\”Doctor, please help me!\” A woman who was obviously emotionally unstable appeared in my clinic. In fact, I encounter such patients almost every day.
After careful inquiry, I found out that she had been troubled by severe menstrual cramps in recent years, and now she was troubled by infertility. “I have been preparing for pregnancy for more than a year, but I haven’t gotten pregnant yet. You must help me.\”
This patient had an induced abortion 4 years ago because she was not married at the time. Since then, she has had lower abdominal pain and increased menstrual flow every time she menstruates. I hurt a lot, and sometimes the pain was so unbearable that I had to take some painkillers.
She also went to the hospital. She complained of dysmenorrhea, and the doctor at the community clinic asked her to take some flavored Xiaoyao Pills, but the effect was not obvious. If it weren\’t for infertility, she wouldn\’t be here and let me know a big secret related to the miscarriage 4 years ago.
Salpingography showed that her bilateral fallopian tubes were unobstructed, but there were adhesions and distortions, and her ovaries were shadowed. Further laparoscopy results showed that there were endometriosis cysts in her ovaries, and the ovaries, fallopian tubes, and intestines had all been adhered together. This is a typical case of endometriosis caused by induced abortion. Her dysmenorrhea and infertility were both caused by this.
During the artificial abortion process, endometrial fragments may be pressed into the pelvic cavity and then take root and grow everywhere, causing a series of symptoms such as adhesion of organs in the pelvic cavity. Endometriosis occurs in the ovaries and forms cysts. The cysts affect the ovulatory function of the ovaries. The twisted fallopian tubes also affect the transport of eggs, thus causing her infertility.
After the diagnosis was clear, I removed the cyst for her under laparoscopy, separated the adhering organs, reset the twisted fallopian tube, and used local drugs to prevent adhesion. After discharge, outpatient treatment continued for 3 months.
Six months later, she happily walked into my consulting room with wedding candy and asked me to eat candy – she was pregnant.
In fact, endometriosis is a gynecological disease caused by the growth of endometrium in any part outside the uterine cavity, mostly invading the ovaries. It is not simply uterine infertility. Uterine infertility includes female infertility caused by uterine dysplasia, uterine malformation, endometritis, uterine fibroids, abnormal uterine position and adhesions in the uterine cavity.
Cervical atresia
Cervical atresia and stenosis are often caused after abortion surgery, mainly Insufficient cervical dilation during aspiration during abortion, or removal of the suction tube with negative pressure, or improper operation by the doctor, etc., can cause damage to the woman\’s endometrium, and the final result is infertility. Women with this condition often feel periodic pain in the lower abdomen. During examination, they will find that the vagina is purple-blue, the cervix is obviously painful when moving, the uterus is slightly full, and there is tenderness with movement.
Cervical atresia and stenosis, cervical dysplasia, are mainly treated with uterine dilation, and there is no other good treatment method. Elevating the buttocks after sexual intercourse can make the semen accumulate in the posterior fornix as much as possible, which will relatively increase the level of semen, thereby helping the cervix to be soaked in semen; or lying prone after sexual intercourse can promote the accumulation of semen in the anterior fornix of the vagina, which can cause upturned The cervix is easily soaked in semen. If you still cannot conceive, intrauterine artificial insemination can be used.
Cervical fibroids
Cervical muscle The main cause of infertility caused by tumors is the deformation and stenosis of the cervical canal, which affects the passage of sperm. The main clinical manifestations are irregular menstruation, increased menstrual blood volume, increased leucorrhea or bladder and rectal symptoms. Some patients are asymptomatic. Gynecological examination may reveal that there are protruding fibroid nodules on the cervix or the appearance of the cervix has changed. The cervix on one side where the fibroids are located is enlarged, while the opposite side is compressed and thinned, and the external cervical opening is stretched and flattened into a twist shape.
As the tumor body continues to grow, cervical fibroids can easily cause blockage, causing menstrual blood to be unable to be discharged from the body in time, easily leading to endometritis, and the harm to women will be aggravated. Some cervical fibroids will enter the female vagina, causing a lot of inconvenience to women. Therefore, cervical fibroids must be treated in time, and do not regret it until the condition is serious enough. After curing, you can become pregnant and give birth under the guidance of a doctor.
