> Sterilità femminile: cause e terapie

    the

  • Sterilità mechanical
  • the

  • Endometriosis
  • the

  • Sterilità hormonal
  • the

  • Hyperprolactinemia
  • the

  • Ovary micropolicistico
  • the

  • high levels of FSH
  • the

  • Hyperandrogenism
  • the

  • Failure of the corpus luteum

Sterilità meccanica

Cause

The use of spiral the grow sexually transmitted diseases, there are many assaults to the level of the tube, which can induce the sterilità. The tube (or salpingi) play a leading role in the conception: just think of the function of “transport” and nutrition vis-à-vis of the embryo.

An infection può determine the formation of adhesions that, in some cases, may even prevent the “communication” between the ovary and salpinge or hinder the progression of the oocyte.

Terapia 

There are cases of sterilità mechanical, in which the capacity, or the ability to conceive, not è reversed but significantly reduced. It is evident that a young couple sarà più easy to recommend to take the time than a pair on in years.

In cases of tubal blockage slight, and this is when the framework does not è among the più serious (tube congeste or winding etc.,) you can make idrotubazioni to 7°-10° day of the cycle, for a maximum of six cycles. Is introduced into the uterus, through the cervical canal, a small quantity; of air followed by liquid medicated (antibiotics and hydrocortisone), and then still air.

The liquid, pushed by the air, creates a pressure on the tube and exerts a mild therapeutic action. It is not; a practice is painful, but annoying, that leaves as the consequences of shoulder pain for a few hours.

best Results are obtained with the microsurgery species in those cases in which a woman who has performed a sterilization decides to retrace his steps. In these cases you have success più comforting becauseé the tubes are generally healthy and becauseé in the obstruction è was made by a doctor and not a disease.

Currently, in cases of disease problems in the fallopian tubes (the fallopian tubes impervious, inaccessible, or unreliable) or sterilità mechanical, we tend to run the road of in vitro fertilization or assisted fertilization.

Endometriosi

Cause 

it Is a disease that is insidious, painful and capable of causing a sterilità permanent. If some women do not cause any symptom, other può appear with considerable violence: gender manifests with menstruation very painful after that for years have not given me any problem.

occurs when the endometrium (i.e.; the mucous membrane of the uterus, which, after having prepared to receive the embryo, and is expelled with blood during the cycle if it has not occurred to the conception) for still unknown reasons makes a reverse path going up through the tube until the cavità the abdomen.

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endometriosis is really a severe illness, in respect of the possibilityà to conceive; in many cases, even when it is reached the complete healing (which is not easy to get) the fertilityà remains, at least in part, compromised.

To deepen see: Endometriosis: symptoms, causes, diagnosis, and treatment

Terapia 

During a diagnostic laparoscopy if the doctor realizes he is in the presence of endometriosis usually intervenes directly by coagulating with diathermy or laser to the diseased tissue or by removing the ovarian cyst. After the surgical phase, the woman is treated with specific drugs: treatment and long ago stidiose that involve a number of unpleasant side effects.

The impacts are not rare, but in 60% of cases treated surgically, you get a healing and a decent qualityà of life. It is the duty of the doctor, before you direct a woman towards assisted conception, assessing the risks associated with the disease.

Sterilità ormonale

Cause 

the Absence of ovulation: to determine if, during ilciclo menstrual is an ovulation are fundamental the signs which are from the basal temperature. It is, however, già an indication of the past menstrual period of the woman; it is rare indeed that, in the absence of the ovulation cycles are always regular.

In the event of amenorrhea, and that is; the absence of the menstrual cycle is a good idea to verify the state of the genital apparatus in order to evaluate if the woman has a uterus is capable of menstruating. Thanks to the dosages of the hormone is then possible to identify the causes of amenorrhea, especially those primitives, and that is; of those that appear in già 16, 18 years.

with regard To the amenorree secondary it occurs after a wait of six months during which the loop is è revealed. The first thing you do a pregnancy test to be sure that it is not a maternityà in progress; the pelvic echography allows you to determine if it is the presence of ovarian cysts or micropolicistiche or multifollicolari. Also, the dosage hormonal can help. Stress, psychological discomfort, anorexia can be the cause of amenorree secondary.

Terapia 

The sterilità of hormonal origin, with some exceptions, può have a happy outcome in the majority of cases prior to initiation of therapy. The “exceptions” to this picture così positive are represented by amenorree ovarian, and those ipergonadotrope (FSH high) sinceé in them, the induction would be useless.

