Endocrine infertility is a whole complex of hormonal disorders, which can lead to irregular ovulation or even to their absence, when it comes to women. In men, this can cause impaired sperm quality. The basis of this diagnosis are various dysfunctions of the thyroid gland, and in addition, the gonads. Treatment with a diagnosis of endocrine infertility consists in eliminating its main cause along with correcting disorders and maintaining a healthy hormonal background. Normalization of functions leads to pregnancy in 70% of cases. Read more about the causes, symptoms and characteristics of treatment in this material.
Diagnosis
It should be emphasized that currently, every third woman has a cause of infertility in the pathology of her endocrine system. As such, the diagnosis acts as a collective definition, which includes a violation of the mechanism of hormonal regulation of the cycle. Regardless of the cause of endocrine infertility in men and women, the basis of its formation is a violation of reproductive functions.
Causes of infertility: hypothalamic-pituitary dysfunction
The absence of ovulation, which leads to the endocrine form of infertility, can occur as a result of hypothalamic-pituitary dysfunction. Typically, such dysfunction can be observed against the background of traumatic brain injuries, with tumors of the hypothalamic-pituitary region, which is accompanied by hyperprolactinemia. The increase in prolactin secretion leads to inhibition of the production of LH and FSH by the pituitary gland, and also inhibits the functions of the ovaries, causing rare menstruation and the development of persistent anovulation along with endocrine infertility.
Hyperandrogenism
The presence in the female body of a small amount of androgens, which are male sex hormones, is necessary for puberty and the healthy functioning of the ovaries. Increased secretion of androgens can be produced by the ovaries and adrenal glands.
Often, hyperandrogenism in women is accompanied by polycystic ovary syndrome, which causes endocrine infertility along with obesity, hirsutism, bleeding and amenorrhea. Adrenal hyperandrogenism mainly develops due to hyperplasia of the adrenal cortex.
For what reasons can endocrine female infertility develop?
Thyroid disorders as a cause of infertility
The course of hypothyroidism with diffuse toxic goiter can often be accompanied by anovulation, and in addition, in this case secondary hyperprolactinemia, infertility, the inability to bear pregnancy and abnormalities of the fetus are characteristic. Often there is a deficiency of estrogen or progesterone. The lack of these sex hormones can contribute to an inferior secretory transformation of the endometrium and a change in the activity of the fallopian tubes, preventing the attachment of the fetal egg. This leads to the inability to bear the fetus or even causes endocrine infertility.
Obesity, which makes it impossible to conceive
Adipose tissue in the female body also performs an endocrine function and affects the metabolic process of the reproductive system. Excess body fat causes the appearance of hormonal imbalance along with menstrual dysfunction and the development of endocrine infertility. At the same time, limiting fat intake with a sharp loss in body weight can also disrupt the normal functioning of the ovaries.
Infertility of endocrine genesis can occur for other reasons.
Resistant Ovary Syndrome
The syndrome is based on a violation of the pituitary and ovarian connections, in the framework of which there is a lack of sensitivity of the receptor apparatus to gonadotropin, which stimulates ovulation, which manifests itself in the form of amenorrhea and infertility with developed sexual characteristics. Damage to the ovaries can cause infection with rubella, flu, and so on.
Premature menopause, mutation of the sex chromosomes as causes of infertility
Secondary amenorrhea, which occurs in young women under thirty-five years of age, can cause changes in the body characteristic of menopausal syndrome and lead to infertility.
In diseases caused by chromosomal abnormalities, there may be a deficiency of female sex hormones, which will be accompanied by sexual infantilism, primary amenorrhea and endocrine infertility.
Infertility symptoms
The main manifestation of this kind of infertility is the inability to get pregnant. Another symptom can be considered various deviations of the menstrual cycle. In this case, menstruation can come with delays from a week to six months, accompanied by soreness, copious discharge, or amenorrhea is possible. Often there may be spotting in the intermenstrual period.
In women with symptoms of endocrine infertility, the menstrual cycle is anovulatory in nature, and directly in its duration corresponds to normal menstruation - from twenty-one to thirty-six days. In such cases, they speak of menstrual bleeding.
Abdominal pain with this form of infertility
Patients may experience pain in the lower abdomen or lower back, with discharge from the genital tract along with dyspareunia and cystitis. Stress with severity in the mammary glands and galactorrhea associated with an increase in prolactin may also be noted. The syndrome of premenstrual tension is also typical, which manifests itself in a worsening state on the eve of menstruation itself. With hyperandrogenism, which accompanies endocrine infertility, acne may appear along with hirsutism, hypertrichosis and alopecia. In addition, pressure fluctuations with the development of obesity or weight loss can be observed.
