Sometimes women who are unable to become pregnant visit their doctors for fertility testing. One disorder is found frequently in women: polycystic ovary syndrome. Known as PCOS, the disorder affects between 1 in 10 and 1 in 20 women in their 20s and 30s, according to the U.S. Department of Health and Human Services. Women with PCOS generally have a family member – a mother or sister – with similar symptoms. Doctors believe the disorder may be genetic. Doctors are unsure how PCOS occurs and develops, though they do understand that the disorder affects women’s hormones. Since PCOS is linked with obesity, a woman’s diet could affect her chances of getting PCOS.

There are several factors used in the diagnosis of PCOS. Women generally display one or more of these warning signs: fluid-filled sacs on their ovaries, erratic menstrual periods and a surplus of the androgen hormone.

Cysts, or Fluid-Filled Sacs, on the Ovaries

Dr. Brown can use vaginal ultrasounds to look inside a woman’s pelvis. The sonogram shows him whether or not there are cysts in your ovaries. Women with PCOS have disproportionate hormones that interfere with their menstrual cycles. During a normal menstrual cycle, an egg develops in the ovary, and during menstruation the egg is released. Women with PCOS don’t always develop and release an egg normally. Instead the hormones can cause cysts to form in the ovaries, and these cysts can easily grow in size and number. When women aren’t releasing eggs during each month’s menstrual cycle, the women can have trouble conceiving.

Erratic Menstrual Periods

Tracking periods could help you discover hormone irregularities. If several months go by without your menstrual cycle, or if you have eight or fewer periods annually, this could be a sign of PCOS. Oftentimes women notice these erratic patterns when they’re trying to get pregnant. According to the U.S. Department of Health and Human Services, women with PCOS have higher risks of premature deliveries, miscarriages, high blood pressure and gestational diabetes.

Surplus of Typically Male Hormones

Women with PCOS sometimes have a surplus of androgens. Androgens are called male hormones, but females naturally produce them as well, just in smaller amounts. Because of the overproduction of androgen and sometimes even testosterone, some women with PCOS experience hair growth typical to males. Women who notice body and facial hair should contact their doctors, especially if the hair is on the chest, abdomen, face or around the breasts. Some women show symptoms of thinning hair or receding hairlines. You may also notice increased acne on your face or on your chest and back due to these male hormones. Doctors can test your blood for androgen and testosterone levels to determine if this hormone signals PCOS. Some women with PCOS may not have heightened levels of androgen or testosterone, even though the syndrome is present.

Obesity and PCOS

Many women with PCOS also suffer from obesity – as many as half. Excessive weight can exacerbate PCOS symptoms, and women with PCOS have higher chances of obesity. It’s a downward cycle. PCOS also puts women at higher risks of developing diabetes, as their bodies can produce high levels of insulin. The U.S. National Library of Medicine reports that a 5 percent body weight reduction can help women’s bodies better regulate their hormones. That’s only 7.5 pounds for a 150-pound woman. If you have PCOS, talk with your doctor about the possibility of developing diabetes. Your doctor should have an actionable plan to keep your insulin levels normal.

If these symptoms sound familiar to you, contact Dr. Esteban Brown for a physical examination or visit www.conciveababy.com for more information about PCOS.

Endometriosis is a Common Cause of Pelvic Pain and Infertility in Women

The uterus or womb is lined with tissue, and that lining tissue is called endometrium. During menstruation the extra endometrial tissues are shed. Endometriosis, named from the endometrial tissue, occurs when these tissue cells grow outside of the uterus. Endometriosis is commonly found in the fallopian tubes, the outside of the uterus, the ovaries and the pelvic lining, according to the U.S. Department of Health and Human Services. Endometrial tissue is occasionally found in the cervix, rectum, bowels, vagina, bladder and vulva.

Endometriosis generally affects women in their 30s and 40s, but it can start much earlier.

The disorder is considered common, as it affects between approximately 5 million women in the U.S. The American Society for Reproductive Medicine reports that 24 to 50 percent of women who experience infertility have endometriosis.

The correlation between endometriosis and fertility isn’t fully known. The most obvious reason endometriosis may reduce fertility is the blockage in the fallopian tubes. Endometrial tissue in the tubes may keep the sperm from effectively fertilizing the egg, and it could also inhibit the egg from its regular path down the fallopian tube.

“It is presumed that endometriosis alters the pelvic environment in subtle but important ways,” the ASRM endometriosis fact sheet reports. “Theories include inflammation, altered immune system, hormonal changes, abnormal function of the fallopian tube, or impaired fertilization and implantation.”

Women with endometriosis have double miscarriage rates compared to women without endometriosis. Researchers are evaluating how endometriosis affects prolactin and how the disorder interacts with healthy ovarian activity.
What are the symptoms of endometriosis?

