Endocrine infertility is the result of a whole complex of hormonal disorders that lead to irregular ovulation or their total absence in women. In men, this pathology is manifested by a violation of spermatogenesis and a decrease in the quality of sperm. At the heart of endocrine infertility are violations in the functioning of the thyroid gland, hypothalamic-pituitary system, gonads.
Timely treatment of such disorders in the body leads to the onset of a desired pregnancy in 70-80% of all cases of endocrine infertility. Otherwise, the only way to achieve successful conception of a child is the method of in vitro fertilization. The choice of the method of infertility treatment is decided only after a full survey of the spouses. It is important that both spouses complete the examination and analyzes. And since they can be identified various causes of violations of the functions of the reproductive system, the treatment usually begins with those reasons that are of paramount importance for conception.
Therapy of endocrine infertility should be differentiated and selected individually. Criteria for choosing a method of treatment are: the causes, the duration of infertility, the presence of concomitant diseases.
Insufficiency of the luteal phase
One of the causes of the violation of ovulation. This pathology is accompanied by inadequate functioning of the yellow body, resulting in secretory changes in the endometrium. In other words, such an endometrium is unsuitable for ovum implantation. Pathology can develop for various reasons: due to thyroid dysfunction, functional hyperprolactinemia, chronic inflammation of the genitals, hyperandrogenism. Almost always, treatment begins with the use of estrogen-progestogen, which helps to achieve ovulation. Usually monophasic combination preparations are prescribed. The duration of their reception is 3-5 cycles. In the future, it is possible to conduct treatment using direct stimulants of ovulation.
In the absence of a positive effect, preparations containing gonadotropic hormones (menogon, humegon) are included in the treatment regimen, and chorionic gonadotropin is administered in an ovulatory dose under ultrasound guidance. If the insufficiency of the luteal phase is a consequence of hyperprolactinemia or hyperandrogenism, then ergot alkaloids or dexamethasone (norprolac, parlodel) are additionally prescribed.
Syndrome of chronic anovulation
This pathology can be caused by endocrine diseases such as hyperprolactinemia of non-tumor and tumor origin, polycystic ovary syndrome, hyperandrogenism of adrenal origin, hypothalamic-pituitary dysfunction, as well as a syndrome of resistant ovaries or a syndrome of depleted ovaries. The purpose of treatment for such disorders is to stimulate ovulation. In the case of polycystic ovary syndrome, the effect of inhibition is first achieved, and then ovarian stimulation is stimulated using gonadotropin or anti-estrogen preparations. The duration of therapy with hormones is 3-5 cycles. In the absence of a positive effect, surgical intervention is performed in the form of wedge resection, bilateral ovarian biopsy, and electrocautery of the ovaries. These operations are performed by laparoscopic access.
With early exhaustion of the ovaries and with the development of resistant ovaries, stimulation therapy is ineffective. Therefore, infertility treatment is carried out using a donor egg on the background of substitution therapy, which was made possible through the introduction of in vitro fertilization and embryo transfer technology into medical practice.
In medicine there is an opinion that 100% success in the treatment of hormonal infertility can be expected with a correctly diagnosed pathology and in cases where the violation of ovulation is caused by a single cause in the family. But in practice this indicator is somewhat lower and is about 60-70%.