Expectations for a fertile tomorrow - Dr. Nalin Abeysinghe writes to eDoctor
eDoctor lk 4:02 AM
Fertility is the natural capability to produce offspring. It explains the whole process
from gamete production, fertilization and carrying a pregnancy to term. Simply it explains the complete process of producing a live offspring. On the other hand fecundity means the potential for reproduction or the ability to get pregnant. Fertile couples are invariably fecund and the reverse is not possible always. Lack of fertility is referred as infertility and lack of fecundity (the basic ability in the process of producing a live offspring) is called sterility.
World Health Organization defines infertility as a DISEASE (certain insurance companies do not accept claims though) of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
Infertility generates disability. Infertility in women was ranked the 5th highest serious global disability. Worldwide one out of every seven couples is infertile. In Sri Lanka 10% of the couples are infertile. In 50% of these cases male is the factor while in one third woman is the factor.
The reasons for infertility are described under five categories (See the Table)
Causes for Infertility
Primary (%)
Secondary (%)
Anovulation (Failure to produce mature eggs)
20
15
Male factors
25
20
Fallopian tube problems
15
40
Endometriosis
10
5
Unexplained
30
20
Although single category may be the only reason for a given couple’s infertility, some of these categories may coexist in the same couple (i.e. anovulation and male factor). Generally likelihood of a spontaneous live birth in an infertile couple is strongly influenced by the age of the female, duration of infertility, previous pregnancies, and cause of infertility. Unexplained infertility has the best outcome.
Anovulation or failure to release mature eggs is one of the commonest causes of infertility. Among conditions causing anovulation, Polycystic Ovarian Syndrome (PCOS) would be the commonest. It is characterized by irregular menstrual cycles, androgen (male hormone) excess and Ultrasound evidence of polycystic ovaries.
PCOS is commonly seen among young women in a prevalence of 5% – 7%. It manifests commonly as irregular menstrual cycles. Not only PCOS possess gynecological implications, but also those related to other systems too. They are obese and tend to get metabolic syndrome and diabetes. They are good candidates for deranged lipid metabolism.
Figure 1 Abnormal Hair Growth in the Face Seen in a Woman with PCOS
Endometriosis by far one of the commonest problems among females. It also found in younger females. The key feature is presence of endometrial tissue (the inner lining of the womb that sheds during menses) outside the uterine cavity. This ectopic tissue too undergoes cyclical bleeding due to hormonal changes and find no way to be drained out hence get collected.
These internal menstrual collections adhere the surrounding structures together. This causes an intense pain during cycles – sometimes outlasting the duration of menses. Endometriosis associates with infertility in various ways by interfering egg maturation, ovulation, gamete (eggs and sperms) transfer and implantation (‘seeding’ of the fertilized egg in the womb).
Fallopian tubes are important transporters contributing to fertility. They involved in transfer of gametes (eggs and sperms towards each other) and transportation of fertilized egg in to womb. In fertility treatment tubal disease exerts a great challenge.
Although infertility has been defined with one year, a couple has to be investigated earlier if they have any pre-existing disease or the female is over 35 years. Extensive clinical assessment of the couple has to be carried out. Baseline investigations will be a Seminal Fluid Analysis (SFA) and Trans Vaginal Ultrasound (TVS) Scan of the female. SFA though a baseline investigation provides a big picture about the male partner; several parameters related to the quality of sperms will be assessed according to a standard criteria issued by the WHO.
Figure 2 Normal Hysterosalphyngogram
Hysterosalphyngogram (HSG) and Diagnostic Laparoscopy and Dye Test (Laparoscopy + DT) will be used depending on each situation to assess the patency of Fallopian tubes while latter provides a comprehensive image (under direct vision) about the female reproductive system. Various hormonal assays are available to investigate the problems with internal signaling pathways related in reproduction and menstrual cycle. Blood tests as well as urinary dipstick tests are available to correctly find out the time of ovulation. As a habit all females seeking treatment for infertility are asked to maintain a menstrual diary where they have to document the details of each day of their cycle. As a standard first day of the period (first day of bleeding) will be taken as Day 1 of the cycle and following days numbered accordingly.
