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1.  L.D., Mangalore

* My husband who is 37 years screams in his sleep. And I have noticed this is usually early mornings. He feels as though someone is holding him tight and is unable to move. He thinks it is sleep paralysis but I somehow am not convinced because in sleep paralysis the person is unable to wake up or scream. But in his case he starts screaming and screams till someone shakes or wakes him up. Through his scream it sounds like he is scared. He did not have this since childhood, its only from 9 years that he has this problem. Would you be kind enough to help me understand what the problem is and will this continue or is there a way to stop this?

**Your husband seems to be having a sleep disorder known as ‘sleep terror’. Sleep terrors or night terrors, are a parasomnia(altered sleep) condition in which the person reacts to a foreboding sense of fear or terror by screaming, thrashing around or crying. Chidren with this problem, may also get out of bed and walk or run around, and adults are at a risk of performing violent acts during this time. The person is still in a sleep like state during this outburst and cannot be awoken without some difficulty. The episode can last as long as 20 minutes, after which the person  will either go directly back to REM or deep sleep without ever leaving their sleeping state, or may wake up to extreme confusion. People waking up from a sleep terror may experience sleeplessness for a short duration following the episode, in which they cannot recall their name, location, or any other distinguishing features of themselves. This usually passes within a couple of minutes.

Sleep terrors (night terrors) are often associated with, or definitively considered a nightmare, though they are in fact quite different. Nightmares occur in the REM stage of sleep, and are traditional  dreams from which the person experiencing them may recall imagery, sound and/or feelings. Typical nightmares include being chased by someone or something, falling for an inordinate amount of time, or things that the person finds particularly disturbing or frightful that are often rooted in their sub conscious.

Sleep terrors are easily detectable in most cases, as the person experience them will often let out loud screams or wails that will likely wake up most people in the household. It can be a scary and traumatic experience for parents or loved ones to see their children or partners in such distress, as the look of fear and terror is often easily visible on the person’s face. It should be remembered that sleep terrors are not dangerous, and many times the victim will not fully recall the experience, but go through feelings of disorientation and embarrassment more than anything else. 

It is important not to try and wake the victim from their state, but to remain by them until it passes. This gives them comfort when they snap out of it, and assures you that they are not getting up and moving about while still in the state, potentially harming themselves or others in the process.

Sleep terrors, like many other parasomnias are deeply linked to genetics, and those with a family history of sleep terrors are more likely to have them as well. Sleep terrors share the same root causes as sleepwalking, as these can include head injuries, hyperthyroidism, encephalitis, stress, other sleep disorders such as obstructive sleep apneas, fevers and medications.

Sleep terrors are most common in children, especially very young children under the age of 7. Adults can also develop sleep terrors, though this is uncommon and is usually brought upon by a deeply traumatic or emotional event, or is developed in adults with a long history of depression, anxiety or bipolar disorders. Adults with sleep terrors should consult a psychiatrist, who should be able to help them to deal with the issues that are plaguing them and causing the terrors. As few as 2% of adults experience sleep terrors. There is no link between sleep terrors in children and emotional disorders, or disorders that will be developed later in life.

 The majority of parasomnias , including night terrors, occur in the stage before deep sleep, and taking measures to achieve deep sleep faster, and remain in it once there can limit the number of parasomnia occurrences. Having proper sleeping conditions, limiting any caffeine intake or the intake of any other stimulants, and having routine bed times can all lead to quicker and better quality deep sleep

2. R.M., Mangalore

* I have a daughter of 7 years of age. She is not putting on weight for the past 3 years. It is just 14 kg. She is not fussy in eating but very very slow eater. She eats all kinds of food without any problem but takes lot of time. 

** Ideally at this age your child should have attained a height of  around 120 cms and her weight should have been around 20 kgs. Many of the children may not get this ideal(or average) height and weight for several reasons, physical constitution(genetic) is the important one. Some children are destined to grow lean and weigh less by their genes and they may not put on weight. As long as their health is good and they are active, nothing need to be done. However, you may consult a pediatrician to find out if there are any other  causes for poor weight gain. If there are no other causes you can stop worrying as genetic inheritance can not be altered. Even some of these children gain weight once they attain puberty.

3. A.D., Mangalore

*I am 54 years of age. Recently I have developed problem of loss of erection. I have tried various herbal medicine which  have not helped me.

