Infertility refers to women of childbearing age who have normal sexual life after marriage and have not conceived after two years of cohabitation without contraception, which is called infertility. According to the survey, the highest conception rate is 80%-90% in the first year after marriage, and the conception rate is 93%-95% in the second year. The World Health Organization (WHO) has prepared the “Standard Examination and Diagnosis Manual for Infertile Couples”, which stipulates that the diagnosis of infertility is one year, with the aim of early diagnosis and early treatment. As the relationship between fertility and female age has been confirmed, the fertility age of women starts to decline after 30 years of age, and the decline is more obvious between 35 and 40 years of age. Therefore, routine checkups for infertility should be done one year after marriage without pregnancy.
(i) Infertility incidence: 7%-10%
Female factor accounts for about 40%
Male factor accounts for about 30%-40%,
Both male and female factors account for 10%-20%
(2) Common causes of female infertility and treatment methods.
1. Ovarian dysfunction: about 30-40% of female infertility
(1) Ovulation disorders: (i.e., follicles do not develop or ovulate) are common in polycystic ovary syndrome, hyperprolactinemia, amenorrhea, premature ovarian failure, unruptured luteinization syndrome and other diseases, and the symptoms are mostly menstrual irregularities or amenorrhea.
(2) Luteal insufficiency: (With ovulation but insufficient luteal function, manifested by slow rise in basal body temperature or short duration of high temperature.) The clinical manifestations are mostly early menstruation, premenstrual bleeding, even if the pregnancy is early abortion, that is, “biochemical pregnancy”, “early pregnancy abortion”.
The endocrine examination (blood sampling on the 2nd-5th day of menstruation, or 7 days after ovulation in case of luteal insufficiency) and ultrasound ovulation detection (continuous examination on the 10th-12th day of menstrual cycle to observe the whole process of follicles from small to large and from large to ovulation, to determine whether there is ovulation and predict the ovulation period. (It is more accurate.) After diagnosis, symptomatic treatment: if there is no ovulation, Chinese and Western medicine combine to regulate the endocrine function and promote ovulation; if there is insufficient luteal function, Chinese and Western medicine supplement to support the luteal function.
Tubal factors: accounting for 23.7% to 35.7% of female infertility, tubal lavage or imaging should be done to confirm the diagnosis (within 3-7 days after menstruation, imaging is more accurate than lavage, and it is better not to have intercourse before the examination).
(1) Tubal infection: the imaging found that the fallopian tubes are incompetent, or pass but not smooth → intervention (i.e. guidewire unblocking) plus Chinese and Western medicine comprehensive treatment; (if not effective) → laparoscopic treatment; (if not effective) → then you have to choose IVF. However, the medical term “lavage” confuses many patients, who think that lavage is a way to open the fallopian tubes, but it is not. It is important to understand that lavage is only a means of examination, not a treatment. The correct meaning of lavage is “the doctor uses fluid to check whether the fallopian tubes are open or not”. Only when there are slight loose adhesions (such as spider webs) in the tubal lumen, lavage can have a certain function in clearing them. However, repeated lavage should not be used, especially when the tubes are not open or not open (such as sludge adhesions), and you should not expect to use “lavage” to unblock the tubes, because as long as there are narrow gaps in the tubes, water can flow slowly through the gaps, but the effect of water is limited, and it does not play a role in unblocking, but only increases the chance of infection. It only increases the chance of infection. To use an inappropriate analogy, like a sewer is not working or there is a lot of dirt stuck in the wall of the water pipe, do you use water to flush or use a wire to stab? Once you understand this, the answer is clear. However, some patients still have concerns that the interventional guidewire may harm the fallopian tubes or cause adhesions again after the procedure, which is not necessary because the interventional guidewire is a special, very soft, ultra-smooth, therapeutic medical material that will not harm the fallopian tubes. That is: existence is justified! Moreover, after the procedure, anti-inflammatory and herbal medicines will be used to prevent adhesions and further unblock the fallopian tubes, with a high success rate.
