FOLLICULAR TRACKING IN INFERTILITY INVESTIGATIONS

FOLLICULAR TRACKING IN INFERTILITY INVESTIGATIONS



FEMALE FACTOR INFERTILITYInfertility is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual intercourse (using no birth control methods).
Female factor infertility means infertility of a couple because of a problem in the female's reproductive system. The main causes of female factor infertility are ovulation disorders, tubal disease and endometriosis.

===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM


INDICATIONS FOR FOLLICULOMETRY[1] Monitoring ovulation for infertility checks
[2] To rule out ovarian failure
[3] To rule out anovulatory cycle
[4] To rule out Luteinised follicular syndrome
[5] Gender selection
[6] IUI and IVF [assisted reproduction]

OVARIAN FAILURE FACTORThe diseases of the ovary which most frequently cause infertility are: anovulation from follicular atresia, the empty follicle syndrome, the luteinized unruptured follicle syndrome; chronic anovulation syndromes, within which polycystic ovarian syndrome plays a major role; ovarian endometriosis.
Sonography and Color Doppler US are the first choice procedures in the monitoring of ovarian cycles, which combined with serum hormone values, are able to identify possible changes in the physiologic sequence of the cycle. In follicular atresia, ovaries with minute follicles (3mm or less) and early disappearance of primary follicle are observed on sonography. The empty follicle syndrome characterized by the lack of oocytes within the primary follicle, is of difficult sonographic diagnosis, a possible sign being the missed visualization of cumulus oophorus. The luteinized unruptured follicle syndrome consists in the absence of oocyte expulsion from primary follicle persisting more than 48 hours after LH blood peak.

THE OVARY
The ovary is an ovum-producing reproductive organ, often found in pairs as part of the vertebrate female reproductive system. Ovaries in females are homologous to testes in males, in that they are both gonads and endocrine glands.
Ovaries are oval shaped and, in the human, measure approximately 3 cm x 1.5 cm x 1.5 cm (about the size of a Greek olive). The ovary (for a given side) is located in the lateral wall of the pelvis in a region called the ovarian fossa. The fossa usually lies beneath the external iliac artery and in front of the ureter and the internal iliac artery.
Each ovary is then attached to the fimbria of the fallopian tube. Usually each ovary takes turns releasing eggs every month; however, if there was a case where one ovary was absent or dysfunctional then the other ovary would continue providing eggs to be released.

===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM


1. OOGENESISThe female germ cells, called oogonia, lodge in the outer layer, or cortex, of the ovary. They divide rapidly and at the fifth month of a female fetus's life number up to 6-7 million cells. At that time, they begin maturation and are now called primary oocytes, eventually maturing to become primordial follicles. At birth, a female baby will have 2-4 million primordial follicles. In terms of numbers, birth is the high point, as many of the follicles will degenerate so that, by puberty, a woman will have, on average, about 400,000 of these follicles in her ovaries. It has been generally accepted that these are all the germ cells a woman has for her lifetime because these cells have not been known to multiply during life the way the spermatogonia do. Although there is one recent article that suggests that germ cells in the ovary may be able to regenerate later in life, in humans, for all practical purposes "what you have at birth is what you get for life" is still the case.

2. FOLLICLE DEVELOPMENT
Throughout female life from the onset of menstruation (menarche) to menopause, a small number of these primordial follicles are constantly beginning development. At puberty, hormones from the hypothalamus and pituitary glands in the brain will start to influence ovarian function. Without these hormones, the follices will not survive. The names of the hormones: gonadotropin releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinizing hormone (LH).

3. OVULATIONWith respect to the ovary, the menstrual cycle is divided into two phases: the follicular phase and the luteal phase. The follicular phase is dominated by the development of the follicle under the influence of FSH, while the luteal phase is dominated by another pituitary hormone, luteinizing hormone (LH). LH and FSH cause the production of prostaglandins and enzymes that disrupt the follicle and release the ovum, or egg, from the ovary. This release into the peritoneal space at the open fringed end of the fallopian duct is called ovulation.


OVARIAN FOLLICLESOvarian follicle is the basic unit of female reproductive biology and is composed of roughly spherical aggregations of cells found in the ovary. They contain a single oocyte (aka ovum or egg). These structures are periodically initiated to grow and develop, culminating in ovulation of usually a single competent oocyte. These eggs/ova are only developed once every menstrual cycle (i.e, once a month).

GRAFFIAN FOLLICLEA mature ovarian follicle in which the oocyte attains its full size and the surrounding follicular cells are permeated by one or more fluid-filled cavities. Also called secondary follicle, vesicular ovarian follicle.The Graafian follicle is characterized by a large, fluid-filled antrum, and an eccentric oocyte. The granulosa cells can be divided into two groups; the zona granulosa is a thin layer along the periphery of the follicle and the corona radiata surrounds the oocyte. The oocyte has undergone the first meiotic division, giving rise to a secondary oocyte and the first polar body. The secondary oocyte is now arrested in metaphase of the second meiotic division and will so remain until fertilization. The first meiotic division appears to be initiated by LH acting on granulosa cells, however the exact mechanism of action is unknown. The Graafian follicle represents the final stage of follicular development before ovulation.
The Graafian follicle is identified by the large antrum , and the corona radiata that surrounds the actual oocyte and projects into the antrum
CUMULUS OOPHORUS: a mass of follicular cells surrounding the oocyte in the vesicular ovarian follicle.


