Health Guide

Health Record provides reliable answers to important health questions. Use this site to learn more about detecting, preventing, and treating a variety of medical conditions.

How Does Human Reproduction Work ?

Written by Mystic on Monday, September 29, 2008

Humans reproduce when two cells (gametes), an egg (ovum) and a sperm, come together. Each gamete contributes half of the genetic material contained in the foetus. The hormones which control the production of sperm and eggs are called gonadotrophins. There are two types of gonadotrophins: Follicle Stimulating Hormones (FSH) and Luteinizing Hormone (LH). These two hormones are produced in a tiny, pea-size gland at the base of the brain called the pituitary gland. In men, they stimulate the testicles to produce sperm and testosterone. In women they act on the ovaries, where the eggs develop, producing the female sex hormones oestrogen and progesterone.

Sperm
Sperm are produced at the rate of about 300 million per day. They take some 80 days to mature. Each sperm has a head, which contains the genetic material, and a tail, which propels it up through the vagina, uterus, and fallopian tubes, to reach and penetrate the egg.

Eggs
In the woman the production of sex hormones and the release of an egg is known as the menstrual cycle. It is counted from the first day of the period ("Day 1"). In an "average" cycle of 28 days, ovulation the release of an egg from the follicle, happens on about day14. However, cycle length varies between women and it is important to note that ovulation and the fertile time occurs earlier in women with short cycles and later in women with long cycles.

At ovulation the egg is released from the ovary and picked up by the fringed end of the fallopian tube. After ovulation the empty follicle produces the hormone progesterone. This prepares the lining of the uterus (the endometrium) to retain an embryo. If an embryo does not implant, the level of progesterone drops and a period starts again. For more information on ovulation, please click here.

Conception
The mature egg survives only 24-48 hours, while sperm remain viable longer. In natural conception sperm is placed inside the vagina at the time of intercourse. The mucus in the cervix (the neck of the uterus) is slippery around the time of ovulation, which enables the sperm to swim into the uterus. The uterus then contracts in such a way as to help the sperm move up into the fallopian tube to reach the egg.

Once a sperm has penetrated the shell surrounding the egg (zona pellucida) it sets up a barrier stopping other sperm from penetrating. When the head of the sperm has released its contents into the egg, the egg is fertilised. The egg then starts to divide and becomes an embryo. Few days after fertilisation the embryo implants in the endometrium and starts to produce Human Chorionic Gonadotrophins (HCG), the hormone that causes a "Positive" pregnancy test.

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Fertility Fitness - the impact of increased weight on fertility

Written by Mystic on Sunday, September 28, 2008

Thirty seven percent of Australians are overweight or obese according to recent Australian Bureau of Statistics data and the number is rising. In addition to the association with cardiovascular disease, diabetes and some cancers, increased weight has now been shown to have an adverse effect on fertility and also increases the risk of miscarriage.

This association was first noted in studies in the 1950's but received little attention until the last decade. Most of the work to date has concentrated on fertility issues in women. As a woman's weight increases she requires higher levels of insulin to maintain a normal blood glucose level. These increased levels impact on the ovary, stopping ovulation and leading to increased male hormone levels. The result is irregular menstrual cycles and fertility problems. Women who have been diagnosed as having polycystic ovaries (PCO) are particularly at risk. Some studies have shown that even women at the higher end of the normal weight range can have their fertility affected.

Increased weight can also impact on the effectiveness of fertility treatments. As a woman's weight increases, she will require more drugs to get the desired response, and in up to 30% of cases, will still not respond well enough for treatment to occur. In addition, despite the increased stimulation, her chance of pregnancy is significantly reduced as a consequence of the effects of the increased weight.

If a pregnancy does occur the risk of miscarriage is increased, with once again women with PCO being particularly at risk.

The good news is that a small amount of weight loss can reverse these problems. An Australian study, which was a world first, has shown that a group programme of exercise and dietary advice, without an emphasis on low calories, can restore menstrual regularity and therefore ovulation and pregnancy for up to 90% of the women involved. Even women with causes of infertility unrelated to producing an egg each month (anovulation), such as tubal blockage or male sperm problems, showed a dramatic improvement in their chance of pregnancy on treatment. In addition, the risk of miscarriage was significantly improved. The women lost a maximum of seven to ten kilograms over six months so it was not necessary to get back to the normal weight range to get the beneficial effects. Even a 2-5% weight change was effective in restoring ovulation.

