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Definitions of infertility for primary and secondary

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,
some which may be bypassed with medical intervention.
Women who are fertile experience a natural period of fertility before and during
ovulation, and they are naturally infertile during the rest of the menstrual cycle.
Fertility awareness methods are used to discern when these changes occur by
tracing changes in cervical mucus or basal body temperature.
!ouples with primary infertility have never been able to conceive, while, on the
other hand, secondary infertility is difficulty conceiving after already having
conceived "and either carried the pregnancy to term, or had a miscarriage#.
Technically, secondary infertility is not present if there has been a change of
$. %ain cause of male and female
&vulation problems
tubal blocage
male associated infertility
age'related factors
uterine problems
previous tubal ligation
previous vasectomy
unexplained infertility
Tuberculosis "T(#
). Treatment
%edical treatment of infertility generally involves the use of medication, medical
device, surgery, or a combination of the following. If the sperm are of good
*uality, and the mechanics of the woman+s reproductive structures are good
"patent fallopian tubes, no adhesions or scarring# physicians may start by
prescribing a course of ovarian stimulating medication. The physician may also
suggest using a conception cap cervical cap which the patient uses at home by
placing the sperm inside the cap and putting the conception device on the cervix,
intrauterine insemination "I,I#, in which the doctor introduces sperm into the
uterus during ovulation, via a catheter. In these methods, fertili-ation occurs
inside the body.
If conservative medical treatments fail to achieve a full term pregnancy, the
physician may suggest the patient undergo in vitro fertili-ation "I.F#. I.F and
related techni*ues "I!/I, 0IFT, 1IFT# are called assisted reproductive
technology "23T# techni*ues.
23T techni*ues generally start with stimulating the ovaries to increase egg
production. 2fter stimulation, the physician surgically extracts one or more eggs
from the ovary, and unites them with sperm in a laboratory setting, with the intent
of producing one or more embryos. Fertili-ation taes place outside the body,
and the fertili-ed egg is reinserted into the woman+s reproductive tract, in a
procedure called embryo transfer.
&ther medical techni*ues are e.g. tuboplasty, assisted hatching, and
4reimplantation genetic diagnosis.
3ecently, a hormone'antioxidant combination therapy was suggested to improve
sperm count and motility in infertile men, according to an 5gyptian study.
1hanem 6 et al. !ombination clomiphene citrate and antioxidant therapy for
idiopathic male infertility7 2 randomi-ed controlled trial. Fertil /teril $889 %ar :;
<e'pub ahead of print=. 4ublished in >ournal Watch 1eneral %edicine %arch )1,
$889 The study included ?8 men who were randomly selected to tae either the
combination treatment of clomiphene citrate and vitamin 5 or a placebo for six
months. The pregnancy rate was about )@ percent among men who had taen
the combination therapy, compared with 1) percent for those in the placebo
group. The men in the treatment group also had a greater increase in sperm
concentration and an improvement in sperm progression, the !airo ,niversity
researchers found. !lomiphene citrate is an anti'estrogen drug designed as a
fertility medicine for women but sometimes used to boost sperm production in
men with low sperm counts and poor sperm motility. .itamin 5 helps counter
oxidative stress, which is associated with sperm DA2 damage and reduced
sperm motility. BThe results of this study will be encouraging to male factor
patients and their doctors,B Dr. 3. Dale %c!lure, president of the 2merican
/ociety for 3eproductive %edicine, said in a society news release. B6owever,
more research is needed to determine how the components of the combination
therapy affect the different semen parameters observed and the advantages of
using these drugs singly or in combination with other drugs not used in this
C. What is cryopreservation
Cryopreservation is a process where cells or whole tissues are preserved by
cooling to low sub'-ero temperatures, such as "typically# @@ D or E19? F! "the
boiling point of li*uid nitrogen#. 2t these low temperatures, any biological activity,
including the biochemical reactions that would lead to cell death, is effectively
stopped. 6owever, when verification solutions are not used, the cells being
preserved are often damaged due to free-ing during the approach to low
temperatures or warming to room temperature.