===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM


FOLLICULAR TRACKING BY ULTRASOUNDUltrasound Folliculometry is a serial Transvaginal ultrasound scan test carried out to monitor follicular growth . Follicular growth can be best monitored by ultrasound , providing 40–70% effectiveness. Folliculometry is one of the most accurate method for determining ovulation. Ovulation scans allow us to determine accurately when the follicle matures; and when it ruptures. Daily scans are done to visualize the growing follicle, which looks like a black bubble on the screen. Other useful information which can be determined by these scans is the thickness of the uterine lining - the endometrium. The ripening follicle produces increasing quantities of estrogen, which cause the endometrium to thicken. We can get a good idea of how much estrogen the patient is producing (and thus the quality of the egg) based on the thickness and brightness of the endometrium on the ultrasound scan.

In a normal ovarian cycle, a single follicle begin to mature under the influence of the gonadotrophic hormone FSH and LH. The follicle appears sonographically as a vesicular echo free structure on the ovary. While some small follicles from 0.4 to 0.6cm in diameter can usually be seen in both ovaries during the initial days of the cycle, a follicle on one of the ovaries become dorminant starting about day 10, enlarging to a diameter of approximately 1 cm. That follicle grows at an almost linear rate of 2 to 3mm per day over the next 4 to 5 days reaching a size of 18 to 24mm just before ovulation. The follicle may have a somewhat elliptical shape initially , but the preovulatory follicle is generally round.
Research found a good correlation between follicular size by ultrasound and the serum estradiol level .
In folliculometry the follicle diameter is determined by measuring the internal diameter of the follicle in three planes [ long, transverse, anterior-posterior] and taking the average of these diameters.
Sonographic follicular monitoring is started on about 6 to 8 days of the menstrual cycle, on day 10 when the dormant follicle presumably has reached a minimum size of 1cm. The scans are repeated at intervals of 1 to 2 days until ovulation is detected.
Occassionally the Cumulus Oophorus can be identified with a high resolution scanner shortly before ovulation. It appears as a peripheral circular feature within the follicular wall.
During folliculometry [transvaginally] we should make an effort to see the Cumulus mass. When a cumulus mass is seen, it can be taken as evidence of a sign of maturity of that particular follicle and oocyte. Cumulus visualization by ultrasound appears to be an indicator for mature oocytes and successful fertilization. Follicles in which the cumulus cannot be visualized are unlikely to contain mature oocytes or oocytes in which fertilization is achieved.
Normally ovulation is not expected to occur until the follicle has reached a size of 1.7cm.

Once ovulation has occurred , various sonographic changes maybe observed
[1] Complete disappearance of the cystic structure in the ovary.
[2] Collapse of the cystic structure with a decrease in its diameter.
[3] A cystic mass with internal echoes [the corpus hemorrhagicum]
[4] The presence of follicular fluid in the cul de sac.

Serial ultrasound examinations cannot only demonstrate normal follicular development. These include failure of the follicle to mature.
Defficient growth of the follicle and Luteinized unruptured follicle syndrome.


COMPLICATIONS
OVARIAN HYPERSTIMULATION SYNDROME

Ovarian hyperstimulation syndrome (OHSS) is a common
complication in assisted reproductive technologies. It is seen
to occur in ,10% of the treatments, and the severe form is
observed in 0.5–2% of IVF cycles . OHSS
is usually described by enlarged multicystic ovaries, ascites
and haemoconcentration. Acute renal failure due to a hypovolaemic
state following production of protein-rich ascites in
patients with OHSS .
Even though the complication risk related to IVF is low,
one should be aware of a possible compression or damage to the ureters with subsequent development of acute renal failure.


===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM

JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria, offer comprehensive infertility screening tests for both couples like Transvaginal Scan for uterine and ovarian functions,Ovulation/follicular tracking, HSG to evaluate the fallopian tubes, blood tests for hormone check, semen analysis etc. We also offer a simple assisted reproductive procedure like INTRAUTERINE INSEMINATION [IUI].

For accurate assessment of your fertility situation, contact us at JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria.

