FEMALE INFERTILITY AND ASSISTED FERTILIZATION

Fecondazione assistita

Female infertility is defined in the medical sphere, as the inability become pregnant after one year of unprotected regular sexual intercourse and the inability to successfully complete a pregnancy. Infertility is classified as primary when history shows no previous pregnancy and as secondary when it occurs after at least one pregnancy. One out of five couples at a fertile age suffers this condition permanently or at least temporarily.

assisted medical reproduction

At Centro Italiano Fertilità e Sessualità in Florence, the first level techniques of assisted fertilization and reproduction are performed in cases of female infertility. These simple, uninvasive basic techniques include monitoring and stimulation of ovulation, and insemination.

This is a series of examinations and ultrasounds designed to monitor the growth of the follicle and check whether ovulation occurs or not. In the case of irregular ovulation, the administration of drugs to stimulate ovarian activity would then follow. Finally, with insemination, which is the most common first level technique of assisted reproduction, sperm is introduced into the woman's body to facilitate the meeting with the oocyte.

Main causes of female infertility

Tubal problems

Internal genital tract infections can lead to pelvic adherence and scar tissue residue that alters the structure of the tubes or causes imperviousness. There are several agents involved (bacteria, mycoplasmas, chlamydia) and sometimes the infection is asymptomatic. Common vaginal infections do not generally cause pelvic inflammation.

Examination to Identify Tubular Problems:

  • Isterosalpingography: a radiographic examination performed with a contrast medium showing the uterine cavity, the progression and the patency of the tubes
  • Sonography: Ultrasound examination by injecting an ecopac liquid through the uterine cavity and tubes.
  • Laparoscopy: Optical fibers introduced into the abdomen give you direct line of sight to be able to judge the condition of the tubes and pelvis.
Therapy: Tubular Surgery and microsurgery for the rebuilding or repair of altered tubes; only suitable in some cases. By bypassing the tubes, in vitro fertilization inserts the embryos directly into the uterus.

Endometriosis

Endometriosis is defined as when the endometrial zone (the mucous membrane that usually covers the uterus) is located outside the uterine cavity, generally in the tubes, ovaries or pelvis.

The tissue suffers from hormonal effects and tends to bleed during the menstrual period. This blood tends to create areas of irritation and consequent scar trauma.

Examinations for identifying endometriosis: Although in some cases it can be diagnosed through ultrasound, a certain laparoscopic diagnosis can provide a direct view of the pelvis.

Therapy: Surgical treatment and treatment with drugs that limit or inhibit the formation of endometriosis.

Ovarian problems

Very irregular menstrual cycles may be a warning sign of a situation where ovulation is rare and absent. A woman who does not ovulate generally is in a situation of amenorrhea, that is, absence of menstruation. Ovulation control is very complex and therefore the cause of this lack of ovulation may be at the pituitary, hypothalamus or ovarian level.

Examinations to identify anovularism: hormone doses (FSH, LH, estrogens), monitoring of ovulation performed with repeated ultrasound and hormone doses.

Therapy: Appropriate medication to induce ovulation.

Hormonal problems

Alterations in the functioning of the thyroid, the adrenals, the pituitary and the hypothalamus may cause altered ovarian function.

Examinations to identify hormonal problems: basal or dynamic evaluation of the function of the various glands.

Therapy: specific treatment depending on the dysfunctional gland.

A particular picture of ovulation problems is represented by the syndrome of the mycophenetic ovary (Stein-Leventhal syndrome). In this situation, ovaries tend to be larger than normal and have many small cysts. There is often a change in the menstrual cycle and sometimes a tendency towards obesity and hair growth caused by hormonal imbalance.

Examination to identify polycystic ovaries: ovarian ultrasound and hormone doses.

Therapy: Introduction of drugs to induce regular ovulation.

Malformations or Uterine Alterations

There may be congenital alterations of the uterus where it is split in two, either fully or partially, through a septum.

Acquired alterations include fibroids that interfere with fertility only when they are large or when they occupy the uterine cavity.

Uterine problems do not always result in sterility; more often they cause problems during pregnancy.

Examination to identify malformations or alterations of the uterus include: gynecological examination , hystrosalpingography, hysteroscopy, ultrasound.

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