Ovarian reserve is one of the major concerns when managing couples with infertility. Unlike men women are destined to have a limited period of fertility. They are provided with limited number of eggs, few of which are disposed in each cycle. Therefore ovarian reserve – in other words the number of retrievable eggs for fertilization has major implications on the success rate of infertility treatment. The main factor determining ovarian reserve is the age of the female.
Figure 1- Laparoscopic Diagnostic Test Showing Free Spill of the Dye
All infertility treatment is focused on utilizing this ovarian reserve effectively in order to provide couple with a healthy pregnancy. Treatment options are enormous. First of all identified underlying diseases contributing to the condition has to be treated. Obese females are encouraged to reduce their weight which will invariably return their regular cycles hence fertility. Few tablets are available in a basic treatment called ovulation induction where doctors stimulate ovaries to produce good quality eggs as required. Seminal fluid (the liquid containing sperms) is processed in laboratory setup so the quality of the sperms is improved, will be used to be deposited inside the womb (Intra Uterine Insemination – IUI). When a male partner cannot produce a sample with adequate amount of sperms donor samples can be used orIUI.
Figure 4 ICSI One of the IVF technologies in which a selected sperm is directly injected into an ovum (egg)
Invitro Fertilization (IVF) has shown some light to many of bereft couples. This technique involves the artificial combination (in a laboratory setup) of sperms and eggs and implanting the embryos formed thereafter inside the female’s womb. Various methods are available under this category. Women are advised to take folic acid throughout and have Rubella vaccination (if it has not been given when schooling) six months prior to the initiation of treatment.
To read the article in our website click here...
Key Facts
· Infertility/Subfertility is a Disease
· Both Males and Females equally contribute for its causation
· Female’s age is the most important factor in determining the success rate of treatment
· Most couples will benefit from simple treatment option
Dr Nalin Abeysinghe MBBS (Sri Jayewardenepura),
Medical Officer in Obstetrics and Gynaecology,
Sri Jayewardenepura General Hospital,
Nugegoda.
Saturday, December 20, 2014
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Friday, December 19, 2014
Treasure the wellness of workforce! - AIDS day workshop
"A Healthy employee ....a Healthier employer"
Though their main service is web based, the eDoctor team also involve in conducting public seminars, School programs and health promotion among employees.
On December 1st, with the world Aids Day being commemorated all over the world, eDoctor initiated yet another offline campaign to promote awareness regarding "Sexually transmitted Diseases {STDs} and Aids prevention" targeting hotel and travel industry.
A Free workshop was conducted to educate the employees of Mount Lavinia hotel, on 2nd of December on the same, as an inauguration. It was participated by more than 100 hotel employees as the Human resources division of the hotel did a good in organizing the event.
Speaking at the workshop a Doctor from STD and AIDS prevention program of National hospital Colombo said "we are just seeing the tip of an Ice burg when it comes to STDs and Aids. There are nearly 2000 people living in our country who don't even know that they are infected with HIV. We can adopt preventive strategies by having a good knowledge about how these diseases are being spread.
CEO of eDoctor Mr.Chris Weerasinghe said that eDoctor would conduct similar programs at relevant institutions on demand. He further said that eDoctor could customize the topic or can give a tailor maid program suiting the institution. Workshops on Ergonomics, Healthy Living, Computer related eye problems and customized health checkups are some of them.
