Physical exercise is performed for various reasons, including strengthening muscles and the cardiovascular system, honing athletic skills, weight loss or maintenance, and merely enjoyment. Frequent and regular physical exercise boosts the immune system and helps prevent the "diseases of affluence" such as heart disease, cardiovascular disease, Type 2 diabetes, and obesity. It may also help prevent depression, help to promote or maintain positive self-esteem, improve mental health generally, and can augment an individual's sex appeal or body image, which has been found to be linked with higher levels of self-esteem. Childhood obesity is a growing global concern, and physical exercise may help decrease some of the effects of childhood and adult obesity. Health care providers often call exercise the "miracle" or "wonder" drug—alluding to the wide variety of proven benefits that it can provide.
With use, muscles consume energy derived from both fat and glycogen. Due to the large size of leg muscles, walking, running, and cycling are the most effective means of exercise to reduce body fat.
Traditional Chinese medicine (TCM) is a style of traditional Asian medicine informed by modern medicine but built on a foundation of more than 2,500 years of Chinese medical practice that includes various forms of herbal medicine, acupuncture, massage (tui na), exercise (qigong), and dietary therapy. It is primarily used as a complementary alternative medicine approach. TCM is widely used in China and is becoming increasingly prevalent in Europe and North America.
One of the basic tenets of TCM "holds that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions." Concepts of the body and of disease used in TCM reflect its ancient origins and its emphasis on dynamic processes over material structure, similar to European humoral theory. Scientific investigation has found nohistological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points. The TCM theory and practice are not based upon scientific knowledge, and its own practitioners disagree widely on what diagnosis and treatments should be used for any given patient. The effectiveness of Chinese herbal medicine remains poorly researched and documented. There are concerns over a number of potentially toxic plants, animal parts, and mineral Chinese medicinals. A review of cost-effectiveness research for TCM found that studies had low levels of evidence, but so far have not shown benefit outcomes. Pharmaceutical research has explored the potential for creating new drugs from traditional remedies, with few successful results. A Nature editorial described TCM as "fraught withpseudoscience", and said that the most obvious reason why it hasn't delivered many cures is that the majority of its treatments have no logical mechanism of action. Proponents propose that research has so far missed key features of the art of TCM, such as unknown interactions between various ingredients and complex interactive biological systems.
TCM's view of the body places little emphasis on anatomical structures, but is mainly concerned with the identification of functional entities (which regulate digestion, breathing, aging etc.). While health is perceived as harmonious interaction of these entities and the outside world, disease is interpreted as a disharmony in interaction. TCM diagnosis aims to trace symptoms to patterns of an underlying disharmony, by measuring the pulse, inspecting the tongue, skin, and eyes, and looking at the eating and sleeping habits of the person as well as many other things.
The fundamental principles of TCM are based on the Yin-Yang doctrine, the symbolic way of designating opposing forces, and the five element theory that everything in the Universe is dominated and balanced by the five elements, wood, fire, earth, metal and water. The therapeutic mechanism of TCM focuses on enhancing human body's resistance to diseases by improving the inter-connections among self-controlled systems and integrating the human body with the environment. The practice of TCM involves physical therapy such as acupuncture and chemical therapy using materials originating from plants, minerals and animals, while TCM natural products may comprise one or more herbs in the form of decoctions.
In Chinese philosophy, the concept of yin yang sometimes referred to in the west as yin and yang) is used to describe how polar or seemingly contrary forces are interconnected and interdependent in the natural world, and how they give rise to each other in turn. Many natural dualities — e.g. dark and light, female and male, low and high, cold and hot — are thought of as manifestations of yin and yang (respectively).
Yin yang are complementary opposites within a greater whole. Everything has both yin and yang aspects, although yin or yang elements may manifest more strongly in different objects or at different times. Yin yang constantly interacts, never existing in absolute stasis. The concept of yin and yang is often symbolized by various forms of the Taijitu symbol, for which it is probably best known in western cultures. There is a perception (especially in the West) that yin and yang correspond to good and evil. However, Taoist philosophy generally discounts good/bad distinctions as superficial labels, preferring to focus on the idea of balance.
In TCM, there are five diagnostic methods: inspection, auscultation, olfaction, inquiry, and palpation.
Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.
Auscultation refers to listening for particular sounds (such as wheezing). Olfaction refers to attending to body odor. Inquiry focuses on the "seven inquiries", which involve asking the person about the regularity, severity, or other characteristics of: chills, fever, perspiration, appetite, thirst, taste, defecation, urination, pain, sleep, menses, leukorrhea. Palpation which includes feeling the body for tender A-shi points, and the palpation of the wrist pulses as well as various other pulses, and palpation of the abdomen. Examination of the tongue and the pulse are among the principal diagnostic methods in TCM.Certain sectors of the tongue's surface are believed to correspond to the zàng-fŭ. For example, teeth marks on one part of the tongue might indicate aproblem with the Heart, while teeth marks on another part of the tongue might indicate a problem with the Liver. Pulse palpation involves measuring the pulse both at a superficial and at a deep level at three different locations on the radial artery (Cun, Guan, Chi, located two fingerbreadths from the wrist crease, one fingerbreadth from the wrist crease, and right at the wrist crease, respectively, usually palpated with the index, middle and ring finger) of each, for a total of twelve pulses, all of which are thought to correspond with certain zàng-fŭ. The pulse is examined for several characteristics including rhythm, strength and volume, and described with qualities like "floating, slippery, bolstering-like, feeble, thready and quick"; each of these qualities indicate certain disease patterns. Learning TCM pulse diagnosis can take several years.
Chinese medicine therapies
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures.
Usually performed by a gynecologist, hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called "complete") or partial (removal of the uterine body while leaving the cervix intact; also called "supracervical"). It is the most commonly performed gynecological surgical procedure. In 2003, over 600,000 hysterectomies were performed in the United States alone, of which over 90% were performed for benign conditions. Such rates being highest in the industrialized world has led to the major controversy that hysterectomies are being largely performed for unwarranted and unnecessary reasons.
Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes) and has surgical risks as well as long-term effects, so the surgery is normally recommended when other treatment options are not available or have failed. It is expected that the frequency of hysterectomies for non-malignant indications will fall as there are good alternatives in many cases.
Occasionally, women will express a desire to undergo an elective hysterectomy—that is, a hysterectomy for reasons other than the resolution of reproductive system conditions or illnesses. Some of the conditions under which a woman may request to have a hysterectomy (or have one requested for her if the woman is incapable of making the request) for non-illness reasons include:
Laparoscopic treatment of endometriosis utilizes the techniques of laparoscopic surgery (Pic. 1) to remove the foci of endometriosis. Endometriosis is defined as the existence of functional endometrium outside the uterus. Endometriosis lesions (Pic. 2) are mainly located in the pelvis. However, they can be found almost anywhere in the body.
Laparoscopic surgery has been considered as the gold standard for the diagnosis of endometriosis as it gives a histological assessment of excised specimens. This is supported by the absence of definitive non invasive tests for endometriosis, although there has been continuing work on this conducted internationally. Hence diagnostic laparoscopy remains the ideal route for diagnosis.
Laparoscopic procedures are performed via small incisions in the abdominal wall. Long and thin instruments are then inserted into the abdominal cavity through trocars, hollow tubes inserted into the incisions. The laparoscopic technique utilizes a laparoscope, an optic cable connected to a video camera and a light source that enables viewing the area (the abdominal cavity) without opening it with a large incision. During the operation, the abdomen is usually insufflated with carbon dioxide(CO2). This technique presents major advantages such as reduced recovery time (due to the smaller incisions), reduced hemorrhaging, less pain and shorter hospital stay (in some cases, the patient can leave the hospital on the same day).
Diagnostic laparoscopy for diagnostic purpose has various limitations, which should challenge this practice. To optimize patient’s outcome and to minimize exposure to multiple surgeries, at present role of surgery would ideally be reserved for diagnostic confirmation and simultaneous treatment. The benefits of an examination and treat approach give the women the opportunity to confirm the pathology and address the underlying condition, all during one anesthesia.
Oophorectomy is a surgical procedure in which one or both ovaries (Pic. 1; Pic. 2) are removed. The term ovariectomy can also be used, but traditionally it has referred to animals (e. g. laboratory mice) rather than humans. Removal of female ovaries is the equivalent to castration of males, where the testes are withdrawn. However, in medical literature, castration is used mostly in relation to men.
