Fathering a Boy

Dear doctor,
I met this lady 2 years ago and we have one girl. I would like to have 3 to 4 kids and possibly 3 boys and the one girl. How do I get boys now?

Am sure you have your own reasons for wishing that your subsequent babies are all boys.It doesn’t seem like you are looking for a family balance, as you clearly want more boys. It may be you have some societal pressures to father boys.

But sex selection purely for social reasons has ethical and demographic dilemmas, and is medically illegal in many jurisdictions. However advanced medical technology and increasing demand for sex selection have both created the need for more debate on the matter. There is a push for relaxation of the rules on a selective basis, and more couples may have a chance to pre-select the desired sexes of their future children.

Sex determination is dictated by chromosomes (structures that contain genes) carried by sperms. Females have the XX chromosome complement, while males are XY. If an X bearing sperm fertilizes an egg, a baby girl is conceived. Conversely a baby boy will be conceived if a Y bearing sperm fertilizes an egg. Thus having a boy or a girl occurs purely by chance.

But can you influence the chances of having either a boy or a girl? You will find common advise based on physical characteristics of X or Y bearing sperms. This includes the timing of sexual intercourse in relation to expected time of ovulation, certain sexual positions,and even changing your diet. Such advice is very imprecise and has not been scientifically proven to influence eventual sex of the baby. You might as well toss a coin!More scientifically sound methods of sex selection are available, but must be combined with assisted conception techniques. X and Y bearing sperms can be separated with laser guided techniques. The desired sperms can subsequently be inseminated into the womb, with over 90 percent chance of success. In-vitro fertilization (IVF) can be used to pre-select fertilized eggs (embryos) of the desired sex. This virtually guarantees conception with the desired sex, but is only licensed in cases where a medical reason for sex selection exists. Accessing such techniques for social sex selection is limited by cost, and the law.

A less desirable option is to determine the baby’s sex soon after conception, followed by termination of the pregnancy if the sex is unwanted. This can be done as early as 7 weeks of pregnancy by doing a blood test, or later with ultrasound imaging. Laws on abortion prohibit this in many countries.Guaranteeing that your next baby will be a boy through natural conception is at best a gamble. Be ready to raise whatever sex you get, statistical chances are that you will father a boy as the number of the children your bear increases.

Women's health calcs

Use handy apps to monitor your health

Health calculators are freely available on multiple platforms. You will find many apps that can easily be downloaded onto your phone, tablet or wearable health gadgets. Many health-related websites will have calculators that are free to use. Your doctors’ offices, or other health facilities, are also likely to have health calculators that you could use to measure some health metrics as you wait your turn.

General health calculators are mostly linked to lifestyles. The commonly used ones are related to weight. You can calculate your body mass index (BMI for short), amount of calories burned during a work-out, or calories ingested with certain meals. You can also calculate how much of your body is actually fat, how much you need to eat daily to maintain health, how much alcohol gets into your blood during a drinking spell, or how much physical activity is needed to raise your heart rate to a certain level.

And then there are calculators sorely for women’s health. One of the commonest one is the pregnancy calculator. Most pregnancy calculators come as handy apps and are capable of tracking almost every aspect of your pregnancy. You will get reminders when clinics are due, prompts about important pregnancy milestones, and even handy advice about common symptoms. Those trying to conceive aren’t left out either, you will easily find ovulation apps that will quickly track your periods and prompt you on the most fertile days. There’s even a contraceptive app available for those who want to avoid pregnancy, and aren’t interested with traditional contraceptives.

If you have the right medical data about yourself, you can also find apps that can predict your risks of certain reproductive cancers. Inputting the required data may sometimes require help from your gynecologist following some evaluations. You will then get individualized predictions, and additional advice on limiting your cancer risks. Those on certain longterm meditations may also use specific apps to remind them on dosages, prescription refills and interval medical reviews.

There are obviously some benefits in being aware of your health metrics. You want to remain within the green zone of whatever you calculate. If you are on the yellow or red zones, you will find additional advice. Or you will instinctively know what to do. But you will still need the odd clinical assessment and routine physical screening for certain diseases.

Beware that clocking nice numbers with your health calculators does not necessarily equate to good health. Your overall health status is an interplay of many variables, and scoring best in self-calculated parameters is only part of the health equation. Even though complex medical algorithms can display almost anything in numbers, you can never completely walk away from a reasoned interpretation by a skilled physician.

Dr Alfred Murage is a Consultant Gynecologist and Fertility Specialist. amurage@mygyno.co.ke

Sleep your way to health

You may well be aware of the recent scientific and social buzz about sleeping patterns and health effects. This is in fact not new, the relationship between sleep durations and health has been known for a long time. The optimal sleep duration for an individual is difficult to work out, and is influenced by a multitude of factors. It’s also not very easy to prove a direct causal effect between some health conditions and sleep durations.

It is all too clear that having adequate sleep has proven benefits. These include cardiovascular health and mental health benefits spanning from good memory, to lower rates of depression. Good sleep appears to curb inflammation, leading to lower rates of inflammatory-related diseases like arthritis, diabetes and strokes. Those who get adequate sleep appear to live longer as well. Most authorities advice getting somewhere between 7 to 9 hours of sleep every day. Sleeping more, or less, predisposes you to ill health.

The much talked about sleep study done in 2010 in the US has raised several sleepy, and non-sleepy discussion points. The sleep patterns of over 50,000 adults were analyzed, and related to chronic diseases. The diseases of interest were cardiovascular disease, stroke and diabetes. The study concluded that those who sleep shorter (less than 6 hours), or longer (more than 10 hours) have higher risks of heart disease, stroke and diabetes.

