Fibroid Tumors


Fibroid Tumors

Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage

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Infertility

Infertility

Factors relating to male infertility include:[6]

Pre-testicular causes[edit]

Pre-testicular factors refer to conditions that impede adequate support of the testes and include situations of poor hormonal support and poor general health including:

Tobacco smoking[edit]

See also: Smoking and pregnancy
There is increasing evidence that the harmful products of tobacco smoking may damage the testicles[12] and kill sperm,[13][14] but their effect on male fertility is not clear.[15] Some governments require manufacturers to put warnings on packets. Smoking tobacco increases intake of cadmium, because the tobacco plant absorbs the metal. Cadmium, being chemically similar to zinc, may replace zinc in the DNA polymerase, which plays a critical role in sperm production. Zinc replaced by cadmium in DNA polymerase can be particularly damaging to the testes.[16]

DNA damage[edit]

Common inherited variants in genes that encode enzymes employed in DNA mismatch repair are associated with increased risk of sperm DNA damage and male infertility.[17] As men age there is a consistent decline in semen quality, and this decline appears to be due to DNA damage.[18] (Silva et al., 2012). These findings suggest that DNA damage is an important factor in male infertility.

Epigenetic[edit]

See also: DNA methylation
An increasing amount of recent evidence has been recorded documenting abnormal sperm DNA methylation in association with abnormal semen parameters and male infertility.[19][20]

Testicular factors[edit]

Testicular factors refer to conditions where the testes produce sperm of low quantity and/or poor quality despite adequate hormonal support and include:
Radiation therapy to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.[26]

Post-testicular causes[edit]

Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation:




Causes and factors[edit]

Causes or factors of female infertility can basically be classified regarding whether they are acquired or genetic, or strictly by location.
Although factors of female infertility can be classified as either acquired or genetic, female infertility is usually more or less a combination of nature and nurture. Also, the presence of any single risk factor of female infertility (such as smoking, mentioned further below) does not necessarily cause infertility, and even if a woman is definitely infertile, the infertility cannot definitely be blamed on any single risk factor even if the risk factor is (or has been) present.

Acquired[edit]

According to the American Society for Reproductive Medicine (ASRM), Age, Smoking, Sexually Transmitted Infections, and Being Overweight or Underweight can all affect fertility.[7]
In broad sense, acquired factors practically include any factor that is not based on a genetic mutation, including any intrauterine exposure to toxins during fetal development, which may present as infertility many years later as an adult.

Age[edit]


Cumulative percentage and average age for women reaching subfertility, sterility, irregular menstruation and menopause.[8]
Main article: Age and female fertility
A woman's fertility is affected by her age. The average age of a girl's first period (menarche) is 12-13 (12.5 years in the United States,[9] 12.72 in Canada,[10] 12.9 in the UK[11]), but, in postmenarchal girls, about 80% of the cycles are anovulatory in the first year after menarche, 50% in the third and 10% in the sixth year.[12] A woman's fertility peaks in the early and mid 20s, after which it starts to decline, with this decline being accelerated after age 35. However, the exact estimates of the chances of a woman to conceive after a certain age are not clear, with research giving differing results. The chances of a couple to successfully conceive at an advanced age depend on many factors, including the general health of a woman and the fertility of the male partner.

Tobacco smoking[edit]

See also: Women and smoking § Unique gender differences and health effects for Females
Tobacco smoking is harmful to the ovaries, and the degree of damage is dependent upon the amount and length of time a woman smokes or is exposed to a smoke-filled environment. Nicotine and other harmful chemicals in cigarettes interfere with the body’s ability to create estrogen, a hormone that regulates folliculogenesis and ovulation. Also, cigarette smoking interferes with folliculogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and the uterine myometrium.[13] Some damage is irreversible, but stopping smoking can prevent further damage.[14][15]Smokers are 60% more likely to be infertile than non-smokers.[16] Smoking reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.[16] Also, female smokers have an earlier onset of menopause by approximately 1–4 years.[17]

Sexually transmitted infections[edit]

Sexually transmitted infections are a leading cause of infertility. They often display few, if any visible symptoms, with the risk of failing to seek proper treatment in time to prevent decreased fertility.[14]

Body weight and eating disorders[edit]

Twelve percent of all infertility cases are a result of a woman either being underweight or overweight. Fat cells produce estrogen,[18] in addition to the primary sex organs. Too much body fat causes production of too much estrogen and the body begins to react as if it is on birth control, limiting the odds of getting pregnant.[14] Too little body fat causes insufficient production of estrogen and disruption of the menstrual cycle.[14] Both under and overweight women have irregular cycles in which ovulation does not occur or is inadequate.[14] Proper nutrition in early life is also a major factor for later fertility.[19]
A study in the US indicated that approximately 20% of infertile women had a past or current eating disorder, which is five times higher than the general lifetime prevalence rate.[20]
A review from 2010 concluded that overweight and obese subfertile women have a reduced probability of successful fertility treatment and their pregnancies are associated with more complications and higher costs.[21] In hypothetical groups of 1000 women undergoing fertility care, the study counted approximately 800 live births for normal weight and 690 live births for overweight and obese anovulatory women. For ovulatory women, the study counted approximately 700 live births for normal weight, 550 live births for overweight and 530 live births for obese women. The increase in cost per live birth in anovulatory overweight and obese women were, respectively, 54 and 100% higher than their normal weight counterparts, for ovulatory women they were 44 and 70% higher, respectively.[22]

Chemotherapy[edit]

