TUBAL BLOCKAGE IVF BETTER TAN SURGERY

The primary benefit of tubal surgery to repair tubal blockage is that it is done once. However, according to Consultant Gynecologist and Invitro-fertilization (IVF) expert, Dr Abayomi Ajayi, the success rate is very poor in the range of between 10-15 per cent. There is also the risk of tubal or ectopic pregnancy following tubal surgery. He disclosed that in IVF, you can avoid surgery and pregnancy rates are in the range of 25-30 per cent. Dr Ajayi spoke on this and other issues.
Tubal surgery vs lVF The primary benefit of tubal surgery to repair tubal blockage is that it is done once. However, its success rate is poor in the range of between 10-15 per cent. There is also the risk of tubal pregnancy (Ectopic) following tubal surgery and this may be life-threatening if rupture occurs. In-Vitro-Fertilization (IVF) has the advantages; you can avoid major surgery and pregnancy rates are in the range of 25-30 per cent. Complications following IVF are also minor. IVF however is more expensive than tubal surgery as it involves the use of hormonal preparations, there is also an increased risk of multiple gestation following IVF. Various factors affect the success of IVF and the single most important is the age of the woman, the younger in age, the better the outcome. Older women however can benefit from IVF by using donor oocytes from younger women. IVF also has the advantage of overcoming male infertility through a process called Intra-cytoplasmic sperm injection for men with low sperm count (oligospermia). It is therefore imperative that tubal fertility problems be promptly referred to assisted conception units for care. Undertaking tubal surgery may not be the best option and it involves a lot of risks. In-Vitro Fertilization and Embryo Transfer remains the most acceptable means of passing tubal factor infertility.
Ectopic pregnancy The tubes may develop adhesions and thickened walls and close off completely. In that case, a woman’s hormones can be fine, her eggs can mature and she can even release healthy eggs every month, but the sperm may not be able to reach them. If the tubes are opened enough to allow the sperm through, fertilization may occur in the fallopian tubes. Then, when the growing zygote is traveling through the tube to reach its destination in the uterus, it may get stuck and implant in the partially-obstructed tube, resulting in an ectopic pregnancy, which may cause further tubal damage and even loss. There is a risk of recurrence of ectopic pregnancy and when both tubes are affected, the woman is unable to conceive by natural means.
Treatment There are two basic approaches to treat infertility due to tubal blockage viz: Tubal Surgery and In Vitro Fertilization (IVF). Tubal surgery involves techniques aimed at re- opening blocked tubes, while IVF replaces the functions of the fallopian tube with laboratory and minor surgical procedures that result in fertilization and transfer of fertilized eggs or embryos into the uterine cavity. Since the advent of In Vitro Fertilization (IVF), reconstructive tubal surgery is becoming a lost skill. IVF is more popular than tubal surgery due to the better pregnancy outcome using assisted conception procedures. Sometimes, a woman’s inability to conceive is because the pathway from her ovaries to her uterus is compromised. The ovaries could be covered with adhesions that obstruct entry of eggs into the pelvic cavity. The fallopian tubes could be narrowed or even completely obstructed or perhaps the uterus is bound up with scar tissue that keeps it from holding the fertilized egg successfully. Blockages such as these may be caused by congenital defects, by scarring from past infections, by surgical procedures like tubal ligation. A blocked tube prevents sperm from being able to reach an egg and also prevents embryos from being able to reach the uterus. Tubal block can be intentional (such as in tubal sterilization) or unintentional (due to disease conditions that result in involuntary infertility). Whether intentional or resulting from disease, tubal blockage may be corrected with reconstructive tubal surgery.
Prevalence and causes An estimated five million women in Nigeria have had a tubal sterilization for one reason or the other. Approximately one-sixth of the cases of infertility in the country are due to tubal disease. Most of these cases are caused by pelvic inflammatory disease (PID) - an inflamatory condition of the fallopian tubes (salpingitis) and may also involve the ovaries (oophoritis), and pelvic peritoneum (peritonitis). In many, perhaps the majority of cases, PID is unrecognized or ‘silent’ and/or misdiagnosed. Endometriosis is another condition that can cause tubal blockage and is sometimes confused clinically with PID. Congenital abnormalities or malformations of the uterus and fallopian tubes may also result in tubal blockage. In these cases, the blockage is usually at the uterine, or proximal, end of the tube rather than at the fimbrial end as occurs with PID.
Symptoms Most fallopian tube obstructions produce no overt symptoms other than infertility. Adhesions and scar tissue may cause pain and limit mobility. Many women discover blocked fallopian tubes only after experiencing infertility and as a result of one or more diagnostic procedures, including a hysterosalpingogram (where dye is injected into the uterus and examined via x-rays to see if it spills into the pelvic cavity), laparoscopy or laparotomy.
Mechanical Infertility Perhaps the most heartbreaking causes of mechanical infertility known to mankind is Pelvic Inflammatory Disease (PID). This infection is being singled out because it can destroy a woman’s fertility without warning, long before the woman even considers getting pregnant. PID is usually the result of bacterial infection that can involve the ovaries, fallopian tubes, uterus and cervix. The bacteria commonly enters the body through the vagina and cervix and spread from there throughout the pelvic cavity. Many women in their teens and 20s are routinely diagnosed with acute pelvic inflammatory disease (PID). The most common cause of PID is sexually transmitted diseases, especially Chlamydia and Gonorrhea. PID can also result from using an intrauterine device (IUD), complication from earlier pregnancy or infection following surgery of the reproductive tract. Depending on the infectious organism and the severity of infection, the acute phase of the disease may be characterized by lower abdominal pain, fever, painful sexual intercourse, irregular bleeding and profuse vaginal discharge. As with any bacterial infection, signs such as these should be treated as quickly as possible with antibiotics. On the other hand, some pelvic infections involving Chlamydia species, may not have symptoms of any kind, yet can cause extensive damage to the reproductive organs, especially the fallopian tubes. Most fertility problems associated with PID are not caused by active infection, but instead by scarring from past infections. Untreated, chronic PID creates a condition of long-standing inflammation within the pelvic cavity, and this sets up a reactionary environment within the reproductive organs, especially the fallopian tubes. One of the most common outcomes of PID is fallopian tube obstruction. The fallopian tube is the ‘golden path’ that the embryo must travel to reach the uterus. It is also the location for fertilization of the egg (oocyte). The tubes contain two specialized kinds of cells viz: those that produce mucus, glucose and other substances needed to nourish the egg (both before and after fertilization) and tiny hair-like structures that move the embryo through the tube and into the uterus. Unfortunately, the fallopian tubes are often the first locations attacked by the opportunistic bacteria. And because they have such narrow structures, it doesn’t take much to obstruct them. The tubes can become inflamed within (salpingitis), become filled with fluid (hydrosalpinx) or pus (pyosalpinx), creating a bulge and/or possibly destroying the lining and musculature needed to nurture the egg and move it along. Fluid from a hydrosalpinx can drain into the uterus and have an adverse effect on implantation.

