Endocrine infertility – a complex of the hormonal violations conducting to an irregularity of an ovulation or its absence at women and to violation of quality of sperm at men. Violations of functions of a thyroid gland, gonads, gipotalamo-hypophysial regulation can be its cornerstone. Treatment of endocrine infertility consists in elimination of its reason, correction of the existing violations and maintenance of a normal hormonal background. Normalization of the broken functions leads to approach of pregnancy in 70-80% of cases of endocrine infertility. In other cases now perspective elimination of endocrine infertility is considered the EKO method.
Endocrine infertility – a complex of the hormonal violations conducting to an irregularity of an ovulation or its absence at women and to violation of quality of sperm at men. Violations of functions of a thyroid gland, gonads, gipotalamo-hypophysial regulation can be its cornerstone. Normalization of the broken functions leads to approach of pregnancy in 70-80% of cases of endocrine infertility. In other cases now perspective elimination of endocrine infertility is considered the EKO method. At every third infertile woman the reason of infertility is covered in pathology of endocrine system.
The concept of "endocrine infertility" is collective, including various violations of mechanisms of hormonal regulation of a menstrual cycle: on - hypophysial level, in the TTG-thyroid gland systems, AKTG - bark of adrenal glands, etc. Irrespective of the reasons of endocrine infertility, its development the dysfunction of ovaries which is shown a resistant anovulyation (lack of an ovulation) or its irregularity is the cornerstone.
Reasons of endocrine infertility
Anovulyation can arise at interest of the central nervous and immune systems, endocrine glands, reproductive bodies - "targets". Anovulyation conducting to an endocrine form of infertility can develop as a result:
- Gipotalamo-gipofizarnoy dysfunctions
It is usually observed after craniocereberal injuries and injuries of a thorax, at tumors of gipotalamo-hypophysial area and is followed by a giperprolaktinemiya. Increase in secretion of Prolactinum leads to braking of cyclic production of LG and FSG a hypophysis, to oppression of functions of ovaries, rare periods (on type oligo-and opsomenore), to development of a resistant anovulyation and endocrine infertility.
- Giperandrogeniya of yaichnikovy or nadpochechnikovy genesis
Presence at an organism of the woman of a small amount of androgens – male sex hormones is necessary for puberty and the correct functioning of ovaries. The strengthened secretion of androgens can be carried out by ovaries or adrenal glands, and sometimes both glands at the same time. Most often the giperandrogeniya at women accompanies a syndrome of polycystous ovaries, causing endocrine infertility, obesity, a girsutizm, bleedings, oligo-and , bilateral damage of ovaries with change of their morphological structure.
The Nadpochechnikovy giperandrogeniya develops as a result of a giperplaziya of bark of adrenal glands with secondary involvement of ovaries more often (secondary ovaries).
- Dysfunction of a thyroid gland
- Deficiency of estrogen and progesterone (at insufficiency of a lyuteinovy phase)
The lack of female sex hormones causes defective sekretorny transformation of endometrium, change of function of uterine tubes, interferes with an attachment of fetal egg in a uterus cavity. It leads to not incubation of pregnancy or endocrine infertility.
- Heavy somatic pathologies (cirrhosis, hepatitises with the expressed damage of cells of a liver, tuberculosis, autoimmune and system diseases of connecting fabric, malignant new growths of various localization etc.).
- Obesity or lack of fatty tissue
Fatty tissue in an organism also performs endocrine function, exerting impact on metabolic processes in fabrics, including reproductive system. Surplus of fatty deposits causes a hormonal imbalance, violation of menstrual function and development of endocrine infertility. At the same time, restriction of consumption of fats or sharp loss of body weight break normal functioning of ovaries.
- Syndrome of resistant ovaries (syndrome of Sevidzha)
Syndrome violation hypophysial is the cornerstone of communication - tolerance of the receptor device of ovaries to the gonadotrophins stimulating an ovulation that is shown amenorey, endocrine infertility at normally developed sexual characters and high level of gonadotropny hormones. Infection with viruses of a rubella, flu, pathology of earlier developing pregnancy, avitaminosis, starvation, stressful situations can cause injury of ovaries.
