Infertility is defined as a couple who has normal sexual intercourse (once every 3-4 days) and has not had a pregnancy for one year without contraception. Patients who have never been pregnant are referred to as primary infertility, while those who have had a pregnancy and remain infertile for one year without contraception are referred to as secondary infertility. Those who have had repeated miscarriages or ectopic pregnancies without obtaining a live baby fall into the category of infertility. It is generally believed that the incidence of infertility in China is about 10%. The causes of infertility are divided into male and female factors and mutual factors: male factors are mainly sperm production disorders and sperm transmission disorders. The former refers to routine semen examination for azoospermia, oligospermia, weak sperm or abnormal sperm morphology. The latter mainly refers to obstruction of the vas deferens or abnormal sexual function (impotence, premature ejaculation, non-ejaculation, retrograde ejaculation) resulting in the inability of semen to enter the female reproductive tract. Female factors are mostly ovulation disorders and tubal factors (including incompetence, incompetence and fluid in the fallopian tubes). These two factors account for about 80-90% of female infertility factors. Ovulation disorders are commonly referred to as non-ovulation, which often manifests as irregular menstruation, especially prolonged menstrual cycles, which are usually longer than 45 days. There are two main categories of ovulatory disorders, one is ovarian failure caused by hypothalamic and pituitary lesions or dysfunction, and the other is ovarian failure caused by ovarian lesions, such as premature ovarian failure, polycystic ovary syndrome, functional ovarian tumors, ovarian insensitivity syndrome, ovarian dysplasia, and others caused by abnormal adrenal or thyroid function. Tubal factors are usually the sequelae of pelvic inflammatory diseases, especially chronic tubal inflammation, and endometriosis and tubal dysplasia can also lead to tubal infertility. Other female infertility factors include uterine factors and cervical factors. Uterine factors include uterine malformations (double uterus, longitudinal uterus), fibroids, endometrial polyps, adenomyosis, uterine adhesions, thin endometrium, etc. These factors affect the fertilization of eggs and cause infertility. Cervical factors are cervical inflammation that affects the passage of sperm leading to infertility or cervical laxity leading to late miscarriage. The bilateral factors include immune factors in addition to sexual abnormalities. The immune factor refers to the antigenic substances of sperm, seminal plasma or fertilized eggs that stimulate the body to produce antibodies thus causing infertility or miscarriage when the immune barrier of the male and female reproductive tract is destroyed. There are three stages in the treatment of infertility patients: the first stage is to find the cause of infertility, the second stage is to treat the cause of infertility, and the third stage is to try to conceive. The first stage is to find the cause of infertility. The male partner should be examined for any deformities of the external genitalia, asked about his sexual life, and examined for routine semen. For the female partner, apart from checking the genitalia for abnormalities, the focus should be on ovarian function and patency of the fallopian tubes. The examination of ovarian function includes sex hormone measurement in the early follicular phase, ultrasound monitoring of follicular development and ovulation, and luteal function measurement in the luteal phase. Commonly used methods for the examination of tubal patency include tubal lavage, hysterosalpingography, hysterosalpingography, hysteroscopic tubal cannulation, and laparoscopic tubal lavage. Tubal lavage has poor accuracy and limited diagnostic value. Hysterosalpingography with iodine oil is currently the most widely used method with high diagnostic value. Hysteroscopic tubal intubation and laparoscopic tubal lavage have the highest diagnostic value than hysterosalpingography. Although they are more expensive and more invasive, hysteroscopy can simultaneously understand the specific conditions of the uterine cavity, such as the presence of uterine malformations, endometrial polyps, submucosal fibroids, uterine adhesions, etc. Laparoscopy can directly understand the specific conditions of the pelvic cavity, such as the presence of adhesions in the pelvic cavity, the presence of endometrial The laparoscopy can directly understand the pelvic cavity, such as pelvic adhesions, endometriosis lesions, uterus, fallopian tubes and ovaries, which cannot be done by other means of examination. Other relevant tests include anti-sperm antibody test for both partners and anti-endometrial antibody, anti-ovarian antibody, anti-hyaline antibody and anti-cardiolipin antibody test for the female partner. The second stage is to treat the cause of infertility. Specific treatment is provided for the various abnormalities found in the first stage of testing. The third stage is the trial pregnancy stage. Patients with a clear cause and successful treatment can be given conception instructions and then wait for a natural pregnancy. For these patients, after six months to a year of observation, if a natural pregnancy is still not possible, artificial insemination is recommended to help conceive. For patients with ovulation disorders, ovulation induction treatment is often performed after the necessary menstrual regulation. Ovulation induction is a very critical but difficult treatment, and poor control can lead to ovulation failure or ovarian hyperstimulation syndrome, which can be life-threatening in severe cases. Since ovulation is not easy to achieve in these patients, in order to increase the pregnancy rate, artificial insemination is often used at the same time as ovulation in these patients to help pregnancy. For patients with clear causes but poor treatment such as tubal incompetence, severe polycystic ovary syndrome, severe endometriosis, and severe oligospermia or weak sperm, early in vitro fertilization and embryo transfer, commonly known as IVF, is recommended to achieve the goal of conceiving the next generation.
Support Us
Discussion
Share your experience, or seek help from fellow patients.