** Most of the men experience erectile dysfunction at some point in their lives, usually by age 40, and are not psychologically affected by it. Some men experience chronic, complete erectile dysfunction (impotence), and others achieve partial or brief erections. The erectile dysfunction can have a negative impact on self-esteem, quality of life and interpersonal relationships. It has many causes, most of which are treatable. 

The causes of erectile dysfunction can generally be classified as either organic or psychological. Although the majority of men with erectile dysfunction are thought to have an organic factor, psychological aspects of anxiety, depression, loss of self-confidence, and partner relationship are important contributing factors.  Consequently, many men have a combination of organic and psychological factors.

The organic causes and risk factors of erectile dysfunction include vascular disease, diabetes mellitus, hypertension (high blood pressure), certain medications, neurological disorders such as multiple sclerosis, chronic alcoholism, prolonged heavy smoking, pelvic trauma and spinal cord injury, pelvic surgery (such as non-nerve-sparing radical prostatectomy, cystectomy, or resection of rectum), Peyronie's disease (buildup of scar tissue in the penis), hormonal abnormalities, and other medical and surgical conditions

Psychological causes of erectile dysfunction include performance anxiety, stress, depression, and marital conflict. 

Although erectile dysfunction is often assumed to be a natural consequence of aging because its incidence increases with age, it is not inevitable. However, many conditions associated with aging—vascular disease, diabetes, cancer, and their treatments—may cause erectile dysfunction.

Erectile dysfunction can cause emotional strain between a couple. Many times, men will avoid sexual situations due to the emotional pain associated with erectile dysfunction, causing their partner to feel rejected or inadequate. Some couples consider seeking treatment for erectile dysfunction together, while other men prefer to seek treatment without their partner’s knowledge. A lack of communication is the primary barrier for seeking treatment, and can prolong the suffering. 

As there is effective treatment for the problem, you may seek the help from an urologist.  He will do a thorough assessment to find organic causes and suggest proper treatment. If there are no organic causes and if required the help from a psychiatrist may be sought.

4.F.S., Kuwait

*I am 49 years of age. Recently I was advised three types of medicines because I had H.Pylori infection in the stomach. Though I have completed the medication, the bloating sensation in the abdomen is still there. 

** Helicobacter pylori (H. pylori) are a type of bacteria found in the stomach. H. pylori infection may be present in more than half the people in the world. Most of the people may not know that they have H. pylori infection, because they never get sick from it. H. pylori is now considered as a common cause of peptic ulcers.  The exact way H. pylori infects someone is still unknown. H. pylori bacteria may be passed from person to person through direct contact with saliva. H. pylori may also be spread through contaminated food or water. This usually happens during childhood. Most people with H. pylori infection will never have any signs or symptoms. It's not clear why this is, but some people may be born with more resistance to the harmful effects of H. pylori.

When signs or symptoms do occur with H. pylori infection, they may include,  the abdominal pain that's worse when your stomach is empty, loss of appetite, frequent burping and bloating. If someone develops signs and symptoms of a peptic ulcer, they are normally tested for H. pylori infection. The infection can be treated with antibiotics. 

The above symptoms also can be due to some other ailments like gastritis. As you are not relieved of your symptoms, you may consult an gastroenterologist for further assessment.

5. S.L., Mangalore

*I am 21 years of age. I have the habit of frequent masturbation. When I get the urge, I can’t concentrate on other things. I feel my penis is bent to left side and at times I get pain after masturbation. Can this be a problem in future?

** This is common in most of the young men of your age. There is nothing like ‘frequent masturbation’ unless it has become an obsession. If you are too much worried about masturbation or wants to stop it by any means, then it can become  an obsession, otherwise it does not cause any problems. Male organ during erection  is not central in most of the men, it deviates to one of the sides and it is normal. If you are not convinced, you can consult an urologist.

 6.J.R., Kuwait

*I am 48 years of age. I get small swellings in my eyelids  It looks like small seed inside my eyelids and so painful. I get repeated problem at least thrice in a year.

** The problem you are having in the eye lids is known as chalazion. It is a  is noninfectious obstruction of the glands known as meibomian glands in the eye lid. It causes extravasations of irritating lipid material in the eyelid soft tissues which causes local inflammation and swelling. Certain disorders of the eye or eyelids can cause this. When it gets infected it is known as stye or hordeolum. You may consult an eye specialist and get evaluated. If the underlying cause is treated, the problem may disappear.