The study found that lifestyle changes are much easier for women to achieve if they were part of a group of women with the same fertility aims as themselves. Conversely, individual dietary advice and lifestyle management has not been shown to be particularly effective. The advantage of the group programme is that it appears that the weight loss is sustained and therefore it is likely that long-term health benefits will also result.

The programme is currently available to women who live in Sydney, Melbourne or Adelaide. Contact details can be obtained through ACCESS. (link to about Access)

Very little is known as yet about the effects of increased weight on male fertility. We do know that as a man's weight increases his testosterone levels can drop and in extreme situations there is an alteration in the semen profile. A study is now underway to explore this issue further. It is being run in association with the Gutbusters programme. Any overweight men interested in seeing the effects of weight loss on their sperm and hormonal profile can contact Wendy on (02) 9586 3214.

In summary, for women in particular, weight loss should be considered as part of the initial treatment of any woman above her 'weight for height' average, who requires fertility management, irrespective of whether it is as simple as ovulation induction or as complicated as IVF. As anyone who has tried to lose weight knows, getting the bit of your brain that wants to lose weight to connect to the bit that has to do it, is very difficult. However, making use of group dynamics, either with a specific programme associated with a fertility clinic or some other means, has been shown to be most effective in achieving the aims of weight loss, pregnancy and a healthy outcome.

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Trying to Conceive: Infertility

Written by Mystic on Saturday, September 27, 2008

A couple is regarded as infertile when they have not conceived after 12 months of regular, unprotected intercourse. About 15% of couples of reproductive age have a fertility problem. Find that hard to believe? That's because most don't talk about it. Three out of five couples conceive within six months of trying, one in four takes between six months and one year. For the rest, conception takes more than a year, which means that there may be a problem of infertility.

The causes of infertility are many and varied and can be related to male or female issues. They include problems with production of sperm or eggs, problems of the fallopian tubes or uterus; endometriosis, frequent miscarriage; and hormonal and autoimmune (antibody) disorders in both men and women.

In about 40% of infertile couples, the problem is a male factor and in about 40% it is due to a female factor. For the remaining 20%, both partners have an infertility problem, or the cause is unknown ("idiopathic").

There is no evidence that stress causes infertility. There is plenty of evidence, however, that infertility causes stress.

Treatments for infertility include surgery to fix blockages of the fallopian tubes, hormone treatments for either partner, insemination of the woman with the sperm of her partner or a donor, IVF (In Vitro Fertilisation) and related treatments such as GIFT (Gamete Intra Fallopian Transfer). Some people try natural treatments, such as herbs, acupuncture and meditation.

If you are trying to get pregnant , and have not succeeded after a year of trying, you may have a fertility problem, and it is worth seeking medical help.

If you are over 35, and have been trying to fall pregnant without success, it may be a good idea to start checking things out even earlier. Infertility investigations can sometimes take a long time, and if you put off seeking help, you could be leaving it too late.

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Down Syndrome Characteristics

Written by Mystic on Friday, September 26, 2008

Other names :
Mongolism, trisomy 21.


Introduction :
Genetic condition characterised by poor muscle tone, abnormal joint movement, mongoloid shaped face, mental retardation, small nose and other characteristics.


Discovery :
Down was a London physician, who in 1866 first described the condition.


Types :
There are as many different types as there are patients, as all vary to some degree in the severity and characteristics of the syndrome.


Cause :
Down Syndrome is a congenital disease that occurs at the moment of conception, due to the presence of three copies of chromosome 21 instead of two (one from each parent). Thus one of the alternate names for this syndrome is trisomy 21. The other name for the syndrome, Mongolism, comes from the patient’s characteristic facial appearance, which is more like that of the Mongol (Chinese) than European. Contrary to some uninformed opinion, Down syndrome can occur in the Chinese, and is easily identifiable.


