Male factor Infertility – Causes and Treatment

Male factor Infertility – Causes and Treatment


How common is male factor infertility and what proportion of infertility in the couple is attributable to the male?

Of all infertility cases, approximately 40–50% is due to “male factor” infertility and as many as 2% of all men will exhibit suboptimal sperm parameters.

The rates of infertility in less industrialised nations are markedly higher and infectious diseases are responsible for a greater proportion of infertility.

The fertility rate in men younger than age 30 years has also decreased worldwide by 15%.

Is it necessary for all infertile men to undergo a thorough evaluation?

 If you are facing difficulty in conceiving then semen analysis should be done at the earliest.

Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity.

Males with sperm parameters below the WHO normal values are considered to have male factor infertility.

The most significant of these are low sperm concentration (oligospermia), poor sperm motility (asthenospermia), and abnormal sperm morphology (teratospermia).

Semen analysis remains the single most useful and fundamental investigation with a sensitivity of 89.6%, that it is able to detect 9 out of 10 men with a genuine problem of male infertility.

What is the clinical value of traditional semen parameters?

Males with sperm parameters below the WHO normal values are considered to have male factor infertility.

The most significant of these are low sperm concentration (oligospermia), poor sperm motility (asthenospermia), and abnormal sperm morphology (teratospermia).

What key male lifestyle factors impact on fertility (focusing on obesity, heat and tobacco smoking)?

Cigarette smoke is a common somatic cell carcinogen and mutagen, and may adversely affect male reproduction factors.

Obesity is also linked to subfertility due to alteration in the hormone environment. Constant exposure to lead for instance, without safety measures, predisposes such individuals to low fertility.

Men who are exposed to high temperature at their workplace – welders, dyers, blast furnace workers and those employed in cement and steel factories – are more prone to infertility. A 1° elevation in testicular temperature leads to 14% depression of spermatogenesis.

Do supplementary oral antioxidants or herbal therapies significantly influence male factor infertility?

 Oxidative stress in the seminal fluid causes damage of the sperm plasma membrane and loss of its DNA integrity. Normally, a balance exists between concentrations of reactive oxygen species and antioxidant scavenging systems. If oxidative damage exceeds natural scavenging capacity then it affects sperm parameters. High dosage of vitamin C & E may rescue from such damage and increase fertility in male factor infertility.


What are the evidence-based criteria for genetic screening of male factor infertility?

Genetic testing is required in all severely oligospermic and non-obstructive azoospermic men. Such men demonstrate small testes and increased FSH. Chromosome structural and numeric abnormalities, YCMD, and other genetic mutations have been implicated in male subfertility. These men may benefit from genetic testing.

How does a history of neoplasia and related treatments in the male impact on reproductive health and fertility options?

Cancer, or post cancer treatments, can interfere with male factor fertility and reduce the ability to have children. Different types of treatments can have different effects.

Higher doses of cancer drugs are more likely to cause permanent fertility changes. The combinations of drugs can have greater effects. The risks of permanent infertility are even higher when males are treated with both chemo and radiation therapy.

What is the impact of varicocele on male fertility and does correction of varicocele improve semen parameters and/or fertility?

Varicocele is among the most common causes of male infertility. Varicocele affects fertility and sperm quality in some, but not in all men. The adverse effect of varicocele on sperm parameters may be due to increased testicular temperature, increased pressure, or reduced blood flow.

Effectiveness of varicocelectomy is however not proved and hence not practiced in many infertility setup.

Eating during Pregnancy, Food & Diet Plans

Eating during Pregnancy, Food & Diet Plans

food in pregnancy

food in pregnancy

Eating during Pregnancy

 A balanced diet provides all of necessary nutrients in proper proportions for adequate nutrition, function and development of body. In pregnancy, balanced diet is essential for growth of the baby and wellbeing of mother. Without good nutrition mother is more prone to disease, infection and restriction of growth of foetus.


Extra calories / eating for two

 During the first three months’ calorie needs of pregnant mothers are basically the same as they were before pregnancy. However, pregnant women should add 200 calories to their usual dietary intake during the second trimester, and 300 calories during their third trimester when the baby is growing quickly.