For FREE Consultation and FREE Counseling. Also for Quality and Accurate Medical Diagnostic Tests Contact

JOAS MEDICAL DIAGNOSTIX

JOAS MEDICAL DIAGNOSTIX-------WE ARE AN ULTRAMODERN MEDICAL IMAGING CENTER. WE ARE EXPERTS IN ULTRASOUND SCAN SERVICES, 3D/4D COLOUR DOPPLER SCAN SERVICES, X-RAY/RADIOLOGY SERVICES, ECG SERVICES, INFERTILITY SERVICES, HSG SERVICES, LABORATORY SERVICES,BLOOD BANKING SERVICES , DNA SERVICES, AND HEALTH CONSULTANCY/COUNSELLING SERVICES.

We are located at

JOAS HOUSE, 2, Okesuna Street,

Opposite The Synagogue Church Busstop,

Bolorunpelu, Ikotun, Lagos

Postcode: 100265

Nigeria.  

TEL:

08032509975,

08184590752,

08058166504,

08064981455

EMAIL:

joasmedicaldiagnostix@yahoo.com

joasmedicaldiagnostix@gmail.com

DISCLAIMER

The contents, blogs and postings provided in this site are offered strictly for informational purposes only and should not be construed as legal, medical nor financial advice on any matter. We have made every effort to ensure the accuracy of the information presented, and if you have any questions regarding the contents please contact us.

The informations provided in this site is subject to change without notice.

This site may contain links to other internet sites, we are not responsible for the privacy, practices nor the content of such sites, nor their relationships

FEMALE FACTOR INFERTILITY

FEMALE FACTOR INFERTILITY

She looked at me in desperation, as if to say ‘’Give me a child now or I die here, because I cannot go home without one. I cannot afford to fail the second time’’.
Her case is like the plight of so many infertile African women.
She had been married to her first husband for over 10 years without giving him a child. When the man got tired of waiting , he decided to test his manhood by playing an away game with his secretary, and scored, she became pregnant for him.
As if that was not enough problem for the poor lady, her mother in-law and sisters in-law came over , beat her thoroughly then threw her out of her matrimonial home to make way for the new pregnant secretary/wife to take over.
Luckily she was such a pretty and desirable lady, so not long she had remarried to another man.
She is now married to her new husband for 4 years without giving him any child.
Now she is desperate.

===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM


INFERTILITY: is usually defined as no pregnancy after one year of unprotected intercourse. This is a relative measurement. Over time, many couples may achieve pregnancy. In five years, nearly one half of "infertile" couples will conceive.

SUBFERTILITY: is used to describe gradations between normal fertility and sterility, often used interchangeably with infertility.

FECUNDABILITY: is the pregnancy rate from one menstrual cycle. The normal rate in humans is 20%. Seventy-five percent of normally fertile couples are expected to have conceived in six months and almost 100% by one year.

STERILITY: is the absolute inability to procreate: an absent uterus in women, absent testes in men. In years past, a woman with blocked fallopian tubes or man with an obstructed vas deferens would be sterile. But with assisted reproductive technology (ART), this is no longer the case.Normal fertility can be considered from several different points of view: the couple, the female and the male. In this article, we are going to look at female fertility: the biological steps and mechanisms, the defects, the causes of the defects and what to do.

THREE BASIC QUESTIONSThere are really three basic questions that have to be answered when doctors try to determine why a woman is having problems getting pregnant.
[1]Is she ovulating?
[2]Is there a clear passage from the ovary to the uterus?
[3]How old is she?
A similar set of questions has to be answered in men. Is there sperm? Can it be delivered to the female? Is the sperm normal? In the male these questions are answered in a preliminary and rather thorough way by semen analysis. With women the process is more complicated.

FEMALE INFERTILITYFemale factor infertility is the inability to conceive or carry a pregnancy to term due to one or more problems specific to females. For example, if a couple is struggling to achieve pregnancy and the male has adequate sperm count, motility, and shape, but the woman has polycystic ovarian syndrome, then their inability to conceive is likely due to female factor infertility.

FEMALE FERTILITY PROBLEMS
There are several conditions that contribute to female factor infertility, including uterine and pelvic abnormalities, secondary infertility, polycystic ovarian syndrome, and hostile cervical mucus. It is important to understand, however, that infertility, whether male infertility or female infertility, is not the same thing as sterility - conception and successful pregnancy are possible in many cases. Likewise, secondary infertility (the inability of a couple to conceive after having already achieved a successful pregnancy or pregnancies) can often be treated.
[1] Abnormal Uterine/Pelvic Area
[2] Blocked Fallopian Tubes
[3] Endometriosis
[4] Hostile cervical mucus. This is a condition in which the cervical mucus creates a thick barrier that sperm cannot penetrate.
[5] Irregular Ovulation
[6] Medications/Contraceptives and Infertility
[7] Polycystic Ovarian Syndrome
[8] Premature Ovarian Failure
[9] Uterine Fibroids
[10] High levels of the hormone prolactin
[11] Galactorhoea (milk leaking from the breasts).
[12] Amennorhoea [absence of periods]
[13] The production of sperm antibodies (when a woman develops antibodies to her partner’s sperm).

