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Unexplained Infertility – What is it?
Background
definition of unexplained infertility. Infertility cases in which a standard test of infertility is not a cause for the missing
The definition of “standard test” is not accepted by all experts in design found. Unexplained infertility is also called idiopathic infertility. Medical studies have shown that 0-26% of infertile couples have unexplained infertility. The figures are reported most often 10-20% of infertile couples. However, these percentages are derived from studies in which all women had laparoscopic surgery study is no longer in the routine assessment of fertility is why we can not do all the causes of infertility, which we are accustomed. – Rental and more couples in the unexplained category. The current rate of unexplained infertility is probably about 50% for couples with a female partner aged 35 years and about 80% in 40 years (see below the age of the woman Matters).
Actually, there are probably hundreds of “causes” of infertility. What this means is that there are many things that need to be designed to achieve perfection and a baby As a simplified example.hormones that stimulate egg development in the brain and the pituitary gland to be done and published properly, the egg must be designed and normal chromosomal The egg has grown to maturity of the brain must be a sufficient increase in the hormone LH survival should stimulate release of the final maturation of the oocyte follicle The rupture and the release of follicular fluid, the tube and the egg has to “pick up” egg, sperm must have its short visit to the vagina, enter the cervical mucus, swim up the fallopian tubes and see “Why must sperm be able to exist by the cumulus cells around the egg and bind the shell (zona pellucida) to the egg, must sperm undergo a biochemical reaction and release their DNA package (23 chromosomes) in the bud, the fertilized should share the egg must share the ability to early embryo further and develop normally after 3 days, the tube should have performed the embryo in the uterus, the embryo must hatch continues in developing blastocyst, the blastocyst must be out of his shell, the endometrial lining of the uterus to develop properly and hatched blastocyst, the endometrium must be receptive and the “implant” Many more miracles in the embryonic development of the eating and Early fetal must follow …
A weak link in the chain can this error
The list above is very simple design, but the point is made cause. There are literally hundreds of molecular and biochemical events that function properly in order to develop a pregnancy. The standard scratch tests for infertility barely at the surface and are really only looking for very obvious factors are those such as blocked tubes, abnormal sperm, the regularity of ovulation, etc. These tests are not related to molecular questions at all. It is still for the future … 2
The causes subtle fertility have been proposed in which the underlying unexplained infertility are follows3
ovarian and endocrine factors
reduce the secretion of growth hormone sensitivity /
cytologic abnormalities in oocytes
genetic abnormalities in oocytes
Antibodies against
From Antichlaydial
tubal factors
abnormal peristalsis or activity cilliac
abnormal T-cells and natural killer cells Cervical factors Altered cervical mucous increased immunogenicity General immune factors Altered cell-mediated immunity Human Factors abnormal head morphology Ultrasructural Embryological factors The poor quality of embryos reduced progression to blastocyst
Women are born with
number of eggs, and if they begin to reach menarche they release the eggs in cycles. Ageing woman they have exhausted it eggs and egg products quality will be poor and therefore the likelihood of a diagnosis of unexplained infertility in women significantly increased 35 and older -. and significantly increased among women on 38th Since we do not have a “standard class” referred to the egg infertility, couples sometimes “inexplicable” in the category of infertility is. Most women over 40 who are trying to become pregnant, it will be difficult, and fertility over 44 years is rare – even in women who ovulate regularly each month. The fact is that the female partner, the more likely it is a problem caused the egg fertility problem. Unfortunately, there is currently no specific test for “egg quality” .2
unexplained infertility and mild endometriosis
chance to get pregnant -. Without the proper treatment of fertility problems – for couples with unexplained infertility
The duration of infertility, the infertility is important if the couple is by design .. 5 years infertility couples with unexplained infertility is less than 10% chance of success on their own.