Oophorectomy can be divided into several categories. Either into unilateral (on one side) and bilateral (on both sides), or depending on the amount of removed tissue. If the whole ovary is taken away, it is a complete oophorectomy. If a part of the ovary is preserved, we are talking about partial oophorectomy (or ovariotomy). The term partial oophorectomy is sometimes used to describe a variety of surgeries such as an ovarian cyst removal or resection of parts of the ovaries. Such a surgery preserves fertility, although ovarian failure (i. e. loos of normal function of the ovaries before 40 years of age) may occur.
In some cases, it might be necessary to remove more than the ovaries only. Salpingo-oophorectomy, unilateral salpingo-oophorectomy or adnexectomy means removal of an ovary together with the Fallopian tube. When both ovaries and both Fallopian tubes are removed, the term bilateral salpingo-oophorectomy (or bilateral adnexectomy) is used. Oophorectomy may also be performed together with hysterectomy (i. e. removal of the uterus), which means that the whole reproductive system of the woman is removed. It is usually referred to as ovariohysterectomy, although the formal name is total abdominal hysterectomy with bilateral salpingo-oophorectomy.
The need to remove one or both ovaries can result from several medical conditions. Most bilateral oophorectomies are performed within ovariohysterectomy, mainly because of a uterine pathology. Another indication can be female-to-male gender reassignment. Unilateral oophorectomy is commonly performed not in conjunction with hysterectomy, often because of diseases such as ovarian cysts (Pic. 3) or cancer (Pic. 4), or as a prophylaxis to reduce the risks of developing ovarian or breast cancer.
Pharmacotherapy of endometriosis is the medical therapy that can efficaciously reduce the severity of pain symptoms caused by endometriosis. In case it is used as long-time treatment, it should reduce the number of surgical interventions and improve the quality of life. Every medical treatment today is well tolerable but should only be used as long as necessary.
Endometriosis is a benign (non-cancerous) gynaecological disease defined as an inflammatory condition characterized by lesions of endometrial-like tissue outside of the uterus, and it is associated with pelvic pain and infertility (Pic. 1).
The basic epidemiology of endometriosis has been difficult to assess for many reasons, including the following:
Consequently, many affected women remain undiagnosed; therefore, the true prevalence rate of this disease in the general population is unknown. However, the prevalence in women of reproductive age is estimated to range between 10% and 15%.
Medical management of endometriosis includes pain relief medication (NSAIDs, oral contraceptives) and hormone replacement therapies that may be used as a treatment for mild endometriosis or as a combined therapy (oral contraceptives, progestins, GnRH analogues), either before, or after surgery, for moderate to severe endometriosis.
Pharmacological agents for treatment of endometriosis-associated pelvic pain are as follows:
Despite limited evidence of effectiveness, oral contraceptives are considered as first-line medical treatment for endometriosis-associated chronic pelvic pain; their use is based on the evidence of a clinical improvement of the disease during pregnancy. Continuous oral contraceptive pills suppress luteinizing hormone (LH; stimulates normal follicular growth and ovulation) and follicle-stimulating hormone (FSH; is responsible for follicular growth and estrogen formation) and prevent ovulation.
Oral contraceptives inhibit the production of gonadal estrogen (to stabilize the endometrium and thereby reduce the incidence of breakthrough bleeding) via a negative feedback mechanism ('stimulus' causes an opposite 'output' in order to maintain an ideal level, Pic. 2). Moreover, by suppressing ovarian activity, they also lead to a reduction in estrogen-induced production of prostaglandins, decreasing the inflammation associated with endometriosis.
The choice should be based on patient preferences, side effects, efficacy, costs, and availability (Pic. 3). For oral contraceptives, further benefits such as contraceptive protection, long-term safety, and control of menstrual cycle should be considered.
Progestins are synthetic compounds that mimic the effects of progesterone. They were reported to reduce or eliminate pain symptoms in approximately 90% of the patients. Progestins are available in many forms, including oral preparations, injections, subdermal implants and intrauterine systems. Continuous progestin use is an effective therapy for the treatment of painful symptoms associated with endometriosis but there had been no evidence of progestin use being superior to other types of treatment in endometriosis-related pain symptoms.