===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM


INFERTILITY AFTER MISCARRIAGEThe termination of a pregnancy is devastating to couples who wish to have a baby; worse yet is the prospect of female infertility after miscarriage. Unfortunately, such a fate is possible. This form of female factor infertility can be caused by hormonal, environmental, immunological, and even physiological problems. There is hope, however, with treatment from a female fertility specialist.

SECONDARY INFERTILITY
Sometimes female infertility occurs after a woman has already given birth to one or more children. If a couple has already successfully conceived and delivered before, but is having difficulty becoming pregnant again, they may be experiencing secondary infertility.Secondary infertility can be caused by a wide range of issues, including age, irregular ovulation, endometriosis, hostile cervical mucus, and an abnormal uterus or pelvis. Scar tissue from the previous pregnancy may be causing blockage to the fallopian tubes or cervix, resulting in female factor infertility.

INFERTILITY CAUSED BY ABORTION
There is a risk of becoming infertile after an abortion, arising from various complications. If you have had a first trimester abortion (in the first 13 weeks) this is done by vacuum suction which can cause perforation of the womb. This is when the womb ruptures and causes internal bleeding. It is life threatening and the surgeon would be required to do additional surgery to repair the damage. Sometimes after this has occurred, the damage to the womb prevents another embryo from attaching. Rupture happens in about 1% of cases, so if 100 women had an abortion, one of them would have this problem.The main abortion complications that could cause infertility:90% of abortions are done in the first trimester. However, a late abortion frequently requires a material called laminaria to dilate the cervix. This makes the passage large enough to allow a suction tube to be inserted. The laminaria could weaken the cervix and conceivably cause infertility.If the physician scrapes too hard, the lower lining of the uterus can be removed. This is extremely rare.An untreated infection can scar the uterus and cause later fertility problems. The infection rate for first trimester abortions is less than 1%. Most women monitor their body temperature after an abortion to detect if an infection has occurred. Early detection should prevent any problems.
A woman who already have gonorrhea or chlamydia are very likely to suffer pelvic inflammatory disease which causes infertility. They are particularly susceptible to damage from PID after an abortion. This can be avoided by obtaining a STD test before the abortion.The suction tube can perforate both the uterus and a large blood vessel or intestine. If the latter happens, then surgery may be required. The surgery can cause infertility. Perforation of the uterus is also quite rare.
It would seem that if the physician is competent, and the woman monitors her body temperature after the procedure, that the chances of an abortion causing later infertility is quite remote.

CAUSES AND MECHANISMS OF FEMALE INFERTILITYThe main causes of female factor infertility are ovulation disorders, tubal disease and endometriosis. In a population of infertile couples, if you consider unexplained and male factor infertility at about 25% each, ovulatory disorders and tubal factors would be about 20% each and endometriosis 5-10%, with small percentages for uterine/cervical problems.3

The history and physical exam offer us many hints about the cause of infertility :


===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM


FEMALE INFERTILITY WORK-UP: HISTORY AND PHYSICAL EXAMINATION.

HISTORY[1]Systemic illnesses: weight gain, weight loss
[2]Cancer, chemotherapy, radiation treatment, surgery
[3]Urogenital system: surgery: D & C, laparoscopy
[4]Pregnancy: outcome
[5]Menstruation: regular, irregular, absent
[6]Pelvic pain, dysmenorrhea, dyspareunia
[7]Sexual history: function, sexually transmitted disease, pelvic inflammatory disease
[8]Endocrine history: diabetes, thyroid disease

FAMILY HISTORYInfertility, cystic fibrosis, endometriosis

MEDICATIONS AND DRUGS
Prescription: endocrine, psychoactive, anti-hypertensive

PHYSICAL EXAMINATION
[1]Height & weight, neck, arms (carrying angle)
[2]Skin: hirsuitism
[3]Breasts: galactorrhea
[4]Abdomen: girth, adiposity
[5]Mass Pelvic exam: uterus, ovaries, pelvic mass, tenderness Genital ulcers, warts

QUESTIONS AND ANSWERS
[1]IS SHE OVULATING?Defects in ovulation comprise about 25% of female fertility problems. The biggest clue that ovulation is occurring is the presence of regular menstrual periods. Regular periods are almost always associated with ovulation. Irregular or scanty menstruation (oligomenorrhea) or absent periods (amenorrhea) have to be investigated by your doctor.It is impossible to describe all the conditions that affect ovulation, but let me hit the highlights and give you some examples of the mechanisms involved. Causes for ovulatory defects can be genetic, as in Turner's syndrome, or hormonal, as in prolactinoma or the polycystic ovary syndrome (PCOS). Deficient or excessive body fat can also lead to hormonal changes that stop ovulation.


[2]IS THERE A CLEAR PASSAGE FROM THE OVARY TO THE UTERUS?The two main conditions that can affect the fallopian tubes are endometriosis and tubal infection.

