Endocrine infertility is a whole complex of hormonal disorders that can lead to irregular or no ovulation in women. In men, it can cause impaired sperm quality. This diagnosis is based on various disorders of the functions of the thyroid gland, and in addition, the sex glands. Treatment for the diagnosis of "endocrine infertility" is to eliminate its main cause, along with the correction of violations and maintaining a he althy hormonal background. Normalization of functions leads to pregnancy in 70% of cases. We will tell you more about the causes, symptoms and features of treatment in this material.
Diagnosis
It should be emphasized that at present every third woman has infertility due to the pathology of her endocrine system. As such, the diagnosis is a collective definition that includes a violation of the mechanism of hormonal regulationcycle. Regardless of the cause of endocrine infertility in men and women, the basis of its formation is a violation of reproductive functions.
Causes of infertility: hypothalamic-pituitary dysfunction
The absence of ovulation, which leads to endocrine infertility, may result from hypothalamic-pituitary dysfunction. Usually, such dysfunction can be observed against the background of craniocerebral injuries, with tumors of the hypothalamic-pituitary region, which is accompanied by hyperprolactinemia. An increase in prolactin secretion leads to inhibition of the production of LH and FSH by the pituitary gland, and also causes inhibition of ovarian function, provoking rare menstruation and the development of persistent anovulation along with endocrine infertility.
Hyperandrogenism
The presence in the female body of a small amount of androgens, which are male sex hormones, is necessary for puberty and he althy functioning of the ovaries. Increased secretion of androgens can be produced by the ovaries and adrenal glands.
Often, hyperandrogenism in women is accompanied by polycystic ovary syndrome, which causes endocrine infertility along with obesity, hirsutism, bleeding and amenorrhea. Adrenal hyperandrogenism is predominantly due to hyperplasia of the adrenal cortex.
For what other reasons can endocrine female infertility develop?
Impaired thyroid activity as a cause of infertility
The course of hypothyroidism with diffuse toxic goiter can often be accompanied byanovulation, and in addition, in this case, secondary hyperprolactinemia, infertility, the impossibility of bearing a pregnancy and fetal anomalies are characteristic. Often there is a deficiency of estrogen or progesterone. The lack of these sex hormones can contribute to inadequate secretory transformation of the endometrium and changes in the activity of the fallopian tubes, preventing the attachment of the fetal egg. This leads to the inability to bear a fetus or even causes endocrine infertility.
Obesity, which leads to the impossibility of conception
Adipose tissue in the female body also performs an endocrine function and affects the metabolic process of the reproductive system. Excess body fat causes hormonal imbalance along with menstrual dysfunction and the development of endocrine infertility. At the same time, limiting the intake of fats with a sharp loss of body weight can also disrupt the normal functioning of the ovaries.
Infertility of endocrine origin can also occur for other reasons.
Resistant ovary syndrome
The syndrome is based on a violation of the pituitary and ovarian connection, within which there is a lack of sensitivity of the receptor apparatus to gonadotropin, which stimulates ovulation, which manifests itself in the form of amenorrhea and infertility with developed sexual characteristics. Damage to the ovaries can cause infection with rubella, influenza, and so on.
Premature menopause, mutation of sex chromosomes as a cause of infertility
Secondary amenorrhea, which occurs in young women under thirty-five, can cause menopausal changes in the body and lead to infertility.
In diseases caused by chromosomal abnormalities, there may be a deficiency of female sex hormones, which will be accompanied by sexual infantilism, primary amenorrhea and endocrine infertility.
Symptoms of infertility
The main manifestation of this kind of infertility is the inability to get pregnant. Another symptom can be considered various deviations of the menstrual cycle. At the same time, menstruation can come with delays from a week to six months, accompanied by soreness, copious discharge, or amenorrhea is possible. Often there may be spotting during the intermenstrual period.
In women with symptoms of endocrine infertility, the menstrual cycle is anovulatory in nature, and directly in its duration corresponds to normal menstruation - from twenty-one to thirty-six days. In such cases, they speak of menstrual bleeding.
Pain in the abdomen with this form of infertility
Patient may experience pain in the lower abdomen or lower back, with discharge from the genital tract along with dyspareunia and cystitis. There may also be tension with heaviness in the mammary glands and galactorrhea associated with an increase in prolactin. The syndrome of premenstrual tension is also typical, which is expressed in a deterioration in the condition on the eve of the mostmenses. With hyperandrogenism, which accompanies endocrine infertility, acne may appear along with hirsutism, hypertrichosis and alopecia. Among other things, there may be fluctuations in pressure with the development of obesity or weight loss.
