Anovulatory infertility

Description:

In 10-20% of cases lack of an ovulation at the woman is the reason of infertility. Disturbances of an ovulation can be caused by the pathology of a hypothalamus leading to disturbance of secretion of gonadotrophins or a direct injury of a hypophysis with deficit of gonadotrophins.

Symptoms of Anovulatory infertility:

Anovulation can be shown by absence or an irregularity of menstrual cycles. In some cases anovulation can meet also at rather regular cycles, and then only on certain clinical signs it is possible to suspect pathology of an ovulatory cycle (absence of premenstrual pains and tension in mammary glands, abdominal distentions, changes of mood; disturbance of the schedule of basal temperature).

Reasons of Anovulatory infertility:

The ovarian reasons of anovulation include early exhaustion of ovaries (lack of oocytes) and a syndrome of polycystic ovaries.

Reasons of anovulatory infertility:
    * I type (hypothalamic and pituitary diseases). The main reasons - loss of weight, general diseases, a heavy exercise stress, a stress, a tumor, a hypophysis heart attack, an injury, hemorrhage. Products of estrogen are lowered. Progestagena do not cause bleeding of "cancellation". Treatment is carried out with use of LG and FSG. The forecast for fertility recovery - favorable. If the anovulation reason - the prolaktinoma, treatment carry out by agonists of dopamine receptors.
    * II type (syndrome of polycystic ovaries). Anovulation in combination with ultrasonic signs of polycystic ovaries or a giperandrogeniya. It is often combined with insulin resistance syndrome. Excess products of estrogen are characteristic. Progestagena usually cause bleeding of "cancellation". Induction of an ovulation is carried out by means of anti-androgens or FSG the Forecast for recovery of fertility depends on weight of a state.
    * III type (premature exhaustion of ovaries). Lack of the ripening follicles in ovaries against the background of raising of FSG Products of estrogen are lowered Progestagena do not cause bleeding of "cancellation". The forecast for recovery of fertility bad (there is no effective treatment; sometimes there are spontaneous ovulations).

Treatment of Anovulatory infertility:

Treatment of the endocrine infertility connected with an amenorrhea or with DMK is directed to elimination of this or that pathological syndrome. At infertility because of a giperandrogeniya and various extragenital diseases at first treat a basic disease.

Treatment of anovulation is carried out on one of the following schemes:

Treatment by Clomifencitratum is applied in case the reasons of female infertility is an endocrine factor. Apply at anovulation with the high and normal level of estrogen, and also at insufficiency of a yellow body. Drug is appointed on 50 mg/days within 5 days, since 5th day of a menstrual cycle (the first course), by the subsequent two courses — on 100 and 150 mg at the same time. If during the second year there are hyper stimulation phenomena (increase in ovaries, pain in the bottom of a stomach, a nagrubaniye of mammary glands), the dose of drug is reduced twice. After a 3-month break treatment can be repeated.

Treatment by Clomifencitratum and chorionic gonadotrophin. Clomifencitratum is appointed on 50 mg/days from the 5th to the 9th day of a menstrual cycle (the first course); the subsequent two courses — on 50 mg/days in the same time, then for the 10, 12 and 14 day enter a chorionic gonadotrophin on 1500 PIECES intramusculary.

Treatment by gonadotropic hormones. It is shown at excretion of estrogen not less 70th nmol/days, absence or weakening of function of a yellow body. The chorionic gonadotrophin is appointed to the 10, 12, 14 and 16 day of a menstrual cycle on 1500 PIECES within 2 — 3 months. At decrease in content of estrogen the combined use of a menopauzny and chorionic gonadotrophin is recommended. The Menopauzny gonadotrophin is appointed on 75 PIECES daily within 10 days from the 5th to the 14th day of a menstrual cycle, and a chorionic gonadotrophin to the 15, 17, 19 day on 1500 PIECES. Efficiency of action of a menopauzny gonadotrophin is estimated on cellular structure of a vulval smear (by 14th day of superficial cells there have to be not less than 70%, phenomena of a pupil and a fern — 3 points). At lower results of functional trials the drug dose at the second year of treatment can be doubled. Treatment is carried out during 2 — 3 menstrual cycles. Treatment by synthetic protestina is applied at a sufficient oestrogenic saturation. Appoint one of two-component drugs within 3 — 4 months on 1 tablet daily from the 5th to the 25th day of a menstrual cycle.

Treatment by estrogen (shock doses) is used at sufficient or a little reduced oestrogenic saturation: 5 mg of oestradiol of Dipropionas or 2 ml of 0,1% of solution of hexestrol enter intramusculary on 12 — the 14th day of a menstrual cycle (once). Treatment by estrogen and progesterone. Shock doses of estrogen (5 mg of oestradiol of Dipropionas or 2 ml of 0,1% of solution of hexestrol enter from 20 mg of progesterone on 12 — the 14th day of a menstrual cycle once. Course of treatment 3 — 4 cycles.

At an insufficient oestrogenic saturation on 12 — 2 ml of 0,1% of solution of hexestrol from 10 mg of progesterone, and on 18 — the 19th day of a cycle — 2 ml of 12,5% of solution of pregnenoldione of a kapronat enter the 13th day of a menstrual cycle. Course of treatment 3 — 4 cycles.

Treatment by progesterone is recommended only at substantial increase of an oestrogenic saturation (excretion of estrogen more 90th nmol/days); 2 ml of 12,5% of solution of pregnenoldione of a kapronat enter once intramusculary on 19 — the 20th day of a menstrual cycle. Course of treatment 3 — 4 cycles. In the presence of an ovulation, but insufficient function of a yellow body of 1 ml of 12,5% of solution of pregnenoldione of a kapronat enter for the 15th and 20th day of a menstrual cycle.

Treatment of endocrine infertility at a giperprolaktinemiya is identical to that at a syndrome of a galactorrhoea and an amenorrhea.