7. A.F., Mangalore

*I am 43 years of age.  I am suffering from arthritis for the past one year. I have swollen elbow and fingers.

** Multiple joint pain with swellings at your age is mostly due to rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disorder that can affect more than one joints of the hands, feet or cervical spine. In some people, the condition also can damage a wide variety of body systems, including the skin, eyes, lungs, heart and blood vessels. This is an autoimmune disorder, when the immune system(defense system of the body) mistakenly attacks own body's tissues.

Unlike the wear-and-tear damage of osteoarthritis, rheumatoid arthritis affects the lining of the joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

Now there are effective medicines which control the autoimmune response as well as inflammation. You may ideally consult a rheumatologist or a physician and get proper treatment.  If properly treated complications like deformities and disabilities can be avoided.

8. J.G., Mangalore

*I am a working mother, my baby is 3 months of age now. I have joined back to work. My office is little far from home so I cannot go home to nurse the baby. When hand press the milk in mornings I do not get that many ounces to have it stored. So I only breast feed in the nights and mornings before I leave to work. Now my baby does not feed that well on breast milk. He latches for 5 minutes and refuses to nurse at times. He refuses and cries while I try to nurse him. I really want to breast feed and continue for a year or 2 maybe. 

** It is very common in babies if they are put on bottle feed early. The baby is required to work a little to get the milk when is on breast feeding; The milk does not flow easily. Once a baby has had a bottle, especially a lot of bottle feeds, baby may begin to prefer the ease of bottle-feeding over the work of breastfeeding. Baby may become frustrated at the breast after the first let-down occurs and the flow of milk begins to slow.

It is normally advised to feed the babies through small spoons than the bottle and artificial nipple when artificial feeding is inevitable. For details you may refer my Konkani book on child care or consult your child’s specialist.

9. P.D., Mangalore

* I am 41 years of age. As I was not interested in marriage I remained single till the age. Now that a proposal come for the marriage with a long age gap.  The man who said YES to be with me is   33 years of age;  so there is 9 years of age difference. Here my question is will I be able to conceive at this age . And I get my periods once in 26 days of cycle . As  we are from poor family we are planning to earn another 4 years in UAE after this we thought of having a family ... What I should do ?

** The fertility in woman gradually reduces as the age advances and it is almost impossible to conceive normally for the first time after the age of 40. Though there are some instances of conception even after the age of 40,  for the first pregnancies the complications during pregnancy and delivery are high. The child also may have abnormalities if the mother is aged. You are already 41 and if you want to postpone the pregnancy by another 4 years, you will be in premenopausal age. The hormones will decline and it may be very difficult to conceive naturally. You can use certain modern methods and try for pregnancy at that age and should be cautious till childbirth. If you are keen to have a child in the proposed marriage, consult a gynecologist for further advice.

10. S.P. Kundapur

*I am 38 years of age. For the past 3 months I have been having too much of weakness and dizziness. I get tired very fast and have no strength in my body. What test should I do in order to know the cause ?

**  You may consult a physician to get properly assessed. There are several causes for weakness and dizziness at your age like anaemia, thyroid hormone problems etc. Unless you are examined it is difficult to opine.

11. B.L.S., Mangalore

*My  baby is of 2 months age and is  suffering from brachial plexus injury from birth, she is moving her fingers and wrist. Can she recovery fully? Or what are the treatments can be done for early recovery?

** I hope your baby is already seen by paediatric orthopaedic surgeon. There are several types of birth brachial plexus injuries and some of them may need active treatment initially. If you have not shown your baby to paediatric orthopaedic surgeon, you may consult now. Paediatric orthopaedic specialists are now available in many of the major institutions.

12. O.M., Mangalore

*I am 45 years  of age and at times I get severe lower back pain. If I stand more than 3-4 hours continuously in the kitchen I  start getting the back pain. If I take rest it reduces.

** There are several causes for this type of pain; weakness of the muscles of the lower back is the commonest cause. You may consult an orthopaedic surgeon and get a x-ray of the lower back. If there are no other problems, exercises to strengthen the back muscles can solve the problems.

