Stroke ... Brain attack

Stroke or Brain attack

A stroke is a "brain attack" that happens when a part of the brain experiences a problem with blood flow. This disruption in blood flow cuts off the supply of oxygen to the cells in that part of the brain, and these cells begin to die.

Damage to the brain can cause loss of speech, vision, or movement in an arm or a leg, depending on the part of the brain that is affected.

Stroke is the major form of cerebrovascular disease, or CVD, a term that sometimes is used interchangeably with stroke.

There are two main types of stroke:

· Stroke caused by a blockage in the artery supplying blood to a particular region of the brain (called cerebral infarction) This is the most common type of stroke.
· Stroke caused by bleeding within the brain (called intarcerberal hemorrhage)
· Mini-stroke, in addition, some people experience brief warning signals that a major stroke is going to happen in the future. The medical term to describe these symptoms is transient ischemic attack or TIA. Sometimes called “mini-stroke”, TIAs are exactly like a stroke, but they last only a few minutes (or sometimes as long as an hour) and leave no disability.

In many cases, a stroke will affect only one side of the body:
. A stroke that damages the right side of the brain will affect the left side of the body.
. A stroke that damages the left side of the brain will affect the right side of the body.

1. Stroke Caused By Blocked Blood Flow
About 85 percent of all strokes happen because not enough blood gets to the brain. Blood flow stops when an artery carrying blood to the brain becomes blocked. The technical name for this type of brain attack is cerebral infarction. It is also called ischemic stroke. "Ischemic" refers to a condition caused by a decreased supply of oxygenated blood to a body part.

The blockage can be caused either by a blood clot that forms in an artery in the brain, or by a blood clot formed elsewhere in the body that travels through the bloodstream to the brain. If this clot becomes stuck in an artery in the brain, a stroke can result.

Clots are more likely to form in arteries that are damaged by atherosclerosis, also called "hardening of the arteries," due to the buildup of cholesterol and other thick, rough, fatty deposits in the arteries.

The blockage also can be caused by a small piece of tissue, usually a blood clot, that has traveled through the bloodstream from elsewhere in the body.



In ischemic stroke, one of two major arteries is usually involved:

The carotid artery (most commonly involved site)

The basilar artery

The carotid arteries start at the aorta (just above the heart) and lead up through the neck, around the windpipe, and into the brain. The basilar artery is formed at the base of the skull from the arteries that run up along the spine, and branches off in the brain.




2. Stroke Caused By Bleeding In The Brain
The other 15 percent of strokes happen when an artery carrying blood to the brain bursts suddenly. The bursting can happen because of a weak spot in the wall of an artery called an aneurysm. This type of brain attack is called a hemorrhagic stroke.



Two kinds of stroke are caused by bleeding in the brain:

A subarachnoid hemorrhage occurs when a blood vessel on the brain bursts and bleeds into the fluid-filled space between the brain and the skull. This type of stroke can happen at any age.

An intracerebral hemorrhage occurs when an artery bursts inside the brain, flooding the surrounding brain tissue with blood. This type of stroke is often associated with high blood pressure.

What Are "Mini-Strokes"?

A "mini-stroke" is exactly like a stroke, but it lasts only a short time and leaves no disability. The term for this event is transient ischemic attack or TIA.

A TIA happens when a blood clot clogs an artery temporarily, cutting off blood flow and, consequently, the supply of oxygen to cells. But the difference between a TIA and a stroke is that, with TIA, the blood clot dissolves on its own and blood flow is restored before permanent damage to the brain can occur.

TIAs are an extremely important warning sign for stroke and should never be ignored.

About 10 percent to 15 percent of strokes are preceded by TIAs ('mini-strokes'), which can happen days, weeks, or even months before a major stroke. However, not everyone who experiences a TIA will have a stroke in the future.

General recovery guidelines for stroke show:
· 10 percent of stroke survivors recover almost completely
· 25 percent recover with minor impairments
· 40 percent experience moderate to severe impairments requiring special care
· 10 percent require care in a nursing home or other long-term care facility
· 15 percent die shortly after a stroke

Facts About Stroke:
· Nearly 4 million people in the United States have survived a stroke and are living with the after-effects.
· Each year, more than 500,000 Americans have a stroke.
· Although stroke is still the third leading killer in the United States, the death rate from strokes has been cut nearly in half over the last two decades.
· A stroke is always serious. Cells in the brain that become damaged cannot be repaired or regenerated. But other areas of the brain may take over the work of the damaged portion.
· Most people know they should seek emergency medical help immediately if they are having symptoms of a heart attack. But the average stroke patient waits more than 12 hours before going to a hospital emergency department, losing precious time that could be critical to treatment.
· Stroke was first recognized more than 2,400 years ago by Hippocrates, the father of medicine, who described a condition marked by the sudden onset of paralysis.
· There are steps you can take to help prevent a stroke. Healthy living is very important in stroke prevention. There also are successful treatments if it does happen.

What Are The Signs Of A Stroke?

The warning signs of stroke are:

. Sudden weakness or numbness of the face, arm, and leg on one side of the body
. Sudden loss of vision or dimmed vision, particularly in one eye
. Loss of speech, or trouble talking or understanding speech
. Sudden, severe headaches with no apparent cause
. Unexplained dizziness, unsteadiness, or sudden falls, especially if accompanied by any of the previous symptoms

Most severe headaches are not a sign of stroke. Migraine, which can cause quite severe and sometimes alarming headaches, is very common and affects about one in five people.

How-To Information:

If you experience migraines, how can you tell if your headache is just another migraine - or a sign of stroke?

A headache caused by a stroke:
Will come on very suddenly, without the aura that sometimes precedes migraines Has been described by stroke survivors as "the worst headache of my life"
Will build up to a peak within a minute or two
May be accompanied by vomiting and a stiff neck

What Do Different Parts Of The Brain Do?

The brain is a very complicated organ. Although it is a relatively small part of the body, it uses one-quarter of the blood supply.
When a person is right handed, the left side of the brain is dominant. About 90 percent of left-handed people have the right side of the brain dominant.

Nice To Know:

In general, the right side of the brain processes:
Music
Art
Mathematics
Memory
Hearing
Sight
Movement

In general, the left side of the brain processes:
Writing
Reading
Speaking
Understanding
Memory
Hearing
Sight
Movement

What Increases The Risk For A Stroke?
Anybody can have a stroke, but certain factors place a person at higher risk. Some factors that increase the risk of stroke cannot be changed, while others are linked to lifestyle.

Risk Factors That Cannot Be Changed
Some risk factors for stroke cannot be changed:
· Age - The older a person gets, the greater the risk of stroke.
· Sex - Men are more likely to have a stroke than women are.
· Race - Blacks have a greater risk of stroke than whites do.
· Diabetes- People with diabetes mellitus are more at risk.
· A history of migraine headaches- Recent studies indicate that women who experience migraines are at higher risk for ischemic stroke (stroke caused by a blockage in a blood vessel).
· A prior stroke -Someone who has had a stroke has a slightly increased risk for another.

Risk Factors That Can Be Changed With Medical Treatment
The major risk factors for stroke that medical treatment can change are:

· High blood pressure- High blood pressure has no warning signs, so regular blood pressure checks are important. The condition can be easily and successfully controlled with medication.
· TIAs, or "mini-strokes" - A surprising number of people ignore the symptoms of TIAs, which are warning signs that a stroke may be about to happen. But people who have had TIAs can take steps to help prevent a major stroke.
· Berry aneurysms - These are small, sac-like areas within the wall of a cerebral artery. Some people are born with berry aneurysms. They occur most often at the junctures of vessels at the base of the brain. Berry aneurysms may rupture without warning, causing bleeding within the brain.
· Cardiovascular disease - Certain disorders of the heart and/or blood vessels, such as atherosclerosis and atrial fibrillation, can produce blood clots that may break loose and travel to the brain.

How is stroke connected to cardiovascular disease ?
Atrial fibrillation is a heart disorder in which the heart beats quickly and in an irregular manner. As a result, the heart's chambers do not completely empty themselves of blood. Blood that remains in these chambers can become stagnant, and clots can form. These clots can then travel in the bloodstream to the brain and cause a stroke.Individuals with atrial fibrillation often need to take anticoagulant drugs ("blood-thinners"). These medications help prevent the formation of blood clots.

Atherosclerosis is also called "hardening of the arteries." Cholesterol plaque and other fatty substances build up on the inner walls of arteries, causing them to narrow. Pieces of plaque from deposits on the inner walls of arteries can break off and travel throughout the body. They can cause a stroke if they block blood flow to the brain.

Atherosclerosis can be especially dangerous if it affects the arteries in the neck, called the carotid arteries, because any clots that might break off will not have far to travel before reaching the brain.

Risk Factors That Can Be Changed By Lifestyle Modifications

Risk factors for stroke than can be controlled by changes in lifestyle are:

.High blood cholesterol levels - Studies have shown that lowering cholesterol levels can reduce the risk of stroke by as much as 30 percent. Keeping cholesterol low can reduce the risk of blood clots and buildup within the walls of an artery in the brain.
· Cigarette smoking - Cigarette smoking has been linked to heart attacks, strokes, artery disease in the legs, and lung cancer. Nicotine raises blood pressure, carbon monoxide reduces the amount of oxygen the blood can carry to the brain, and cigarette smoke makes the blood thicker and more likely to clot. It is never too late to give up smoking.
· Taking birth control pills if you are a smoker - Research has proven that smoking and taking birth control pills significantly increases a woman's risk for stroke. Together, they can cause blood clots to form. Women who take birth control pills should not smoke.
· Drinking large amounts of alcohol - Frequent intoxication can make a person more likely to experience bleeding in the brain. Also, alcohol in large amounts can raise blood pressure.
· Obesity - Being overweight increases your risk of having a stroke, along with other health problems.
· Lack of exercise - Moderate exercise can help keep blood pressure and cholesterol levels within normal ranges.
· Poor diet - A diet high in fat can cause conditions within the body that can contribute to a stroke

How Is A Stroke Treated?
A stroke is a medical emergency, regardless of whether it is a major stroke or a short-lasting TIA. A person suffering a stroke should be taken immediately to a hospital emergency department.

