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What else can I help you with?
What is parakeratosis?
Parakeratosis is a skin condition where the keratinocytes (skin cells) in the outer layer of the skin retain their nuclei, which is unusual as these cells normally lose their nuclei as they move to the skin surface. This can result in a thickened and scaly appearance of the skin. Parakeratosis can be seen in conditions such as psoriasis or chronic dermatitis.
How do you treat Parakeratosis?
I have Amended Orthokeratosis and columnated Parakeratosis. I don't know what that is or how to treat it. I have had it for 2 years now on the bottom of my right foot, and I'm at a loss. PLEASE can you help me. I am 29 years old not sure if that helps... thanks..
If there is Parakeratosis neutophils within the stratum comeum psoriasiform mean?
Psoriasis is a common condition of the skin. Talk with your health care provider about what treatment is recommended given the severity of your disease.
What is the difference between erythema and hyperaemia?
Erythema is the physical sign of redness of an ectodermal structure like skin or the exocervix. It is caused by Hyperemia, which is the presence of increased blood flow to a particular structure. Erythema is a physical sign, while Hyperemia is a physiologic process. Hyperemia can also occur in other parts of the body like in a myocardial infarct.
Is your sheep low in zinc?
Growing lambs require ~30 ppm of zinc in the diet on a dry-matter basis. Classic zinc deficiency (parakeratosis) is more common in other small ruminants (goats), but is occasionally encountered in sheep, particularly if fed excessive quantities of dietary calcium (legumes).
Treatment for parakeratosis skin condition?
I have had perikaratosis for 40 yrs. and have tried everything from burnt motor oil to toe itch medicine . The only thing that relieves it but not cures it is exfoliate soap from Wal-Mart. My arms have itched so bad , I have scratched in my sleep so hard that my arms bled all over the bed. It feel like my nerves are being zinged by an itch bug. I have to wear long sleeve shirts to cover the sores. I even went to the Dr. and got medicine but to no avail. I hope someone finds a cure for this as this is very embarrassing to be asked why are you scratching and what do you have or is it contagious?
Will apples hurt cows?
Apples should only be fed as a treat. Apples are quite high in starch and sugars which can induce bloat. Also, since cattle like swallowing feed whole and cannot bite an apple in half nor chew it like a horse would, they can choke on them causing the animal to suffocate and die. Other concerns in the past have been about cattle coming down with what is called ruminal parakeratosis, which is another term for damage and clumping of the ruminal epithelium, which can cause death in cattle. This condition is only from those animals that have been fed a high-apple diet, not from those that have been fed apples as a treat now and then. Little research, however, has been done in the feeding of apples to cattle, so precaution must be taken when feeding this fruit to ruminants. Apples can actually be fed to cattle as a replacement to corn. They are cheaper to buy by the ton, even though apples are lower in energy (TDN) and higher in crude fibre (CF) than corn is. Check out the related link below for more info.
What is digital pitting?
The digital pitting scar is a common clinical feature in patients with progressive systemic sclerosis (PSS). Its pathogenesis is unclear, but it may result in small ulcerations. The clinical and histological features of these lesions are poorly understood. Eighty-seven patients with PSS were examined at least once per year. Pitting scars were defined as pinhole-sized digital concave depressions with hyperkeratosis. They were seen in 34 cases (39%) and were located not only on the tips of the fingers, but also on the sides, especially on the radial border of the index and middle finger and the ulnar side of the thumb, where they had a linear arrangement. Additional pitting scars were noticed on the dorsal surface of the proximal interphalangeal and metacarpophalangeal joints. Pitting was closely associated with several signs of PSS, e.g. Raynaud's phenomenon, skin thickening or articular involvement (e.g. stiffness, swelling, pain). There was no relationship between the number of pitting scars and the duration of PSS. Biopsy samples were taken of the lesions on the lateral sides of fingers in 3 patients. Histologically, there was a plug-like hyperkeratosis with parakeratosis, homogenized collagen fibers and slight perivascular mononuclear cell infiltration. Calcification and altered collagen fibers were observed in the deep dermis. Although pitting scars of the fingertips may be different from those of the lateral sides of the fingers, both histologically and pathogenetically, they were similar clinically. The scar locations on the fingertips and finger joints (proximal interphalangeal and metacarpophalangeal) suggest that exogenous trauma, vibration injury and/or cold exposure may play a role in their pathogenesis.
