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Surgery and medications are options in the treatment of infertility

Surgery and medications are options in the treatment of infertility

There are several types of treatment for the same patient, however always one of them is the most indicated. Usually, it starts at least complex when there is this possibility. The best treatment is one that corrects the change that is compromising fertility in the simplest way possible. Thus, many patients benefit from clinical treatment with antibiotics or ovulation inducers.

It is clear that treatment will only work if the rest of the basic research is normal. The clinical picture and diagnosis should always be taken into account to determine the best treatment. In this context, the age of the patient is of extreme relevance: the younger (less than 30 years) can wait for longer treatments; the elderly (over 35 years old) have an urgent need for a positive result.

The treatment can be clinical or surgical, we have the option of assisted reproduction. The first two may have immediate results, but in general they take months, for although there is apparently nothing wrong with the patient, it can only be said that the treatment did not work out at the end of a time of observation and attempts, usually one year. So the use of clinical and, especially surgical, treatments in older women is well considered by the risks of being "wasted" a precious time that she does not have. On the other hand, assisted reproduction is not the best indication for all patients.

Clinical treatment

Hormonal changes are usually resolved with clinical treatment. Patients who do not ovulate can become pregnant with hormone administration. They may present micro-polycystic ovaries. The simplest medicine is clomiphene citrate (Clomid, Indux, Serophene), which causes the growth of follicles that release the eggs in the middle of the menstrual cycle. Ovulation can also be promoted with the use of gonadotrophins (Gonal, Puregon, Menopur, Gonadopin, among others), which stimulate the ovary more vigorously, so it must have strict medical control.

Illustration of a micro- polycyclic and follicle in another ovary - photo: Joji Ueno

Uncontrolled administration can lead to ovarian hyperstimulation, causing life threatening or insufficient response. Ultrasound and / or hormonal dosing is required. The other clinical treatments aim to adapt other hormones that interfere with reproductive physiology or to heal genital infections with antibiotics or vaginal creams.

Surgical treatment

Surgical treatments are aimed at facilitating the spermatozoon with the ovum or allowing embryo implantation in the uterus, as well as its development. Therefore, the purpose of surgeries is the functional and anatomical recovery of pelvic organs and nearby structures. The surgery must be done by a trained professional, because in a second surgery the success rate is very small, compromising the fertility definitively. One should choose a professional with experience in surgery to promote fertility.

Currently, laparotomy (conventional surgery using incision similar to cesarean section) is rare. Most surgeries can be performed by gynecological endoscopy (diagnostic and therapeutic technique). Laparoscopy reversal is performed by laparotomy and micro-surgical technique and achieves pregnancy in women with no other cause of infertility by up to 80-90%, so it is still the preferred access route for most specialists. Video-laparoscopy and robotics may be alternatives. But, they add no greater success than laparotomy in the reversal of tubal ligation and are generally more costly, in addition to fertilization gynecologic endoscopy may be diagnostic or therapeutic and refers mainly to laparoscopy and hysteroscopy. Laparoscopy: performed at the operating room, under general anesthesia. An optic is inserted through the umbilical scar, after a scalpel incision in the local skin, so as not to compromise the umbilical aesthetics. This optic, which has a diameter of 1 cm, allows the transmission of the image to a colored monitor (videolaparoscopy). In addition to the close examination of the internal genital organs, it allows the performance of several surgeries in a minimally invasive manner, that is, with less aggression to the organism than the cut of the abdomen (laparotomy). With two or three more holes near the pubic hair, practically all surgeries for fertility restoration, such as tubal plastic surgery, can be performed. This consists of the morphological and functional recovery of the tuba. Laparoscopy, with advantages, treats endometriosis, adhesions, various tubal abnormalities and fibroids.

Diagnostic hysteroscopy: it is usually done in the office (ambulatory), it allows to examine in detail the color of the interior of the uterus. A thin optic is introduced into the uterus through the vagina and the image transmitted to a colored monitor.