The ability to pinpoint quickly the precise location of a stroke and determine the extent of damage is critically important in treatment decisions. A stroke caused by a blocked artery is treated in an entirely different way than a stroke caused by bleeding within the brain.

The key to survival and recovery is prompt medical treatment.

How-To Information:

If a stroke is caused by a blocked artery, medications are now available to reverse damage to the brain and significantly increase the odds of survival. However, these medications are effective only if they are given within a few hours of the time when the first stroke symptoms begin.

Tests That May Be Performed At The Hospital
Scans of the brain are performed to confirm a diagnosis of stroke and to determine the type of stroke. This is important since the treatment of different types of stroke differs.

These tests include:
· Computed tomography scan (CT scan) is generally the first diagnostic test done after a person suspected of having a stroke arrives in the emergency department. The test uses low-dose x-rays to take pictures of the inside of the brain.
· Magnetic resonance imaging (MRI) is an advanced diagnostic tool that uses the principals of magnetism to view the inner body. An MRI of the brain can show small blood vessels that may be blocked or bleeding. .
· Transcranial doppler (TCD) is a new, noninvasive ultrasound procedure that uses a small probe placed against the skull to track the blood flow through the vessels in the brain.
· SPECT imaging uses low doses of a harmless radioactive substance injected into a vein in the arm, then uses a specialized camera to view the blood flow in the brain.

Medicines To Treat Stroke

If the stroke is caused by a blockage:
· Drug therapy is a relatively recent approach to the treatment of stroke. If the

stroke is caused by a blockage in an artery, medications called thrombolytic drugs can be used. The only drugs approved by the FDA for treatment of stroke are tissue plasminogen activators (TPA drugs). Popularly referred to as "clot-busting" drugs, these medications have been used for years to treat heart attacks.

Some studies have indicated that if TPA drugs are given to stroke patients within three hours of the onset of symptoms, more than half of them will make a full recovery in a matter of months.

Not all hospitals, however, have the ability to give TPA drugs to people having a stroke. Before these drugs can be given, doctors must be certain that the stroke is the result of a blockage in the artery and not due to bleeding from an artery. This is determined through imaging procedures such as computed tomography (CT) scans and magnetic resonance imaging (MRI). But not all hospitals have around-the-clock imaging services.

If a stroke is caused by bleeding:
Medication can be given to reduce swelling of brain tissue.
Surgical Procedures

If the stroke is caused by a blockage:
A procedure called carotid endarterectomy can be used to remove a buildup of plaque from inside the carotid artery, one of the major sources of blood to the head and neck. Carotid endarterectomy can be used to treat people who have had a stroke and also as a preventive measure for people at risk for stroke.

If the stroke is caused by bleeding:
An artery within the brain sometimes can be "clipped" to prevent further bleeding.
If the bleeding has occurred in the subarachnoid space, pooled blood (hematoma) can dangerously increase pressure on the brain and damage delicate tissue. If it is feasible, surgery may be necessary to drain blood from within the area of damaged brain tissue.

Other Procedures
Several types of interventional radiology also are available to treat stroke. These procedures have been in existence for some time, but they have been improved and refined in recent years. However, not all hospitals are equipped to offer interventional radiology.

Interventional radiology is performed by inserting a long, thin, flexible tube called a catheter into blood vessels. The insertion point is usually in the groin, and the incision is about the size of the tip of a pencil. The catheter is guided to various parts of the body while a computer tracks it and records images of the blood vessels. This procedure creates a precise road map of even the tiniest vessel in the body.

· The catheters can be guided to areas of bleeding and used to effectively close off the leaking vessels.
· The catheters can be used to widen areas of blood vessels that have become narrowed because of a buildup of plaque.
· The catheters can be used to place stents made of a fine, tubular wire mesh to hold a blood vessel open.

What To Expect During A Hospital Stay
After the initial tests to determine the type of stroke and the best treatment, other procedures may be necessary to find the cause of the stroke. These procedures may include tests of the heart or the arteries to the brain.

The length of the stay in the hospital and the type of treatment will depend on the severity of the stroke. Many people need some form of therapy to help their brain relearn skills lost because of the stroke.

Q: My father had all the signs of a stroke, but he waited more than six hours before getting to the hospital. Even though his stroke was caused by a blocked artery, doctors did not give him "clot-busting" medicines. Why not?

A: TPA drugs are powerful blood thinners that can help dissolve a clot and restore blood flow, but the FDA requires that they be given within three hours after stroke symptoms first begin. When TPA is given more than three hours after stroke onset, there is a greater risk that it will cause uncontrollable bleeding. It is very important that this guideline is followed and that everyone is made aware of the critical importance of seeking help immediately if experiencing stroke symptoms.

Effects Of A Stroke
A stroke affects different people in different ways. While some people make a full recovery, others may find that some problems do persist. These may include:

Speech Changes
Some people have difficulty with speech. When stroke has damaged the part of the brain that controls the muscles used to produce speech, speech may become slurred. The survivor understands words and conversation but cannot speak distinctly. This condition is called dysarthria.

When stroke has damaged the part of the brain that controls language, the survivor may lose the ability to speak and understand speech. The ability to read and write can be affected. The person may have difficulty finding the right word or may use an incorrect word. He or she may find, when reading, that some words make no sense. This condition is called aphasia.

Some tips for caregivers of people with speech or language difficulties:
· Avoid distractions. Do not have many other people in the room, turn off the television or radio when someone is speaking.
· Have a one-on-one conversation. Do not allow more than one person to speak at one time.
· Give the person a lot of time to speak.
· Allow the person to speak for himself or herself if someone else asks a question; don't try to answer it yourself.

Vision Changes
Stroke may affect vision on one side (usually the same side that has been weakened by the stroke). When talking to someone with impaired vision, always stand or sit on the "good" side. Consider that the person may ignore people or objects on the other side and may bump into them.

Memory And Concentration Difficulties
Memory and concentration may be affected after a stroke. In the early stages, individuals may not be able to concentrate for very long and may become easily distracted. They may have problems with particular tasks, such as finding the way about the house or getting dressed, yet have no other major difficulties.
Paralysis

Stroke frequently causes paralysis on one side of the body. This condition is called hemiplegia. The paralysis may affect only the face, an arm, or a leg; or it may affect one entire side of the body and face.
· A person who suffers a stroke in the left side of the brain may show right-sided paralysis.
· A person who suffers a stroke in the right side of the brain may show paralysis on the left side of the body.

Weakness And Stiffness
Paralyzed limbs may recover their strength but may remain clumsy or stiff. Some types of muscular stiffness (a condition called spasticity) can be helped with medication. People with weak hands often are given a soft ball to squeeze to help improve their grip.

Difficulty Eating And Swallowing
Damage to certain areas of the brain can cause difficulty eating and swallowing. This condition is called dysphagia. Therapy to help the brain relearn these skills has shown great success. Until a person is able to eat again, he or she can receive sustenance intravenously (with an IV that delivers nourishment directly into the bloodstream). Most people who have had a stroke will recover their ability to swallow safely.

Mood Changes
The days and months after experiencing a stroke are a stressful time. The stroke survivor may be unable to return to work immediately and may lose independence for a while. After the immediate shock, a stroke survivor may feel anxiety, anger, and frustration. A lack of information may contribute to the anxiety. Anxiety and frustration can be reduced by support from doctors, therapists, and other caregivers.

Q: My wife just hasn't been herself since her stroke. She seems to have lost interest in many things and no longer seems to be enjoying life, even though her recovery is progressing well. What could be wrong?

A: Your wife could be suffering from depression. After recovery from a stroke, many people do feel depressed. This depression is normal, and usually disappears within three months after the brain attack. Medication is available to relieve symptoms of depression.

Personal Relationships

Many people worry that sexual intercourse may bring on another stroke. This is not true. A person who has recovered from a stroke can return to all normal activities, including sexual relations. Even people who are still experiencing some difficulties related to a stroke can resume normal loving and intimate relationships.

Open discussion and careful consideration of each other's needs is the secret to maintaining a successful relationship after stroke. Restoring a warm, loving relationship with a partner is an important step in returning to a normal life.

Other Challenges To Face

Because a stroke affects each person differently, there may be other physical challenges:
· The sensitivity of the skin may be altered after a stroke. Some people experience numbness while others feel as if their skin is extra sensitive.
· Certain individuals experience pain, uncomfortable numbness, or strange sensations after a stroke. These sensations may be caused by many factors, including damage to the sensory regions of the brain.
· Control of bowels and bladder may be lost temporarily after a stroke, but most people do recover function

Recovering From A Stroke
Many people begin to recover from a stroke almost immediately after it has occurred.

The recovery process is most rapid in the first three months after a stroke, but improvement will continue for six months or a year. Many stroke survivors report that they slowly continue to regain function for years after their brain attack. It is very important not to lose hope.

Everyone's recovery is different, but some general rules hold true. Simple skills will be recovered first:
· The ability to sit up and balance while sitting, then
· The ability to stand, and then
· The ability to walk.
· The leg usually starts to improve before the hand.

Some people will notice that "things do not work so well" when they are tired or get a minor illness such as a cold. For example, a person's speech may get more hesitant toward the end of a busy day, or the person may become more unsteady after the flu. These ups and downs are to be expected and are not a sign that another stroke is about to occur.

