Fertility

It refers to the natural capability to produce an offspring

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Common Causes of Infertility

Some women want children but either cannot conceive or keep miscarrying. This is called infertility. Lots of couples have infertility problems. About one-third of the time, it is a female problem. In another one-third of cases, it is the man with the fertility problem. For the remaining one-third, both partners have fertility challenges or no cause is found. Some common reasons for infertility in women include: Age – Women generally have some decrease in fertility starting in their early 30s. And while many women in their 30s and 40s have no problems getting pregnant, fertility especially declines after age 35. As a woman ages, normal changes that occur in her ovaries and eggs make it harder to become pregnant. Even though menstrual cycles continue to be regular in a woman's 30s and 40s, the eggs that ovulate each month are of poorer quality than those from her 20s. It is harder to get pregnant when the eggs are poorer in quality. As a woman nears menopause, the ovaries may not release an egg each month, which also can make it harder to get pregnant. Also, as a woman and her eggs age, she is more likely to miscarry, as well as have a baby with genetic problems, such as Down syndrome. Health problems – Some women have diseases or conditions that affect their hormone levels, which can cause infertility. Women with polycystic ovary syndrome (PCOS) rarely or never ovulate. Failure to ovulate is the most common cause of infertility in women. With primary ovarian insufficiency (POI), a woman's ovaries stop working normally before she is 40. It is not the same as early menopause. Some women with POI get a period now and then. But getting pregnant is hard for women with POI. A condition called luteal phase defect (LPD) is a failure of the uterine lining to be fully prepared for pregnancy. This can keep a fertilized egg from implanting or result in miscarriage. Common problems with a woman's reproductive organs, like uterine fibroids, endometriosis, and pelvic inflammatory disease can worsen with age and also affect fertility. These conditions might cause the fallopian tubes to be blocked, so the egg can't travel through the tubes into the uterus. Lifestyle factors – Certain lifestyle factors also can have a negative effect on a woman's fertility. Examples include smoking, alcohol use, weighing much more or much less than an ideal body weight, a lot of strenuous exercise, and having an eating disorder. Stress also can affect fertility. Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm. They also have a slightly higher risk of sperm gene defects. Or they might produce no sperm, or too few sperm. Lifestyle choices also can affect the number and quality of a man's sperm. Alcohol and drugs can temporarily reduce sperm quality. And researchers are looking at whether environmental toxins, such as pesticides and lead, also may be to blame for some cases of infertility. Men also can have health problems that affect their sexual and reproductive function. These can include sexually transmitted infections (STIs), diabetes, surgery on the prostate gland, or a severe testicle injury or problem. When to see your doctor You should talk to your doctor about your fertility if: You are younger than 35 and have not been able to conceive after one year of frequent sex without birth control. You are age 35 or older and have not been able to conceive after six months of frequent sex without birth control. You believe you or your partner might have fertility problems in the future (even before you begin trying to get pregnant). You or your partner has a problem with sexual function or libido. Happily, doctors are able to help many infertile couples go on to have babies. Infertility treatment Some treatments include: Drugs – Various fertility drugs may be used for women with ovulation problems. It is important to talk with your doctor about the drug to be used. You should understand the drug's benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur. Surgery – Surgery is done to repair damage to a woman's ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery. Intrauterine insemination (IUI), also called artificial insemination – Male sperm is injected into part of the woman's reproductive tract, such as into the uterus or fallopian tube. IUI often is used along with drugs that cause a woman to ovulate. Assisted reproductive technology (ART) – ART involves stimulating a woman's ovaries; removing eggs from her body; mixing them with sperm in the laboratory; and putting the embryos back into a woman's body. Success rates of ART vary and depend on many factors. Third party assistance – Options include donor eggs (eggs from another woman are used), donor sperm (sperm from another man are used), or surrogacy (when another woman carries a baby for you). Finding the cause of infertility is often a long, complex, and emotional process. And treatment can be expensive. Many health insurance companies do not provide coverage for infertility or provide only limited coverage. Check your health insurance contract carefully to learn about what is covered. Some states have laws that mandate health insurance policies to provide infertility coverage. Content Source Feature Image Source

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How Cervical Mucus Helps Predict Your Most Fertile Days?

