1- Laboratory challenges in diagnosing female infertility (Part 1 - Early definitions)

1- Laboratory challenges in diagnosing female infertility (Part 1 - Early definitions)

Definition of infertility?

In Medicine, If a couple does not have children at the age of fertility (and the age of the woman is less than 35 years) 12 months after marriage, despite having normal, frequent sexual activity and without the use of contraceptives, one of the couples is infertile and the initial assessment for Fertility begins in the couple.

Between the ages of 35 and 40, this time is reduced to 6 months.

The following assessments for infertility begin immediately in less than 6 months:

1- Women 40 years or older

2- The existence of a known clinical cause of infertility or the existence of a history of an infertility underlying factor such as:

- Menstrual disorders (oligomenorrhea / amenorrhea)

- Advanced endometriosis

- A history of a severe pelvic infection

- Family history of early menopause

- History of ovarian surgery or extensive pelvic surgery

- Premenstrual ovarian failure sign

- History of recurrent miscarriage

- Anatomical insufficiency in the genital system

- Women with a history of chemotherapy or radiation therapy

- Women with known disorders in the uterus or fallopian tubes

- Smoking women

- History of testicular surgery, adult mumps, impotence or sexual dysfunction, chemotherapy or radiotherapy in the husband. .

Infertility in humans can be of paternal origin such as varicocele and azoospermia, or of maternal origin such as Turner syndrome, ovarian asthenia, Asherman's syndrome (a condition characterized by adhesion or fibrosis of the uterine endometrium). Uterine curettage or miscarriage often occurs several times). .

It should be noted that infertility does not mean not producing gametes, but the inability to give birth to a live baby, for example, in men with the disease who have the potential to produce sperm after a vasectomy, but in practice cannot have children.

The same is true for women who do not have a congenital uterine rupture and have a fallopian tube rupture after surgery.

The cause of 35% of infertility is male and 35% is female and 30% is due to unknown cause.

Research in Iran shows that one in six couples who decide to have children does not have children.

Statistics show that there are more than three million infertile couples in Iran.

With increasing age of women from ideal age, ie 22 years of age, the probability of fertility decreases.

Since many people in our country get married in about 25 to 30 years and then have fertility, the infertility rate is about 20%.


Fertility stages?

To perform the reproductive process, the following steps must be performed:

- Production of healthy sperm in men and healthy eggs in women

- There should be a natural vaginal environment and cervix to accept sperm

- The opening of the fallopian tubes to allow sperm to reach the egg

- The ability of the egg to be fertilized by sperm (which includes the attachment of sperm to the egg and its penetration into the egg)

- The ability of the fertilized egg (the fertilized egg or embryo) to implant inside the uterine wall

- Formation of a quality and healthy fetus

- The presence of a sufficient hormonal environment in the woman to continue fetal growth

Any problems with these steps can lead to infertility.

Generalities of sex hormones

The ovaries are the main sex secretory glands in females. These glands are after the week. 9 Pregnancy begins to differentiate and remains dormant during fetal development.

The two main functions of gametogenesis and steroid formation are the ovaries.

Among the most important ovarian steroid hormones are estrogens, progesterone, and androgens. Under the influence of LH and FSH (secreted gonadotropins secreted by the anterior pituitary gland) are regulated and secreted, he noted.

The ovarian follicle and the corpus luteum contain granulosa and Teka cells and play a protective role. It is responsible for the egg.

The hormone LH affects the cells of the inner layer and thus stimulates cell growth and steroid formation. Slow, while FSH affects the aromatization of androgens to estrogens in granulosa cells. Gives.

Estradiol reduces the production and secretion of two hormones, FSH and LH, by negative feedback on the hypothalamus and pituitary gland. Gives.

 Estrogens and progesterone in the liver to inactive metabolites converted to sulfate and glucuronide Conjugated, excreted in the urine. .

The major metabolites of estradiol include estrogen and estriol, and the major metabolites of progesterone include preganidiol. Showed.

What is the menstrual cycle?

Menstrual bleeding is part of the menstrual cycle.

In a menstrual cycle, a woman's body changes to be ready to get pregnant every month.

A menstrual cycle begins on the first day of menstrual bleeding. .

The average time for a normal menstrual cycle is 28 days, but a normal cycle can vary from 21 to 35 days.

The average age of onset of menstruation is around 12 years old, but this does not mean that all girls become menstruating by the age of 12.

A girl between the ages of 8 and 16 may be the norm.

The age at which menstruation begins is not exactly predictable, but in most cases it depends on the family pattern, meaning that if the mother's period has started early, it is likely that the daughter will have a period soon.

Starting a menstrual cycle later also depends on other factors, such as severe weight loss, anorexia nervosa, being an athlete (intense and permanent exercise), severe stress, or certain illnesses.

In general, menstruation is irregular in adolescent girls, but in more than 90% of girls, the duration of each cycle lasts between 21 and 45 days (bleeding time is between 2 and 7 days and the amount of pads or tampons used is equal to 3). Up to 6).

This time may be as long as 90 days in the first year, but in 60 to 80% of adolescent girls, it reaches about 21 to 35 years (almost similar to menarche), almost three years after menarche (first menarche). .

The organs involved in creating a menstrual cycle are the brain, pituitary gland, uterus and cervix, ovaries and fallopian tubes and vagina.

Changes in the levels of sex hormones in the body cause different stages of the menstrual cycle.



Common terms related to the menstrual cycle

Secondary amenorrhea: More than three months of amenorrhea in girls or women who have had a regular period before and more than 6 months in girls or women who have had an irregular period before is called secondary amenorrhea.

Hyperpigmentation: Bleeding persists for more than 7 days due to problems such as fibroids or submucosal myomas, adenoviruses, pregnancy complications, tumors, and hormonal imbalances.

Menorrhagia: Menstrual bleeding more than 80 ml (such as hypermenorrhea): Normally, the volume of bleeding should be between 5 and 80 ml of blood.

On average, each pad or tampon absorbs between 10 and 15 milliliters of blood. Therefore, if more than 8 pads or tampons are used (or, according to some sources, the pad needs to be replaced every two hours), it is a sign of increased menstrual bleeding or menorrhagia.

Metrorrhagia: Irregular bleeding between menstrual cycles (for reasons such as spotting in the middle of the menstrual cycle due to ovulation, estrogen consumption, infection of the lining of the uterus-endometritis-, hyperthyroidism, endometrial polyps, and cervical and endometrial cancers). Very rare cases)

Hypothyroidism: Mild and minor menstrual bleeding, usually spotting (for reasons such as taking birth control pills, cervical stenosis or hymen, intrauterine adhesions or Asherman's syndrome)

Oligo menorrhea: The duration of menstruation is more than 35 days (for reasons such as severe weight loss, hypothyroidism, etc.).

Polymenorrhea: Length of menstruation less than 21 days (for reasons such as hypothyroidism and bleeding due to hormonal disorders)

Monometry: Irregular menstrual cycles with increased or changed duration and amount of menstrual bleeding (for reasons such as pregnancy complications, polycystic ovary syndrome, and some malignancies)


Postpartum hemorrhage: Bleeding due to proximity or by examination (for reasons such as protrusion or ulcers of the cervical mucosa, polyps, cancer or cervical infections)


Postmenopausal bleeding: Bleeding after one year of menopause in menopause (for reasons such as cervical and uterine cancer, vaginal and cervical infections, uterine myomas)

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