TREATMENT OF INFERTILITY.

The treatment of infertility should be tailored to the problems unique to each couple. Even so, a woman above 30 years is treated hastily because the biological clock is closer to menopause and also because epidemiological studies have proven the increasing health risks associated with increased age of  mother at birth of the baby.

Ovulatory Dysfunction

Treatment of ovulatory dysfunction should first be directed at identification of the etiology of the disorder to allow specific management when possible. Dopamine agonists, for example, may be indicated in patients with hyperprolactinemia while life-style modification may be successful in women with low body weight or a history of intensive exercise.

Medications used for ovulation induction include clomiphene citrate, gonadotropins, and pulsatile GnRH.

1.       Clomiphene citrate is a nonsteroidal estrogen antagonist that increases FSH and LH levels by blocking estrogen negative feedback at the hypothalamus. The efficacy of clomiphene for ovulation induction is highly dependent on patient selection. It induces ovulation in 70 to 80% of women with PCOS and is the initial treatment of choice in these patients.

2.       Gonadotropins are highly effective for ovulation induction in women with hypogonadotropic hypogonadism and PCOS and are used to induce multiple follicular recruitment in unexplained infertility and in older reproductive-aged women. Disadvantages include a significant risk of multiple gestation and the risk of ovarian hyperstimulation, but careful monitoring and a conservative approach to ovarian stimulation reduce these risks.

3.       Pulsatile GnRH is highly effective for restoring ovulation in patients with hypothalamic amenorrhea .Pregnancy rates are similar to those following the use of gonadotropins, but rates of multiple gestation are lower and there is virtually no risk of ovarian hyperstimulation.

None of these methods are effective in women with premature ovarian failure in whom donor oocyte or adoption are the methods of choice.

Tubal Disease

If hysterosalpingography suggests a tubal or uterine cavity abnormality, or if a patient is ≥35 at the time of initial evaluation, laparoscopy with tubal lavage is recommended, often with a hysteroscopy. Although tubal reconstruction may be attempted if tubal disease is identified, IVF is often used instead, as these patients are at increased risk of developing an ectopic pregnancy.

Endometriosis

laparoscopic resection or ablation appears to improve conception rates even though most women with mild cases of endometriosis are capable of giving birth to babies within a year.

 Medical management of advanced stages of endometriosis is widely used for symptom control but has not been shown to enhance fertility.

In moderate to severe endometriosis, conservative surgery is associated with pregnancy although some patients prefer IVF as the treatment of choice.

 Though often effective, IVF is expensive and requires careful monitoring of ovulation induction and invasive techniques, including the aspiration of multiple follicles. IVF is associated with a significant risk of multiple gestation (31% twins, 6% triplets, and 0.2% higher order multiples).

Assisted Reproductive Technologies

The development of assisted reproductive technologies (ART) has dramatically altered the treatment of male and female infertility. IVF is indicated for patients with many causes of infertility that have not been successfully managed with more conservative approaches. IVF or ICSI is often the treatment of choice in couples with a significant male factor or tubal disease, whereas IVF using donor oocytes is used in patients with premature ovarian failure and in women of advanced reproductive age. Success rates depend on the age of the woman and the cause of the infertility.

Amenorrhea

This complex termonlogy literally means no menstruation (a- no; menorrhea- menstruation).

There are several  pathologies and physiologic states that alter the menstruation cycle and they do so at different stages. This one for one, is regarded as primary when a female well into her teenage years hasn’t bled yet i.e menarche. The usual cause is delayed puberty but it may also occur secondary to anatomical defects in the development of the reproductive system.

Other causes include anorexia nervosa, the eating disorder that creates bony skeletons out of beautiful girls.

The secondary type is generally cessation of menstruation. A common physiologic cause is menopause in the 4th to 5th decades of life. Another such cause is pregnancy.

Cases for concern are underlying ovarian  (such as in auto-immune ovarian failure )or uterine dysfunction and hormone (pituitary or hypothalamic) failure.

Some diseases such as tuberculosis(TB) and malabsorption disorders are also involved in the etiology of amenorrhea. PCOS-polycystic ovarian syndrome is another but it has characteristics i.e, Hirsutism (male-like hair distribution in a female), obesity and long-standing irregular periods which are specific to it.

As we all know, it isn’t normal for a woman in their reproductive age to miss a monthly visit from their “Aunt”. If you didn’t know why it is very important, well now you do.

CAUSES OF FEMALE INFERTILITY

Haven’t  you ever wondered what causes a woman to be unable to conceive a child within a whole year of frequent unprotected sex? Here are some of the reasons.

PSYCHOLOGICAL ASPECTS OF INFERTILITY

Infertility is invariably associated with psychological stress.When extreme, stress can contribute to infertility; for example, stress may impair hypothalamic control of ovulation.