What are Reproductive-system-disorders?
Some Female Reproductive disordersPremature Ovarian FailurAlso called: POF, Primary ovarian insufficiencyPremature ovarian failure (POF) is when a woman's ovaries stop working before she is 40. POF used to be called premature menopause. However, POF is not the same as menopause. Some women with POF still have occasional periods. Premature menopause is when periods stop before age of 40. This can be natural or caused by surgery, chemotherapy or radiation. READ MORE http://living4good.blogspot.com/2007/12/women-reproductive-disorders-ovaries.htmlPelvic Inflammatory DiseasePelvic inflammatory disease (PID) is a general term that refers to infection of the uterus (womb), fallopian tubes (tubes that carry eggs from the ovaries to the uterus) and other reproductive organs. It is a common and serious complication of some sexually transmitted diseases (STDs), especially chlamydia and gonorrhea. PID can damage the fallopian tubes and tissues in and near the uterus and ovaries. Untreated PID can lead to serious consequences including infertility, ectopic pregnancy (a pregnancy in the fallopian tube or elsewhere outside of the womb), abscess formation, and chronic pelvic pain. READ MORE http://living4good.blogspot.com/2007/12/pelvic-inflammatory-disease.htmlBacterial VaginosisBacterial vaginosis (BV) is the name of a condition in women where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. It is sometimes accompanied by discharge, odor, pain, itching, or burning. Bacterial vaginosis (BV) is the most common vaginal infection in women of childbearing age. In the United States, BV is common in pregnant women.The cause of BV is not fully understood. BV is associated with an imbalance in the bacteria that are normally found in a woman's vagina. The vagina normally contains mostly "good" bacteria, and fewer "harmful" bacteria. BV develops when there is an increase in harmful bacteria. READ MORE http://living4good.blogspot.com/2009/07/vaginal-infection-bacterial-vaginosis.htmlVaginal AgenesisVaginal agenesis is a congenital disorder of the reproductive system affecting one in 5,000 females. It occurs when the vagina, the muscular canal connecting the cervix of the uterus to the vulva, stops developing because the vaginal plate fails to form the channel.Some patients may have a shorter vagina, a remnant of one or lack of one all together (Mayer-von Rokitansky-Kuster-Hauser's syndrome). With vaginal agenesis, it is not uncommon to have other malformations in the reproductive tract, such as an absent or small uterus.In addition, 30 percent of patients with vaginal agenesis will have kidney abnormalities, the most common of which is the absence of one kidney or the dislocation of one or both organs. The two kidneys may also be fused together, forming a horseshoe-like shape. Approximately 12 percent of patients also have skeletal abnormalities, with two-thirds of this group experiencing problems affecting the spine, ribs or limbs.READ MORE http://living4good.blogspot.com/2009/07/vaginal-agenesis.htmlVaginal drynessVaginal dryness is a common problem for women during and after menopause, although inadequate vaginal lubrication can occur at any age. Symptoms of vaginal dryness include itching and stinging around the vaginal opening and in the lower third of the vagina. Vaginal dryness also makes intercourse uncomfortable.A thin layer of moisture always coats your vaginal walls. Hormonal changes during your menstrual cycle and as you age affect the amount and consistency of this moisture. READ MORE http://living4good.blogspot.com/2009/07/vaginal-dryness.htmlVaginal Yeast InfectionVaginal yeast infection, or Vulvovaginal Candidiasis, is a common cause of vaginal irritation. In addition, 12 to 15 percent of men develop symptoms after sexual contact with an infected partner READ MORE http://living4good.blogspot.com/2009/07/vaginal-yeast-infection.htmlVaginitisVaginitis is an inflammation of the vagina. It is often caused by infections, some of which are associated with serious diseases. The most common vaginal infections areSome vaginal infections are transmitted through sexual contact, but others, such as yeast infections, probably are not. READ MORE http://living4good.blogspot.com/2009/07/vaginitis-is-inflammation-of-vagina.htmlCervical CancerThe cervix is the lower part of the uterus (womb). It is sometimes called the uterine cervix. The body (upper part) of the uterus, is where a fetus grows. The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix. The part next to the vagina is the exocervix (or ectocervix). The place where these 2 parts meet is called the transformation zone. Most cervical cancers start in the transformation zone.Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. There are 2 main types of cervical cancers: squamous cell carcinoma and adenocarcinoma. About 80% to 90% of cervical cancers are squamous cell carcinomas. These cancers are from the squamous cells that cover the surface of the exocervix. Under the microscope, this type of cancer is made up of cells that are like squamous cells. Squamous cell carcinomas most often begin where the exocervix joins the endocervix. READ MORE http://living4good.blogspot.com/2009/07/cervical-cancer-detailed-guide.htmlFor more Female Reproductive Disorders, Visit http://living4good.blogspot.com/search/label/Female%20Reproductive%20SystemMale Reproductive DisordersPenile CancerThe penis contains several types of tissue, including skin, nerves, smooth muscle, and blood vessels. Running through the inside of the penis is a thin tube called the urethra. Urine and semen come out through the urethra. The head of the penis is called the glans. At birth, the glans is covered by a piece of skin called the foreskin, or prepuce. The foreskin is often removed in infant boys in an operation called circumcision.Inside the penis are 3 chambers that contain a soft, spongy network of blood vessels. Two of these cylinder-shaped chambers, known as the corpora cavernosa, lie on either side of the upper part of the penis. The third lies below them and is known as the corpus spongiosum. This chamber widens at its end to form the glans. The corpus spongiosum surrounds the urethra, a tube that carries urine from the bladder through the penis. The opening at the end of the urethra is called the meatus. READ MORE http://living4good.blogspot.com/2007/12/penile-cancer.htmlUrethral StrictureUrethral stricture is an abnormal narrowing of the urethra (the tube that releases urine from the body).CausesUrethral stricture may be caused by inflammation or scar tissue from surgery, disease, or injury. It may also be caused by external pressure from an enlarging tumor near the urethra, although this is rare.Increased risk is associated with men who have a history of sexually transmitted disease (STD), repeated episodes of urethritis, or benign prostatic hyperplasia (BPH). There is also increased risk of urethral stricture after an injury or trauma to the pelvic region. Any instrument inserted into the urethra (such as a catheter or cystoscope) increases the chance of developing urethral strictures. READ MORE http://living4good.blogspot.com/2007/12/urethral-stricture-is-abnormal.htmlRetrograde ejaculationRetrograde ejaculation is when semen goes into the bladder rather than out of your penis during orgasm. Although you still reach sexual climax, you may ejaculate very little or no semen (dry orgasm). Retrograde ejaculation isn't harmful, but it can cause fertility problems.Retrograde ejaculation can be caused by medications, health conditions or surgeries that affect the nerves or muscle that control the bladder opening. If retrograde ejaculation is caused by a medication, stopping the medication may be effective. For retrograde ejaculation due to a health condition or as a result of surgery, treatment with medications may restore normal ejaculation and fertility. READ MORE http://living4good.blogspot.com/2007/12/retrograde-ejaculation.htmlPriapismPriapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.It can occur in all age groups, including newborns. However, it usually affects men between the ages of 5 to 10 years and 20 to 50 years. There are two categories of priapism: low-flow and high-flow. READ MORE http://living4good.blogspot.com/2007/12/priapism.htmlMale Yeast InfectionMale yeast infection is widely misunderstood and is a much overlooked disease today. This report explains their causes, symptoms, and natural treatments without drugs and unwanted side effects. Recent advances have made it possible to eliminate yeast from the body by treating the cause and not just the very uncomfortable effects and symptoms...Most men will go through life never knowing that they have a candida or fungal infection because it is extremely difficult to detect since men are built different than women. Women will get a vaginal infection and this is the clue that things are amiss in their body. Whereas men will