Not all women with endometriosis experience warning signs. Some women only find out they suffer from endometriosis when they are unable to get pregnant. Infertility is the sole sign of endometriosis in approximately a third of endometriosis cases.

Women who experience signs sometimes suffer from severe menstrual cramps, which doctors call dysmenorrhea. Other menstrual-related signs include abnormal spotting, very heavy menstrual periods and long lasting periods. Some women experience pain during or after sex, which doctors call dyspareunia, and others experience painful bowel movements or lower back pain.

How is endometriosis diagnosed?

Doctors use a variety of tests to determine endometriosis in patients. Your health care provider will thoroughly discuss your menstrual history. Women who began menstruating at a young age and women who bleed for more than seven days have higher risks of developing endometriosis. Your doctor will also examine your pelvis and perform a laparoscopy. During a laparoscopy your doctor will check your ovaries, your uterus, your abdomen and your fallopian tubes for any abnormalities. Your doctor will determine whether you have endometriosis from all of these tests.

How do doctors treat endometriosis?

Endometriosis treatment depends on several factors, including your age, the seriousness of your case, and whether or not you want to become pregnant in the future. Women who want to get pregnant will need treatment that eliminates blockages and adhesions caused by endometrial tissue. The treatment will free the paths for sperm and eggs to fertilize normally. The next step of treatment will be to keep the endometriosis from progressing with reduced hormone stimulus.

Women who have any of the endometriosis warning signs should contact a doctor, like Dr. Esteban Brown as soon as possible. Your doctor will be able to thoroughly examine you for endometriosis, and if you have it, your doctor will determine a treatment plan that fits your needs.

Contact Reproductive Institute

A variety of tests can be implemented during the semen analysis. Semen is analyzed for total volume, for pH levels and for liquefaction, or when the semen changes from a thick gel to a thinner liquid. The sperm within the semen sample is tested for shape (morphology), movement (motility) and number of sperm per milliliter (sperm count).

To test semen and sperm, doctors need a semen sample. Men are given space to masturbate privately, and they catch the ejaculate in a sterile sample cup. It’s most common for semen to be analyzed in a laboratory. Sometimes semen can be collected at home, but this method introduces certain factors that may skew the results. The collected semen should be analyzed soon after ejaculation to get the most exact results.

Normal and Abnormal Semen Analysis Results

First, let’s discuss total volume. A normal total volume value is between 2 and 5 milliliters. A sample that is smaller than 2 mL could mean the patient’s body is not producing an adequate amount of fluid. Sometimes, however, the patient’s seminal vesicles produce enough fluid, but the fluid is being blocked. Other times low total volume suggests an issue with the patient’s prostate gland.

Within the sperm sample, doctors also measure sperm count per milliliter. Some doctors regard a sperm count of at least 20 million per mL or more normal, as long as other factors are also normal. Others would rather call a sperm count of between 40 million and 300 million per mL normal. A sperm count of 10 million per mL or fewer is abnormal, and the low count could contribute to a male’s infertility.

Motility describes the sperm’s movement within the sample, and their movement should be forward. This forward movement makes the sperm looks as if they’re swimming through the semen. After an hour of observation, at least 50 percent of the sperm should show normal movement. If more than 50 percent of the sperm can’t swim at all or can’t swim properly, the sample is considered abnormal. Doctors use a scale from 0 to 4 to rate the quality of the sperm’s motion. A rating of 2 or higher is normal.

Morphology describes the sperm’s shape. Normal sperm have one oval-shaped head, one tail, and are appropriately sized. Abnormal sperm include those with more than one head or tail, those with very small heads, those with too-round heads, and those with shortened tails. Any of these factors could inhibit proper swimming or egg penetration. A normal morphology is a rate of at least 30 percent normal sperm within the sample.

A high or low semen pH level can negatively affect fertility. A normal semen pH falls between 7.1 and 8.

 Dr. Brown explained the significance of this testing: “Couples that are both carriers have a 1 in 4 chance of having a baby with the active disease. With cystic fibrosis, for example, 1 in 25 Caucasians, 1 in 46 Hispanics and 1 in 61 African Americans carry the gene for CF. An estimated 1 in 12 African Americans have the sickle cell trait.”

 Because Dr. Brown is committed to helping his patients achieve successful pregnancies that result in healthy babies, Reproductive Institute of South Texas is offering one free in-vitro fertilization (IVF) cycle with preimplantation genetic diagnosis (PGD)* to couples that both test positive with the Natera One™  preconception test for carrier traits that could result in an inheritable disease for the affected child.