This is influenced by the endocrine factor of infertility. What is it, now we know.
Diagnosis of pathology
As part of the history taking of patients suffering from this form of infertility, the time of the onset of their menstruation is specified along with profuseness and soreness. There are likely to be questions about the history (including the mother of the patient) of any menstrual dysfunction along with the duration of the absence of pregnancy. In addition, it is important to find out the outcome and complications if conception did occur. Among other things, it is required to find out if any gynecological operations have been performed before. Equally important is information about the type and duration of contraceptive use.
General examination of the patient includes an assessment of her height along with the presence of obesity, virilism, development of the mammary glands, secondary sexual characteristics. An examination by a gynecologist is mandatory, during which the shape and length of the vagina is determined along with the condition of the cervix and appendages. Based on the data of a gynecological examination, the causes of endocrine infertility in women are found out. They may be sexual infantilism with polycystic ovaries and the like. Assessment of the hormonal functions of the ovaries with the presence of ovulation in endocrine infertility is determined by applying the followingfunctional tests:
- A test aimed at analyzing basal body temperature.
- Performing a urine test to determine the possibility of ovulation.
- Ultrasonic monitoring of follicle maturation.
Temperature chart
The presence or absence of ovulation is determined by the basal temperature chart. The temperature curve shows the level of post-ovulatory production of progesterone by the ovaries, which prepares the endometrium of the uterus for subsequent egg implantation. The basal curve is built on the basis of morning temperature figures, which should be measured daily in the rectum. With ovulatory cycles, the schedule is two-phase: on the day of ovulation, the temperature drops by 0.3 ° C, and in the second phase, which lasts about fourteen days, it rises by 0.6 ° C compared to the normal value. The anovulatory cycle is characterized by a monophasic temperature curve steadily below 37 °C.
You can confirm or, conversely, refute the presence of ovulation by determining the level of progesterone. During the anovulatory cycle, this indicator in the second phase is extremely low, and during the luteal phase it is reduced compared to the ovulatory cycle. An ovulation test makes it possible to determine the increase in LH twenty-four hours before its occurrence. And ultrasound monitoring helps to control the maturation of the dominant follicle in the ovary.
Reflection of the work of the ovaries is the state of the endometrium of the uterus. In an endometrial scraping that wastaken two days before menstruation, with endocrine infertility, hyperplasia of varying severity or secretory insufficiency is found.
In order to establish the causes of such infertility, the level of FSH is determined along with estradiol, prolactin, testosterone and so on. An analysis for hormones is given on the fifth day for several cycles. Conducting a hormonal test makes it possible to clarify the state of the reproductive system against the background of endocrine infertility. The testing mechanism is to measure the patient's hormone levels after treatment with certain stimulant drugs.
If there is a need to clarify the cause of endocrine infertility, an x-ray of the skull, ultrasound diagnostics of the thyroid gland and ovaries, adrenal glands are performed. They also do diagnostic laparoscopy. The diagnosis of the presence of endocrine inability to conceive is established for women only after the male factor of infertility is excluded. In addition, there should be no pathology of the uterus and tubal infertility.
Treatment of endocrine infertility in women
What is the therapy? How effective will it be?
The first stage of treatment includes the normalization of the impaired function of the endocrine glands. In this case, correction of diabetes mellitus is required along with obesity, adrenal activity, removal of tumors, and so on. In the future, hormonal stimulation of the maturation of the follicle and the onset of ovulation are carried out. In order to induce ovulation, Clomiphene is prescribed. This drug causes an increase in follicle-stimulatinghormone. Among the pregnancies that have come after such stimulation, twins and triplets are born in ten percent of cases.
In the event that pregnancy still does not occur during six ovulatory cycles against the background of stimulation with Clomiphene, they turn to treatment with gonadotropins. But treatment with these drugs can increase the incidence of multiple pregnancies along with the occurrence and development of multiple side effects.
Treatment of endocrine infertility should be carried out comprehensively. It is important to follow all the doctor's recommendations for success.
In most situations, infertility can be hormonally corrected, while in others, surgery is required. For example, against the background of polycystic ovary syndrome, doctors resort to laparoscopic thermocauterization. After this procedure, women experience a significant percentage of pregnancy: from 70 to 80% of cases, which occurs due to the exclusion of the formation of adhesions in the pelvis. Against the background of the endocrine form of infertility, which is aggravated by tubal-peritoneal causes, in vitro fertilization with transplantation of ready-made embryos into the uterine cavity is indicated. The important thing to remember is to never give up.
