Should methods of natural family planning fail then there are currently a number of methods of assisted conception that can be used. The choice of which technique to use (for any couple) is dependent on a range of factors and includes the:
With regard to the latter point, it is a sad reflection that in circumstances where public money is unavailable to fund treatment and the couple needs to fund their own, then the choice of treatment may be sometimes dictated by the cost rather than its clinical effectiveness. However, little has been published on this topic and so it remains anecdotal as to whether the avail-ability of funding is a major factor in influencing the outcome of fertility treatment in this group of patients.
As such, there are very different treatment prednisone online pharmacy options available for a man who has some recovery of spermatogenesis following a medical treatment compared with a man who might be azoospermic after treatment and only have the limited resource of his frozen samples in storage.
For example, for a man who, at the time of entering an assisted conception programme with his partner, is ejaculating moderate number of motile spermatozoa and from whose ejaculates at least five million motile sperm per millilitre can be prepared, a relatively simple procedure such as IUI using freshly ejaculated sperm would seem most appropriate. Whereas in a man whose ejaculates have been consistently azoospermic but who has frozen samples from which at least 10 or 20 motile sperm can be identified, then ICSI would certainly be required. However, in reality this is a some-what simple way of looking at the decision as in each case account needs to be taken of the biology of the man’s partner and there are many circumstances where the aggressiveness of the assisted conception treatment has to be increased because of pathological factors on the female side. For example, previous disease or damage to the Fallopian tubes will almost certainly require the couple to use IVF even if the quality of sperm available would be sufficient for IUI in another woman.
An interesting question is the decision that is made surrounding the use of fresh or frozen sperm in cases where the quality of the two (in terms of the concentration of motile sperm) is very similar post-treatment. Anecdotally, opinion is divided as to which is the better option, the anxiety being that following any medical treatments involving cytotoxic drugs there is a known increase in sperm chromosomal abnormalities that theoretically could lead to an increase in spontaneous abortions, stillbirths or birth defects in children.
Overall, the risk of myocardial infarction during sexual activity is negligible. Although maintaining sexual activity has been reported to have potential health benefits, it can trigger myocardial infarction (MI), arrhythmia, or sudden death in a very small minority of patients. The Myocardial Infarction Onset Study (MIOS) enrolled 1,712 patients with a first episode of MI. Sexual activity was the potential trigger for MI in 1.5% of cases. Among 858 sexually active in the year before MI, 70 (9%) reported sexual activity in the 24 h preceding the acute coronary event, and 27 (3%) in the 2 h preceding the onset of symptoms. Canadian viagra pharmacy
The relative risk of MI was assessed by “case-crossover” methodology. Overall, the relative risk of MI was increased by two to three times and confined to the 2-h period after sexual activity. After correcting for chance occurrence, 0.9% of cases could be attributed to sexual activity within the 2-h period before MI onset. Of paramount importance was the observation that the risk decreased to none if the subject engaged in regular physical activity (at least three times per week) at moderate workload (5–6 METs). A similar study from Sweden reported identical findings.
A more important concept is the absolute risk of MI during sex. In the Framingham Heart Study, the baseline risk of MI for a 50-year-old non-smoking, non-diabetic man is 1% per year or one chance in a million per hour. As sexual activity increases the relative risk by two to three times, this subject will have a 1.01% risk per year or two to three chances in a million per hour, but only for a 2-h period. In patients who have had a previous MI, the baseline risk of reinfarction for death is: 10% per year, or 10 chances in a million per hour increasing to 1.1% per year, or 20 chances in a million for a 2-h period after sexual activity.
Once again, the risk decreases to <3% if the patient could exercise >7 METs. Coital sudden death is very rare. In three large studies, death related to sexual activity was 0.6% in Japan, 0.18% in Frankfurt, and 1.7% in Berlin. Extramarital sex was responsible for 75%, 75%, and 77% respectively, and the victims were men in 82%, 94%, and 93% of cases, respectively. The partnership of an older man with a younger woman was the most common setting. Excessive drinking and sex too close to a large meal were frequently associated.