There are many ovulation predictor kits on the market, but there’s one inside every woman that’s absolutely free. Cyclical changes in the secretions produced by the cervix provide a simple, easy way for women to monitor their cycles–and their most fertile times. As opposed to the change in basal body temperature that occurs after ovulation, the change in cervical mucus (CM) occurs several days prior to ovulation, giving women the opportunity to time intercourse for conception. For most of the cycle, CM acts as a barrier to sperm. It protects the cervix chemically–with white blood cells fighting foreign bodies–and mechanically–acting as a plug and closing the cervical canal. But during the fertile phase, the consistency and composition of CM changes. Instead of being a barrier, CM now aids and accelerates the sperms’ passage through the cervix. CM during the fertile phase also extends sperm longevity, allowing them to live for up to five days within the female body. The CM even acts as a quality control device, screening the sperm and catching any with irregular or curved swimming. By observing CM pinpoint the fertile phase, women can help increase their chances of conception. Changes in Cervical Mucus Changes in CM will indicate the days leading up to ovulation, and sexual intercourse during this time will ensure that sperm—nourished by fertile phase CM—will be present when the egg is released. What to Look For A woman can monitor her CM by feel or appearance. The sensation of CM in the vagina–dry, moist, or wet–is one clue to follow for detecting impending ovulation. The color (white, creamy, cloudy or clear) and consistency (sticky, or smooth and slippery) are others. Women can see and feel CM when it moistens their underwear, or when they wipe themselves with toilet paper. Bearing down (such as with a bowel movement) or releasing the muscles following a Kegel exercise may release more mucus. Women can also conduct a “finger test.” To do this, a woman should first thoroughly wash her hands, then carefully insert a finger into the vagina. When the finger is removed, she can observe and note the color and consistency of the CM by stretching it out between two fingers. Because it may sometimes be difficult to distinguish between CM and semen, it’s best to test CM before intercourse or wait for a while afterward. Cervical mucus can also be altered by vaginal infections, medication, and birth control. The chart below gives information for de-coding CM to detect ovulation. Phase Sensation CM Appearance Pre-ovulatory Dry No visible mucus. Fertile Moist or sticky White or cream-colored, thick to slightly stretchy. Breaks easily when stretched. Highly Fertile Slippery, wet, lubricated Increase in amount. Thin, watery, transparent, like egg white. Post-ovulatory Dry or sticky Sharp decrease in amount. Thick, opaque white or cream-colored. Content and Feature Image Source

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Fertility and Endometriosis

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What is male infertility?

Male infertility is any health issue in a man that lowers the chances of his female partner getting pregnant. About 13 out of 100 couples can't get pregnant with unprotected sex. There are many causes for infertility in men and women. In over a third of infertility cases, the problem is with the man. This is most often due to problems with his sperm production or with sperm delivery. What Happens Under Normal Conditions? The man's body makes tiny cells called sperm. During sex, ejaculation normally delivers the sperm into the woman's body. The male reproductive system makes, stores, and transports sperm. Chemicals in your body called hormones control this. Sperm and male sex hormone (testosterone) are made in the 2 testicles. The testicles are in the scrotum, a sac of skin below the penis. When the sperm leave the testicles, they go into a tube behind each testicle. This tube is called the epididymis. Just before ejaculation, the sperm go from the epididymis into another set of tubes. These tubes are called the vas deferens. Each vas deferens leads from the epididymis to behind your bladder in the pelvis. There each vas deferens joins the ejaculatory duct from the seminal vesicle. When you ejaculate, the sperm mix with fluid from the prostate and seminal vesicles. This forms semen. Semen then travels through the urethra and out of the penis. Male fertility depends on your body making normal sperm and delivering