[A] ENDOMETRIOSISIn this condition, implants of endometrial tissue are found outside the uterine cavity, primarily in the pelvis, on the ovaries, tubes, body linings and adjacent organs of the GI and GU tracts. This extra endometrial tissue responds to cyclical estrogen and progesterone in the same way the uterine endometrium does -- proliferating, swelling and bleeding. The implants can invade the surrounding tissues, affect nerve endings, and cause scarring and adhesions on adjacent peritoneal surfaces. The most common symptoms of endometriosis are pelvic pain, painful periods (dysmenorrhea) and painful sexual intercourse (dyspareunia). These symptoms generally coincide with menstruation but can become chronic. That said, there are women who have had no complaints at all and are found to have endometriosis at laparoscopy or surgery.

[B] PELVIC INFLAMMATORY DISEASE [PID] / SALPINGITIS
PID is the most common cause of tubal factor infertility. The infection involves the upper genital tract (the uterus, the fallopian tubes and the ovaries) and structures around these organs. The infection of the fallopian tube (salpingitis) is the most crucial element causing infertility. The fallopian tube is lined with special, ciliated cells that direct the egg toward the sperm and the fertilized egg into the uterine cavity. Infection can destroy these cells and distort and/or block the tube.
The main bacterial culprits are Neisseria gonococcus (NG) and Chlamydia trachomatis (CT). NG is directly kills the special cells; CT probably destroys cells through immunological mechanisms. With the infection, the tubes can become thickened, distorted and blocked. Abscesses can form between the tube and the ovary or in the adjacent pelvis, and can be life threatening. This condition requires prompt, broad-spectrum antibiotic treatment. Interestingly, in about half of cases of tubal infertility secondary to PID, there is no history of acute infection. Chlamydia in particular can linger in the genital tract, causing ongoing subclinical damage. Chronic pelvic pain, infertility and ectopic pregnancy (where the pregnancy develops in the tube instead of the uterus) are the serious consequences of PID.


[3]HOW OLD IS SHE?
Fertility decreases with age. Nationally, in assisted reproductive technology facilities, live birth rates are 37% for women <35>42. As mentioned earlier, there are only so many primordial follicles present in the ovary at birth and they decrease steadily until the time of menarche, from 2-4 million to 400,000. With every cycle, primordial follicles are lost. As women age, more chromosomal abnormalities occur during cell division of the ova. The decreasing numbers of follicles, cycles without ovulation (anovulatory) and poor quality of the ova all combine to diminish the chances of older women, especially after age forty, becoming pregnant.While age is the strongest predictor of a women's ovarian function, there are some tests that are also helpful. They are the follicle count, which is determined by ultrasound, and blood tests for follicle stimulating hormone (FSH) and estradiol. All these tests are performed on or about the third day of the menstrual cycle. Follicle count is used because the number of small follicles seen on Day 3 gives a good idea about ovarian reserve.The hormone levels give indirect evidence about ovarian reserve because inhibin, secreted by cells of the follicles, effects the hormone FSH. As the follicle number diminishes, there are fewer cells producing inhibin and FSH increases. As the specialized cells, called granulosa cells, continue to diminish, ovarian estrogen decreases despite elevated FSH. A high FSH and a low estrogen indicate severe loss of follicles.
<35>
<35>
<35>===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM



INFERTILITY DIAGNOSTIC TESTS
The Female Work-up (Diagnostic Tests)

[1] ULTRASOUND : Ultrasound scan is a simple and easy outpatient procedure to examine the internal reproductive organs. It can clearly show the position and size of uterus, endometrial lining and the ovaries. Certain abnormal conditions such as fibroid, double uterus and ovarian cyst can be diagnosed through ultrasound scan alone. In addition, ultrasound scan can be used for the diagnosis of ovulation.
Ultrasound scan appears as a routine practice in the management of infertility, from the initial stages of diagnosis of the cause of infertility, to the eventual confirmation of pregnancy, including routine monitoring of early pregnancy. Ultrasound scan is probably the most important test in investigation of infertility. A well-preformed and detailed ultrasound scan of the female pelvis will give more information than any other single test.
Ultrasound is the only definitive way to tell you have ovulated. Especially TRANSVAGINAL ULTRASOUND SCAN. This can tell if you have LUFS (Lutenized Unruptured Follicle Syndrome), which looks exactly like you are ovulating in every way except the egg is not released.

[2] HORMONAL BLOOD TESTS: perform some basic hormone blood tests. Here is a list of the common blood tests performed. FSH (Follicle Stimulating Hormone)LH (Lutenizing Hormone)EstrogenProgesterone
including estradiol, inhibin B, Pooled progesterone, prolactin,thyroid stimulating hormone, testosterone.

[3] POSTCOITAL TEST: This test will tell if you and your partner's cervical mucus and sperm are compatible. During the fertile time of your cycle, the doctor will take a sample of the female's cervical fluid withintwo hours of intercourse. If the sperm survive and move forward in the cervical fluid, you will know the sperm andcervical mucus are compatible.

