Infertility is an actual problem of modern women. Part 2

Endocrinological infertility is the second most common type of female infertility, accounting for about 20-40% of all cases of infertility. Failures in the work of the endocrine system, affecting the reproductive function, can occur at two levels: at the hypothalamic-pituitary level, and directly at the level of the ovaries. There are a huge number of pathological conditions that provoke a malfunction of the endocrine system. The tactics of treating endocrinological infertility is determined depending on what disease it was caused by. That is why a practicing gynecologist-endocrinologist needs to know and be able to differentiate such diseases from each other. Whether a patient with endocrinological infertility will be able to become pregnant, bear and give birth to a healthy child directly depends on the literacy of the doctor.

The main causes of endocrinological infertility in women

Endocrinological infertility or ovarian failure can be primary or secondary. With primary insufficiency, disturbances in the endocrine system occur even before the onset of puberty, therefore, the girl's menstrual cycle is not established and infertility develops in the same period. With secondary ovarian insufficiency, infertility develops against the background of a disease that leads to disturbances in the functioning of the reproductive system, previously functioning normally. Gene-chromosomal pathology is one of the leading causes that disrupt the endocrine system. Diseases such as gonadotropic hypogonadism, Shereshevsky-Turner syndrome, hermaphroditism and many other chromosomal pathologies can be the cause of ovarian failure. Increased androgen synthesis, and the virilizing syndrome they cause are also often the cause of ovarian failure. Against the background of hyperandrogenism, diseases such as adrenogenital syndrome, polycystic ovary syndrome, Morris syndrome and others develop. Hyperprolactinemia due to a decrease in the synthesis of dopamine in the hypothalamus, as well as a violation of the production of prostaglandins, are also common causes of endocrinological infertility. Recent studies suggest that the stress factor, so relevant at the present time, plays an important role in the disruption of the hypothalamic-pituitary-ovarian system, and, as a result, can cause infertility.

Hyperprolactinemia due to a decrease in the synthesis of dopamine in the hypothalamus, as well as a violation of the production of prostaglandins, are also common causes of endocrinological infertility. Recent studies suggest that the stress factor, so relevant at the present time, plays an important role in the disruption of the hypothalamic-pituitary-ovarian system, and, as a result, can cause infertility.

Hyperprolactinemia due to a decrease in the synthesis of dopamine in the hypothalamus, as well as a violation of the production of prostaglandins, are also common causes of endocrinological infertility. Recent studies suggest that the stress factor, so relevant at the present time, plays an important role in the disruption of the hypothalamic-pituitary-ovarian system, and, as a result, can cause infertility.

Diagnostic methods confirming endocrinological infertility

The choice of methods for diagnosing ovarian failure depends on the suspected disease that provokes such a condition. An important role is played by a well-collected obstetric history, a gynecological examination, as well as functional tests necessary for the doctor to find out if a woman's cycle is anovulatory. Determining the levels of pituitary and reproductive hormones, of course, is the most important moment in the diagnosis of endocrinological infertility. It is the levels of hormones that will indicate at what level of the endocrine system a failure has occurred. Instrumental studies help to visualize the pathology of the glands of the endocrine system: X-ray and ultrasound studies are widely used. With the help of endoscopic examination, it is possible not only to visually assess the pathological process, but also to biopsy the affected gland. Medical genetic counseling is mandatory in case of suspected chromosomal pathology.

Methods of conservative and surgical treatment of endocrinological infertility

>The treatment regimen for a patient with endocrinological infertility must be selected strictly in accordance with the established diagnosis. There is an erroneous opinion that endocrine pathology is treated only through hormone therapy. But hormones are just one of the components of the complex treatment of ovarian failure, and must be selected strictly individually. In case of hypothalamic-pituitary insufficiency, gonadotropic hormones are prescribed, in order to initiate ovulation - releasing hormones, in case of estrogen deficiency - estrogens, insufficiency of the luteal phase - progesterone. In case of confirmation of the anovulatory cycle in the patient, the use of the drug clomiphene citrate and its analogues, which produce an antiestrogenic effect and enhances the production of pituitary hormones, is recommended. Glucocorticosteroids have a positive effect in adrenogenital syndrome. Surgical treatment is used in case of detection of hormone-producing tumors and neoplasms of the endocrine organs. In addition, endoscopic ovarian surgeries are used, such as diathermocoagulation and thermocauterization. In the absence of a positive effect from all of the above methods of therapy, the patient is recommended to use in vitro fertilization.