OVULATORY DYSFUNCTION

Amenorrhea (absence of menses) or as irregular or short menstrual cycles may be taken very lightly but may be symptoms of an issue that is more grave.

You never know, maybe your ovary is dysfunct.

TUBAL DISEASE

Tubal disease may result from pelvic inflammatory disease (PID), appendicitis, endometriosis, pelvic adhesions, tubal surgery, and previous use of an intrauterine device (IUD). However, a specific cause is not identified in up to 50% of patients with documented tubal factor infertility.

Subclinical infection with Chlamydia trachomatis may be an underdiagnosed cause of tubal infertility and requires the treatment of both partners.

ENDOMETRIOSIS

Endometriosis is defined as the presence of endometrial glands or stroma outside the endometrial cavity and uterine musculature. Its presence is suggested by a history of dyspareunia (painful intercourse) and worsening dysmenorrhea that often begins before menses.

It could be another cause of infertility.

When should I see a doctor about my period?

See your doctor about your period if:

• You have not started menstruating by the age of 15.
• You have not started menstruating within 3 years after breast growth began, or if breasts haven't started to grow by age 13.
• Your period suddenly stops for more than 90 days.
• Your periods become very irregular after having had regular, monthly cycles.
• Your period occurs more often than every 21 days or less often than every 35 days.
• You are bleeding for more than 7 days.
• You are bleeding more heavily than usual or using more than 1 pad or tampon every 1 to 2 hours.
• You bleed between periods.
• You have severe pain during your period.
• You suddenly get a fever and feel sick after using tampons.

STIs MANAGEMENT

THE 4 C's OF STI MANAGEMENT

Each and every treatment of STI must include the 4 C's:

1.      Compliance to the full drug course &

              follow−up

2.      Counselling: On safer sexual behaviour

3.      Condom: Ensure proper use

4.      Contact tracing, partner treatment and

Notification

Patient Education

·         Avoid multiple or anonymous partners, prostitutes or any other person with multiple sex

·         partners

·         Use condoms correctly

·         Avoid alcohol or drug abuse which may lead to irresponsible sexual behaviour.

·         Seek urgent medical attention when you suspect symptoms of S.T.I’s.

·         Observe high standard of hygiene – do not share private items such as sharp objects.

N/B. Sexually transmitted diseases can also be transmitted through other means other than sexual contact:

-          Infected panties

-          Blood products

-          Contact with infected body fluids

-          Contaminated instrument.

                       Common Conditions Occurring at Menopause

Cardiovascular system:  palpitations, high blood pressure, hot flashes (the major symptom)

Musculoskeletal:  aches and pains (not osteoporosis, as it is usually symptomless), but usually a form of arthritis.

Genital:  irregular bleeding, decreased libido, vaginal dryness

General:  dryness and wrinkling of the skin

Neurological:  nausea, dizziness, mood changes, irritability, depression, insomnia, numbness, tingling

Cause of Hot Flashes

Unknown but two theories merit mention.

1.      Inadequate breathing efforts. Lose weight, if necessary, to reduce the metabolic rate and to make each breath deeper.  Practice deep breathing daily.

2.        Blood vessel tone. Women with hot flashes tends to lack the normal tightening of blood vessels

DYSMENORRHEA

Painful menstruation is difficult to treat, not because the disorder will not yield to therapy, but because women have about the worst record of noncompliance to medical counsel with this disorder that with any other. The reason for noncompliance will become obvious as the causes of dysmenorrhea are discussed. 

One important cause of dysmenorrhea is that of wearing improper clothing. Tight bands around the waist, hips, or thighs impede the circulation to the pelvic organs and increase the likelihood of painful menstruation. Also, the clothing of the extremities must be proper. There should not be one inch of chilled skin on the extremities any time during the month, not only during the menstrual period itself. The extremities should be covered with as many layers of clothing as is the trunk. To fail to do so is to cause the circulation to be imbalanced, and increases the likelihood of pelvic congestion and painful menstruation.

Posture is also important as a cure for painful menstruation. The contracted ligaments give rise to compression of the nerves which increases the symptoms of painful menstruation.

Dietary measures can be of great benefit, particularly since many of the things that irritate the gastrointestinal tract reflexively irritate the genitourinary tract. All irritants in the gastrointestinal tract such as spices, alcohol, aspirin, other drugs, hot pepper, vinegar, overeating, failure to chew properly, and any other matter known to irritate the gastrointestinal tract should be eliminated. Constipation should be corrected, particularly just prior to the onset of the menstrual period.

Rest and regularity are mandatory for the sufferer from dysmenorrhea. After the age of 20, eight hours of sleep or bed rest daily should be obtained. From childhood a pattern of regular bedtime and rising time without weekend or seasonal variation is the ideal order of life. Such a person rarely has difficulty with relaxing or sleeping. Regularity in all things is essential. 