GnRH analogues (GnRH-a) suppress estrogen ovarian production, causing a low estrogen level (hypoestrogenism), and, consequently, amenorrhea (absence of menstruation) and a thickness of uterine lining. This effect is readily reversible after stopping GnRH-a administration. They are considered as a second-line treatment in case of failure of therapy with oral contraceptives or progestins or when they are not tolerated or contraindicated. GnRH analogues provide a reduction of symptoms in about 50% of cases, and their administration after surgical treatment prolongs the pain-free interval. The treatment for 3 months with a GnRH-a may reduce the painful symptoms for about 6 months.
For GnRH analogues significant side effects, such as bone loss and hypoestrogenic symptoms (such as hot flashes, headaches, lowered libido, and breast atrophy), should be considered. Due to side effects, they should only be prescribed to women for whom other treatments have proven ineffective.
Among the limitations of their use, there are the high rate of recurrence of pelvic pain (5 years after withdrawal of therapy is at 75%) and the side effects, such us deterioration in the lipid profile, depression, flushes, urogenital atrophy, loss of libido, and bone mass decrease.
Danazol is a weak androgen that can be used for a short time period only due to the possibility of osteoporosis development (low bone density), has numerous side effects such as weight gain, fluid retention, acne, hirsutism (excessive body hair on parts of the body where hair is normally absent or minimal), and voice deepening.
GnRH agonist (leuprolide, gosarelin) causes negatively feedback to reduce the GnRH secreted also leading to low estrogen, side effects include hot flashes, vaginal dryness, and reduced libido.
Non-steroidal anti-inflammatory agents
With attention to inflammatory nature of endometriosis, for decades non- steroidal anti-inflammatory agents (NSAIDs) such as naproxen and ibuprofen have been administrated for pain control, in endometriosis. NSAIDs are recommended as a first-line therapy to ease the milder symptoms of endometriosis.
Presacral neurectomy (PSN) is a surgical method for the treatment of severe chronic pelvic pain, most commonly caused by extensive endometriosis (the presence of uterine lining in abnormal localizations), and dysmenorrhea (painful menstruation). This procedure involves excision or interruption of the nerves coming from the pelvic organs, which carry pain signals upward into the brain.
The organs of the female reproductive system have sensory nerves that pass through the inferior hypogastric plexus (Pic. 1) to the spinal columns. If the so-called presacral nerve trunk is cut, the sensory signals are no longer conducted to the central nervous system. This causes denervation (loss of nervous function) of the uterus and a part of the urinary bladder. The desired effect of denervation is the reduction of pain conduction from the uterus to the spinal cord and the brain.
The nerve interruption or removal can be performed by open laparotomy, or, more commonly, by laparoscopic approach. The procedure is therefore nowadays commonly referred to as Laparoscopic presacral neurectomy (LPSN). Due to the proximity of the nerve trunk to major blood vessels, meticulous surgical technique is essential. The surgery is performed under general anaesthesia, and average hospital stay length after the procedure is two days.
Egg donation is the process by which a woman donates eggs for purposes of assisted reproduction or biomedical research. For assisted reproduction purposes, egg donation typically involves IVF technology, with the eggs being fertilized in the laboratory; more rarely, unfertilized eggs may be frozen and stored for later use. Egg donation is a third party reproduction as part of ART.
Egg donor may have several reasons for donate her eggs:
First step is choosing the egg donor by a recipient from the profiles on or clinic databases (or, in countries where donors are required to remain anonymous, they are chosen by the recipient's doctor based on recipient woman’s desired trait). This is due to the fact that all of the mentioned examinations are expensive and the agencies/clinics must first confirm that a match is possible or guaranteed before investing in the process.
