I. The importance of pretreatment before ovulation in patients with polycystic ovary syndrome
The pretreatment process must be performed and cannot be omitted
Pre-treatment includes the reduction of androgens and luteinizing hormones and the improvement of insulin sensitivity. For example, if a patient is taking three boxes of birth control pills to regulate hormones and has her period after the last box, she is expected to come in for hormone testing within 3-5 days of her period. If it is determined that the hormones have dropped to normal, oral ovulation treatment with clomiphene is recommended as the first line of treatment, starting within 5 days of menstruation. Some patients are able to ovulate normally, have intercourse and become pregnant in the first month, or with the help of other forms of pregnancy assistance, such as artificial insemination. The pre-treatment process must be carried out without any rush.
Follicle quality
If ovulation is forced with medication, there is a risk that the follicles will not grow. Also. A poor quality follicle may not conceive, get pregnant but end in miscarriage, because such eggs are grown in very abnormal conditions. However, sometimes even with very standard pretreatment and ovulation treatment, the chances of conceiving at intercourse are not very high, averaging about 10%, so it is necessary to go through several ovulation treatments.
Importance of pretreatment
Some patients may stop treatment for reasons such as work. During this time, if hormone control is not continued with oral medication, the hormones will quickly return to their original abnormal state. Because the cause of polycystic ovary syndrome is unknown, clinical treatment cannot correct the cause, but can only bring down the hormone levels that are causing the abnormality, but the effect is short-term. If this is the case, the patient is advised to continue taking oral contraceptives during this period. This will allow them to start ovulation treatment again after 2 or 3 months of returning from work without delay. However, if there is no treatment during this period, most patients’ hormone levels return to the abnormal state of the original disease and they need to start pretreatment again from the beginning and start ovulation promotion again after about 3 months of treatment, which will delay the process again for some time. This shows that pretreatment is very important and worthwhile, both for the doctor and the patient.
There are several other things that can be done at the same time during the pretreatment waiting period
There are several things that can be done at the same time during the waiting process. The male partner’s semen can be examined and the female partner’s fallopian tubes can be examined and the appropriate plan can be developed after the examination. If the female partner has a problem with polycystic ovulation disorder and also has a problem with incomplete fallopian tubes, the patient will need to be operated on or go directly to IVF. There are also some mixed problems, such as the female partner has polycystic ovary syndrome and the male partner has severe abnormal sperm count and morphology, which can only be solved by IVF techniques. This pre-treatment can directly enter the IVF process afterwards, making the whole treatment process more scientific and smoother.
Analysis of the causes of repeated implantation failure and endoscopic scraping
Analysis of the causes of repeated implantation failure
Repeated implantation failure is a difficult problem in the field of reproduction. Many patients transfer embryos more than three times, and even if there are good quality embryos, they still cannot obtain a successful pregnancy even after transferring more than 10 embryos. There are many reasons for this situation, which can be generally divided into three aspects.
First, embryo problems
In the future, embryos with no genetic and chromosomal problems can be selected for transfer through screening of embryos. It can also be done in other ways, such as improving the culture medium and trying to choose blastocysts. There are also relatively new techniques to replace the cytoplasm and retain the part of its genetic material, the cytosol.
Secondly, there is the issue of endometrial tolerance
Such as endometrial polyps, uterine adhesions, etc. Repeated uterine operations, especially abortions, cause a significantly higher incidence of uterine adhesions. With more than three abortions, the chance of cavity adhesions is as high as 30%. Therefore, young women are advised to choose a reasonable form of contraception to reduce the possible damage caused by surgical operations on the uterus until they have completed childbirth. In addition, submucosal fibroids and longitudinal uterine diaphragms should be treated promptly after detection. Many teams in China and abroad have also conducted in-depth studies, such as changes in the corresponding genes in endometrial tolerance, some defects occurring during embryo implantation, and some teams have made progress in the research of new drugs, for example, it has been found that cyclophilin A, an immunosuppressant, can reduce the rate of miscarriage.
Third, maternal factors and the existence of immunological problems between the mother and the embryo
For example, there is currently a lot of concern about the thyroid gland, where hyperthyroidism or hypothyroidism can be routinely screened for. It is now considered routine to perform serum testing of thyroid function before conception and before IVF or artificial insemination. Patients who have had more than two failed transplants are recommended to be screened for immunological aspects such as anti-cardiolipin antibodies, beta2 glycoprotein, homocysteine, etc. for the presence of diseases such as antiphospholipid syndrome. Antiphospholipid syndrome can cause recurrent implantation failure, miscarriage, and intrauterine fetal death.
Hysteroscopy
Hysteroscopy is a relatively basic operation in gynecology. Hysteroscopy is now considered an option for patients with more than two failed implantations, even if no typical endometrial lesions are detected on ultrasound. Even if the intraoperative examination is not problematic, the postoperative clinical pregnancy rate can be significantly improved. The reason for this may be related to the scratching of the endometrium through the uterine operation.
Endometrial scratching
It is well established in the literature that repeated implantation failures can be treated with endoscopic scraping from around the mid-luteal phase of the previous cycle to the first 7 days of the transplantation cycle, which significantly improves the clinical pregnancy rate and the rate of going home with the baby. However, if endoscopic scratching is performed on the day of egg retrieval, the clinical pregnancy rate is significantly reduced. Therefore, the recommended time is seven days after the mid-luteal phase of the previous cycle, or seven days before the transplantation cycle. The method of scraping varies, initially reported in the literature with a spatula, but also with a suction tube or a cytobrush, which is more commonly used clinically. The negative pressure and rotational scraping action of the brush in the uterine cavity can increase the clinical pregnancy rate by brushing a certain amount of endometrium, causing an inflammatory response to the endometrium and even altering its tolerance. Most current Meta-analyses suggest that this increases the clinical pregnancy rate.