“Advanced technology such as pre-implantation genetic diagnosis (PGD) allows us to screen the embryos before the transfer,” explained Dr. Brown. “Any couples that could pass these serious illnesses on can rest easy knowing that their children won’t struggle with that kind of burden.”

Through the Natera One™  test, Dr. Brown can determine whether two partners possess one or more gene mutations in common that could put them at risk of having children with a particular genetic disorder.

“Usually, carriers have no symptoms, so they may not realize they have the gene for a certain disease,” said Dr. Brown. “Certain illnesses only occur when both parents are carriers for the same condition and both individuals pass on the mutation to their offspring.”

In the past, most parents didn’t realize they carried these defective genes until they had a child with the active disease.

“The Natera screening gives any couples that have a family history of CF or other inherited diseases, as well as those concerned about such conditions, the opportunity to have a basic blood test that will analyze genetic makeup and identify risks for passing potential illnesses to their children,” Dr. Brown said.

* Please see www.conceiveababy.com for more information

About the Doctor:

Esteban Ortega Brown, MD began his career by attending prestigious Stanford University, receiving his Bachelor’s degree in Economics in 1979.  He continued his education in medicine from 1979 to 1984 at Baylor College of Medicine in Houston, Texas where he earned his MD. Between 1984 and 1988, he completed his internship and residency at the University of Texas Medical Branch in Galveston, Texas with a specialty in Obstetrics and Gynecology. Dr. Brown received sub-specialty training in Reproductive Endocrinology at the University of Pennsylvania in Philadelphia from 1988-1991. Dr. Brown’s specialization in male as well as female fertility issues is complemented by his sensitive approach toward the unique difficulties men face when confronting their fertility issues.

Awareness for this. Awareness for that.

Read More from Advance News Journal

Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse.

Who gets it?

Infertility is a medical problem. Approximately 30% of infertility is due to a female factor and 30% is due to a male factor.  In the balance of the cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.

What are the risk factors for infertility?

• Weight
• Age
• Sexually Transmitted Diseases (STDs)
• Tubal Disease
• Endometriosis
• DES Exposure
• Smoking
• Alcohol

What are the signs and symptoms?

Often there are no signs or symptoms associated with an infertility problem. Listening to your body and getting regular checkups will help to detect a problem. Early detection and treatment of a problem are often critical in achieving successful pregnancy outcomes later.

How is infertility treated?

Medical technology now offers more answers and treatment options to men and women trying to conceive a child. From hormonal treatments, ovulation induction and Intrauterine insemination to more advanced technologies like in vitro fertilization, ICSI to surrogacy, egg/sperm donation and even embryo donation.

What medications are used?

There are a variety of medications used to treat infertility.  It is important to understand the medications and what their purpose is and to speak with your physician about the medications that will be used in your specific treatment plan.

What is artificial insemination?

Artificial insemination is now more commonly referred to as IUI (intrauterine insemination).  It is a procedure used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. The procedure uses the husband’s or donor’s sperm, washing and treating the sperm, and then injecting it into the woman during the time of ovulation.

What is In Vitro or IVF?

In vitro fertilization (IVF) gets its name from the fact that fertilization occurs outside of the woman’s body, in a lab dish instead of a woman’s fallopian tubes.  Typically, a woman will use ovulation stimulating drugs to produce an excess number of eggs.  These eggs are surgically removed from the woman and fertilized in a dish with sperm. If fertilization takes place, the physician transfers the embryo(s) into the woman’s uterus.

For more information about infertility causes and treatment visit http://conceiveababy.com/

• Infertility affects 7.3 million people in the U.S. This figure represents 12% of women of the childbearing age, or 1 in 8 couples.

• Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or, is unexplained.

• A couple, ages 29-33 with a normal functioning reproductive system has only a 20-25% chance of conceiving in any given month. After six months of trying, 60% of couples will conceive without medical assistance.

• Approximately 44% of women with infertility have sought medical assistance. Of those who seek medical intervention, approximately 65% give birth.

• Approximately 85-90% of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3% need advanced reproductive technologies like in vitro fertilization (IVF)

• The most recently available statistics indicate the live birth rate per fresh non-donor embryo transfer is 41.2% in the woman is under 35 years of age and 31.6% in the woman is age 35-37.

• Fifteen states have passed laws requiring that insurance policies cover some level of infertility treatment. Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.

• Offering a comprehensive infertility treatment benefit with appropriate utilization controls may actually reduce costs and improve outcomes by eliminating the inappropriate use of costly covered procedures and allowing specialists to use the most effective, efficient treatment for a specific type of infertility. (Infertility as a Covered Benefit, William M. Mercer, 1997)

• A study published in the New England Journal of Medicine (August 2002) found that the percentage of high-order pregnancies (those with three or fetuses) was greater in states that did not require insurance coverage for IVF.  The authors of the study noted that mandatory coverage is likely to yield better health outcomes for women and their infants since high-order births are associated with higher-risk pregnancies.

