Honestly about infertility and failed pregnancy
When can we talk about infertility?
Infertility is not an independent disease, but always the consequence of some underlying pathological condition. Accordingly, treatment must always be preceded by a detailed examination.
There are several types of infertility
We can talk about primary sterility if there has been no pregnancy yet. In the case of secondary sterility, there has been a previous conception in the relationship, regardless of whether the pregnancy resulted in a healthy newborn or not. There are times when infertility can be cured or reversed, so after appropriate treatment there is a good chance of conceiving. For a few, it may also happen that infertility is incurable and irreversible, according to our current knowledge, we cannot help the condition. Certain chromosomal abnormalities (Turner's syndrome) can be classified here, if the uterus had to be removed due to some medical process or if menstruation has already stopped (premature ovarian exhaustion or natural climax), or if - very rarely - the uterus has died. endometrium.
When the pregnancy is unsuccessful
In the event of an unsuccessful pregnancy, the pregnancy does not result in a live, healthy newborn. This can occur for several reasons and forms:
- Spontaneous miscarriage (abortus spontaneus): termination of pregnancy before the 24th week. Up to the 12th week is early, from the 12th to the 24th We are talking about a late miscarriage between weeks. If the abortion takes place spontaneously in its entirety, it is complete (abortus completus), if it starts but does not take place in its entirety, it is an incomplete abortion (abortus incompletus); if the embryo dies, but the miscarriage does not start on its own, we speak of a missed abortion. All pregnancies are approx. 10-15% end in spontaneous abortion.
- Recurrent (regular) miscarriage (abortion habitual): occurs when three consecutive pregnancies end in miscarriage. Primary (primary), if there has been no birth before, secondary (secondary) if there has been a birth before. Occurs in about 1%.
- A pregnancy that died in utero
Why is the investigation important?
Infertility is always the result of some underlying pathological condition. The exact examination is also very important, because many diseases can be revealed, which can seriously affect the later life and health of the woman or man. Such e.g. diabetes, increased blood clotting or thyroid diseases, autoimmune conditions.
It stands on two
It is important that the investigation must affect both the male and female members of the couple. The investigation process takes approximately two months. In the background approx. We find a female cause in 40%, a male cause in 30%, and in nearly 10% both parties have a discrepancy. For the remaining 10%, we cannot find a cause at all, or we know the difference from scientific research, but there is currently no diagnostic procedure or treatment that can be used in humans.
Women's studies
- Routine gynecological examination: ultrasound, gynecological cancer screening, microbiological tests (vaginal secretion culture, STD tests / Chlamydia, Ureaplasma, Neisseria, Gardnerella)
- Examination of the uterine cavity and fallopian tubes: The ultrasound device available at the Duna Medical Center can spatially map the uterine cavity and endometrium, as well as possible deviations of the underlying tissues (polypus, myoma, septum, division into two (adenomyosis). With its help, we can create a spatial image of the individual anatomical formulas , with the help of advanced computer technology, we can even view them afterwards by turning them around. The device is also suitable for serial examination of layers that can be adjusted as desired - similar to the operation of CT or MR devices. During the investigation of unsuccessful pregnancies - when we look for deformities of the uterine cavity - it can also trigger hysteroscopy. With the help of ultrasound the patency of the fallopian tubes can also be assessed, but first a contrast material that is clearly visible on ultrasound must be introduced with the help of a thin catheter (the procedure is called HYCOSY: HysteroContrastSalpingoGraphia). we can more clearly separate healthy and pathological tissues from each other (e.g. detection of small endometriosis)
- Examination of the hormonal system : During this, we check the hormones of the pituitary gland (hypophysis) controlling the ovaries (FSH, LH), the hormones of the ovaries (estradiol, progesterone), the hormone indicating the reserve capacity of the ovaries (AMH), the hormone responsible for milk production (prolactin), we examine the thyroid gland in detail, or the antibodies that may be produced against it, the male sex hormone (testosterone) and the protein that transports it (SHBG), the functioning of the adrenal glands (ACTH, DHEAS, cortisol), and the body's carbohydrate balance (possible insulin resistance). The latter is particularly important in cases of high body mass index (BMI ≥ 25) and irregular, especially missed, menstrual cycles.
