HOMEOPATHY BLOG: DR. HARSHAD RAVAL (M.D.) HOMEOPATHIC SOURCE » azospermia

LOW SPERM | NO SPERM | AZOSPERMIA CAUSE , SINE ,SYSMPTOMS TREATMENT BY DR HARSHAD RAVAL MD

Dr. Harshad Raval (M.D. Homeopathy) — Fri, 11 Sep 2009 13:51:33 +0000

What is Azoospermia (Nil Sperm): Azoospermia is called when there is no sperm in semen. This type of semen disorder is found in approximately 3% of infertile men i.e. absent sperm. You should know that testis has two separate functions
(i) Production of normal sperms in semen which needed for pregnancy & normal fertility.
(ii) The other function of testis is production of male hormones i.e. testosterone & others. So in most patients with nil sperms though semen has absent sperms still production of male hormones remains normal.
How sperms develop: When boy becomes of 14 years of age then L.H. & F.S.H. hormone secretion from pituitary increases. The rise in these hormones leads to proliferation of sperm forming cells (Germ Cells) in the testis. These germ cells start multiplying under the effect of above-mentioned pituitary hormones along with assistance of other hormones as testosterones, Growth hormones, Androstenidione, insulin like growth factor-I, Thyroids hormone, paracrine hormone & growth factors. Under the control of above-mentioned hormones germs cells divide & transformed into primary spermatocytes. Then further maturation of primary spermatocytes to spermatids & then finally into mature spermatozoa (i.e. normal sperms) occurs under the control of above-mentioned hormones. After few weeks of progressive maturation inside the testis these sperms become normally motile & develop the capacity to fertilize the ovum. This total sperm cycle, from first stage to final stage of normal mature sperms is of three months. Thus to produce normal sperms testis should have normal sperm producing germ cells & normal regulating hormones. Any major hindrance in the development of these spermatozoa will lead to absent sperm production resulting into nil sperm..

Causes of Nil Sperms: The various causes of nil sperm are as follows :

Hormone disorder : The various endocrine (Hormone) disorder leading to azoospermia are as follows

(i) Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic hypogonadism & due to many more causes.

(ii) Obstruction in the outflow of semen (Sperms) from testis to outside through urethral opening. Many times the production of sperms in testis is absolutely normal but these sperm are unable to come out due to obstruction in the out flow tract leading to absent sperms in the semen. The various causes of obstruction are absent vas deferens, absent seminal vesicle, posttraumatic, post surgical ligation of vas deferens. After some infections, as chlamydial, gonococcal urethritis. It may also be due to post tubercular epididimo-orchitis. The sperm may also not come out of testis if the are imotile due to any of the following causes as imotile cilia syndrome, kartagener syndrome cystic fibrosis & many other rare diseases.

(iii) Absence of germ cells in testis also called sertoli cell only syndrome. In this there are no germs cells i.e. sperm forming cells in the testis. For you knowledge, I wish to inform you that in testis germ cell come to testis from neural cord area of the body during neural cord area of the body during development of fetus. So in some fetuses this migration of sperm cells do not occurs leading to testis only having testosterone forming & sertoli cells. Thus this condition is called sertoli sell only syndrome it is a developmental defect.

(iv) Maturation Arrest (. Spermatid arrest): of primary spermatocytes to secondary spermatocyte, spermatids or to mature spermatozoa. Due to may local, systemic, hormonal growth factor deficiency or due to idiopathic factor. The various paracrine hormones and growth factors are essential for normal development i.e. maturation of one germ cells to multiplication of ultimately production of multiple mature, normal & motile sperms. Many other factor as infection, varicocele, drugs, chemotherapy may also lead to maturation arrest. The other causes may by developmentally defective germs cells & spermatocyte. So that they did not have inherent capacity of developing into a mature & motile sperms.

4) Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)
5) Varicocele (Grade 3 or more severe): A varicocele is a varicose vein in the cord that connects to the testicle. (A varicose vein is one that is abnormally enlarged and twisted.)
Varicocele decreases sperm productions by elevating temperature of the testis, may produce higher levels of nitric oxide chemical in the testis which blocks sperm production, varicocele damages sperms directly & lastly varicocele decrease the oxygen supply to testis.
6) Drugs (e.g. spironolactone, alcohol, ketoconazole, cyclophosphamide, estrogen administration, sulfasalazine)
7) Presence of Antisperm antibody. These Antisperm antibodies bind with sperms & either make them less motile, totally immotile or even dead which is called necrospermia
Trauma
9) Environmental toxins
10) Viral orchits
11) Granulomatous disease as tuberculosis, sarcoidosis of the testis
12) Defects associated with systemic diseases, Liver diseases, Renal failure, Sickle cell disease, Celiac disease
13) Neurological disease as myotonic dystrophy
14) Development and structural defects, Germinal cell aplasia, sertoli cell only syndrome, Cypt-orchidism
15) Androgen resistance
16) Mycoplasma infection

17) Cystic fibrosis patients often have missing or obstructed vas deferens (the tubes that carry sperm) and hence a low sperm count.
18) Klinefelter syndrome patients carry two X and one Y chromosomes (the norm is one X and one Y), which leads to the destruction of the lining of the sperm forming germ cell in the testis.
19) Environmental Assaults: Over exposure to environmental assaults (toxins, chemicals, infections) can cause nil sperm either by direct suppression of sperm production or on the hormone. Some chemicals that affect sperm production men are: Oxygen-Free Radicals, Estrogen emulation pesticidal chemicals (DDT, aldrin, dieldrin, PCPs, dioxins, and furans), plastic softening chemicals like Phthalates, hydrocarbons (ethylbenzene, benzene, toluene, and xylene)

20) Exposure to Heavy Metals: Chronic exposure to heavy metals such as lead, cadmium, or arsenic may affect sperm production and may cause nil sperms in otherwise healthy men. Trace amounts of these metals in semen seem to inhibit the function of enzymes contained in the sperms, the membrane that covers the head of the sperm.

20) Radiation Treatment: Over-exposure to radiation & xrays affect any rapidly dividing cell, so cells that produce sperm are quite sensitive to radiation damage. Cells exposed to significant levels of radiation may take up to two years to resume normal sperm production, and, in severe circumstances, may never recover.
21) Misuse of substances: There are a number of banned substances that can have potentially lethal effects on sperm production. Taking anabolic steroids, for example, to increase performance in sports such as weight lifting, can dramatically alter both the motility and the health of the spermatozoa. Other banned substances, such as cocaine, marijuana and heroin
can reduce sperm production & may make a man infertile.
22) HGH Deficiency

Diagnosis of Cause of Nil Sperm Count
For correct diagnosis of cause of nil sperm count, we need detail history & physical examinations then certain relevant investigations are required.
History & Physical Examinations: First step in proper treatment is accurate diagnosis of cause of nil sperm count. So we first try to find out cause. We take detailed history, thorough drug history, and general physical examination, examination of testis, epididymis & testicular veins & sperm carrying duct examinations. These examinations give idea about whether testis is normally developed or not & how is its function. After that depending on likelihood of particular, cause relevant tests are done. All testing facilities are available at our centre. Thus you may consult us at our centre & at same time you may get all tests done. The time taken in getting all the reports ready is 36 hours. So if you are from out of Delhi, you may come here for two days.