have absolutely no idea they may have a male yeast infection until it creates other problems with their health. READ MORE http://living4good.blogspot.com/2007/12/male-yeast-infection.htmlHypospadiasHypospadias is a common birth defect of the penis. Usually, the urethral opening (the opening of the tube that carries urine out of the penis) appears at the very tip of the head (or glans) of the penis. In hypospadias, the opening can appear anywhere on the underside of the penis. In a mild case of hypospadias, the opening may be just below the head of the penis (coronal). In more severe cases of hypospadias, the opening can be anywhere from the middle of the underside of the penis (mid-shaft) to below the place where the penis and scrotum meet (perineal). Frequently there is a downward curving of the penis called chordee. This curvature may be more pronounced when the penis is erect. The foreskin is also incomplete and has the appearance of a dorsal hood (skin covering only the top and sides of the head of the penis).How often does hypospadias occur? READ MOREhttp://living4good.blogspot.com/2007/12/hypospadias.htmlPenile DisordersProblems with the penis can cause pain and affect a man's sexual function and fertility. Penis disorders includeErectile dysfunction - inability to get or keep an erectionPriapism - a painful erection that does not go awayPeyronie's disease - bending of the penis during an erection due to a hard lump called a plaqueBalanitis - inflammation of the skin covering the head of the penis, most often in men and boys who have not been circumcisedPenile cancer - a rare form of cancer, highly curable when caught earlyAnd many others.READ about explanation of each of these at http://living4good.blogspot.com/2007/12/male-reproductive-system-disorders_07.htmlProstate diseasesThe prostate is a gland. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from the bladder and out of the body. A young man's prostate is about the size of a walnut. It slowly grows larger with age. If it gets too large, it can cause problems. This is very common after age 50. The older men get, the more likely they are to have prostate trouble.Some common problems are:Prostatitis - an infection, usually caused by bacteriaBenign prostatic hyperplasia, or BPH - an enlarged prostate, which may cause dribbling after urination or a need to go often, especially at nightProstate cancer - a common cancer that responds best to treatment when detected earlyREAD ABOUT EXPLANATION OF EACH AT http://living4good.blogspot.com/2007/12/male-reproductive-system-disorders.htmlTesticular TorsionSometimes, the tissue surrounding a testicle is not well attached to the scrotum. As a result, the testicle may become twisted around the spermatic cord resulting in the blood supply being cut off. The following information should help you better understand this potentially serious health hazard. READ MORE http://living4good.blogspot.com/2007/12/testicular-torsion.htmlVaricoceleA varicocele is an enlargement of the veins within the scrotum, the loose bag of skin that holds the testicles. A varicocele is similar to a varicose vein of the leg.Up to one in five men have a varicocele. For males who are infertile, the figure is higher - about 40 percent. Varicoceles are the most common cause of low sperm production and decreased sperm quality, although not all varicoceles affect sperm production. READ MORE http://living4good.blogspot.com/2007/12/varicocele.htmlProstate cancerProstate cancer is cancer of the small walnut-shaped gland in men that produces seminal fluid, the fluid that nourishes and transports sperm.For many men a diagnosis of prostate cancer can be frightening, not only because of the threat to their lives, but because of the threat to their sexuality. In fact, the possible consequences of treatment for prostate cancer - which include bladder control problems and erectile dysfunction (ED) or impotence - can be a great concern for some men. READ MORE http://living4good.blogspot.com/2007/12/prostate-cancer.htmlTesticular cancerTesticular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 34. The cause of testicular cancer is unknown. READ MORE http://living4good.blogspot.com/2007/12/testicular-cancer.htmlFor more and detailed explanation of male reproductive disorders visit http://living4good.blogspot.com/search/label/Male%20Reproductive%20SystemFor other health diseases and disorders visit http://living4good.blogspot.com
Artificial insemination is successful?