:. Aew techni*ue of procedure"I.%#
2 new assisted reproduction technology "23T# procedure called in vitro egg
maturation, I.% for short, may be safer and cheaper than the normal I.F
regimen. Instead of removing fully mature eggs from the ovaries and then
fertili-ing them, physicians remove immature eggs, ripen them in a lab dish, then
add sperm. With this approach, the woman re*uires only three days of fertility
drugs to stimulate her ovaries ' compared with up to two wees under the
conventional method. This may be particularly useful for women who suffer from
polycystic ovarian syndrome, a hormonal disorder that disrupts ovulation. ItGs a
leading cause of female infertility and it maes infertility treatment extremely risy
because the ovaries can easily be overstimulated.
In fact, I.% is not really new. It has been used successfully in some cases since
199C. (ut it is a challenge because during normal egg maturation the egg
undergoes meiosis in which the nucleus Hettisons half of its chromosones in
preparation for receiving DA2 from a sperm. (ut achieving meiosis in laboratory
glassware instead of inside an ovary is not a perfected process. 2nd even when
it is achieved the egg often develops a hardened membrame that reduces the
changes of a sperm penetrating and fertili-ing it. /till, the process holds promise
as it is developed further.
?. /emen 2nalysis
2 semen analysis evaluates certain characteristics of a maleGs semen and the
sperm contained in the semen. It may be done while investigating a coupleGs
infertility or after a vasectomy to verify that the procedure was successful. It is
also used in stud farming, dog breeding and farm animal breeding.
The most common way to collect a semen sample is through masturbation,
directing the sample into a clean cup.
2 sample may also be collected during intercourse in a special type of condom
nown as a collection condom. !ollection condoms are made from silicone or
polyurethane, as latex is somewhat harmful to sperm. %any men prefer collection
condoms to masturbation, and some religions prohibit masturbation entirely.
2dherents of religions that prohibit contraception, such as !atholicism, may use
collection condoms with holes priced in them.
2 third option for collecting a sample is through coitus interruptus "withdrawal#.
With this techni*ue, the man removes his penis from his partner near the end of
intercourse and eHaculates into a cup.
Finally, if a blocage in the vas deferens is suspected to impede fertility, semen
can be taen directly from the epididymis. /uch a collection is called per
cutaneous epididymal sperm aspiration "45/2#. 2lternatively, the testicular
tissue itself, instead of the sperm produced can be investigated. Then, the
collecting method is called TESE.
Sperm count
2pproximate pregnancy rate varies with amount of sperm used in an artificial
insemination cycle. .alues are for intrauterine insemination, with sperm number
in total sperm count, which may be approximately twice the total motile sperm
/perm count, or sperm concentration to avoid mixup, measures the
concentration of sperm in a manGs eHaculate, distinguished from total sperm
count, which is the sperm count multiplied with volume. 2nything over $8 million
sperm per milliliter is considered normal. 2nything less is considered
oligospermia. 2 vasectomy is considered successful if the sample is
a-oospermic, or if only rare non'motile sperm are observed "fewer than 188,888
per millilitre#.
The average sperm count today is around ?8 million per milliliter in the Western
world, having decreased by 1'$I per year from a substantially higher number
decades ago.
The motility of the sperm is evaluated. Web%D defines normal motility as ?8I of
observed sperm, or at least J million per millilitre, showing good forward
For instance, a man can have a total amount "sperm count# of far
over the limit of $8 million sperm cells per milliliter, but still have bad *uality,
because too few of them are motile. 6owever, if the sperm count is very high,
then a motility of less than ?8I might not matter, because the fraction might still
be more than J million per millilitre. The other way around, a man can have a
sperm count far less than $8 million sperm cells per millilitre and still have good
motility, if more than ?8I of those observed sperm cells show good forward
The World 6ealth &rgani-ation "W6&# criteria are that normal motility is when at
least :8I of observed sperm move forward normally.