13. A.D’C., Goa

*I am 69 years of age. I am diabetic and my fasting sugar varies from 8 to 10, even though I am under medication. I am taking my normal diet, but of late I am getting swelling in my feet. But doctor says its normal with sugar patient, my right leg toes are numb for quite some time, just a week ago I noticed toe nail fell off and a new one came on. Is this normal or should I have to go through any other tests? 

** It appears that you are having the complications related to diabetes mellitus, like diabetic neuropathy. It may be better you get yourself assessed by a specialist to know the health status of your kidneys, retina(eyes) and peripheral  nerves. Some of these complications if detected early can be controlled better.

14. S.S., Mangalore

*I am aged 31 years. I have  a child of 4 years of age. After my delivery I am feeling  very weak. I have leg pain.  I feel  as if I don’t have strength in my legs. I take calcium tablets. My weight is 45 Kgs. its not increasing. I consulted my gynecologist, she gave calcium and vitamin tablets. There is no improvement even after using them.

** You  may take opinion from a physician. You may be advised to undergo certain blood tests to find out the cause for weakness.

15. S. L., UAE

*We are newly married and my wife is 8 weeks pregnant. Doctor informed that she had high blood sugar (like 10.5) which she never had before. I am afraid, will this continue in future. What precautions she has to take. Since the food here is rich what sort of food we can suggest? Do we have to avoid eating rice? Since she is pregnant will this sugar affect the baby?

** The detection of increased blood glucose level in mother during pregnancy is known as ‘gestational diabetes’. Gestational diabetes (GDM) is defined as glucose intolerance of variable degree with onset or first recognition during the present pregnancy. The growth and maturation of the fetus are closely associated with the delivery of maternal nutrients, particularly glucose. This is most crucial in the third trimester and is directly related to the duration and degree of maternal glucose elevation. Gestational diabetes is pathophysiologically similar to type II diabetes. Approximately 90% of the persons identified have a deficiency of insulin receptors (prior to pregnancy) or a marked increase in weight that has been placed on the abdominal region. The other 10% have deficient insulin production and will proceed to develop mature-onset insulin-dependent diabetes later. (The chances of your wife having diabetes after delivery is only 10%)

The diabetic status has to be brought under control to prevent various maternal and foetal problems. The doctor must have advised your wife what precautions to be taken, how frequently blood sugar levels are to be evaluated. Nutritional counseling is the mainstay of therapy for the gestational diabetic woman. The optimal dietary prescription would be one that provides the calories and nutrients necessary for maternal and fetal health, results in normal blood sugar level, prevents diabetic complications and results in appropriate weight gain. One of the difficulties with dietary prescription for women with GDM is the difference between lean and obese women. Obese women with GDM may benefit from a low calorie diet and weight reduction to reverse the metabolic disturbances, but proper nutrition is needed to assure fetal growth and development. The use of rice or not depends on the dietary habits. If your wife uses rice as a common food it can be continued as per the advice of her doctor. It is not possible to give an advice on diet for your wife here in this column. This has to be discussed with your doctor. The periodic blood glucose evaluation will indicate whether the diet is sufficient in maintaining blood glucose level.

If diet is not successful in maintaining relative normal blood glucose level, then insulin therapy is recommended. To identify the women who will require insulin, circulating glucose levels should be monitored at frequent intervals.

Your wife must follow the advice of your doctor. The doctor will decide if she has to be put on insulin. If the diabetes is kept under control, your wife can have normal pregnancy,

16. S. K.Mangalore.

*My wife is pregnant and she is in her 6th week, could you please advise us for what precautions we should take while making love during pregnancy. Is it necessary to abstain from sex?

** There is no need to abstain from regular sexual activity during pregnancy except when it is contraindicated due to ill health of the pregnant partner. Most of the couple has an additional emotional surge of feelings during pregnancy and they are able to express this most effectively through sexual union. Couple can have regular and normal activity during entire pregnancy.

However certain precautions may be taken while having sex during pregnancy:

• Physical union has to be avoided if the lady had abortion in previous pregnancies, especially in the first trimester. (First three months)

• Precautions are to be taken not to put stress if there was spotting or minimal bleeding during pregnancy.

• It may be ideal not to put stress on the pregnant lady in the first few weeks of first pregnancy 

• During the last months of pregnancy, the couple may choose a position such that no stress is put on the pregnant uterus. (Rear position, side position or chair position may be opted)

17. G. D.Bangalore

* I am 57 years of age and having vitiligo since 2000. I have tried puva, homeopathy but of no benefit. Is there permanent and definite cure for vitiligo?

