(i) Ovulation abnormalities: These are anovulation, sparse ovulation or irregular ovulation. Ovulation abnormalities can lead to infertility. Anovulation can be due to poor follicular development or impaired release of eggs from the follicular fluid.
Diagnosis.
1) Blood FSH levels: Blood FSH levels can predict whether you are approaching menopause.
2) Blood progesterone levels: progesterone levels can determine whether ovulation is occurring.
3) Ultrasound: You can dynamically observe follicle development and ovulation; you can also estimate ovarian function, such as a small ovary with few small follicles is a sign of near menopause.
4) Endometrial biopsy: A small piece of endometrial tissue is taken for pathological examination to observe whether its growth can support pregnancy.
Q&A.
1. How do I know if I am ovulating?
A: Monitoring whether you are ovulating can be determined by measuring the LH peak in the urine. Ovulation occurs 24-36 hours after the urinary LH peak. Ovulation usually occurs 2 weeks before your period (if your menstrual cycle is 28 days, ovulation is usually on day 13-15, the first day of your period with bright red blood is counted as day 1). If you test your urine panel every day in the middle of your period but there is no LH peak, you may not have ovulated. If you have a delayed period, ovulation will also be delayed.
2. What kind of basal body temperature can help predict ovulation?
A: After ovulation your basal body temperature can rise by 0.3-0.5°C usually 2 weeks before the start of your next period. If your basal body temperature does not rise in the middle of your period, you may not be ovulating. Basal body temperature cannot predict ovulation, but it can determine if you have ovulated.
(ii) Tubal disease: This refers to blocked or damaged fallopian tubes. Tubal disease is one of the common causes of infertility. The main causes of obstruction by adhesions are acute and chronic inflammation of the pelvis (which may not have obvious clinical manifestations), endometriosis, and a history of abdominal or obstetrical and gynecological surgery. Tubal disease can prevent the union of the egg and sperm in the fallopian tube for fertilization, or if a fertilized egg forms, it cannot move to the uterus and may form a tubal pregnancy, causing further damage to your fallopian tubes.
Diagnosis: A history of previous treatment and pelvic examination can be helpful.
1. Hysterosalpingography: A contrast agent is injected into the uterine tubes to observe any tubal abnormalities under X-ray.
2.Laparoscopy: A thin fiber optic mirror is placed into the abdomen through the umbilicus to observe the pelvic cavity, uterus and adnexa, and sometimes to separate the adhesion zone.
(iii) Pelvic adhesion disease: It refers to the scarred adhesion zone sticking the pelvic organs together.
The human abdominal organs are covered with a layer of smooth tissue, and the lubrication of the organ surface allows the adjacent organs to glide freely, but when the surface is damaged or inflamed, scar tissue tends to form. The scar tissue can cause adhesions between the two organs, and the band of scar tissue between the two organs is called an adhesion zone.
Adhesions often cause infertility. If they occur in or around the fallopian tubes, they can prevent the union of the sperm and egg; if the tubes are only partially blocked, the sperm and egg can be fertilized but the embryo is prevented from moving back to the uterus, resulting in an ectopic pregnancy. If there are adhesions in the ovaries, ovulation may be affected; if the adhesions occur in the uterine cavity, embryo implantation will be affected.
Diagnosis: Your medical history and pelvic examination can help with the diagnosis, but to confirm the diagnosis, a laparoscopy or hysteroscopy is needed. A laparoscopy can look directly at your pelvic adhesions and sometimes loosen them. Hysteroscopy can look at the uterine cavity for adhesions and can loosen them.
Q&A.
1. What can cause pelvic adhesive disease?
A: Any cause of injury to the peritoneum covering the organs (dirty peritoneum) can cause adhesions. Infection, history of surgery, and inflammation due to endometriosis are the most common causes. Less common causes are intestinal or appendiceal surgery. Surgery of the ovaries, fallopian tubes, uterus or cervix can also cause adhesions. Infections and endometriosis can cause infections that damage the peritoneum and cause adhesions.
2. What are the symptoms of pelvic adhesions?
A: Women with pelvic adhesions may not have any symptoms except for infertility. The main symptoms that may be present are conscious abdominal or pelvic pain, menstrual cramping pain, pressure pain, pain during sexual intercourse, or pain during bowel movements.