This is affected by the endocrine factor of infertility. What is it now we know.
Pathology Diagnosis
As part of the collection of anamnesis in patients suffering from this form of infertility, the time of the onset of their menstruation along with profusion and soreness is specified. There are likely questions about the history (including the patient’s mother) of any menstrual dysfunction along with the length of the absence of pregnancy. In addition, it is important to find out the outcome and complications if conception nevertheless occurred. Among other things, you need to find out if any gynecological operations have been performed before. Information on the type and duration of contraception is equally important.
A general examination of the patient includes an assessment of her growth along with the presence of obesity, virilism, the development of mammary glands, and secondary sexual characteristics. A gynecologist is required to check, during which the shape with the length of the vagina is determined along with the condition of the cervix and appendages. Based on the data of a gynecological examination, the causes of endocrine infertility in women are clarified. They may turn out to be sexual infantilism with polycystic ovary and the like. Evaluation of the hormonal functions of the ovaries with the presence of ovulation in endocrine infertility is determined by applying the following functional tests:
- Test aimed at analyzing basal temperature.
- A urinal test to determine the possibility of ovulation.
- Ultrasonic monitoring of follicular maturation.
Temperature graph
The basal temperature graph determines the presence or absence of ovulation. The temperature curve shows the level of postovulatory production by the ovaries of progesterone, which prepares the uterine endometrium for subsequent egg implantation. The basal curve is built on the basis of the numbers of morning temperature, which should be measured daily in the rectum. During ovulatory cycles, the schedule is biphasic: on the day of ovulation, the temperature drops by 0.3 ° C, and in the second phase, which lasts about fourteen days, rises by 0.6 ° C compared with the normal value. An anovulatory cycle is characterized by a monophasic temperature curve steadily below 37 ° C.
Confirm or, conversely, refute the presence of ovulation can be done by determining the level of progesterone. In the anovulatory cycle, this indicator in the second phase is extremely low, and in the luteal phase it is reduced compared to the ovulatory cycle. Conducting an ovulation test makes it possible to determine the increase in LH twenty-four hours before it appears. Ultrasound monitoring helps to control the maturation of the dominant follicle in the ovary.
A reflection of the work of the ovaries is the condition of the uterine endometrium. In endometrial scraping, which was taken two days before menstruation, with endocrine infertility, hyperplasia of varying severity or secretory insufficiency is detected.
In order to establish the causes of such infertility, the level of FSH is determined along with estradiol, prolactin, testosterone and so on. A hormone test is given on the fifth day for several cycles. Conducting a hormonal test makes it possible to clarify the state of the reproductive system against the background of endocrine infertility. The mechanism for performing the tests consists in measuring the level of the patient’s hormones after treatment with certain stimulant drugs.
If there is a need to clarify the causes of endocrine infertility, an X-ray of the skull is carried out, ultrasound diagnostics of the thyroid gland and ovaries, adrenal glands. Diagnostic laparoscopy is also done. The diagnosis of the presence of endocrine inability to conceive women is established only after the male factor of infertility is excluded. In addition to this, there should be no pathology of the uterus and tubal infertility.
Treatment of endocrine infertility in women
What is the therapy? How effective will it be?
The first stage of treatment includes the normalization of impaired endocrine gland function. In this case, correction of diabetes mellitus is required along with obesity, adrenal gland activity, removal of tumors, and so on. In the future, hormonal stimulation of follicular maturation and the onset of ovulation is carried out. In order to induce ovulation, “Clomiphene” is prescribed. This drug causes an increase in follicle-stimulating hormone. Among pregnancies following such stimulation, in ten percent of cases twins and triplets are born.
In the event that pregnancy did not occur during six ovulatory cycles against the background of stimulation with Clomiphene, they turn to treatment with gonadotropins. But conducting therapy with these drugs can increase the incidence of multiple pregnancies along with the occurrence and development of multiple side effects.
Endocrine infertility treatment should be comprehensive. It is important to follow all the doctor’s recommendations to succeed.
In most situations, infertility can be amenable to hormonal correction, while in others, surgical intervention is required. For example, against the background of polycystic ovary syndrome, doctors resort to laparoscopic thermocauterization. After this procedure, women have a significant percentage of pregnancy: from 70 to 80% of cases, which is due to the exclusion of the formation of adhesions in the pelvis. Against the background of the endocrine form of infertility, which is weighed down by tubal-peritoneal causes, in vitro fertilization with transplantation of ready-made embryos into the uterine cavity is shown. It is important to remember that you should never despair.