Therapy options

This application helps to propose an appropriate fertility therapy method and to find the most suitable clinic worldwide based on the price, duration and legislative options of the treatment in various countries.

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Avoid or decrease alcohol consumption

There are different medical treatments one can turn to in order to treat alcohol addiction. These include pharmaceutical options as well as natural remedies. Some drugs are specifically designed to reduce the cravings for alcohol, while others cause one to experience symptoms of aversion if they have a drink; in essence conditioning their body to reject alcohol. Naltrexone and Acamprosate, classified as opioid antagonists, help to reduce the craving feeling for alcohol in a recovering alcoholic, and also serve to alleviate some of the effects of alcohol on a person's system.

Excessive alcohol consumption and the associated negative consequences are a major public health concern throughout the world. Policy initiatives also have demonstrated considerable effectiveness and include changes in the minimum legal drinking age, reductions in acceptable legal limits for blood alcohol concentration while operating a motor vehicle, as well as decreasing availability and access to alcohol for underage individuals. Primary prevention programs that have used exclusively educational approaches have received mixed results. Increasing effectiveness has been associated with prevention programs that have utilized a multi-component approach and have included educational initiatives with environmental changes.

Alcohol addiction is difficult to get rid of. It may even seem impossible but with persistence and determination one can overcome it. A person does not always need to visit a doctor or a rehabilitation center to get of the muddle unless the addiction has been very serious. Otherwise, the person can follow a specific regime and get himself free from past bad habits.

Herbal therapy of erectile dysfunction

Several orally active drugs are currently prescribed for treating ED to improve the arterial blood flow to the penile tissue. 

A wide variety of human disorders is currently being treated with the use of plant materials due to their decreased toxicity levels, cost-effectiveness as well as minimized side effects in order to avoid drug resistance caused by pharmacological agents.  

Although many synthetic drugs are available and/or used to treat erectile dysfunction, some of the drawbacks for these drugs include them being expensive and also their ability to provoke serious adverse effects, effective natural treatments are therefore still in demand. Even if many of the plants or natural products claim to prove their effectiveness without scientific evidence, a number of them are active and possess biological activity, proven by scientific data. Moreover, there is a dearth of systematic review of scientific literature on experimental evidence generated for medicinal plants useful in treating erectile dysfunction and there is a need for in depth pharmacological evaluation.

For thousands of years, certain herbs and foods known as aphrodisiacs have been speculated to contain sexually arousing properties. When these herbs are ingested, it is believed that they cause sexually enhancing properties, such as increased libido, sex drive, and sexual performance for both men and women.


Various Aphrodisiac Herbs:

  • Ginkgo Biloba has repeatedly been shown to increase the flow of blood throughout the body, including in the brain. This herb has also been sought for medical reasons. It is shown to cure impotence caused by clogged arteries, which is primarily found in individuals with circulatory problems. Since the arteries run all over the body, they include the genitals, and lack of blood flow to the genitals is a cause of erection problems. (Pic. 1)
  • Nervines are herbs that are designed to calm the body. A popular form of these herbs is kava. Kava is a fermented beverage that includes nervine herbs, and it’s known to calm the nerves without bringing the mind down. It also reduces depression and anxiety, and has a calming effect. However, if a person consumes kava in a large amount, (s)he may experience symptoms similar to alcohol intoxication.
  • Asian Panax ginseng is known to bring the body into balance. In regard to sexual performance, this herb can help relieve stress, high blood pressure, depression, and exhaustion. However, it is possible that it may need to be taken for as long as three months before its effects are felt. (Pic. 2)
  • Yohimbe (Pausinystalia yohimba) is known to enhance male sexual arousal. It dilates blood vessels, lowers blood pressure, and stimulates reflex excitability in the lower regions of the spinal cord. Yohimbe, however, is also the most controversial. Yohimbe can produce anxiety attacks and painfully prolonged erections, and the possibility of adverse side effects is increased when Yohimbe is taken with drugs or alcohol. 
  •  Damiana (Turnera diffusa-aphrodisiaca) has a reputation of being an erotic aid. This plant's leaves are also considered an effective antidepressant, urinary antiseptic, mild laxative and tonic for the central nervous system, prostate gland, and endocrine system. (Pic.3)
  •  Tribulus terrestris is a herb that has been used in the traditional medicine of China and India for centuries. The results are comparable to that of standard drug, sidenafil citrate. Findings of the studies validate the traditional use of T. terrestris for its role in enhancing sexual behaviour and potential to be used in the treatment of ED. (Pic. 4)

Kegel exercises

Kegel exercises are the most popular method of reinforcing pelvic floor muscles and are noninvasive treatment such that they do not involve the placement of any vaginal weights/cones. They are the most cost-effective treatment and differ from other therapies in that the patients can do them by themselves anytime, anywhere, while doing other work, and without regular hospital visits. 

