A complex of hormonal disorders that provoke the absence of ovulation, change the quality of sperm and lead to hormonal infertility is called endocrine infertility. How the pathology flows, is diagnosed and corrected, you will learn from the article.
- Prognosis and prevention.
Endocrine infertility is a collective term that includes a variety of disturbed mechanisms of hormonal regulation of the menstrual cycle: in the hypothalamic-pituitary-adrenal system, at the level of the ovaries, the thyroid gland. Irrespective of the pathology trigger, its essence is disturbed ovarian function with anovulation or its irregularity. It is worth correcting the function of the appendages, and in 80% of cases, pregnancy occurs. In the remaining 20%, the problem is solved by IVF. The relevance of endocrine infertility is explained by the fact that it occurs in every third woman.
Anovulation is a consequence of the association of disorders of the CNS, immunity, endocrine glands and target reproductive organs.
The absence of menstruation of endocrine nature occurs as a result of:
- Dysfunction of the hypothalamic-pituitary system after craniocerebral trauma, chest deformities, against the background of tumors that are accompanied by hyperprolactinemia. Maximum synthesis of prolactin inhibits the pituitary cycle of production of luteinizing and follicle stimulating hormones, which is manifested by blocked ovarian function and rare periods, persistent anovulation and endocrine infertility.
- Hyperandrogenism of ovarian genesis. A minimum of male sex hormones in women is a prerequisite for puberty and normal ovarian function. Hypersynthesis of androgens is performed by the ovaries or adrenal glands, or more often both at once. High production of androgens provokes the formation of polycystic ovaries, which causes infertility, endocrine obesity, hirsutism, persistent cramping, ovulation dysfunction in the ovaries. Since the centers responsible for reproduction and eating behavior are located very close to the hypothalamus, the involvement of leptin is obvious.
- Hyperandrogenism of adrenal genesis – the result of adrenal hyperplasia, its cortical zone, in which the lesion of the ovaries is secondary (secondary polycystic disease).
- Thyroid dysfunction: hypo- and hyperthyroidism, diffuse toxic goiter often go together with absence of ovulation, secondary increased prolactin synthesis, infertility, habitual miscarriages, fetal abnormalities.
- Estrogen and progesterone deficiency with a luteal phase deficiency, which causes endometrial secretory degeneration, fallopian tubes dysfunction. This prevents the implantation of the fetus in the uterine cavity. This leads to pregnancy failure and endocrine infertility.
- Severe somatic pathologies: from hepatitis and tuberculosis to autoimmune processes and tumors.
- Obesity or hypotrophy of adipose tissue changes the metabolic processes in the body, which affects the reproductive capacity of the person. Hyperaccumulation of fat, in which leptin, the hormone of fat cells, is directly involved, causes hormonal imbalance, disruption of the monthly cycle, and endocrine infertility. Fat restriction and drastic weight loss automatically disrupt normal ovarian function.
- Savage or resistant ovarian syndrome, which is a disorder of the pituitary-ovarian communication, causing insensitivity of the ovarian receptors to gonadotropins which stimulate ovulation. This manifests as amenorrhea, endocrine infertility with normal development of sexual characteristics and high levels of gonadotropins. Injuries to the ovaries can cause viral infections: rubella, flu, pathology of an already existing pregnancy, avitaminosis, starvation, stress.
- Depletion of the ovaries and premature menopause, which provoke secondary amenorrhea in young women under the age of 38, and the manifestations of menopause automatically lead to endocrine infertility.
- Mutations in the sex chromosomes that lead to a deficiency of female sex hormones, sexual infantilism, primary amenorrhea and endocrine infertility.
The main manifestation of endocrine infertility is the inability to become pregnant and irregularities in the monthly cycle. Menstruation comes with a delay of up to six months, accompanied by pain and profuse discharge or absent at all. Often there are menstrual menstruations with spotting during the intermenstrual period.
One third of patients have periods with anovulation and their duration corresponds to the norm. In this case we speak not about menstruation, but about menstrual-like bleeding. Women are disturbed by pains in the lower abdomen or lower back, discharge from the genital tract, cystitis, painful intimacy.
Heavy breasts, discharge of colostrum from nipples, premenstrual tension syndrome are also noted. With increased androgen synthesis, endocrine infertility, acne, hirsutism, hypertrichosis, and hair loss are observed. Blood pressure fluctuations, obesity or weight loss with eating disorders on the background of leptin resistance, formation of stretch marks on the skin are diagnosed.