them. The sperm go into the female partner's vagina. The sperm travel through her cervix into her uterus to her fallopian tubes. There, if a sperm and egg meet, fertilization happens. The system only works when genes, hormone levels and environmental conditions are right. Causes Making mature, healthy sperm that can travel depends on many things. Problems can stop cells from growing into sperm. Problems can keep the sperm from reaching the egg. Even the temperature of the scrotum may affect fertility. These are the main causes of male infertility: Sperm Disorders The most common problems are with making and growing sperm. Sperm may: not grow fully be oddly shaped not move the right way be made in very low numbers (oligospermia) not be made at all (azoospermia) Sperm problems can be from traits you're born with. Lifestyle choices can lower sperm numbers. Smoking, drinking alcohol, and taking certain medications can lower sperm numbers. Other causes of low sperm numbers include long-term sickness (such as kidney failure), childhood infections (such as mumps), and chromosome or hormone problems (such as low testosterone). Damage to the reproductive system can cause low or no sperm. About 4 out of every 10 men with total lack of sperm (azoospermia) have an obstruction (blockage). A birth defect or a problem such as an infection can cause a blockage. Varicoceles Varicoceles are swollen veins in the scrotum. They're found in 16 out of 100 of all men. They are more common in infertile men (40 out of 100). They harm sperm growth by blocking proper blood drainage. It may be that varicoceles cause blood to flow back into your scrotum from your belly. The testicles are then too warm for making sperm. This can cause low sperm numbers. For more information please refer to the Varicoceles information page. Retrograde Ejaculation Retrograde ejaculation is when semen goes backwards in the body. They go  into your bladder instead of out the penis. This happens when nerves and muscles in your bladder don't close during orgasm (climax). Semen may have normal sperm, but the semen cannot reach the vagina. Retrograde ejaculation can be caused by surgery, medications or health problems of the nervous system. Signs are cloudy urine after ejaculation and less fluid or "dry" ejaculation. Immunologic Infertility Sometimes a man's body makes antibodies that attack his own sperm. Antibodies are most often made because of injury, surgery or infection. They keep sperm from moving and working normally. We don't know yet exactly how antibodies lower fertility. We do know they can make it hard for sperm to swim to the fallopian tube and enter an egg. This is not a common cause of male infertility. Obstruction Sometimes sperm can be blocked. Repeated infections, surgery (such as vasectomy), swelling or developmental defects can cause blockage. Any part of the male reproductive tract can be blocked. With a blockage, sperm from the testicles can't leave the body during ejaculation. Hormones Hormones made by the pituitary gland tell the testicles to make sperm. Very low hormone levels cause poor sperm growth. Chromosomes Sperm carry half of the DNA to the egg. Changes in the number and structure of chromosomes can affect fertility. For example, the male Y chromosome may be missing parts. Medication Certain medications can change sperm production, function and delivery. These medications are most often given to treat health problems like: arthritis depression digestive problems infections high blood pressure cancer Diagnosis Causes of male fertility can be hard to diagnose. The problems are most often with sperm production or delivery. Diagnosis starts with a full history and physical exam. Your health care provider may also want to do blood work and semen tests. History and Physical Exam Your health care provider will take your health and surgical histories. Your provider will want to know about anything that might lower your fertility. These might include defects in your reproductive system, low hormone levels, sickness or accidents. Your provider will ask about childhood illnesses, current health problems, or medications that might harm sperm production. Such things as mumps, diabetes and steroids may affect fertility. Your provider will also ask about your use of alcohol, tobacco, marijuana and other recreational drugs. He or she will ask if you've been exposed to ionizing radiation, heavy metals or pesticides. Heavy metals are an exposure issue (e.g. mercury, lead