female embryos have the same genitals for the first 8 weeks of growth. Either a female or male reproductive system can develop.

A healthy XY embryo will develop male genitals, as the testes will release androgens.

Since a genetic change results in a limited number of androgen receptors, the body of a person with AIS will not respond to the androgen. Full androgen insensitivity syndrome (CAIS) can contribute to a complete loss of response.

Instead of falling to the scrotum, the testicles remain in the body. The genitals, seen from outside the body, would mimic those of a person.

An individual with AIS inherits the mutated gene from their mother in 70 percent of cases.

A carrier may be a female with one abnormal X chromosome. A carrier is a woman who has the impaired gene while contemplating AIS and can carry it on without feeling its effects. Her female offspring may also be carriers, and the disease may be due to her male offspring.

Other cases are thought to arise from a defect that occurs either before the eggs of the mother are created or shortly after conception of an embryonic cell. However, the precise explanation is unclear.

AIS is an intersex disorder that is distinct from dysphoria in gender. An individual with gender dysphoria produces natural reproductive organs and genitals, but believes it is not true for their assigned sex. Gender dysphoria is encountered by people who are transgender.

Types

There are 3 forms of androgen insensitivity syndrome:

  • Complete: A person with CAIS will have female external genital features, and is likely to develop as a female.
  • Partial: In partial androgen insensitivity syndrome (PAIS), there is some sensitivity to androgen. Depending on the level of sensitivity, the person may appear completely male or female, or they may have some features of both sexes. Children born with this condition may grow into either females or males, depending on their degree of androgen sensitivity and subsequent genital development.
  • Mild: Mild androgen insensitivity syndrome (MAIS) affects males during puberty. They may form female breast tissue. A boy with MAIS may also not be able to produce effective sperm.

Signs and symptoms

A typical symptom of AIS is infertility, but it does not occur in mild cases.

It would not develop the internal reproductive organs of females born with AIS, causing infertility. Non-development of reproductive organs is attributed to the release of male hormones by testes in the body.

Complete androgen insensitivity syndrome

If an inguinal hernia is present in a child, it could be due to undescended examination. In children, between 0.8 and 2.4 percent of inguinal hernia cases are due to CAIS.

Normally, at birth, there are no outward signs or symptoms, and the disorder does not manifest before the person reaches puberty. When the person may not grow pubic or underarm hair, CAIS will become evident, and menstruation may not begin.

Females experiencing CAIS will have a short “ pouch ”vagina.

Partial androgen insensitivity syndrome

Child growth is impaired by partial androgen insensitivity. During puberty, an individual with high insensitivity may grow as a girl. Those with low insensitivity will develop as boys, but breasts may start to develop. They may have a clitoris that is somewhat enlarged or an almost completely developed penis.

A child will develop as a boy, but with the onset of puberty, more female traits develop.

Diagnosis

Androgen insensitivity, if the genitals look irregular, may be detected at birth. For eg, this may be detected if the presence of the genitals does not correlate to that expected by prenatal amniocentesis.

Chorionic Villus Sampling (CVS) can show AIS during pregnancy. In CVS, for research, cells are drawn from the placenta.

A physician may diagnosis AIS if a woman has an inguinal hernia, is having difficulties conceiving, or has physical problems with sexual intercourse.

A blood test can confirm the diagnosis by measuring hormone levels and detecting the altered chromosome.

The soft tissues and cavities within the body are illustrated by an ultrasound scan. The lack of female reproductive organs can be indicated by this.

Unborn infants, although there is a family background, are not regularly screened for AIS.

The disorder can be rated from 1 to 7 after checking. Grade 7 refers to CAIS, while grades 1 to 6 indicate that there is PAIS for a child.

The genitals tend to be feminine in grade 7. A individual with grade 1 AIS may have male genitals but is likely to be infertile.

Treatment

Because of their outwardly feminine genitals, children with CAIS are commonly regarded as males, but often parents have to consider whether to raise their child as a male or a female. When the genitals have both male and female traits, this may be complicated.

Hormone therapy can help guide development into a particular gender during puberty. It may even prolong puberty until the infant is old enough to assess which gender is acceptable.

Counseling will also help determine a gender for a child with AIS.

Most PAIS children maintain the sex they were assigned at birth, but some believe that this does not reflect their true identity and want to alter.

Surgery

When the infant was young and a gender had been identified, reconstructive genital surgery was done. It is usually delayed nowadays before the child can tell.

When a woman has testicles, they could be removed by a doctor because they may become cancerous. This is listed as an orchidectomy.

The procedure is typically performed after adolescence, since the testes may transform androgen to estrogen. The hormone that promotes female sexual activity is estrogen.

Waiting to perform an orchidectomy well after puberty helps a girl with AIS to develop a feminine body without hormone therapy.

Orchiopexy may be needed for a person with testicles embedded in the abdomen. Orchiopexy is a surgical technique intended for the release into the scrotum of an undescended testis.

Surgery to lengthen the vagina is another choice. For a person with AIS, this may facilitate sexual intercourse. After puberty, this treatment is usually done, helping the individual to make an informed decision.

Few women prefer to reduce the clitoris surgically and to widen the vaginal opening. This can contribute to a partial clitoral loss of sensitivity.

After finishing puberty, women with complete androgen insensitivity who have their testes removed may undergo hormone therapy.

Supplements of estrogen can avoid signs of menopause, including the onset of osteoporosis. As their Y chromosome carries genes for taller growth, they may also stop a woman from being too tall.

If the testes are removed at a young age, hormone therapy can begin to induce puberty at about 10 or 11 years of age.

To promote such male characteristics, such as the development of facial hair and a deeper voice, boys with partial insensitivity may require androgen supplements.

For both the person with the disorder and their parents, social assistance is often important.

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