Nowadays, more and more people are suffering from infertility, but there are many institutions treating infertility in China, and there are also many fraudulent hospitals, so this article is intended to help more infertility patients.
First of all, to understand infertility, it is necessary to know how pregnancy is achieved. Pregnancy is a systemic project that requires a series of conditions to be in place for pregnancy to occur. For the male partner, the requirements are relatively simple, as long as there are enough healthy sperm discharged during sex. A woman’s menstrual cycle and pregnancy are closely related. After the middle of the menstrual cycle, the endometrium becomes ready to receive a fertilized egg under the influence of progesterone and becomes the “secretory phase”. If conception does not occur at this time, the prepared endometrium will shed and be excreted as menstruation. The ovaries in a woman’s body are prepared for fertilization every month, and ovulation occurs in the middle of the menstrual period. After the egg is discharged, it is picked up by the fallopian tube and gradually transported in the direction of the uterus. Only then does it become a child.
Problems with any of these processes can interfere with a normal pregnancy and lead to infertility. In clinical practice, the definition of infertility is when a man and a woman fail to conceive after a year of normal intercourse. Under normal circumstances, the probability of this is over 80%.
Knowing the process of conception, you can probably understand how to perform the tests related to infertility. In clinical practice, the examination for infertility is a gradual process, from simple to complex, from non-invasive to invasive, step by step, to obtain the most valuable information at the simplest cost, this is the principle.
If infertility is diagnosed, the first test to be performed is the male partner’s semen to find out if there are abnormalities in sperm quantity and quality, because this is a non-invasive test, so it should be performed as the first step. The thing to note about the sperm test is that there needs to be no sexual intercourse for 5 days before the semen test, otherwise there will be inaccuracy. If the male partner’s semen is found to be abnormal in quantity or quality, he should go to the male department for further examination to understand the cause of the abnormal semen.
If there is no problem with the male partner after the examination, then the examination of the female partner will be performed, which is relatively more complicated and invasive. The first examination for the female partner is relatively simple. As mentioned before, a woman can conceive only when she ovulates each month, and there are several methods to understand ovulation.
1. The simpler method is the basal body temperature monitoring. Since after ovulation, the corpus luteum of the ovary starts to develop, and under the influence of progesterone, the body temperature measured in the quiet state in the morning will increase, therefore, through the method of basal body temperature measurement, to understand whether there is a lower body temperature in the early part of the menstrual cycle and a higher body temperature of 0.5℃ in the later part (if there is a biphasic body temperature), we can determine whether there is ovulation.
In the middle of the menstrual cycle, ovulation of the ovaries is affected by the action of a kind of luteinizing hormone (LH), and ovulation can now be measured with LH ovulation test paper, which is also a way to know whether there is ovulation.
This is also a way to know whether ovulation is occurring or not. 3. Monitor the follicle development in the ovary directly with ultrasound, especially in the middle of menstruation, and if you observe enlarged follicles and subsequent follicle rupture, you can probably determine whether ovulation is occurring or not. Usually, the first two methods are more economical and are often preferred for ovulation monitoring, while the third method is usually used for follicle monitoring during ovulation promotion because it requires ultrasound monitoring in the hospital, which is more laborious.
Ultrasound examination of the uterine appendages is also an important test to understand infertility. It may be a benign cyst in the fallopian tube or ovary, but it is useful as an aid to clinical diagnosis.
If there is no problem with ovulation, the next thing to know is the patency of the fallopian tubes. When inflammation occurs in the pelvis, the fallopian tubes are very prone to blockage and fluid accumulation, which are also the main causes of infertility. Tubal lavage is the use of saline injection into the uterine cavity to determine the patency of the fallopian tubes by resistance. If the pressure of the injection into the uterine cavity is too high, it may be accompanied by pain, suggesting the possible existence of tubal obstruction. A tubal iodography is an injection of contrast into the uterine cavity and an X-ray examination of the uterus and fallopian tubes. The difference between a hysterosalpingogram and a hysterosalpingogram is that the latter has an X-ray film that can be preserved, and after the examination, another physician can use the X-ray film to understand the condition of the fallopian tubes. Usually, a tubal x-ray needs to be repeated 2 hours or 24 hours (depending on the contrast material used) after the initial examination to see how the pelvic cavity is coated. Tubal lavage and hysterosalpingography are considered invasive because they involve the injection of fluid into the uterine cavity through the vagina and therefore carry the risk of potential infection and can cause discomfort and pain to the patient, but they are relatively less invasive compared to laparoscopic and hysteroscopic examinations.
