What are the causes of infertility? Finding the cause is the key

What is the reason for infertility tests not to reveal the cause? Infertility makes many female friends sad. Failure to conceive may break up a family. If you want to get pregnant, you must find the cause. Finding the cause is the key to treatment. Let's take a look at this case.

Case: A woman in her early 30s, who had been married for many years and had been trying hard to get pregnant, still had no pregnancy. She came to the clinic about 7 months ago. The results were the same as her previous examinations, with both the man and the woman being normal, but the ultrasound showed suspicion of polyps. However, she was a little hesitant and noncommittal about the suggestion of a hysteroscopy. I had no choice but to give her ovulation pills and an egg test. After 2 months, I suggested a fallopian tube photography, but it continued to fail for two months. I said that if it failed again, she must have a hysteroscopy, and she reluctantly agreed.

After the examination, my guess was confirmed to be correct. A polyp of about 1.5 cm was placed in the middle of the uterine cavity. I pointed at the screen and said that it was a polyp and that surgery was needed to remove it so that she could conceive successfully in the future. This time she listened to me. Two months later, she is pregnant.

Pregnancy for women requires three major elements: ovaries, fallopian tubes and uterine cavity. As for ovarian function, everyone knows that blood tests for FSH and PRL are required, among which PRL is the most important, but there are countless infertile patients who have not been tested. As for whether to test thyroid function or male hormones, I think they should be put in the second place and there is no need to rush. As for the amount of estrogen and progesterone in the blood, I think it is not necessary at all. As long as menstruation and ovulation are normal, these two must be normal, otherwise they will be abnormal, so it is passive.

Everyone knows that in order to understand whether the fallopian tubes are obstructed or not, fallopian tube photography is the best examination tool. However, what needs to be emphasized here is that when injecting contrast agents, some brands can be very irritating and make the patient feel very painful, causing the fallopian tubes to automatically spasm and the contrast agent cannot be injected. This may lead to the patient mistakenly thinking that the fallopian tubes are obstructed. Everyone should pay special attention to this. If in doubt, it is better to ask other doctors to assist in the interpretation.

As for the uterine cavity, it is a place that is rarely mentioned and unfamiliar to everyone. At most, people would take an ultrasound to check the thickness of the endometrium, but in fact, the world inside the uterine cavity is very colorful. Therefore, if infertile patients still have no news after trying their best, they should find a place with flexible hysteroscopy equipment to have an examination.

Every time a woman's menstruation comes, the endometrium is reshuffled and then grows flat again. However, because the estrogen receptors of each endometrial cell are different, the growth rate will be inconsistent. Some may even grow too fast, and eventually there is a chance of forming endometrial polyps.

So any age group has the opportunity, whether she is unmarried or menopausal. Polyps have two disadvantages, one is abnormal and irregular uterine bleeding, the other is infertility, so women with these two problems are best to do a soft hysteroscopy. It is a waste of time and energy to always rely on ultrasound.

Endometrial polyps can be large or small, and they can be more or less numerous. Large ones are easy to detect with a hysteroscope, but small ones, especially very small ones, are not easy to detect. However, no matter how large or small they are, the mechanism of causing infertility or bleeding is the same. Therefore, they should be treated together when they are found. However, some doctors like to use surgery with a hysteroscope to remove larger polyps, believing that surgery under visual observation is more accurate. However, according to reports, the results after surgery are very high in recurrence. Recently, a related research article appeared in China and pointed out that the recurrence rate is as high as 45%.

Scholars in other countries have made the same discovery. In order to avoid the high recurrence rate, some doctors simply combine the two treatment methods, that is, hysteroscopic resection plus uterine curettage. In this way, the recurrence rate can be rapidly reduced to only about 6%. But my opinion is that using hysteroscopy to remove polyps is a good method, but for a large number of small polyps, the hysteroscopic knife is powerless.

I think it is unnecessary to perform hysterectomy followed by curettage. Therefore, I have been performing direct curettage for a long time. A case can be completed in about 10 minutes. The recurrence rate is 5% according to my own tracking. In addition, I use hysteroscopy to track postoperative recurrence cases and find that the recurring polyps are all newly grown. None of them grew in the same place. Therefore, it is difficult to conclude whether they are recurrence or new growth.

Although the name literally says uterine curettage, it looks scary and may have side effects, so many people are worried, but in fact it uses the principle of a vacuum cleaner to eliminate polyps, so there will be no scratches on the uterine wall and it can be cleaned 360 degrees in all directions, so please rest assured.

If there are no obvious factors causing infertility, the pregnancy rate can be increased to about 60% after polyp removal. Therefore, wives who have infertility problems and have not yet undergone a hysteroscopy should go as soon as possible. However, I still recommend that a flexible hysteroscopy be used, which is simpler.