Investigation & Diagnosis: For completes diagnosis of causes of azoospermia (nil sperms) one or more of the following tests may be required as:
1) Complete male hormone profile: This profile includes all the male hormone tests which affect testicular development, growth & other genital organ development as well as genital functions. L.H., F.S.H., Testosterone, prolactins, thyroids test,
2) Antisperm antibody
3) USG or Doppler study of scrotum & testis
4) Semen culture sensitivity
5) Semen fructose
6) Fine Needle Testicular Biopsy of the testis to look for evidence of spermatogenesis & testicular structure.
Human Sperm-Zona Pellucida Binding Ratio
9) Human Sperm-Zona Pellucida Pentration test
10) Genetic Studies
11) FNAC Testis
12) Egg penetration test
13) Molecular genetic studies done in some special cases
14) Chromosome analysis i.e. Karyotype (chromosome analysis)
15) Assessment of androgen receptor
16) Combined Pituitary hormone tests is performed when needed
17) Immunobead test
18) MRI head, Hemogram, test for systemic diseases.
19) Olfactory test is done to find out kallman’s syndrome
At our center facility for all the above tests are available.
Treatment of Nil Sperms:
After the finding out cause of azoospermia treatment is started depending on the cause found.

The various treatments are as follows:
Correction of the Cause: First of all we try to find out the primary cause of nil sperms by above mentioned investigations. Then we correct the basic defect i.e. correction of hormone disorder & other defects. We also give following treatment for permanent cure of low sperm count & motility disorder.
1) Correction of Hormone deficiencies: Once the hormone disorder is found then it is corrected by any of the below medicines. Usually sperm count normalizes in three month time with proper hormone treatment.
2) Gonadotropin Therapy: Gonadotropins are most potent natural stimulators of sperm production in the testis. Once we start gonadotropin therapy, these gonadotropins stimulates the sperm producing cells in testis. Under the stimulating influence of gonadotropins dormant sperm forming cells which were not producing any sperms, they start dividing & produce multiple immature sperm cells with in three to four weeks. These are further matured in next two to three month into mature sperms under the influence of gonadotropin treatment. Thus in more than 90% cases sperm production can be normalized in three to four months time if it is started in properly selected cases of nil sperms. Gonadotropin therapy is most successful of all the available treatment for nil sperms till now. In many cases of nil sperm count, when all other treatment has failed even in those cases gonadotropin therapy is effective. Thus treatment of nil sperms with gonadotropin results in pregnancy soon.
3) Repronex.
4) Bravelle
5) Ovidrel
) Gonadotropin-releasing hormone (Gn-RH) analogs
7) Growth hormone therapy in many cases where somatropin deficiency is found
In cases of Antisperm antibody induced cases treatment is sperm washing followed by intrauterine insemination, steroid use or intra-cytoplasmic injection of sperms (ICSI).
Growth Factor, Mineral & Micronutrient Therapy
9) Free Radial Scavengers: These are drug to reduce the free damaging oxidative radical in the testis. For your information every minute lot of oxidant radicals are generated inside the testis which damages sperm forming cells. These special antioxidant drugs scavenge these damaging oxidative free radicals thus leading to production of normal sperms by the testis. In many study these free radical scavengers have been found to be very-very effective in normalizing sperm count.
10) Coenzyme ubique: These drugs improve the nutritional status of the testis. Thus sperm forming cells get enough nutrient which helps in fast generation of sperms in good number with good motility & fertilizing capacity.
11) carnititine supplimentation increases the production of sperm, with normalization of sperm count in three months.
13) Bromocriptine. This medication is for men who has elevated levels of prolactin, then this hormone rise decreases the sperm production
14) Correction of thyroid hormone
15) Correction of congenital adrenal hyperplasia
17) Zinc
19) Antibiotics
23) Hgh
26) AIH
27) Certain Newer Drugs has been found very effective
28) Surgery: Depending on the surgery may be a treatment option for nil sperm count due to blockade of the tract from testis to the tip of pennis (i.e. obstructive azoospermia). Surgery is also the treatment of choice for significant varicocele. Similarly surgery may be one of the treatment options for many endocrine tumours.
Surgical reconstruction When obstruction in transport of sperm from testis to outside is diagnosed, it is treated by surgical reconstruction. All this surgical treatment facility is provided by our expert micro surgeon. In this obstruction segment is bypassed by surgical anastomosis.
29) But there are many cases of azoospermia in which inspite of best treatment sperm production either does not improves or is impossible. In these cases we do fine needle testicular biopsy in which sometimes we may get some normal sperms or even spermatids. These spermatocytes or sperms are then injected in ovum leading to formation embryo. These embryos are ten transferred into uterus leading to achievement of pregnancy.

