Patient's question:
I had a comprehensive medical check-up at the hospital before I got pregnant. The doctor I saw at the time said that my ovaries were not in good condition and that there seemed to be some issues. He also asked if I had felt any abnormalities in my lower abdomen regularly. I didn’t feel anything, so I asked him what exactly was wrong. He said that my ovarian problems could lead to infertility. I want to understand what exactly is going on.Doctor's answer:
Hello! Etiology of Ovarian Infertility 1. Congenital anomalies of the ovaries: Common conditions include Turner syndrome, 47,XXX syndrome, true hermaphroditism, and testicular feminization. None of these fall within the scope of infertility treatment, and they are relatively common diseases. 2. Polycystic Ovary Syndrome (PCOS): The incidence has been increasing in recent years. The first-line treatment is clomiphene. For some patients, ovarian wedge resection, ovarian incision, and cyst puncture may be considered, with certain effects. 3. Ovaritis-induced infertility: This disease can be divided into tuberculous and non-specific ovarian parenchymal inflammation, as well as periorchitis. Anti-inflammatory treatment should be the main approach for inflammation; for those with fibrous adhesions, laparoscopic adhesiolysis may be considered; for tuberculous infections, anti-tuberculous treatment should be administered. 4. Abnormal ovarian position: Ovarian ptosis can alter the anatomical position of the fallopian tube fimbriae, affecting the entry of oocytes into the fallopian tubes. Ovarian ligament shortening surgery or fixation of the ovarian mesentery to the posterior wall of the uterus may be considered. Adhesive uterine position abnormalities are often caused by inflammation or endometriosis, both of which can lead to infertility. Surgical or laparoscopic adhesiolysis may be considered. 5. Ovarian tumors: Ovarian cysts are sometimes associated with infertility. Polycystic follicular cysts that secrete excessive estrogen can cause persistent anovulation. tumors of the ovary, such as various hormone-secreting tumors, granulosa cell tumors secreting female hormones, and theca cell tumors. 6. Ovarian endometriosis: Among infertility caused by endometriosis, the most common is when the lesions invade the ovaries. Daazol (a derivative of 17-α-ethynyltestosterone) can be used for drug treatment; conservative surgery can be performed, with the aim of preserving normal ovarian tissue while as much visible lesions as possible are removed. Smaller lesions can also be cauterized laparoscopically, and mild pelvic adhesions can be released. Additionally, the contents of endometrial cysts can be aspirated through the accessory needles of the laparoscopic tube. 7. Ovarian amenorrhea: In patients with ovarian amenorrhea, after treatment with gonadotropins, there are two categories: ineffective and effective. Therefore, the examination of patients with ovarian amenorrhea should be conducted in the following order: measuring FSH and LH in urine or blood; performing a gonadotropin stimulation test; if possible, conducting an LH-RH pituitary stimulation test; chromosomal and sex chromatin testing; laparoscopic examination; and, if necessary, laparotomy.