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In all other cases of sterilità hormonal you get good results with drugs and dopamine: it is therapies annoying that, however, are well accepted by women. If the anovulatorietà chronic è linked to causes-the hypothalamic should be administered before the induction of the ovulation, a progestogen if the woman menstrual means that his body produces a good amount; of estrogen and therefore you can; try the card in the induction of ovulation with drugs “weak”; on the contrary, if you do not verify the pseudomestruazione is a good idea to start immediately with drugs più powerful as the GnRH and the gonadotropins.

Iperprolattinemia

È excessive production of the pituitary hormone that regulates milk production: the prolactin. Often the woman has amenorrhea and galactorrhea (leakage of milk from the nipples). The examination reveals levels of prolactin in the blood must be executed in più times: this hormone, in fact, is sensitive to stress and, therefore, the result of the examination può be tampered with.

hyperprolactinemia usually resolves with the intake of certain medications. The healing also involves the return of ovulation and thus of the capacity of conceiving.

Ovary micropolicistico

Is put in evidence by ultrasound of the pelvic area, that by the results of the hormone assays. The woman often has irregular menstrual cycles, periods of amenorrhea, obesityà, acne, and hirsutism (excessive hair). See: polycystic Ovarian syndrome: what is it, symptoms, causes, diagnosis, and treatment

high levels of FSH

Even in the presence of regular menstrual è possible that the hormone assays put in evidence high values of FSH; thereò means, in the majority of cases, the menopause is nearby even if it is impossible to determine exactly when arriverà. In these cases, it is good to perform the examination of the più times to avoid getting to the point where you want to step in and find yourself in front of an ovary that has completed its production cycle.

Iperandrogenismo

The woman has acne, hirsutism, seborrhea. The ovaries, on the ultrasound examination, are micropolicistiche and the ciclomestruale is anovulatory. Except in the cases più serious, after a normal therapeutic procedure a large number of the women had a pregnancy.

Terapia

depending On the source of the alteration ormonalesi seguirà a course of treatment. In the case where is the adrenal gland to cause problems in the therapy of corticosteroids is effective to restore ovulation, and therefore fertilityà; if, instead, it is the ovary the cause of hyperandrogenism anovulatory usually starts a therapy with medicines “weak” (such as clomiphene) that are easy to administer and do not require special controls.

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After five or six cycles of this therapy if results are not obtained (which is quite common in 60% of women treated), adopt a treatment with GnRH analogs-GnRH-pulsatile: it is applied to the woman a micropump supported by a waistband that releases a drug capable of stimulating at scheduled intervals a hormone hypothalamic.

The advantage of this therapy (if you exclude the hassle of it all bearable of the pump) is represented by the fact that stimulation is controlled, and then is not going to encounter in twin pregnancies, trigemine etc.,

If after a few cycles, this kind of therapy proves to be ineffective in 30% of cases), then you switch to the direct stimulation of the ovary with the gonadotropin FSH. An effective treatment, but that carries some risk such as iperstimolazioni or multiple pregnancies.

If this path proves to be ineffective, all that remains is to resort to wedge resection of the ovary. The woman undergoes laparoscopy, and they are given small “openings” on the ovaries. The advantage of this therapy is not only is limited in time but canò lead to the risk of a subsequent sterilità mechanical.

At this point in the therapeutic procedure only 8-9% of women with hyperandrogenism anovulatory has not had a pregnancy (purché therapies have been performed correctly). You canò go the way of assisted fertilization.

Failure of the corpus luteum

è simple diagnosis diinsufficienza functional corpus luteum. The luteal phase is represented by that period – usually 14 days – which starts with ovulation and ends with menstruation.

During this phase the body produces hormones, estrogen, and progesterone to prepare the endometrium to accept a fertilized egg and consentirnelo development. If the luteal phase lasts less than 10 days, speaks of “insufficiency luteal” characterized, therefore, by a very short interval and, accordingly, a lack of production of progesterone.

Terapia

with regard To the corpus luteum a first limit is represented by the diagnosis, and by therapy: I’m still not very familiar with the causes of the failure of the corpus luteum and even therapies to follow.

Ettore Cittadidini, Carlo Flamigni, A Child, wanting to be able to have – And. The New Italy Scientific

page updated on December 27, 2007