30) But in some cases inspite of all efforts no sperm can not be produced. In such cases we advise artificial insemination by semen from donor. In this normal semen is taken from sperm i.e. semen bank. This is one of the very successful method of treatment with minimal cost involvement.
31) Test tube baby is also delivered with our efforts by use of intra-cytoplasmic sperm injection (ICSI), then transfer of embryo to uterus of mother.
32) Semen Bank: Facility for good quality sperm is semen bank in also available. At our center we have facility for all the testing & treatment facility required for low sperm count to achieve pregnancy.
33) Assisted reproductive technology (ART)
ART has revolutionized the treatment of infertility. Each year thousands of babies are born in India as a result of ART. Medical advances have enabled many couples to have their own biological child.
The most common forms of ART include:
a) In vitro fertilization (IVF). This is the very effective ART technique. IVF involves retrieving mature eggs from a woman, fertilizing them with a sperm from sperm bank in a dish in a laboratory and implanting the embryos in the uterus three to five days after fertilization.
b) Surgical sperm aspiration. This technique involves removing sperm from part of the male reproductive tract such as the epididymis, vas deferens or testicle. This allows retrieval of sperm if blockage is present.
c) Intracytoplasmic sperm injection (ICSI). This technique consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure.
34) Varicocele ligation
A varicocele is an abnormal tortuosity and dilation of veins of within the scrotum. It can be surgically treated – which might help fertility in some cases.
At our center we have facility for all the testing & treatment facility required for nil sperm count to achieve pregnancy.

Response of Treatment: By above treatment many patients are cured in three to four months times. But if we diagnose that this problem is not curable in such cases we tell the patient that your problem is incurable & suggest them other available options as test tube baby, ICSI, AIH etc..

Pus in Semen

Pus cells in semen may be due to infection into genito-urinary tract due to any of the following causes:

1.) Chlamydia infection

Chlamydia is a common infection of genitourinary tract all over world. It’s a bacterial infection. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.

2) Gonorrhea (Gonococcal Urethritis)

It is caused by the bacterium Nesseria gonorrhoea.
Symptoms include pus in semen. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.

3) Non-Specific urethritis or NSU (Non-gonococcal Urethritis): It is caused by any of the following causative agent Chlamydia trachomatis, Ureaplasma urelyticum, Mycoplasma genitalium ,Candioda species, Anaerobes, Trichomonas vaginalis,, Unidentified / idiopathic. Some times it may be Persistent/recurrent non-gonococcal urethritis or Prolonged urethritis.

4) Candidal Balanitis (Thrush) is a fungal infection.

5) Prostatitis( Acute or Chronic)

Diagnostic tests
Urine may show threads or ‘beads of pus’ positive leycocyte esterase test.
Gram Stain
Culture
Molecular identification
Methelyne blue stain
Antigen detection techniques
Poly merase chain reaction
Trichomonas vaginalis
Fungi detection test
Herpes simplex virus antibodies

Anti-Sperm Antibody

In some male’s, antibody production starts against its own sperms. These antisperm antibodies may then enter the testis & seminal fluid and ‘attack’ the sperms & sperm forming cells. These antisperm antibodies stick the sperms with each other and thus tend to seriously reduce sperm motility, thereby causing infertility. By the use of various treatments, the amount of antibodies may be reduced and fertility restored.

Antisperm antibodies have been found to be present in up to 40% of couples with unexplained infertility, and in 10% of unexplained male infertility. Infertility in a couple can occur if the woman’s cervical mucus provides a hostile environment by producing antibodies to her partner’s sperm. More often, the problem is due to the male partner producing antibodies against his own sperm. Unilateral or bilateral obstruction of the genital tract (either congenital or acquired), epididymitis and varicocele are also sometimes associated with an autoimmune response against spermatozoa.