[4] HSG (Hysterosalpingogram) : This is a Special X-Ray examination. This will tell if your fallopian tubes are open by injecting dyethrough the cervix. Blocked tubes and lesions or polyps on the uterine cavity can be foundwith this method.

TRANSVAGINAL ULTRASOUND SCAN
Definition
Transvaginal ultrasound is a imaging technique used to create a picture of the genital tract in women. The hand-held device that produces the ultrasound waves is inserted directly into the vagina, close to the pelvic structures, thus often producing a clearer and less distorted image than obtained through transabdominal ultrasound technology, where the probe is located externally on the skin of the abdomen.
Purpose
Transvaginal ultrasound can used to evaluate problems or abnormalities of the female genital tract. It may provide more accurate information than transabdominal ultrasound for women who are obese, for women who are being evaluated or treated for infertility , or for women who have difficulty keeping a full bladder. However, it does provide a view of a smaller area than the transabdominal ultrasound.

Types of conditions or abnormalities that can be examined include:
[a]the endometrium of women with infertility problems or who are experiencing abnormal bleeding
[b]sources of unexplained pain
[c]congenital malformations of the ovaries and uterus
[d]ovarian cysts and tumors
[e]pelvic infections, such as pelvic inflammatory disease
[f]bladder abnormalities
[g]a misplaced IUCD (intrauterine contraceptive device)·
[h]other causes of infertility
Transvaginal ultrasound can also be used during pregnancy. Its capability of producing more complete images means that it is especially useful for identifying ectopic pregnancy, fetal heartbeat, and abnormalities of the uterus, placenta, and associated pelvic structures.


FOLLICULOMETRY [ULTRASOUND]
Ultrasound Folliculometry is a serial Transvaginal ultrasound scan test carried out to monitor follicular growth . Ovulation/Follicular growth can be best monitored by ultrasound folliculometry, providing 40–60% effectiveness.
Folliculometry is one of the most accurate method for determining ovulation. Ovulation scans allow the doctor to determine accurately when the egg matures; and when you ovulate. This is often the basic procedure for most infertility treatment since the treatment revolves around the wife's ovulation. Daily scans are done to visualize the growing follicle, which looks like a black bubble on the screen. Most women can see the follicle clearly for themselves - and know by the scans when the egg has ruptured.
Other useful information which can be determined by these scans is the thickness of the uterine lining - the endometrium. The ripening follicle produces increasing quantities of estrogen, which cause the endometrium to thicken.
The doctor can get a good idea of how much estrogen you are producing (and thus the quality of the egg) based on the thickness and brightness of the endometrium on the ultrasound scan. Ultrasound Folliculometry is started from day 6 – 8 counting from the first day of menstruation. Folliculometry is performed every 2 or 3 days in the initial stages and can be done daily from the day 12, till after the follicle ruptures [post ovulation]. So in a routine ultrasound folliculometry the lady could be scanned transvaginally for between 3 to 6 sessions.
<35>
<35>
<35>===> ==> CLICK THIS LINK TO GET FREE ACCESS TO DOWNLOAD THE SECRET FERTILITY SYSTEM

JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria, offer comprehensive infertility screening tests for both couples like Transvaginal Scan for uterine and ovarian functions,Ovulation/follicular tracking, HSG to evaluate the fallopian tubes, blood tests for hormone check, semen analysis etc. We also offer a simple assisted reproductive procedure like INTRAUTERINE INSEMINATION [IUI]. For accurate assessment of your fertility situation, contact us at JOAS MEDICAL DIAGNOSTIX, Ikotun Lagos Nigeria. For FREE Consultation and FREE Counseling. Also for Quality and Accurate Medical Diagnostic Tests Contact JOAS MEDICAL DIAGNOSTIX JOAS MEDICAL DIAGNOSTIX-------WE ARE AN ULTRAMODERN MEDICAL IMAGING CENTER. WE ARE EXPERTS IN ULTRASOUND SCAN SERVICES, 3D/4D COLOUR DOPPLER SCAN SERVICES, X-RAY/RADIOLOGY SERVICES, ECG SERVICES, INFERTILITY SERVICES, HSG SERVICES, LABORATORY SERVICES,BLOOD BANKING SERVICES , DNA SERVICES, AND HEALTH CONSULTANCY/COUNSELLING SERVICES. We are located at JOAS HOUSE, 2, Okesuna Street, Opposite The Synagogue Church Busstop, Bolorunpelu, Ikotun, Lagos Postcode: 100265 Nigeria. TEL: 08032509975, 08184590752, 08058166504, 08064981455 EMAIL: joasmedicaldiagnostix@yahoo.com joasmedicaldiagnostix@gmail.com DISCLAIMER The contents, blogs and postings provided in this site are offered strictly for informational purposes only and should not be construed as legal, medical nor financial advice on any matter. We have made every effort to ensure the accuracy of the information presented, and if you have any questions regarding the contents please contact us. The informations provided in this site is subject to change without notice. This site may contain links to other internet sites, we are not responsible for the privacy, practices nor the content of such sites, nor their relationships