2 more specified measure is motility grade, where the motility of sperm are
divided into four different grades7
Grade 47 /perm with progressive motility. These are the strongest and swim fast
in a straight line. /ometimes it is also denoted motility a.
Grade 37 "non'linear motility#7 These also move forward but tend to travel in a
curved or crooed motion. /ometimes also denoted motility b.
Grade 27 These have non'progressive motility because they do not move forward
despite the fact that they move their tails.
Grade 17 These are immotile and fail to move at all.
The morphology of the sperm is also evaluated. With W6& criteria as described in
the old manual of 19J9, a sample is normal if )8I or more of the observed sperm
have normal morphology. If morphology is evaluated using the Tygerberg strict
criteria developed by Dr. 3oelof %enveld, Tygerberg 6ospital, /outh 2frica, and
disseminated by Dr. Thinus Druger from the same hospital,
a sample is normal if
1CI or more of the observed sperm have normal morphology.
. The Tygerberg
strict criteria for morpology assessment are recommended in the most recent W6&
manual on semen analysis "W6& 1999#. 2ccording to the above references,
morphology was developed as a predictor of success in fertili-ing oocytes during
invitro fertili-ation.
The volume of the sample is measured. Web%D advises that volumes between
1.8 mK and ?.: mK are normal; W6& criteria specify that any volume greater than
$.8 mK is normal. Kow volume may indicate partial or complete blocage of the
seminal vesicles, or that the man was born without seminal vesicles.
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1. 4rocedure of gram staining
Gram staining "or Grams method# is an empirical method of differentiating
bacterial species into two large groups "1ram'positive and 1ram'negative#
based on the chemical and physical properties of their cell walls. While 1ram
staining is a valuable diagnostic tool in both clinical and research settings, not all
bacteria can be definitively classified by this techni*ue, thus forming Gram
variable and Gram indeterminant groups as well.
The method is named after its inventor, the Danish scientist 6ans !hristian 1ram
"1J:) L 19)J#, who developed the techni*ue in 1JJC to discriminate between two
types of bacteria with similar clinical symptoms7 Streptococcus pneumoniae "also
nown as the pneumococcus# and Klebsiella pneumoniae bacteria.
2. 6ow to differentiate between bacteria 5'coli and /taphylococcus
spp from this procedure
Gram!negative bacteria
The proteobacteria are a maHor group of 1ram'negative bacteria. &ther notable
groups of 1ram'negative bacteria include the cyanobacteria, spirochaetes, green
sulfur and green non'sulfur bacteria.
These also include many medically relevant 1ram'negative cocci, bacilli and
many bacteria associated with nosocomial infections.
Gram!positive bacteria
In the original bacterial phyla, the 1ram'positive forms made up the phylum
Firmicutes, a name now used for the largest group. It includes many well'nown
genera such as Bacillus, Listeria, Staphylococcus, Streptococcus,
Enterococcus,Diplococcus pneumoniae and Clostridium. It has also been
expanded to include the %ollicutes, bacteria lie Mycoplasma that lac cell walls
and so cannot be stained by 1ram, but are derived from such forms.
3. 5xplain the method of sensitivity test
Mour rabbit'experienced vet will tae a sample of infected tissue or discharge
from the infected area "the capsule of an abscess is the best location from which
to tae a sample, as the internal pus often contains only dead bacteria that will
not grow in culture#, and send it in a special culture tube to a licensed laboratory
for testing.
In the lab, technicians will spread a sample of the infective material onto a plate
of nutrient substance "usually agar, a type of gel made from algae# and allow to
grow whatever species of bacteria were in the bunnyGs infected area.
