Endometritis and blocked tubes

What are the expectations for success with different types of treatments? Can I get pregnant with #ArtificialInsemination? Can I get pregnant taking pills? Well, each case is unique and first we have to know how you are, how your partner is to be able to talk about true expectations of success, that is why Dr. Otto Paredes, Creafam fertility expert, shares with us 2 cases that apparently were very similar. , but they ended up being completely different. Remember that #KnowledgeIsSuccess

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Case 1: Infertility due to endometritis (Inflammation of the endometrium)

For example, I always remember a patient who had 3 years of infertility in which she had 2 or 3 biochemical abortions, that is, a very short period of time. All the basic tests were normal: tubes, semen, ovarian reserve… The issue was those 2 or 3 early losses that she had and we decided to do a hysteroscopy.

In the hysteroscopy I found signs of endometritis, that is, signs of inflammation of the endometrium (Not to be confused with endometriosis) so I prescribed antibiotics, that is, a 10-day course of antibiotics and we waited for her next cycle to continue with other evaluations, the issue is that the patient waited two or three months to return to the consultation. And how was it? She came back pregnant, so she told me: “Doctor, since when I had that study done, it was something magical, something incredible.”

I tell him, look, we really followed a basic protocol: Regarding what you had, we did a little more, we solved the problem because it was very easy to solve, simply with an antibiotic cycle we improved the conditions of the uterus and finally, well, the reproductive magic came out, there it is Her pregnancy was finally progressive, normal and… She had her baby.

Caso 2: Infertility with blocked fallopian tubes

This is a couple who had 5 or 6 years of infertility, they also went to other doctors, other gynecologists and in theory “everything was in order” a woman of 34 or 35 years old when she arrived here, her partner of a similar age and They had said that they had normal basic tests, particularly normal semen analysis and hormonal tests and ultrasounds. Only with that information did they start their treatment…

3 cycles of scheduled intercourse and nothing, 2 cycles of intrauterine insemination and nothing, finally they arrive here at Creafam and when we are interrogating her, I explain to them: Look, we have to confirm how the male factor is, at the end of the day fertility is a matter of 2, because you don’t have the report for me to see and in order to move forward I have to confirm what the result is.

Regarding her, she did not have a hysterosalpingogram, which is why I think it is a mistake. How are you going to carry out an insemination without confirming that the uterine tubes are capable of generating pregnancy? Especially in a patient or a young couple who in theory is still functioning well… Surprise! We evaluate the semen and we find that it has oligoasthenozoospermia, that is, decreased concentration, decreased mobility and within this, there are many categories, it is true, but this patient’s criteria were not enough to go to treatment and insemination, was within the criteria for in vitro fertilization.

In the case of the patient, when I see her for ultrasound, I describe to her that her uterine cavity looked smaller than usual and she had something called uterine septum sonographically. It is true that uterine septa are not a reliable cause of infertility, but they can compromise the prognosis of the pregnancy and if we want to have a happy term, then obviously the evaluation must be improved, then we perform a hysteroscopy and in the hysteroscopy I get a small uterine cavity, reduced in size, with a septum, so we then perform the resection of the septum and expand the cavity.

As a finding of the hysteroscopy we saw that the uterine ostium, that is, the site where the tube begins, looked closed. So as an extra diagnosis to hysteroscopy we have the presumption that the uterine tubes must be obstructed… It is not the ideal strategy to evaluate the tubes but we already had that information. So look how the puzzle is put together: We have a male factor that compromises fertility, a uterine factor that decreases the prognosis of a healthy pregnancy, and a suspected tubal factor in a couple who has had infertility for 5 years. So when we add factors we see that the problem really was a little more complex and that way we decided to take them to in vitro fertilization.

In in vitro fertilization, as you have seen in other of our videos, we can have a greater number of eggs. We have strategies to solve the male factor because when we perform an ICSI and inject one sperm per egg, we solve the basic problem of fertilization. And yes, indeed they had a good number of embryos, they developed adequately as we expected for their age, we did a simple embryo transfer of two embryos in this uterine cavity that we already know is healthy and finally we had a positive result.

Today they have a twin pregnancy that has progressed satisfactorily with babies that are close to being born without having had any type of complications or risks during the pregnancy. So what we want to convey to them above all is that they should not be afraid, that they should go to the consultation, sometimes when they are told: “No, let’s go to the fertility clinic. It’s going to be very expensive! You’re going to spend a lot of time doing tests.” , tests, thousands of things” It’s really not about establishing a very extensive diagnostic protocol where you need many tests to finally make a decision.

“Bring the information you have and with each individual case we say what you really need to do to decide which is the most effective treatment for you”

Dr. Otto Paredes
Dr. Otto Paredes
Fertility Expert

Reproductive medicine and gynecological endocrinology
Instituto Valenciano de Infertilidad, Spain.

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