The Importance Of Rehabilitation Therapy
Successful recovery after a stroke depends on the extent of brain damage, the person's attitude, the skill of the medical team, and the cooperation of family and friends. Not all people recover on their own. For them, rehabilitation therapy can be invaluable.

Rehabilitation can teach new skills to replace old skills that may have been lost. It involves teaching other areas of the brain to take over the work of the damaged portions.

One of the first rules of successful rehabilitation is that it must begin as soon after a stroke as possible. Therefore, it usually starts in the hospital and is continued as long as necessary after the person goes home. The goal of therapy is to improve function so that the person who has had a stroke can become as

Rehabilitation - teaching an individual certain skills that might have been lost - can consist of one or more of the following:
· Physical therapy - Teaches walking, sitting, and lying down, switching from one type of movement to another.
· Occupational therapy - To relearn eating, drinking, swallowing, dressing, bathing, cooking, reading, writing, toileting.
· Speech therapy - To relearn language and communication skills.
· Psychological/psychiatric therapy - To help relieve some mental and emotional problems.

Depending on the severity of the stroke, rehabilitation options include:
· A rehabilitation unit in the hospital
· A subacute care unit
· A rehabilitation hospital
· Home therapy
· Home with outpatient therapy
· A long-term care facility that provides therapy and skilled nursing care

Avoiding Another Stroke
Many survivors are afraid that they will have another brain attack. However, with proper medical treatment, it is quite unlikely that a person who has had a stroke will experience another. The risk of a second stroke is higher for people who are not receiving proper medical treatment for their first stroke.
Effective treatment to reduce the risk of another stroke includes making lifestyle changes to decrease risk factors and taking medication, such as aspirin, as directed by a doctor.

Q: I had a stroke nearly a year ago, and I still have a strange sensation of pain on my left side. My doctor has tried a variety of drugs, but nothing seems to work. What else can I do?

A: This type of pain, called central post-stroke pain, is uncommon and can be difficult to deal with. There are a variety of medications you can try, including antidepressants and anticonvulsants. You also may want to consider complementary therapies such as acupuncture. Other options include transcutaneous nerve stimulation (TENS), which is a small device that sends an electrical current to a certain area of the body in order to block the sensation of pain. Surgery to interrupt the nerves that carry this abnormal sensation (stereotactic surgery) also is a possibility, but it does have some risk.

Preventing A Stroke

The best way to prevent stroke is to reduce your risk factors and take control of your own health:

· Lower your cholesterol level if it is elevated - some people can do this by modifying diet; others need to take medication. Lowering cholesterol levels has been proven by researchers to reduce the risk of stroke. .
· If you smoke, stop smoking - Many excellent smoking cessation programs are available today; your doctor can advise you about tools you can use, such as the nicotine patch. .
· Drink alcohol in moderation - A drink or two a day is considered acceptable.
· Keep your weight within normal limits.
· Get a moderate amount of exercise at least five days a week.
· Eat a healthy diet that is high in fruits and vegetables and low in fats.
· If you have cardiovascular disease, work with your doctor to treat it. Certain types of problems with the heart and blood vessels, such as atherosclerosis and atrial fibrillation can cause blood clots to form. These clots can block an artery in the brain and cause a stroke (or can block a blood vessel in the heart and cause a heart attack).
· If you have diabetes, keep it under good control.
· If you have high blood pressure be sure to take your medication regularly.
· Know the warning signs of TIAs and strokes, and get help right away if you experience them.

Medications For Prevention

Certain medications have been shown to reduce the risk of stroke. These drugs fall under two major categories. They aim to prevent the formation of dangerous blood clots:

. Antiplatelet agents such as aspirin - These drugs work by preventing or reducing platelet aggregation in the bloodstream. Platelets are tiny blood cells that cause blood to coagulate or clot. When a blood vessel is damaged or injured, platelets will migrate to the area to begin a healing process. However, large numbers of platelets can clump together or aggregate and form a clot that is essentially a plug in an artery. Antiplatelet agents help prevent this clumping.
· Anticoagulants - These drugs work by thinning the blood and preventing clotting. Common anticoagulants are heparin and warfarin.

Antiplatelet and anticoagulant drugs can also be used to treat heart disease, so taking one medicine can help reduce your risk of both heart attack and brain attack. Your doctor can advise you on what medications are right for you.
The medical community first became aware of aspirin's protective effects for stroke in 1978, and since then, several large studies have shown that aspirin reduces the risk of stroke. But aspirin isn't the only antiplatelet medicine available. If you can't take aspirin because of allergy or the risk of stomach ulcers, other drugs are available.

Surgery For Prevention

Carotid endarterectomy - the same procedure that can sometimes be used to treat strokes caused by a blockage - can also be used to help prevent such strokes from happening in the first place.
The procedure involves removing plaque buildup in the carotid artery . It is performed when the artery is blocked by more than 70 percent.

· It has been proven that for certain individuals who have had minor strokes or TIAs, and the carotid artery in the neck is more than 70 percent blocked (i.e. severely blocked), this procedure can reduce the risk of future strokes.
· It also is beneficial for individuals with blocked carotid arteries who have not had previous symptoms of stroke.

Carotid endarterectomy takes about an hour to perform. A tube is placed to transport blood around the area to be treated. After the surgeon has scraped away the built-up plaque, the artery is sewn back together and blood flow is restored.

Currently, carotid endarterectomy is available only at major treatment centers in the U.S. Among the risks is the possibility of experiencing a stroke during the procedure itself. If you are considering this procedure, you and your doctor should weigh the risks and benefits.

The Role Of Vitamin E
Research suggests that vitamin E helps prevent arteries from clogging by blocking the conversion of cholesterol into its most dangerous form. Vitamin E is also a powerful anti-clotting agent. It helps the blood flow more easily through arteries when fatty plaques are present. It also is an antioxidant, which means it helps prevent cell damage. Ask a doctor about the proper amount of this vitamin to take daily.

What Is The Long Term Outlook?
Today, the outlook for people who have had a brain attack is more hopeful than ever before. Because of advances in treatment and rehabilitation, many people can return to a fulfilling life.

A stroke survivor's family plays a vital role in recovery. Family members need to understand what the person is going through, what to expect, and how to handle problems that will arise. A person's will to recover and desire to be independent play a big part in recovery; the family can help by providing a warm, supportive, and encouraging atmosphere.

The understanding of what causes strokes and how best to treat them is still expanding. Researchers at the National Institute of Neurological Disorders and Stroke in Bethesda, Md., predict that Americans should be able to prevent 80 percent of all strokes within the next 10 years. They believe this will happen because of continued attention to reducing the risks of stroke and by using currently available therapies and developing new ones.
Among those new therapies are drugs that make the brain less susceptible to the damaging effects of a stroke. Called neuroprotective agents, these drugs include citicoline and lazaroid compounds. They currently are under evaluation in clinical trials.

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Frequently Asked Questions
Here are some frequently asked questions related to stroke.

Q: Can a stroke just happen out of the blue?

A: A stroke, which also is referred to as a "brain attack," often does happen without any prior warning. However, the conditions that lead to a stroke have usually been present for many years. Maintaining the healthiest lifestyle possible, therefore, is very important in stroke prevention.

Q: My father suffered a stroke three months ago but insists he is capable of driving. Should I worry?

A: A stroke can affect eyesight, coordination, the movement and strength of arms and legs, balance, reaction time, concentration, speed of thought, memory, awareness of where objects are in relation to each other, and even the awareness that anything is wrong at all. A difficulty in any one of these areas carries with it the possibility of making driving unsafe. Your father's doctor can provide the best advice on whether he should be driving.

Q: Ever since his stroke, my husband has been reluctant to have sex, even though he seems to have made a full recovery. Is this normal?

A: There are many myths about having sex after a heart attack or stroke. The most common one is that sexual activity will bring on another heart attack or stroke and cause sudden death. This simply isn't true. There's no reason why someone who has had a heart attack or stroke can't resume usual sexual activity as soon as he or she feels ready to do so. For some men, fear about performance can greatly reduce sexual interest and ability to have an erection. An understanding partner, patience, and open discussion with a doctor or therapist are extremely helpful in resuming sexual intercourse.

Q: At what age should I seriously consider taking aspirin to help reduce my risk of having a stroke?

A: The need for aspirin therapy depends on individual risk factors and is different for everybody. Most health care providers suggest that after age 50, you and your doctor should make a decision about aspirin therapy. Some people benefit from taking aspirin before age 50.

Putting It All Together
Here is a summary of the important facts and information related to stroke.
• A brain attack or stroke happens when a part of the brain is damaged by a change in blood flow. This change can happen if something blocks the flow of blood to the brain or if a blood vessel bursts and causes bleeding in the brain.
• In many cases, a stroke can happen without warning. But some people do experience "mini-strokes," called TIAs, which are exactly like a stroke but last only a short time. A TIA, like a stroke, is considered a medical emergency and should never be ignored.
• The signs of stroke are sudden weakness or numbness on one side of the body, sudden loss of vision or speech, sudden severe headaches, or unexplained dizziness that comes on quickly.
• Some risk factors for stroke, such as age and race, cannot be changed. But there are steps you can take to reduce other risk factors, such as high blood pressure, high cholesterol, and cigarette smoking.
• If a brain attack does happen, medical treatments can be given in the hospital emergency department. These treatments have shown great success in minimizing damage to the brain. The key is to get medical help immediately. Too often, people having a stroke wait for hours before seeking help.
• A stroke can cause trouble speaking or seeing, memory difficulties, paralysis or weakness, difficulty eating, and mood changes. The good news is that therapies are available to help teach the brain skills it might have lost. Many people can make a full recovery and resume a fulfilling life after a stroke.
• The best way to prevent stroke is to reduce risk factors - improve diet, keep diabetes under control, quit smoking, and get enough exercise. Medication is also available to help prevent stroke. The most frequently used preventive medication is aspirin, which helps prevent blood clots.
• The long-term outlook for people who have had a stroke is more hopeful than ever before. Because of advances in treatment, more people are surviving strokes, and because of advances in rehabilitation, more people are conquering the disabilities that can be caused by a stroke.