‘s options for the treatment of unexplained infertility
Stimulation of the ovaries and / or intrauterine insemination (IUI)
IUI vs. timed traffic – no drugs in the game
showed studies that the likelihood of pregnancy “with intrauterine insemination versus time sexual intercourse increased
p. > Clomid and time intercourse
Glazener et al. 100women contracts, of which 43% porous, with either 100 mg clomid day 2-6 and placebo in a randomized cross over study. Overall, there was a 50% increase in pregnancy rates after three treatment cycles. Benefit was after 3 years of infertility and parks in the same study showed that it had no idea women.The observed in women over 35 years 5 These results suggest that these women are not candidates for the treatment clomid and must aggressively methods in vitro fertilization treatment.
more Clomid IUI
treatment with tablets of Clomid more IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, success rates per month more Clomid insemination is about 10% per cycle. The pregnancy rate can be up to about 3 trials and the success rate is much lower then.
Deaton et al A randomized time sexual intercourse or IUI with clomid and showed that the monthly fertility was 9.5% in most clomid IUI compared with the control group a significant difference.6-The same study shown, there was no difference in the number of follicles between conception and non conception cycles, suggesting that insemination components have a greater impact than the Clomid on the results, but success rates are higher when both are used together.
installation of all studies and a recently published systematic review Hughes et al. reported that the treatment is superior to clomid with no treatment or placebo (95% CI 1.5 to 4.65) 0.7
gonadotropin injection and Reports
<> This is studied less extensively. But a study by Maschke et al have shown that superovulation with gonadotropins significantly increased the pregnancy rate in unexplained infertility.8
gonadotropin injection (shots of the hormone FSH) and IUI
Several studies have shown
improved success rate of pregnancy with FSH injections and IUI treatment compared with no treatment. A meta-analysis showed that more Hughes9 FSH IUI increases the pregnancy rate of 2 to 3 times more compared to timed intercourse FSH.
It is likely that the two super-ovulation and IUI independent potential increase in fertility, with relatively greater benefits from the fertility component IUI. Assisted Reproductive TechnologiesIVF
In-vitro fertilization (IVF) has high success rate in young women with normal ovarian reserve (normal FSH) and unexplained infertility. Most couples with unexplained infertility with a female partner aged 35 years, the artificial insemination about 3 and when not to try to get pregnant, it is advisable to IVF. was offered on the other side of the women over 35 years through IVF as first-line treatment.
GIFTintrafallopian transfer Gamat goes further than superovulation / IUI, because it belongs to the collection of eggs and sperm in the fallopian tube. The main disadvantage compared to IUI, the need for laparoscopy and complex arrangements of ovarian stimulation. be compared with the main advantages of IVF GIFT, that the opportunity for fertilization studies, the possibility of the best quality embryos transferred into the uterus and there are also some with excess fertilized eggs for future use cryo be stored. P
A large randomized multicenter study by the European Society of Human Reproduction and Emryology conducted to compare five treatments for unexplained fertility. The study found that there was no significant difference between the results of it. (Super ovulation cycle by 15%, 27% GIFT28 super ovulation superovulation / IUI 27%,%, IVF26% 10
In summary, the strategic management of unexplained infertility should be on the effectiveness of focus, the method of cost-effectiveness and invasiveness of the procedures involved. evidence that there are little or no benefit when treatment begins with a woman under 35 years. Therefore, it is useful to superovulation review and / or IUI for 3 cycles after 3 years of infertility, and in case of failure to go the IVF. But for older women (over 35) to consider IVF immediately.
is
1. Hull MGR, Glazener CMA, Kelly NJ et al (1985), population study of the causes,
http; .. / / www.advancedfertility.com / unexplain.ntm (accessed 11 / 03/2008)
3 Adam, HB & Howard, SJ, .. (2003), infertility in practice, Churchill Livingstone, London.
5 Glazener CMA, Coulson C, Lambert PA et al (1990), treatment of women with clomiphene unexplained infertility. controlled study versus placebo and hormonal responses conception rate Gynecol Endocrinol. 4: 75-83
7 E Hughes, J Collins .., P & Vandekerchhove (2002), clomiphene citrate for infertility in women unexplaine Cochrane Database of Systematic Reviews, Issue 1, 2002
8 L Mascarenhas, G Khastgir, Davies WAS & Lee S (1994), and superovulation reported time …: it can be a useful alternative for those who can not afford Aided Design Hum Reprod offer 9: 67-70
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