Intrauterine insemination is at the forefront of many Ob/Gyns' efforts to move beyond evaluating infertility to treating the condition. In this article, the authors detail patient selection, procedural protocols, success rates, and more for this increasingly common component of gynecologists' office-based care. BY P.M. ZAVOS, EdS, PhD, and P.N. ZARMAKOUPIS-ZAVOS, MD(originally posted at obgmanagement.com) Several factors have converged in recent years to encourage Ob/Gyns to extend their fertility care beyond the basic workup to provision of first-line therapies. Those factors include many physicians' desire to reduce their obstetric caseloads in favor of office-based services, and managed care contracts that effectively discourage referrals. Further, many fertility patients would rather receive care from their long-time Ob/Gyn than from a reproductive endocrinologist at a referral center, and the development of new, straightforward fertility technologies has made it relatively easy for gynecologists to accommodate those patient preferences. Perhaps the most striking manifestation of this trend is that many Ob/Gyns now perform intrauterine insemination (IUI) in the office setting. Should you join their ranks? Let's look at whatÕs entailed in providing IUI and examine the benefits and drawbacks of adding this procedure to the care an Ob/Gyn provides. For properly selected patients, IUI offers pregnancy rates comparable to those achieved by in vitro fertilization (IVF) and other assisted reproductive technologies (ARTs) that are far more costly and involved.1 Meanwhile, fees for IUI range from $250 to $1,000 per cycle, compared to IVF fees ranging between $10,000 and $12,000. Further, we've found that third-party payers generally will cover IUI (which is reported with CPT code 58322), while securing reimbursement for IVF can be difficult, or impossible, in certain states and with particular insurers and managed care plans. IUI carries essentially the same risks of antenatal and perinatal complications as pregnancies resulting from normal sexual intercourse. In a 1999 study of perinatal outcomes, the incidence of preterm delivery, low birth weight, low Apgar scores, and need for neonatal care among IUI-induced pregnancies was similar to that of pregnancies resulting from regular intercourse and from IVF.2 Also, the risk of spontaneous abortion is no greater after IUI than it is after normal intercourse if the insemination is performed properly. In terms of the appeal the procedure holds for clinicians, no specific laboratory certification is required to offer IUI in the office setting. Also, many of the sperm-preparation devices used to facilitate insemination are exempt from CLIA and other governmental regulations, although some third-party payers might require inspection certification. Still, the decision to offer IUI should not be made lightly. Ob/Gyns must commit themselves to staying current with the rapidly changing field of fertility medicine and, in our view, must be willing to perform inseminations on weekends or holidays in order to provide their patients with the optimal chance of conceiving. Most Ob/Gyns already have much of the equipment needed for this type of treatment; a minimal investment might be necessary to purchase semen processing kits, IUI catheters, ovulation prediction kits, and, possibly, a vaginal ultrasound probe for proper ovulation detection. Most importantly, the physician must be willing to organize his or her practice and staff in a way that allows for proper execution of each step in the IUI protocol. More than most procedures an Ob/Gyn will perform in the office, the success of IUI is very strongly tied to precise adherence to proven methods for everything from preparing the sperm to inseminating the patient. In fact, in a 1997 study of pregnancy rates after IUIs performed at infertility centers, we found that unsuccessful outcomes often were attributable to physician error and a lack of familiarity with the procedure.3 IUI is indicated for patients with a cervical factor (cervicitis, cervical stenosis, a severely thickened cervical wall), vaginal anomalies, anti-sperm antibodies in the cervix or uterus, male-factor infertility (which accounts for the inability to conceive in approximately 40% of cases), sexual dysfunction in either partner, immunologically mediated infertility, and unexplained infertility. Roughly 10% of all infertility cases are idiopathic. In the above-cited cases, IUI may be administered before other ARTs are attempted. IUI is not appropriate for patients with ovarian failure, pelvic disease, or tubal occlusion. Patients with these complications require other therapies and, in most cases, should be referred to a reproductive endocrinologist. As with any infertility treatment, a full evaluation of both partners is a prerequisite to therapy. In the case of IUI, it is important to determine that, in addition to the condition that would make a woman a candidate for IUI, she does not have a concomitant condition that would preclude successful insemination. == Timing is of the essence when performing IUI. The procedure must be done on the anticipated day of ovulation, or as close to it as possible. For that reason, ovulation management-either through pharmacological intervention or simply by monitoring the patient's menstrual cycle-is crucial to successful insemination. Detection of the luteinizing hormone (LH) surge via urine analysis remains a standard for gauging the onset of ovulation. (Normal and pre-ovulatory hormone levels are listed on page 82.) Numerous over-the-counter ovulation predictor