Moderator: Having a healthy baby and being a happy mother is the wish of almost every woman after marriage, a wish that cannot be fulfilled in many families. Today’s topic is going to start with a story. Professor Yan, can you tell us about this story?
Yan Changxiang: Good. I am a neurosurgeon, and you may feel a little confused to talk about conception and fertility on this occasion: what is the relationship between neurosurgery and infertility? Let me tell you a story. Five years ago, I treated a patient who was from my hometown. She had been married for eight years and never got pregnant, and had been treated by many hospitals with no success. One day my parents called me and asked me to find a way to help her, and I said okay, let her come to Beijing. She told me after marriage often because of some trivial things angry, quarrels, menstruation gradually reduced, and then simply do not come, eat a lot of Chinese medicine also did not have any effect, and then eat Western medicine, after the use of drugs to come, do not use it does not come, and then after the use of drugs also do not come, she did gynecological examination are no problem, begging God and worshiping Buddha also no results, she completely desperate, because not reproductive, facing family and surrounding pressure we can Imagine.
Fortunately, her lover not only did not abandon her, but also loved her very much, which made him feel relieved. This time, she didn’t have much hope to come to Beijing, and if she couldn’t be cured, she would be completely dead. She said she told me with doubts, perhaps doubting that I could see this disease as a neurosurgeon. I did some tests on her, including blood hormones and an MRI of her head, and found that there was a small tumor, less than a centimeter, growing on the pituitary gland. I told her that the root of your disease was now found, and that the reason for your inability to have children was this tiny tumor. At that time, I was also very happy. I said that you can have this disease surgically removed and she did not hesitate in any way. We operated on her via the nostril, and about three or four months after the operation she called me and said that she couldn’t eat these days, she didn’t want to eat and sometimes she wanted to vomit, was it a complication after the operation? I was excited to hear this news and I thought he might be pregnant. I said you can do a test to see if you are pregnant, and she didn’t believe it at all at that time. She then went to the local hospital for a test, and this hospital said she was pregnant, and she didn’t believe it, so she went to another hospital for a test, and she did get pregnant, and later gave birth to a healthy, cute little baby.
Moderator: We know that traditionally infertility would consider gynecological and male diseases, why would a tumor in the brain be related to infertility. Please tell us what kind of disease is pituitary tumor?
The first thing you need to do is to get a good idea of what you are getting into.
Yan Changxiang: With the development of the disease, the tumor will increase in size, the patient can develop headaches, vision loss, but also other symptoms of endocrine disorders, such as the inability to get pregnant, lactation, obesity and so on. Pituitary tumor can not only destroy the normal internal environment of human body, but also affect the social image of a person.
Moderator: What are the causes of pituitary tumor? What are the symptoms?
There is another theory that the primary cause of pituitary adenoma lies in the pituitary gland itself, due to an intrinsic abnormality of pituitary cells (e.g., cell mutation), which leads to an abnormal clonal increase and finally the formation of a tumor. At present, it is believed that both theories have a role in the occurrence and development of pituitary tumors.
Yan Changxiang: The early symptoms of pituitary tumors are mainly weakness, decreased sexual function, and some also begin to show signs of visual stress: decreased vision, visual field defects, endocrine disorders, decreased menstruation, even amenorrhea, lactation, acromegaly, and centripetal obesity. Others manifest as headache. The headache may be caused by the growth of pituitary tumor in the saddle, which increases the tension of the septum and strains the dural nerve.
The host: you just said the weakness, headache these symptoms, is it possible to appear these symptoms after we may have pituitary tumor?
The reason for this is very complex, so you should look for the cause. (We) treat this type of patient is quite a lot, some is headache, to neurology, Chinese medicine, all kinds of methods, drugs are used, the effect is not good, and finally found a very small tumor, the tumor removed, the patient’s symptoms are better. Therefore, if headache or even weakness occurs and the effect is not good after various methods of treatment, the possibility of pituitary tumor should be considered.
Moderator: If a patient has those symptoms you just mentioned and she suspects that she has a pituitary tumor, what tests are needed to confirm the diagnosis?
The actual fact is that you can find a lot of people who are not only in the market, but also in the marketplace.
The main reason for this is that it is a good idea to have a good understanding of the pituitary tumor. The first thing you need to do is to get a good idea of what is going on.