With a sufficient population of bacteria grown on the plate in the form of a BlawnB,
the technicians will perform two main operations7
1. ID5ATIFM T65 /45!I5/ &F (2!T53I2.
o This is done with various techni*ues, including examination of lawn
characteristics "color, texture, growth pattern, etc.# gram'staining,
microscopic examination, metabolic re*uirement BfootprintsB and even
DA2 se*uencing.
o (acterial species commonly isolated from rabbit infections include
Pasteurella multocida, Pseudomonas aeruginosa, Bordetella
bronchiseptica, Staphylococcus aureus, and several others, though Hust
about anything might turn up, depending on the location and cause of the
$. D5T53%IA5 T65 (2!T53I2K 4&4,K2TI&A/ /5A/ITI.ITM T& 2 32A15
&F 2ATI(I&TI!/.
o This can be done by placing small diss of filter paper or agar
impregnated with various types of antibiotics onto the bacterial lawn. The
bacteria are allowed to incubate for a day or two, and then the plate is
examined to see whether the bacterial growth is inhibited "or not# by the
antibiotics on each dis.
/5A/ITI.57 In this case, a clear, circular BhaloB "technically
nown as a Bpla*ue,B or -one of inhibition# will appear around the
antibiotic dis, indicating an absence of bacteria. The antibiotic
has inhibited their growth andNor illed them, meaning that this
particular antibiotic should be effective against the infection your
rabbit has.
IAT53%5DI2T57 2 somewhat cloudy pla*ue indicates that not all
the bacteria in the area around the dis have been illed. This
means that there are some members of the bacterial population
that are sensitive to this particular antibiotic, but others that are
genetically immune to its effects. If an antibiotic to which the
bacteria show BintermediateB sensitivity is used, it is liely that the
sensitive members of the bacterial population will be illed, and
the resistant ones will survive, resulting in the selection of a
population resistant to that particular antibiotic.
35/I/T2AT7 In this case, the filter paper will have no discernable
pla*ue around it, meaning that the bacteria are growing normally,
even in the presence of the antibiotic. 2n antibiotic producing no
pla*ue will most liely be ineffective against the bacteria causing
your bunnyGs infection.
4. What is your opinion regarding the microbiology field and
microbiology lab in K44DA
Microbiology is the study of microorganisms, which are or cell'unicellularcluster
microscopic organisms. This includes euaryotes such as fungi and protists, and
proaryotes, which are bacteria and archaea. .iruses, though not strictly classed
as living organisms, are also studied. In short; microbiology refers to the study of
life and organisms that are too small to be seen with the naed eye.
%icrobiology is a broad term which includes virology, mycology, parasitology,
bacteriology and other branches. 2 microbiologist is a specialist in microbiology.
%icrobiology is researched actively, and the field is advancing continually. We
have probably only studied about one percent of all of the microbe species on
5arth. 2lthough microbes were first observed over three hundred years ago, the
field of microbiology can be said to be in its infancy relative to older biological
disciplines such as -oology and botany.
%icrobiology lab in K44DA is almost specific in certain cases. It is no sample of
sputum., feaces and somemore. Aormally in lppn there are most things
regarding to reproductive section. 6ere only certain cases and sample will be
observed for example the semen sample, blood sample, urine sample and cervix
5. Define the serology method of 6I., 6(/ 2g, 6(/ 2b and .D3K
Serology is the scientific study of blood serum. In practice, the term usually
refers to the diagnostic identification of antibodies in the serum. /uch antibodies
are typically formed in response to an infection "against a given microorganism#,
against other foreign proteins "in response, for example, to a mismatched blood
transfusion#, or to oneGs own proteins "in instances of autoimmune disease#.
/erological tests may be performed for diagnostic purposes when an infection is
suspected, in rheumatic illnesses, and in many other situations, such as checing
an individualGs blood type. /erology blood tests help to diagnose patients with
certain immune deficiencies associated with the lac of antibodies, such as O'
lined agammaglobulinemia. In such cases, tests for antibodies will be
consistently negative.
There are several serology techni*ues that can be used depending on the
antibodies being studied. These include7 5KI/2, agglutination, precipitation,
complement'fixation, and fluorescent antibodies.
/ome serological tests are not limited to blood serum, but can also be performed
on other bodily fluids such as semen and saliva, which have "roughly# similar
properties to serum.
/erological tests may also be used forensically, generally to lin a perpetrator to
a piece of evidence "e.g., lining a rapist to a semen sample#.
