According to the location of the lesion, the degree of adhesion, the scope of involvement, the years of infertility, whether it is complicated with other infertility reasons and the patient's wishes, choose the appropriate method to treat tubal infertility.
(1) The treatment of bilateral tubal obstruction depends on the location and degree of tubal obstruction. ① Pelvic adhesion release and tubal umbrella plasty are feasible for tubal umbrella end adhesion obstruction. If salpingostomy is feasible for mild hydrosalpinx, the impact on ovarian function may be less than salpingectomy. On the one hand, it not only drains harmful hydrosalpinx, but also hopes to restore the function of fallopian tube through body reconstruction, thus retaining the possibility of natural pregnancy. However, there is a possibility that postoperative adhesion will form effusion again. For fallopian tubes with serious hydrops and complete loss of function, salpingectomy is feasible. The mesentery should be preserved as much as possible during resection to reduce the possible impact on ovarian blood supply. ② The recanalization of interstitial tubal obstruction is difficult and the recanalization rate is low. IVF-ET is recommended directly. ③ Simple isthmus obstruction after tubal ligation can be considered as end-to-end anastomosis of tubal isthmus after tubal ligation.
(2) If tubal obstruction is caused by umbrella tip partial obstruction and unilateral tubal isthmus obstruction, bilateral tubal obstruction can be used. Patients with interstitial tubal obstruction and isthmus obstruction may have no positive findings by laparoscopy, so hysteroscopic tubal intubation can be used for treatment.
(3) The treatment of chronic inflammation of fallopian tubes is only suitable for those with tubal adhesion, mild obstruction and short lesion time, otherwise the treatment effect is not good. It is feasible to promote local blood circulation by oral administration of traditional Chinese medicine for promoting blood circulation and removing blood stasis, retention enema, acupoint injection and ultrashort wave physiotherapy, which is conducive to the elimination of inflammation.
(4) Patients who can't conceive naturally after in vitro fertilization-embryo transfer (IVF-ET) tubal and pelvic plastic surgery for half a year to one year have a very low chance of natural pregnancy. It is generally recommended to use IVF-ET directly without cosmetic surgery. Patients with tubal infertility tend to use IVF, especially when they are older, have a long pregnancy period, are complicated with other infertility factors, or the above surgical and non-surgical treatments are not effective, IVF should be used as soon as possible to avoid missing the best reproductive period of women and leading to a decline in pregnancy rate.
2. Treatment of ovulatory infertility
Ovulation induction, commonly known as ovulation induction, is the main means to treat anovulatory infertility, which means that patients with ovulation disorder induce ovarian ovulation through drugs or surgery. The general purpose is to induce the development of a single follicle or several follicles. Mainly used for treating ovulatory infertility and/or combined with intrauterine insemination technology.
3. Treatment of immune infertility
We can reduce the production of AsAb, inhibit the production of AsAb, remove AsAb combined with sperm and overcome the interference of AsAb.
(1) production of asab-isolation therapy uses condoms for contraception for more than 6 months, which reduces or disappears the original antibody titer in the body and prevents semen antigens from entering the female reproductive tract to produce new antibodies. The curative effect is uncertain. At present, it is generally used in combination with other treatments, or condoms are only used during non-ovulation period.
(2) Inhibition of AsAb production-drug therapy can be divided into the following categories: ① Appropriate antibacterial drugs are used for the causes of immune infertility, such as genital infection, prostatitis, seminal vesiculitis, epididymitis, etc. ② Immunosuppression therapy, mainly using corticosteroids, such as prednisone, methylprednisolone, betamethasone, dexamethasone, etc. The general course of treatment is about half a year.
(3) Overcoming the interference of anti-sperm antibody-conservative treatment of assisted reproductive technology is ineffective, and intrauterine insemination can avoid cervical mucus barrier. For unexplained infertility patients who are highly suspected of immune problems and the above treatment methods are ineffective, it is suggested to adopt appropriate ART technology (IVF) as soon as possible.
4. Treatment of unexplained infertility
(1) At present, there is no research data on the long-term prognosis of the natural process of expectant treatment for unexplained infertility. Most of the existing studies are short-term observations. The results of long-term observation may prove a good prognosis. When couples with unexplained infertility come to consult, it is important to inform them that there may be a better pregnancy rate without treatment. Based on this baseline assessment of untreated pregnancy rate, clinical trials found that couples with unexplained infertility were divided into control group (untreated), and the monthly pregnancy rate was 3% to 4%. When infertile couples consult, they generally want direct treatment. It is not the judgment of infertility that is diagnosed as unexplained infertility, and their doubts should be dispelled. The possibility of unexplained infertility and natural pregnancy largely depends on women's age, duration of infertility and previous pregnancy history. Over the years, many different people have confirmed that infertility is negatively correlated with age, natural pregnancy decreases with age, and the decline rate is accelerated when women are close to 39-40 years old. Therefore, for the treatment of unexplained infertility, the cumulative pregnancy rate of young women is higher than that of old women, and the possibility of pregnancy decreases with the extension of infertility duration, which may be due to the increase of age and the decrease of reproductive stage. Previous pregnancy history is also important. Couples with secondary infertility are more likely to get pregnant naturally than couples with primary infertility.
(2) Drug treatment For couples who are younger and have shorter infertility years, they should be given sufficient waiting time, generally at least 2 years. During this period, we should pay attention to other health problems related to pregnancy, such as quitting smoking, reducing overweight and improving the original bad habits. The treatment steps of unexplained infertility are summarized as "three steps": ovulation induction, intrauterine insemination and in vitro fertilization-embryo transfer.
In the treatment of unexplained infertility, ovulation induction (IUI) with or without intrauterine insemination (IUI) began in the mid-1980s, and is still in use, with a significant increase trend. Clomiphene citrate (CC) and gonadotropin are used to treat ovulation induction.
Regarding ovarian stimulation, ovulation induction increases the number of fertilized eggs and the possibility of pregnancy. How many dominant follicles are most suitable for ovulation induction in IUI is still inconclusive. It is generally believed that 1 ~ 2 follicles is the best number. Similarly, increasing the density of exercise sperm through artificial insemination may further increase the monthly pregnancy rate. To some extent, ovulation induction and/or IUI will lead to an increase in the monthly pregnancy rate, which will have a cumulative effect after a period of treatment.
In vitro fertilization-embryo transfer (IVF-ET), if the treatment of ovulation induction plus IUI continues for more than 3 cycles, it is still unsuccessful, indicating that the effect of this treatment is not very optimistic. IVF also provides etiological diagnosis of unexplained infertility to see if the infertility problem occurs during fertilization. There is a risk of 1 1% ~ 22% failure in IVF for couples with unexplained infertility. This kind of patients can get a higher pregnancy rate by intracytoplasmic sperm injection (ICSI) in the next cycle.
5. Treatment of male infertility
Different treatment methods should be adopted according to different pathogenic factors. For patients with definite etiology, corresponding measures should be actively taken to improve their semen quality. For the low sperm quality caused by unknown reasons, we can try to adjust the mental state and living habits with traditional Chinese medicine to improve sperm quality. If the effect is not obvious, or combined with other infertility reasons, the woman is old and not pregnant for a long time, assisted reproductive technology should be adopted in time.
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