The pelvic floor muscles are used in order to stop the flow of urine, grasp a penis during intercourse, or hold back a bowel movement. Since the anal sphincter is usually the strongest of these muscles, it needs very little attention, while the other two areas are usually stressed when the Kegel exercises are taught in childbirth preparation classes.

Kegel exercises are considered by childbirth educators to be essential to all women – whether or not they have borne children (Cesarean or vaginally) or intend to, and no matter what their age. Contrary to common belief, pelvic floor muscle laxity is not always associated with childbirth and can be caused by other factors, including the aging process, hormonal decreases, a woman's particular physiology, an injury or disease, or simply an unawareness of the existence of these muscles.

Though most commonly used by women, men can also use Kegel exercises. Kegel exercises are employed to strengthen the pubococcygeal muscle (the main muscle of the pelvic floor) and other muscles of thepelvic diaphragm. Kegels can help men achieve stronger erections, maintain healthy hips, and gain greater control over ejaculation. The objective of this may be similar to that of the exercise in women with weakened pelvic floor: to increase bladder and bowel control and sexual function.

The exercises consist of exercising the pubococcygeus (PC), contracting it and relaxing it repeatedly (Pic.1). This muscle is used to prevent leakage of urine, so it is possible to identify throught first making cuts during urination. Once identified, is advised start with sets of 10-20 contractions / relaxations, repeating the exercise throughout the day. Should be consistent and, if possible, to reach 200 daily repetitions spread over four sets of 50.

Lifestyle change

Lifestyle is a term to describe the way individuals, family circles, and societies live and which behavior they manifest in coping with their physical, psychological, social, and economic environments on a day-to-day basis.

Lifestyle is expressed by daily work and leisure profiles, including activities, attitudes, interests, opinions, values, and allocation of income. Lifestyle is a composite of motivations, needs, and wants and is influenced by factors such as culture, family, reference groups, and social class.

The leading causes of global deaths today are largely lifestyle related. A healthy lifestyle is an important predictor of future health, productivity and life expectancy. It has been found to reduce the factors which contribute to health risks.

The combination of the main healthy lifestyle factors-maintaining a healthy weight, exercising regularly, following a healthy diet, and not smoking-seem to be associated with as much as an 80% reduction in the risk of developing the most common and deadly chronic diseases.

Lifestyle diseases or chronic diseases are associated with the way a person or group of people lives on a daily basis. In other words, lifestyle diseases characterize those diseases whose occurrence is primarily based on the daily habits of people and are a result of an inappropriate relationship of people with their environment.

Lifestyle is associated with the development of many chronic diseases. The World Health Organization (WHO) has recognized diabetes, hypertension, stroke, diabetes, obesity, high cholesterol, cardiovascular disease and stroke, cancer and chronic lung disease as major non-communicable diseases (NCDs). There are many other conditions associated with modern living like stress, depression and substance abuse are important factors also contributing to lifestyle related morbidity and mortality like suicides. These major NCDs share common lifestyle related risk factors like physical inactivity, unhealthy diet, tobacco use and harmful use of alcohol. Globally, the current scenario of NCDs is the major cause of morbidity and mortality. 

Recently, the pivotal role that lifestyle factors play in the development of infertility has generated a considerable amount of interest. Lifestyle factors are the modifiable habits and ways of life that can greatly influence overall health and well-being, including fertility. Many lifestyle factors such as the age at which to start a family, nutrition, weight, exercise, psychological stress, environmental and occupational exposures, and others can have substantial effects on fertility; lifestyle factors such as cigarette smoking, illicit drug use, and alcohol and caffeine consumption can negatively influence fertility while others such as preventative care may be beneficial. A summary table of each lifestyle and the associated relative risk (RR) and odds ratio (OR) is provided (Tab. 1).

