Dr. Sun, I am 30 years old and my husband is 32 years old. We have been married for more than a year and have normal sex life. We have not used any contraceptive methods, but we have not been able to get pregnant successfully. What should we do?
Among the infertile patients, there are elderly couples, but there are also such young couples. When they first came to the hospital, they did not know their own health status, nor were they familiar with the hospital treatment process, often appearing confused and anxious.
Let’s talk about the medical guidelines for infertile patients.
Why check the man first?
Couples suffering from infertility and infertility should first start the examination from the man after the doctor has ruled out various obvious controllable factors (such as the frequency of sexual life) when they arrive at the hospital.
Because the man’s examination is simple, non-invasive and less painful, the man’s internal and external genital development is checked first, and after the development and sexual function are confirmed to be normal, the semen examination is followed. If the semen examination is OK, the man’s factor is basically excluded, and the woman’s factor can continue to be checked.
Infertility is not all women’s fault!
Many people are limited by traditional ideas and think that the inability to conceive and have children is a woman’s problem. The first reaction is to let the woman come to the hospital for examination. In fact, otherwise, the problem is probably the man.
Among the causes of infertility, the woman’s factor accounts for 40% ~ 55%, the man’s factor accounts for 25% ~ 40%, the husband and wife’s factor accounts for 20%, and the etiology is difficult to determine (including immune factors, abnormal egg quality and other reasons are difficult to diagnose) about 10%, so both husband and wife need to carry out examination together.
The woman is going to have a what test?
In infertility, the main causes of the woman’s infertility include reproductive tract malformation, inflammation, tumor, endometriosis and ovulation disorder. If everything is normal after male semen is detected, the woman should do the following examinations:
Routine gynecological examination: For example, leucorrhea examination can eliminate vaginal malformation, vaginal inflammation and cervical lesions.
Ultrasound examination: It can roughly check whether there are pathological changes in uterus, ovary and fallopian tube, and exclude uterine muscle, uterine malformation, ovarian cyst or tumor, polycystic ovary or fallopian tube hydronephrosis.
Ovulation examination: can monitor follicle development under ultrasound to see if ovulation is normal. If there is no ovulation, where does the pregnancy come from?
Endocrine examination: including various hormone examinations to understand ovarian reserve capacity (the function of normal ovulation), excluding hyperprolactinemia, hyperandrogenemia, thyroid dysfunction, etc.
Tubal patency examination: detect whether the fallopian tube is unobstructed, and determine the location of tubal obstruction, uterine malformation, submucosal leiomyoma, tubal tuberculosis, etc.
Antibody or chromosome examination: Check whether there are chromosome abnormalities, anti-endometrial antibodies, anti-sperm antibodies and anti-zona pellucida antibodies.
Endoscopic surgery examination: If the above examination cannot find out the reason, hysteroscopy or laparoscopic surgery can be considered to directly observe the pelvic cavity, uterus, fallopian tube and ovary for pathological changes or adhesions.
Check everything is normal, what should I do?
In about 10% ~ 20% of the cases, everything is normal after examination by both parties and the cause cannot be determined.
At this time, we generally suggest to adopt [artificial insemination] to assist pregnancy first. If you cannot get pregnant after repeated 3 to 6 times once a month, you can choose [test tube baby] instead.
Of course, the treatment plan varies from person to person, and the specific problems need to be analyzed. If it is an infertile patient over 38 years old with unknown causes, once the [artificial insemination] fails for 3 times, it can be directly transferred to [test tube baby].
If the patient has diseases, such as anemia, liver dysfunction or acute infectious diseases, and the physical condition is not suitable for pregnancy, we suggest to postpone the treatment of infertility and infertility until all aspects of physical quality are restored, and then carry out the treatment of infertility and infertility.
Artificial insemination or IVF?
If it is found to be the woman’s cause, then treat the specific cause directly, and then try natural conception or accept the following assisted reproduction methods.
What should I do if it is the man’s reason? Then the assisted reproduction method is usually directly adopted: artificial insemination or test-tube baby.
The most fundamental difference between artificial insemination and IVF is that the former’s fertilization site is still in the body, while the latter’s fertilization site is in vitro. If the woman’s fallopian tubes are unblocked, artificial insemination is generally selected, and if it is not unblocked, IVF is generally selected.
1. Artificial insemination
Artificial insemination refers to the artificial injection of treated semen into the woman’s reproductive tract during the ovulation period to help her pregnancy. It is divided into two types: artificial insemination with the husband’s semen or insemination with the donor’s semen.
The premise of both kinds of [artificial insemination] is that the woman’s fallopian tubes are unobstructed and ovulation is normal. Therefore, before [artificial insemination] is carried out, the woman is required to provide hysterosalpingography report and endocrine examination report.
If the woman’s fallopian tube is not unobstructed, hysteroscopic fluid drainage can be adopted to make the fallopian tube unobstructed. However, if the fallopian tube is still not unobstructed after treatment, it is recommended that the couple choose [test tube baby].
[IVF] is the common name of [in vitro fertilization and embryo transfer] among Chinese people. It is to take out eggs and sperm from both husband and wife’s bodies respectively, and embryologists fertilize sperm and eggs in the laboratory. The fertilized eggs are cultured in vitro, developed into embryos and then transplanted into women’s uterus.
According to different applicable situations, [IVF] can be divided into the first, second and third generations, respectively corresponding to in vitro fertilization-embryo transfer (IVF-ET), intracytoplasmic sperm microinjection (ICSI) and preimplantation genetic diagnosis techniques.
How to Avoid Hereditary Diseases?
If one of the spouses has chromosomal diseases, Or there are some diseases with high genetic possibility, Such as hemophilia, thalassemia, progressive muscular dystrophy, congenital adrenal hyperplasia, Or for patients with recurrent abortion of unknown reasons, the third generation [test tube baby] can be selected, that is, after the egg and sperm are combined in vitro to form embryos, healthy embryos are screened out by advanced gene detection technology, and then transferred to the uterus, so as to avoid the birth of children with hereditary diseases as much as possible, reduce the risk of abortion and improve the birth rate of healthy babies.
What needs to be reminded is that even after this kind of pre-implantation screening, routine prenatal examination cannot be ignored.
It is impossible to rush to the doctor for illness.
With the full opening of the two-child policy, many older couples are stirring up. It can be imagined that many couples who want to give birth but cannot give birth will join the ranks of seeking treatment for infertility.
However, the examination of infertility is complicated, some of which are invasive and some are closely related to the experience and level of the operating doctors. Therefore, if there is a need for treatment, it is necessary to find a regular hospital, preferably a special reproductive medicine center, to screen step by step according to the process, and to make an accurate assessment before performing the examination according to the symptoms.
If you are not sure which hospital is good at this kind of problem, you can download [Doctor Clove App] and directly search [Infertility] to see the hospitals in your city with strong comprehensive strength on infertility.
To be honest, our traditional Chinese concept attaches great importance to marriage and children. Infertility is a piece of [fat meat]. Many irregular small hospitals focus on related projects. After going there, they are likely to be fooled, starting with the most painful and expensive examination.
Finally, don’t believe what folk prescription, only clear diagnosis can symptomatic treatment be carried out, otherwise the waste of money is small, the birth time is delayed and even the body is injured, which is really not worth the cost.
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