What ovarian factors can cause infertility?
(1) Congenital anomalies: Congenital ovarian hypoplasia, 47XXX syndrome, true hermaphroditism, testicular feminization, etc. are not included in the scope of infertility treatment. . Congenital ovarian agenesis means that a woman is born without ovaries or has very small ovaries, making it difficult to secrete enough estrogen and progesterone. For example, the hereditary disease Turner syndrome is caused by the loss of an essential X chromosome in both couples during fertilization. Therefore, women with Turner syndrome only have one X chromosome, while women with normal reproductive functions must have Two X chromosomes. Patients with Turner syndrome have the basis for diagnosis at birth, but patients are often not diagnosed until the pubertal stage, because at this time women still have no secondary sexual characteristics and no menarche, so they are taken seriously and go to see a doctor. . For patients with Turner syndrome, after combined treatment with estrogen and progesterone, the female breasts, pubic hair, genitals and secondary sexual characteristics can further develop, but patients with homozygous (45XO) Turner syndrome cannot. Those who can ovulate, therefore have no fertility, are absolutely infertile. Adapting to society and the environment is the best choice for these patients. Women with a type of Turner syndrome (chimeric type 45XO/46XX) can get pregnant, but the incidence of habitual miscarriage after pregnancy is very high. Even if the child is delivered at term, the child is often accompanied by chromosomal abnormalities, such as Down\’ \’s syndrome. For the treatment of women with Turner syndrome, it is best to consult a geneticist and an infertility treatment specialist. There are also rare congenital ovarian dysplasia, ovarian insensitivity syndrome, premature ovarian failure and gonadal dysplasia that can cause infertility. The causes are still unclear. In some cases, maternal viral infections or metabolic disorders during early pregnancy may be causative factors for the fetus in the abdominal cavity. Sometimes, these lesions are transient, but the ovaries later respond to ovulation-stimulating drugs. Therefore, patients with this type of infertility should get in touch with infertility treatment experts and do not miss the opportunity for treatment.
(2) Polycystic ovary syndrome: Also known as Stein-Leventhal syndrome, it is a common disease in women under the age of 30. Under normal circumstances, after the follicle matures, it breaks through the ovarian capsule and releases the egg. In patients with polycystic ovary syndrome, the ovarian capsule thickens and multiple small follicles develop and stay under the ovarian capsule, so they cannot ovulate eggs. Polycystic ovary syndrome may be caused by: hypothalamic or pituitary gland dysfunction, orEndocrine disorders between ovaries and adrenal glands. Clinical manifestations include enlarged ovaries, irregular menstruation, infertility, hirsutism, and obesity (excessive weight gain). For infertility caused by polycystic ovary syndrome, clomiphene can be used to induce ovulation; if hormone therapy fails, wedge resection of the ovaries is recommended. Its purpose is to make the ovaries smaller and reduce the number of follicles in the ovaries to restore normal ovulation function.
(3) Ovaritis: It can be divided into tuberculous and non-parenchymal ovarian parenchymal inflammation and peripheral ovarian inflammation. For inflammation, anti-inflammatory treatment should be given priority; for those with surrounding fibrous adhesions, laparotomy or laparoscopic adhesion decomposition can be considered; those suffering from tuberculosis can be treated with anti-tuberculosis.
(4) Abnormal ovarian position: Ovarian sagging changes the anatomical position of the fimbriae of the fallopian tube and the ovary, thus affecting the entry of eggs into the fallopian tube. The mesoovary can be shortened or fixed to the posterior wall of the uterus by shortening the intrinsic ovarian ligament. Adhesive uterine position abnormalities are often caused by inflammation and endometriosis, all of which can cause infertility. Surgery or laparoscopic adhesion dissection may be considered.