- Premature menopause (syndrome of the exhausted ovaries)
- The diseases connected with mutations of sexual chromosomes
Symptoms of endocrine infertility
The main manifestations endocrine infertility are the impossibility of approach of pregnancy and a deviation in a menstrual cycle. Periods can come with delays of various expressiveness (of a week before half a year), to be followed by morbidity and plentiful allocations or to be absent absolutely (). The smearing bloody allocations during the intermenstrual period are quite often noted.
At 30% of patients with an endocrine form of infertility menstrual cycles have anovulyatorny character and on the duration correspond to a normal menstrual cycle (21-36 days). In such cases it is not about periods, and about menstrualnopodobny bleeding.
At patients allocations from a genital tract, a dispareuniya, cystitis are noted pain in the lower departments of a stomach or a waist. Tension and weight in mammary glands, (releases of colostrum from nipples), connected with increase in level of Prolactinum can be observed. The syndrome of premenstrual tension – deterioration in a state on the eve of periods is characteristic. At the giperandrogeniya accompanying endocrine infertility the acne, a girsutizm or , an alopetion develop. Fluctuations of arterial pressure, development obesity or weight loss, formation of striya on skin are observed.
Diagnosis of endocrine infertility
When collecting the anamnesis at patients with endocrine infertility time of the beginning of periods, their profuseness, morbidity, existence in the anamnesis (including the patient's mothers) violations of menstrual function, existence and duration of lack of pregnancies, in the presence – an outcome and complications of pregnancies is specified. It is necessary to find out whether earlier gynecologic operations and manipulations, type and duration of use of contraception were performed.
The general survey includes assessment of growth of the patient (less than 150 cm or more than 180 cm), existence of obesity, a virilizm, development of mammary glands and secondary sexual characteristics. Consultation of the gynecologist during which at gynecologic survey find out a form and length of a vagina and uterus, a condition of a neck of a uterus, a parametriya and appendages is held. According to the general and gynecologic surveys such reasons of endocrine infertility as sexual infantility, ovaries, etc. become clear. Assessment of hormonal function of ovaries and existence of an ovulation at endocrine infertility are defined by functional tests: construction and analysis of a basal temperature curve, uric test for an ovulation, ultrasonic monitoring of maturing of a follicle and control of an ovulation.
Existence or lack of a fulfillment of an ovulation is determined by the schedule of basal temperature. The basal temperature curve reflects the level of postovulyatorny development by ovaries of the progesterone preparing uterus endometrium for implantation of the impregnated ovum. The basal curve is under construction on the basis of indicators of the morning temperature taken daily at the same time in a rectum. At an ovulyatorny cycle the schedule of temperature two-phase: in day of an ovulation rectal temperature falls on 0,2-0,3 °C, and in the second phase of a cycle proceeding from 12 to 14 days rises in comparison with temperature of the first phase by 0,5-0,6 °C. The Anovulyatorny menstrual cycle is characterized by a monophase temperature curve (below 37 °C are resistant), and insufficiency of a lyuteinovy phase is shown by shortening of the second phase of a cycle less than 11-12 days.
It is possible to confirm or disprove the fact of commission of an ovulation by means of determination of level of progesterone in blood and a pregnandiol in urine. At an anovulyatorny cycle these indicators in the second phase are extremely low, and at an insufficient lyuteinovy phase - are lowered in comparison with an ovulyatorny menstrual cycle. Test for an ovulation allows to define increase in concentration of LG in urine in 24 hours prior to commission of an ovulation. Ultrasonic monitoring of a follikulogenez gives the chance to track maturing in an ovary of a prepotent follicle and release of an ovum from it.
As reflection of functioning of ovaries serves the condition of endometrium of a uterus. In scrape or a bioptata of the endometrium taken in 2-3 days prior to the expected periods at an anovulyation and endocrine infertility the giperplaziya of different degree of expressiveness (ferruterous and cystous, ferruterous, polyposes, adenomatosis) or sekretorny insufficiency is found.