Each egg donor is first referred to a psychologist who will evaluate if she is mentally prepared to undertake and complete the donation process. These evaluations are necessary to ensure that the donor is fully prepared and capable of completing the donation cycle in safe and success manner. The donor is then required to undergo a thorough medical examination, including a pelvic exam, blood tests to check hormone levels and to test for infectious diseases, Rh factor, blood type, and drugs and an ultrasound to examine her ovaries, uterus and other pelvic organs. A family history of approximately the past three generations is also required, meaning that adoptees are usually not accepted because of the lack of past health knowledge. Genetic testing is also usually done on donors to ensure that they do not carry mutations (e.g., cystic fibrosis) that could harm the resulting children; however, not all clinics automatically perform such testing and thus recipients must clarify with their clinics whether such testing will be done. During the process, which usually takes several months, the donor must abstain from alcohol, sexual intercourse, cigarettes, and drugs, both prescription and non-prescription.
Once the screening is complete and a legal contract signed, the donor will begin the donation cycle, which typically takes between three and six weeks. An egg retrieval procedure comprises both the egg donor's cycle and the recipient's cycle. Birth control pills are administered during the first few weeks of the egg donation process to synchronize the donor's cycle with her recipient's, followed by a series of injections which halt the normal functioning of the donor's ovaries. These injections may be self-administered on a daily basis for a period of one to three weeks. Next, FSH is given to the donor to stimulate egg production and increases the number of mature eggs produced by the ovaries. Throughout the cycle the donor is monitored often by a physician using blood tests and ultrasound exams to determine the donor's reaction to the hormones and the progress of follicle growth.
Once the doctor decides the follicles are mature, the doctor will establish the date and time for the egg retrieval procedure. Approximately 36 hours before retrieval, the donor must administer one last injection of hCG to ensure that her eggs are ready to be harvested. The egg retrieval itself is a minimally invasive surgical procedure lasting 20-30 minutes, performed under sedation (but sometimes without any). A small ultrasound-guided needle is inserted through the vagina to aspirate the follicles in both ovaries, which extracts the eggs. After resting in a recovery room for an hour or two, the donor is released. Most donors resume regular activities by the next day.
Laws by state
The legal status and compensation of egg donation has several models across states with examples:
During ICSI just one sperm is injected directly into the egg cytoplasm using a micromanipulative apparatus that transforms imperfect hand movements into fine and precise movements of micromanipulation tools.
Intracytoplasmic Sperm Injection (ICSI) is an assisted reproductive technique (ART) initially developed by Dr. Gianpiero D. Palermo in 1993 to treat male infertility. It is most commonly used in conjunction with in vitro fertilization (IVF). Following IVF procedure, the physician places the fertilized egg into the female’s uterus for implantation. Sperm are obtained by the same methods as with IVF: either through masturbation, by using a collection condom, or by surgically removing sperm from a testicle through a small incision (MESA, TESE). The females are treated with fertility medications for approximately two weeks prior to oocyte retrieval to stimulate superovulation, where the ovaries produce multiple oocytes rather than the normal one oocyte. The oocytes are retrieved by either laparoscopy, or more commonly, transvaginal oocyte retrieval. In the latter procedure, the physician inserts a thin needle through the cervix, guided by a sonogram and pierces the vaginal wall and then the ovaries to extract several mature ova. Before the embryologist can inject the sperm into the oocyte, the sperm must be prepared by washing and exposing it to various chemicals to slow the sperm movement and prevent it from sticking to the injection plate. Also, the oocytes are treated with hyaluronidase to single out the oocyte ready for fertilization by the presence of the first polar body. Then, one prepared sperm is injected into an oocyte with a thin needle. Often, embryologists try to fertilize several eggs so they can implant more than one into the uterus and increase the chance of at least one successful pregnancy. This also allows them to save extra embryos, using cryopreservation, in case later IVF rounds are needed.
After the embryologist manually fertilizes the oocytes, they are incubated for sixteen to eighteen hours and develop into a pronucleate eggs (successfully fertilized eggs about to divide into an embryo). The egg then grows for one to five days in the laboratory before the physician places it in the female’s uterus for implantation.