Brain growth of baby

 Baby’s brain starts forming just three weeks after conception and it undergoes rapid changes during pregnancy. Majority of brain growth is completed when the baby is born and later it undergoes few fine changes only. Food containing docosahexaenoic acid (DHA) is important in pregnancy for helping the brain and central nervous system mature. Iodine deficiency during pregnancy is the leading cause of preventable mental health.


Which Food in pregnancy is to be avoided?

 Avoiding certain foods in pregnancy is recommended for maternal and fetal well-being. Pregnancy is a state of lower immunity and pregnant women catch infections easily. Moreover, not all medications can be used to treat diseases in pregnancy. Hence it is safer to avoid certain foods in pregnancy which can give rise to food poisoning or infections. Fish such as shark, swordfish, king mackerel, and tilefish have high mercury levels and must be avoided. Smaller fish have less mercury content can be chosen instead as their longevity in water is short such as fresh water fish.

Similarly, smoked meat or fish should be avoided as they can cause infections. Raw uncooked eggs or poultry, unpasteurised milk and milk products, raw sprouts, unwashed fruits or vegetables are not advisable as well. Pregnant women should carefully avoid excess caffeine, alcohol or tobacco as these could harm the baby. Artificial sweetners, sugar rich foods, canned foods and foods containing nitrates as in frozen meat are better avoided in pregnancy.


Vegetarian food in pregnancy

 Vegetarians can meet their protein needs by eating select milk and egg foods, protein-rich vegan foods like nuts, hummus, and beans, soy milk, soy cheese, soy yogurt, and tofu. Pregnant women require an additional 45 grams of carbohydrates per day which can be obtained from fruits, vegetables, grains, and several dairy products. Nuts and vegetable oils can provide the dietary fat requirement for pregnant women. Carbohydrates enriched with folic acid reduce the rate of birth defects. Milk, yogurt, dark green leafy vegetables such as spinach, dried beans and peas and cheese are good sources of calcium.


Role of dietary fibres in pregnancy

 Dietary fibre is a nutrient that cannot get digested by human gastrointestinal tract. It absorbs water and helps bowel movements. Insoluble fibre like vegetables (especially dark green leafy ones), root vegetable skins, fruit skins, whole wheat products are essential during pregnancy to prevent constipation. Soluble fibres absorb water, bind to fatty acids and slow down sugar absorption. Some types of soluble fibres are: kidney beans, sprouts, broccoli, spinach, apple, orange, grapefruit, grapes, prunes, grains, oatmeal etc.


Choosing fruits and vegetables

Pregnant women need at least 70 mg of Vitamin C daily, which is contained in fruits such as oranges, grapefruits and honeydew, and vegetables such as broccoli, tomatoes, and sprouts. At least 2-4 servings of fruit and 4 or more servings of vegetables daily is recommended during pregnancy. Fresh fruit contains lots of essential vitamins and nutrients and eating plenty of fresh fruit during pregnancy can help wellbeing of mother and baby. Broccoli and dark, green vegetables, such as kale and spinach, contain vitamin C, vitamin K, vitamin A, calcium, iron, folate and potassium which are essential in pregnancy.

Planning meals in pregnancy

 Pregnant women should plan for small frequent meals. Lighter meals help prevent gastrointestinal upsets like abdominal distension and vomiting. Fatty foods like fried, baked snacks can be replaced by servings of fruits and nuts. Drinking 3-4 litres of water daily is essential during pregnancy.


Foods to avoid vomiting of pregnancy

Foods with high content of sugar, fat or salt lead to vomiting in pregnancy. A large evening meal can give rise to morning sickness. Having small and frequent meals and drinking a lot of cold water suppresses vomiting sickness of pregnancy. At times, fast foods and street foods can cause food poisoning and better be avoided in pregnancy.