THE IMPORTANT OF BREAKFAST

Breakfast is the most important meal of the day? It is important to note that a good breakfast provides the nutrients that is needed to start off the day right.

Almost everyone is conversant with the fact that breakfast is the most important meal of the day. But despite this knowledge, not many have taken breakfast seriously and made it a part of their daily diet. Just like adults, skipping breakfast has also become a practice among school going children and as parents and caregivers, it is our responsibility to provide them with a healthy breakfast.

Many students refuse to eat breakfast before going to school for several reasons like lack of time, not feeling hungry, to mention a few reasons. However, they do not realise that not eating breakfast actually hampers their health and can cause various learning problems. To avoid such problems, it is necessary that students develop the habit of eating breakfast daily. Rather than forcing children to eat breakfast, it is to make them understand the importance of breakfast for students and the ways it will benefit them.

The exact meaning and importance of breakfast lies in the word itself. By eating breakfast, we are actually breaking the fast or long gap after dinner, the previous night. By the time we wake up in the morning, all our energy is used up and hence we need new energy to go through our daily routine. Students who do not eat or skip breakfast on a regular basis are at a high risk of developing gastroenteritis and several other health problems.
A number of studies have shown that regular consumption of breakfast leads to improved mood and better memory. Breakfast eaters also tend to be less stressed and feel calmer. Adults perform better in mental tasks after eating breakfast, and children who eat breakfast perform better in school. Breakfast should ideally provide around 25 per cent of the body's daily nutritional requirements. Nutrition experts have revealed that skipping breakfast, whether due to lack of time or trying to lose weight, can mean missing out on essential nutrients, which are not likely to be made up later in the day and, as such, could result to a negative effect on both short and long term health.

However, it is interesting to know that breakfast provides an excellent opportunity to eat a variety of foods, ranging from something light, to a more substantial meal, depending on individual needs at the time.