The chance of fertilization increases dramatically with ICSI compared to simply mixing the oocytes and sperm in a Petri dish and waiting for fertilization to occur unaided (classical IVF procedure). Studies have shown that successful fertilizations occur 50% to 80% of the time. Since the introduction of ICSI, intrauterine insemination (IUI) has decreased in popularity by 80%.See full description of ICSI
Sperm donation is the donation by a male (known as a sperm donor) of his sperm (known as donor sperm), principally for the purpose of inseminating a female who is not his sexual partner. Sperm donation is a form of third party reproduction including sperm donation, oocyte donation, embryo donation, surrogacy, or adoption. Number of births per donor sample will depend on the actual ART method used, the age and medical condition of the female bearing the child, and the quality of the embryos produced by fertilization. Donor sperm is more commonly used for artificial insemination (IUI or ICI) than for IVF treatments. This is because IVF treatments are usually required only when there is a problem with the female conceiving, or where there is a “male factor problem” involving the female's partner. Donor sperm is also used for IVF in surrogacy arrangements where an embryo may be created in an IVF procedure using donor sperm and this is then implanted in a surrogate. In a case where IVF treatments are employed using donor sperm, surplus embryos may be donated to other women or couples and used in embryo transfer procedures.
On the other hand, insemination may also be achieved by a donor having sexual intercourse with a female for the sole purpose of initiating conception. This method is known as natural insemination.
Donor sperm and fertility treatments using donor sperm may be obtained at a sperm bank or fertility clinic. Here, the recipient may select donor sperm on the basis of the donor's characteristics, e.g. looks, personality, academic ability, race, and many other factors. Sperm banks or clinics may be subject to state or professional regulations, including restrictions on donor anonymity and the number of offspring that may be produced, and there may be other legal protections of the rights and responsibilities of both recipient and donor. Some sperm banks, either by choice or regulation, limit the amount of information available to potential recipients; a desire to obtain more information on donors is one reason why recipients may choose to use a known donor and/or private donation.
A sperm donor will usually donate sperm to a sperm bank under a contract, which typically specifies the period during which the donor will be required to produce sperm, which generally ranges from 6–24 months depending on the number of pregnancies which the sperm bank intends to produce from the donor. Donors may or may not be paid for their samples, according to local laws and agreed arrangements. Even in unpaid arrangements, expenses are often reimbursed. Depending on local law and on private arrangements, men may donate anonymously or agree to provide identifying information to their offspring in the future. Private donations facilitated by an agency often use a "directed" donor, when a male directs that his sperm is to be used by a specific person. Non-anonymous donors are also called known donors, open donors or identity disclosure donors.
A sperm donate must generally meet specific requirements regarding age (most often up to 40) and medical history. Potential donors are typically screened for genetic diseases, chromosomal abnormalities and sexually transmitted infections that may be transmitted through sperm. The donor's sperm must also withstand the freezing and thawing process necessary to store and quarantine the sperm. Samples are stored for at least 6 months after which the donor will be re-tested for sexually transmitted infections. This is to ensure no new infections have been acquired or have developed during the period of donation. If the result is negative, the sperm samples can be released from quarantine and used in treatments.
Preparing the samples
A sperm donor is usually advised not to ejaculate for two to three days before providing the sample, to increase sperm count and to maximize the conception rate. A sperm donor produces and collects sperm by masturbation or during sexual intercourse with the use of a collection condom.
Sperm banks and clinics usually "wash" the sperm sample to extract sperm from the rest of the material in the semen. A cryoprotectant semen extender is added if the sperm is to be placed in frozen storage in liquid nitrogen, and the sample is then frozen in a number of vials or straws. One sample will be divided into 1-20 vials or straws depending on the quantity of the ejaculate and whether the sample is washed or unwashed. Following the necessary quarantine period, the samples are thawed and used to inseminate women through artificial insemination or other ART treatments. Unwashed samples are used for ICI treatments, and washed samples are used in IUI and IVF procedures.
Anonymous sperm donation occurs where the child and/or receiving couple will never learn the identity of the donor, and non-anonymous when they will. Non-anonymous sperm donors are, to a substantially higher degree, driven by altruistic motives for their donations.
Even with anonymous donation, some information about the donor may be released to the female/couple at the time of treatment. Limited donor information includes height, weight, eye, skin and hair color. In Sweden, this is all the information a receiver gets. In the US, on the other hand, additional information may be given, such as a comprehensive biography and sound/video samples.
Information made available by a sperm bank will usually include the race, height, weight, blood group, health, and eye color of the donor. Sometimes information about his age, family history and educational achievements will also be given.