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Aphrodisiacs To Stimulate Your Senses

Aphrodisiacs To Stimulate Your Senses

For many centuries' couples have tried to bring pleasure to their partners by using aphrodisiacs. In Greek mythology, an aphrodisiac was a festival, which was celebrated throughout Greece where Aphrodite (the ancient Greek goddess of love and beauty) was worshipped through sexual intercourse with her priestesses (women who represented the goddess). This was not considered prostitution, but just one of the many ways of worshiping Aphrodite.





There are parallels of Aphrodite in many of the ancient civilizations. The Romans, for example, called her Venus and Cupid was her messenger. Throughout time, however, the word aphrodisiac has come to describe any food, drug, potion, or other agent that arouses sexual desire.

Many herbs and foods with aphrodisiac properties can also be used when cooking and preparing everyday food or teas. The power of aphrodisiacs, however, is not to be underestimated. So, take careful precautions by asking questions or discussing any concerns with your pharmacist or doctor.

Aphrodisiacs are real. You can buy them or make them, and you are born with them. The history of aphrodisiacs began with the history of mankind. Certainly, the first known aphrodisiac was human body order.

Pheromones are naturally occurring chemicals that evoke a sexual response and there is considerable scientific evidence to substantiate the relationship between scent and sex. Yet, pheromones are but one segment of a broad range of reputedly aphrodisiac substances.

Aphrodisiacs are a part of every culture and most of our current knowledge about aphrodisiacs is rooted in myths, folklore, and anecdotal evidence. For sake of clarity, anecdotal evidence is defined here as evidence that is supported by testimony that is not substantiated by clinical research.

Aphrodisiacs come in a surprising number of forms including animal, plant, food, and chemical substances. Many have no established scientific basis in fact other than in folklore, anecdotal evidence, and common knowledge. For some, the anecdotal evidence is quite persistent and a few even has some backing from scientific research. For example, some research has been conducted on Ginseng, Green Oats (Avena Sativa), Mauri, Yohimbe, Viagra®, and a few others that suggests a strong link between these substances and heightened sexual response in both males and females.

Most over-the-counter aphrodisiacs are generally safe to use in moderation, but like any substance, abuse and overuse can result in negative consequences for your health, and, if you have any kind of special health condition or are taking any kind of medication, always consult with your physician before ingesting any new substances into your body.
You may decide to use some type of aphrodisiac to rectify a sexual dysfunction, to enhance the sexual experience, or just out of curiosity. However, no matter how powerful or potent the aphrodisiac, the experience will always be less than it could be without a meeting of the minds and hearts of the partners involved, in any type of sexual experience.

Theophrastus (4th century B.C.), a Greek botanist, recommended a love potion that included a leafy plant called mandrake Mandragora officinarum soaked in vinegar. Supposedly mandrake contains substances that create the sensation of "feeling high". According to ancient Indian recipes, love can be enhanced with a mixture of black pepper, honey, chili peppers, and mandrake.

Today there are thousands of foods presumed to have aphrodisiac properties. These include (raw) seafood, chocolate, wine, spices, and even sugar. the maize, a type of corn, contains a compound called "tryptophan". Can combines with other chemicals in the brain to act as an aphrodisiac

Why Women Need Chocolate, "chocolate is a pleasure food". When we eat chocolate, certain brain chemicals flood the brain that make us feel happy.

Different animal foods can exhibit different aphrodisiac properties. Aphrodisiac’s can originate for ocean animal species, fish or shellfish. Oysters spring to mind as having a BIG aphrodisiac reputation. Equally, aphrodisiacs can eventuate from certain land animal species that have aphrodisiac reputation:

CAVIAR: Caviar is considered an aphrodisiac for several reasons. Eggs are a symbol of fertility. Caviar, like Aphrodite who was born from sea foam, comes from the sea. Caviar, like many aphrodisiacs, is a very precious food that reserved for special occasions.

FISH: Aphrodite, the goddess of love was born from sea foam, so in general any type of seafood is considered to be an aphrodisiac. The high phosphorus and iodine content of seafood may actually have a beneficial effect on sexual potency.

LOBSTER: This is a very sexy food to eat. You rip the flesh apart with your hands and dip in butter.

Oysters: Oysters are one of the world's classic love foods. Legend has it that Casanova ate 50 raw oysters every morning in the bath tub using a beautiful woman's breasts as a plate. Oysters are very high in zinc. Research has found that a low sperm count is connected to low zinc levels.

Beef One of our favorites. Meat works wonders on your libido and brain. After a high protein meal, your blood stream is flooded with the amino acid tyrosine. The chemicals made from tyrosine, dopamine and norepinephrine, trigger brain cells that enhance mental alertness and concentration.

Lamb Rack of lamb for two is one of life's most romantic foods.

Unagi Unagi, or raw sea eel, is a popular Japanese aphrodisiac. In America, it's a popular item on sushi menus.

HONEY:Ever wonder about the term "Honeymoon"? Honey is an aphrodisiac due to its rich B vitamin and amino acid content.

ROYAL JELLY: stimulates and has the aphrodisiac properties for rejuvenating sexual glands very rapidly.

The legend of SPANISH FLY dates back to the Roman Empire. The
Blister beetle contains an active ingredient known as cantharidin, a blistering agent.
Plants

Nuts: Whether you prefer walnuts, almonds or macadamias, nuts have had a reputation as aphrodisiacs for centuries.

Pine Nuts: These nuts (actually seeds of the pine tree) have been used as an aphrodisiac throughout the Mediterranean and the East. prescription to restore a man's sexual vigor: "A glass of thick honey, plus 20 almonds and 100 pine nuts repeated for three nights."

Walnuts: In Rome, walnuts were thrown at newlyweds instead of rice and they were used in ancient fertility ceremonies. Walnuts have also been used in Italy and France to intensify desire

Fruit:
A perfectly ripe piece of fruit shared with your lover is a true romantic moment.

Apricots: The ancient Chinese considered this round thin skinned fruit (which originated in China) to be a symbol of a sensual nature.

Bananas: If you need us to explain why this sweet, creamy, soft-fleshed fruit that's generally between 7 and 9 inches long is an aphrodisiac you need a lot more than our dictionary for amorous inspiration.

Dates: If you can't get one maybe you need to eat more dates. In Iran dates are used to help people who's sex life is withering.

Figs: One of the sexiest fruits on the planet. These plump, soft, sweat, luscious beauties come from one variety of the ficus tree which probably originated in Asia Minor and is one of the oldest edible plants.

Grapes: It increase fertility and procreation.

Mango: This exotic, sensual fruit has a moist flesh resembling peach, papaya and apricot.

Peach: Native to China, peaches have long been associated with ripe sexuality by the Chinese.

Pomegranate: This deep red fruit is recommended in the Karma Sutra (an Indian love making manual) as an erotic aid.

Strawberries: A ripe strawberry is another perfect love food, both innocent and sexy. Try dipping them in chocolate, sour cream and brown sugar or whipped cream.

Vegetables

Asparagus: Perhaps the most erotic member of the vegetable kingdom, it has reputed powers to arouse.

Carrots: This popular root vegetable, with its phallic shape and sweet flavor, was used to seduce lovers by Middle Eastern royalty.

Celery: Celery is suspected to be somewhat sexually exciting or even straightforward arousing." Forget those phenol sprays that are supposed to make you more attractive to the opposite sex. Celery contains androsterone, a powerful male hormone that researchers believe is released through sweat and attracts females

Cucumbers: it is cool vegetables are considered to be an aphrodisiac. The Chicago Smell and Taste Treatment and Research Foundation found that women become aroused by the scent of cucumbers.

Garlic: If you are a young man in the Fertile Crescent of the Middle East (Jordan, Lebanon, Palestine, Syria) one of your uncles will tell you to eat or swallow whole a raw garlic clove every morning to maintain your sexual overdrive all your life. Garlic is antibiotic and certainly preserves the organic health of the body. I'm not sure it is an aphrodisiac but I've never heard of an Arab who didn't claim he could please four wives and I don't know of anyone else who would try this so we may never know.

Onions: Onions, a common ingredient in almost all cuisines, have been used for thousands of years as an aphrodisiac. Onions are recommended in both ancient Hindu and Arabic texts on the art of making love. In France, newlyweds were served onion soup the day after their wedding to restore sexual vigor, and Egyptian priests abstained from onions because of their lusty reputation.

Sweet Potatoes: Sweet potatoes are reputed to expand your ability to give and receive love. In late 16th century Europe sweet potato tarts were recommended to increase sexual desire.

Tomatoes: Known as love-apples by the French, the humble tomato may have been the real culprit that got Adam and Eve kicked out of Eden. Fresh, ripe tomatoes, locally grown and eaten in season are a very seductive food. Tomatoes are rich in the phytochemical lycopene which can help prevent prostate cancer.

Zucchini: The phallic shape says it all.

Spices

Cayenne: Not only does he release endorphons into the systems of men and women and build the immune system, but in men he builds and fans a fire. Loaded with vitamin C, his erotic effects will be most effective shorlty after consumption. Cayenne is hot in every way. The more you can stand, the better. The powdered pepper in a soup or sauce that is cooked is best.

