Female Infertility

Диагностика безплодие при жената

Ovulation Irregularities

The norm: the menstrual cycle is the period between successive menstrual onsets. It usually lasts 28 days, with intervals of between 21 and 35 days considered normal.

Deviations: Absence of menstruation (amenorrhoea) or irregular menstruation most often lead to an absence of ovulation. Other menstrual irregularities include the LUF (Luteinized Unruptured Follicle) Syndrome and Progesterone Deficiency.

Testing:

  • Determining basal body temperature;
  • Detecting ovulation through urinary testing;
  • Ultrasound monitoring (Folliculometry)
  • Detecting dynamic hormone balance through blood testing.

Treatment: Drug or surgical treatment to restore normal ovulation. If this fails, specific treatment includes:

  • Replacing, boosting or reducing GnRH (Gonadotropin Releasing Hormone Antagonist);
  • Replacing or boosting FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone);
  • Restoring and boosting Progesterone serum levels during the luteal phase;
  • If egg reserves are depleted or uterine functions have ceased early, an In Vitro fertilisation programme may be conducted using donor eggs.

Cervical Factors

The norm: During the normal ovulatory menstrual cycle, cervical mucus helps sperms move freely on their way into the female reproductive tract.

Deviations: Inborn flaws of the cervical neck, cervical neck therapies such as cryo or laser treatment or conisatio and certain drugs can affect cervical mucus quality.

Testing:

  • РСТ (post-coital testing) assesses the interaction between cervical mucus and semen after intercourse.
  • Cervical mucus рН testing determines important factors for sperm survival.

Treatment: Diverse hormonal and non-hormonal treatments are possible:

  • Bypassing cervical mucus through intrauterine insemination;
  • Conservative treatment involving replacing current drugs with other drugs.

The Uterus

The norm:The normal uterine cavity offers conditions for the growing embryo to implant. The uterine membrane changes under the impact of Oestrogens and Progesterone and prepares to accept the embryo.

Deviations: Ovulation disruptions and certain drug therapies impact normal endometrial development. Inborn anomalies of the uterus or uterine cavity can also hinder normal embryo implantation. Other negative factors include intrauterine scars from prior surgery or tumours of the uterine membrane or uterus.

Testing:

HSG (Hysterosalpingogram) testing, hydrotubation under ultrasonic observation (sonohysterography) and hysteroscopy.

Treatment:

  • Changing the drugs used to induce ovulation or using additional hormone treatment;
  • Surgical treatment of anatomical imperfections and pathological changes in the endometrium and uterus.

Tubal Factor

The norm: The major function of the fallopian tubes is to transport the fertilised egg cell to the uterine body.

Deviations: Reasons for the egg cell to fail to be intercepted by the tubes, for sperm to fail to reach the tubes or for fertilised egg cells to be transported along them to the uterine cavity all cause infertility.

Testing: HSG (Hysterosalpingogram) testing, hydrotubation under ultrasonic observation (sonohysterography), laparoscopy or laparotomy.

Treatment:

  • Surgical treatment where small blockages may be found at the distal ends of the fallopian tubes;
  • IVF (In Vitro fertilisation): the main form of treatment in tubal factor infertility over the past 25 years.

Peritoneal Factors:

The norm: The peritoneal cavity houses the digestive and sexual organs. It offers an environment where egg cells can develop normally and where the interaction between fallopian tubes and ovaries that leads up to egg cell entry into the fallopian tubes and fertilisation by sperm takes place.

Deviations: 

  • Blockages caused by surgical interventions;
  • Blockages caused by past inflammations in the lower pelvic area;
  • Displacement of uterine membrane cells from their normal place in the uterus (Endometriosis).

Testing: Laparoscopy is the major diagnostic method.

Treatment:

  • Surgical, to remove endometrial blockages;
  • Combined surgical and drug treatment;
  • IVF is the method of election when other techniques have failed.