(2) Peritubal lesions affecting the fallopian tubes causing infertility include the following factors.
adhesions or exaltation around the fallopian tubes (e.g. adhesions with the intestines)
adhesions at the umbilical end of the fallopian tube
hydrosalpinx in the fallopian tubes
Endometriosis
After various tubal surgeries
Adhesions after gynecological or surgical procedures
Tumor compression
Fallopian tube dysplasia
Countermeasure: All need laparoscopic examination and treatment, i.e. tuboplasty, ostomy and separation of adhesions. And with the comprehensive treatment of Chinese medicine.
3. Uterine factors.
Uterine dysplasia (need Chinese and Western medicine treatment)
Various malformations such as longitudinal uterus, double uterus, bicornuate uterus, etc.
Intrauterine adhesions and stenosis
Submucosal fibroids, endometrial polyps
All of them can lead to infertility due to implantation of fertilized egg and obstruction of embryo development.
Countermeasures: Ultrasound and hysteroscopy are needed for examination and treatment. Hysteroscopy can directly observe the morphology of the uterine cavity, the presence of adhesions and the opening of the fallopian tubes at the corners of the uterus on both sides, especially for inflammation, polyps or fibroids at the corners of the uterus blocking the opening of the fallopian tubes in the uterus and affecting their patency, and treatment can be carried out.
4. Cervical factors.
Abnormal development of the cervix
Congenital cervical canal stenosis or atresia
Inflammation of the cervix (e.g., erosion, polyps, etc.)
Cervical fibroids, polyps, cervical cancer, etc.
The above factors affect the nature of the cervical mucus or change the structure of the cervical canal, thus affecting conception.
Countermeasures: Gynecological examination, colposcopy, TCT examination are required, and according to the examination, corresponding treatment methods such as “Lipo” or surgery will be chosen.
5. Vulvar and vaginal factors
Abnormal development of hymen
Partial vaginal atresia
Scar stenosis caused by vaginal trauma
It can affect the sexual life and sperm entry and cause infertility.
Countermeasures: Rarely, surgical treatment is required.
6. Immunological factors: Blood test is required (available at any time on an empty stomach, not affected by menstrual cycle): anti-sperm antibodies, anti-endometrial antibodies, anti-hyaline antibodies, anti-cardiolipin antibodies, etc.
Countermeasures: If positive, a combination of Chinese and Western medicine drug treatment is required.
7. Unexplained infertility evidence.
Countermeasure: special examination should be done – laparoscopy, hysteroscopy
Laparoscopy can directly observe whether there are lesions or adhesions in the uterus, fallopian tubes and ovaries. About 20% of patients can find lesions that are not clearly diagnosed before surgery through laparoscopy and can be treated at any time, such as separation of adhesions, tubal plastic surgery, ostomy and treatment of endometriosis. In cases of unexplained infertility, laparoscopy can also be used to perform tubal intubation and lavage through the hysteroscope or directly through the cervix to observe the overflow of fluid through the umbilical end of the fallopian tube and the morphology of the fallopian tube to directly determine whether the fallopian tube is patent, which is the gold standard for diagnosing whether the fallopian tube is patent and whether the pelvic cavity is adherent. Laparoscopy should also be performed for a history of infertility of more than 3 years. Many studies have reported that laparoscopy in patients with unexplained infertility revealed that 1/3 of the patients had endometriosis and 15%-30% had tubal disease and pelvic adhesions, etc. Therefore, unexplained infertility must be determined by laparoscopy.
Hysteroscopy provides insight into the uterine cavity and can detect uterine adhesions, submucosal fibroids, uterine polyps Uterine malformations, etc. It can be seen from the above analysis that the diagnosis and treatment of infertility cannot be achieved by just one clinic visit or by certain drugs. To improve the diagnosis and cure rate and to take fewer detours, it is necessary to make correct judgments through various laboratory tests, ultrasound, tubal lavage or imaging, hysteroscopy, laparoscopy and other related examinations in order to improve the efficacy of treatment.
The above is only a brief description of the common causes and treatments of infertility, and we hope to provide some help for our patients. It is understandable that many patients are eager to seek medical advice on the website on how to cure infertility, but online is not the way to see and prescribe medicine. Therefore, it is advisable to visit the hospital, after all, the doctor has to choose the right treatment according to the specific situation of the patient. But here is a reminder: go to a regular public hospital, do not follow the advertisements and believe in the so-called reductions or free examination and treatment, so as not to be deceived and end up spending more money than the reductions. After all, there is no pie in the sky, and there is no free lunch.