kits are designed for urinary LH detection at home or in the practice setting. While these kits have an overall accuracy rate of 98%, patients anxious to conceive often misinterpret the results, mistaking a false positive as a sign that ovulation is occurring. For that reason, the Ob/Gyn should double-check the results by running the test in the office. Effective ultrasound use also is integral to predicting ovulation and to identifying the optimal timing of IUI. We feel strongly that Ob/Gyns should receive additional training in transvaginal ultrasound before offering fertility treatment. An ultrasound scan is performed to evaluate the number and size of the follicles. The identification of a dominant follicle (which will be approximately 22 mm in diameter) indicates that ovulation is imminent. If a second ultrasound scan the next day reveals that the same follicle has returned to a smaller size, ovulation has occurred. Sonography also is used to gauge the thickness of the endometrium. A thickness of 8 mm is required for proper implantation. An overly thick (between 12 mm and 14 mm) or thin (less than 8 mm) endometrium can be corrected with hormone therapy. An inadequate endometrium often indicates the existence of other reproductive problems that must be corrected before IUI is attempted. If thickened cervical mucus is detected, use of the expectorant guaifenesin may be advised to stimulate the production of thinner, more abundant mucus. We have found that use of an ovulation induction agent-clomiphene citrate, human chorionic gonadotropin (hCG), or human menopausal gonadotropin (hMG)-increases the success rate for IUI by 10%. We must stress, however, that these agents should never be prescribed when the cause of infertility is unknown; they should be reserved for clearly identified cases of ovulatory problems. Clomiphene citrate usually is the first-line ovulation-induction agent. We typically start patients on 50 mg b.i.d. and increase the dosage to 100 mg b.i.d. if basal body temperature charts and other means of assessment, such as sonography, fail to demonstrate a response to the medication. It also is important to assess the cervical mucus of patients receiving clomiphene therapy. Clomiphene has been shown to bring about a thickening of that mucus and so has the paradoxical effect of making insemination more difficult. If the patient does not respond to clomiphene, use of injectables (follitropin beta, menotropins, or others) may be necessary to initiate ovulation for the next cycle. This might necessitate referring the patient to a reproductive endocrinologist for administration and hormonal (estradiol) monitoring of ovulation. If administered correctly, superovulation agents carry only the normal risk of multiple gestation. Twin, triplet, or higher-order gestations resulting from ovulation induction invariably can be attributed to hyperstimulation due to improper use of these agents, either through physician error or the patient's disregard for instructions on how to use the medication. So in addition to monitoring the patient for negative effects, it is important to impress upon her and her partner the need to follow directions exactly when taking fertility agents. Proper sperm processing is crucial to successful insemination, as well. Processing separates the sperm from the seminal fluid so that only fully motile, morphologically valid sperm are placed beyond the cervical mucus. A processed 0.5 mL specimen should contain between 20 million and 30 million sperm/cc. Semen processing also is necessary to purify the sperm. With coitus, only "good" sperm can enter the uterus through the cervix. Since the cervix is bypassed during IUI, this process must be replaced by clinical means. Otherwise, introducing sperm along with its seminal agents and factors into the uterus via IUI will trigger contractions of the uterine wall and will result in failed conception or other complications. Semen samples should be monitored carefully at each insemination for the presence of adequate numbers and quality of sperm. This can be done by viewing the processed specimen under a microscope. Processing can offset abnormalities identified in the sperm and maximize the chances of a successful outcome. In a 1995 study addressing how sperm morphology affects the efficacy of an IUI-ovulation induction regimen, pregnancy rates were significantly higher among couples with more than 14% normal sperm morphology than among those whose sperm morphology was less than 14% normal.4 Once the exclusive function of andrology labs, semen processing also has become more common in the Ob/Gyn's office. Newer, "office-friendly" processing techniques allow the physician to prepare semen without special licensing, equipment, or overhead. In-office semen processing takes anywhere from 30 minutes to 2 hours, depending on which device or method is used. Because no 2 semen specimens are the same, no single technology will effectively process all specimens. For example, a normal specimen can be processed via "swim-up" or other conventional separation techniques, while a more deficient specimen (e.g., one with 15 million sperm cells/cc with 40% motility) might require processing via centrifugation or other techniques. It therefore makes sense to invest in and utilize several sperm processing technologies, each averaging between $25 and $70 in price. Once the sperm sample is processed and the Ob/Gyn has ascertained that ovulation is about to occur, insemination is performed. Because ovulation occurs between 24 hours and 35 hours after the LH surge, the procedure must be performed