Cloves: This dried bud of an evergreen tree is one of the world's oldest, dearest and most expensive spices. Cloves were probably first used by the Chinese around 200 B.C. The word clove comes from the Roman word for (nail) clovis. They were believed to have medicinal powers and still have a reputation as a powerful love food. Cloves have a warm, sweet almost peppery flavor that is frequently used to add character to cakes, fruit compotes and rice.

Pepper: According to The Perfumed Garden (an ancient Arabic love manual), ground pepper mixed with cardamom or lavender, galanga, musk, honey and ginger is a potent topical aphrodisiac for men. In India pepper corns are crushed with almonds, mixed with milk and consumed as an aphrodisiac.

Aniseed: A very popular aphrodisiac with many culinary uses. It has been used as an aphrodisiac since the Greeks and the Romans, who believed aniseed had special powers. Sucking on the seeds is said to increases your desire.

Ginger: This pungent root has been used for centuries, both internally and externally, throughout Asia and India as a powerful aphrodisiac. To combat impotence, Indian herbalists recommend eating a mixture of ginger juice, honey and half-boiled eggs.

Licorice: According to the Chicago Smell and Taste Treatment and Research Foundation the smell of black licorice combined with donut significantly increase penile blood blood flow.

Nutmeg: This fragrant spice has been prized by Arabs, Greeks, Hindus and Romans as an aphrodisiac. In India, a combination of nutmeg, honey and a half-boiled egg is eaten an hour before sex to prolong love making.

Saffron: This expensive spice has been reputed to work like a sex hormone and make erogenous zones even more sensitive. Saffron is made from the dried stigmas of a type of crocus. About 225,000 stigmas are needed to make one pound of saffron. (Each crocus has about 3 stigmas which must be picked by hand.) Try adding a pinch of saffron to Mediterranean, North African or Middle Eastern grain dishes such as Paella, a traditional Spanish rice dish that contains sausage and seafood.

Herbs

Ashwagandha : can be used by both men and women, acts to calm the mind and promote sound, restful sleep.It is promoting the body's ability to maintain resist stress, which prevents or minimizes imbalances that may lead to health problems, whether from poor diet, lack of sleep, mental stress. Ashwagandha is a revitalizing herb that maintains proper nourishment of the tissues, and drive for sex Libido

Damiana: Ah! A subtle one is the damiana! Traditionally a woman's aphrodisiac, she will rock your inhibitions and fears loose inside before you notice your tea is gone. She will not overwhelm you and make her your slave like the yohimbe but rather offer you the gift of unlocking your own fire.

Basil: This flavorful herb is used in Voodoo love ceremonies in Haiti.

Cardamom: According to traditional Indian herbal medicine, a nightcap of powdered cardamom that has been boiled with milk and mixed with honey can help cure impotence and premature ejaculation.

Dandelion: It's vitamin A content is chiefly responsible for waking the desire.

Fennel: The Greeks and Hindus considered fennel to be a potent sexual stimulant. A Hindu formula for sexual vigor includes: fennel juice, honey, ghee (clarified butter), sugar and licorice. In the Mediterranean fennel soup is thought to increase sexual desire.

Savory: is called the herb of happiness, especially for men.

Yohimbe: This is indeed the magical potion of pleasure. It will increase blood flow everywhere, so watch the amount you take and watch your heart. Yohimbe is more a man's herb by African tradition but I can tell you as a female that the yohimbe loves the women very much and is kinder to them in terms of side effects with all the heart pounding in tact.

Flowers
Jasmin: is a wonderfully scented aphrodisiac. Flowers are often cultivated and used to perfume liqueurs. Jasmin seeds are POISONOUS.

Roses: Roses are by far the most popular flower given to lovers. Roses have been used for centuries in love potions and the petals are edible. (Just make sure those you eat are grown without chemicals.) Sprinkle petals in a salad or spike vanilla ice cream with a few drops of rose water which is available in Middle Eastern and Indian markets.

Other Products
Eggs: All kinds of eggs, from chicken to fish eggs (caviar), have been thought of as fertility symbols and by extension aphrodisiacs. Scrambled eggs for two at 2 a.m. is one of our sexiest recipes.

Ice cream: Another one of our favorite love foods

Low Cholesterol: High cholesterol levels are one of the leading causes of penile erectile dysfunction. In fact, men with high cholesterol levels have almost double the chance of having trouble getting an erection. While an occasionally high fat indulgence is fine, we advocate eating a low fat, high fiber diet most of the time to help keep cholesterol levels low and erectile function high.

Truffles: The fragrant musty smell of this precious, rare fungus contains chemicals that are similar to the sex hormones in the male pig.

Ginkgo: The Ginkgo tree is the world's oldest known living species. Ginko is also known for its tonic effects for sexual potency. Ginkgo has been known to increase blood flow throughout the body, especially in the brain. It may also increase penile blood flow resulting in better erections.

Ginseng: Ginseng has a thick, fleshy, spindle-shaped root 2 to 3 inches or more in length and about 1/2 to 1 inch in diameter, often branched. After the second year the root becomes branched or forked, and it is the branched root, especially if it resembles the human form, which finds particular favor with the Chinese, principal consumers of the root.
A Chinese materia medica of the fourth century presented a list of exotic ginseng recipes that supposedly increased sexual appetites.

Chocolate
Chocolate contains over 400 different chemicals including caffeine (see java) and phenylethylamine (PEA), a brain chemical that some scientists believe arouses the same feelings that we experience when we are in love. Medical findings on chocolate's love potency have asked what makes a muddy-brown colored confection a magical love elixir? Medical experts suggest its all chemical. A "love chemical," in fact, called phenylethylamine which is normally present in the brain.

Aromatherapy and Essential Oils
Using oils and essences is an important part of a sensual massage. Oil contributes to a smooth, flowing massage, enabling your hands to glide easily around the body. There are a lot of things you have to know about oils and essences if you want to become a master of erotic massage.

Some aphrodisiac oils: cedarwood, cinnamon, cloves, neroli, patchouli, rose, sandalwood and ylang-ylang. A few drops of essential oil added to 25ml (1fl.oz) of carrier oil should be sufficient for a massage, or you can add up to 25 drops of essential oils to a 50ml (2 fl.oz) bottle of carrier oil.
SUGGESTION FOR AN APHRODISIAC BLEND: 3 drops ylang-ylang 2 drops sandalwood 3 drops rose or jasmine

Perfume

YOU SHOULD WEAR PERFUME WHERE YOU WANT TO BE KISSED" (COCO CHANEL) On your neck - it is a place with strong sanguine throbs; that's why it is by far the most adequate place.
On the nape of your neck - it is an erogenous zone "dedicated" to men who really know the art of seduction.
Behind your ears - perfume applied behind your ears is not an unnecessary gesture of coquetry but a necessity. Your wrist - the perfume is subtle and delicate like a breeze.

Infertility in Man and Women

What Is Infertility?

If a couple is infertile, this means that they have been unable to conceive a child after 12 months of regular sexual intercourse without birth control.

· Primary infertility means they have never had a child.
· Secondary infertility means that the infertile person has had one or more children in the past, but a medical problem is impairing fertility.
Many people may be infertile during their reproductive years. They may be unaware of this because they are not seeking to create a pregnancy. On any one occasion, the chance of pregnancy is just one percent.
Age, lifestyle and physical problems can all contribute to infertility.
Reproduction In A Woman
Five important hormones stimulate the reproductive system of a woman:
· gonadotropin-releasing hormone
· luteinizing hormone
· follicle stimulating hormone
· estrogen
· progesterone

Here is how the hormones work:
· The hypothalmus, a region in the brain, first releases a hormone called gonadotropin-releasing hormone (GnRH).
· GnRH causes the pituitary gland to produce two more hormones--luteinizing hormone and follicle stimulating hormone.
· These hormones, in turn, tell the ovaries, to release estrogen and progesterone.


How hormones regulate a woman's fertility
A woman's ovaries contain 200,000 to 400,000 egg follicles--small sacs that contain the ingredients needed to form ripened eggs.

· Over a two-week period in a woman's monthly cycle, FSH causes several follicles in the ovaries to ripen and mature.
· FSH also orders the ovaries to produce estrogen, which in turn, launches the manufacture of large amounts of LH hormone.
· LH hormone stimulates the release of an egg from the largest follicle into the fallopian tubes - a process called ovulation.
· LH hormone also stimulates the follicle to produce corpeus luteum - a collection of yellow tissue that manufactures progesterone.
· Progesterone and estrogen work together to thicken and prepare the lining of the uterus for a fertilized egg.
· Together, these hormones swell the lining of the uterus with blood, making it easier for a fertilized egg to implant itself there.

How the egg is fertilized

An egg is usually fertilized by sperm within the fallopian tubes - but only if the woman has sex with a man around the time the egg is released. The sperm must penetrate the egg to fertilize it.
Sperm can survive for six days after entering a woman's vagina and can fertilize the egg at any time during this period. However, research shows that fertilization is most likely to occur two days before or on the day the egg is released. The fertilized egg then moves on to the uterus, where it implants and grows into an embryo, and pregnancy results.

The Unfertilized Egg If the egg is not penetrated by sperm, it lives for 12 to 24 hours. The egg and the bloody lining of the uterus then slough off, traveling out of the uterus, the cervix and vagina - a process called the woman's menstrual period

Reproduction In A Man
Men have four primary hormones involved in reproduction. They are:
· gonadotropin-releasing hormone (GnRH).
· follicle stimulating hormone (FSH)
· luteinizing hormone (LH).
· testosterone

Here is how the hormones work:
· In a man, the brain's hypothalmus first releases gonadotropin-releasing hormone (GnRH).
· GnRH stimulates the pituitary gland to produce two hormones - follicle stimulating hormone (FSH) and luteinizing hormone (LH).
· These hormones regulate the production of sperm and the release of the male hormone testosterone, all of which takes place in the male testes, located in the scrotal sac.

