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Milk Secretion from Breast (Galactorrhoea) / Hyperprolactinemia 

Galactorrhoea i.e. milk secretion from breast (in absence of lactation) occurs due to high prolactin, thyroid and pituitary hormone disorders &g milk in response to many stimuli. By investigating & finding the exact hormone defect it can be effectively cured. For effective treatment qualified hormon due to abnormally increased sensitivity of breast cells to prolactin hormone so that they start makine specialist is must.

Hyper prolactinemia (High prolactin hormone due to prolactinoma micro or macro).

Causes of high prolactin are : Stress, milk feeding by mother (Lactation).

Other cause :- 

Cushing's disease
Pituitary tumour
Hypothalmic disease
Empty Sella Syndrome
Chest wall irritant lesions
Drugs as antipychiatric drugs, TCA, Metoclopramide
Renal, Liver disease

Symptoms : In women it causes menstrual irregularity as delayed & less period even absent periods, milk secretion from breast (Galactorrhoea), decreased desire for genital , infertility & recurrent abortions. In girls it may cause small breast.
In males it leads to decreased desire, breast enlargement, decreased sperm count, Infertility. In young boys it may leads to absence of beard & moustache & small pennis.

Treatment : There are many drugs which can cure, it in two month to six months time. Sometimes surgery is required or radiosurgery by Gamma knife i.e. surgery by rays without cutting the body or using the blade.

Pregnancy & high prolactin (Prolactinoma micro & macro) In hyperprolactinema women becomes pregnant only when serum prolactin is normalized. Once pregnancy is confirmed then Bromocriptine (proctinal/sicryptin) or cabergoline (Caberlin) should be stopped, if there is no evidence of local Tumour compression. If tumour enlarges & produces compressive signs then antiprolactinemic therapy should be restarted.

Stopping of Lactation : After delivery of body due to some reasons as mother living away from baby or death of baby there are certain drugs which stop milk secretion.

Medicines to start lactation i.e. milk secretion are available.

3) Premenstrual syndrome occurs due to some hormone disorder & fluid retention in which patient get depressed, anxiety, body pain, fullness & bloating of body, Swelling over body. These symptoms are more pronounced before, during & after the periods. There are certain medicines which can cure it in few month time. The medicines are

a) Medroxyprogesterone
b) Desgestrol
c) Megestrol
d) Norethisterone
e) Hydroxyprogesterone
e) Oral E & P Combination Pills

2) Infertility In Female
Infertility is defined as inability to conceive in a couple having unprotected intercourse for over one year. Difficulty in conceiving & inability to have child in female can be due to many of below mentioned hormone diseases & other causes as discussed below. 

Causes of Infertility 
common causes for infertility are 
- Male Factor infertility
- Female Factor infertility
- infertility due to minor defects in both couple

Causes of Female Factor infertility:

Hormone Disorder: thyroid hormone disorder, high prolactin, Estradioal deficiency LH, FSH deficiency, Polycystic ovarian disease (PCOD), defective egg formation, decrease in progesterone hormone, Hypothalmic & pituitary disorder, excess of various male, Hyperprolactinemia, Anavulation/oligoanovulation, Chronic anovulation (polycystic ovary syndrome), Hypothalmic amenorrhea-anovulation, Pituitary disease (including hyperprolactinemia), Adrenal disease, Thyroid disease, Luteinized unruptured follicle syndrome, Ovarian failure, Gonadal dysgenesis
hormone in female. 
Vaginal Causes : Excessive acidity, chronic vaginitis
Cervical Causes : Hormonal, Inadequate estrogen, Infection : Chalmydia trachomatis, Ureaplasma urealyticum, Anatomic : Destruction by cone biopsy or cauterization, Immunologic.
Uterine causes : Leiomyomas, Polyps, Intracterine synechiaq (Asherman syndrome), Chronic endometritis, Ureaplasms urealyticum, tuberculosis.
Tubal Causes : Infectious, Chlamydia trachomatis, Neissaria gonorrhoeae, Mycobacterium tuberculosis, streptococcus, anaerobes, Inflammatory salpingitis isthmica nodosa.
Congenital Abnormalities : Diethylsitilbestrol exposure, idiopathic.
Endometriosis: Mild, Moderate, Severe
Ovulatory Disorders : Luteal phase deficiency, Hypoprogesteronemia, Pelvic Adhesions : After intrauterine device use, Associated with pelvic inflammatory disease, Associated with appendicitis, Associated with other bowel disease, Idiopathic 
Immunological disorders - eg. SLE.
Infections eg TORCH infections.
Metabolic Diseases : Diabetes

Investigations & Diagnosis : We need detailed history examination , blood tests as LH, FSH, Prolactin, Thyroid test, testosterone, free testosterone, androstenidione,17-hydroxyprogesterone, Dheas, SHBG, . 
Antisperm antibodyn sometimes also required to know the cause of infertility in females.
TORCH IgM for infection screening
USG for follicular/ Ovulation study, hysterosalpingography for uterus & tube status & Laproscopy
Transvaginal follicular monitoring with color Doppler for egg development

Hysteroscopy for diagnosos & treatment of uterine cavity diseases.