arsenic). All of these can affect fertility. Your health care provider will learn how your body works during sex. He or she will want to know about you and your partner's efforts to get pregnant. For example, your healthcare provider may ask if you've had trouble with erections. The physical exam will look for problems in your penis, epididymis, vas deferens, and testicles. Your doctor will look for varicoceles. They can be found easily with a physical exam. Semen Analysis Semen analysis is a routine lab test. It helps show the cause of male infertility. The test is most often done twice. Semen is collected by having you masturbate into a sterile cup. The semen sample is studied. It can be checked for things that help or hurt conception (fertilization). Your health care provider will study your sperm volume, count, concentration, movement ("motility"), and structure. The quality of your sperm tells much about your ability to conceive (start a pregnancy). For instance, semen is normal if it turns from a pearly gel into a liquid within 20 minutes. If not, there may be a problem with the seminal vesicles, your male sex glands. Lack of fructose (sugar) in a sperm-free sample may mean there are no seminal vesicles. Or it may mean there is a blocked ejaculatory duct. Even if the semen test shows low sperm numbers or no sperm, it may not mean you are permanently infertile. It may just show there's a problem with the growth or delivery of sperm. More test may be needed. Transrectal Ultrasound Your health care provider may order a transrectal ultrasound. Ultrasound uses sound waves bouncing off an organ to get a picture of the organ. A probe is placed in the rectum. It beams sound waves to the nearby ejaculatory ducts. The health care provider can see if structures such as the ejaculatory duct or seminal vesicles are poorly formed or blocked. Testicular Biopsy If a semen test shows a very low number of sperm or no sperm you may need a testicular biopsy. This test can be done in an operating room with general or local anesthesia. A small cut is made in the scrotum. It can also be done in a clinic using, a needle through the numbed scrotal skin. In either case, a small piece of tissue from each testicle is removed and studied under a microscope. The biopsy serves 2 purposes. It helps find the cause of infertility. And it can collect sperm for use in assisted reproduction. Hormonal Profile The health care provider may check your hormones. This is to learn how well your testicles make sperm. It can also rule out major health problems. For example, follicle-stimulating hormone (FSH) is the pituitary hormone that tells the testicles to make sperm. High levels may mean your pituitary gland is trying to get the testicles to make sperm, but they won't. Treatment Treatment depends on what's causing infertility. Many problems can be fixed with drugs or surgery. This would allow conception through normal sex. The treatments below are broken into 3 categories: Non-surgical therapy for Male Infertility Surgical Therapy for Male Infertility Treatment for Unknown Causes of Male Infertility Non-Surgical Treatment for Specific Male Infertility Conditions Many male infertility problems can be treated without surgery. Anejaculation Anejaculation is when there's no semen. It's not common, but can be caused by: spinal cord injury prior surgery diabetes multiple sclerosis abnormalities present at birth other mental, emotional or unknown problems Drugs are often tried first to treat this condition. If they fail, there are 2 next steps. Rectal probe electroejaculation (RPE, better known as electroejaculation or EEJ) is one. Penile vibratory stimulation (PVS) is the other. Rectal probe electroejaculation is most often done under anesthesia. This is true except in men with a damaged spinal cord. RPE retrieves sperm in 90 out of 100 men who have it done. Many sperm are collected with this method. But sperm movement and shape may still lower fertility. Penile vibratory stimulation vibrates the tip and shaft of the penis to help get a natural climax. While non-invasive, it doesn't work as well as RPE. This is especially true in severe cases. Assisted reproductive techniques like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are of great value to men with anejaculation. Congenital Adrenal Hyperplasia (CAH) CAH is a rare cause of male infertility. It involves flaws from birth in certain enzymes. This causes abnormal hormone production. CAH is most often diagnosed