The Production of sperm
Sperm begin life in the testes in cells called Sertoli cells.
· At the beginning of a sperm's life cycle, hormones develop its head and tail.
· The sperm then escapes from the Sertoli cell into the epididymis, located behind the testes.
· For three weeks, a sperm travels through the epididymis in an energizing fluid containing fructose. As the sperm swims through this fluid, it matures and acquires the ability to swim and move back and forth.
· A mature sperm has a head that contains the man's DNA - his genetic material - and a tail that rapidly moves from side to side, propelling it forward.
Ejaculation
When a man ejaculates during sex, muscular contractions push the sperm out of the epididymis to channels called the vas deferens. The sperm then move to the ejaculatory ducts and out the urethra, (the passage through which urine and semen are passed from the body).

· Just before ejaculation, the sperm in the ejaculatory ducts mix with fluids that come from the prostate gland, and from glands called the seminal vesicles, creating semen.
· During orgasm, the seminal vesicles push the semen forcefully out into the urethra.
· A muscle in the bladder also locks shut to prevent the semen from traveling backward into the bladder and mixing with urine.
· The semen moves from the urethra to a holding area at the bottom of the penis, where muscles propel it out of the penis.

How a sperm fertilizes the egg
Of the 100 to 300 million sperm released when a man ejaculates, only about 40 survive the trip through the acidic environment of the vagina and cervix. The woman's thick cervical mucous can also be a barrier. But during ovulation, the woman's mucous thins and allows the sperm to travel more freely.
After it bores through the cervical mucous, the sperm trigger the acrosome (a special membrane located on their heads), and it dissolves and releases special enzymes. These enzymes allow the sperm to penetrate the tough coating surrounding the egg in the fallopian tubes. Only one sperm ultimately fertilizes the woman's egg.

Nice To Know:

What should I do if I think I am infertile?
If you've had more than a year of regular sex without birth control and you haven't achieved a pregnancy, it may be time to see a doctor.
If a year hasn't passed yet, a good strategy is to plan to have sex during the days the woman is ovulating. To find the days when she ovulates, a woman can take her temperature by mouth or in the vagina with special thermometers available in drugstores. Her temperature will rise slightly on the days she ovulates.

Facts About Infertility:
· It's a myth that infertility is always a "woman's problem." Half of all cases of infertility result from problems with the man's reproductive system.
· The best protection against infertility is using a condom while you are not attempting to conceive a child. Condoms protect against sexually transmitted diseases, a major cause of infertility.
· Of couples that seek medical treatment for infertility, 20 percent conceive before the treatment actually begins. One reason may be that anxiety about infertility may have contributed to the fertility problem, and contacting a doctor provides emotional relief.
· Fifty percent of infertile couples conceive within two years of starting treatment.
· A woman's temperature rises about 1 degree Fahrenheit during the days she is ovulating (producing eggs). By taking her temperature every morning with a special thermometer, a woman and her partner can chart the rises and falls in her morning temperature. They can then plan intercourse for the days she is ovulating--her most fertile time.

Hot water in bath tube can lead to infertility

What Causes Infertility?

Most infertility results from physical problems in a man or woman's reproductive system.
· About 35 percent of all cases of infertility arise from problems in the man's system.
· About 35 percent arise from abnormalities in the woman's system.
· About 20 percent of the time, the man and woman both have fertility problems.
· In 10 percent of cases, no cause can be found.
· Age often increases the risk of infertility.
Infertility can be caused by poor sexual or lifestyle habits that are easily remedied. For example, the couple may be using a sexual lubricant that interferes with the survival of the man's sperm. Or, they may not be having sex often enough. Other easily treated illnesses or lifestyle habits that may contribute to infertility are:
· Heavy use of alcohol, tobacco or drugs.
· Starvation diets or anorexia in the woman.
· Tight underwear or pants in the man, which raises the crotch temperature and reduces sperm count.
· Stress. In a woman, this may cause her periods to be irregular. In a man, stress may reduce his sperm count.
Most of these problems can be resolved with medical treatment or lifestyle changes, such as wearing boxer shorts, avoiding a sexual lubricant, or trying some simple stress reduction methods such as physical exercise or relaxation techniques.
Changing the timing of sex and the couple's sexual techniques may also increase the chance of pregnancy. Sometimes the semen from the man fails to reach the woman's cervix. Placing a pillow under the woman's hips after intercourse may help prevent spillage of semen.

Nice to Know:
Does limiting sex boost the man's sperm count?

It may. However, research shows that having sex every day or even several times each day both before and during ovulation is the best way to achieve pregnancy. The sperm count may be lower when sex is this frequent, but the constant release of semen may be more likely to fertilize the egg.
Why Does A Woman Become Infertile?
Infertility in a woman may stem from many causes, such as hormonal deficiencies, problems in the reproductive organs, and some illnesses. Complications from surgery and certain medications may also impair fertility.

The most likely causes for female infertility are:

Pelvic Inflammatory Disease (PID) - PID is the most common cause of infertility worldwide. It's an infection of the pelvis or one or more of the reproductive organs, including the ovaries, the fallopian tubes, the cervix or the uterus. Sometimes PID spreads to the appendix or to the entire pelvic area.
PID usually stems from the same bacteria that cause sexually transmitted diseases, such as gonorrhea or chlamydia. Chlamydia, in fact, causes 75 percent of fallopian tube infections.
PID may also develop from bacteria that reach the reproductive organs through abortion, hysterectomy, childbirth, sexual intercourse, use of an intrauterine (IUD) contraceptive device or a ruptured appendix.
Not only does PID cause infertility, but it may also lead to ectopic pregnancy and blood poisoning, a potentially fatal complication.

Polycystic ovary syndrome (PCO) - This condition affects 5 million American women and is another major cause of infertility. In PCO, the ovaries produce high amounts of male hormones, especially testosterone. LH levels also remain abnormally high while FSH levels are abnormally low; thus, the follicles do not produce eggs. Instead they form fluid-filled cysts that eventually cover the ovaries.
Recent research indicates that PCO is caused by the failure of muscle, fat and liver cells to accept glucose (the cellular fuel made from the food that humans eat). As a result, the pancreas, begins churning out large amounts of insulin, a hormone that usually ushers glucose from the blood to the body's cells. This extra insulin plays havoc with the ovaries, as well as other parts of a woman's body.

PCO not only causes infertility, but also increases the risk of diabetes, cancer and even heart disease.

The symptoms include:

o Excessive facial hair
o Thinning hair
o Acne
o Depression
o Unexplained weight gain
o Irregular or no periods
o High insulin or cholesterol readings

1. Endometriosis - This disease is another common cause of female infertility. Endometriosis refers to a condition in which sections of the uterine lining implant in the vagina, ovaries, fallopian tubes or pelvis. These implants eventually form cysts that grow with each menstrual cycle, and may eventually turn into blisters and scars. The scars can then block the passage of the egg.
2. Other sexually transmitted diseases such as genital herpes can decrease fertility.
3. Ovary Problems - Decreased production of any one of the five hormones that regulate a woman's reproductive cycle may result in infertility. Problems within the ovaries may inhibit reproduction as well. Instead of releasing an egg, the ovarian follicle remains empty, fails to rupture or traps the egg.
4. Hormonal Problems - Adrenal or thyroid deficiencies may cause hormonal and ovarian problems. Some women produce excess amounts of prolactin, a hormone that normally stimulates the production of breast milk. Prolactin can also prevent ovulation. High levels of prolactin in a woman who is not nursing may indicate a pituitary tumor. It can also result from the use of oral contraceptives.
5. Immune System Problems - Women may develop antibodies or immune cells that attack the man's sperm, mistaking it for a toxic invader. Certain autoimmune diseases, in which the woman's immune cells attack normal cells in her own body, may also contribute to ovarian problems.
6. Luteal Phase Defect - In a luteal phase defect, a woman's corpus luteum - the mound of yellow tissue produced from the egg follicle - may fail to produce enough progesterone to thicken the uterine lining. Then the fertilized egg may be unable to implant.
7. Fibroids - Fibroids, or benign growths, may form in the uterus near the fallopian tubes or cervix. As a result, the sperm or fertilized egg cannot reach the uterus or implant there. Fibroids in the uterus are very common in women over age 30.
8. Other Uterine Problems - Abnormal reproductive organs or endometritis (an abnormal swelling of the uterine lining) may make it difficult for the fertilized egg to implant.
9. Surgical Complications - Scar tissue left after abdominal surgery can cause problems in the movement of the ovaries, fallopian tubes, and uterus, resulting in infertility. Frequent abortions may also produce infertility by weakening the cervix or by leaving scar tissue that obstructs the uterus.
10. Uterine muscle problems - Some women may produce weak, infrequent or abnormal contractions in the uterus. During ovulation, these contractions usually push the sperm up to the fallopian tubes.
11. Poor quality cervical mucous - Sometimes a woman's mucous fails to thin around the time of ovulation, and consequently it prevents the sperm from traveling through it. A cervical infection may also be the cause.
12. Illness - Certain diseases, such as diabetes, kidney disease or high blood pressure may cause infertility. Ectopic pregnancy and some urinary tract infections may also elevate the risk of infertility.
13. Medications - Many medicines, such as hormones, antibiotics, antidepressants, and pain killers may bring on temporary infertility. Commonly used medications such as aspirin and ibuprofen can also impair fertility if taken mid-cycle. Acetaminophen (Tylenol) pills can reduce the amount of estrogen and luteinizing hormones in the body, impairing fertility.
14. Premature Menopause - Some women may experience premature menopause, when their ovaries stop producing eggs. Often the cause is excessive exercise or anorexia.
15. Other causes: some other contributors to infertility include excessive exercise, stress or anorexia.