Surgical hysteroscopy: it is done in the operating room. With this technique they are able to remove submucosal myomas, polyps or perform lysis of sinecy (intrauterine adhesion) and septoplasty (treatment of intrauterine septa). Synechiae and septa are different as to etiology, but resemble each other in the form of treatment. Both are communications between the uterine walls, that is, they become united, reducing the internal space.

Some common causes of infertility

Application of insulin - image: Joji Ueno

Endometriosis

Tissue similar to that of the inner lining of the uterus that is implanted in other places . They can be located in the film that lines the inside of the abdomen, manifesting as reddish spots, white or black. Even small lesions can lead to infertility due to the production of substances that impair the normal functioning of the reproductive system.

They can progress leading to severe adhesions, causing agglutination of local organs, making it difficult to obtain naturally. Endometriosis can be located in the ovaries and cause cysts to appear containing chocolate-like material (endometrioma). These cysts may be small or reach several centimeters in diameter. The disease can cause pain and infertility due to distortion of the local anatomy or producing substance that makes conception difficult. The severity of this disease is not always related to infertility or pain. Sometimes minimal endometriosis may be accompanied by severe symptomatology or infertility, and advanced forms may be asymptomatic. Surgical treatment consists of the removal of lesions or their laparoscopic cauterization, lysis of adhesions or excision of endometriomas.

Pelvic Adhesions

Pelvic Adhesions - Image: joji Ueno

Agglutination of organs located in the lower abdomen. They can be derived from infections that attack the structures locally and, in the healing process, determine the distortion of the local anatomy. Other causes of adhesion are endometriosis and previous surgeries. Adhesions may lead to isolation of the ovaries, preventing access to the tubas, tubal deformities and even complete tubal occlusion; with surgery, lysis of adhesions and pelvic reconstruction are performed to restore functionality. However, it is important to emphasize that they can be reworked in a number of patients, so the surgeon must attend to the details to minimize this recurrence, which, however small, may impede conception.Tubas alterations

Hidrossalpinge - image: joji Ueno

The tubas serve as a pathway for the spermatozoa to the encounter with the ovum, as well as an "incubator" for pre-embryos in the first days after fertilization. There is local production of liquid that provides nutrients for the pre-embryo, until its arrival inside the uterus, culminating with implantation in 5 to 7 days after fertilization. Other times the accumulation of fluid inside the tuba due to infections or local traumas may cause accumulation of fluid (hidrosalpinge), making the tuba irrecoverable and difficult to implant after transfer of pre-embryo in the in vitro fertilization, caused by the embryo- toxicity of the damped liquid within the tuba. The tubas can also distort by virtue of local adhesions, compromising their function. Laparoscopy makes it possible to remove the excessively damaged tube or its recovery through plastic surgery.

Uterine myoma

Uterine fibroids - image: Joji Ueno

A benign tumor of the uterus that appears in the uterine wall. Surgery is indicated if it is symptomatic or causes complications. It was not often easy to determine if it really is the cause of infertility. But if so, it should be withdrawn. Removal of myoma (myomectomy) should be done by a competent professional due to the risk of bleeding, local damage that can lead to adhesions or rupture of the uterus during pregnancy. Therefore, laparotomy and myomectomy with microsurgical care may be a more interesting option than laparoscopy.


Marilene Saade receives discharge and recovers at home

Marilene Saade receives discharge and recovers at home

After spending more than 20 days in the São Vicente Clinic in Rio de Janeiro, due to complications in surgery to remove the uterus , Marilene Saade was discharged on Sunday (23) but should continue treatment at home. Actor Stênio Garcia's wife suffered from Acute Respiratory Distress Syndrome (SARS), an acute lung injury caused by several disorders that cause "I'm very weak and tired, I could not stand the hospital any more, so I asked the doctors to recover at home, after leaving the hospital.

(Family)

Is it possible to get pregnant by taking the contraceptive pill?

Is it possible to get pregnant by taking the contraceptive pill?

The contraceptive pill is one of the most common contraceptive methods. However, its effectiveness is not 100% and therefore, any woman is at risk of becoming pregnant, even taking the medication regularly. In addition, some factors may contribute to changing the efficacy of the pill, increasing the risk of gestation.

(Family)