Yoga is a mind-body exercise that combines spiritual traditions with physical movements. It was first practiced by Hindus in India more than 5,000 years ago. These movements, known as "postures," involve deep stretching and meditation (Pic. 1). The word yoga means "union" in the ancient Indian language of Sanskrit (ancient Indian language).
Yoga in Indian traditions, however, is more than physical exercise, it has a meditative and spiritual core. One of the six major orthodox schools of Hinduism is also called Yoga, which has its own epistemology (branch of philosophy concerned with the theory of knowledge) and metaphysics, and is closely related to Hindu Samkhya philosophy (one of the six orthodox schools of Hindu philosophy).
Many studies have tried to determine the effectiveness of yoga as a complementary intervention for cancer, schizophrenia, asthma, heart disease and infertility. The results of these studies have been mixed and inconclusive, with cancer studies suggesting none to unclear effectiveness, and others suggesting yoga may reduce risk factors and aid in a patient's psychological healing process.
It appears that there is a burgeoning number of women who struggle to get pregnant naturally. As a result of infertility problem, many mothers experience chronic stress. It can wreck havoc on body, change mood and depress the immune system. In this case, yoga not only increases blood flow and strengthens pelvic region but also addresses the root cause of stress.
Some major ways in which yoga can effect and treat infertility:
As mentioned before, stress plays a major role in slowing down your fertility. Yoga is a great way to beat stress and achieve peace of mind. Yoga is not just about the body it is also about breathing. The breathing techniques associated with yoga can help lower the stress hormone cortisol in the body. This in turn can increase chances of conceiving.
Detoxifies the body
Certain yoga poses can help detoxify the body and help boost fertility. Yoga can also help relax tight muscles and connective tissues.
Many infertility issues arise due to blockages. With yoga, it is possible to increase blood circulation and ensure that it reaches the reproductive organs. This can help create a positive environment for a pregnancy.
Works on immune system
Yoga is great way to boost immunity. Practicing yoga helps find inner calm, which in turn can help raise the number of white blood cells in the body. This not just helps keeping common diseases at bay but can also help beat infertility.
Helps keep the ovaries healthy
Certain yoga poses reroute the blood flow to reach the ovaries. This helps to provide these specific organs with more oxygen, making them healthier. It is important to note that ovarian dysfunction is a common cause of infertility in women. So, yoga can be a great tool for women with ovary related issues.
Helps deal with hormonal treatment better
With all those hormones in the body, it is easy to fall into the depths of physical and mental distress. This negative energy in the body can reduce chances of conceiving. With yoga, it is possible to minimize these side effects and increase chances of becoming pregnant.
Yoga involves a lot of stretching poses and exercises, thus strengthening reproductive muscles and organs which play a major role both in pregnancy and delivery. Fertility yoga is gentle and not demanding. An example of fertility yoga is Hatha which is slow-pacing.
These simple yet powerful fertility yoga poses should be practiced on a routine basis. Learning from a good yoga teacher is advised to get the pose right. These are some of the poses advisable for increasing fertility.(Pic.2)
• Cobra pose
• Lotus pose
• Legs up the wall pose
• Bridge pose
• Cobbler´s pose
• Supported head stand
• Supported shoulder stand
There is no need to be experienced in these practices to try fertility yoga. Doing these special poses can help women to gain more confidence about themselves and help towards parenthood. It can also help through reproductive difficulties.
Women are unique individuals and the desire to reproduce can be over-whelming. Never is that yearning more magnified then when they are unable to accomplish getting pregnant. Yoga can get women to the place they need to be so that they can free their hearts and prepare for a baby.
Thyrostatics (antithyroid drugs) are drugs that inhibit the production of thyroid hormones, such as carbimazole and methimazole, and propylthiouracil. Thyrostatics are believed to work by inhibiting the iodination of thyroglobulin by thyroperoxidase, and, thus, the formation of tetra-iodothyronine (T4). Propylthiouracil also works outside the thyroid gland, preventing conversion of (mostly inactive) T4 to the active form T3. Because thyroid tissue usually contains a substantial reserve of thyroid hormone, thyrostatics can take weeks to become effective, and the dose often needs to be carefully titrated over a period of months, with regular doctor visits and blood tests to monitor results. A very high dose is often needed early in treatment, but, if too high a dose is used persistently, patients can develop symptoms of hypothyroidism.
