Infertility seek medical treatment, do not indiscriminate treatmentPublished: 2012-10-23 11:31 Source: Into the e-newsletter Chutian Metropolis Daily Supplement □ reporter Yan Wen correspondent Zhang Hongyu Wang Chen Infertility is a distressing and worry about the topic, more and more families are troubled by it, at the same time, the infertility patients in a hurry to seek medical treatment for lack of knowledge and took a lot of curved paths. In this issue of Famous Doctors, we invited Dr. Song Xiaojie, deputy director of the Department of Obstetrics and Gynecology of Wuhan Maternal and Child Healthcare Hospital, to talk to us about all aspects of infertility treatment. Wuhan Women’s and Children’s Healthcare Center Obstetrics and Gynecology Song Xiaojie Question 1: Can celiac disease cause infertility? Does celiac disease need to be treated? Song Xiaojie pointed out that, from the point of view of fertility, if the secretion is not much, generally does not affect the sperm transmission into the uterine cavity, but if the secretion is viscous, the amount of relatively weak sperm will be cervical mucus, the first natural barrier to block. What kind of treatment is used? Celiac disease is chronic cervicitis, so is it not nonsense to treat it with antibiotic infusions for half a month. Pseudo erosion of celiac disease, located in the cervical canal of the columnar epithelium occupies the squamous epithelium on the surface of the cervix, is a change in histomorphology, and is not the usual septic, infected or ulcerated. With a cauterizing drug cervical epithelium, for mild celiac disease may be effective, for moderate and severe celiac disease almost no help, there have been patients on the drug for about six months, spending ten thousand yuan is still ineffective. Physical therapy such as laser or microwave to treat moderate and severe celiac disease, the effect is more certain. The immediate concern is whether it will cause cervical dysplasia during delivery in the future. In fact, this concern was lifted by a lot of research and observation as early as in the 1990s, unlike freezing or electrocautery (which cannot accurately control the depth) in the early years, the depth of the laser or microwave is about 0.4 millimeters, which will not cause cervical scarring, and does not increase the chances of cervical dysplasia. Question 2: Uterine fibroids, should they be treated before pregnancy? Ms. Zhou was found to have a 2 cm sized uterine interstitial fibroid before pregnancy, and because it was not big, no special treatment was done. By the time Ms. Zhou was 9 weeks pregnant, the fibroid had increased to 8 cm and caused the embryo to stop conceiving, so she had to undergo an operation to remove the uterus. Four months after the surgery and the return of menstruation, Ms. Zhou’s fibroid shrunk to 3 cm. Song Xiaojie explained that it is generally accepted that uterine fibroids larger than 4 cm, or submucosal fibroids, are recommended to be removed before a pregnancy is planned. However, in cases like Ms. Zhou’s, although the fibroid is less than 4 cm, it is particularly sensitive to estrogen and progesterone, and it rapidly increases in size after pregnancy, leading to embryonic arrest or miscarriage, and after menstruation is restored, the fibroid shrinks, so it is still recommended that it be removed prior to the next planned pregnancy. In addition, fibroids compressing the lining of the uterus may affect the implantation of the embryo or lead to miscarriage, and are recommended to be removed especially before assisted reproduction techniques are performed. Due to the high cost of assisted reproductive technology, it is important to remove as many unfavorable factors as possible to improve the pregnancy rate. Question 3: What should I do about fibroids and endometriosis? Pregnancy is the best treatment for these patients, but about 50% have difficulty conceiving and can be helped by GnRHa (gonadotropin-releasing hormone), surgery or IVF (in vitro fertilization). Song Xiaojie reminds that before proceeding with assisted reproductive technology, it is important to confirm that there is infertility, and then to choose the right protocol for the specific situation by pre-treating before IVF. In addition IVF is not a panacea, doctors should fully discuss the success rate and cost with patients and their families. Since the ovarian function of such patients is often impaired, if the cycle of egg retrieval does not get a good embryo there may be no pregnancy, and it is impractical to do IVF every cycle. However, if the patient has ovulation, the oviducts are open and the husband’s semen is normal, there is a chance of getting pregnant naturally in each subsequent natural cycle. Question 4: The fallopian tubes do not work, how exactly How to choose the way to check the fallopian tubes, sometimes it is really difficult to decide, Song Xiaojie pointed out that it depends on the patient’s specific situation, but do not repeat the fluids and imaging, because these two methods can not solve the problem, it is impossible to melt off the adhesions that are already scarring. Every pelvic operation may create a chance of pelvic infection. Fluidization: convenient, simple and inexpensive. If there is no resistance and no large amount of fluid reflux, or if ultrasound reveals the presence of fluid in the pelvis, at least one side of the oviduct is diagnosed to be patent, but it is not possible to determine the presence or absence of pelvic adhesions and lesions. Tubal iodine-oil angiography: to find out what is going on in the uterine and oviductal cavities and whether there are pelvic adhesions (although it is not possible to tell where the adhesions are), but it does not solve the problem. It cannot be done in people who are allergic to iodine. Smear films must be taken to help recognize the presence of ovarian fluid and pelvic adhesions. Laparoscopy: Contrary to previous beliefs, laparoscopy of the oviducts is also not the gold standard. Although laparoscopy can observe specific