At least one bowel movement daily is ideal, two or more bowel movements being preferred. Fruits, vegetables, and whole grains are helpful in maintaining good bowel health. The avoidance of oil is advisable, particularly, since oil tends to cause red blood cell clumping, creating circulatory problems through the rich meshwork of tiny capillaries found in the reproductive organs. Fats also alter the platelet function of the blood, causing clotting of the blood to be improper, a condition which may lead to painful menstruation.

One should develop a good emotional outlook. A mature, vigorous, and healthy adult should be able to cope with any problems that are presented to her during a 24-hour day. With Divine aid and sympathetic understand of family and friends, the individual should have the emotional equilibrium to cope with all of life's trials.

When the painful menstruation occurs, a "hot half bath" in a bathtub, or a hot foot bath up to the upper portions of the calf muscles using a deep bucket, tub or trash can will very often provide complete relief. Warm or hot water as determined by experimentation are both acceptable for the hot water baths.

                   

Prostate Cancer

Definition: Cancer of the male reproductive system that affects the prostate (an exocrine gland, under the bladder and in front of the rectum). Prostate apart from producing fluid that forms part of semen, is involved in urine control (continence).

PSA (Prostate Specific Antigen)

It is produced by the epithelial cells in the prostate gland. PSA helps keep the semen in liquid state. If a man’s PSA levels are high, it might be an indicator of either a prostate cancer or some kind of prostate condition.

Symptoms of Prostate Cancer

When symptoms do exist, they are usually one or more of the following:

·         The patient urinates more often

·         He may find it hard to start urinating

·         There may be blood in urine

·         Urination might be painful

·         Achieving or maintaining an erection may be difficult (less common)

Advanced Prostate Cancer

·         Bone pain, often in the spine

·         Leg weakness (if spinal cord has been compressed)

·         Urinary incontinence

·         Fecal incontinence

What are the causes of prostate Cancer?

Related but not limited to:-

·         Age, genetics, Diet, Obesity, STDs

Possible complications

·         Metastasis

·         Incontinence

·         Erectile dysfunction

Substance abuse among students in Public Universities in Kenya

Objective: To investigate the association between HIV/STI and substance abuse among students in Public Universities in Kenya.

 Males 69% and females 31%.

 Only 30.5% had ever used tobacco while 17.1% were current users. Males accounted for 75% of current users compared to 25% amongst females.

 Of the current users, 84% believed that tobacco was not harmful to health. Two important sources of introduction to tobacco use were friends that accounted for 81% and relatives 18%.

Use of tobacco amongst significant others were: friends 24%, fathers 11.0%, relatives 6.2% and mothers 0.2%. The most common sources of supply were nearby shop outlets 51.1% and friends 14.4%.

Gender multivariate analysis of associations with daily smoking (adjusted for age, University, leisure activities and gender, respectively), parental monitoring exhibited a consistently protective, dose response effect.

Attending a place of worship and going to the movies were protective for females as was watching sports, whereas playing team sport was protective for males and attending a movie was a risk factor for females.  

Median age at initiation of smoking was 17 years which did not vary according to Universities.

Research by:      Magu D, Mutugi MW, Ndahi LW, Wanzala P

parallelism

Parallelism- a style encompassed in poetry and narration describing simultaneous situations that are similar in certain aspects but occur under very different circumstances. The concept is derived from the word parallel. Remember those geometrical lines that ran in the same direction but were never to meet ahead? Well, such is the paradox of life and death.

News headlines all over the country have been a tribute to the late Hon. Mutula KIlonzo since his demise on Saturday morning. The different stations competing (as usual) and attempting to unravel the brilliant and gifted man he was. Up till now, no one knows what exactly caused his untimely death. Speculations and hearsay are all Kenyans are getting from the media. It is said that the honourable went to bed and was never seen alive thereafter. He was all alone in his room through the night.

Now if you’ve ever lost someone close to you, you understand how painful it is. That feeling of being chocked by the throat and when you try speaking all that comes out is tears. They flow aimlessly down as if to block all your visions of life thereafter. The sight of so many people when the one you want to see lies motionless in some box. Grieve is what you can only do.

On another tiny hospital bed this evening, a little princess sleeps warm beside her mother. Her father has probably stepped out of the room to escort all their friends who have been visiting with their congratulatory messages since her Grande arrival on planet earth.

To be honest though, the birth process wasn’t all bliss and Elysium at first for me-an observer. In fact, when I saw that tiny head struggling to come out to the world I was scared and unsure of the outcome. I have read widely on scenarios of congenital anomalies such as a bad heart, a blue baby, too many toes, no toes, a big head, and no head…hell! Anything could go wrong!