Yan Changxiang: Conception is a very complex physiological process, which must have the following conditions: the female ovaries have normal mature eggs every month, the male partner can ejaculate during intercourse, the semen contains a normal number of viable sperm, the woman’s fallopian tubes are open, so that sperm and eggs can meet in the fallopian tubes, fertilized eggs must enter the uterine cavity through the fallopian tubes, and planted in the endometrium. Any of the above obstacles can lead to infertility.
Moderator: What are the causes of female infertility?
Yan Changxiang: There are four main categories: First, abnormal ovulation function. The first is abnormal ovulation, which is the absence of ovulation during the menstrual cycle, or in some cases, ovulation, but the luteal function is incomplete after ovulation. Another reason is congenital abnormalities of the reproductive organs or acquired pathologies of the reproductive organs that hinder the smooth flow of the fallopian tubes and prevent the union of sperm and eggs, resulting in infertility. There are also immunological factors, such as the presence of anti-sperm antibodies in the female reproductive tract or in the serum, which cause mutual coagulation of sperm, loss of vitality, or even death, resulting in infertility. In addition, some infertile women have antibody-like substances in their serum against their own egg zona pellucida, which can prevent sperm from passing through the egg and cause infertility. Another is sexual dysfunction, lack of sexual knowledge, systemic diseases and unexplained infertility, which accounts for about one-third of the causes of infertility.
Host: We know that male and female infertility have many causes, but in many cases, couples usually consider male and gynecological diseases when infertility occurs.
The most common functional pituitary tumor is the prolactin-type pituitary tumor, which occurs during the reproductive years and is one of the most important causes of female infertility. The main pathological mechanism is interference with the endocrine axis in the gonads, that is, the hypothalamic-pituitary-ovarian endocrine axis, which inhibits ovulation, and excessive serum prolactin, which, through short feedback, causes hypothalamic dopamine hypermetabolism and gonadotropin-releasing hormone hypersecretion, resulting in luteinizing hormone and estrogen negative feedback mechanism, leading to follicular dysplasia, as well as increased prolactin. This reduces the number of gonadotropin receptors in the pituitary gland and decreases their sensitivity, resulting in a decrease in pituitary gonadotropin secretion and ovulation disorders. High prolactin directly inhibits the secretion of progesterone by ovarian cells and reduces the ovarian response to gonadotropins.
Moderator: Among the many infertility patients, how many of them are caused by pituitary tumors? What is the percentage of infertility?
Yan Changxiang: There are many causes of infertility, and infertility caused by hypothalamic and pituitary tumors accounts for about 12% of infertility.
The host: We have analyzed the symptoms and causes, I would like to ask how to treat infertility caused by pituitary tumors if it is true?
The previous view was to avoid surgery as much as possible, and some people say that pituitary tumors are damaged after surgery, which is not the case. Now we advocate that both functional and non-functional pituitary tumors, once discovered can be considered for surgery.
Yan Changxiang: The main means of surgical treatment is to remove the tumor to restore the function of the pituitary gland, so surgery is generally not aggravate the pituitary damage, will try to protect the function of the pituitary gland, to cut off the tumor, and let her normal pituitary function to restore, more conducive to her pregnancy. Nowadays, the microsurgery technology has made the total resection rate of tumor very high, and the pituitary function preservation rate is still very high, so we advocate using surgical means as much as possible, that is, surgery to achieve the purpose of cure.
Moderator: I would like to ask, after the removal of pituitary tumor or other treatments, can her infertility be cured? I’m not sure how long it will take to get pregnant again after the surgery.
Yan Changxiang: A very important goal of our treatment of pituitary tumors is to restore her normal endocrine function, so that infertile patients can achieve the goal of conception. If the surgery did not damage the pituitary gland, the tumor is removed after the endocrine recovery is normal, the general situation can be pregnant. As for the time of pregnancy is different, it depends on the recovery of her hypothalamus-pituitary gonadal axis. The patient I just introduced to you was pregnant three or four months after surgery, so each patient’s situation is different. Some patients may be more unresponsive to the prolonged pressure of the pituitary tumor, and their hypothalamic-pituitary-gonadal axis may take longer to recover, so it will take longer for them to resume menstruation.
I want to ask, pituitary tumor treatment after pregnancy, their babies will not be affected?
Yan Changxiang: Definitely not.