Incidence :
Down syndrome occurs at a rate of one in every six hundred births overall, but rises to a rate of two in every hundred for mothers over forty years of age.


Prevention :
There is no method of prevention other than women having their children well before turning forty.


Investigations :
Cells from the child can be examined for characteristic genetic changes to confirm the diagnosis.


Screening :
Diagnosis of the condition in older pregnant women before the birth of the child is possible from the 15th. week of pregnancy by two processes - amniocentesis and chorionic biopsy. In these, samples of cells from the fluid around the baby, or the placenta, are examined under a microscope for the characteristic triple chromosome 21. If this is present, the foetus has Down syndrome.


Course :
The condition can be very easily recognised and diagnosed at birth by observing some of the many characteristics of the syndrome. Infants have poor muscle tone, joints that move further than normal, slanted eyes, a flattened facial appearance, small stature, mental retardation, small nose and a short broad hand. Other characteristics that may be present include a fissured protruding tongue, short neck, widely spaced first and second toes, dry skin, sparse hair, small genitals, small ears, poorly formed teeth, and a squint. Close examination of the hands of these people reveals characteristic finger prints that have a whorl with the loop on the thumb side of the finger tip, only one crease on the palmar surface of the little finger instead of two, a smooth pad at the base of the thumb and a prominent crease across the hand from the web between the thumb and index finger to the other side of the palm.


Treatment :
There is no cure possible, as the abnormal chromosome pattern is present in every cell in the entire body. Treatment involves special education, occupational therapy and physiotherapy. They are otherwise treated medically as normal patients.


Diet :
Some patients have difficulty in eating because of their protruding tongue and require food to be mashed or blended before than can cope with it.


Complications :
Down syndrome patients have a higher incidence of abnormal heart formation, a clouded lens in the eye (cataract), infertility, and leukaemia.


Outcome :
Provided there are no serious heart abnormalities or other complications, the life expectancy of these people is relatively normal. Their intelligence is about 40% that of normal (an IQ of 40), and although there is significant individual variation, almost all require lifelong care from devoted parents, carers or an institution.


Further information :
The Down Syndrome Association has branches in every state offering information and support for the families and carers of people with Down Syndrome.

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Nice Guidelines for Diabetes

Written by Mystic on Thursday, September 25, 2008

Other names :
Diabetes mellitus, sugar diabetes.


Introduction :
An inability of the body to process sugar effectively.


Discovery :
The effects of insulin were discovered in 1921 by Canadian Dr. Frederick Banting and his medical student assistant Charles Best, after experimenting on dogs.


Types :
There are two totally different types of sugar diabetes - juvenile (type one) and mature (type two). Most people who develop juvenile diabetes which requires daily insulin injections, do so as a child or in early adult life. They must use the injections for the rest of their lives, as we do not have a cure for diabetes, only an effective form of control. Older people who develop maturity onset diabetes can often have the disease controlled by diet and tablets (see Medication Table). This is because there is not a lack of insulin, but a lack of response by the cells to the insulin. The tablets make the cell membrane respond to insulin again.


Cause :
Glucose, a type of sugar, is essential for the efficient working of every cell in the body. It is burned chemically to produce the energy for the cell to operate, and is found in most fruit and vegetables. When glucose is eaten, it is absorbed into the bloodstream from the small intestine. It then travels to all the body's microscopic cells through the arteries and capillaries. Once glucose reaches a cell, it must enter across the fine membrane that forms its outer skin. This skin is normally impermeable to all substances, but insulin has the ability to combine with glucose and transport it from the bloodstream, through the cell membrane and into the interior of the cell where it can be used as an energy source for that cell. Insulin is a chemical of very great complexity. It is made in the pancreas, which sits in the abdomen below the stomach. The insulin it produces enters the bloodstream, and is attracted to those cells that are running short of energy and require more glucose. If there is no glucose available because you have not been eating, or because the glucose cannot enter the cell, the cell weakens and eventually stops working altogether. People who lack the insulin necessary to take the glucose into the cells have type one (juvenile) diabetes, and if the insulin is not supplied, they become steadily weaker because their muscles and other organs cannot work properly. There may be very high levels of glucose in their blood stream, but because it cannot enter the cells, it cannot help them. These diabetics therefore require regular supplements of insulin to keep them well. Insulin from pigs and cattle has been available for many decades, and in the last few years, human insulin has been produced by genetic engineering techniques to enable diabetics to lead relatively normal lives. The only problem with insulin is that it cannot be taken by mouth as it is destroyed by acid in the stomach. It must be given by injection two or more times a day. This way insulin enters the blood stream directly and can start transporting the necessary glucose into the cells immediately.