(iv) Endometriosis: Endometriosis is the growth of endometrial tissue outside the uterus.
Endometriosis is one of the common causes of infertility. Endometrial tissue grows outside the uterus and attaches to other tissues in the abdominal cavity such as the ovaries and fallopian tubes. Endometrial tissue, whether inside or outside the uterus, responds equally to the hormonal changes of the menstrual cycle, proliferates and then bleeds the next period, but the endometrium that grows in the pelvic cavity cannot expel blood from the body as it does with menstruation, and the bleeding site is prone to inflammatory reactions and the formation of adhesions.
Adhesive tissues can block the fallopian tubes or affect ovulation. In addition, the endometrial tissue growing in the ovaries bleeds during the cycle, forming ovarian cysts called endometriosis cysts, which can interfere with ovulation. Endometriosis is progressive disease; it may tend to get worse and is prone to recurrence after treatment. Endometriosis usually resolves symptoms by menopause.
Diagnosis: Your medical history and pelvic examination can suggest endometriosis, but only laparoscopy can provide a definitive diagnosis.
Q&A.
1. What are the symptoms of endometriosis?
A: There can be dysmenorrhea, abnormal menstrual bleeding or painful intercourse, or no symptoms.
2.Why do I have this disease?
A: The cause of endometriosis is still unclear.
(E) Unexplained infertility: It is a condition in which the cause of infertility cannot be determined even after various examinations of the female and male partners. About 10-15% of infertility patients belong to this category.
The diagnosis of unexplained infertility must be made after laparoscopy to exclude endometriosis and pelvic adhesions. Unexplained infertility may have functional abnormalities of eggs and sperm, but cannot be detected by convenient and practical methods.
(vi) Polycystic ovary syndrome (PCOS): a group of disorders in which the ovaries produce excessive amounts of androgens and many small follicles, PCOS triggers a hormonal imbalance that results in ovulation disorders. Women diagnosed with PCOS usually have low FSH and high levels of LH. FSH stimulates the growth of follicles in the ovaries to produce mature eggs, if you have a chronic lack of FSH, your follicles will not mature and you will not be able to ovulate, thus causing infertility. Instead, immature follicles in the ovaries form small cysts.
High levels of LH produce excessive amounts of estrogen and androgens. High levels of estrogen can thicken the endometrium, causing excessive and/or irregular menstruation; chronic high androgen levels can produce acne and hirsutism.
Women with PCOS may have abnormal insulin metabolism, which can exacerbate ovulation abnormalities, increase androgen levels and lead to obesity.
Diagnosis: History and pelvic examination are necessary for the diagnosis of PCOS
1. Blood hormone levels: FSH LH E2 T DHEAS (dehydroepiandrosterone)
2, Ultrasonography: ≥12 sinus follicles in each ovary
3. Endometrial biopsy: an endometrial biopsy can reveal if there are any abnormalities in your endometrium.
Q&A.
1. What are the common symptoms of PCOS?
A: You can have significant irregular periods or amenorrhea and may also have other symptoms including acne, hirsutism, obesity and infertility.
2. Why do I have this disease?
A: The cause of PCOS is not known. Genetic factors and abnormal insulin metabolism may play an important role.
(G) Premature ovarian failure: Menopause usually occurs in women between the ages of 42-56. Premature ovarian failure (early menopause) is defined as menopause occurring before the age of 40. Women who experience early menopause usually have depleted eggs in their ovaries. The causes of premature ovarian failure are not known, but there are a number of reasons why the ovaries stop producing eggs: certain chemical and medical treatments can damage the ovaries, including chemotherapy and radiation; autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis sometimes cause premature ovarian failure because the immune system forms antibodies that can damage the ovaries; and genetic factors also play an important role.
Diagnosis: Medical history is an important basis for the diagnosis of premature ovarian failure, and some additional laboratory tests are needed to clarify the diagnosis.
1. FSH level in blood: elevated FSH levels at specific times of the menstrual cycle can confirm the diagnosis of premature ovarian failure.
2, Ultrasonography: indicates significant ovarian shrinkage or a significant decrease in the number of sinus follicles.
3. Immunologic testing: detection of autoimmune such as thyroid, parathyroid and adrenal problems that can be associated with developing early menopause.
