How To Get Pregnant? | Causes And Diagnosis Of Female Infertility
Infertility is known as the inability to get pregnant after one year of regular and unprotected sex. When a couple is not able to conceive after several efforts while doing regular intercourse is defined as the infertility. There are so many factors which can be blame to take the responsibility for causing infertility in men and women. In order to know the exact reason of inability to conceive, clinical assessment is necessary. After doing clinical assessment to know the reason of not getting pregnant naturally, physicians have found many causes which are associated with infertility and the range goes from tubal and peritubal abnormalities to uterine, cervical and ovarian abnormalities.
Infertility treatments are very vast but it starts from HSG (Hysterosalpingography). This is usually the first test that evaluates the patency of fallopian tubes. HSG (Hysterosalpingography) test can also show the uterine filling defects and contour abnormalities but it often require further imaging with Saline Infusion Sonography (SIS), pelvic ultrasonography or pelvic magnetic resonance imaging (MRI). If woman is suffering from infertility and the reason is cervical abnormalities, it can be seen during attempts at catheterization for HSGs or SISs. Ultrasound can reveal the ovarian abnormalities.
Fallopian tube abnormalities are one of the most common causes of infertility among women. It has been found that approximately 30 to 40 per cent cases of not getting pregnant naturally are linked with fallopian tube abnormalities. HSG (Hysterosalpingography) test shows the depiction of tubal patency, tubal occlusion, tubal irregularity, and peritubal disease. The diagnosis of fallopian tube abnormalities includes tubal spasm, infection, and prior surgery. In the very rare case of tubal occlusion include granulomatous salpingitis due to tuberculosis, intraluminal endometriosis, parasitic infection, and congenital blockage of the fallopian tubes. According to health experts, selective salpingography and recanalisation can be performed after getting confirmation of a proximal tubal occlusion at HSG (Hysterosalpingography). The causes of tubal irregularities is inflammatory condition which is linked with pelvic inflammatory disease, ectopic pregnancy (pregnancy outside the womb), and infertility. Women who suffer from any of these conditions are often conceiving her child through IVF (in vitro fertilization). According to experts, both endometriosis and pelvic inflammatory disease may lead to peritubal adhesions which can be the reason of female infertility. Women with peritubal adhesions can be evaluating with MRI (magnetic resonance imaging).
Intrauterine filling defects
An abnormal uterine cavity can lead you to infertility. Sperm that enters the uterine cavity through the cervical mucus must then traverse this cavity and enter the fallopian tube to reach the egg in order to fertilization. These structures should be confirmed to be normal early in the infertility evaluation. This condition can be evaluated by HSG. The causes of Intrauterine filling defects are air bubbles, intrauterine adhesions, sub mucosal fibroids, endometrial polyps, or blood clots. In order to get the oblique views during a HSG will help to identify mobile filling defects like air bubbles and clots but saline infusion sonogram is performed to get the full detailed evaluation.
Uterine synechiae are adhesions or you can call it scar tissue also can form inside the cavity of the uterus. It can be classified according to their location and extension. It generally covers the small part of the uterine cavity and doesn’t affect the fertility. It causes infertility when it covers too much space under uterine cavity. It generally occurs due to previous pregnancy’s dilation and curettage, surgery or infection. They appear as bright bands that traverse the endometrial cavity on SIS.
Endometrial polyps and sub mucosal fibroids
These factors are able to interfere with the transfer and implantation of the eggs which is directly associated with infertility. SIS (Saline Infusion Sonography) helps to identify the number and location of these lesions and then provides guidance for their removal.
Uterine contour abnormalities
The most common causes of uterine contour abnormalities are adenomyosis, uterine fibroids, and mullerian duct abnormalities. Adenomyosis occurs due to presence of ectopic endometrial glands under the muscular wall of the uterus which is surrounded with smooth muscle enlargement. It may cause impaired uterine contractility, which may hamper the transportation of sperms through the uterine cavity. Sub mucosal adenomyosis is also responsible to impair the implantation of the eggs. There is a strong link between adenomyosis and endometriosis has been found among the young women. HSG, pelvic MRI or ultrasound may help to evaluate the adenomyosis. The most common pelvic mass lesion is uterine fibroids and this is the most common cause of uterine enlargement among non pregnant women. It can be easily identified through performing HSG by uterine enlargement, endometrial distortion, or filling defect. Fibroids can be traced through pelvic ultrasound but MRI is very sensitive and it’s very specific.
Blocked tube clearance
You may be wonder to hear that a radiologist could clear your blocked tubes. Selective salpingography is a kind of diagnosis, in which a small catheter directly opacifies the fallopian tube through the uterine ostium. It has been used since 30 years to distinguish spasm from true obstruction. Blocked tube clearance procedure requires catheter and guide wire system is used to clear proximal tubal obstruction. The success rate of this procedure is about 71 to 92 per cent and pregnancy rates after procedure average 30 per cent.
You may get the vast information about Endometriosis from my previous article but here I will give you the short review if this factor of infertility. Endometriosis is a condition, when elements which make up the lining of the womb (endometrial glands and stroma) are found outside the womb or uterus. It has been found that approximately 30 to 50 per cent of women who are fighting with infertility are found to have this condition. In order to evaluate endometriosis includes pelvic ultrasound and MRI. Endometriosis may change the shape and sizes form of either small implants or cysts that change in size and appearance during the menstrual cycle. It is responsible to cause an inflammatory reaction, which leads to fibrosis and scarring. MRI imaging is found to have more sensitive and specific way for the detection of endometriosis, but laparoscopy remains the gold standard.
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