Many of the common symptoms of hyperthyroidism such as palpitations, trembling, and anxiety are mediated by increases in beta adrenergic receptors on cell surfaces. Beta blockers, typically used to treat high blood pressure, are a class of drugs that offset this effect, reducing rapid pulse associated with the sensation of palpitations, and decreasing tremor and anxiety. Thus, a patient suffering from hyperthyroidism can often obtain immediate temporary relief until the hyperthyroidism can be characterized with the Radioiodine test (noted below in "Other therapies" section) and more permanent treatment take place. Note that these drugs do not treat hyperthyroidism or any of its long-term effects if left untreated, but, rather, they treat or reduce only symptoms of the condition. Some minimal effect on thyroid hormone production however also comes with Propranolol - which has two roles in the treatment of hyperthyroidism, determined by the different isomers of propranolol. L-propranolol causes beta-blockade, thus treating the symptoms associated with hyperthyroidism such as tremor, palpitations, anxiety, and heat intolerance. D-propranolol inhibits thyroxine deiodinase, thereby blocking the conversion of T4 to T3, providing some though minimal therapeutic effect. Other beta blockers are used to treat only the symptoms associated with hyperthyroidism.
Levothyroxine is a stereoisomer of thyroxine which is degraded much slower and can be administered once daily in patients with hypothyroidism. Natural thyroid hormone from pigs is also used, especially for people who cannot tolerate the synthetic version.
Radioiodine therapy is the administration of radioactive isotope of iodine (I131), used as a treatment method in patients with hyperthyroidism.
Hyperthyroidism is a state of excessive production of thyroid hormones by the thyroid gland (Pic. 1). Thyreotoxicosis, on the other hand, denotes a state of excessive thyroid hormones due to any cause. Thus, thyreotoxicosis includes conditions of hyperthyroidism, but these two terms are often used interchangeably. The most prevalent cause of hyperthyroidism is Graves’ disease (GD), where auto-reactive antibodies bind to thyrotropin receptor (TSH) receptors of the thyroid gland cells and stimulate them into excessive hormone production. Other causes of hyperthyroidism include multinodular goiter (a swelling of the thyroid gland, Pic. 2) or thyroid gland inflammation.
The three main methods of managing hyperthyroidism are surgically (thyroidectomy), radioactive iodine-131 (RAI) therapy, and antithyroid medication (ATD).
RAI therapy is administered in order to severely restrict, or altogether destroy the function of a hyperactive thyroid gland (so-called ablative therapy). Radioiodine emits beta-radiation particles which damage cells and tissues in their vicinity. Iodine-131 in this treatment is picked up by the active cells in the thyroid and destroys them, rendering the thyroid gland mostly or completely inactive. Since iodine is picked up more readily (though not exclusively) by thyroid cells, and (more important) is picked up even more readily by over-active thyroid cells, the destruction is local, and there are no widespread side effects with this therapy.
The aim of RAI is to achieve a euthyroid (normal function of the thyroid gland) or hypothyroid state (low production of thyroid hormones by the thyroid), with the latter being treated by thyroid hormone replacement. Typical therapeutic doses of I-131 are between 2220-7400 megabecquerels (MBq). Because of this high radioactivity and because the exposure of stomach tissue to beta radiation would be high near an undissolved capsule, I-131 is usually administered to human patients in a small amount of liquid. On occasion, some patients may require more than one radioactive treatment, depending on the type of disease present, the size of the thyroid, and the initial dose administered.
IAEA (Inetrnational Atomic Energy Agency) International Basic Safety Standards recommend that patients are not discharged until the activity falls below 1100 MBq (a value of radioactivity considered safe for the patients’ surroundings). Patients receiving I-131 radioiodine treatment may be warned not to have sexual intercourse for one month (or shorter, depending on dose given), and women told not to become pregnant for six months afterwards.
Surgery (thyroidectomy to remove the whole thyroid or a part of it) is not extensively used because most common forms of hyperthyroidism are quite effectively treated by the radioactive iodine method, and because there is a risk of also removing the parathyroid glands, and of cutting the recurrent laryngeal nerve, making swallowing difficult, and even simply generalized staphylococcal infection as with any major surgery. Some people with Graves' may opt for surgical intervention. This includes those that cannot tolerate medicines for one reason or another, people that are allergic to iodine, or people that refuse radioiodine.