**Vitiligo is a pigmentation disorder in which melanocytes (the cells that make pigment) in the skin, the mucous membranes (tissues that line the inside of the mouth and nose and genital and rectal areas), and the retina (inner layer of the eyeball) are destroyed. As a result, white patches of skin appear on different parts of the body. The hair that grows in areas affected by vitiligo usually turns white.

The goal of treating vitiligo is to restore the function of the skin and to improve the patient's appearance. Therapy for vitiligo takes a long time--it usually requires to be continued for 6 to 18 months. The choice of therapy depends on the number of white patches and how widespread they are and on the patient's preference for treatment. Each patient responds differently to therapy, and a particular treatment may not work for everyone. You may discuss the about the benefits and adverse effects of a particular treatment with the doctor treating you. Current treatment options for vitiligo include medical, surgical, and adjunctive therapies (therapies that can be used along with surgical or medical treatments).

1. Topical Steroid Therapy: Steroids may be helpful in repigmenting the skin (returning the color to white patches), particularly if started early in the disease. It takes long time for the skin to regain its colour. It is the simplest and safest treatment but not very effective. 

2. Psoralen Photochemotherapy: Psoralen photochemotherapy (psoralen and ultraviolet A therapy, or PUVA) is probably the most beneficial treatment for vitiligo available now. However, it is time-consuming and care must be taken to avoid side effects. Psoralens are drugs that contain chemicals that react with ultraviolet light to cause darkening of the skin. The treatment involves taking psoralen by mouth (orally) or applying it to the skin (topically). This is followed by carefully timed exposure to ultraviolet A (UVA) light from a special lamp or to sunlight. Patients usually receive treatments in their doctors' clinics so they can be carefully watched for any side effects. Patients must minimize exposure to sunlight at other times.

3. Depigmentation: Depigmentation involves fading the rest of the skin on the body to match the already white areas. For people who have vitiligo on more than 50 percent of their bodies, depigmentation may be the best treatment option. Patients apply the drug monobenzylether of hydroquinone twice a day to pigmented areas until they match the already depigmented areas. Patients must avoid direct skin-to-skin contact with other people for at least 2 hours after applying the drug. 

4. Surgical Therapies: All surgical therapies must be viewed as experimental because their effectiveness and side effects remain to be fully defined. They include:-

A. Autologous skin grafts- In this procedure the skin from one area of a patient's body is removed attaches it to area where there is vitiligo. This type of skin grafting is sometimes used for patients with small patches of vitiligo.)

B. Micropigmentation (Tattooing):  Tattooing involves implanting pigment into the skin with a special surgical instrument. This procedure works best for the lip area, particularly in people with dark skin

C. Autologous Melanocyte Transplants: In this procedure, a sample of the patient's normal pigmented skin is cultured in a special cell culture solution to grow melanocytes. When the melanocytes in the culture solution have multiplied, they are transplanted into depigmented skin patches.

18. J.C., Mumbai

*I am 33 years of age. I am married for four years. I have some problem in conceiving. I checked with a gynaec who informed that I had prolactation problem and that was the reason for  irregular periods and infertility. I have another problem, after union the semen flows out from me. What should I do? 

** Prolactin is a hormone secreted by the pituitary gland, located at the base of the brain.  In non pregnant women, it circulates in low levels in the bloodstream.  When a woman is pregnant the level increase tenfold and stimulate milk production. There are several known causes of excessive prolactin.  Surgical scars on the chest wall, some medications like tranquilizers, high blood pressure medications, oral contraceptives and anti-nausea drugs can all lead to hyperprolactinemia.  Some women with PCOS also have hyperprolactinemia. 

The most common cause of hyperprolactinemia is hypothyroidism, in which an inadequate amount of the thyroid hormone is produced.  Treating the hypothyroidism with thyroid hormone can correct prolactin levels.  However, in about 30 percent of the cases, the root cause is 

unexplained. Hyperprolactinemia can create several problems including: 

• Inadequate progesterone production during luteal phase after ovulation 

• Irregular ovulation and menstruation 

• Absence of menstruation 

• Galactorrhea (breast milk production in non-nursing woman) 

There are effective medicines available to suppress the raised prolactin levels. Consult a gynecologist for proper advice. 