Vitamins and minerals in pregnancy

 The lack of calcium, iron, iodine and other vitamins lead to baby’s learning disabilities, delay in language development, behavioural problems, delayed motor skill development, and a lower I.Q. Deficiency of Folic acid in pregnancy leads to severe malformations of the brain and spinal cord.  Folic acid is found in green leafy vegetables, broccoli, beans, citrus fruits and liver.

 Eating well during pregnancy is essential and the guidelines for eating well for a healthy pregnancy are simple and easy to follow. Healthy eating keeps the mother safe throughout pregnancy and provides baby the essential nutrients they need inside the uterus.



Excessive growth of facial or body hair on women may be symptom of an underlying disorder. Dark and coarse hair may appear on the face, chest, abdomen, back, upper arms, or upper legs due to excess androgens in blood. Most common medical disorder causing hirsutism is PCOS (Polycystic Ovary Syndrome) accounting up to 10% of all cases.

Excessive growth of facial or body hair on women may be symptom of an underlying disorder.

Excessive growth of facial or body hair on women

Excessive growth of facial or body hair on women may be symptom of an underlying disorder. Dark and coarse hair may appear on the face, chest, abdomen, back, upper arms, or upper legs due to excess androgens in blood. Most common medical disorder causing hirsutism is PCOS (Polycystic Ovary Syndrome) accounting up to 10% of all cases. Prompt medical attention often improves the condition whereas delaying medication makes the treatment more difficult and may have long-term health consequences.

The Human Hair

The human hair follicle is a complex structure and much has not been learnt about it. The hair follicle can be divided into 3parts: the lower segment (bulb and suprabulb), the middle segment (isthmus), and the upper segment (infundibulum). The lower segment around 4mm in length stays below the skin surface. The middle segment is a short section and the upper segment extends from the entrance to the skin to outside. Hair grows continuously in a cyclical fashion and rate of hair growth differs according to its position. Human body is covered by small vellus hair throughout except the palm and sole. In contrast the scalp is covered by lengthy terminal hair. The number of hair follicle at birth is fixed for life and it is around 100000 follicles in the scalp and 50 million on the body on an average.

Growth Cycle of Hair

 Each hair grows from a follicle deep inside skin. Hair continues to grow even if it is plucked or removed as long as hair follicles are not completely destroyed. The number of hair follicles slowly begins to decrease at around age 40. Hair density varies by ethnic origin. Men and women of the same ethnic group have similar numbers of hair follicles and similar hair patterns. Asians and American Indians generally have less body hair than people of Mediterranean descent. Excessive hair that is due to genetic and ethnic variation is typically located on the arms, hands, legs, and feet, whereas hirsutism typically affects the face, abdomen, chest, inner thighs, and back.

Adults have two types of hair, vellus and terminal Vellus hair is soft, fine, generally colourless, and usually short. In most women, vellus hair covers the face, chest, and back and gives the impression of “hairless” skin. Terminal hair is long, coarse, dark, and sometimes curly and covers the face and body of men. Terminal hair grows on the scalp, pubic, and armpit areas in both men and women. A mixture of vellus and terminal hair covers the lower arms and legs in both men and women.

Hair growth occurs in cycles. While some hair follicles grow, others rest, and still others are shed. Hormonal changes, such as those associated with oral contraceptives (birth control pills) or pregnancy, may synchronize hair growth and make it appear to grow and shed more than usual. However, hair growth patterns usually return to normal within 6 to 12 months.


Terminal hair that covers the face and body of men is usually the result of androgens. In men, androgens are produced primarily by the testes and the adrenal glands. In women, androgens are also produced but at a lower amount by the ovaries and the adrenal glands. Oestrogens, the female hormone reduces the effect of androgens in women. If vellus hair in women are sensitive to androgen then it may change to thick coarse terminal hair which grows faster. Once a vellus hair has changed to a terminal hair, usually it does not change back and is called hirsutism. Androgens increase sebum production, which results in oily skin and acne. Excess androgens in women can cause irregular or absent ovulation and menstruation. Extremely high androgen levels, such as when a tumor is present, may cause male-like balding, deepening of the voice, increased muscle mass, enlargement of the clitoris, and decreased breast size. These effects of excess androgens are called virilisation.