(5) Ovarian tumors:Ovarian cysts are sometimes related to infertility. Multiple follicular cysts that secrete too much estrogen can cause persistent anovulation. Solid tumors of the ovary, such as various hormone-secreting tumors, granulosa cell tumors that secrete female hormones, and ovarian thecocytoma. Most ovarian tumors are not malignant, but as long as the ovaries continue to enlarge, further testing is necessary to confirm the diagnosis. Ovarian biopsy is the most accurate diagnostic method for enlarged ovaries. Ovarian cysts are different from ovarian tumors. Ovarian cysts can be functional, and functional ovarian cysts often disappear on their own. Under normal circumstances, the follicles mature and release eggs. If the egg is not released and the follicle continues to enlarge and is accompanied by fluid retention, a cyst will form. This is how corpus luteum cysts form as well. After ovulation, if pregnancy does not occur, the corpus luteum shrinks rapidly. If after the egg is released, fluid remains in it or is accompanied by bleeding (also known as blood corpus), a corpus luteum cyst is formed. If the cause no longer exists, follicular cysts and corpus luteum cysts will also disappear. Ovarian tumors often have no accompanying symptoms, but some women will feel pain during sexual intercourse, or when the tumor increases significantly, they will feel abdominal distension, symptoms of bladder and rectal compression, or compression of surrounding blood vessels and lymphatic vessels, causing varicose veins, hemorrhoids, and swelling of the perineum and thighs. ; If the tumor grows further, it can cause the uterus to shift. Ovarian tumors can cause infertility due to menstrual irregularities. Some tumors secrete abnormal male or female hormones, disrupting the body\’s hormone balance. Patients with tumors that secrete female hormones may experience symptoms such as pseudopregnancy, precocious puberty, irregular bleeding, uterine hypertrophy, and endometrial hyperplasia. Tumors that secrete androgens are rare, and patients may experience amenorrhea, hair growth on the face and chest, deepening of the voice, and changes in female secondary sexual characteristics, such as smaller breasts and enlarged clitoris. After the tumor is removed, the disease is reversed and the symptoms disappear. The prognosis of malignant tumors is related to tissue type and stage. Usually, once a malignant tumor is diagnosed,Most of them are in the late stage. Chemotherapy can leave patients in a state of infertility or relative infertility. Oncologists advise against pregnancy in any case because the high hormone levels associated with pregnancy may increase tumor recurrence. However, not all oncologists are against the patient\’s pregnancy. The decision on whether to become pregnant should be based on the treatment situation. Ovarian tumors that continue to grow require surgical treatment. If you hope to have children, doctors will try to preserve a woman\’s ovaries, but there are certain risks. To this day, this issue remains controversial. Removal of one ovary does not affect pregnancy. As long as the contralateral ovary is functioning normally, you can still get pregnant. Many people believe that removing one ovary cuts the chances of conception in half. This is not the case. As long as menstruation is normal, the remaining ovary will ovulate every month as usual.
(6) Ovarian endometriosis:Among the infertility cases caused by endometriosis, lesions that invade the ovary are the most common. Derivatives of 17-ethinyltestosterone can be used for treatment; conservative surgery is possible, and visible lesions should be removed as much as possible while retaining normal ovarian tissue; smaller lesions can also be cauterized under laparoscopy, and the pelvic cavity can also be released at the same time Mild adhesions in the endometrium, or the contents of the endometrial cyst can be extracted through the accessory needle of the endometrial tube.
(7) Ovarian amenorrhea: Patients with ovarian amenorrhea may be ineffective or effective after gonadotropin treatment. Therefore, the examination of patients with ovarian amenorrhea should be carried out in sequence: ① Determination of follicle-stimulating hormone and luteinizing hormone in urine or blood; ② Gonadotropin stimulation test; ③ If conditions permit, a gonadotropin-releasing hormone pituitary stimulation test can be performed; ④ Chromosome and sex chromatin examination; ⑤ Laparoscopy; ⑥ Laparotomy examination if necessary.
If you have ovarian surgery, try to consider pregnancy after 3 months to help the ovaries completely return to normal.
This article is provided by Baidu Reading and is excerpted from \”The Clear \”Conception\” Plan\” Author: Sun Jianqiu and Xie Yingbiao