Endocrine infertility in women and men: causes and treatment

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Endocrine infertility is a collective notion, implying a complex of disorders of the endocrine system. Pronounced hormonal imbalance in women causes lack of ovulation. Men have severely affected sperm quality. Pathology leading to reduced fertility, making conception unlikely

 

 

 

Causes of endocrine infertility in men

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Endocrine infertility is caused by dysfunction of the gonads (sex glands), the hypothalamic-pituitary axis or thyroid.

In women, the mechanism of hormonal regulation of the menstrual cycle can be disrupted at different levels, but in the end, one way or another, suffer from developing ovaries and anovulation.

 

 

 

 

 

 

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The main causes of endocrine infertility in women include:

  • dysfunction of the hypothalamus and (or) pituitary;
  • hyperplasia of the adrenal cortex;
  • hypothyroidism;
  • serious somatic pathology;
  • excess or lack of fat tissue;
  • the resistant ovary syndrome (savage syndrome);
  • early menopause (syndrome of the exhausted ovaries);
  • genetic mutations;
  • malformations of the reproductive glands;
  • damage to the gonads under the influence of some pharmacological agents;
  • polycystic ovarian.

besplodiePlease note! Hypothyroidism and hypothalamic-pituitary dysfunction is often accompanied by increased levels of prolactin in the blood (hyperprolactinemia).

Causes of hypothalamic-pituitary disorders, accompanied by hypersecretion of prolactin can be a brain tumor and traumatic brain injury. On the background of hyperprolactinemia decreased production by the pituitary gland and folliclestimulating luteinizing hormones (LH and FSH). As a result, there is inhibition of ovarian function. Developing oligomenorrhea or opalneria (lengthening of the menstrual cycle more than 35 days), and maturation of the follicle does not occur, making conception impossible.

Hyperandrogenism is observed in polycystic ovaries and hyperplasia of the outer layer of the adrenal glands. A certain amount of androgens needed female body to regulate functions of gonads, but their hypersecretion by the adrenal gland and (or) in the ovaries, leading to amenorrhea or oligomenorrhea. Hyperandrogenism accompanied by metabolic disorders (especially obesity) and hirsutism (a pilosis on man’s type).

Dysfunction, “thyroid”, accompanied by a decreased production of its hormones, a secondary cause excess prolactin. When this pathology of the endocrine glands often develop anovulation and infertility. Even if pregnancy does not exclude the miscarriage and intrauterine abnormalities.

Deficit of estrogen and progesterone negatively affects the endometrium endometrial (inner mucous membrane) and the fallopian tubes. Pathology prevents the attachment of the ovum, causing infertility or miscarriage.

Endocrine infertility cause malignant tumors of different localization, autoimmune disorders, systemic lesions of connective tissue, tuberculosis, and severe liver cirrhosis or hepatitis.

Adipose tissue affects the metabolism in organs and tissues of the reproductive system. Excess as a deficiency, leads to ovarian dysfunction and dysmenorrhea.

Please note! Fertility often suffers in young women who excessively keen on various restrictive diets or anorexic.

Savage syndrome is caused by disruption of communication between the pituitary gland and the female sex glands. The level of gonadotrophic hormones are high, but the ovaries insensitive to them due to damage after viral infections (including influenza and rubella), hypovitaminosis, stress or prolonged fasting. Secondary sexual characteristics in these patients are normally developed but revealed amenorrhea and as a result – infertility.

Early menopause is characterized by secondary amenorrhea in patients up to 35 years. When it developed changes characteristic of menopause, so conception does not occur.

There are diseases, which are caused by abnormalities of sex chromosomes due to their mutations. To the pathologies of this group include Turner syndrome and Marfan. They can lead to a deficiency of female hormones, the underdevelopment of the sexual characteristics and amenorrhea.

Causes of endocrine infertility in men

Endocrine infertility in male patients is most often caused by a lack of androgens or excess prolactin.

besploidieCauses of hormonal imbalance in men:

  • lesions of the pituitary gland (including tumor Genesis);
  • congenital hypoplasia of testicles (hypoplasia);
  • inflammation of the genital organs;
  • the effects of chemo – or radiotherapy.

Symptoms of endocrine infertility

The most important manifestations of the disease in men to be a deterioration in the quality of semen and the inability to conceive, and women – the inability to become pregnant and deviations according to the type of oligo – or amenorrhea.

Delays in monthly varies from 1 week to 6 months or more. In some cases, menstruation is absent. During the intermenstrual period, many patients notice bleeding in a small volume.

Almost a third of women with endocrine infertility cycle is within the boundaries of the norm (21-36 days). But ovulation is absent in this case, so in such situations it is customary to talk about menstruation, and about menstrualnopodobnoe bleeding.