What causes hirsutism?

  1. Excessive production of androgens by the ovaries (polycystic ovary syndrome, tumor)
  2. Excessive sensitivity of hair follicles to androgens (genetic)
  3. Excessive production of androgens by the adrenal glands (non-classical adrenal hyperplasia [NCAH])
  4. Insulin resistance
  5. Hyperandrogenism, insulin resistance, acanthosis nigricans (HAIR-AN syndrome)
  6. Excessive production of cortisol by the adrenal glands (Cushing syndrome)
  7. Menopause
  8. Medications

Polycystic ovary syndrome is the most common cause of hirsutism and it is due to associated hormonal imbalances that cause the ovaries to overproduce androgens.

Unexplained Hirsutism

For unknown reasons, some women have hair follicles that are abnormally sensitive to androgens. Androgen levels are normal and menstrual periods occur regularly in these patients. This tendency to develop hirsutism is clearly genetic, but the exact abnormality is not known.

Ovarian or Adrenal Tumors

On rare occasions, an androgen-producing tumor may develop in the ovaries or adrenal glands. This tumor may produce extremely high androgen levels. Symptoms, such as hirsutism, usually appear suddenly and progress quickly. Very high androgen levels may cause male-like balding, deepening of the voice, and increased muscle mass. Fortunately, most of these tumors are not cancerous.


 Around the time of menopause, the ovaries stop producing estrogen but continue to produce androgens. The decreased levels of estrogen may allow the androgens to have a greater impact, leading to an increase in 8 the number of dark terminal hairs, especially on the face. For this reason, many menopausal women complain of new facial hair (moustache and whiskers) and mild balding.

Which drugs may cause hirsutism?

Drugs with characteristics of androgens may cause hirsutism. Anabolic steroids used to increase muscle mass in chronically ill and debilitated people and by some bodybuilders, are chemically related to androgens. Natural supplements such as DHEA may cause hirsutism. Danazol, phenytoin, minoxidil, and diazoxide are other medications associated with increased hair growth.

How Hirsutism is diagnosed?

Physicians trained to treat hirsutism and related problems generally include reproductive and medical endocrinologists. Some gynecologists, dermatologists, and general practitioners also have acquired the necessary expertise. After identifying the causes of hirsutism, physician can recommend appropriate treatment. Any unwanted hair remaining after treatment may be removed by a variety of cosmetic treatments, including laser and electrolysis.

Doctors might recommend an ultrasound or a CT scan to check ovaries and adrenal glands for tumours or cysts. Tests that measure the amount of certain hormones in blood, including testosterone or other testosterone-like hormones, might help determine whether elevated androgen levels are causing hirsutism.

What laboratory tests should be ordered for a patient with hirsutism?

Laboratory testing depends on the symptoms expressed by patients. Cases of mild hirsutism may be left alone without any investigations. However, serum levels of total and free testosterone, DHEAS, and 17-OHP can be useful tests, depending on the individual patient. Patients with signs or symptoms of hypothyroidism,

hyperprolactinemia, acromegaly, or Cushing syndrome also should be evaluated with serum thyroid-stimulating hormone (TSH), prolactin, IGF-I, or 24-hour urine cortisol testing, respectively.

How is hirsutism treated?

  1. Treatment of hirsutism is usually with a combination of oral contraceptive pills, spironolactone, other drugs like eflorinithine and cosmetic measures; however, other antiandrogens and gonadotropin-releasing hormone agonists can be used.
  2. Patients with polycystic ovary syndrome may have improvement of symptoms if they are treated with insulin sensitizers.
  3. Treatment of virilization is surgical removal of the tumor or steroid treatment for congenital adrenal hyperplasia.

How do you choose the appropriate therapy for hirsutism?

Most patients are given a trial of OCPs, with or without spironolactone, and are advised to use cosmetic measures while waiting for the medications to work. The topical cream eflornithine HCl may be used alone or in combination with other measures. Because of their more serious side effects and higher cost, the other medications are reserved for the most severe cases in which OCPs and spironolactone fail.