It is normal for some amount of ejaculate to flow out after physical union. It does not hamper the chances of conception.

19 N. S. Gulf

* I am from India presently working in Gulf.  When I was 16 years old started masturbation continuously up to the age of 23-24, then I completely stopped as I was told that it would create problems in married life. Now I am 31 years old, for the last one year I have been suffering from nightfall once in 3-4 days, after that I have feeling pain in joint and in legs. I have consulted so many doctors, Ayurvedic experts here and also in India, but I did not get any cure. These days I am feeling more pain in legs as well as in the lower back. Due to this I cannot concentrate on my job. I am planning to get married next year. Will this problem affect my married life?

** The night fall or nocturnal emission is an  ejaculation experienced by males during sleep. It is also called a "wet dream", an involuntary orgasm, or simply an orgasm during sleep.

Nocturnal emissions are most common during teenage and early adult years. However, nocturnal emissions may happen any time after puberty. They may or may not be accompanied by erotic dreams. Some males will wake during the ejaculation, while others will sleep through the event.

The source of nocturnal emissions is not known. A common theory, is that they are the direct result of the stimulation caused by either erotic dreams or memories of waking sexual activities. For this reason the term wet dream (but not the others) is also used figuratively for something very pleasurable but often imagined or hoped for. However, there has been little experimental evidence to support this theory. Another common theory is that wet dreams are the way the body disposes of "built-up" semen, to make room for more. However, the body does not in fact need to do this, as is evident from the many men who ejaculate only on rare occasions.

The frequency of nocturnal emissions is highly variable. Some men have experienced large numbers of nocturnal emissions as teenagers, while some men have never experienced one in their lives. Men who experience wet dreams more or less frequently than others usually do not have any sort of disease or problem. Some have them only at a certain age, while others have them throughout their lives following puberty. Contrary to popular belief, the frequency of nocturnal emissions has not been conclusively linked to  frequency of masturbation. 

Although purported treatments to help prevent or diminish nocturnal emissions are available in abundance, none are known to have any benefit. Moreover, because no physical harm is caused by the act and it is not symptomatic of any underlying problem, there is no need to undergo any sort of treatment except in cases of severe psychological trauma.

Your present problems are probably due to undue mental stress. You have to stop worrying about this. Nocturnal emission is normal and present in most of the males of your age. Once you convinced that the nocturnal emissions are normal your present problems likely to get relieved. If you are still disturbed you may consult a psychiatrist.

Nocturnal emissions are common phenomenon in all males and have no adverse effects on married life.

20. M. N.,Mumbai

*I am 36 yrs married. I have no children yet. My semen analysis is as follows: Sperm count is 13 mill/ml.; Activity motile 35%. My doctor suggested me treatment of clomophene citrate 25 mg once daily for three months. What may be the minimum requirement of sperm count for conceiving? Whether the above treatment is enough or something else has to be done?

** The World Health Organization recommends there be a minimum of 20 million sperm available for effective conception to occur with intercourse. Male factor infertility occurs when the numbers are less than this. The average ejaculate contains over 100 million sperms. A common question is why so many are required for conception to occur if one sperm is sufficient to fertilize an egg. The reason lies in the tremendous journey sperm must make from the top of the vagina (after emission) to the end of the fallopian tube where the egg awaits. Relative to a grown man’s size, the sperm must swim across the Pacific Ocean to match the distance. If there were 100 million of them, perhaps some would make it. However, if there are fewer numbers or half are crippled, the likelihood is much smaller. 

The Clomiphene citrate in Clomiphene works on the pituitary gland to facilitate the increased production of follicle stimulating hormone (FSH) and luteinizing hormone (LH). These are responsible for stimulating testosterone and sperm production. In theory the net result is an increased sperm count. You may continue the Clomophene tablets for three months and get semen analysis. If there is no improvement you may consult an urologist to know if there are any other problems for low sperm count.

If the sperm count does not increase there are other simple forms of treatment like intrauterine insemination. There are other advanced reproductive techniques like Gamete intra-fallopian transfer (GIFT) and IVF, which places the sperm as close as the egg. These treatments have greatly reduced the threshold of sperm needed to achieve conception and have helped tens of thousand of couples worldwide to become parents.