Incidence :
90% of diabetics have the maturity onset (type two) form of the disease. There is an hereditary tendency to developing this type of diabetes, but there is no inheritance in type one diabetes.


Preventio Guideline :
If there is a family history of type two diabetes, patients should ensure that they remain within normal weight limits, and so delay or prevent the onset of the disease.


Investigations :
If you suspect that you may have diabetes, your doctor can perform a simple test on your blood or urine to determine the diagnosis within minutes. More sophisticated blood tests can be undertaken to measure the severity of diabetes, its type and even give a three month average for the blood sugar levels.


Screening :
Urine tests can be simply and cheaply undertaken to detect most cases of diabetes, but wide scale screening is not routine in the community.


Course :
The early symptoms of diabetes are excessive tiredness, thirst, excess passing of urine, weight loss, itchy rashes, pins and needles and blurred vision.


Treatment :
Juvenile diabetes is controlled by regular injections of insulin. Different types of insulin with varying periods of effect are available. Maturity onset diabetics must follow a strict diet and sometimes take medication (see Medication Table) on regular basis every day to control their blood sugar levels. The earlier diabetes is controlled, the better the outcome for the patient, as side effects and body damage are less likely.


Diet :
Diet is essential for all diabetics, because the amount of glucose you eat is not normally constant, and diabetics lack the means of adjusting the amount of glucose in their blood with insulin. As the insulin injections remain at a constant strength, the glucose intake must also remain constant. A diabetic diet has minimal sugar, and is low in fat and cholesterol. Regular, equal sized meals are better than occasional meals off varying size. Fat cells can react abnormally to insulin very easily, and so overweight diabetics must lose weight and remain within certain strict limits. Dietitians can assist diabetics with guidelines on an appropriate diet.


Complications :
Poorly controlled diabetes can cause eye cataracts and visual damage, glaucoma, kidney disease and failure, poor circulation to the feet with ulceration and gangrene, damage to nerves, impotence and an increased risk of all types of infection.


Outcome :
Prior to the isolation of insulin, diabetics died within a few months or years of diagnosis, but today, provided a diabetic is careful in managing their disease, patients can lead a normal length and healthy life.


Further information:
Diabetes Australia is a major charity that is represented in all major towns and cities. It offers education, supplies, support and services for diabetics.


Medical curiosity :
Diabetes has been recognised as a disease for over three thousand years. In ancient Egypt, and up to relatively recent times, diabetes was diagnosed by the physician sipping the patient’s urine and noting its sweet taste. Fortunately for doctors as well as patients, more sophisticated diagnostic tests are now available

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Heartburn: Upset Stomach

Written by Mystic on Wednesday, September 24, 2008

Other names :
Reflux oesophagitis.


Introduction :
Burning pain behind the breast bone caused by reflux of acid from the stomach into the oesophagus.


Types :
May be caused by over indulgence, weakness of the diaphragmatic sphincter of the stomach, a hiatus hernia or other causes of excess acid production.


