Female factor in infertility
Fallopian tubes and tubal infertility
- Fallopian tubes are the major causes for infertility and the diseases and damages in these tubes are highly responsible for infertility. The fallopian tubes project out from the uterus body and form the passages. This helps egg to transfer to the uterus form ovary. Usually these are 10cm long and funnel shaped ending called fimbriae (long fringes), which is responsible for catching the matured egg and forces it to the fallopian tube. The sperm and egg mets in the outer half of the fallopian tube called ampulla. Fertilization occurs in this tube and it takes a major role in the ovulation process.
- If there are any abnormalities in the tubes, results in 50-70a% case of infertility. This is caused due to infection in pelvis, which is caused by STD, miscarriage, severe endometriosis and tuberculosis. Rubins test (RT) is the most popular and conventional method for diagnosing this infection. Hysterosalpingogram (Uterotubogram) or HSG is a specific X-ray test for the uterus and tubes. This test is conducted at the 6th day or 7th day of the menstrual cycle. A slow process will be done by the doctors and those films are taken for accuracy. A normal HSG defines the internal side of reproductive system. Abnormal HSG is identified in the uterine cavity. But these are some defects in this HSG as it is highly painful and is technically difficult for most of the women. These tests limitedly provide the information about the closed tubes.
Advanced technologies for diagnosis and treatment
- Fluoroscopic guided procedures: this method uses image intensifier and some advanced techniques from coronary angioplasty. By performing selective salpinography, the treatment is given to the patient.
- Sonosalpingography: this can be done under the guidance of ultrasounds. A fluid is injected into the tubes and doctors track the flow of fluid into the tubes.
- Tuboscopy: A fine telescope is injected into the tube for identifying the defects in the tube.
- Falloposcopy: This is the most advanced technology for accurate identification. A fine fiberoptic tube is inserted into the cervix and uterus to each of the fallopian tubes and identifies the damage of the tube with clear visuals.
Infertility due to irregular cycles (PCOD or poor ovarian reserve)
- PCOD – Polycystic Ovarian Disease is the major reason for irregular periods. Generally a women who ovulates regularly will get regular periods and who does not ovulate they get irregular periods, which is called anovulation. The general; cause for this is PCOD. The main reason for irregular periods can be diagnosed by blood tests for hormones FSH, LH, AMH and TSH on third day of the cycle. The other one is the vaginal ultrasound scan, for ovarian tube, antral follicle.
Managing guide for PCOD
- Patients with PCOD will get irregular periods and this irregularity is mainly due to hormonal imbalance. Most of the doctors without diagnosing the exact reason prescribe progesterone for getting regular periods. But PCOD is a chronic disease and the patient should be guided properly about the basic principles.
- Firstly, women should plan of getting 12 periods a year, irrespective of the dates. Taking a five days course of normal progesterone improves the chances of getting regular periods. Taking progesterone hormone every month is recommended. If the periods are missed in one month, taking MPA helps in getting periods. In some cases bleeding would be high at the time of periods and this can be controlled by a dose of antiprostaglandins for 3-4 days is enough. For a PCOD patient to get pregnant, graded basis medical treatment is sufficient starting from ovulation induction, IUI to IVF.
Infertile women- endometriosis treatment
- Regularly endometriosis is diagnosed and treated during laparoscopy. Generally doctors do surgery for fixing the problem. In many cases, the treatment is a failure. Instead of doing painful surgeries, we prefer checking the AMH levels for identifying the ovarian function. The second step could be 3 cycles of super ovulation with IUI and the chocolate cyst, can be cleared by IVF cycles.
- Ovarioan response of the women decreases gradually with age and the measurement of the in the ovary is called the ovarian reserve. FSH is the traditional method for testing these reserves. Poor reserves are known by high FSH levels. The major tests for oopause are checking the ratios of FSH and LH. Another test is the measurement of AMH hormone in blood.
- We in our hospital use biomedical tests to evaluate the function of ovary with ultrasound technology. The most common test is Antra follicle count. Among many other treatments, IVF is regarded as the most aggressive treatment, which offers high success rates. Letrozole-Antagon protocol also provides better results for poor ovarian responders.
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