What are Antisperm Antibodies?
Antisperm antibodies are one immune factor which could be involved in infertility. Antisperm antibodies are cells that fight against normal, healthy sperm. If you have antisperm antibodies, instead of seeing sperm as natural cells, your immune system fights against your sperm and destroys them. This prevents you from producing any viable sperm. Though still to be proven, there is evidence that antibodies against sperm can result in male infertility.

How Do Antisperm Antibodies Affect Fertility?
Antisperm antibodies can really impair the function of healthy sperm. These antibodies attach to your sperm, reducing motility and making it more difficult for sperm to pass through cervical mucus. Antisperm antibodies can also force sperm to clump together, making it difficult for your sperm to fertilize an egg.

In-Vitro Fertilization(IVF): IVF is the most successful treatment for couples with antisperm antibodies. This allows the sperm to be directly injected into the egg, without havng to travel throguh the uterus and fallopian tubes.

Less Semen Formation reduced amount of ejaculated semen (less than 0.5 milliliters per sample) may be caused by a

1) Obstruction in the tube carrying the sperm from testis to outside i.e. structural abnormality in the tubes transporting the sperm.

2) Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder.

(3) Absent Ejaculation or Orgasm: There are certain conditions in which patient does not get orgasm even after prolonged sexual activity. the cause of this can be primary, Psychogenic or due to certain medication, neurological diseases, surgeries etc. Treatment needs diagnosis of cause & then treatment.

4) Hormone deficiency of pituitary gland as L.H., F.S.H., Prolactin, thyroids hormone, hypothalmic deficiency of GnRH, Pituitary gland failure, Hypopituitarism, Idiopathic hypopituitarism, Kallman syndrome, Isolated hypogonadotropic hypogonadism, Drugs, toxins, Idiopathic hypogonadotropic hypogonadism & due to many more causes.

5) Testicular disorders (primary leydig cell dysfunction), Chromosomal (Klinefelter syndrome and variants, XX male gonadal dysgenesis), Defects in androgen biosynthesis, Orchitis (mumps, HIV, other viral, ),Myotonia dystrophica, Toxins (alcohol, opiates, fungicides, insecticides, heavy metals, cotton seed oil), Drugs (cytotoxic drugs, ketoconazole, cimetidine, spironolactone)

Absent Ejaculation

Absent Ejaculation Orgasm

Absent ejaculation in which patient does not gets orgasm & semen discharge even after prolong sexual activity

3. Delayed ejaculation: In this disorder orgasm & semen discharge occurs after abnormally prolonged sexual activity.

4. Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder.

Pus in Semen
Pus cells in semen may be due to infection into genito-urinary tract due to any of the following causes:
1.) Chlamydia infection
Chlamydia is a common infection of genitourinary tract all over world. It’s a bacterial infection. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.
2) Gonorrhea (Gonococcal Urethritis)
It is caused by the bacterium Nesseria gonorrhoea.
Symptoms include pus in semen. The infection with bacteria decreases sperm count motility & fertilizing capacity of sperms. Complication of this can be epididymitis, and inflammation in the scrotum that may leave the man sterile.
3) Non-Specific urethritis or NSU (Non-gonococcal Urethritis): It is caused by any of the following causative agent Chlamydia trachomatis, Ureaplasma urelyticum, Mycoplasma genitalium ,Candioda species, Anaerobes, Trichomonas vaginalis,, Unidentified / idiopathic. Some times it may be Persistent/recurrent non-gonococcal urethritis or Prolonged urethritis.
4) Candidal Balanitis (Thrush) is a fungal infection.
5) Prostatitis( Acute or Chronic)
Diagnostic tests
Urine may show threads or ‘beads of pus’ positive leycocyte esterase test.
Gram Stain
Culture
Molecular identification
Methelyne blue stain
Antigen detection techniques
Poly merase chain reaction
Trichomonas vaginalis
Fungi detection test
Herpes simplex virus antibodies