Cause :
Heartburn is caused by the reflux of hydrochloric acid from the stomach into the lower part of the gullet (oesophagus). If the patient has a hiatus hernia, where part of the stomach slips through into the chest cavity, acid can more easily escape up into the gullet to cause heartburn. A hiatus hernia and heartburn may occur during pregnancy because of the pressure of the enlarging womb and the hormonal effect on muscle tissue in the oesophagus and stomach. The oesophagus (gullet) runs from the throat to the stomach through the back of the chest. At its lower end, it passes through the diaphragm, which is a sheet of muscle that separates the chest from the belly. At the point where it passes through the diaphragm, there is a muscle ring (sphincter), which opens when you swallow food, but remains closed at other times to prevent the concentrated hydrochloric acid in the stomach from coming back up (refluxing) (Upset Stomach ?) into the oesophagus when lying down or bending over. The cells lining the inside of the stomach are made acid resistant by a thick layer of mucus, but those lining the oesophagus lack the protective mucus. If acid (along with food) is able to flow back up into the oesophagus, the acid will attack the unprotected cells, to cause inflammation, ulceration, pain and scarring. This is heartburn or reflux oesophagitis. There are two types of hiatus hernia. In some patients the hernia remains fixed in the one position, but in others, the hernia may slide up and down, depending on the patients position or activity. A large meal may be sufficient to push the overloaded stomach up into the chest. Some babies are unlucky enough to have a defect or temporary weakness in the muscle ring at the bottom of the oesophagus. The reflux of acid into the oesophagus causes considerable pain to the infant. Most children will grow out of the problem, but medication must be given in the meantime to prevent the burning and pain. In adults, factors such as obesity, smoking, over eating, rapid eating, alcohol, stress and anxiety, and poor posture may cause the excessive production of acid in the stomach or slackness in the muscle ring.


Incidence :
Probably five percent of adults suffer from heartburn at least once a week, often following dietary indiscretions. Babies and overweight elderly men are the two groups who are most likely to suffer from reflux oesophagitis.


Prevention :
Lying down, stooping and heavy lifting should be avoided after heavy meals. Meals should be kept small and frequent, rather than the traditional three large meals a day. Smoking will lower the tone of the muscles at the lower end of the gullet, and aggravate heartburn. Overweight patients should shed those extra kilograms to prevent the fat pressing on the stomach. If a hiatus hernia is present, raising the head of the bed is also useful.


Investigations :
When reflux oesophagitis and/or hiatus hernia is suspected, it will be proved by either gastroscopy, in which a flexible tube is passed down into the stomach, and through which a doctor can see exactly what is happening; or by a barium meal, in which a special fluid is swallowed, and its passage into the stomach (and sometimes its reflux back up into the oesophagus) can be followed by a series of x-rays.


Course :
Heartburn has absolutely nothing to do with the heart. The name derives from the sensation of burning pain or warmth behind the lower end of the breast bone. The pain may spread all the way from the top of the stomach to the back of the mouth. The patient may also experience a bitter taste on the back of the tongue, a feeling of fullness, burping as gas escapes easily from the stomach, difficulty in swallowing, bleeding from the damaged part of the stomach, pain from ulceration or pinching of a hiatus hernia, and palpitations if a large hiatus hernia pushes onto the heart. Heartburn is often worse at night, after a large meal and when the patient is lying down, as it is easier in these situations for the acid to flow up out of the stomach. If the attacks of acid reflux are intermittent and mild, the lower end of the oesophagus can recover between each episode, but if the attacks are regular or constant, the pain will become more severe, and significant damage may occur to the area. A hiatus hernia may may be present but cause no symptoms.


Treatment :
Treatment of reflux involves the appropriate advice with regard to losing weight, propping up the head of the bed, having the main meal in the middle of the day, avoiding bending and heavy lifting, stopping smoking and reducing alcohol (nicotine and alcohol relax the diaphragm muscle ring). Medication can be given to reduce the acid concentration in the stomach (antacids) and to act as a foam that floats on the stomach acid to protect the lower end of the oesophagus. Further treatment will involve the use of medication to drain acid out of the stomach, and reduce acid production (cisapride and other ulcer treatments - see Medication Table) Only in severe, resistant cases is it necessary to resort to quite major surgery to treat the problem. Gravity is the most important factor in keeping the stomach in the abdomen rather than the chest, and the acid in the stomach rather than the oesophagus. Bending over to garden or lift, and any heavy lifting are banned. The head of the bed should be elevated, and three or more pillows used to raise the chest higher than the abdomen. Lying on the right side rather than the left, to enhance the drainage of the stomach, can also be tried. In only a very small percentage of patients, who do not respond adequately to the above regimes, should surgery be contemplated. A number of different procedures can be performed. These are major operations, that require a significant time in hospital, but more than 80% of patients obtain a satisfactory result. Babies with reflux are treated with a mixture (eg: Gaviscon) which is given after every feed. More sophisticated treatments (eg: cisapride - see Medication Table) are available for the intractable cases.