Ovarian hormone testing is usually used to assist in understanding the function of the ovaries in the body, if the purpose is to understand the basal status of ovarian hormones, blood is usually drawn on day 2 of the menstrual cycle to check the ovarian estradiol (E2), progesterone (P), follicle stimulating hormone (FSH), luteinizing hormone (LH), androgen (T) and prolactin (PRL), if a hormone abnormality is found, it is often necessary to further understand the cause. It is often necessary to further understand the cause. Checking the level of progesterone in the second half of the menstrual cycle can also provide information about the function of the corpus luteum in the body.
There is disagreement in the academic community regarding tests such as antisperm antibodies, so they are not discussed here. The exact clinical relevance of this test needs to be further evaluated.
For infertility, the last and invasive test is the combined laparoscopic and hysteroscopic procedure. Usually, laparoscopy is used to examine the organs of the abdominal cavity to understand the surface of the uterus, fallopian tubes, ovaries, peritoneum and other organs in the abdominal cavity, while hysteroscopy looks at the inside of the uterine cavity. The two are usually combined under one anesthesia to compensate for the lack of one test. Laparoscopic surgery is usually performed by making several holes in the abdomen, while hysteroscopic surgery is done through a vaginal examination. One advantage of laparoscopy and hysteroscopy is that they are more direct. If imaging is used to understand the shape of the fallopian tubes and uterus, endoscopy is a direct observation. Another advantage is that if any abnormality is found during the procedure, it can be treated surgically immediately. For example, if hydrocele is found, tubal reconstruction or stoma can be done under laparoscopy; if fibroids are found, they can be removed under laparoscopy; if polyps or mediastinum are found in the uterine cavity, they can be removed surgically under hysteroscopy. Since this is an operation that requires anesthesia, there is a risk of complications. Usually, such an operation is considered if the cause cannot be found in the previous tests or if the cause is found and needs to be treated laparoscopically or hysteroscopically.
Some patients may not be able to find the cause of infertility after some previous tests, which may be clinically referred to as unexplained infertility, and in these cases the physician will need to further explore the cause. Once the cause of infertility is understood, the next step is to consider treatment.
Abnormal semen in the male partner often requires male examination and treatment. Some causes, such as varicocele, can be treated, while others cannot be removed. Depending on the degree of abnormal sperm quality, the doctor may recommend artificial insemination to enrich the sperm or collection of individual sperm for direct injection into the egg (ICSI). Incidentally, sperm are sensitive to high temperatures and if you work or drive in a hot environment for long periods of time, the scrotum temperature may be too high and may affect sperm development. Therefore avoiding prolonged high temperatures is also helpful for men to improve their sperm quality.
For infertility caused by ovarian failure to ovulate, some patients have mental factors, such as the constant fear that they will not be able to conceive, the more nervous they are about not conceiving, the more nervous they are about inhibiting ovulation. If the ovaries are functioning well, it is usually possible to promote ovulation. However, if some patients have premature ovarian failure or are older, it may be difficult to promote ovulation and it is necessary to consider borrowing someone else’s eggs to help conceive.
Treatment of abnormal ovarian corpus luteum function is relatively simple and can be replaced by artificial progesterone supplementation to replace the needed progesterone. If there is an abnormal organic occupancy inside or outside the uterus, treatment is often done through hysteroscopic or laparoscopic surgery. For example, in endometriosis, the patient often has dysmenorrhea and painful intercourse, and if it can be treated by laparoscopic surgery, the patient’s chances of getting pregnant after the procedure are often increased.
For infertility due to tubal obstruction, some patients can be considered for laparoscopic tubal ostomy or recanalization, while some hospitals try hysteroscopic recanalization with a tubal guide wire, but if unsuccessful, IVF may be the last resort to solve the tubal problem.
There is no widespread support for the status of TCM in the treatment of infertility due to the lack of evidence-based medical evidence. However, TCM has become a means of excessive treatment and financial gain for many unscrupulous hospitals, and it is easy to be deceived when seeking medical help. Infertility is a disease that is not difficult to say that it is not difficult to say that it is difficult, and standardized diagnosis and treatment is the key. This process usually consumes several months.