How are you, good afternoon. Look, today we are going to talk to you about something that is very important from what you write to us daily on our page, on YouTube, on social networks about the four main causes of infertility in women, remember: Knowledge Is Success.

So let’s talk, the first causes right now we are going to mention, they are generally… I put 4, there will be a 5th out there which are ovarian tumors or fibroids or polyps, the anatomical issues of the uterus are practically more or less tied with endometriosis. We divide it like this so that we understand SETE, which is Polycystic Ovary Syndrome, the age of the woman, endometriosis and tube or tubal factor. Look, in a study from Spain they came up with some let’s say ideas or rather how the doctor perceived the factors in percentages. They put age at the top with 25%, Polycystic Ovary Syndrome 11%, tubal factors 7% and endometriosis 13%, obviously that is in Spain, in Mexico I wanted to mention I think it is a little more invested, because yes Age is already one of the main causes of infertility, in fact I believe it is the first because our patients come over 36 or 37 years of age just to look for a pregnancy, but in second place is Polycystic Ovary Syndrome (PCOS). ).

Remember that the Latina patient has a genetic mutation, which causes adolescents and women of reproductive age to have characteristics of polycystic ovary that leads to connotations of infertility, which we will mention each one. After the tubal factor, I think that these two are very tied, that is, at best, more or less 20% of our patients who come to assisted reproduction for infertility: Tubal tubes and polycystic ovary are tied, and a fourth, which is endometriosis. There we can put an asterisk or a question mark, because it could be endometriosis or it could also be uterine factors, mainly fibroids or polyps.

Remember, we had already done a talk on polycystic ovary if you like to search for it on YouTube or on our Creafam channel, polycystic ovary syndrome mainly has two alterations: One, women do not ovulate and obviously have oligoamenorrhea cycles, that is, they are patients who Every day they say: “Doctor, every time I go to menstruate it is a month and a half, two or it can take up to six months.” Why don’t I menstruate? That is called oligoamenorrhea because they do not ovulate and if they do not ovulate obviously we do not have that egg that is going to fertilize and therefore we are going to have the problem of infertility, however remember, these are patients who can have very abundant bone acne even if they have already passed that of adolescence, oligoamenorrhea as we had said, acanthosis nigricans and hirsutism and obesity. So, acanthosis nigricans is a darker pigmentation, generally in the folds of the neck, armpits, or the inner surface of the groin. Hirsutism is patients who have a little more hair of androgenic distribution, bone in the pubic region and centripetal obesity, they may also have obesity very similar to that of men, which is like the classic love handle.

Age, here it is very important to highlight, we are always asked if age is a cause or is important in assisted reproduction and the answer is “Yes”. Nowadays, women delay the idea of pregnancy a little longer, they marry later to pursue a professional life and find a job, start working and want to get pregnant after 36, 37 years of age.

So, remember that from the age of 40 the possibility of spontaneous pregnancy is less than 5% per ovulation cycle. What does that mean? If we compare a 40-year-old woman with a 30-year-old woman, the 30-year-old woman will get pregnant more or less 20% per 100 in each ovulatory cycle and the woman over 40 will get pregnant less than 5 women per 100. So, it is very important to go to the doctor when we are 36 or 37 years old, to come with us to do a comprehensive assessment.

Remember that we can do a basal follicular count with a vaginal ultrasound to see if we have more than five or six basal follicles in each ovary and another hormone or an indirect marker is the anti-Müllerian hormone. What the anti-Müllerian hormone does is give us a prognosis of how good the ovarian response will be or how much ovarian reserve there is. Generally, at a global level, what the Poseidon group does is look at age, antral follicle count and the anti-Mullerian test to more or less draw a table and see what the reproductive prognosis is for that woman.