TYPHOID FEVER KILLS AGAIN

TYPHOID FEVER KILLS AGAIN

As a resident of Nigeria, a third world country in Africa, whenever I think of typhoid fever I feel dreadful, especially after the numerous times I myself have falling prey to this highly resistant and recurring illment.
Since typhoid fever seem to be a very popular illment in Nigeria, it never really got to me that it is also a ‘’KILLER DISEASE’’ until it hit very close to me.
Brother A is a very close friend and a fellow church member. I remembered asking about him in Church one Sunday, because he was not in church service that day, and I know him to be a very serious church goer, never missing church service.
Latter that day, I and some church members went to visit him at home, and found him very ill and weak. We quickly rushed him to the nearest General Hospital, where the doctors confirmed that he has typhoid fever, he was admitted and treatment commenced.
The next day I received a call from one of the church members, who informed me that my friend, Brother A has died early that morning, he died from complications of typhoid perforation. That really got to me and up till this day remains with me.

Typhoid fever, also known as enteric fever, is a potentially fatal multisystemic illness caused primarily by Salmonella typhi. The protean manifestations of typhoid fever make this disease a true diagnostic challenge. The classic presentation includes fever, malaise, diffuse abdominal pain, and constipation .Untreated, typhoid fever is a grueling illness that may progress to delirium , obtundation, intestinal hemorrhage, bowel perforation, and death within one month of onset. Survivors may be left with long-term or permanent neuropsychiatric complications.
Typhoid fever is a bacterial disease, caused by Salmonella typhi. It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people.

SYMPTOMS

Typhoid fever is characterized by a sustained fever as high as 40 °C (104 °F), profuse sweating,gastroenteritis, and nonbloody diarrhea. Less commonly a rash of flat, rose-colored spots may appear.
Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells, with eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic Widal test is negative in the first week.
In the second week of the infection, the patient lies prostrated with high fever in plateau around 40 °C (104 °F) and bradycardia (Sphygmo-thermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around 1/3 patients. There are rhonchi in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea-soup. However, constipation is also frequent. The spleen and liver are enlarged ( hepatosplenomegally) and tender and there is elevation of liver transaminases. The Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. (The major symptom of this fever is the fever usually rises in the afternoon up to the first and second week.)
In the third week of typhoid fever a number of complications can occur:

[1]Intestinal hemorrhage due to bleeding in congested Peyer’s patches ; this can be very serious but is usually non-fatal.
[2]Intestinal perforation in distal ileum: this is a very serious complication and is frequently fatal. It may occur without alarming symptoms until septicaemia or diffuse peritonitis sets in.
[3]Encephalitis
[4]Metastatic abscesses, cholecystitis, endocarditis and osteitis
The fever is still very high and oscillates very little over 24 hours. Dehydration ensues and the patient is delirious (typhoid state). By the end of third week the fever has started reducing ( defervescence). This carries on into the fourth and final week.

TRANSMISSION
S typhi has no nonhuman vectors. The following are modes of transmission:
[1]Oral transmission via food or beverages handled by an individual who chronically sheds the bacteria through stool or, less commonly, urine
[2]Hand-to-mouth transmission after using a contaminated toilet and neglecting hand hygiene
[3]Oral transmission via sewage-contaminated water or shellfish (especially in the developing world)


DIAGNOSIS/TESTS
In order to make a typhoid fever diagnosis, a doctor will ask a number of questions about the patient's recent medical and travel history, perform a physical exam, and recommend certain tests. As part of diagnosing a typhoid fever bacterial infection, the doctor will also rule out other causes of possible typhoid fever symptoms, such as viral hepatitis, mononucleosis, and malaria (to name a few).
Diagnosis is made by any blood, bone marrow or stool cultures and with the Widal test (demonstration of salmonella antibodies against antigens O-somatic and H-flagellar). In epidemics and less wealthy countries, after excluding malaria, dysentry or pneumonia, a therapeutic trial time with chloramphenicol is generally undertaken while awaiting the results of Widal test and blood cultures.
The term "enteric fever" is a collective term that refers to typhoid and paratyphoid.

ULTRASOUND SCAN IN THE DIAGNOSIS OF TYPHOID FEVER
In endemic areas like Nigeria, ultrasound findings of hepatomegaly, splenomegaly, ileal and cecal thickening, mesenteric lymphadenopathy and thick-walled gallbladder are diagnostic features of typhoid. Ultrasound can be a non-invasive, economical and a reasonably sensitive tool for diagnosing typhoid when serology is equivocal and cultures are negative. So abdominal ultrasound scan is a vital initial diagnostic tool in assessing typhoid fever. It has also being found to be very useful in areas of typhoid intestinal perforation, because it can locate the site of perforation and also identified fluid collections [peritonitis].