Diet :
The pain can be brought on if certain foods are eaten to excess. Common offenders are salad dressings, peppermints, fatty or fried foods, pineapple, citrus fruits, coffee, alcohol and highly spiced foods. Medications such as aspirin and some arthritis treating drugs can also cause heartburn.


Complications :
If ulcers form in the oesophagus because of acid reflux, they may erode down to a vein or artery, and severe bleeding may occur, that in extreme cases may be life threatening. The other main complication is scarring and narrowing of the lower end of the oesophagus, to the point where it may be difficult, or even impossible, to swallow food. Rarely, if left untreated this process may continue to develop into cancer. Long before these advance stages, most patients have sought medical assistance for the problem. The symptoms of a heart attack may be neglected because the patient thinks it is heartburn. This may have fatal consequences.


Outcome :
The majority of patients can have their heartburn controlled if they follow a doctor's advice, and use the appropriate medication.


Medical curiosity :
In the past, patients with heartburn often got worse with treatment rather better because milk and cream soothed the burning, but increased the patient's weight, thus aggravating the heartburn.

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Stress Cause Infertility

Written by Mystic on Wednesday, September 24, 2008

Stress and infertility are intricately linked. There is little evidence that stress causes infertility but it is well known that infertility causes stress.

Stress is a normal part of life - but many would argue that dealing with infertility isn't normal. Finding ways of dealing with the stresses of infertility help a person cope both with the physical treatments and outcomes that occur.

Many see that management of stress is one of the major roles of infertility counsellors. Counselling is not only for those who aren't coping but talking with the unit counsellor can be a positive way of taking back control of the emotional side of infertility.

Counselling is important when someone is in crisis and maybe needs more therapeutic options. It is also useful and sensible to discuss options, outcomes and ways of managing stress as a way of avoiding situations getting too difficult or out of control.

Obtaining information is also a way of taking control. It is easier to cope if you have as much clear accurate information as you feel you need to make your own decisions. The counsellor isn't a clairvoyant who can predict what is going to happen, but by looking at options and thinking about possible outcomes it will be easier to manage feelings at that time. Thus seeking counselling can be proactive.

All Australian infertility clinics provide access to trained counsellors (social workers or psychologists). Some clinics see counselling as more integral to their service than others. In some states counselling is mandatory and in others it is variable. But however it is offered, counselling is of most benefit when it is client motivated ... when people are doing something for themselves and getting what they want from that service.

As everyone who has been there knows, infertility is more than a medical diagnosis. A diagnosis of infertility brings a range of emotions which can be hard to handle at times happens in the midst of and often linked to a lot of other social pressures such as tense work environment, elderly relatives or pregnant friends.

Most people cope with infertility most of the time, but reactions can be surprisingly strong and unexpected when they do hit. Many a person has seen a counsellor to find out if their emotional responses are normal, to get reassurance that others have similar reactions, and to work on coping techniques. This can also be part of the information gathering - finding out how others have coped and what has helped them.

It can be particularly difficult for people who are used to being able to organise their lives to suddenly come to this big problem - infertility. The usual methods of setting goals and steps to achieve them don't work and even more frustration occurs.

Frustration is one of the most common words used to describe infertility. People get annoyed at not being able to achieve what they want and the usual coping mechanisms aren't being effective. However the very nature of infertility often means that all the annoyances, disappointments and fears are bottled up and it helps to let them out by being able to talk.

The private and sensitive nature of infertility means that a person's usual sources of support may be inappropriate or hard to use at this time. Partners who are usually very supportive may be having their own responses to this crisis and aren't able to help each other. Or it maybe too hard to talk because both are too close to the situation.

Likewise it may be difficult to talk with friends and relatives because they don't really understand or their social circumstances are very different. Sometimes because of their very concern and closeness it may be hard to talk for fear of upsetting them as well.

It may be better to talk with someone who is not personally involved, who understands both the technology and the range of emotions, and who has professional training and experience in this area. This may be useful in untangling confused fears and looking realistically at the situation.

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