Chronic cervicitis
Chronic cervix Inflammation is a common gynecological disease and generally does not affect pregnancy. Normal cervical mucus protects sperm, supplies energy, and is where sperm is stored. The main clinical symptom of this disease is increased leucorrhea. Due to the different scope and degree of pathogenic bacteria and inflammation, the amount, nature, color and smell of leucorrhea are also different. It can be milky white mucus, sometimes light yellow purulent, and when accompanied by polyps, it is easy to have bloody leucorrhea or bleeding during sexual intercourse. When inflammation spreads to the pelvic cavity through the uterosacral ligaments, there may be pain in the waist and sacral area, falling pain in the pelvic area, andDysmenorrhea, etc., worsen during menstruation, defecation or sexual intercourse. During the examination, it can be seen that the cervix has varying degrees of erosion, hypertrophy, sometimes hardening, and polyps, lacerations, ectropion, glandular cysts and other lesions.
Patients with chronic cervicitis need to be treated in regular hospitals and recovered before they can become pregnant normally.
Abnormal cervical mucus
Cervical mucus The glucose and other nutrients contained in sperm have a great impact on the survival and motility of sperm when crossing the cervix. Because the sperm itself only stores a small amount of glycogen, it must rely on extracellular nutrients to meet its own energy needs when it stays and travels through the female reproductive tract. Ovarian hormones regulate the secretion of cervical mucus. The physical properties and certain chemical compositions of cervical mucus change periodically to facilitate sperm penetration, nutrition and survival.
For patients with abnormal cervical mucus, estrogen can be supplemented to promote the production of cervical mucus; adjust and improve the endocrine function of the ovary to promote ovulation; treat reproductive immune disorders; treat related diseases, such as cervical cancer inflammation and vaginitis, etc. If you are still not pregnant after the above treatments, you can use intrauterine insemination and, if necessary, in vitro fertilization.
Cervical erosion
Cervical erosion is One of the local characteristics of chronic cervicitis is cervical erosion, which is a relatively common gynecological disease. Cervical erosion is divided into mild, moderate and severe. If the erosion area accounts for 1/3 of the total area of the cervix, it is classified as mild cervical erosion; if the area accounts for 1/2 of the cervix, it is moderate cervical erosion; if the erosion area exceeds 1/2 of the total area of the cervix, it is classified as severe cervical erosion.
Cervical columnar epithelial ectopia does not require any treatment. Most of the current methods for treating cervical erosion are wrong. But for symptomatic cervicitis, treatment is required. Acute inflammation can be treated with suppositories, while chronic inflammation can be treated with physical therapy such as laser or freezing. After treatment, pregnancy can be normal.
Abnormal position of cervical canal
Chronic Pelvic inflammatory disease or endometriosis can cause the uterus to tilt backward, backward or forward, which is not conducive to the upward movement of sperm. In addition, a prolonged, short cervix or cervical prolapse may also change the normal positional relationship between the external cervical os and the posterior fornix, hindering the upward movement of sperm.
Patients with abnormal cervical canal position must be diagnosed and treated in a regular hospital. They can then get pregnant under the guidance of a doctor, but multiple times should be avoided.Pregnancy and strict prenatal check-up.
Uterine adhesions
Due to surgery Causes such as dilation and curettage, electrocautery and drug corrosion lead to endometrial injury and infection, which may lead to adhesion of the cervical canal and uterine basal layer, uterine cavity deformation, menstrual disorders and infertility syndrome.
The treatment of intrauterine adhesions needs to be based on the principle of syndrome differentiation, that is, different treatment methods are adopted for different conditions. However, the common treatment methods mainly include the following four types: drug treatment, using traditional Chinese medicine intraperitoneal infusion therapy, for intrauterine adhesions. According to the characteristics of the disease, high and new technologies are used, traditional Chinese medicine is used for syndrome differentiation and treatment, and unique Chinese medicine prescriptions are used to promote the absorption and subsidence of inflammation. Surgical treatment, using hysteroscopy technology, and the clinical application of hysteroscopy, some difficult gynecological diseases can be solved intuitively, simply and safely. Hysteroscopy can not only determine the degree and type of adhesions in the treatment of intrauterine adhesions, but also determine the toughness of the adhesions. Physical therapy can relieve patients\’ ideological concerns, enhance their confidence in treatment, increase nutrition, exercise, pay attention to the balance between work and rest, and improve the body\’s resistance. For hysteroscopic therapy, membranous adhesions and fibromuscular adhesions can be separated under hysteroscopy or surgically removed; while for connective tissue-like dense adhesions, electroresection and separation are required under B-ultrasound monitoring, and they are placed intrauterine after surgery. The IUD prevents re-adhesion, and continuous administration of estrogen and progesterone is given to promote the growth of the endometrium, allowing the patient to resume menstruation, and some patients can become pregnant again.