TREATMENT/PREVENTION
Typhoid fever can be treated with antibiotics. However, resistance to common antimicrobials is widespread. Healthy carriers should be excluded from handling food.
In many developing nations, the public health goals that can help prevent and control typhoid — safe drinking water, improved sanitation and adequate medical care — may be difficult to achieve. For that reason, some experts believe that vaccinating high-risk populations is the best way to control typhoid fever.
Two vaccines are currently in use — one is injected in a single dose, and the other is given orally over a period of days. Neither is 100 percent effective, and both require repeat vaccinations.
If you're traveling to an area where typhoid fever is endemic, consider being vaccinated. But because the vaccine won't provide complete protection, be sure to follow these guidelines as well:

[1]Wash your hands. Frequent hand washing is the best way to control infection. Wash your hands thoroughly with hot, soapy water, especially before eating or preparing food and after using the toilet. Carry an alcohol-based hand sanitizer for times when water isn't available.
[2]Avoid drinking untreated water. Contaminated drinking water is a particular problem in areas where typhoid is endemic. For that reason, drink only bottled water or canned or bottled carbonated beverages, wine and beer. Carbonated bottled water is safer than uncarbonated bottled water is. Wipe the outside of all bottles and cans before you open them. Ask for drinks without ice. Use bottled water to brush your teeth, and try not to swallow water in the shower.
[3]Avoid raw fruits and vegetables. Because raw produce may have been washed in unsafe water, avoid fruits and vegetables that you can't peel, especially lettuce. To be absolutely safe, you may want to avoid raw foods entirely.
[4]Choose hot foods. Avoid food that's stored or served at room temperature. Steaming hot foods are best. And although there's no guarantee that meals served at the finest restaurants are safe, it's best to avoid food from street vendors — it's more likely to be contaminated.

To prevent infecting othersIf you're recovering from typhoid, these measures can help keep others safe:

[1]Wash your hands often. This is the single most important thing you can do to keep from spreading the infection to others. Use plenty of hot, soapy water and scrub thoroughly for at least 30 seconds, especially before eating and after using the toilet.
[2]Clean household items daily. Clean toilets, door handles, telephone receivers and water taps at least once a day with a household cleaner and paper towels or disposable cloths.
[3]Avoid handling food. Avoid preparing food for others until your doctor says you're no longer contagious. If you work in the food service industry or a health care facility, you won't be allowed to return to work until tests show that you're no longer shedding typhoid bacteria.
[4]Keep personal items separate. Set aside towels, bed linen and utensils for your own use and wash them frequently in hot, soapy water. Heavily soiled items can be soaked first in disinfectant.

JOAS MEDICAL DIAGNOSTIX Ikotun Lagos Nigeria ,have a well equipped computerised laboratory and also a 4D Colour Doppler Ultrasound Scan. We also have qualified, very experienced and licensed medical laboratory scientists and Clinical Specialist Sonographers. We offer accurate Typhoid Fever Testing like blood and stool cultures, including Widal Tests and General Abdominal Ultrasound Scan. We also offer other laboratory tests. If you suspect you have Typhoid fever or other feverish conditions, contact JOAS MEDICAL DIAGNOSTIX Ikotun Lagos Nigeria.

Regards
Dr. Victor Efughi
Consultant Clinical Specialist Sonographer

For FREE Consultation and FREE Counseling. Also for Quality and Accurate Medical Diagnostic Tests Contact
JOAS MEDICAL DIAGNOSTIX

JOAS MEDICAL DIAGNOSTIX-------WE ARE AN ULTRAMODERN MEDICAL IMAGING CENTER. WE ARE EXPERTS IN ULTRASOUND SCAN SERVICES, 3D/4D COLOUR DOPPLER SCAN SERVICES, X-RAY/RADIOLOGY SERVICES, ECG SERVICES, INFERTILITY SERVICES, HSG SERVICES, LABORATORY SERVICES,BLOOD BANKING SERVICES , DNA SERVICES, AND HEALTH CONSULTANCY/COUNSELLING SERVICES.
We are located at

JOAS HOUSE, 2, Okesuna Street, Opposite Synagogue Church Busstop, Bolorunpelu, Ikotun, Lagos, Nigeria, WestAfrica.

TEL:
+23418112054
+2348023069403
+2348033535729

EMAIL:
joasmedicaldiagnostix@yahoo.com
joasmedicaldiagnostix@gmail.com

http://www.joasdiagnostix.8m.net
http://www.joasmedicaldiagnostix.8m.com
http://www.youtube.com/watch?v=0DqKdifKE7I

DISCLAIMER
The contents, blogs and postings provided in this site are offered strictly for informational purposes only and should not be construed as legal, medical nor financial advice on any matter. We have made every effort to ensure the accuracy of the information presented, and if you have any questions regarding the contents please contact us.
The informations provided in this site is subject to change without notice.
This site may contain links to other internet sites, we are not responsible for the privacy, practices nor the content of such sites, nor their relationships