Treatment of female infertility in Germany begins with diagnosis.
Diagnosis of infertility in women
Anovulatory cycles are cycles without ovulation.
Norma: The most common cycle length is 28 days, but an interval of 21 to 35 days is also considered normal. During this period, the female reproductive system undergoes various endocrine and morphological changes.
The menstrual cycle is conventionally divided into three phases.
Follicle maturation: under the influence of a specific pituitary hormone, the follicle containing the future egg matures, the egg undergoes development and maturation before being prepared for fertilization.
Ovulation: the process of the egg leaving the follicle,
The formation and development of the corpus luteum: the cavity of the burst follicle is gradually filled with cells containing a yellow-colored substance that produces the hormone progesterone, if the egg is fertilized, pregnancy will occur, if fertilization does not occur, the egg goes into the uterine cavity, where it is destroyed. The yellow body hormone delays the maturation of the next follicle and prepares the uterine mucosa for the embryo, the duration is usually 12-14 days.
Deviations: absence of menorrhea (amenorrhea) or irregular menstruation, most often resulting in a lack of ovulation. Other ovulation disorders are LUF syndrome.
Tests:
- basal body temperature;
- determination of ovulation by urine analysis;
- ultrasound (folliculometry);
- dynamic determination of hormonal balance by blood tests.
Treatment for female infertility in Germany includes: treatment or surgery to restore normal ovulation. If the first treatment is unsuccessful, a special treatment is carried out.
Specifically:
- replacement, increase or decrease in gonadotropin-releasing hormone (GnRH) secretion;
- replacement and activation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH);
- replacement and increase in serum progesterone levels during the luteal phase;
- in case of reduced ovarian reserves or early ovarian dysfunction, an in vitro fertilization program with donor eggs is used.
Cervical factors
Norma: in a normal ovulatory menstrual cycle, estrogens synthesize so-called granulosa cells, increase the amount of cervical mucus and change its characteristics. This allows sperm to travel easily and enter the woman’s reproductive system.
Deviations: The quality of cervical mucus is affected by birth defects of the cervix.
Cervical treatment: PAP (cryo treatment, laser treatment, conization) and the administration of specific medications.
Tests:
The cervical mucus test (PCT) evaluates the interaction between cervical mucus and sperm after sexual intercourse. In this test, cervical mucus is extracted and examined under a microscope.
The PH of cervical mucus is an important factor for sperm survival. Low pH values prevent sperm from passing this first physiological barrier in the female reproductive system.
Treatment: Hormonal and non-hormonal methods are used:
Bypass the cervix by intrauterine insemination;
Conservative treatment of infertility in Germany is carried out by discontinuing previously used medications and introducing other medications. For example: replacing SS (clomiphene citrate) with an aromatase inhibitor for ovulation induction.
The uterine cavity
Normal: a normal uterine cavity creates the conditions for a developing embryo
The uterine mucosa (endometrium) changes under the influence of estrogen and progesterone and prepares to receive the embryo.
Deviations: normal development of the endometrium is impeded by ovulation disorders or certain medications. Congenital anatomical abnormalities related to the uterine body or uterine cavity can also interfere with normal embryo implantation. Other negative factors are intrauterine adhesions from previous surgical procedures or tumor masses.
Tests:
Hysterosalpingography (HSG), ultrasound-guided hydrotubation (sonohysterography) and hysteroscopy.
Treatment:
Changing the type of medication used to induce ovulation, using additional hormone therapy that can improve endometrial development;
Surgical treatment of anatomical defects and pathologic changes in the endometrium and uterine body.
Adhesions in the fallopian tubes:
Norma: The main function of the fallopian tubes is to transport the fertilized egg to the uterus.
Deviations: Infertility is caused by factors that prevent the egg from advancing out of the tube while transporting the fertilized egg into the uterine cavity.
Tests: hysterosalpingography (HSG), ultrasound hydrotubation (sonohysterography), laparoscopy or laparotomy.
Treatment:
Surgical treatment — if there are small adhesions at the distal end of the fallopian tubes.
In vitro fertilization (IVF) has been the main treatment for infertility for the past 25 years.
Factors that can cause infertility:
- Presence of adhesions after surgery;
- The presence of adhesions due to a previous inflammatory process in the pelvis;
- Endometriosis (presence of uterine mucosal cells outside the uterine cavity). Endometriosis can be a cause of infertility, regardless of the presence of uterine patency, due to the release of specific local inflammatory factors from endometriotic lesions.
Diagnosis: the primary method is laparoscopy.
Treatment of fallopian tube adhesions:
- Surgery — to remove adhesions caused by endometriosis;
- Combined — surgery and medication;
- IVF is used when previous methods have failed.