Male Infertility

the diagram shows a simple description of a hu...Structure of sermatozoo

       Brave & mighty rules earth.And that is also true in case of fertilizing an ovum ,of course in human.Millions of sperms rush to fertilize one ovum and one succeeds.Obviously  this is an arrangement by nature to have the fittest sperm take part in reproduction.Many a times male fails to fulfill the obligation resulting in male infertility.
   There are a number of causes for it.There may be abnormality in sperm production,transport,fertilization and above all timing to be able to meet the ovum in female partner.The quality of sperm has certain parameters such as 1)Quantity-2-5 ml/ejaculate 2)Number-60-150 millions/ml 3)Morphology-No structural defect at least in 80-90% 4)Motility->95% motile & 5)Fructose content-150mg% 6)Liquification Time 5 minutes. .These are to be met.
  Deficient production may be due to testicular defects such as 1) abnormally placed testis 2) defective or

The process of fertilizing an ovum (Top to bottom)Process of Fertilization

atrophied testis etc.The testis develops inside the abdomen but come down to house in the scrotum before birth.Because it requires some sort of air-conditioned atmosphere to be able to produce sperm.And the arrangement by nature is in such a way that scrotum provides that .The scrotal temperature is less than abdominal  temperature and that is favourable for working of testis.And if for some fault testis can not descend down as in undescended or impefectly descended testis the functionality decreased or abolished.This air conditioning mechanism may be defective if there is a hydrocele where fluid surrounds the testis or a varicocele where dilated blood vessels surround it resulting in bad sperm formation. .

    Trauma to it,infection with mumps/syphilis or diabetes mellitus may affect sperm production.There may not be testis at all in some and may be rudimentary in some other.A careless radiation dose may damage the functionality of testis. An abnormality in the male organ must be looked into for possible cause.
    And last but not the least timing with ovulation in female must match .

Transverse section through the left side of th...Cross Section Of Testis In Scrotum

   So in this background the person must be assessed to arrive at the cause of infertility.First of all is the semen analysis which should be performed  at least after 72 hours of abstinence.If it is not within the normal parameters or   no sperm in ejaculate a biopsy of testis should be performed to know the status of structural integrity of testis and vas is to be assessed for possible blockade.If  semen analysis is normal the timing factor is to be looked into.Ovulation usually occurs around day fourteen of a 28days menstrual cycle.And that time is to be targeted.
 If all of  the above found to be within standards then probably the female partner is to be assessed for..

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SICKLE CELL DISEASE IN ORISSA,INDIA.

Human red blood cells, like those of other mam...Image via Wikipedia

Red blood cells(RBC) in blood are responsible for carriny oxygen to the cells and bring out carbondioxide from  there.The protein iron complex in it called haemoglobin is the carrier of oxygen and carbondioxide.Normal hemoglobin is termed as HbA.But many abnormalities do occur.One is HbS ( Sickle haemoglobin) derived the name from sickle as it tramsforms the RBC in a oxygen deprived condition . It is hereditiry and mostly circulates in a closed area and consanguineous marriage spreads it in a local population.Western Orissa is the storehouse of this disease.

RBC is a mocroscopic cell of discoid shape and is biconcave.This means if a RBC will be likened to a coin the sides of coin should cave in to resemble a RBC.This shape facilitates it to deform while passing through a narrow road inside the smallest calibered blood vessel called capillary.This quality lacks in a RBC containing HbS.It may sometimes occurs in conjuction with other abnormal type of Hb such as HbF which is the cause of Thalassaemia.So what happens when these RBCs negotiate through a capillary and delivered

Micrograph of a piece of karan bagga's, studen...Sickle cell RBC

oxygen to cause a  oxygen deprived environment where these get deformed to a sickle shape and become rigid to conglomerate with each other  blocking the blood flow causing more oxygen deprived environment to form more sickles and the cascading effect.The blocked site hampers blood flow causing death of cells beyond the segment.So commonly this effect is seen in spleen,bone marrow,lungs,kidneys and liver etc. This causes various symptoms such as pain arising from the organ,blood in urine,anemia and infection of bone and lungs etc.
This can be screened by sickling test in a oxygen deprived environment and conformed by electrophoresis of haemoglobin.
Tretment is not very satisfactory.It can be prevented by marriage counselling and diagnosis of condition in utero where the parents may like to discontinue the pregnacy.
Folate deficiency precipitates this condition as well as acidosis .So folate suplimentation and avoiding oxygey deprived situation are two important steps .Prevention of infection by different vaccinations against infectious diseases and prophylaxis for malaria will eaable the petient to lead a near normal life.

In sickle cell hemoglobin (HbS) glutamic acid ...Glutamic acid is changed to valine in the position  6 in B chain in the protein in HbS.

Marriage counselling should be based on blood  matching tests and not merely basing on horoscopes.


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BLACK STOOL/ACID PEPTIC DISAEASE

Gastroscopy image of :en:esophageal varices wi...ESOPHAGEAL VARICES.

Bleeding from upper intestine ,most commonly from an ulcer in stomach and duodenum causes black stool .Black stool is due to action of acid (hydrochloric)on the hemoglobin (present in the red blood cells).That is substantiated by occult blood test of a stool sample.
The exact disease of stomach and duodenum can be determined by endoscopy.Amongst various other causes of bleeding cancer of stomach,
esophageal varices and tear of upper end of stomach are important.
Bleeding
blood vessels in an ulcer can be sealed endoscopically and further blood loss be prevented. Along with that acid suppression also important.Some times it may be required to transfuse blood to the patient.
Analgesics are most common triggering factor for ulceration and subsequent bleeding.To prevent this dreaded complication analgesics to be taken when it is essential and informing doctor for previous acid peptic disease while getting treatment is absolutely necessary.

gastric ulcer This 1-cm benign gastric antral ...Stomach Ulcer

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