Why Does A Man Become Infertile?
The most common cause for male infertility is a problem with the sperm - either low sperm count or sperm with poor quality. Sperm with poor quality cannot move rapidly enough or in the right direction, or may be abnormally shaped. Some conditions that may contribute to sperm problems include:
· Under-developed testes-usually arising after a mumps (viral infection to parotid glands), a hernia surgery, an injury or birth defect.
· Swollen veins in the scrotum.
· Undescended testes-a problem often present from birth in which the testes remain in the body cavity. Normally they descend into the scrotum before birth.
· Infections, such as gonorrhea or tuberculosis, that block the ducts through which the sperm travel.
· Exposure to metals such as leads, or chemicals such as pesticides.
· Certain medications, such as Tagamet (cimetidine), Dilantin (phenytoin), Folex (methotrexate), Axulfidine (sulfasalazine), corticosteroids and chemotherapy drugs such as Cytoxan and Neosar (cyclophosphamide).
· Injury to the testicles
· Chronic prostate infections

Other common causes of male infertility are:
· Autoimmunity, in which antibodies or cells of the man's immune system attack sperm cells, mistaking them for toxic invaders. The antibodies attach themselves to the sperm and may cause them to stick together, or may stop them from penetrating the cervical mucous or the egg.

Nice To Know:
What causes male autoimmunity?

Male autoimmunity often develops after vasectomy. Sperm actually are produced after a vasectomy, but may leak out into the body where immune cells target them as invaders.
Even when a vasectomy is reversed through surgery, this autoimmunity may continue.
Antibodies to sperm have also been located in men without vasectomies-in about 10 percent of infertile men. In these cases, the reason for the existence of these antibodies is often unknown.
· Retrograde ejaculation. In retrograde ejaculation the muscles of the urethra do not force the sperm out. Instead, the sperm travel backward into the bladder.

Causes of retrograde ejaculation include:

· Drugs such as tranquilizers or high blood pressure medicines.
· Diseases such as diabetes or multiple sclerosis.
· Neck, bladder or prostate surgery.
· Spinal cord injury.

In a small percentage of cases, male infertility is caused by:

· Sexual difficulties such as impotence, premature ejaculation, or painful intercourse. These problems can often be easily treated.
· Genetic defects or structural problems. In germ-cell aplasia, for instance, the sperm-producing germ cells do not develop correctly. Defects in the Y chromosome or in certain genes may also play a part in infertility.
· Rarely, a hormonal difficulty that decreases or stops the man's production of sperm. Hormonal problems may be present from birth or can develop from brain or pituitary gland tumors or radiation treatment. Sometimes, hormonal difficulties are induced by excessive exercise, malnutrition or other illnesses.

How Is Infertility Diagnosed?
A complete medical history and a physical exam are the first steps in diagnosing a fertility problem. Both partners need to be evaluated. The couple may also need blood tests, semen specimens from the man, and ultrasound exams or exploratory surgery for the woman.

Need To Know:

Your Doctor Will Want to Know

During the initial medical exam and history, the doctor will need information about the couple's sexual and medical history. They should prepare for these questions:

· What medical conditions have you had?
· What medications do you take?
· Have you had any past surgeries?
· How often do you have intercourse?
· When do you have intercourse?
· Do you use a lubricant?
· Is there any discomfort during intercourse?
· Do you feel anxious or depressed about being unable to conceive?
For the woman:
· When did your periods begin?
· How regularly do your periods occur, and how long do they last?
For the man:
· Do you experience any erection or other sexual problems during intercourse?

How Is Infertility Diagnosed In A Woman?

If a woman has an infertility problem, she will be referred to a doctor who specializes in reproductive endocrinology. Her diagnostic tests may include:

· Blood tests and urine tests to check hormone levels.
· A Pap smear to study the health of the cervix.
· Urine tests to evaluate LH surges.
· A basal body temperature test, which checks whether the woman is releasing eggs from her ovaries. A woman's temperature rises slightly during the days she ovulates. The woman will chart her basal body temperature every day for a few months on a graph. She will take her temperature orally or may take her temperature vaginally with a special ultra-sensitive thermometer available at most drugstores.
· An endometrial biopsy, in which the doctor removes a piece of tissue in the uterine lining. Examining this tissue will tell the physician whether eggs have been released and whether the corpeus luteum is producing enough progesterone. This test is often done if the results from the woman's basal body temperature chart are unclear.
· An ultrasound to look for fibroids and cysts in the uterus and ovaries. This test uses sound waves to picture the uterus and ovaries, causes little discomfort, and is very effective.
· A postcoital test, in which the doctor takes a sample of mucous from the woman's vagina. She must have the test during her fertile days and within 12 hours after she and her partner have sex. The test will tell the doctor if the man's sperm can survive in the woman's cervical mucous.

More complex tests include:
· A laparoscopy: If the doctor suspects ovarian or fallopian tube scarring or endometriosis, a woman may undergo a laparoscopy. The doctor makes two small incisions at the pubic bone and navel, and carbon dioxide gas is injected into the stomach to enlarge it. Then the doctor inserts a laparoscope, a long tube with lenses and a fiberoptic light, into one incision and a long probe through the other opening in the skin. With the probe, the doctor can view the ovaries, fallopian tubes and uterus to check for scar tissue. In some cases, he may cut away scar tissue discovered during this operation.The woman usually has to undergo general anesthesia for the procedure, but the risks of bleeding, infection and reaction to the anesthesia are slight.

· A hysterosalpingogram: This test checks the condition of the woman's fallopian tubes. The doctor clamps the cervix and injects a needle filled with dye into the woman's uterus. An X-ray is taken to determine whether the dye passes through the open ends of the fallopian tubes. If the dye emerges from the end of the tubes, they are not blocked. The test may also reveal other fertility problems, such as fibroid tumors, structural abnormalities and endometrial polyps. In some cases, the dye actually clears away blockages in the fallopian tubes, and restores the woman's fertility. The dye is harmless and is absorbed by the woman's body after going through her tubes. The test may be uncomfortable, but is rarely painful. Unfortunately, it is noted for both false positive and false negative diagnoses.

How Is Infertility Diagnosed In A Man?
The tests for male infertility are fairly simple and easy. After a medical history and an examination, the man's sperm are tested. He'll be asked to ejaculate into a cup in a private place in the doctor's office or at home, and this specimen will be evaluated. The man should not ejaculate for several days before he takes the test, because each ejaculation may reduce the sperm count.

Health workers will check the man's semen for several factors:
Try to conceive for 2 years with no result and there is nothing wrong with the woman. Low sperm counts, or high concentrations of abnormally shaped sperm, & slow motility. In approx. 40 percent of infertility cases, sperm abnormalities are either a factor or the factor.

Male Infertility is assessed on the following:

· Sperm Count (less than 10 million per milliliter)
· Volume (more than 2 ml per ejaculate)
· Sperm motility (over 50% should be motile and show forward movement)
Sperm morphology (more than 5% should be of normal shape) The average ejaculate has about 200 million sperm. Only a few sperm actually reach the egg.

This shows how the odds are played against a man with poor sperm quality. Although, there are ways to imporve sperm count, motility, and morphology.

· sperm count (20 to 100 million sperm is the normal number)
· movement
· maturity and shape of the sperm (which reveal its quality)
· the amount of sperm produced (one teaspoon is sufficient)
· acidity (the semen should be slightly acidic)

Diagnosis of Male InfertilityMedical history will be taken; childhood disease, undescended testes, mumps, sexual disease.

· Structural abnormalities will be examined; varicocele (swelling of the scrotum), size and shape of testes.

· Secondary sex characteristics will be evaluated.

· Hypothyroidism, hypopituitarism, adrenal disorders, hypogonadism, diabetes, and other endocrine disorders will be checked for.
2-3 specimens of sperm will be needed for a proper evaluation. Volume and other characteristics vary from time to time. The semen should look somewhat viscous and opaque. The volume should be around 0ne full tea spoon, There should be over 20 million sperm per ml of semen.

Sperm is evaluated into the following categorie
· adequate
· aspermia (absence of ejaculate)
· azoospermia (absence of sperm in semen)
· oligospermia (lowered sperm density)
· poor motility and forward movement
· high percent of abnormal sperm morphology
· antisperm antibodies

The man may be asked to undergo this test twice, because some illnesses such as infections or viruses can affect the sperm. If a man has abnormal sperm, he'll be referred to a fertility specialist, where he'll experience more tests, such as:

· Hormonal blood tests.
· Imaging tests that check for swollen veins or reproductive system blockages.
· A testicular biopsy. This is a procedure done in the office. The doctor takes bits of tissue from the testes, and this tissue is examined to see whether the cells that produce the sperm are working properly.
· Anti-sperm antibody tests, which check whether the woman's mucous rejects the man's sperm. These tests also show whether the man produces antibodies to reject his own sperm.
· A hamster egg test, which studies the sperm's ability to penetrate a hamster egg. The outer covering of the egg is removed to allow the sperm to more easily penetrate. This test cannot result in a living embryo. It's expensive, however, and sometimes unreliable.
· A human zona penetration test, which tests whether the man's sperm can fertilize dead human eggs. Again, this test cannot result in a living embryo, and is thought to be more reliable than the hamster egg test.
· A bovine cervical mucous test, which checks whether the sperm can penetrate cervical mucous taken from a cow.

How Is Infertility In A Woman Treated?
After the physician has determined possible causes of the infertility, a course of treatment can then be planned. Sometimes simple instructions, like knowing when having sex is most likely to produce a pregnancy, are all that is needed. In many cases, medications are indicated, while in other cases, the woman may require surgery or other forms of treatment.
If medications are unhelpful or surgery is not appropriate, other specialized techniques will be offered.
Medications can help solve hormonal problems and ease infections in women with fertility problems. Surgery to repair reproductive organs may also resolve a woman's infertility.