6I. T5/T
Tests used for the diagnosis of 6I. infection in a particular person re*uire a high
degree of both sensitivity and specificity. In the ,nited /tates, this is achieved
using an algorithm combining two tests for 6I. antibodies. If antibodies are
detected by an initial test based on the 5KI/2 method, then a second test using
the Western blot procedure determines the si-e of the antigens in the test it
binding to the antibodies. The combination of these two methods is highly
6(/ 2ATI15A
6epatitis ( surface antigen "6(s2g# is a protein antigen produced by 6(.. This
antigen is the earliest indicator of acute hepatitis ( and fre*uently identifies
infected people before symptoms appear. 6(s2g disappears from the blood
during the recovery period. In some people "particularly those infected as
children or those with a wea immune system, such as those with 2ID/#, chronic
infection with 6(. may occur and 6(s2g remains positive.
/ometimes, 6(. goes into PhidingQ in the liver and other cells and does not
produce new viruses that can infect others, or produces them in such low
amounts that they cannot be found in the blood. 4eople who have this form are
said to be carriers. In other cases, the body continues to mae viruses that can
further infect the liver and can be spread to other people. In both these cases,
6(s2g will be positive. The next test is helpful for distinguishing these two states.
6(/ 2ATI(&DM
&ne of the uses for the test for anti'6(s is to evaluate the immune response in
persons who have received hepatitis ( vaccine. In its initial recommendations,
the Immuni-ation 4ractices 2dvisory !ommittee "2!I4# defined an ade*uate
"protective# antibody response as greater than or e*ual to 18 sample ratio units
"/3, Rsample signal divided by the test it negative control meanS# by
radioimmunoassay "3I2# "1#. This level was based on results of routine
screening and hepatitis ( vaccine'efficacy studies conducted in the early 19J8s
"$':#. /ubse*uently, the determination of anti'6(s levels was standardi-ed by
expressing anti'6(s concentrations in milli'international units per milliliter
"mI,NmK# using the W6& 2nti'6(s 3eference 4reparation "?#, and an anti'6(s
level of greater than or e*ual to 18 mI,NmK was recommended by 2!I4 as the
standard for demonstrating postvaccination protection against hepatitis ( "@#.
(ecause the value of 18 /3, by 3I2 and the manufacturersG recommended
positive threshold for en-yme immunoassays "5I2# were similar to 18 mI,NmK,
2!I4 recommendations issued in 19J@ defined the protective level of anti'6(s
as greater than or e*ual to 18 mI,NmK, approximately e*uivalent to 18 /3, by
3I2 or positive by 5I2.
V"#$ test% 2 blood test for syphilis ".D3K stands for .enereal Disease
3esearch Kaboratory# that detects an antibody that is present in the bloodstream
when a patient has syphilis.
2 negative "nonreactive# .D3K is compatible with a person not having syphilis,
but in the early stages of the disease, the .D3K often gives false negative
results. !onversely, a false positive .D3K can be encountered in infectious
mononucleosis, lupus, antiphospholipid antibody syndrome, hepatitis 2, leprosy,
malaria and, occasionally, pregnancy.
Venereal "isease #esearch $aboratory test% 2 blood test for syphilis. .
enereal Disease 3esearch Kaboratory is commonly abbreviated .D3K.
2 negative "BnonreactiveB# .D3K is compatible with a person not having syphilis.
6owever, a person may a negative .D3K and still have syphilis since, in the
early stages of the disease, the .D3K often gives negative results. This is called
a false negative .D3K.
The .D3K test is sometimes positive in the absence of syphilis. For
example, a false positive .D3K can be encountered in infectious mononucleosis,
lupus, the antiphospholipid antibody syndrome, hepatitis 2, leprosy, malaria and,
occasionally, pregnancy.
The 343 "rapid plasma reagin# test is similar to the .D3K test. It is also
designed to detect an antibody substance in the bloodstream when syphilis is
present but, as with the .D3K, early syphilis infections may give a false negative
343 result. The 343, lie the .D3K, can also give false positive results.