Now we are going to talk about the fallopian tubes, we have also talked a little about the tubal factor alone, but right now what we want to mention is that the fallopian tubes are the oviducts that connect the ovary with the uterus and that is where the oocyte is captured. and there the sperm fertilizes the egg in the distal third, the zygote is formed and then the cellular development of that zygote will last four days, five in the tube to fall into the uterus and implant. So, there are multiple causes or multiple factors that can alter the oviduct, either obstructing it, inflaming it or also causing malfunction of the cilia and mucus production at the tubal level:

• Infections are the most common.
• Sexually transmitted diseases
• Pelvic inflammatory inflammation, well, we fortunately see very little of it but if it has anything to do with it it depends on the region or the socioeconomic status of the patient so that pelvic inflammatory disease is a little higher than one believes.
• Previous surgeries: Patients who have had surgery, whether cesarean sections, who have had fibroids removed, who have even had appendectomies, or patients who said “hey, I had an acute abdomen and when they entered the appendix it had already ruptured.” These patients also tend to have tubal obstructions.
• Anatomical anomalies of the tubes.
• Endometriosis as such, that’s why I told you: Tube and endometriosis almost always go hand in hand.
• Tubal operations

Sometimes they ask us “Well, they tied me up… But they just tied me in a knot. Does that have less cost or more cost for recanalization?” The important thing here is not that if it is a surgery, a tubal ligation, the cost that is charged. It must be remembered that the fallopian tubes, the oviduct, only measure 1 mm. in diameter, then it is really a surgery, that is, an aesthetic reconstructive surgery and it is very laborious, so the importance of the surgery, of the recanalization depends, as we have said, if they burned you, if they did not burn you and they ligated you or you They cut, but it depends on the ability, the dexterity and obviously how we do that reconstruction so that we have a better prognosis that the tube remains patent, so if it is important that patients who have already had surgery can be recanalized, we have to see how old they are. , how many years have passed since the surgery and whether it is worth doing recanalization or it is better to go directly to an In Vitro technique.

Finally, endometriosis is a pathology that worldwide is one of the main causes of absence from work in women of reproductive age because one of its main symptoms or manifestations is dysmenorrhea, that is, moderate or intense pain during the cycle. menstrual periods that even incapacitate the patient even with analgesics and anti-inflammatories, the pain does not allow them to move for two or three days.

We must remember that the uterus in its cavity inside has this covering tissue called endometrium, that endometrium only has to be inside but sometimes it makes like small seeds or seeds outside the uterus, in the fallopian tubes, in the peritoneum, in the omentum or in the ovaries and it is called endometriosis, then we must see where these lesions are extended, the age of the patient that they appeared with dysmenorrhea, the parity satisfied or not, that is, if a patient wants to get pregnant or not , the therapeutic management of endometriosis is very individualized, that is, it is particular if a patient has already had children, continues with menstrual pain, has endometriosis, perhaps it is only treated with some second phase progesterone, if a patient is starting her life reproductive and have dysmenorrhea and endometriosis or an endometriotic cyst is diagnosed, it may be worth doing a surgical procedure as we have shown in the talk about surgery or benign ovarian tumors, although it is not an autoimmune disease, it has similar characteristics such as inflammation and low defenses, yes, that is, endometriosis, I always tell my patients, it is as if it were a fungus or humidity that begins to proliferate and when you do these sowings what it does is that it inflames and also creates certain adhesions, so Sometimes the intestine sticks to the ovary or the uterus sticks to the ovary or the posterior surface or the omentum sticks to the ovary and the tubes and then it generates an inflammatory but non-infectious pelvic disease, but nothing more than a self-regulated immunological or inflammatory.

Finally, we must remember in assisted reproduction the causes of infertility in women are many, but the four main ones and we could put there a 5th that does not appear here, which are benign tumors of the uterus, which are fibroids or polyps. There is the Syndrome of Polycystic Ovary, age is very important. When? After 36 years of age, tubal factors, even if you have not had surgery, the tubes and endometriosis may be blocked. Please, if you have any questions, remember at Creafam we have been doing treatments and fulfilling dreams for 14 years, call us, write to us, we can do a virtual consultation if you want a second opinion or come with us and we have a countless number of specialists, in addition, We can deal with all infertility problems, assisted reproduction of low complexity, high complexity and above all treat each specific case individually, particularly if it is polycystic ovary, particularly if it is endometriosis, the age of the woman or tubal factors. Knowledge is success, write to us, we are here to help you.

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