Breakfast cereals are nearly all fortified with minerals and vitamins. When combined with low fat milk, they provide a nutritious, balanced meal. A glass of fruit juice, too, with vitamin C in the juice, helps to absorb the iron in the cereal. For those who prefer toast in the mornings, there are varieties of bread or bread based foods to choose from, such as, granary, whole-meal, bagel, rye bread, bread rolls and lots others. Served with a scraping of butter or spread and a little jam or marmalade, and a glass of fruit juice, this makes an easy, no-fuss healthy breakfast. When it comes to cooked breakfasts, you can make these healthier too, by grilling instead of frying, poaching or scrambling eggs, and limiting portions of sausages and bacon. Add extra tomatoes, mushrooms or baked beans instead, to boost vitamins, minerals and fibre. For a light breakfast, opt for low fat yogurt with fresh or dried fruit. Breakfast provides an ideal opportunity to count towards your five daily servings of fruit and vegetables: a glass of fruit juice provides your daily vitamin C; top breakfast cereals with dried apricots, raisins, prunes or with fresh strawberries or banana; and remember tomatoes, mushrooms and baked beans all count too.

Here are some breakfast ideas to kick-start your day with this New Year.

Blueberry smoothie with toasted-cheese Sandwich

Recipe for 2 servings:

4 slices whole-wheat bread

1/2 cup cereal

11/2cup fat-free milk

1cup blueberries (frozen)

1/2 cup cheese (sliced)

Pop bread into the toaster. Dump the cereal, milk, and berries into a blender to soften. Stick a slice of cheese between the warm slices of toast and place sandwich in a microwave for 15 seconds to nuke.

Quark cr�me

Recipe for 3 servings:

2cups yogurt cheese or any other cheese

21/2 tablespoons milk

1/2 cup sugar

1/2 cup whipping cream (whipped)

1 tablespoon chocolate (grated)

1/2 cup watermelon (diced)

2 bananas (cut into chunks)

1 apple (cut into small sizes)

Stir quark, milk and sugar together until smooth. Fold in the whipped cream and grated chocolate. Refrigerate until dessert time. Serve with fruit.

For yogurt cheese: Pour 1quart yogurt into a strainer with several layers of cheesecloth. Place strainer in a bowl and allow to drain for about some time, preferably overnight in the refrigerator.

Scrambled eggs with celery & bread

Recipe for 4 servings:

12 eggs, beaten

1/2 stalk of celery, chopped to a pulp

2 onions (chopped to a pulp)

3 tablespoons butter

Pinch salt & other seasonings to taste

Pour little water into a medium size skillet on medium high heat. Combine celery and onions. Cook for 3 minutes, stirring all the time. Add butter and cook for another 3 minutes until butter is dissolved. Thereafter, add the beaten eggs and scramble together for 2 to 4 minutes. Serve immediately with 2 to 4 slices of bread and a cup of tea.

Ogi ati akara (hot pap & bean cake)

Recipe for 3 servings:

2 cups brown beans

1 large onion (chopped)

3 hot chili peppers (chopped)

2eggs (beaten)

2 tin milk

1/3cup sugar

60ml groundnut oil

Pinch salt & seasoning to taste

1medium cup ogi

In a medium size bowl soak beans for not more than 20 minutes. Then, rub beans with hand or pound lightly in a mortar to remove skin. Sieve in a strainer to remove all dirt. Rinse well in clean water, then blend beans in a food processor until it becomes a smooth, thick, finely-ground paste. Add pinch salt & seasoning of choice to taste. Add beaten eggs and stir together. Add in chopped onion and pepper, stir.

Heat groundnut oil in a shallow skillet on low heat for 2 minutes. With a small but deep scoop or spoon, arrange bean balls into oil for about 6-10 minutes or until balls becomes light brown. Flip balls to make sure both sides are fried.

Remove balls from oil and place in a colander to drain excess oil.

FOR PAP: Boil some water in a kettle. Meanwhile, dish pap into serving containers, add a little water and stir until pap is smooth. Pour boiling water on pap and stir, add sugar and milk and serve with bean cake, akara

Rice and stew

Recipe for 3 servings:

10 fresh tomatoes (ground)

1medium size onion (ground)

4chilli peppers (crushed)

40ml oil

2 smoked fish (pieced, bones removed)

Dash salt and seasoning to taste

2 cups rice

Heat oil on medium high heat for 2-3 minutes. Add onion, fry for a few seconds, then add tomato, pepper, salt and seasonings. Continue to fry. Add fish, fry under low heat for yet another 10 minutes. Simmer for another 10-15 minutes. Meanwhile, boil rice in another pot. When done serve with stew and chilled water or fruit juice.