 It could but it didn’t. Not in the very least today. She came out with ten perfect and tiny toes and fingers. She let out a soft cry and opened her eyes and when I held her in my arms I understood how mighty God is. The feeling was amazing!! Surely no amount of writing can sum up the pride and sheer joy that encircles your entire being when you come face to face with a new-born baby.

And so the circle of life continues. As it has been and as it shall continue to be. That while others jump in joy and jubilation, others wail and weep in despondency. I would like to join my countrymen to mourn the loss of a mighty giant and look up as well to the proud parents and congratulate them on their daughter’s arrival. Mean as it seems, that is life and it must go on.

Beaded Rape

He threw her on the wall and inched in closer as if to grab her by the neck. His burly build created an intimidating shadow over her existence. His calloused hands reached out to her cotton dress and left pieces of what stood between her and nudity. He threw her on the cold hard floor and followed atop. Her tears and cries grew distant with each thrust that came. She grew weary looking on to the door that was heavily latched. The pain she felt seared through the core of her being. Endless tears would not express the emptiness she harboured within. She took one last look at him. His eyes were closed. He let out an eerie groan and smirked. It was over.

Such a story is known all too well by the girls of the Loikop people commonly known as the Samburu in the Kenyan plains. Some of them view this as culturally correct and even go ahead to fight for the way of the community. Beading is a practice that has been there from time immemorial and even to-date a young Samburu girl can only be married off after going through it. A moran is at liberty to pick a teenager in whom he delights. He places a necklace on her as a sign of booking. The entire community respects his choice and allows him to decide when to have the rendezvous. At no point can the girl interject or give an opinion.
This wayward practice has caught the eye of both local and international press. Not so much because of the practice itself but because of the effects it has caused and what has been done about it. The issue came up last year after watching a local TV station air the work of Josephine Kulea then an energetic 28 year old fighting tooth and nail against the way she was brought up. It was an eye-opener to me. It made me realize how shielded I was from pertinent issues in my own homeland. I am saddened however, to note that I am not the only one who saw this for the very first time.
Josephine found out that the girls not only face the risk of contracting venereal diseases but could also get pregnant. Most of them actually do but even then, culture doesn't go easy on them. The girls aren't allowed to cater for their infants. This makes them so desperate that they go to lengths to get rid of the whole mess by aborting the fetuses. The ones that live to be married after the ordeal then face the risk of being unable to give birth and if they do give birth, they have to deal daily with the trauma and scars brought about by the abortive measures.
Rape is a brutal act that causes so much damage be it physical, mental and/or emotional. It is sad to note that until last month, 8 rape victims of the 2007/8 post-election violence were still suing the government a lump sum of about £20M over its alleged failure to protect them or investigate the crimes committed against them. The question as to whether this is the first time the Kenyan government has been blamed for failing to do one thing or another with regard to this issue is sternly answered by a violent no. The L.A Times has articles from as early as 1992 when the tourism department had two of its game rangers facing possible death row over the death of a British tourist Julie Ward in 1988. A year later Somali women refugees complained of "an appalling lack of concern for their plight".
Away from the government and some 29 boys aged between 14 and 19 in 1991 were charged with manslaughter for the murder of 19 and the rape of 71 other girls who were their schoolmates at St. Kizito. FIDA, the federation of women lawyers, record on their blog police statistics that reveal the fact that 5 children wake up defiled, 3 people end up dead and 2 women are raped every dawn. This is very alarming. Among these people could be your mother, your sister, daughter, wife or friend.
You could be among the millions of women living in slums and facing the fear of an impending attack on your way to the toilet. You could be a mother unaware of what your daughter has gone through in the dark or the sister who saw it all. You could be the friend who was confided in or the lawyer who was entrusted with the task of obtaining justice. Or you could simply be the reader who is yet to figure out what I am trying to pass across.

Only one in 20 of the raped victims report the offense. It could be due to lost faith in the Kenya Police or the authorities. It could also be due to the fact that in most cases the offense is done by people we know. Whatever the reason, we should at least improve the number of those that seek medical help from a worrying one in every 6 of the cases.
Today, on world International Women's' day, let us make a choice to stand up for and with these women, men and even children that have been victims of rape. We may not be able to reverse time and change their fates or change where we live because it is beyond us. We can however be more sensitive to this issue and support those like Josephine who are marching on the front-line. We can educate teenagers on the importance of walking in groups to and from school. We can discourage little girls from accepting gifts from strangers and train them to be alert at all times. We can show teens how to discern an ulterior motive. We can and should be careful when we are out partying with friends in order to avert date rape and being "Chipo-d". Truth be told, there's a lot that we can all do yet the most important place we can choose to be is at the side of the victims renewing their hope and helping them rise back on their feet, mending the torn pieces of cloth and wiping their tears. We could form support groups for them to run to depending on our different capacities. After all, it could happen to anyone of us.