conditions such as adhesions, endometriosis, and can partially solve the problem, it cannot see inside the lumen of the uterus and fallopian tubes. And minimally invasive surgery, the cost is higher. Question 5: Hydrosalpinx, how to deal with the best Hydrosalpinx has a great impact on pregnancy, there are many harmful factors in the fluid of the fallopian tube, which will be unfavorable to the lining, leading to failure of the embryo’s implantation, or harm to the embryo, resulting in miscarriage. Infertile women who have been found to have fluid in the fallopian tubes need to undergo surgical management. Laparoscopic surgical options include opening, oophorectomy, and oophorectomy. If the hydrocele is completely removed, the blood supply to the ovaries will be affected, and oophorectomy is generally not recommended. If the structure of the umbrella is restored to normal, the natural pregnancy rate will be very good; if the structure of the umbrella is completely destroyed and only a cross opening is made at the hydrocele end, it is very likely to be adhered again or the fertility is low because of the weak ability of the disabled umbrella to pick eggs. If the hydrocele adheres again after surgery, a second laparoscopy is needed. Oophorectomy for hydrosalpinx: If the hydrosalpinx is cut off and the other oviduct is normal, the patient may still have a natural pregnancy. If both oviducts are cut off, the patient has no chance of getting pregnant naturally and can only undergo IVF. However, if the ovarian function is very poor, the pregnancy success rate will be very low, and the patient will not be able to get pregnant. It is important to assess ovarian function before surgery to give the patient a fully informed choice. If you choose to cut the oviduct, cut the oviduct from the root, not a small section, in case this small section of the oviduct becomes hydrated, which can also have an impact on the pregnancy. [Specialist] Song Xiaojie, Deputy Director of Obstetrics and Gynecology, Wuhan Municipal Maternal and Child Health Hospital, Chief Physician. She is a member of the Hubei Obstetrics and Gynecology Branch of the Chinese Society of Obstetrics and Gynecology, a member of the Hubei Perinatal Medical Association of the Chinese Society of Perinatal Medicine, a member of the Hubei Pelvic Floor Society, and an expert of the Wuhan Medical Accident Appraisal Committee. She has been engaged in obstetrics and gynecology for more than 30 years, skilled in high-risk pregnancy, perinatal medicine, genetics, eugenics counseling and diagnosis and treatment of pregnancy complications, good at gynecological oncology and infertility standardized treatment, especially skilled in complex hysterolaparoscopic surgery, hormone replacement therapy for women in menopause, and diagnosis and treatment of infectious diseases of women’s reproductive tract. Expert clinic time: every Tuesday morning, Friday afternoon, Sunday morning Consultation telephone number: 027-82433247 【Experts have words】 Infertility, do not over-treatment Wuhan Municipal Maternal and Child Health Hospital, deputy director of the Department of Obstetrics and Gynecology Song Xiaojie, chief physician, in her years of clinical diagnosis and treatment of infertility patients, there is the biggest problem is that too many patients in the case of the cause of the disease has not yet been diagnosed clearly to carry out the blind non-standardized The biggest problem is that too many patients are blindly non-standardized treatment without a clear diagnosis of the cause of the disease, listening to false advertisements and thus over-treatment, random ovulation promotion, unprincipled surgery, and not seeking individualized treatment plan for the cause of the disease, and so on. The first is that the uterus will not cause infertility. Song Xiaojie said that the uterus is not easy to get pregnant, which seems to be a joke, but many people are convinced. She explains that whether the uterus is positioned anteriorly, centrally or posteriorly, the cervix is in the vagina. After sex, the vagina remains closed, semen exists in the vaginal vault, and after half an hour to an hour of liquefaction, the sperm begins to swim, relying on the clockwise swing of the sperm tail to move straight ahead, with external collisional forces forcing it to change direction. Whether the sperm can successfully enter the fallopian tube example and meet the egg has nothing to do with the location of the uterus. Reminder 2: Kuko guide wire, the efficacy is quite limited Tubal intervention (Kuko guide wire), is a method of examination and treatment, but the effect is quite limited. Song Xiaojie introduction, Kuko guide wire is only useful for the treatment of interstitial part of the fallopian tube secondary to cellular debris and tubal spasm caused by blockage, but if the fallopian tube is completely blocked lumen, even if it is a small cut-off, with the guide wire drilling a tunnel to the normal anatomical structure of the lumen of the tube can not be restored, the mucous layer of the longitudinal wrinkled wall scarring, and the epithelial cells of the surface layer of the epithelial cells are destroyed, especially ciliated cells, the oocyte Transportation is greatly affected. If the distal fallopian tube is hydropsic, a guide wire is inserted and a tiny hole is opened, which is clear at that time, and then quickly adheres to the hydrops again. Reminder 3: check the fallopian tubes, do not advocate hysteroscopy Hysteroscopy is to observe the intrauterine cavity, such as the presence of uterine malformation, adhesions, polyps, the presence of submucosal fibroids, etc., you can see the endothelial scarification, but can not measure the thickness of the endothelium. Hysteroscopic fluids, see the water flow along the opening of the fallopian tube into, perhaps the fallopian tube is open, but can not determine the presence of adhesions, not as intuitive as laparoscopy, do not advocate for the purpose of observation of the oviduct is open and do hysteroscopy.