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:
ERA test (Endometrial Receptivity Array) is a molecular diagnostic test used to assess endometrial status and to determine whether or not the patient’s endometrium (uterine lining) had a receptive state (seen from the gene profile) at the time of sampling before embryo transfer.
Principe of ERA
Normally, the optimal endometrial state for embryo transfer is evaluated by ultrasound, but it can only show its thickness and structure. The ERA test requires an endometrial biopsy that should be carried out seven days after luteinizing hormone (LH) surge in natural cycle or after five full days of progesterone exposure of artificial cycle. The test determines the expression (i.e. the information from a gene is used in the synthesis of a functional product, most often proteins) level of 236 genes that are involved in endometrial receptivity at molecular level.
The results from the analysis will determine if the woman was receptive or not at the time of sampling. If she is receptive, this implies that her implantation window (see below) falls on the day of the cycle during which the biopsy was performed and the embryo could therefore be transferred to the uterus during this period.
A non-receptive status may imply a displaced window of implantation. The procedure will be performed once again according to the computational predictor.
The implantation (Pic. 1), the process whereby the blastocyst (day 5 embryo) gets fixed to the uterine epithelium and penetrates though it, requires a receptive endometrium and an embryo at the blastocyst stage, as well as an interaction between both. The human endometrium undergoes to a complex series of proliferative and secretory changes in each menstrual cycle and displays only a short period of receptivity, known as the "window of implantation", necessary for the implantation of the blastocyst in the uterus.
Therefore, gene expression in the human endometrium is likely to exhibit neat and distinct changes throughout the various stages of the menstrual cycle in accordance with the oscillations (waves generated by pulsatile release) in estrogen and progesterone serum levels and their tissue receptor levels. Since these ovarian steroid hormones drive these processes eliciting an array of cellular and biochemical responses, mostly through genomic pathways, current thinking suggests that at the onset of receptivity, expression of some genes in given cell types of this tissue, is temporarily turned on or increased while some others are temporarily turned off or decreased.See full description of ERA test
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.
The two most common types of thyroid diseases are hypothyroidism and hyperthyroidism. Studies assessing the role of hypo- and hyperthyroidism in male infertility have also been conducted in human subjects. Hypothyroidism may result in a decrease in the sex hormone binding globulin (SHBG) levels and a decrease in total serum testosterone levels, as well as a decrease in the LH and the follicle stimulating hormone (FSH) levels. In cases of prolonged pre-pubertal hypothyroidism due to drop in LH and FSH levels, the Leydig and Sertoli cells, respectively are less stimulated to differentiate into mature cells, negatively affecting spermatogenesis. This increases the number of cells in the testes but decreases the number of mature cells. Thus, in patients with hypothyroidism, increased testicular size is observed along with a significant drop in mature germ cells within the seminiferous tubules.
Fortunately, hypothyroidism is very rare in males with an occurrence rate of only 0.1% in the general population.
Hypothyroidism adversely affected semen quality by compromising semen volume and progressive sperm motility.
It is therefore evident that hypothyroidism adversely affects male fertility. Similarly, all the studies on hyperthyroidism also reported adverse effects on male reproductive organs and fertility. Male infertility is more common than previously thought in males with hyperthyroidism, possibly in correlation with elevated levels of testosterone, LH, and FSH. Hyperthyroidism delays Leydig cell development and adversely affects spermatogenesis.
Autoimmune thyroid diseases (AITD); are the most common autoimmune conditions encountered in females in reproductive age characterized by presence of antibodies against to some structure of thyroid gland such as thyroglobulin (TG), thyroid peroxidase (TPO) and thyroid microsomale (TM). All AITD, to some extent, have implications for fertility and obstetrics. The presence of antithyroid antibodies may react against the structures of the placenta or fertilized egg and cause problems in embryo implantation.
The older the woman, the higher the probability of anti-TPO antibodies. Anti-TPO antibodies increase with age.
Hypothyreoidism – negatively affects the rate of abortion, especially in the first trimester. Abortions occur 2 times more often. It also negatively affects sexual function such as decreased desire, increased pain in sex and also affects the orgasm of women.
Women with hypothyreosis often have oligomenorrhea, amenorrhea. Despite an increased prolactin, anovulation is present. Therefore, the menstrual cycle is completely affected.