by looking for too much steroid in the blood and urine. CAH can be treated with hormone replacement. Genital Tract Infection Genital tract infection is rarely linked to infertility. It's only found in about 2 out of 100 men with fertility problems. In those cases, the problem is often diagnosed from a semen test. In the test, white blood cells are found. White blood cells make too much "reactive oxygen species" (ROS). This lowers the chances of sperm being able to fertilize an egg. For example, a severe infection of the epididymis and testes may cause testicular shrinking and epididymal duct blockage. The infection doesn't have to be sudden to cause problems. Antibiotics are often given for full-blown infections. But they're not used for lesser inflammations. They can sometimes harm sperm production. Non-steroidal anti-inflammatories (such as ibuprofen) are often used instead. Inflammation from causes other than infection can also affect fertility. For example, chronic prostatitis, in rare cases, can also block the ejaculatory ducts. Hyperprolactinemia Hyperprolactinemia is when the pituitary gland makes too much of the hormone prolactin. It's a factor in infertility and erectile dysfunction. Treatment depends on what's causing the increase. If medications are the cause, your health care provider may stop them. Drugs may be given to bring prolactin levels to normal. If a growth in the pituitary gland is found, you may be referred to a neurosurgeon. Hypogonadotropic Hypogonadism Hypogonadotropic hypogonadism is when the testicles don't make sperm due to poor stimulation by the pituitary hormones. This is due to a problem in the pituitary or hypothalamus. It's the cause of a small percentage of infertility in men. It can exist at birth ("congenital"). Or it can show up later ("acquired"). The congenital form, known also as Kallmann's syndrome, is caused by lower amounts of gonadotropin-releasing hormone (GnRH). GnRH is a hormone made by the hypothalamus. The acquired form can be triggered by other health issues such as: pituitary tumors head trauma anabolic steroid use. If hypogonadotropic hypogonadism is suspected, your health care provider may want you to have an MRI. This will show a picture of your pituitary gland. You will also have a blood test to check prolactin levels. Together, an MRI and blood test can rule out pituitary tumors. If there are high levels of prolactin but no tumor on the pituitary gland, your provider may try to lower your prolactin first. Gonadotropin replacement therapy would be the next step. During treatment, blood testosterone levels and semen will be checked. Chances for pregnancy are very good. The sperm resulting from this treatment are normal. Immunologic Infertility Scientists first showed that some infertility cases were linked to immune system problems in the early 1950s. There has been much research since then. Though steroids (by mouth) are sometimes used to lower antisperm antibodies, this rarely works. In vitro fertilization with Intracytoplasmic Sperm Injection (ICSI) is now preferred for fertility problems caused by the immune system. This abnormality is very rare. Reactive Oxygen Species (ROS) ROS are small molecules found in many bodily fluids. They are in white blood cells. They are also in the sperm cells in semen. ROS can help prepare the sperm for fertilization. But too much ROS can hurt other cells. Sperm are easily harmed by ROS. Recent studies have shown more ROS molecules in the semen of infertile men. Many compounds have been used to detoxify or "scavenge" (fix) ROS levels. The most studied of these, Vitamin E (400 IU twice daily), can work well as an antioxidant. Pentoxifylline, coenzymeQ, and Vitamin C have also been shown to lower sperm ROS. They're used much less often than Vitamin E. Retrograde Ejaculation Retrograde ejaculation, semen flowing back instead of going out the penis, has many causes. It can be caused by: prostate or bladder surgeries diabetes spinal cord injury anti-depressants certain anti-hypertensives medications used to treat prostate enlargement (BPH) Retrograde ejaculation is found by checking your urine for sperm. This is done under a microscope right after ejaculation. Drugs can be used to correct retrograde ejaculation. It is often treated first with over-the-counter medications like Sudafed®. If medications don't work and you need assisted reproductive techniques (ARTs), your health care provider may try to collect sperm from your bladder after