• Blood Tests: In women, blood tests are commonly used to detect the antibody.
• Post-Coital Test: The post-coital test can detect the presence of antisperm antibodies in a woman’s cervical mucus.
• Sperm Testing: In men, sperm testing is the best way to analyze for antisperm antibodies. The immunobead assay and the mixed agglutination reaction test are both used.
Treating Antisperm Antibodies?
There are a variety of treatments available to help couples struggling with antisperm antibodies to conceive.
• Corticosteroids: Corticosteroids help to decrease the production of antisperm antibodies. Unfortunately, corticosteroids are associated with side effects, including hipbone damage.
• Intrauterine Insemination(IUI): IUI can help couples to overcome antisperm antibodies as it allows sperm to bypass the cervical mucus. Fertility drugs can also be used.
• In-Vitro Fertilization(IVF): IVF is the most successful treatment for couples with antisperm antibodies. This allows the sperm to be directly injected into the egg, without havng to travel throguh the uterus and fallopian tubes.

Less Semen Formation
Low Semen Levels
A reduced amount of ejaculated semen (less than 0.5 milliliters per sample) may be caused by a
1) Obstruction in the tube carrying the sperm from testis to outside i.e. structural abnormality in the tubes transporting the sperm.
2) Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder.

3. Delayed ejaculation: In this disorder orgasm & semen discharge occurs after abnormally prolonged sexual activity.

4. Retrograde ejaculation: In which patient gets orgasm at normal time but semen in place of coming out through penile opening goes into bladder.

(4) Absent Ejaculation or Orgasm: There are certain conditions in which patient does not get orgasm even after prolonged sexual activity. the cause of this can be primary, Psychogenic or due to certain medication, neurological diseases, surgeries etc. Treatment needs diagnosis of cause & then treatment.
Tests for Infertility
For a woman to be fertile, the ovaries must release healthy eggs regularly, and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes for a possible union.

After your doctor asks questions regarding your health history, menstrual cycle and sexual habits, a general physical examination is done. This includes a regular gynecological examination. Specific fertility tests may include:

Confirmation of ovulation. A blood test is sometimes performed to determine the levels of hormones involved in successful ovulation.
Hysterosalpingography. This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected into your uterus, and an X-ray is taken to determine whether the fluid progresses out of the uterus and into your fallopian tubes and general peritoneal cavity. Blockage or problems often can be located and may be corrected with medication or surgery.
Laparoscopy. Performed under general anesthesia, this procedure involves inserting a thin viewing device into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus. A small incision (8 to 10 millimeters) is made beneath your navel, and a needle is inserted into your abdominal cavity. A small amount of gas (usually carbon dioxide) is inserted into the abdomen to create space for entry of the laparoscope — an illuminated, fiber-optic telescope.The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Often a blue dye is injected into the cervical canal and through the uterus and fallopian tubes to determine whether they are open. At the end of the procedure, the gas and laparoscope are drawn out and the incision is closed. Laparoscopy generally is done on an outpatient basis.
Basal body temperature. Although this test was once a standard, basal body temperature charting is used less often today. Charting a woman’s body temperature doesn’t give as precise time of ovulation as earlier believed.
Urinary luteinizing hormone (LH) detector kits. A number of at-home kits are available to test your LH level. Although these kits may be helpful, they also can be inaccurate and misleading. Consult your doctor before using one.

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www.homeopathyonline.inDr Harshad Raval MD [Homeopathy]

INFERTILITY | STERILITY |AZOSPERMIA | OLIGOSPERMIA | HOMEOPATHY TREATMENT

Dr. Harshad Raval (M.D. Homeopathy) — Thu, 07 May 2009 13:31:27 +0000

According to medical statistics it is estimated that infertility can affect around 40% of women with Endometriosis

Infertility can be one of the consequences of Endometriosis. Women are not only dealing with a debilitating disease but they are also in fear of not being able to have children.

But let’s not paint a gloomy picture here. It is fortunate that not all women who have endometriosis are infertile. (If all women who had endometriosis were infertile then birth rates would drop considerably and a rush to find successful treatment for this disease would, hopefully, be implemented.)