Physical exercise

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.

Stop smoking

Stop smoking is a process of discontinuing tobacco smoking. Cigarette smoking remains the leading preventable cause of death and disease in the developed world, and increasing the number of smokers successfully quitting is one of the most effective measures available to improve population health. Stop smoking isn’t easy but with the right tools and support quitting smoking is possible and will be one of the most rewarding achievements of your life.

Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly the substance is the dried leaves of the tobacco plant which contains nicotine, which is addictive, making the process of quitting often very prolonged and difficult.

Nicotine binds to nicotinic receptors in the brain that, in turn, cause an increase indopamine. Dopamine is the major chemical that stimulates reward centers in the brain. The brain recruits an opposing force to dampen the effects of nicotine and this causes tolerance (the reduction in the effect of nicotine). The onset of this opposing force and the fact that the brain becomes used to and dependent on nicotine to function normally is known as physical dependence. When nicotine intake is decreased, the brain's opposing force is now unopposed and this causes withdrawal symptoms.

Ways how stop smoking

  • Unassisted
Only 6% on average will successfully stop smoking their first try. Summoning up the willpower to make that decision permanent is key to succeeding in the long run.´

There is no significant difference in quit rates between smokers who quit by gradual reduction or abrupt cessation as measured by abstinence from smoking of at least six months from the quit day, suggesting that people who want to quit can choose between these two methods.

Gradual reduction involves slowly reducing one's daily intake of nicotine. This can theoretically be accomplished through repeated changes to cigarettes with lower levels of nicotine, by gradually reducing the number of cigarettes smoked each day, or by smoking only a fraction of a cigarette on each occasion.

  • Nicotine replacement therapy
Nicotine replacement therapies including patches, lozenges, gum, inhalators, mouth spray, and mouth strips give your body some nicotine without all the harmful chemicals in cigarette smoke. Nicotine replacement therapy should be used for at least 8 weeks.

  • Pharmacotherapy
Varenicline Tartate (Champix)- is a non-nicotine medication designed to block the nicotine receptors in the brain. People who want to quit will need to get a prescription from their doctor to use Champix. The treatment course is 12 weeks.
Bupropion (Zyban)- is a non-nicotine medication designed to work on the reward pathways in the brain to minimise nicotine withdrawal symptoms. People who want to quit will need to get a prescription from their doctor to use Zyban. The treatment course is 9 weeks.

  • Psychosocial approaches
Group or individual psychological support can help people who want to quit. This form of counselling can be effective alone; combining it with medication is more effective, and the number of sessions of support with medication correlates with effectiveness. The counselling styles that have been effective in smoking cessation activities include motivational interviewing, cognitive behavioural therapy and Acceptance and Commitment Therapy.

People quit in different ways, so it is important to think about what way would suit you best. Some people prefer to cut down their smoking before quitting altogether. Others like to set a quit date and abruptly stop. Quit smoking medication and nicotine replacement therapy can be used to help you cut down and ease into quitting.

Vacuum devices for ED

Penis pumps are a type of vacuum constriction device which is used by men to achieve and maintain a satisfactory erection (erectile dysfunction).

A vacuum erection device (Pic. 1) helps draw blood into the penis by applying negative pressure. This type of device is sometimes referred to as penis pump and may be used just prior to sexual intercourse. Several types of approved vacuum therapy devices are available with a doctor's prescription. When pharmacological methods fail, a purpose-designed external vacuum pump can be used to attain erection, with a separate compression ring fitted to the penis to maintain it. These pumps should be distinguished from other penis pumps (supplied without compression rings) which, rather than being used for temporary treatment of impotence, are claimed to increase penis length if used frequently, or vibrate as an aid to masturbation. 

A penis pump is a cylinder that is fitted over the penis, with a manual or motorized pump to create a partial vacuum around the penis, engorging it as blood is drawn in. A variety of penis pump designs have been adopted by penis pump manufacturers. As vacuum increases, the pressure within the blood vessels of the penis increases as well; excessive vacuum causes vascular damage. Penis pumps may be used to temporarily overcome symptoms of impotence, but do not cure the condition: a tourniquet-like ring must be applied to keep the blood trapped within the penis, otherwise the erection will immediately subside. Pumps may work even if there is nerve or vascular damage preventing a natural erection, but excessive or prolonged use (hours) will cause permanent harm as over-enthusiastic pumping can burst blood vessels and form blisters. 