ejaculation. Surgical Therapy for Male Infertility Varicocele Treatments Varicoceles can be fixed with minor outpatient surgery called varicocelectomy. Fixing these swollen veins helps sperm movement, numbers, and structure. For more information on varicocele treatments please refer to our Varicoceles page. Azoospermia Treatments If your semen lacks sperm (azoospermia) because of a blockage, there are many surgical choices. Microsurgical Vasovasostomy Vasovasostomy is used to undo a vasectomy. It uses microsurgery to join the 2 cut parts of the vas deferens in each testicle. For more information on this treatment please refer to our Vasectomy Reversal page. Vasoepididymostomy Vasoepididymostomy joins the upper end of the vas deferens to the epididymis. It's the most common microsurgical method to treat epididymal blocks. For more information on this treatment please refer to our Vasectomy Reversal Page. Transurethral Resection of the Ejaculatory Duct (TURED) Ejaculatory duct blockage can be treated surgically. A cystoscope is passed into the urethra (the tube inside the penis) and a small incision is made in the ejaculatory duct. This gets sperm into the semen in about 65 out of 100 men. But there can be problems. Blockages could come back. Incontinence and retrograde ejaculation from bladder damage are other possible but rare problems. Also, only 1 in 4 couples get pregnant naturally after this treatment. Treatment for Unknown Causes of Male Infertility Sometimes it's hard to tell the cause of male infertility. This is called "non-specific" or "idiopathic" male infertility. Your health care provider may uses experience to help figure out what works. This is called "empiric therapy." Because infertility problems are often due to hormones, empiric therapy might balance hormone levels. It's not easy to tell how well empiric treatments will work. Each case is different. Assisted Reproductive Techniques If infertility treatment fails or isn't available, there are ways to get pregnant without sex. These methods are called assisted reproductive techniques (ARTs). Based on the specific type of infertility and the cause, your health care provider may suggest: Intrauterine Insemination (IUI) For IUI, your health care provider places the sperm into the female partner's uterus through a tube. IUI is often good for low sperm count and movement problems, retrograde ejaculation, and other causes of infertility. In Vitro Fertilization (IVF) IVF is when the egg of a female partner or donor is joined with sperm in a lab Petri dish. For IVF, the ovaries must be overly stimulated. This is often done with drugs. It allows many mature eggs to be retrieved. After 3 to 5 days of growth, the fertilized egg (embryo) is put back into the uterus. IVF is used mostly for women with blocked fallopian tubes. But it's being used more and more in cases where the man has very severe and untreatable oligospermia (low sperm count). Intracytoplasmic Sperm Injection (ICSI) ICSI is a variation of IVF. It has revolutionized treatment of severe male infertility. It lets couples thought infertile get pregnant. A single sperm is injected into the egg with a tiny needle. Once the egg is fertilized, it's put in the female partner's uterus. Your health care provider may use ICSI if you have very poor semen quality. It is also used if you have no sperm in the semen caused by a block or testicular failure that can't be fixed. Sperm may also be taken from the testicles or epididymis by surgery for this method. Sperm Retrieval for ART Many microsurgical methods can remove sperm blocked by obstructive azoospermia (no sperm). The goal is to get the best quality and number of cells. This is done while trying not to harm the reproductive tract. These methods include: Testicular Sperm Extraction (TESE) This is a common technique used to diagnose the cause of azoospermia. It also gets enough tissue for sperm extraction. The sperm taken from the testicle can be used fresh or frozen ("cryopreserved"). One or many small biopsies are done, often in the office. Testicular Fine Needle Aspiration (TFNA) TFNA was first used to diagnose azoospermia. It is now sometimes used to collect sperm from the testicles. A needle and syringe puncture the scrotal skin to pull sperm from the testicle. Percutaneous Epididymal Sperm Aspiration (PESA) PESA, like TFNA, can be done many times at low cost. There is no surgical cut. More urologists can do it because it doesn't call for a high-powered microscope. PESA