If you are a scientist, you may wish to look closely at how the study was done and may spot some limitations. If you are a lazy person, all you want to know is how the study conclusions relate to your sleeping patterns. Either way, your overall health is affected by how much you sleep. You don’t even need a study to tell you this. Deprive yourself of sleep for several days and see what effect that has on your overall productivity. Or just try sleeping the whole day and see what happens.

What you need is a good balance of your sleep and wakeful periods. Aim for at least 6 hours of good sleep every day. Resist the temptation to sleep beyond 10 hours. What you do every day will have an influence on how much you sleep. And so will anything else that you ingest, including foods, beverages, medicines or other stimulants. There can never be a one-fits-all recommendation. Some of us need more sleep, while others can do with very little. What is important is to find a balance that works for you.

Do not suddenly lose any sleep over your sleeping patterns. You are allowed to enjoy the occasional long snooze, or the odd late night. What you must desist from is a persistent state of sleep deprivation, or repeated prolonged hours of sleep. All this seems to interfere with the body’s dynamic health mechanisms, and can predispose you to various diseases.

When the flag flies half-mast

A problem with having or sustaining an erection is referred to as Erectile Dysfunction (ED). Men with ED are unable to have satisfactory penetrative sexual intercourse. Studies suggest about 40 percent of men over the age of 40 suffer from some form of ED. Remedial measures are readily available, and men should not shy away from seeking help.

Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Likewise, stress and mental health problems can cause or worsen ED. Sometimes a combination of physical and psychological issues causes ED. Many men experience transient ED, this is not usually a cause for concern unless it is sustained. But ED should not be confused with decreased libido, which is lack of sexual desire. Men with ED usually have normal libido.

In most cases, ED is caused by something physical. Common physical causes include heart disease, diabetes, obesity, low testosterone, injuries affecting the pelvic area or substance abuse (tobacco, alcohol, and illicit drugs). Psychological causes include depression, anxiety, stress, relationship problems or other mental illnesses. As men grow older, they take longer to achieve and sustain an erection. Sometimes this may be an effect of medications they may be on, for example blood pressure tablets.

Men experiencing ED should make attempts to see a doctor, either a general practitioner or a specialist. A detailed evaluation is done, and may include psychological assessment and review of any relationship issues. Blood tests and some imaging studies may be done to pinpoint the diagnosis.

Specific treatment for ED will depend on what the cause is. Optimal treatment of existing conditions may improve ED. Oral medications, such as Viagra, are appropriate and satisfactory treatments for many men with ED. Caution must be advised in men with specific conditions like heart disease, or those on other medications that may potentiate Viagra’s side effects. Other options include self-injections, urethral suppositories and testosterone replacement. Penile pumps and surgically inserted implants are also available, and some men may require blood vessel surgery. Herbal or internet purchased remedies must be used with caution, as they may contain potentially harmful components not usually listed in the label. Acupuncture has also been tried.

Psychosexual counselling is an important component of ED, regardless of whether the cause is physical or psychological. Women should support their partners whilst seeking remedies for ED, rather than berate them with unkind actions, which just erodes their self-confidence further.

Some causes of ED may not be preventable, but leading healthy lifestyles is a good starting point. Men with ED should quit smoking, reduce alcohol intake, optimise weight, exercise and work through relationship issues.

You getting value for your health expenditure?

Traditionally, healthcare expenditure has been based on a fee-for-service model. That means when you access healthcare, you almost blindly pay for whatever gets done, regardless of whether all you got billed for was beneficial to you. The alternate model is referred to as value-based care. This aligns healthcare payments to outcomes that are of benefit to patients. Thus payments or reimbursements to healthcare providers and doctors isn’t based on clinical volumes, but on measurable ‘value’ of care and patient benefits.

The business of medicine is tuned to sustainability and profitability. Hence the volume of work matters, inevitably leading to repeated consults, multiple tests, expensive interventions, multiple prescriptions, and inappropriate admissions. All such actions generate huge revenues for healthcare providers. But the real value to individual patients is questionable, especially when faced with a multiplicity of billable interventions that do not correlate with desired health outcomes.

If you are a lay person, you might find it hard to determine if you are getting value for your healthcare expenditure. But you only need to maintain a certain level of alertness during your clinical encounters, and be ready to question everything. A few examples are in order. No one really benefits from repeated consults and unending follow-ups for stable conditions. There’s nothing like routine tests, any tests recommended must add value to your diagnosis or treatment. If you find yourself with a bagful of prescribed meds, most or all are useless. No one ever needs to be admitted into a hospital for a mundane reason, doesn’t confer any benefits. The list goes on and on. If anything doesn’t appear valuable to you, don’t accept to pay for it.

The other side of value-based care rests on healthcare providers. The emphasis must be on quality rather than quantity. Health service providers must build teams whose primary goal is to provide the best possible care, with the lowest costs. This requires adherence to evidence-based medicine, and quick avoidance of the temptation to recommend unnecessary interventions. Technological innovations already allow for adoption of many strategies to balance cost and good outcomes. Compensation models and incentives to doctors and other service providers must increasingly be linked to patient outcomes, rather than the clinical volumes accrued.

If you are getting value for your healthcare, you will spend less and achieve even better health. Your doctor will focus more on getting you better. You should expect fewer doctor’s visits, fewer medical tests and procedures, and less prescriptions. Your healthcare provider will benefit too by becoming more efficient, and achieve even higher patient satisfaction ratings. Further downstream, there will be benefits with overall costs of health insurance and improved accessibility to healthcare by those in the low socio-economic group.

The next time you are in a clinical encounter, think value. Hopefully your doctor will think value too, and not volume.