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Reproductive System and Sexual Disorders

Infertility primarily refers to the biological inability of a person to contribute to conception. Infertility may also refer to the state of a woman who is unable to carry a pregnancy to full term. There are many biological causes of infertility, including some that medical intervention can treat.

For a woman to conceive, certain things have to happen: intercourse must take place around the time when an egg is released from her ovary; the systems that produce eggs and sperm have to be working at optimum levels; and her hormones must be balanced. Some women are infertile because their ovaries do not mature and release eggs. Other factors that can affect a woman’s chances of conceiving include being over- or underweight, or her age as female fertility declines sharply after the age of 35. Sometimes it can be a combination of factors, and sometimes a clear cause is never established.
Common causes of infertility of females include:

  • Ovulation problems (e.g. polycystic ovarian syndrome)
  • Tubal blockage
  • Pelvic inflammatory disease
  • Age-related factors
  • Uterine problems
  • Previous tubal ligation
  • Endometriosis
  • Advanced maternal age

 

Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility.  Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.  Factors relating to male infertility include:

  • Hypogonadotropic hypogonadism
  • Drugs, alcohol
  • Strenuous riding (bicycle riding, horseback riding)
  • Medications, including those that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironolactone; those that decrease FSH levels such as phenytoin; those that decrease sperm motility such as sulfasalazine and nitrofurantoin
  • Tobacco smoking
  • Age
  • Genetic defects on the Y chromosome
  • Mumps
  • Malaria
  • Testicular cancer
  • Vas deferens obstruction
  • Infection, e.g. prostatitis
  • Retrograde ejaculation
  • Ejaculatory duct obstruction
  • Hypospadias
  • Impotence

 

Sexual dysfunction refers to a difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including desire, arousal or orgasm. A thorough sexual history and assessment of general health and other sexual problems (if any) are very important. Assessing (performance) anxiety, guilt, stress and worry are integral to the optimal management of sexual dysfunction. When a sexual problem is managed inappropriately or sub-optimally, it is very likely that the condition will subside immediately but re-emerge after a while. When this cycle continues, it strongly reinforces failure which may eventually cause one to not want to seek further treatment and experience symptoms all their life. It is important to get a thorough assessment from professionals and therapists who are qualified to manage sexual problems. Internet-based information is good for gaining knowledge about sexual functioning and sexual problems but not for self-diagnosis and/or self-management.

 

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