Whatever therapy may be chosen, the results do not last for more than 3 to 6 months. Although many medications and combinations have been used, only topical eflornithine HCl is currently approved by the Food and Drug Administration for treatment of hirsutism. Unfortunately, most patients have a relapse of hirsutism approximately 12 months after discontinuation of medical therapy.

What cosmetic measures can be used for the treatment of hirsutism?

Bleaching, shaving, plucking, waxing, depilating, and electrolysis are effective measures that can be used alone or in combination with medications. By these procedures terminal hair that is already present is removed. Simultaneous use of medications decrease new growth and rate of transformation to terminal hair. Laser-assisted hair removal is a commonly used method of treatment for hirsutism. It is done on outpatient basis using intense pulsed light therapy which cause thermal injury to the hair follicle. At least three to six treatments about 2 to 2.5 months apart are required. The techniques result in removal of hair, and a period of 2 to 6 months before the regrowth of hair, which is thinner and lighter. Patients with light skin and dark hair have the best results with the fewest side effects. The side effects include minimal discomfort, local swelling and redness lasting 24 to 48 hours.





Healthy Habits and periodical screening can Prevent Breast Cancer.

Healthy Habits Prevents Breast Cancer.

Screening mammography can be done every year for women starting from age  40 to reduce risk of breast cancer

What is the relation of breast cancer with alcohol drink?

The more alcohol you drink, the greater your risk of developing breast cancer. Hence ,  stop or reduce your alcohol quantity that reduces your risk of breast cancer.

What is the relation of smoking and breast cancer risk ?

Smoking increases breast cancer risk. Hence , Stop smoking that keeps you healthy.

Is there a relation between weight of a person and breast cancer risk ?

Overweight is a risk factor for breast cancer. Overweight women has increased  risk of breast cancer.

How physical activity helps to reduce breast cancer risk ?

Physically active people maintain a healthy weight, which helps to reduce the risk of breast cancer.

What is the type of physical exercise helps to maintain a healthy weight and decrease the breast cancer risk ?

For a healthy life healthy weight is essential . Hence , You can observe the following for a healthy weight :

  • At least 150 minutes a week of moderate aerobic activity  or
  • 75 minutes of vigorous aerobic activity weekly

One of the above with  strength training at least twice a week keeps you healthy.

Is there a role of breast feeding in prevention of breast cancer?

Breast-feeding play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect. So breast feeding to the baby reduces the risk of breast cancer too.

What is the effect of hormone therapy on risk of breast cancer?

Combination hormone therapy for more than three to five years increases the risk of breast cancer. Hence be careful while on long term hormone therapy. Is it really necessary ?

You should screen yourself for breast cancer by consulting the doctor.

What is the role of radiation exposure/CT Scan in Breast cancer?

Some studies showed relation between between breast cancer and radiation exposure so it is better to reduce your exposure to radiation.

Which diet reduces risk for breast cancer?

Mediterranean diet with extra-virgin olive oil and mixed nuts may  reduce the risk of breast cancer in women.

Fruits ,vegetables, whole grains, legumes and nuts are healthy for your body and also reduces the risk of breast cancer.

Hence , healthy diet including vegetables, fruits and nuts with loads of antioxidants reduces the risk of breast cancer.

Is there a relation between birth control pills and breast cancer?

Birth control pills and intrauterine devices (IUDs) increases the risk of breast cancer due to the hormone in it. Risk is  estimated to be very small . The risk decreases after the medicine is stopped . As there is a small risk of breast cancer for people taking hormone therapy, you should be vigilant about breast cancer screening. If you find any mass oin breast then immediately consult the doctor.

What is the role of family history in Breast cancer ?

Genetics is  the primary cause of 5–10% of all cases. So women with family history of breast cancer to the mother should be vigilant about breast cancer detection.

When you should suspect breast cancer ?

Appearance of new lump or mass in the breast needs a screen and consultation of doctor. If you develop some skin changes over breast always consult the doctor.