For more information please visit http://conceiveababy.com/

Preimplantation Genetic Diagnosis (PGD) Identifies Embryos with Defective Chromosomes to Improve IVF Success Rates

“Many couples experiencing infertility aren’t aware of advances in reproductive technology that can mean the difference between conception and another failed cycle,” says Dr. Esteban Brown with Reproductive Institute of South Texas. “PGD used in conjunction with IVF can help us identify the most viable embryos, while minimizing the financial burden of repeated cycles.”

A fertility doctor can order a simple blood test or cheek swab prior to fertility treatment to analyze maternal and paternal DNA. If tests reveal an inheritable disease, such as cystic fibrosis, Huntington’s disease or sickle cell disease, embryologists at the Reproductive Institute’s IVF lab can employ targeted PGD to search for that chromosome in a single cell retrieved from an embryo. From the resulting chromosomal information, Dr. Brown can then choose the healthiest embryo to transfer into the uterus for conception.

PGD helps identify genetically unaffected embryos, assuring parents that they will not pass on inheritable diseases to their children. For couples that experience recurrent miscarriages or unexplained infertility, Dr. Brown may cast a wider net and recommend PGS as a screening tool to search for potential causes of infertility in the embryos themselves.

“The IVF lab is the first line of defense for anyone concerned with inheritable or chromosomal abnormalities,” says Dr. Brown. “Embryos with unbalanced chromosomes can fail to implant or result in miscarriage, birth defects or other problems, PGD can greatly reduce uncertainty for couples hoping to start or build a family.”

In some instances, PGD may also assist couples with family balancing, or sex selection of their baby. Genetic traits carried on the X or Y chromosome enable embryologists to differentiate between male and female embryos.

About the Doctor:
Esteban Ortega Brown, MD began his career by attending prestigious Stanford University, receiving his Bachelor’s degree in Economics in 1979.  He continued his education in medicine from 1979 to 1984 at Baylor College of Medicine in Houston, Texas where he earned his MD. Between 1984 and 1988, he completed his internship and residency at the University of Texas Medical Branch in Galveston, Texas with a specialty in Obstetrics and Gynecology. Dr. Brown received sub-specialty training in Reproductive Endocrinology at the University of Pennsylvania in Philadelphia from 1988-1991. Doctor Brown’s specialization in fertility issues is complemented by his sensitive approach toward the unique difficulties couples face when confronting their fertility issues.

These two surgical procedures for male infertility, referred to as TESA or Testicular Sperm Aspiration and MESA or Microscopic Epididymal Sperm Extraction are two methods that are being used as a first line approach for sperm collection with great success in McAllen and surrounding areas of the Valley in Texas.

Dr. Esteban Ortega Brown, medical director and founder of the Reproductive Institute of South Texas explains: “The TESA methodology is effective in instances where the epididymis is enlarged as a result of a vasectomy or other blockage.” The benefits of this approach are that they are relatively painless and do not require an incision in the scrotum or a general anesthetic. The risks of the procedure include bleeding, damage to the epididymis and not being able to obtain sufficient sperm. If these techniques fail, sperm may be found using more advanced methods.

MESA is a technique for collecting sperm that involves using a surgical microscope to open the small tubes within the epididymis to look for sperm. Dr. Brown says “this technique works well in conditions where sperm are being produced in adequate numbers but are blocked from traveling from the testicle to the ejaculate. In a recent analysis of nine cases in our practice, we experienced an 87.5% success percentage in pregnancies in this group of patients.”

Examples of the ‘blockage’ conditions include: a prior vasectomy, prior hernia repair with mesh, blockage of the seminal vesicles, cystic fibrosis, and non motile cilia syndrome. This is the favored approach when harvesting sperm after a vasectomy. “Essentially what it means for men,” explains Dr. Brown “is that they need not fear being infertile as a result of having had a vasectomy or other issues.”

About the Doctor:
Esteban Ortega Brown, MD began his career by attending prestigious Stanford University, receiving his Bachelor’s degree in Economics in 1979. He continued his education in medicine from 1979 to 1984 at Baylor College of Medicine in Houston, Texas where he earned his MD. Between 1984 and 1988, he completed his internship and residency at the University of Texas Medical Branch in Galveston, Texas with a specialty in Obstetrics and Gynecology. Dr. Brown received sub-specialty training in Reproductive Endocrinology at the University of Pennsylvania in Philadelphia from 1988-1991. Dr. Brown’s specialization in male fertility issues is complemented by his sensitive approach toward the unique difficulties men face when confronting their fertility issues.