Uterine dysplasia
Uterine development Poor uterus, also known as immature uterus, generally refers to the fact that the uterus is still smaller than normal after puberty. A simple small uterus is not necessarily the direct cause of infertility. If the ovaries are underdeveloped at the same time, it is the direct cause of uterine infertility. These include congenital absence of uterus and uterine hypoplasia, obstruction of the union of the paramesonephric ducts on both sides, failure of the duct to penetrate after the union of the paramesonephric ducts, congenital uterine ectopia, and iatrogenic congenital uterine anomalies.
For patients with this disease, continuous hormone therapy can be used for 3 to 6 months. After the uterus enlarges, an appropriate amount of progesterone can be given in the second half of menstruation to make the corpus luteum function strong and facilitate pregnancy. Continuous therapy with estrogen and progesterone can also be used. On the basis of uterine enlargement caused by hormone therapy, cervical dilation surgery and endometrial curettage can be added to increase the chance of pregnancy. Patients can also choose treatment options that combine traditional Chinese and Western medicine.
Uterine malformation
Whether uterine malformation affects fertility depends on the type and degree of the malformation. Most of these patients have no obvious symptoms, but some also present with primary amenorrhea and irregular menstruation, such as oligomenorrhea, oligomenorrhea, dysmenorrhea or dysfunctional uterine bleeding, etc.; some also present with genital and breast development. Undesirable conditions, such as sexual immaturity, poor development of breasts and secondary sexual characteristics, low ovarian function, and anovulation. Even if some patients can conceive, because the uterine cavity cannot expand accordingly, they are prone to miscarriage, premature delivery, abnormal fetal position, abnormal placental position, or stillbirth.
No uterus/solid primordial uterus can be left alone. Those with primordial uterus who have periodic abdominal pain or intrauterine hemorrhage require surgical removal of the primordial uterus. For immature uterus, sequential cycles of estrogen and progesterone are recommended. treat. Some patients with uterine malformations may not have any conscious symptoms and have no abnormal symptoms in menstruation, sexual life, pregnancy, childbirth, etc., and may even go undetected throughout their lives, or they may be discovered occasionally during physical examinations.
Uterine fibroids
Uterine muscle Tumors are sex hormone-dependent tumors. Smaller uterine fibroids rarely affect pregnancy, but larger and submucosal fibroids can cause infertility and miscarriage.
Endometritis
Uterus Intimal inflammation can lead to disorders of menstruation, reproduction, barrier function, excretion and endocrine function, causing infertility. Endometritis can be divided into acute and chronic types according to the duration of the disease. According to the pathogenic bacteria of infection, it can be divided into tuberculosis, venereal disease and general bacterial infection. Among infertile women, the incidence of endometritis found through endometrial biopsy can reach 9.4%. Common pathogenic bacteria are mostly Staphylococcus aureus, Escherichia coli, Streptococcus aureus and anaerobic bacteria. Of course, gonococcal, mycobacterial and chlamydial infections have increased significantly in recent years and have become the main pathogenic bacteria in some areas.
Endometritis can be treated in regular outpatient clinics, and you can feel confident about getting pregnant after it is cured.
Endometrial insufficiency
Uterus Endometrial insufficiency can be divided into three main types: endometrial atrophy, abnormal endometrial hyperplasia, and luteal phase endometrial insufficiency.
The treatment of endometrial atrophy and whether you can get pregnant depend on the degree of pituitary gland involvement. If the degree of involvement is mild, no treatment may be required, or drugs may be used to induce ovulation and menstruation to allow pregnancy based on the estrogen level in the patient\’s body; if the degree of involvement is severe, hormone induction may be used when there are good internal conditions and the patient urgently desires to have a baby.To trigger ovulation and strive for conception. Excessive endometrial hyperplasia or glandular cystic or adenomatous hyperplasia are mostly caused by ovulatory dysfunction and can be treated symptomatically. Endometrial insufficiency in the luteal phase allows normal fertilization, but the endometrium at the site of implantation of the fertilized egg is not fully developed, which affects pregnancy. However, it can also be treated under the guidance of a doctor to strive for pregnancy.
Endometrial polyps
Uterus Endometrial polyps fill the uterine cavity, hindering the retention and implantation of sperm and eggs, causing infertility. The treatment plan is to dilate the cervix and remove polyps, followed by dilation and curettage. Diffuse small polyps can be cured and sent for pathological examination. Postoperative follow-up should be carried out regularly, attention should be paid to recurrence and malignant transformation, and timely treatment should be carried out. In recent years, some people have successfully used hysteroscopic surgical resection or laser treatment of small polyps.
This article is provided by Baidu Reading. It is excerpted from \”Very Good Pregnancy: You Can Get Pregnant by Doing This\” Author: Yu Yue\’e