Mass or lump in the breast , is it always indicates cancer?


There are a number of benign conditions which can cause mass or lump in the breast and these issues can be solved by medicines or may need a small surgery. Hence , never get scares if you find a mass or lump in a breast, consult the doctor.


What is the common screening for breast cancer?

Mammograms are the commonly used for  screening for breast cancer and early diagnosis too.

What is mammography ?

Mammography is a specific type of breast imaging that uses low-dose x-rays to detect cancer in early stages .This can detect the breast cancer before women experience any symptoms . At this point the disease is mostly treatable  so  the patient can have a healthy life further .

When I should have a screening mammogram ?

Mammography helps in early detection of breast cancers .

Mammography can show changes in the breast up to two years before it can be detected clinically.

Current guidelines from the U.S. Department of Health and Human Services (HHS) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.

Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.

Current guidelines from the U.S. Department of Health and Human Services (HHS) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.

Healthy Habits Prevents Breast Cancer.

Screening mammography: every year for women starting from age  40  reduce risk of breast cancer . Healthy habits including breast feeding reduces the risk of breast  cancer .



Gender Assignment at birth, A Challenge For Parents

Gender Assignment at birth, A Challenge For Parents

Biggest Assignment as a Parent- Raising a child with Genital Ambiguity

The decision to have a baby is the first step in a lifelong commitment of love, time, and financial resources and dealing with a baby with sexual ambiguity is devastating and painful .

Sexual ambiguity is a complex issue. An accurate diagnosis is essential and may take some time. Sex of assignment must be based not only on the underlying diagnosis and karyotype but also on the potential for adult sexual function, fertility, and psychological health. For these reasons, input from several specialties, including endocrinology, genetics, neonatology, psychology, urology, and an ethicist, is important. All members of the team must communicate adequately with each other. Parents must fully understand the medical recommendation for sex assignment and required therapy. They must wholeheartedly agree and support the assigned sex to avoid ambivalence, which can lead to gender confusion and psychological trauma for the child.

Parents may be dealing with two major categories of children presenting with this problem:

  • Virilized 46, XX females –females look like male
  • Under virilized 46, XY males- males look like female

The most common cause of sexual ambiguity in newborns is congenital adrenal hyperplasia secondary to 21-hydroxylase deficiency. Adrenal gland is situated above the kidneys and secretes several hormones.

As a general rule, gonadal tissue containing Y chromosomal material is at higher risk for development of malignancy.

When infant is born with ambiguous genitalia, and the sex of the infant is uncertain, what next ?

Accept the truth, cooperate with medical professionals as further testing is necessary to determine the infant’s sex. Explain all the relevant history during pregnancy that may help in a diagnosis.


Reference to more commonly understood birth defects may be useful. Several days may be necessary to complete the testing and a team will participate to make an accurate diagnosis and a considered recommendation.


Completion of the birth certificate should not be postponed, and sex assignment should not be delayed. Accept the sex assigned by Medical team.

What can cause genital ambiguity in newborn? Is it preventable?

Drug ingestion, alcohol intake, and ingestion of hormones during pregnancy can lead to such a situation. Hence Maternal history is particularly important. Progestational (androgenic) therapy used for threatened abortion or androgens for endometriosis during pregnancy should be avoided as far as possible. If the mother has signs of excessive androgen or parental family history for occurrence of ambiguity, neonatal deaths, consanguinity, or infertility it can lead to sex disorders.


What is the extent of problem?

The most common cause of a virilised female is congenital adrenal hyperplasia (CAH). Virilisation may also be caused by maternal ingestion of androgens or synthetic progesterone during the first trimester of pregnancy. The measurement increased ACTH in blood is useful for making a diagnosis. These babies have female chromosomes with male outlook, however they do have ovaries and uterus like any other female child.


An undervirilized male (previously called male pseudo hermaphroditism) refers to a male with female external genitalia. The abnormality may range from various grades of feminisation to a completely female phenotype. Such disorders result from deficient androgen stimulation of genital development and most often are secondary to testosterone biosynthetic defects. These boys have male chromosomes with female outward looks.