Patients may develop the following symptoms:

  • discomfort during sexual intercourse (dyspareunia);
  • pain in the back or lower abdomen (pelvic area);
  • pathological vaginal discharge;
  • the feeling swollen breast;
  • galactorrhea (secretion of milk or colostrum that is not associated with the birth of a child);
  • a General deterioration in the condition before the arrival of menstruation.

Quite often in the background dysmenorrhea is a development of or exacerbation of inflammation of the bladder (cystitis).

When excess of male hormones appears acne (acne). There is excessive hair growth (hypertrichosis) or the appearance of body hair of male type (particularly on the face and thighs). In some cases, possible alopecia, i.e. baldness banal. Hyperandrogenism provokes instability of blood pressure and metabolic disorders (sudden weight loss or obesity). On the skin appear crimson “stretch” — stretch marks.

Diagnosis

The detection of endocrine infertility is of great importance, a detailed medical history. Patient find out the time of onset of menstruation, their frequency and profusion, and the presence of pain during menstruation (algodismenorrhea). Specified pregnancies and their outcome. Must take into account the fact of hormonal contraception.

The physical examination, attention is paid on the growth (rates < 150 cm or > 180 cm allow to suspect a hormonal imbalance) and possible signs of virilization or obesity. In addition, you need an objective assessment of the development of secondary sexual characteristics.

A survey of women includes a pelvic exam; be sure to specify the parameters of the uterus and vagina.

To establish the presence of ovulation are required:

  • urinary test pregnandiol;
  • a blood test for progesterone;
  • plotting the changes of basal temperature;
  • Ultrasound.

prichiny-endokrinnogo-besplodiyaOn the temperature curve, you can set the level of synthesis of progesterone in the second (postovulatory) phase of the cycle. To plot the patient should be in the morning every day to measure rectal temperature. In norm it is higher in the second phase (0.5-0.6 °C), and the day of ovulation is reduced by 0.2-0.3 °C. If the cycle is anovulatory, the figures kept at the same level (below 37 °C).

The day before ovulation in the blood increases concentration of luteinizing hormone.

When the release of the egg occurs, the indicators of blood progesterone and pregnandiol in the urine low.

Ultrasound scanning enables to identify the maturation of the dominant follicle.

For the study of the epithelial lining of the uterus (endometrium) for 2-3 days before the onset of menstruation take a sample of tissue by biopsy or scraping. If in the course of a laboratory study of the samples revealed secretory insufficiency or signs of hyperplasia, it allows with high probability to speak about endocrine infertility.

Within a few cycles on a 2-3 day hold hormone samples to determine the activity of the reproductive system components. Before sampling the material for analysis the patient will receive a stimulant medication.

Diagnostic importance of the following hormones:

  • folliclestimulating;
  • luteinizing;
  • prolactin;
  • thyroid stimulating;
  • estradiol;
  • testosterone;
  • dehydroepiandrosterone-sulfate;
  • tyrosine;
  • triiodothyronine.

To find out the true cause of the development of endocrine infertility, you may need an ultrasound scan of the adrenal glands and thyroid, as well as x-ray examination of the skull. According to testimony carried diagnostic laparoscopy.

laporoskopy

For diagnosis verification it is important to exclude infertility of the husband (or permanent partner), pathology of uterus and disorders of the immune system.

Men have primarily investigated semen. Determine the level of testosterone, prolactin, FSH and LH, and if there are signs of the feminization of estradiol. Interpretation of test results task of a specialist andrologist.

Treatment of endocrine infertility and forecast

Successful treatment of endocrine infertility is first necessary to eliminate the causes of its development. May require removal of neoplasms (particularly hormonally active and malignant) and pharmacological treatment of diabetes.

In the next phase of treatment is hormonal therapy, the goal of which is to stimulate ovulation in women or increase the quality of sperm in men.

Women diagnosed with polycystic ovaries is an indication for minimal invasive surgery – laparoscopic resection of tumors or their thermocautery. The second method is more preferable because it eliminates the development of adhesions, and increases the chance of pregnancy to 90%.

If, in spite of the treatment, pregnancy does not occur, resort to the procedure of in vitro fertilization (IVF). It entails the transfer to the uterus began to develop embryos.

To restore the reproductive function is possible in almost 80% of cases. More than half of patients diagnosed with endocrine infertility become pregnant during hormonal stimulation of ovulation.

The least optimistic forecast with hypothalamic-pituitary disorders.

After the establishment of the fact of conception, a woman is the control until successful delivery.

Plisov Vladimir, medical columnist