Expanding their Initial medical advisory portal which is web based, www.edoctor.lk expects to reward their clients with a new array of new services from the beginning of the new year.
nATANDA at the Malayisa international performing Arts festival 2014
This is such a treat!!!! I am so happy to see these incredible pictures from nATANDA at the Malayisa international performing Arts festival 2014. Thank you so much for your great images Anna . Truly truly appreciate. You an amazing photographer! Tears in my eyes!!!!!nATANDA is a modern dance troupe based in Colombo, founded as a non-profit organization by Kapila Palihawadana in 2002, trained in Germany for Modern Dance.The nATANDA dance troupe is trained in modern and classical Sri Lankan dance, showcasing their work in Sri Lanka and Thailand. nATANDA has also provided dance workshops to over 1500 young people so far. It pushes the boundaries of dance theatre, looking beyond form, physicality, culture and geography, to richly and vibrantly portray aspects of life and nature. http://www.natanda.lk/html/natanda.html
Funny - A dog sleeping Mannerly-Doggy is going to bed and put blanket on..
A dog sleeping Mannerly.
Doggy is going to bed and put blanket on..
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Thursday, December 18, 2014
Free download year 2015 Sri Lanka Calendar with holidays
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Sri Lankan Calendar for year 2015 with Public holidays , Bank Holidays and Mercantile Holidays with beautiful sceneries of Sri Lanka
Download Calendar :
2015 Year Planner 2015
2015 Wall Planner 2015
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The 2015 wall planner shows 2015 on an A4 landscape page with days running horizontally. You are very welcome to download it. The 2015 year planner is in Word format so it's easy to change it to your favourite colours or change the size to A3 or A5. The Year Planner shows 2015 Public Holidays in England and Wales. At a glance 2015 calendar and diary.
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List of Free / Open Source Classifieds Ads PHP Scripts
List of Free / Open Source Classifieds Ads PHP Scripts
Rapid Classified: ASP Classified Software Scripts
Rapid Classified: ASP Classified Software Scripts
Rapid Classified is a mid-size online classified ads software based on ASP script with load of features. Application can utilize Access, SQL or MySQL database. Automated setup builds database and installs classified in minutes.
PHP/mySQL Classified Ads & Matchmaking script with easy setup, multi languages, and easy customization with variables & templates
Multiple categories for Classified Ads software, Users can place ads with photo (via their own browser) , Browsing ads sorted by pages displays latest ads first, and Admin can specify the time period before ads expire.
StudentTrader was originally created in PHP to offer a free classifieds ads and booktrading system for every college in the usa. After running for almost a year and building a pretty good user base – it was taken down and rebuilt using java.
A working case study of a PHP4/mySQL classifieds system that allows unregistered users to browse categories and ads, and register for an account. Registered users may post new ads, and edit and delete their existing ads.
Open Classifieds is a script for classifieds / advertisement / listings. This web application is developed to be fast, light, secure and SEO friendly. Template enabled and easy to administrate
FladsClassifieds is a multilingual application for publishing classified advertisements on a website. Advertisements are grouped within categories configured by the website administrator. Categories are arranged in category trees to allow for subcategory support.
NWS-Classifieds allows you to set up a classifieds website very easily. The current version has 3 main categories: things, cars and real-estate. The owner of the market website can ask for listing fees and recieve them via PayPal
Open Auto Classifieds is a free, open source vehicle classifieds manager. Intended to be easy to install and easy to administer. OAC is Based on open technologies such as PHP, MySQL, XHTML, and CSS styling, making it easy to customize for your needs.
The e-Classifieds Free Edition allows you to quickly set up your own classifieds section using easily configurable categories and other variables. In fact, just one program file controls all operations. The only other files to install are a counter file and a few graphics files. All pages are generated dynamically using your settings, so there is no need to manually edit any HTML files.
Our latest version of the World Wide Classifieds allows you to run a complete classifieds system. Here are some features: – Auctions! You can add auctions to your categories! – Users can edit category when editing their ad.
If you are looking to make money online, look beyond blogging and start your own classifieds site now !
Adssiyalla.lk: Welcome to best market place in Sri Lanka
siyalla.lk/
Wednesday, December 17, 2014
Most Funnest Videos 2014
Most Funnest Videos 2014
Too funny but showing some stupidity !
See cool videos , but do not try to do it your self if you don't confident of it.
Too funny but showing some stupidity !
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