How the condition is diagnosed? What are the tests done?

The diagnosis of the origin of sexual ambiguity can rarely be made by examination alone, it is always combined with a series of tests. Tests are directed to determining the presence or absence of palpable gonads (presumably testes), the presence or absence of a uterus, and the karyotype to allows classification of the infant as a virilized female, an under virilized male, having a disorder of gonadal differentiation, or having one of the

unclassified forms. Certain forms of CAH may cause dehydration, hypertension, or areolar or genital hyperpigmentation. Turner’s stigmata may be present, including webbed neck, low hairline, and edema of hands and feet.

Radiographic studies are necessary to find out structural abnormalities like the presence of gonads and other reproductive structures. Pelvic ultrasound examination by qualified and experienced personnel should be performed as soon as

possible to look for a uterus. The presence of gonads, fallopian tubes, and a vaginal vault may also be determined. If necessary, a genitogram may be performed to see the lower reproductive organs like presence of vagina and its extent.

Because 21-hydroxylase deficiency is a common cause of sexual ambiguity, the level of 17-hydroxyprogesterone (17-OHP) should be assessed in all such infants who do not have palpable gonads. Screening of newborns for CAH with measurement of a 17-OHP level is now mandated in all 50 of the United States and in many countries throughout the world. A karyotype is essential and must be obtained expeditiously. Buccal smears are absolutely contraindicated because they are inaccurate. In many laboratories, a karyotype can be completed within 48 to 72 hours.

Defects in testosterone synthesis can be diagnosed by low testosterone levels with defect in its synthesis pathway (from the level of enzymes block either in the adrenal or in testicular pathways).

What is the role of parents in upbringing?

The decision about sex assignment must be carefully made, taking into consideration each “level” of sex determination. Sex assignment also depends on fetal sex hormone exposure, the potential for adult sexual function, and psychological and cultural considerations. It is vital that parents completely understand and support the decision because ambivalence about sex of rearing may result in gender confusion and psychological trauma.

Virilized females are usually assigned a female sex. They have normal ovaries as well as uterus and vaginal structures and, with surgical correction and steroid replacement, can have normal sexual function and achieve fertility. However, severely virilized females should be assigned a male sex.

Undervirilized males are often infertile, and sex assignment has usually been based on

phallic size. Adult social and fulfilling sexual function should be the primary goals of gender assignment. If male sex assignment is contemplated, a trial of depot testosterone (25 mg every 3-4 weeks) for 1 to 3 months indicates whether phallic growth is possible.

In patients with gonadal dysgenesis and Y chromosomal material, gonadectomy is necessary, and fertility is not possible. Internal duct structure is also frequently deranged. Small phallic size usually leads to a female sex assignment.

True hermaphrodites who have a unilateral ovary and uterine structures may have spontaneous puberty and normal fertility and may be raised as females. External genital size and structure may allow male assignment, but more commonly, external genitalia are poorly virilized, and affected infants are assigned a female sex.

 What are the future prospective regarding marriage, child bearing etc.?

Parents must understand that having normal sexual performance does not correlate with reproductive ability. However, physicians always give preference to sexual ability than childbearing probability. Our aim in parenting is to give the child a sexual identity which may contradict the genetic makeup and at places may force us to sacrifice the gonads for future life.

We have much to learn about gender identity and must consider which decisions may be made later than previously thought (e.g., surgery). Some surgical interventions are cosmetic, and some affected patients have expressed the wish to make the decisions in adolescence or adulthood. This field challenges many of our perceptions of sex and gender and our role as physicians. Although the infant with genital ambiguity presents a medical and social emergency, decisions should be made carefully, cautiously, and with all necessary biochemical and anatomic information available. Most important, the multidisciplinary team approach must involve the parents in an open and honest

discussion of the options. In the end, it is the parents who come first in decision making on sex assignment.