During the collection of patients’ medical history with endocrine pathology, the time of the beginning of menstruation, its abundance, pain syndrome, the presence of similar symptoms before, the course of pregnancy, if there was one. It is important to understand whether there were any gynecological interventions, contraception and its nature and duration. General examination involves assessing the patient’s height, the degree of obesity, virilism, breast development and secondary sexual signs.
For this purpose, it is important:
- Gynecological consultations to determine the shape and length of the vagina, uterus, cervix, parametrium and appendages. Endocrine infertility triggers are identified, such as sexual infantilism, polycystic ovaries.
- Diagnostic tests to evaluate ovarian function, ovulation: construction and analysis of the basal temperature curve, urinary ovulation test Ultrasound monitoring of follicle maturation and ovulation control. If we talk about the basal temperature curve, it is an aid in determining the presence or absence of ovulation. The basal temperature curve is the level of post-ovulatory progesterone production by the ovaries, which is designed to prepare the uterine endometrium for embryo implantation. The basal curve takes into account morning temperature readings, which are measured daily at the same time in the rectum. It is a biphasic graph: on the day of ovulation, the rectal temperature drops by 0.2-0.3 ° C, and rises by 0.5-0.6 ° C in the second phase of the cycle. Anovulatory monthly cycle is characterized by a monophasic curve: persistently below 37 ° C, and insufficient luteal phase is fixed by a short second phase of the cycle of less than 11-12 days.
- Ovulation monitoring allows confirming or denying the fact of ovulation by testing the level of progesterone in the blood and pregnandiol in the urine. Anovulation gives a minimum in the second phase, and if the luteal phase is deficient, a decrease compared to ovulatory menses. Ultrasound monitoring of folliculogenesis allows you to trace the maturation in the dominant follicle and the release of the egg from it.
- The endometrial scrape test serves as a reflection of the function of the ovaries and the condition of the endometrium. In case of anovulation and endocrine infertility, hyperplasia or secretory insufficiency is visible.
- Hormonal examination helps to determine the cause of endocrine infertility: levels of FSH, LH, TSH, estradiol, prolactin are determined on the 5th-7th day of the cycle for several months.
- Hormonal tests make it possible to clarify the state of the links of the reproductive system in endocrine infertility. The essence is the measurement of the concentration of your own hormones after taking special stimulating hormone preparations.
- Instrumental diagnostics involves X-ray of the skull, ultrasound of the thyroid, ovaries, adrenal glands, diagnostic laparoscopy.
The diagnosis of endocrine infertility can be made only with a normal spermogram and the absence of pathology from the uterus, immunological and tubal forms of infertility.
Therapy correcting endocrine obesity includes several options:
- Hormonal stimulation: the first stage of correction involves the restoration of disturbed functions of the endocrine glands. This is the correction of diabetes, obesity, hypo- and hyperthyroidism, tumors. The next step is the actual stimulation of the maturation of the dominant follicle and ovulation, using the drug Clomiphene Citrate, which activates the secretion of follicle-stimulating hormone by the pituitary gland. Of the pregnancies that follow, about 10% are multiple pregnancies. If there is no pregnancy within 6 ovulatory cycles, gonadotropins are turned on: human menopausal gonadotropin, recombinant follicle-stimulating hormone, human chorionic gonadotropin. such treatment increases the frequency of multiple pregnancies and development of adverse side effects;
- Surgical intervention is carried out as a result of the complete absence of the effect of hormonal correction. Laparoscopic wedge resection of the ovaries or laparoscopic thermocauterization is used for polycystic ovaries. After the latter the maximum percentage of pregnancy is fixed, up to 90%, since there are no commissures in the small pelvis.
- The ART method is used in cases of a complicated tubal-peritoneal factor or decreased sperm fertility. IVF with embryo transfer into the uterine cavity is indicated.
We emphasize that the desirable ovulation and conception in women with hormonal infertility and carrying a fetus is possible only with a comprehensive approach to solving this problem.
Prognosis, preventive measures
Infertility as a result of endocrine disorders is not a sentence. In 80% of cases, it can be successfully treated using conservative methods. If all is restored and there are no other infertility factors, half of the women become pregnant within the first 6 cycles of stimulation.
If the trigger of endocrine infertility – dysfunction of the hypothalamus and pituitary gland, the results of conservative therapy are less rosy. But in any case, control of the development of pregnancy and its course up to delivery is established. Prevention of endocrine infertility begins in childhood, and involves the prevention of childhood infections, the proper education of girls emotionally and physically.
There is no doubt that infertility, including as a result of endocrine disorders, is formed as a post-abortion complication and after pathological childbirth, so the prevention of such conditions is so important.