within that period,5 even if that means opening your office and calling the patient in on a Sunday or other inconvenient time. Some researchers argue that if ovulation occurs on a Sunday, IUI can be performed on a Saturday or Monday without reducing the chance of pregnancy.6 We feel strongly, however, that reproductive medicine is an around-the-clock proposition, and that an Ob/Gyn must be available at all times if he or she is serious about helping couples conceive. Ideally, semen is obtained within an hour of the procedure. Because sperm can lose potency within 24 hours, a fresh specimen must be obtained. The initially viscous semen is allowed to stand for between 15 and 30 minutes to liquefy before processing. The patient assumes the standard position for a pelvic exam, lying straight and flat on the examination table. To avoid unwanted body curvature, pillows cannot be placed beneath the patient except under her head. If desired, stirrups can be used to stabilize her feet. A speculum is used to facilitate introduction of the IUI catheter intracervically and to ensure proper placement of the specimen. The physician should be able to see clearly through the vagina and isolate the exocervix. Neither a local anesthetic nor antibiotic prophylaxis is needed. The exocervix is cleansed with a sterile pad that has been soaked with saline, Ringer's lactate, or a similar solution. Overall, patient preparation takes about 5 minutes. A 0.5-cc specimen of sperm processed from the partner's ejaculate is aspirated into the reservoir of an 18-cm polyethylene catheter. The device's outer shaft, roughly 1 mm in diameter, is flexible so as not to traumatize the uterus and to facilitate placement despite an anteflexed or retroflexed uterus. The catheter is slowly inserted through the vagina and cervix to the fundus. The catheter should extend 5.5 cm into the uterus. (The outer shaft is marked in 1-cm increments.) Insertion should take between 60 and 90 seconds, and must be accomplished in a slow, steady manner to prevent trauma. The sperm then are injected slowly into the uterine fundus. It is imperative that the injection be very deliberate-taking about 2 minutes to deliver the 0.5-cc specimen. Injecting too briskly and striking the uterine wall will distend the endometrial muscles, leading to cramping or myometrial contractions. Once the sperm are injected, the catheter is gently removed (this should take about 60 seconds) and the patient instructed to remain lying flat and still for 15 minutes. While theories vary greatly among Ob/Gyns and reproductive endocrinologists, we see no need to elevate the patient's legs to keep the sperm within the uterus. Nor is there risk of sperm discharge after the 15-minute rest period. If the procedure is performed correctly, the patient should feel no discomfort and should be able to resume her normal activities upon leaving the office. Subsequent sexual intercourse has not been shown to impede fertilization, but we suggest abstinence for 24 hours after insemination just to be safe. If the dominant follicle is fully ruptured on the day of the insemination and tests show that there are no sperm deficiencies, we do only 1 insemination per cycle. In all other cases, however, we perform a second insemination between 12 and 24 hours after the first one. Some researchers report no significant difference in pregnancy rates between patients who were inseminated twice within a cycle and those who received only 1 IUI treatment per cycle.7,8 However, because sperm loses its fecundity within 24 hours after ejaculation, we opt for a second insemination in about 80% of cases. We have seen an increase of approximately 6% in the procedure's success rate when a second insemination is performed. Testing for pregnancy is performed 2 weeks after IUI. Testing procedures are no different for an IUI-induced pregnancy than for one that occurs after normal intercourse (an at-home OTC pregnancy test, followed by a confirmatory in-office urine or blood analysis). We feel that IUI should be administered for a minimum of 3 cycles in order to be effective. Our overall pregnancy rate with the procedure is approximately 25% without superovulation and 35% when superovulation is employed. Those rates reflect a composite of higher and lower etiology-specific rates. If pregnancy has not been induced after the sixth cycle, consider referring the patient to a reproductive endocrinologist for a more aggressive infertility workup and, possibly, IVF or other ARTs. Finally, Ob/Gyns must understand that time is a factor when treating infertility. Because the patient's "biological clock" ticks with every failed attempt at conception, the physician must develop a clear sense of when to refer her to an infertility specialist to more comprehensively address reproductive difficulties. Offering IUI requires a commitment of both practice and personal time, but we believe that it also enables the Ob/Gyn to perform an invaluable service while adding a valuable dimension to his or her practice. {| |+ align="top" |Normal levels of key reproductive hormonesHormone evaluation is crucial to successful insemination. The following chart lists key reproductive hormones and the ideal level for each. |- | Hormone Normal Level Luteinizing hormone (LH) Follicular phase (day 2 or 3) 15 mIU/mL Follicle stimulating hormone (FSH) Follicular phase 15 mIU/mL Estradiol Day of LH surge >100 pg/mL Mid-luteal phase (7 days after 0) >60 pg/mL Progesterone Day of LH surge 15 ng/mL Prolactin
What is a 13 letter word with a as a second letter?
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