is done under local or general anesthesia. The urologist sticks a needle attached to a syringe into the epididymis. Then he or she gently withdraws fluid. Sperm may not always be gotten this way. You may still need open surgery. Microsurgical Epididymal Sperm Aspiration (MESA) With MESA, sperm are also retrieved from the epididymal tubes. This method uses a surgical microscope. MESA yields high amounts of motile sperm. They can be frozen and thawed later for IVF treatments. This method limits harm to the epididymis. It keeps blood out of the fluid. Even though MESA calls for general anesthesia and microsurgical skill, it has a lower problem rate. It's also able to collect larger numbers of sperm with better motility for banking. After Treatment Male infertility can often be fixed with an outpatient procedure. These are done under general anesthesia or IV sedation. While pain after surgery is usually mild, recovery and follow-up vary. After varicocele repair, your health care provider should do a physical exam. This is to see if the vein is completely gone. Often the veins stay enlarged, since they are not removed during surgery but only closed off to prevent abnormal blood flow. Semen should be tested about every 3 months for at least a year, or until pregnancy. If your varicocele returns, or you stay infertile, ask your health care provider about ARTs. Vasectomy reversals cause only mild pain after surgery. But expect an out-of-work recovery of 4 to 7 days. The chance for pregnancy depends on many things. It mostly depends on the age and fertility of your female partner. The number of years between your vasectomy and reversal also affects success. The longer you wait, the less likely the reversal will be a success. content source

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Polycystic ovary syndrome (PCOS)- an overview

Polycystic ovary syndrome (PCOS) is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease. Symptoms Signs and symptoms of PCOS often develop around the time of the first menstrual period during puberty. Sometimes PCOS develops later, for example, in response to substantial weight gain. Signs and symptoms of PCOS vary. A diagnosis of PCOS is made when you experience at least two of these signs: Irregular periods. Infrequent, irregular or prolonged menstrual cycles are the most common sign of PCOS. For example, you might have fewer than nine periods a year, more than 35 days between periods and abnormally heavy periods. Excess androgen. Elevated levels of male hormone may result in physical signs, such as excess facial and body hair (hirsutism), and occasionally severe acne and male-pattern baldness. Polycystic ovaries. Your ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly. PCOS signs and symptoms are typically more severe if you're obese. When to see a doctor See your doctor if you have concerns about your menstrual periods, if you're experiencing infertility or if you have signs of excess androgen such as worsening hirsutism, acne and male-pattern baldness. Causes The exact cause of PCOS isn't known. Factors that might play a role include: Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar, your body's primary energy supply. If your cells become resistant to the action of insulin, then your blood sugar levels can rise and your body might produce more insulin. Excess insulin might increase androgen production, causing difficulty with ovulation. Low-grade inflammation. This term is used to describe white blood cells' production of substances to fight infection. Research has shown that women with PCOS have a type of low-grade inflammation that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems. Heredity. Research suggests that certain genes might be linked to PCOS. Excess androgen. The ovaries produce abnormally high levels of androgen, resulting in hirsutism and acne. Complications Complications of PCOS can include: Infertility Gestational diabetes or pregnancy-induced high blood pressure Miscarriage or premature birth Nonalcoholic steatohepatitis — a severe liver inflammation caused by fat accumulation in the liver Metabolic syndrome — a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease Type 2 diabetes or prediabetes Sleep apnea Depression, anxiety and eating disorders Abnormal uterine bleeding Cancer of the uterine lining (endometrial cancer) Obesity is associated with PCOS and can worsen complications of the disorder. content source

What Should one Look For In A Surrogate?