Treatment: . After a diagnosis of infertility, the best treatment plan based on the specific requirement is selected. Many times a combination of fertility treatments is necessary to achieve pregnancy. Commonly recommended treatments include ovulation induction, injectable ovulation induction, intrauterine insemination (IUI), in vitro fertilization (IVF) and reproductive surgery. By correction of these disorders good egg formation occurs & leads to conception in three to six months time. 

1) Drugs For Infertility 
a) Clomiphene
b) Gonadotropin Therapy
c) HCG Therapy
d) Hmg therapy
e) Metformin
f) Glitazones
g) Micronized progesterones
h) Laser Ovulation Induction
i) Tamoxifene
j) Letrozole
k) Diathermy of Ovaries

Ovulation Induction
Ovulation Induction is used for patients with ovulatory dysfunction. The first line of treatment may include oral medications, such as Metrformin or Clomiphene citrate. Other diagnoses may necessitate the need for injectable medication called gonadotropins. These may include Follicle Stimulating Hormone (FSH), Leutinising Hormone (LH), human Chorionic Gonadotropin (hCG) or combination of all of these. Both types of medications stimulated the ovaries to produce one or more eggs. Frequent monitoring is usually necessary to manage the effects of the medication. Monitoring includes ultrasound of the ovaries to measure follicle growth/egg development and the thickness of the uterine lining and Hormone Blood Tests.

Super ovulation
Super ovulation is frequently used for patients with unexplained infertility; for those who had unsuccessful surgical treatment for mild endometriosis or for patients with a mild male infertility factor. In fact, super ovulation is recommended following the patient's infertility workup but before in initial laparoscopy to avoid the surgery completely. The objective of super ovulation is to stimulate the production of 2-5 oocytes (eggs), giving the sperm more 'targets' to fertile. Treatment includes Clomiphene citrate tablets or the synthetic FSH. This egg stimulation process is monitored with frequent vaginal ultrasounds and Hormone Blood testing. When the follicles (which house the eggs) are large enough, hCG is injected to trigger ovulation. Super ovulation is combined with IUI for better results.

2) Intrauterine Insemination: it is done for any defect in female vagino-cervical canal, or for a defect in male sperm count or motility. For this semen wash done & healthy motile sperms are taken & then they are injected directly in uterus leading to good pregnancy rate. IUI allows the placement of millions of sperm directly into the uterine cavity at the time of ovulation. The sperm are 'washed' with special solutions to remove the semen and to concentrate the sperm. There is a greater chance of pregnancy when the sperm are closer to the eggs with the IUI.

Therapeutic Donor Insemination (TDI) 
TDI involves timed insemination from an anonymous or a known donor. It is recommended to use frozen semen to prevent genitally transmitted disease by the Food Drug Administration (FDA), USA and the Centers for 

3) In Vitro Fertilization: Test tube baby procedure is adopted for various male & female causes of infertility.

4) ICSI - (Inracytoplasmic Sperm Injection): In this procedure single sperm is injected into a single eggs with the help of microinjector so that one achieves good fertilized egg & later normal baby even with single egg. The single sperm are picked and injected into the eggs using specially designed microscopes, micro needles and micromanipulation equipment. The eggs are checked then for evidence of normal fertilization. Fertilization rates for ICSI are very good. In various IVF programs the success rate foe for pregnancy are about 60-85%.

5) Gamete/Zygote Intra-fallopian Transfer
Gamete intra-fallopian transfer (GIFT) and zygote intra-fallopian transfer (ZIFT) are adaptations of IVF. GIFT and ZIFT are used in unexplained female infertility and in mild male infertility.
6) Blastocyst Transfer
7) Assisted Hatching (AH)

8) Artificial Insemination of Sperm from semen bank .This facility is not very costly with good success rate.
9) Reproductive Surgery
Surgery for fertility problems includes operative laparoscopy and/or hysteroscopy. Laparpscopy is performed to diagnose and treat endometriosis, adhesions and tubal problems. Hysteroscopic procedures are used to diagnose and treat intrauterine problems such as polyps, fibroids, adhesions and uterine septums. At times, both these surgeries may be required. 


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