For clarification of the reasons of endocrine infertility determine the FSG levels, an estradiol, LG, Prolactinum, by TTG, testosterone, T3, T4, DEA-S (degidroepiandrosteron-sulfate) for the 5-7th day during several menstrual cycles. Conducting hormonal tests allows to specify a condition of various links of reproductive system at endocrine infertility. The mechanism of conducting these tests consists in measurement of level of own hormones of the patient after reception of a certain stimulating hormonal medicines.
In need of specification of the reasons of endocrine infertility X-ray of a skull, ultrasonography of a thyroid gland, ovaries, adrenal glands, a diagnostic laparoscopy is carried out. The diagnosis of endocrine infertility to the woman is established only after an exception of a men's factor of infertility (existence of a normal spermogram), and also pathology from a uterus, immunological and pipe forms of infertility.
Treatment of endocrine infertility
The first stage of treatment of endocrine infertility includes normalization of the broken functions of endocrine glands (correction of diabetes, obesity, activity of adrenal glands, a thyroid gland, removal of tumors etc.). Further hormonal stimulation of maturing of a prepotent follicle and ovulation is carried out. For stimulation of an ovulation medicine clomifene the citrate causing increase in secretion by a hypophysis of follikulostimuliruyushchy hormone is appointed. From the pregnancies of 10% which occurred after stimulation clomifene citrate - polycarpous (twins and triplets are more often).
In case of lack of pregnancy during 6 ovulyatorny cycles at stimulation clomifene citrate resort to treatment by gonadotrophins: HMG (human menopausal gonadotrophin), r-FSG (recombinant follikulostimuliruyushchy hormone), and HGP (horionichesky gonadotrophin of the person). Treatment by gonadotrophins increases the frequency of approach of polycarpous pregnancy and development of side effects.
In most cases endocrine infertility gives in to hormonal correction, in the others surgery is shown. At a syndrome of polycystous ovaries resort to their wedge-shaped resection by a laparoscopic method or a laparoscopic termokauterization. After carrying out a laparoscopic termokauterization the highest percent of approach of pregnancies – from 80 to 90% of cases since formation of solderings in a small basin is excluded is observed.
At the endocrine infertility burdened pipe by a factor or decrease in fertility of sperm carrying out a method of extracorporal fertilization (EKO) with change of embryos, ready to development, in a uterus cavity is shown. It is possible to achieve approach and incubation of pregnancy from women with endocrine infertility only at the complex solution of this problem.
The forecast at endocrine infertility
Today endocrine infertility is not a sentence. The modern gynecology and endocrinology through joint efforts successfully treat 80% of patients, applying only medicamentous methods. If there was a restoration of an ovulation and there are no other factors of infertility, more than 50% of women become pregnant throughout the first six cycles of the stimulating hormonal therapy. Less favorable results from medicamentous therapy at the endocrine infertility caused by dysfunction of gipotalamo-hypophysial regulation.
Right after approach of pregnancy careful control of its development is established, hospitalization of the patient is carried out at signs of spontaneous termination of pregnancy. The diskoordination and weakness of patrimonial activity are quite often noted.
Prevention of endocrine infertility
It is necessary to care for prevention of endocrine forms of infertility from children's age. Reduction and the prevention of children's infections, chronic tonsillitis, rheumatism, flu, toxoplasmosis at children's and teenage age will allow to avoid dysfunction of ovaries and processes of gipotalamo-hypophysial regulation.
Preventive value has the correct emotional and physical training of girls since function of ovaries quite often suffers owing to an intellectual overstrain, psychological and sexual injuries. The fact that often endocrine infertility develops after pathological childbirth, termination of pregnancy, intoxications, inflammatory infections of the female reproductive sphere therefore it is necessary to pay attention to prevention of these states is indisputable.
The correct conducting pregnancy, reasonable use of some medicines, in particular hormones during pregnancy, will help to avoid congenital hypofunction of ovaries and a giperplaziya of bark of adrenal glands at girls.