female infertility

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Ovulation disorders:

We can examine ovulation disorders in 3 groups. The first of these is a condition called hypogonadotropic hypogonadism, which is caused by insufficient hormones secreted from the brain and controlling the ovaries. In the treatment, the hormones secreted from the brain should be replaced by injections. In these women, a head film (spot sella) should be taken and prolactin measurements should be made before the treatment. Another group of ovulation disorders is a condition called hypergonadotropic hypogonadism (early menopause) due to premature depletion of eggs in the ovary. It is also known as early menopause. There is no known cure for having children. The most common hormonal disorder in women is polycystic ovary syndrome (PCOS). In fact, PCOS is the most common hormonal disorder not only within the scope of gynecological diseases, but also within the scope of all organ systems in the body. The cause is not fully known; theories are sick. It is thought to be an ovarian disease with a genetic predisposition. The syndrome typically occurs in young girls and usually during adolescence. In polycystic ovary syndrome, inability to conceive (infertility) occurs due to infrequent or absent ovulation. Women who want to have children should use drugs that stimulate ovulation. In this context, the first thing to do is to lose weight, if possible, to get rid of excess weight. Being overweight increases resistance to infertility treatment and can increase miscarriage rates; In addition, some risks may increase in the presence of pregnancy. However, losing weight is often very difficult in practice. Clomiphene citrate is the first step in medical treatment (clomiphene citrate; CC; Serophene, Gonaphenei Klomid). With CC, 80% ovulation and 40% pregnancy are achieved in 6 months. After menstrual bleeding spontaneously or with progesterone (Farlutal, 2 tablets per day, 10 days) of the 3rd-7th day of the period. It is started orally, 1 tablet a day, for 5 days between days. 10–17. Frequent (2–3 days) sexual intercourse between days 21–24. The presence of ovulation is investigated by the determination of progesterone in the blood between days and days. If the progesterone level is above 5 ng/ml in the blood during this time period, it suggests ovulation. If there is no pregnancy despite ovulation, there is no need to increase the CC dose. If ovulation is not achieved with CC, the dose is increased to 100 mg/day and the same scheme is described to the patient. If necessary, the dose can be increased up to 150 mg/day. If ovulation and/or pregnancy cannot be achieved with 150 mg/day for 5 days, these cases are considered as CC failure. In these cases, the second-line treatment option is daily injection (FSH; Gonal-F, Puregon, Menogon, Menopu, Merional, Fostimon). A low-dose step-up protocol is used; 95-98% ovulation and 20-23% pregnancy are obtained per month of application. Pregnancy rates in 4 months go up to 50-60%. The administration of this treatment requires experience within the scope of necessary dose adjustments and must be carried out by persons experienced in this field. Otherwise, there may be a risk of overstimulation syndrome and most pregnancy. In cases where no response can be obtained with daily needle therapy, the third-line treatment option is in vitro fertilization. Pregnancy rates with IVF are very good in these cases. .

Metformin (Glucophage, Glucofen) treatment is used extensively in patients with PCOS today. essentially insulin I This drug, which is a sensitizing anti-diabetic drug, has a very limited place in terms of fertility in patients with PCOS. In a very large, well-designed recent study, outcomes with Metformin alone were worse than with CC alone; Adding it to CC also does not provide benefits only in terms of live birth rates in addition to the use of CC. As for its use in terms of metabolic protection, further studies are needed.

Tube Occlusions:

Tubes are often blocked due to infections. Almost all of these infections are caused by sexually transmitted microbes. The most important of these microbes are gonorrhea (gonorrhea) and chlamydia. Another important factor in Turkey is tuberculosis (TB disease). After the tuberculosis microbe is taken through the respiratory tract, it settles in the lungs and comes to the tubes through the blood and destroys the tubes. Apart from these, as a result of previous surgical interventions (removal of fibroids or cysts or endometriosis surgery), the tubes may become clogged or the tube-ovary relationship may be disrupted. In cases where women who have children choose tube ligation as a family planning method, the tubes are also blocked. The clogged tubes are usually detected by a uterine-tube film called HSG. After it is understood that the tubes are clogged, if the obstruction is in the area adjacent to the uterus, it is most appropriate to perform in vitro fertilization directly. Even though the tubes can be opened with microsurgery, this procedure is more laborious and requires an experienced surgeon. If the tubes are blocked at the ends close to the ovary (hydrosalpinx), laparoscopy should be performed. In laparoscopy, the tubes should be opened and removed if they cannot be opened. The presence of blocked tubes in the form of hydrosalpinx reduces the success of IVF. In some studies, the pregnancy rate with IVF was found to be less than half in women with hydrosalpinx.

Endometriosis:

It is the reproduction of the endometrial cells lining the inside of the uterus by settling outside the uterus. (Endometriosis) It is usually seen in women over 35 years of age. The reason is not entirely clear. The most popular theory is the retrograde menstruation theory. In women, menstrual bleeding occurs with the shedding of the cells lining the inner layer of the uterus. Some of these cells go backwards and fall into the abdominal cavity through the tubes. In general, these cells are destroyed by the body’s defense mechanisms. However, in some women, these mechanisms do not work well and endometrial cells begin to reproduce by settling on the peritoneum. Endometriosis disease mostly affects the peritoneum and ovaries. Apart from this, it settles between the uterus and the rectum, which is the last part of the large intestine, and forms the rectovaginal septum endometriosis. The disease usually shows a progressive character and its prevalence can only be detected by laparoscopy. Symptoms include pain, mass, and infertility. Endometriosis cysts in the ovary are called endometriomas. When endometriomas are associated with infertility, they should be removed laparoscopically. Half of women are expected to become pregnant within the first 6 months following laparoscopic endometrioma removal. For those who cannot conceive, another 6-month wait may be recommended, depending on the age of the woman. In cases where the age is over 35, it should be directed to IVF without losing much time. In some cases, advanced anatomy may be impaired and the chance of spontaneous pregnancy cannot be given. In cases where endometriosis is extremely common and disrupts the relationship between the tube and the ovary, it is most appropriate to do IVF as soon as possible. In the treatment of endometriosis foci on the peritoneal membrane, which is called peritoneal endometriosis, laparoscopy, cauterization or laser vaporization can be applied. There is no difference between the two techniques in terms of results. Rectovaginal septum endometriosis usually has a nodule located in this area. Painful menstruation, painful intercourse and painful urination are the most common symptoms. The nodule should be removed by laparoscopy. This surgery is a very difficult procedure that requires high technical experience. Endometriosis is a recurrent disease. In half of the cases, the disease may recur following the surgical procedure.

Other infertility causes and treatment:

Apart from the above-mentioned conditions, there are diseases that are associated with infertility but are not considered to be a definite cause of infertility. The most important of these are congenital abnormalities of the uterus and fibroids.

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