Different factors motivate individuals to seek sperm from outside their home state. For example, some jurisdictions do not allow unmarried women to receive donor sperm. Jurisdictional regulatory choices as well as cultural factors that discourage sperm donation have also led to international fertility tourism and sperm markets.
A sperm donor is generally not intended to be the legal or de jure father of a child produced from his sperm. Depending on the jurisdiction and its laws, he may or may not later be eligible to seek parental rights or be held responsible for parental obligations. Generally, a male who provides sperm as a sperm donor gives up all legal and other rights over the biological children produced from his sperm. However, in private arrangements, some degree of co-parenting may be agreed, although the enforceability of those agreements varies by jurisdiction.
Laws prohibits sperm donation in several countries: Algeria, Bahrain, Costa Rica, Egypt, Hong Kong, Jordan, Lebanon, Lithuania, Libya, Maldives, Oman, Pakistan, Philippines, Qatar, Saudi Arabia, Syria, Tajikistan, Tunisia, Turkey, UnitedArab Emirates, and Yemen.See full description of Sperm donation
In vitro fertilization (IVF) is a process by which an egg is fertilised by sperm outside the body: in vitro . The process involves monitoring and stimulating a woman's ovulatory process, removing an ovum or ova (egg or eggs) from the woman's ovaries and letting sperm fertilise them in a liquid in a laboratory. The fertilised egg (zygote) is cultured for 2–6 days in a growth medium and is then implanted in the same or another woman's uterus, with the intention of establishing a successful pregnancy.
IVF techniques can be used in different types of situations. It is a technique of assisted reproductive technology for treatment of infertility. IVF techniques are also employed in gestational surrogacy, in which case the fertilised egg is implanted into a surrogate's uterus, and the resulting child is genetically unrelated to the surrogate. In some situations, donated eggs or sperms may be used. Some countries ban or otherwise regulate the availability of IVF treatment, giving raise to fertility tourism. Restrictions on availability of IVF include to single females, to lesbians and to surrogacy arrangements. Due to the costs of the procedure, IVF is mostly attempted only after less expensive options have failed.
The first successful birth of a "test tube baby", Louise Brown, occurred in 1978. Louise Brown was born as a result of natural cycle IVF where no stimulation was made. Robert G. Edwards, the physiologist who developed the treatment, was awarded the Nobel Prize in Physiology or Medicine in 2010. With egg donation and IVF, women who are past their reproductive years or menopause can still become pregnant. Adriana Iliescu held the record as the oldest woman to give birth using IVF and donated egg, when she gave birth in 2004 at the age of 66, a record passed in 2006.
Endometriosis can cause infertility. In endometriosis, there is a risk of female infertility of up to 30% to 50%. The abnormal growth of endometrial tissue with each female hormonal cycle causes adhesions and scars from forming in the organs where it is. This, in the case of the female reproductive organs can be fatal for the smooth passage of the ovum to the uterus.
The mechanisms by which endometriosis may cause infertility is not clearly understood, particularly when the extent of endometriosis is low.
Still possible mechanisms include:
The other way around, endometriosis may more likely develop in women who fail to conceive for other reasons and thus be a secondary phenomenon. For this reason it is preferable to speak of"endometriosis-associated infertility" rather than any definite "infertility caused by endometriosis" by the same reason that association does not imply causation.
Only surgical treatment has been shown to improve the fertility of patients whose infertility was thought to be due to endometriosis. One study has shown that surgical treatment of endometriosis approximately doubles the fecundity (pregnancy rate).
In younger women with unfulfilled reproductive potential, surgical treatment attempts to remove endometrial tissue and preserving the ovaries without damaging normal tissue.
It is recommended that the small cysts do not operate at all to reduce the valuable ovarian parenchyma.
The use of medical suppression after surgery for minimal/mild endometriosis has not shown benefits for patients with infertility. It is advisable to stimulate the patient immediately after the chirugical exercise in the IVF treatment program. Ovarian stimulation does not aggravate the course of the endometriosis. Use of fertility medication that stimulates ovulation (clomiphene citrate, gonadotropins) combined with intrauterine insemination (IUI) enhances fertility in these patients.