- Examination of the blood coagulation system (in case of suspicion): We take it for granted that our blood is in a liquid state in our blood vessels, even though there are conditions (thrombophilias) in which blood clots form even within intact blood vessels without injury. These pathological conditions can be congenital (the best-known form is the Leiden mutation of coagulation factor V) or acquired during life. The latter are often associated with autoimmune changes. With these changes, the patient may develop deep vein thrombosis or pulmonary embolism, especially during pregnancy or taking birth control pills, or hormone treatment (e.g. infertility treatments). In connection with pregnancy, the blockage of the small end arteries running to the placenta can lead to the death of the placenta and, as a result, to the termination of the pregnancy. A blood sample from the patient is sufficient for the diagnosis, the sample must be sent to a special laboratory to establish the diagnosis.
- Examination of the immune system: During the development of the cells of the immune system, those cells that attack the cells and tissues of the body are selected. Nevertheless, there are unfortunately conditions where the immune system attacks its own host, these are called autoimmune conditions. In such cases, the attack may be directed against the cells of the cake, damaging their function; often the blood coagulation system is also activated (acquired thrombophilias). These changes can also be detected by taking blood, with special (and usually very time-consuming) laboratory tests. We also examine a special group of immune cells called natural killer cells (NK cells). These cells can be detected in the peripheral blood, but a subgroup of them can also be found in very large quantities in the endometrium. If their number or activity increases, they can damage the developing placenta (in fact, NK cells decide whether the pregnancy can be maintained or not, in immune-related miscarriages the "executive" role is assigned to them). It is also possible to conduct a test in which we determine how the woman's body reacts to her partner's cells, this is called an incompatibility test.
Male studies
- Andrological examination : In the course of this, we investigate possible pathological deviations of the male genital organs. The most well-known is varicocele, i.e. varicose veins of the testicle.
- Microbiological examination of semen : Breeding and the so-called STD tests (as for women).
- Spermiogram: The amount of ejaculated semen, the number, concentration, movement and shape of the spermatozoa all influence the ability to fertilize.
- Special laboratory tests: With their help, we get a much more accurate picture of the fertilizing capacity of the sperm and the further fate of the embryo. These include: sperm acrosome reaction, HBA test, sperm DNA fragmentation (fragmentation) test (SCSA), test of reactive free radicals (ROS) in semen, but it is also possible to test various substances produced by the immune system (Interleukins). Our tests can also cover any anti-sperm antibodies produced by the female partner, which can be detected in the semen or the woman's blood.
- Hormonal examination: In men, the same hormones are produced as in women, only in different proportions, or they exert a different effect elsewhere (e.g. FSH acts in the testes), accordingly we examine FSH, LH, TSH, oestradiol, testosterone and prolactin levels. In the case of overweight men, it is also worth checking for possible insulin resistance or diabetes (an enzyme in adipose tissue can convert male sex hormones into female sex hormones - oestrogens; this is obviously not good for a man's sexual function).
For both partners
In some cases - especially in the case of repeated miscarriages or repeatedly unsuccessful IVF (vial-bottle) treatments - it may be necessary to examine the genetic material (chromosomes) of both the woman and the man (karyotyping).
Treatment options
For anatomical deviations:
For both men and women, surgery may be the solution of choice if there is an anatomical discrepancy. In the operating theater of the Duna Medical Center, we can correct the deviations with only minimal tissue damage with a highly advanced endoscopic system that provides a spatial image. The so-called The big advantage of minimally invasive interventions is that recovery is very fast after them - the day after the operation - in the case of some operations, the same day - the patient can go home.
In case of disorders of the hormonal system and carbohydrate balance:
We can promote improvement with appropriate medication and dietary and lifestyle changes. This usually results in a noticeable improvement after two to three months, and in many cases conception occurs spontaneously without any other intervention.
For blood clotting disorders:
The formation of abnormal blood clots can be prevented with anticoagulant drugs.
In diseases of the immune system:
If autoimmunity is detected, drug treatment can be used to reduce the pathological activity after an immunological consultation.
In case of "incompatibility", we can help maintain the pregnancy by giving IVIg (Intravenous Immune Globulin) infusion. The drug normalizes the pathological activity of NK cells, it is repeated every 4 weeks until the 12th week of pregnancy; its administration naturally requires a hospital stay of several hours.
In case of follicular rupture (ovulation) disorder:
We can help with medication and ovulation induction. In such cases, we stimulate the functioning of the ovaries with medication, check the effectiveness of the treatment with an ultrasound, and then with an injection we can time the follicular rupture to a given time, that is, we can tell when the best time for fertilization is. It is also possible to perform artificial insemination (insemination - AIH), when, after hormonal stimulation of the ovaries, the sperm is properly pretreated and brought up to the uterine cavity with the help of a thin catheter, thus significantly shortening the path that the sperm must "travel", and the treatment selects the most viable sperm.
Feel free to contact our gynecologists regarding infertility and unsuccessful pregnancy:
Dr. László Nagy