Avicenna was a Persian polymath who is regarded as one of the most significant thinkers and writers of the Islamic Golden Age (Pic. 1). His most famous works are The Book of Healing – a philosophical and scientific encyclopedia, and The Canon of Medicine.
The Canon of Medicine is an encyclopedia of medicine in five books. It presents an overview of the contemporary medical knowledge, which had been largely influenced by Galen (a Greek physician, surgeon and philosopher).
The Canon of Medicine remained a medical authority for centuries. It set the standards for medicine in Medieval Europe and the Islamic world and was used as a standard medical textbook through the 18th century in Europe. It is still used in Unani medicine (a form of traditional medicine practiced in India).
Much advice was given with respect to the proper diet to encourage health and in particular fertility.
Dietary Nutrients and Male Infertility:
Diet as the main part of lifestyle could seriously affect fertility; the fact that has attracted more attention in recent studies. Unfortunately, male fertility has decreased in recent decades due to the reduction in sperm quality and quantity which is not irrelevant to lifestyle changes. Indeed, nutritional approach which is considered in idiopathic male infertility is the basis of treatment. Based on the holistic approach of Traditional Persian Medicine (TPM), nutrition plays a fundamental role in a healthy lifestyle. In the perspective of this school of medicine, semen is the final product of metabolic chain in reproductive system.
Traditional Persian medical and pharmaceutical manuscripts authored by medieval Persian scholars including Avicenna offer not only accumulation of traditional medical systems knowledge, but also contain collection of ingenious studies that provide vast information in the field of medicinal herbs application. According to the investigated manuscripts, thirty-one substances, incorporating plant exudates relating to sixteen plant families, were used to combat simple to sophisticated ailments.
There is an increasing demand for alternative medicine methods in treatment of menstrual bleeding cessation and oligomenorrhea (very light menstruation). Sesamum indicum L. is a well-known medication in the Avicenna traditional medicine to induce menstrual bleeding in women with oligomenorrhea. There was a study with effort to evaluate the efficacy of this treatment on the patients suffers from oligomenorrhea.
Oligomenorrhea, a prevalent disease with serious complications, has been declared in the Avicenna traditional medicine in detail. Avicenna presents a syndrome termed ‘uterine strangulation’, as a complication of menstrual bleeding cessation and lack of sexual satisfaction. This syndrome was explained from both traditional and conventional medicine viewpoints to propose a new hypothesis for diagnosis and treatment of women with oligomenorrhea and systemic signs/symptoms admitting to clinics for further evaluation. This hypothesis definitely needs to be further assessed and confirmed by strong clinical trials.
Polycystic ovary syndrome (PCOS) is a prevalent, complex endocrine disorder characterised by polycystic ovaries, chronic anovulation and hyperandrogenism leading to symptoms of irregular menstrual cycles, hirsutism, acne and infertility. Preclinical and clinical studies provide evidence that six herbal medicines may have beneficial effects for women with oligo/amenorrhea, hyperandrogenism and PCOS. However the quantity of pre-clinical data was limited, and the quality of clinical evidence was variable.
Menstrual disorders include several conditions of menstrual cycle (Pic. 1) irregularity, which can be treated pharmacologicaly. Disorders can be divided into two main categories- disorders of menstrual lenght and disorders of menstrual flow.
Disorders of menstrual lenght
Disorders of menstrual lenght include polymenorrhea (cycles with intervals of 21 days or fewer), oligomenorrhea (infrequent menstruation) and amenorrhea (the absence of menstruation).
Hormonal imbalance can be the cause of polymenorrhea. Depending on which hormon is decreased during menstrual cycle, the replacement takes place.
In case of estrogen deficiency and shor follicular phase (the phase of the menstrual cycle during which follicles in the ovary mature) the option is to use an estrogen substitution of 4-10 day cycle or ovulation induction with clomiphene. Usually, the menstrual cycle is stabilized in 2-3 months.
Another problem might be an insufficient function of the luteum body (progesterone and estrogen secreting body in the female reproductive system), so the estrogen-progesteorne substitution is needed during the second phase of the cycle- from 14th to 25th day of cycle.
Very often more frequent menstrual bleeding can cause anemia, so it is necessary to start substitution therapy with an iron.
As for physiological treatments to hypothalamic amenorrhoea (absence of menstrual periods due to disorder of hypothalamus), injections of metreleptin (a synthetic analog of the hormone leptin used to treat diabetes) have been tested as treatment to estrogen deficiency resulting from low gonadotropins (follicle stimulating hormone and luteinizing hormone which are made in the pituitary which stimulates the sex glands). Metreleptin has appeared effective in restoring defects in the hypothalamic-pituitary-gonadal axis (controls development, reproduction, and aging) and improving reproductive hormones.
Looking at hypothalamic amenorrhoea, studies have provided that the administration of a selective serotonin reuptake inhibitor (SSRI) might correct abnormalities of functional hypothalamic amenorrhoea (FHA) related to the condition of stress-related amenorrhoea.
However, SSRI therapy represents a possible hormonal solution to just one hormonal condition of hypothalamic amenorrhoea. Furthermore, because the condition involves the inter workings of many different neurotransmitters, much research is still to be done on presenting hormonal treatment that would counteract the hormonal affects.
Disorders of flow
Disorders of menstrual flow include hypomenorrhea (extremely light menstrual blood flow), menorrhagia (menstrual periods with abnormally heavy or prolonged bleeding) and dysmenorrhea (painful periods, or menstrual cramps, is pain during menstruation).
Hypomenorrhea can be caused by hormonal imbalance of estrogen and progesterone. If there are low levels of estrogen, the innner lining of the uterus is thin, which leads to light menstrual blood flow during period.
Hormonal imbalance can be treated with oral contraceptives, which restore the natural cycle of hormonal release and contain both hormones.
In case of hypothyroidism, the scanty menstruation can be one of the signs. Due to lower levels of thyroid hormones produced by the thyroid gland, they must be supplement pharmacologically.
Causes may be due to abnormal blood clotting, disruption of normal hormonal regulation of periods or disorders of the endometrial lining of the uterus. Depending upon the cause, it may be associated with abnormally painful periods. Excessive bleeding can lead to anaemia (low concentration of red blood cells in blood) which presents as fatigue, shortness of breath and weakness.
If the degree of bleeding is mild, all that may be sought by the woman is the reassurance that there is no sinister underlying cause. If anaemia occurs then iron tablets may be used to help restore normal hemoglobin levels (the levels of the molecule in red blood cells that carries oxygen). Treatment may be given for a fixed period of time to replenish the body stores. Alternatively therapy may be continued long-term, often in a cyclical regimen on the days of menstruation.
The condition is often be treated with hormones, particularly as dysfunctional uterine bleeding commonly occurs in the early and late menstrual years when contraception is also sought. Usually oral combined contraceptive or progesterone only pills may be taken for a few months, but for longer-term treatment the alternatives of injected Depo Provera or the more recent progesterone releasing IntraUterine System may be used.
Fibroids may respond to hormonal treatment, else require surgical removal.
Many therapies are proposed for dysmenorrhea and include the use of non-steroid anti-inflammatory drugs (NSAIDs; used to treat inflammation, mild to moderate pain, and fever), oral contraceptives, vitamins and tocolytic agents (reduce or stop uterine contractions).
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.
Because women suffering from olligomenhorea are only experiencing a period a few times a year, their body is also ovulating less which affect woman's ability to get pregnant. Oligomenorrhea contributing to chronic anovulation and infertility are the most frequent conditions observed. If ovulation does not take place then of course, pregnancy becomes impossible.