This method yields a successful erection for intercourse that can be rated as 90%. The satisfaction rates range between 27-94% but about <30% of the patients discontinue use after 2 years because of the negative side effects that include penile pain, delayed ejaculation and numbness that occur.

Medical nutrition therapy

Medical nutrition therapy (MNT) is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a medical doctor, registered dietitian or professional nutritionist. The diet is based upon the patient's medical record, physical examination, functional examination and dietary history.

The role of MNT when administered by an MD or DO physician, dietitian or professional nutritionist is to reduce the risk of developing complications in pre-existing conditions such as type 2 diabetes as well as ameliorate the effects any existing conditions such as high cholesterol.

Pharmacotherapy of erectile dysfunction

Pharmacotherapy of erectile dysfunction represents various medications used to treat erectile dysfunction (ED). Erectile dysfunctions represents he inability (that lasts more than 6 months) to develop or maintain an erection of the penis during sexual activity. Some men suffering from ED may return to active sex life just by treating their underlying disease, such as hypertension (high blood pressure), or with the help of certain lifestyle modifications (quitting smoking, exercising regularly etc.) and counselling. Others may need medications to successfully treat the condition. The most widely used medications for treatment of ED include: 

  • PDE5 inhibitors
  • Alprostadil injection
  • Topical alprostadil
  • Trimix
  • Testosterone replacement

PDE-5 inhibitors

Phosphodiesterase 5 inhibitors (PDE5 inhibitors, PDE5i) are the firts-line medication in the treatment of ED. They work by enhancing the effect of nitric oxide (NO) on blood vessels, causing them to dilate and subsequently increasing blood flow. This allows for the cavernous bodies in the penis to fill with blood and produce an erection. These medications only enhance the blood flow, so sexual stimulation is still needed to produce an erection. These medications include Sildenafil (sold under the brand name Viagra, Pic. 1), Tadalafil (Cialis), Vardenafil (Levitra, Staxyn) and Avanafil (Stendra). They vary in dosage and how long their effet lasts, but their mechanism of action is the same.

Alprostadil injection

Alprostadil is another name of Prostaglandin E1, a naturally-occurring bioactive molecule in the body that is also used as a medication. This drug causes blood vessels to dilate, increasing the flow of blood. Alprostadil is used in the form of self-injection (Pic. 2), which is injected into either side of the penis by the patient to produce an erection. The injectable form of alprostadil causes an erection firm enough for sexual intercourse in roughly 80% men.

Topical alprostadil

Alprostadil can be also administered in the form of urethral suppository, which is inserted into the opening of the urethra. It should produce an erection in about 10 – 30 minut after the application of the suppository. However, the urethral form is not as effective as the self-injection, causing an erection in only about 30 – 40%. Quite recently, a cream containing alprostadil has been approved for the treatment of ED in some countries. Sold under the name Vitaros, it is applied to the urethra by a preloaded delivery device. Trials have shown promising results of this cream in patients with ED.

Trimix

Alprostadil can be combined with other drugs that also cause vasodilation (dilation of blood vessels), most notably phentolamine and papaverine. Depending on the specific combination, the mixture is known as Bimix (two-drug medication) or Trimix (three-drug medication). This medication is coumpounded by a pharmacy and administered via self-injection into the cavernous bodies of the penis.

Testosterone replacement

In some men, ED may be attributed to low levels of testosterone (the male sex hormone). These men may benefit from the administration of testosterone.

Psychotherapy of erectile dysfunction

It is important for men to discuss their anxiety regarding their ED with their partners. It will help them to reduce their fears while their partner will be able to help them to cope. When is necessary to assess their erectile function by qualified professionals - talk therapy may be the first treatment for men with erectile dysfunction, licensed therapist can ease sexual anxiety.
Cognitive Behavioural Therapy (CBT) or sex therapy could be helpful in treatment of psychological problems which could be contributing to erectile dysfunction. For sex the mind and body cooperation is very crucial and sometimes persistent feelings of stress and anxiety may actually lead to problems with erection. Anxiety, stress or even relationship troubles could be addressed during counselling. Also sex therapy which is focused on improving overall relationship between partners could be useful for some people. Sex therapy is aimed to overcome sex difficulties and is led by trained mental professionals or psychologists.