Surrogates are generally caring, generous, family-oriented women who feel very strongly about giving others the gift of family. Most are responsible, conscientious woman who are very devoted to the process of surrogacy. The majority of surrogates come from medium to low-income households. The relationship status of surrogates varies from single moms to married women, and education levels vary from GED’s to advanced degrees. What should intended parents look for in a surrogate? Clearly, the primary concern of any intended parent should be the surrogate’s general health and lifestyle and pregnancy history. That being in order, here are some things every intended parent should take into consideration:   • The support system the surrogate will have during the surrogacy (will she have the support of a partner, a parent, a roommate, her place of employment or a close friend)?   • Her responsiveness to requests from the agency, e.g. whether she has followed through with appointments, etc. (You can ask your agency about that.) • How her partner, husband and/or family feels about the surrogacy? • Whether or not she plans on dating during the surrogacy (assuming she is single). • Whether you and she agree on issues such as reductions or pregnancy terminations. • How your surrogate feels about invasive procedures such as amniocentesis, etc. • How much involvement you want in the surrogate’s life during (and after) the pregnancy/birth (e.g. phone calls, Skype, emails, appointments, through agency only, on-going relationship, etc.) • How important a surrogate’s diet is during the pregnancy and how willing she is to follow requested guidelines.   Also, don’t discount your own “Spidey Sense”. Sometimes you just get a vibe about someone, good or bad, and you should go with your instinct. What does an agency look for in a potential surrogate? As you can imagine, many factors go into deciding whether or not we should accept a potential surrogate into our program. Among the factors we consider are:   • Health history   • Criminal background check • Willingness to work with all types of families • Whether she responds to emails, calls, etc. in a timely manner • Her motivations for wanting to become a surrogate • Her level of openness about the surrogacy • Her ability to make it to her appointments (reliable car and/or form of transportation) • Her overall health, including:   o BMI   o non-smoker, drugs or alcohol o mental health o pregnancy history   • Current living situation:     o how many people she lives with and whom   o whether her environment is safe and clean o whether her home is close to medical facilities o how her partner and children feel about the surrogacy You mentioned the potential surrogate’s motivations—can you elaborate? There’s no question that compensation is a big motivator for potential surrogates. The funds often help with down-payments on a house, college education, children’s college funds and other major expenses. Additionally, surrogates tend to be women who enjoy helping others and love being pregnant. How do you screen your surrogates?   It depends how the surrogate finds or is referred to an agency, but generally the process is this:   • The agency has an initial phone conversation with the surrogate to discuss general requirements like height, weight, why she wants to become a surrogate, etc. • Assuming she meets the basic standards of surrogacy, she is then asked to fill out an application which delves deeper into her medical/personal history, etc. At this time, most agencies ask her for permission to conduct a background check for any criminal history she may have. • If everything, including the background check, looks good, a home visit to check her living situation, meet her children and partner (if applicable) and get a general overall view of her lifestyle is conducted. • It’s at that point that an agency will formally admit her into their program and start sending her profile out to intended parents for consideration. content source

Considerations for Choosing a Surrogate Mother

Whether you are a single man or woman or a couple, you may choose to use a surrogate to help bring your dreams of parenthood to reality. When you’ve decided to choose a surrogate mother to help you start a family, there are still further options to consider, like whether you’ll use traditional or gestational surrogacy. With a gestational surrogacy, the carrier becomes pregnant by means of in vitro fertilization (IVF) using the eggs of the intended mother or an egg donor. This means that the surrogate baby is not genetically related to the carrier. With a traditional surrogate, the surrogate’s egg is fertilized with sperm from the intended father or sperm donor through IVF or artificial insemination, making the carrier and the child genetically related. This form of surrogacy is less common than gestational surrogacy. Choosing a Surrogate If you do not already have a surrogate in mind, such as a friend or family member, you can contact an agency or fertility clinic who will help you find one. There are a number of important factors to consider when choosing a carrier for your surrogate baby including: The surrogate’s medical history—this should include a genetic profile (traditional surrogates only), blood tests and obstetric history. The surrogate’s lifestyle choices including their history of drinking and substance abuse. The cost of the surrogacy process—this includes surrogacy compensation, health and life insurance, legal fees, agency fees, psychological screening and monitoring, travel costs, medical expenses, and egg donation compensation and expenses (if applicable) . The legal issues—the laws on surrogacy vary from state to state, so the location of your surrogate is an important issue to consider. What kind of relationship you wish to have with the surrogate after the child is born—you may wish the surrogate to remain an integral part of your child’s life, or have the relationship complete upon delivery. When you are looking for a surrogate with whom you can entrust the first nine months of your baby’s life, you will want to find someone who will treat the pregnancy as if it were her own. If you do choose to find your surrogate through an agency, ask them about their screening process for surrogates, what they are like and why they do this to determine if the agency is able to provide you with the right surrogate for you. Ultimately, the key to making the right choice, is finding a surrogate that you can trust completely and with whom you can feel at ease. content source