What Medicines Treat Female Infertility?

If the woman isn't producing eggs, often she can be helped with fertility drugs. Fertility drugs are fairly safe, although some researchers have voiced concern that they may increase the risk for ovarian cancer. Several of the most recent studies, however, have found no increased risk of ovarian cancer and suggest that the drugs may even protect against cervical cancer. Fertility drugs include:
Clomiphene: This drug triggers the release of FSH and LH, boosting egg growth and helping the ovaries release a monthly egg. The drug is considered safe, is fairly inexpensive, and carries less risk of multiple births than other drugs. Women who have polycystic ovary syndrome or menstruate irregularly apparently benefit most from this drug. Sixty percent of women on clomiphene successfully ovulate, and about 30 percent of women become pregnant in the first three months of being on the drug. Side effects may include nausea, insomnia, breast tenderness and headaches.

Bromocriptine: This drug suppresses a hormone called prolactin, which, if released in excessive amounts, may cause a woman to stop ovulating. Ninety percent of women on bromocriptine release eggs while on the drug. It's considered fairly safe, but side effects may include nausea, dizziness, headaches and low blood pressure.

Human Menopausal Gonadotropins (HMG): If other drugs don't work, the doctor may prescribe HMG. This drug is comprised of hormones extracted from the urine of postmenopausal women and contains large amounts of LH or FSH. Women who have trouble ovulating, endometriosis, infertility caused by cervical problems or unexplained infertility are good candidates for this drug. To monitor the woman's progress, the doctor will order regular ultrasounds to check the quality and number of eggs being released.

Nice To Know:

· Seventy five percent of women release eggs while on HMGs.
· But the chance of pregnancy varies widely, ranging from 20-80 percent.
· HMGs are also fairly expensive, and carry considerable risks- including an increased chance of spontaneous abortion and ovarian enlargement, which can lead to ovarian cysts.
· A woman on this drug will face an increased chance of multiple and premature births. Possible side effects include weight gain and swelling in the stomach area.

Luteinizing Hormone-Releasing Hormones (LH-RH): LH-RH drugs are used when the pituitary or hypothalamus gland is not producing hormones. They are also used to treat endometriosis. Most women must administer these drugs themselves with a portable pump, and the equipment is unwieldy and expensive. Risks include an increased chance of infections and clotting, and multiple births.
Human Chorionic Gonadoptropin (hCG). Chorionic gonadoptropins are often prescribed with HMGs, and sometimes with clomipheme, to stimulate the release of the egg. They may also be used to treat endometriosis. One of these drugs, Humegon, has resulted in pregnancy in more than 26 percent of cases in clinical trials. Possible side effects are ovarian enlargement, ovarian cysts and multiple births.

Urofollitropin (FSH): This drug is made up of FSH taken from the urine of postmenopausal women. It can be used with hCG to bring on the release of an egg. It's an effective drug for women with polycystic ovary syndrome, for whom clomiphene has been ineffective.

Other medications that may cure fertility problems include:
· Antibiotics - They may cure infections in the reproductive system, such as in the cervix or lining of the uterus, and some sexually transmitted diseases.
· The hormone progesterone - This hormone develops the lining of the uterus and helps a fertilized egg implant.
· Corticosteroids -These may be prescribed for the treatment of endometriosis.
· Oral contraceptives, antiandrogens, and drugs to reduce insulin levels - These drugs are used in women with polycystic ovary syndrome to restore regular periods and ovulation and to reduce symptoms stemming from an oversupply of male hormones.
· Drugs to treat thyroid disease, benign tumors or to improve poor quality cervical mucous.

What Surgeries Treat Female Infertility?
If investigations suggest that surgery may cure infertility, then depending on the cause, surgery may be used to deal with:
· Fibroids or defects in the woman's uterus.
· Endometriosis in the woman. In these surgeries, the doctor removes the uterine tissue that has grown outside the uterus.
· A scarred fallopian tube in the woman. In surgeries for this problem, the scarred tissue is removed or the entire scarred section of the tube may be cut out. The tube is then rejoined and reattached to the uterus.

How Is Infertility In A Man Treated?
Illnesses and problems in the male reproductive organs can often be resolved with medicines and surgery.

What Medicines Treat Male Infertility?
A number of drugs can be prescribed to ease male fertility problems, but their effectiveness varies widely. Here's a look at some of them:

· Hormones - Though hormones can be quite successful in women, they are only occasionally effective in men. Hormone drugs for men include testosterone, menotropins, GnRH medications, bromocriptine, clomiphene citrate and human chorionic gonadotropin (hCG). Many of these drugs are quite expensive, however.
· Antibiotics - These may help treat sexually transmitted diseases and other infections.
· Corticosteroids - These drugs can aid men who make antibodies to reject their own sperm, but they may also have serious side-effects after long use.
· Viagra - This is a newly developed medicine for male impotence. The man takes Viagra an hour before having sex. The medication improves blood flow to the penis, resulting in an erection. Studies have revealed that 70 percent of men who used Viagra improved their ability to maintain an erection. The drug can have severe side effects for certain men, however, especially those with heart disease. Men with heart disease, who have had a heart attack, or those with low blood pressure should not take the drug.

What Surgeries Treat Male Infertility?
If investigations suggest that surgery may help with male infertility, then depending on the cause, surgery may be used to deal with:

· Varicose (or swollen) veins in the man's scrotum, helping to restore proper sperm movement.
· An obstruction in the man's reproductive organs, including the epididymis, vas deferens and ejaculatory duct. These blockages can halt the sperm's passage or prevent it from
Coping With The Emotions Of Infertility
If your doctor tells you that you are infertile, you may experience a wealth of emotions.
Couples often feel frustrated, angry or guilty after such a diagnosis. Women may feel unfeminine and men may feel powerless and unmasculine.

Women are more likely to discuss their feelings, while men often sublimate their anger in sports or other activities. Women may feel angry when they see pregnant women or women with infants.

Treatment for infertility is also likely to be stressful, not only because some treatments may be painful, but more likely because of the concern and fear that the treatment will not work. The side effects of the medications, and the necessity of going through procedures several times, can test a couple's patience and create a strain on their relationship.

It's important that you don't become isolated as a couple after a diagnosis of infertility. In organizations like Resolve, a national support group made up of infertile couples, you can discuss your feelings and learn about other people's solutions to infertility. Resolve has chapters in many cities in the United States.

A diagnosis of infertility does not mean you are a failure. There are many medical treatments that may improve your fertility. Even if you can't achieve a pregnancy, there are other options that may leave you fulfilled, such as adoption or deciding to remain childless.

Frequently Asked Questions
Here are some frequently asked questions related to infertility.

Q: What should I do if I think I am infertile?

A: If you've had more than a year of regular sex without birth control and you haven't achieved a pregnancy, it may be time to see a doctor. If a year hasn't passed yet, a good strategy is to plan to have sex during the days the woman is ovulating. To find the days when she ovulates, a woman can take her temperature by mouth or in the vagina with special thermometers available in drugstores. Her temperature will rise slightly on the days she ovulates.

Q: My husband and I are having trouble conceiving a child. Should he try wearing loose underwear?

A: Tight fitting underwear as well as hot tubs and saunas decrease a man's sperm count because they raise the temperature of the testes. It might be wise to try loose underwear, and refrain from using hot tubs and saunas.

Q: If I'm over 40, can I have children?

A: A woman's fertility declines markedly at age 40, but in many cases, she may still have children. Men's sperm begins to decrease after age 25, but they can stay fertile into their 60s and 70s.

Q: Can marijuana cause infertility?

A: Marijuana, as well as nicotine and other legal and illegal drugs, can be a cause of infertility. If you smoke marijuana and you're trying to have a child, it's best to abstain.

Q: I've heard that assisted reproductive techniques usually result in multiple births, such as twins, triplets or more. Is this true?

A: The great majority - about two thirds - of assisted reproductive births are single births. The rest are multiple births, with most being twins. Only six percent of these births are triplets or more.

Putting It All Together
Here is a summary of the important facts and information related to infertility.
· Infertility is a common condition that can be caused by illness, lifestyle habits or defects in the reproductive system.
· Many treatments can successfully resolve infertility, including medications, surgery and assisted reproduction.
· The emotions of infertility can seem overwhelming at times. Many support groups can give infertile couples advice and emotional support.

Herbal products works for male to increase fertility

Ashwagandha - the Indian ginseng

Benifits:
· Rejuvenates body and reproductive system
· Increases body energy levels
· Rectifies erectile dysfunction
· Increase libido
· Increase sperm count and motility
· Increases sexual energy
· Boosts body immunity

Eurycoma Longifolia Jack (Tongkat Ali)

Traditionally used for:
· Support general health and vitality
· Increase male sex drive
· Natural remedy for impotence
· Support healthy blood circulation

Herbal products works for female to increase fertility:

Agnus Castus (Vitex or Chaste tree berry)

This is the herb of choice for helping to restore hormone imbalance and increasing fertility. In one study 48 women diagnosed with infertility took agnus castus daily for three months, 7 of them became pregnant during that time and 25 of them regained normal progesterone levels.

Agnus castus is particularly helpful for those women who have a luteal phase defect (shortened second half to the cycle) or those with high prolactin levels, because it stimulates the proper functioning of the pituitary gland which controls the hormones.

Agnus castus works to restore hormonal balance and can be used where there are hormone deficits as well as excesses it:

· Regulates periods
· Restarts periods which have stopped
· Helps with heavy bleeding
· Increases the ratio of progesterone to oestrogen by balancing excess oestrogen