A male child be with complete androgen insensitivity should be raised female. Complete androgen insensitivity usually does not have suspicion of ambiguity in the new born period or early childhood. Affected children grow as normal females until puberty. They feminize with normal breast development at puberty because high levels of testosterone are aromatized to oestrogen, but they have no pubic or axillary hair and no menses because they lack uterus and ovaries. Gender identity is usually female. Patients come to medical attention because of lack of menses in adolescent period.

The diagnosis is therefore frequently made when patients are in their middle to late teens. If diagnosed early the testes should be removed to prevent cancer and oestrogen therapy should start early. This therapy helps in developing the vagina and performance as a female is not compromised.

Undervirilized males traditionally, infants with 5-alpha-reductase deficiency were raised as females until puberty, then continued life as males, and, in some cases, achieved fertility. More recently, however, the condition has been recognized early in life, and affected males are now raised from infancy as boys.

Virilized females are usually assigned a female sex. They have normal ovaries as well as

Uterus and ovaries and, with surgical correction and steroid replacement, can have normal sexual function and achieve fertility.

However, severely virilised females should be assigned a male sex. They can perform sexual function as a male but cannot reproduce as they don’t  have male gonads.

Patients with Y-related chromosomal or genetic disorders that cause mal development of one or both testes are said to have gonadal dysgenesis. They present with ambiguous genitalia and may have inadequate virilisation, uterus and vagina may be present in such children. The Y-containing dysgenetic testes are at risk for developing cancer and must be removed better reared as females.

How to deal with infertility in such cases?

Fertility potentiality is decided by karyotyping, presence of gonads and presence of uterus and vagina. Accordingly, they can go for gamete donation programme or surrogacy. The decision has to be taken after discussion with the couple.


Noise pollution : Health Hazards

Noise pollution : Health Hazards

noise pollution

noise pollution

What is noise?

Noise is unwanted unpleasant sound which is loud or disruptive to hearing. From definition of physics, noise is same as any form of sound but it is perceived in the brain in a different way.

What is noise pollution?

Noise pollution is environmental noise and the propagation of noise which cause  harmful impact on the activity of human or animal life.

What are the health issues associated with noise pollution?

Exposure to noise is associated with adverse health outcomes.


  • Hearing loss
  • High blood pressure
  • Ischemic heart disease
  • Sleep disturbances
  • Injuries
  • Peptic ulcer
  • Decreased work performance

What are the Psychological effects of noise pollution?

Noise has following psychological effects –

  • Annoyance
  • Psychiatric disorders
  • Adverse psychosocial well-being

What is the noise levels allowed for residential areas?

WHO recommends value of 50 dB allowed for residential areas.

How noise pollution affects cardiovascular health?

High noise levels can result in cardiovascular effects. Exposure to moderately high levels during a single eight-hour period causes a statistical rise in blood pressure of five to ten points and an increase in stress, and vasoconstriction leading to the increased blood pressure as well as increased incidence of coronary artery disease.

Can we reverse noise induced hearing loss?

Noise-induced hearing loss is permanent. But this is very much preventable.

What is the acceptable noise levels in India?

The Central Pollution Control Board of India has set the safe limit for ambient noise at 55 dB for residential areas and 65 dB for commercial areas.

What is the average city noise ?

Average city traffic noise corresponds to 70 dB.

  What is the heavy city noise ?

Average city traffic noise corresponds to 90 dB.

What are examples of very loud noise and its measure?

Very loud noise spans 90 to 110 dB. Examples of 100 and 110 dB respectively are a farm tractor and a jet plane flying 310 meter overhead.

Which is the most nosiest city in India?

A study by the National Physical Laboratory indicated that Mumbai is ‘the noisiest city in India’, the biggest source of noise for a person there being vehicular traffic .

What is the noise level that can drive the person insane?

A noise of 140 decibels is sufficient to drive a person insane.

Which noise can make a permanent hearing loss?

Prolonged  exposure to noise levels greater than 85 decibels can impair hearing permanently.

How to avoid noise pollution?

Ear plugs and ear muffs can be used for this purpose. The workers in noisy environment should be rotated to avoid prolonged exposure. Education about noise pollution and its health hazards are important steps.

Health Tips

Healthy Habits