4. Karyotype analysis: It can detect whether genetic factors are responsible for premature ovarian failure.
Q & A: 1. What are the symptoms of premature ovarian failure?
A: Early menstruation may include irregularity, low menstrual flow, hot flashes, mood changes, decreased libido and vaginal dryness, etc., with gradual menopause.
2.Can a patient with premature ovarian failure get pregnant?
A: If a patient with premature ovarian failure wants to get pregnant, she needs to undergo IVF with egg donation.
(H) Repeat miscarriage: The occurrence of 3 or more spontaneous miscarriages can be defined as repeat miscarriage.
Approximately 20% of pregnancies are spontaneously aborted before 20 weeks, with the majority of abortions occurring before 12 weeks, and usually three or more occurrences before they are called recurrent abortions. The main causes of recurrent miscarriage are genetic defects, uterine anomalies, fibroids and uterine adhesions, and imbalances in certain hormones such as prolactin, thyroid hormone or progesterone can also cause miscarriage. Certain diseases such as diabetes or immune system abnormalities can also increase the chances of miscarriage. There are also miscarriages of unknown origin.
Diagnosis: Your medical history, pelvic examination and the following tests may help in the diagnosis
1. Karyotype test: to help determine if there is a genetic defect.
2. Hysterosalpingogram: can confirm the presence of uterine abnormalities.
3. Hysteroscopy: to rule out the presence of uterine adhesions.
4. Vaginal ultrasound: to observe the uterus, ovaries and fallopian tubes
5. Hormone level in blood: to observe any abnormal hormone level.
6. Anti-cardiolipin antibody: elevated antibodies can cause miscarriage.
7. Thyroid function test: Abnormal thyroid function can cause miscarriage.
8. Blood sugar: detect the presence of diabetes.
Questions and answers.
1. What risk factors are associated with miscarriage?
A: The chance of miscarriage increases with age, especially if the woman is over 35 years old. Smoking, caffeine and alcohol can increase the chance of miscarriage. There are also some medications that can increase the risk of miscarriage.
2. What are the treatments for habitual miscarriage?
A: If problems are found to be treated symptomatically, such as uterine abnormalities or fibroids, surgery should be performed. Some immune problems or imbalance of hormone levels should be treated with the right choice of medication or immunotherapy.
(ix) Immune infertility
Anti-sperm antibodies: presence in semen and cervical mucus: sperm flutter phenomenon, decreased sperm penetration, preventing sperm from passing through the cervical mucus.
Diagnosis: Blood sampling and taking seminal plasma and cervical mucus for examination
Treatment: 1 Condoms for 6-12 months to avoid exposure of sperm antigens to the female reproductive tract, which can lead to a decrease in AsAb.
2. Immunosuppressants: steroids (suppositories, oral medications)
3. IUI: avoidance of cervical mucus + sperm washing minimizes harmful effects. Present throughout the reproductive tract, some have poor effects.
4.IVF-ET: good effect
(X) Age and infertility
Age plays an important role in female fertility.
As we age, many biological changes occur that are detrimental to pregnancy and the maintenance of pregnancy. The fertility of women decreases gradually from the age of 30-35 years; it decreases sharply after the age of 40 years. The incidence of spontaneous abortion and chromosomal abnormalities, e.g., the chance of Down’s syndrome, also increases with age. The success rate of assisted reproductive technologies such as IVF also decreases with age.
Why does age play an important role in fertility? One reason is that when women are older, they rarely ovulate regularly; another is that this is when they have many of the conditions that cause infertility, such as endometriosis. But a more important reason is the decrease in the quality and quantity of a woman’s eggs. More eggs tend to be chromosomally abnormal, which leads to miscarriage.
Diagnosis of age-related infertility.
Your medical history and pelvic examination are necessary, and one or more of the following tests are additionally required.
1, FSH: Elevated FSH levels in the blood at the beginning of menstruation may be associated with age-related infertility.
2. E2: Elevated E2 levels in the blood at the beginning of menstruation may be associated with age-related infertility.
3. Ultrasound shows: low number of sinus follicles.
3. Clomiphene test: It can be used to check ovarian function. Blood is drawn on day 3 of menstruation for FSH, oral clomiphene is given on days 5-9, and the blood is repeated on day 10 of menstruation for FSH. If there is a significant increase in FSH, it indicates low ovarian function.