Chemotherapy poses a high risk of infertility. Chemotherapies with high risk of infertility include procarbazine and other alkylating drugs such as cyclophosphamide, ifosfamide, busulfan, melphalan, chlorambucil and chlormethine.[23] Drugs with medium risk include doxorubicin and platinum analogs such as cisplatin and carboplatin.[23] On the other hand, therapies with low risk of gonadotoxicity include plant derivatives such as vincristine and vinblastine, antibiotics such as bleomycin and dactinomycin and antimetabolites such as methotrexate, mercaptopurine and 5-fluorouracil.[23]
Female infertility by chemotherapy appears to be secondary to premature ovarian failure by loss of primordial follicles.[24] This loss is not necessarily a direct effect of the chemotherapeutic agents, but could be due to an increased rate of growth initiation to replace damaged developing follicles.[24] Antral follicle count decreases after three series of chemotherapy, whereas follicle stimulating hormone (FSH) reaches menopausal levels after four series.[25] Other hormonal changes in chemotherapy include decrease in inhibin B and anti-Müllerian hormone levels.[25]
Women may choose between several methods of fertility preservation prior to chemotherapy, including cryopreservation of ovarian tissue, oocytes or embryos.[26]

Other acquired factors[edit]

Genetic factors[edit]

There are many genes wherein mutation causes female infertility, as shown in table below. Also, there are additional conditions involving female infertility which are believed to be genetic but where no single gene has been found to be responsible, notably Mayer-Rokitansky-Küstner-Hauser Syndrome (MRKH).[37] Finally, an unknown number of genetic mutations cause a state of subfertility, which in addition to other factors such as environmental ones may manifest as frank infertility.
Chromosomal abnormalities causing female infertility include Turner syndrome. Oocyte donation is an alternative for patients with Turner syndrome.[38]
Some of these gene or chromosome abnormalities cause intersexed conditions, such as androgen insensitivity syndrome.
Genes wherein mutation causes female infertility[39]
GeneEncoded proteinEffect of deficiency
BMP15Bone morphogenetic protein 15Hypergonadotrophic ovarian failure (POF4)
BMPR1BBone morphogenetic protein receptor 1BOvarian dysfunction, hypergonadotrophic hypogonadism and acromesomelic chondrodysplasia
CBX2; M33Chromobox protein homolog 2 ; Drosophila polycomb class
Autosomal 46,XY, male-to-female sex reversal (phenotypically perfect females)
CHD7Chromodomain-helicase-DNA-binding protein 7CHARGE syndrome and Kallmann syndrome (KAL5)
DIAPH2Diaphanous homolog 2Hypergonadotrophic, premature ovarian failure (POF2A)
FGF8Fibroblast growth factor 8Normosmic hypogonadotrophic hypogonadism and Kallmann syndrome (KAL6)
FGFR1Fibroblast growth factor receptor 1Kallmann syndrome (KAL2)
HFM1Primary ovarian failure[40]
FSHRFSH receptorHypergonadotrophic hypogonadism and ovarian hyperstimulation syndrome
FSHBFollitropin subunit betaDeficiency of follicle-stimulating hormone, primary amenorrhoea and infertility
FOXL2Forkhead box L2Isolated premature ovarian failure (POF3) associated with BPES type I; FOXL2
402C --> G mutations associated with human granulosa cell tumours
FMR1Fragile X mental retardationPremature ovarian failure (POF1) associated with premutations
GNRH1Gonadotropin releasing hormoneNormosmic hypogonadotrophic hypogonadism
GNRHRGnRH receptorHypogonadotrophic hypogonadism
KAL1Kallmann syndromeHypogonadotrophic hypogonadism and insomnia, X-linked Kallmann syndrome (KAL1)
KISS1R ; GPR54KISS1 receptorHypogonadotrophic hypogonadism
LHBLuteinizing hormone beta polypeptideHypogonadism and pseudohermaphroditism
LHCGRLH/choriogonadotrophin receptorHypergonadotrophic hypogonadism (luteinizing hormone resistance)
DAX1Dosage-sensitive sex reversal, adrenal hypoplasia critical region, on chromosome X, gene 1X-linked congenital adrenal hypoplasia with hypogonadotrophic hypogonadism; dosage-sensitive male-to-female sex reversal
NR5A1; SF1Steroidogenic factor 146,XY male-to-female sex reversal and streak gonads and congenital lipoid adrenal hyperplasia; 46,XX gonadal dysgenesis and 46,XX primary ovarian insufficiency
POF1BPremature ovarian failure 1BHypergonadotrophic, primary amenorrhea (POF2B)
PROK2ProkineticinNormosmic hypogonadotrophic hypogonadism and Kallmann syndrome (KAL4)
PROKR2Prokineticin receptor 2Kallmann syndrome (KAL3)
RSPO1R-spondin family, member 146,XX, female-to-male sex reversal (individuals contain testes)
SRYSex-determining region YMutations lead to 46,XY females; translocations lead to 46,XX males
SOX9SRY-related HMB-box gene 9Autosomal 46,XY male-to-female sex reversal (campomelic dysplasia)
STAG3Stromal antigen 3Premature ovarian failure[41]
TAC3Tachykinin 3Normosmic hypogonadotrophic hypogonadism
TACR3Tachykinin receptor 3Normosmic hypogonadotrophic hypogonadism
ZP1zona pellucida glycoprotein 1Dysfunctional zona pellucida formation[42]

By location[edit]

Hypothalamic-pituitary factors[edit]

Ovarian factors

Tubal (ectopic)/peritoneal factors

Further information: Tubal factor infertility

Uterine factors[edit]

Previously, a bicornuate uterus was thought to be associated with infertility,[51] but recent studies have not confirmed such an association.[52]

Cervical factors[edit]

Vaginal factors[edit]

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Fibroid Tumors

Fibroid Tumors Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called l...

  • Infertility
    Infertility Factors relating to male infertility include: [6] Pre-testicular causes [ edit ] Pre-testicular factors refer...
  • Sexual Problems
    Sexual Problems