Interestingly, it has been found that between 30 to 40 percent of women undergoing laparoscopy as part of an infertility evaluation are found to have Endometriosis. This is when women are finally diagnosed with the disease by default.

There appears to be a number of mechanisms by which Endometriosis impacts on fertility. Scarring or adhesions in the pelvis, for example, may cause infertility. The fallopian tubes and ovaries may adhere to the lining of the pelvis or to each other, restricting their movement. The scarring and adhesions that takes place with Endometrisois may mean that the ovaries and fallopian tubes are not in the right position, so the transfer of the egg to the fallopian tubes cannot take place. Similarly, Endometriosis can cause damage and/or blockage to the inside of the fallopian tube, impeding the journey of the egg down the fallopian tube to the uterus.

Another factor which could cause infertility for women with Endometriosis, may be the over-production of prostaglandins. These are hormones which play and important role in the fertilization and implantation of the embryo. An excess of prostaglandins may interfere with these processes.

Because Endometriosis often causes painful intercourse, couples may fail to have intercourse during the woman’s most fertile time, which will obviously impede the possibility of conception.

A closer look at some of the possible causes of Infertility as speculated by the medical proffession

Abdominal Adhesions and Infertility

As the Endometriosis implants grow and develop in the abdomen, the body tries to surround them with fibrous connective tissue (scar tissue). The body does this in an attempt to isolate the implants and prevent them from doing harm. Adhesions can also be formed during surgery when abdominal tissue is traumatized.

These fibrous growths also have the effect of making the implants stick to adjacent tissue, and in some case organs can be ‘glued’ together. Also the blood from internal bleeding from the implants can forms adhesions, so that an implant may be stuck to several different tissues. For example, an Endometriosis implant on the top of the uterus may cause the ovary and small intestine to become attached at the site of the implant.

If the adhesions caused by Endometriosis pinch off the fallopian tube or if they cause blockage to the opening of the fallopian tube, they could obstruct the merger of egg and sperm and prevent fertilization and conception. Also ectopic pregnancy is more common with Endometriosis, if the embryo can’t travel to the womb. This type of obstruction can be easily diagnosed and surgically corrected.

However, this does not explain how patients with just a few Endometrial implants and no adhesions can become infertile. Adhesions can also cause pain, as internal organs which normally slip and slide are firmly glued together. For example, if the bowel is stuck to a tender, painful ovary, flatulence could cause pain.

Secretions from implants

The normal Endometrium which lines the womb is a very active and vital tissue that secretes a wide variety of nutrients and hormones required for normal conception. The endometrial implants also secrete these same substances, but instead of depositing them into the lumen (center) of the womb as normal, the endometrial implants release their chemical secretions into the abdominal cavity. Some of these substances are potent hormones which could interfere with fertility.

Prostaglandins

One major group of hormones secreted by the normal endometrium is that of the prostaglandins. Prostaglandins are oil-based hormones found in nearly all the tissues of the body and are required for many bodily processes, including several stages of the menstrual cycle and pregnancy.

Prostaglandins are required for ovulation, regression of the corpus luteum (i.e., ending the monthly menstrual cycle), sperm motility, immune interaction, contraction of the uterus at birth and menstrual cramps. Endometriosis implants and the endometrium of the uterus are the richest source of prostaglandin production in the body.

However, the problem with Endometriosis implants includes:
- Prostaglandins are released into the abdomen instead of inside the womb
- Prostaglandins release by the implants seem to be out of phase with their release by the uterus. Prostaglandins are produced at the wrong time sending the wrong message.

For instance, there is a normal surge in prostaglandin F production at the end of the menstrual cycle, causing the effect of the copus luteum of the ovary to die down and signaling the start of a new menstrual cycle. The implants of Endometriosis produce their own prostaglandin surge several days after that of the womb lining. This may be one of the main causes of very early miscarriage.