Surgical therapy of erectile disfunction


In patients with ED, inflatable penile prosthesis (IPP) surgery is regarded as the gold standard treatment in medically refractory cases or where its conservative treatment options are contraindicated. 
There are two primary types of penile prosthesis: noninflatable, semirigid devices and inflatable devices. Noninflatable, semirigid devices consist of rodsim planted into the erection chambers of the penis and can be bent into position as needed for sexual penetration. With this type of implant the penis is always semi-rigid and therefore may be difficult to conceal.
Hydraulic, inflatable prosthesis also exist and were first described in 1973 by BrantleyScott et al. These saline-filled devices consist of inflatable cylinders placedin the erection chambers of the penis, a pump placed in the scrotum for patient-activated inflation/deflation, and a reservoir placed in the abdomen which stores the fluid. The device is inflated by squeezing the pump several times to transfer fluid from the reservoir to the chambers in the penis. After successful sexual relations, the pump can be deactivated to return the penis to a flaccid condition. Almost all implanted penile prosthesis devices perform satisfactorily for a decade or more before needing replacement.

Egg donation

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:

  • Unrelated donors to the recipients – they do it for altruistic and/or monetary reasons. The European Union limits any financial compensation for donors to at most $1500. In some countries, most notably Spain and Cyprus, this has limited donors to the poorest segments of society. In US, donors are paid regardless of how many egg she produces. In most countries (excluding the US and the UK), the law requires such type of donors to be anonymous.
  • Egg sharing – the woman decides to provide unused egg from her own IVF for another patient.
  • Designated donors – couple bring their friend or the donor specifically to help them.

Procedure

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:

  • Totally illegal procedure (Italy, Germany, Austria, Costa Rica, Sunni Muslim countries, Bahrain, Egypt, Hong Kong, Lebanon, Lithuania, Maldives, Norway, Oman, Pakistan, Philippines, Qatar, Saudi Arabia, Syria, Tajikistan, Turkey, Yemen),
  • Legal, no compensation, anonymous donor (France),
  • Legal, no compensation, non-anonymous donor (Canada),
  • Legal, possible compensation, anonymous donor (Spain, Czech Republic, South Africa),
  • Legal, possible compensation, non-anonymous donor (the UK),
  • Legal, possible compensation, anonymous or non-anonymous (the US).

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ICSI

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%.

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Sperm donation

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.

The donation
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.

Donor selection
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.

Screening includes:

  • Taking a medical history of the donor, his children, siblings, parents, and grandparents etc. for three to four generations back. This is often done in conjunction with the patient’s family doctor.
  • HIV risk assessment interview, asking about sexual activity and any past drug use.
  • Blood tests and urine tests for infectious diseases, such as: HIV-1/2, HTLV-1/2, Hepatitis B and C, Syphilis, Gonorrhea, Chlamydia, Cytomegalovirus (CMV), not all clinics test for this.
  • Blood and urine tests for blood typing and general health indicators: ABO/Rh typing, CBC, liver panel and urinalysis
  • Complete physical examination including careful examination of the penis, scrotum and testicles.
  • Genetic testing for carrier traits, for example: Cystic Fibrosis, Sickle-cell disease, Thalassemia, other hemoglobin-related blood disorders.
  • General health
  • Semen analysis for: sperm count, morphology, motility, acrosome activity may also be tested

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.

Anonymity
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.

Legal aspects
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. 

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Standard IVF

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.

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How can Erectile dysfunction affect fertility

As was mentioned above, feelings of stress, depression, guilt, or anxiety in infertile men can cause psychogenic impotence, which heightens the feelings of inadequacy that already accompany infertility. The psychological stress of infertility has been shown to affect sperm parameters in significant and demonstrable ways that may further contribute to difficulties with erectile potency; emotional reactions to the infertility may alter or even undermine a previous consolidation of a sense of self as sexually adequate. Infertility weighs on many males' minds; this creates mental instability, which often results in impotence. Even with an erection problem, a man may still have sexual desire and be able to have an orgasm and to ejaculate. Thus, it is important to keep in mind that it can be helped if the roots of stress are detected. Talking to a partner about worries,changing life-style and/or maintaining work-life balance can decrease the likelihood of erectile dysfunction.

Erection
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