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t allows us to check the normality of the internal genital tract of the woman. By this ultrasound, it is checked that the uterus is normal (we can rule out many uterine malformations or the presence of endometrial polyps, etc.); the ovaries are also visualized (size, characteristics, presence of ovulatory signs if the ultrasound is done in mid-cycle, etc.). It is also possible to detect specific diseases (for example, hydrosalpinx, which is an accumulation of fluid in the tubes). |
Different types of cysts, some of which (like the endometriosic cysts) can negatively affect fertility.
It is also important in each ultrasound to assess the number of anthral follicles (the eggs are inside of them), which allows us to obtain information about the ovarian reserve.
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H
ormonal determinations in the study of infertility are done at two times of the cycle: baseline (i.e., when the woman is with her period) and on day 21 of the cycle.
This is because the levels of ovarian and pituitary hormones (which are the ones we measure) undergo a series of parallel changes along the woman´s cycle. To know whether these levels are normal or not, it is necessary to measure them at the same time. Thus, it is possible compare them. The hormones that are usually measured are the follicle-stimulating hormone ( FSH), the luteinizing hormone ( LH), prolactine, estradiol, and thyrotrophic hormone ( TSH).
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Hormones measured during the first days of the cycle (baseline) allow us to obtain information about the ovarian reserve. Hormones analyzed on day 21 of the cycle allow us to know whether ovulation takes place or not. We can also detect some anomalies in the luteal phase, such as the luteal phase defect or hyperprolactinemia. |
Test to check the permeability of the tubes |
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Test to check the permeability of the tubes ( Hysterosalpingography or sonohysterosalpingography).
With this test, it is checked that the way the spermatozoids must follow from the uterus to the end of the tubes is free. |
Artificial insemination in natural cycle |
The requirements for insemination with sperm from a donor in the natural cycle are:
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A normal ovarian reserve normal
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- Open tubes (permeable) |
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he main advantage of the natural cycle is that the chances of having a twin pregnancy are the same as in a spontaneous pregnancy (about 1%), since the ovulation is not induced. The chances of success with this technique depend on the age of the woman, but in women under 38 year-old, the chances are about 10-15% per attempt.
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If this technique fails in 3 or 4 cycles, then it would raise the possibility of artificial insemination with induction of the ovulation. |
Artificial Insemination with induction of the ovulation |
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In women o ver 38 years-old we must consider the induction of the ovulation from the beginning to increase the chances of success.
When the ovulation is induced, the chances of pregnancy increase, although there is also a slight increase in the risk of twin pregnancy. The process is simple: when a woman has her period, a vaginal ultrasound is done to check if the ovaries are at rest. Then, the process of induction of the ovulation is initiated. There are several medications to induce the ovulation ( clomiphene, FSH, HMG). FSH and HMG are the most commonly used.
The process is monitored by ultrasound until one to three follicles larger than 17 mm are detected in the ovaries. Then, the maturation of the follicles is induced with HCG and the insemination is scheduled at the 36th hour.
The ultrasound control of the induction of the ovulation is essential to avoid the risk of multiple pregnancies. Sometimes, the response of the ovary is higher than expected. Then, it is necessary to cancel the cycle. Usually, in a cycle of ovular induction for artificial insemination, two or three ultrasounds are necessary.
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When artificial insemination does not work |
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After passing through a number of cycles of artificial insemination, many women will become pregnant. However, others will not. This may be due to the existence of any pathology (like endometriosis, for example). We are often unable to get a diagnosis.
The step following the insemination is the
In Vitro Fertilization.
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Dr. Braulio Peramo Moya
Medical specialist in obstetrics and gynecology. Assisted reproduction.
Colegiado nº 282844119 del Ilustre Colegio Oficial de Médicos de Madrid | Registered Specialist n 6063017, General Medical Council of London” |
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