If a women is a few days pregnant then the Endometriosis implants producing prostaglandin F would incorrectly signal the ovary to start a new menstrual cycle, causing the womb lining with the implanted egg to be expelled – and the consequence is an early miscarriage.

Prostaglandins also play an important role in the contractions of womb and fallopian tubes. During the normal menstrual cycle, the gentle contraction of the womb and fallopian tube aids the movement of egg and sperm to the outer third of the fallopian tube where fertilization occurs. High concentrations of endometriosis implants may prevent fertilization. An excess of PGF2 and PGE2 could cause contractions that are too strong and expel the egg too quickly.

Early Miscarriage

The most common time for a miscarriage to occur is during the first three months of pregnancy. During this time, the embryo is developing into a fetus and is undergoing dramatic changes, including the formation of most of its internal organs. This is a critical period of development that requires an appropriate nutrient-rich environment, a healthy placenta and a very delicate balance between the various hormones involved in pregnancy.

However, the real problem of a an early miscarriage, is that if it occurs during the first six weeks of pregnancy there is a good chance that women may not even be aware that they were pregnant. They may think their period was late.

Regardless of whether or not there is a high miscarriage rate in Endometriosis patients, it is imperative to eat the right sort of nutrient-rich food to try to ensure the maintenance of a pregnancy. Nutrition in both parents, even before pregnancy has a profound effect on the state of the egg and sperm, as well as on the nature of the secretions within the peritoneal cavity. Choice of foods, particularly fats and oils, may be a crucial factor as these affect the production of prostaglandins, cell membranes, steroid hormones, and neurotransmitters etc.

Fertility and the Alert Immune System

In order to achieve pregnancy, sperm has to enter the body. This sperm can be judged as ‘alien’ by a women’s immune cells, because it is ‘non-self’. If pregnancy is achieved, the women’s immune system has to adapt to the presence of ‘alien’ tissue growing inside her for nine months.

However, there will be some mechanism in nature, which tells the female immune system that this alien tissue is not a danger, in order to avoid damage to the embryo. Perhaps when the immune system is malfunctioning in Endometriosis, this mechanism fails and causes an immune attack on the embryo and sperm, thought to lead to infertility. Correcting or strengthening the immune system may help to achieve fertility for women with Endometriosis.

Tests for Infertility

For a woman to be fertile, the ovaries must release healthy eggs regularly, and her reproductive tract must allow the eggs and sperm to pass into her fallopian tubes for a possible union.

Confirmation of ovulation. A blood test is sometimes performed to determine the levels of hormones involved in successful ovulation.
Hysterosalpingography. This test evaluates the condition of your uterus and fallopian tubes. Fluid is injected into your uterus, and an X-ray is taken to determine whether the fluid progresses out of the uterus and into your fallopian tubes and general peritoneal cavity. Blockage or problems often can be located and may be corrected with medication or surgery.
Laparoscopy. Performed under general anesthesia, this procedure involves inserting a thin viewing device into your abdomen and pelvis to examine your fallopian tubes, ovaries and uterus. A small incision (8 to 10 millimeters) is made beneath your navel, and a needle is inserted into your abdominal cavity. A small amount of gas (usually carbon dioxide) is inserted into the abdomen to create space for entry of the laparoscope — an illuminated, fiber-optic telescope.The most common problems identified by laparoscopy are endometriosis and scarring. Your doctor can also detect blockages or irregularities of the fallopian tubes and uterus. Often a blue dye is injected into the cervical canal and through the uterus and fallopian tubes to determine whether they are open. At the end of the procedure, the gas and laparoscope are drawn out and the incision is closed. Laparoscopy generally is done on an outpatient basis.
Basal body temperature. Although this test was once a standard, basal body temperature charting is used less often today. Charting a woman’s body temperature doesn’t give as precise time of ovulation as earlier believed.
Urinary luteinizing hormone (LH) detector kits. A number of at-home kits are available to test your LH level. Although these kits may be helpful, they also can be inaccurate and misleading. Consult your doctor before using one.