What to do or make? B.Kamenetskomu's question

[Natalia1]

Dear Boris Aleksandrovich!

Very much I ask your advice or council in a following situation.

To me of 30 years, to the husband 32. The experience of sterility or barrenness - 3,5 years.



Have passed or Have taken place full inspection. My results: hormones in norm or rate, pipes are completely passable, adherent or adhesive process in an abdominal cavity (GSG), infections and are not present any gynecologic diseases and was not, the cervical factor (at bad SG - 100 % motionless).

The husband: in the beginning of treatment was oligoastenoteratozoospermija. Has passed or has taken place treatment. For the present or true moment - normozoospermija, some depression of mobility (last SG). There was a prostatitis. The rest - hormones, infections, US - that's all right.



Genetics did not hand over.



Have passed or Have taken place 4 cycles of AI, including last in clinic EKO with a superovulation on menopure (5 follicles, input of a semen up to (there was a low quantity or amount of spermatozoons), during (normal parameters SG), after an ovulation (SG here norm or rate) - it is ineffectual. The first 3 procedures spent in usual paid clinic. In 3 insemination there were enormous abdominal pains and rise of temperature up to 38,5 degrees.



Has received opinion of 2 competent doctors on the further actions. Opinion of one - EKO, opinion of another - the further inseminations. What your opinion? Can you see any other reasons or can offer other order of actions? Please, very much there is no opinion of the competent expert.



Yours faithfully,

Natalia

[boris]

Uv. Natalia!





Presence of permeable uterine pipes and so-called *quot; cervical oaOOa*quot; (about which ksati it is possible to speak at absence of changes in spermogramme and provedeni not less than 2 assays) to formal attributes it is possible to regard really as sterility or barrenness caused *quot; cervical oaOO?*quot; at which a method of a choice can javljatsja AI a semen of the husband.

However I have knowingly mentioned errors in carrying out of research of assay *quot; on ?o?N?O???Oy*quot;, that competency of the similar diagnosis puts under doubt.



Except for that already far not for the first time I wish to stop on concept *quot; uterine pipes OOn??U*quot; at adherent or adhesive process (even at performance of a preliminary reconstructive intervention).

1. The uterine pipe carries out the transport function not only due to permeability. After restoration of its or her permeability operative she is by really formally passable (why formally? Since she is passed or taken place;passable for a contrast agent (liquid) which enter for check of its or her permeability after a canalization. The patient for some reason piously believes, that restoration of permeability means permeability for an ootid.

2. In the second at once after the termination or ending of an operative measure new solderings can be formed again (and often happens so). And than the description *quot is longer; iOyiU*quot; with solderings in the report surgical the intervention, is especially probable, that solderings are formed again. Besides do not forget, that for check of permeability of a uterine pipe a contrast agent enter by means of a syringe under pressure, and the ootid should pass or take place this way without it or him, but under influence of other transport factors.

3. Now about the transport factors also influencing passage of an ootid on a uterine pipe. Vnutrennja the wall of a uterine pipe is covered by a special tissue (a villiferous epithelium), which by means of microvillis *quot; nu?nNO*quot; an ootid to a uterus. The transferred or carried inflammatory process (a salpingitis, a salpingo-oophoritis, adnesit), destroys or blasts a villiferous epithelium and by that this component of transport function is lost. Appear vnutritubarnye solderings which besides at formal permeability are prepjadstviem for passage of an ootid. The probability of offensive or approach of an extrauterine pregnancy or a salpingocuesis after such intervention increases.

4. The transferred or carried inflammatory process breaks also the nervously-muscular apparatus of a uterine pipe, that it or her sokratitelnaja activity (in norm or rate muscular reductions allow an ootid to move on a permeable uterine pipe to the necessary party or side) can be absent or can be diskoordinirovannym.



Thus in a context of genesial function it is necessary to speak not about permeability of uterine pipes, and about their functional full value, what not the same.



... Opinion of one - EKO, opinion of another - the further inseminations. What your opinion?



Carrying out more than 3 AI is inexpedient and is the basis for change of tactics of treatment.

[Natalia1]

Thanks big for the answer!:)

[Natalia1]

Dear Boris Aleksandrovich!



Very much I ask to express the opinion on a question exciting me.



By results of GSG solderings in an abdominal cavity are revealed. How they look or appear on a picture? (a question 1). I consider or examine;survey this picture and I see shadows in the field of the right ovary. In the field of left - a precise picture. Yesterday considered or examined;surveyed extracts from course of treatment and on strange coincidence of circumstances has found out, that all 4 AI have been spent with follicles in the right ovary (including and last with 5 DF). But in left too there are follicles, but all AI dropped out on right. Whether can be so, what solderings are localized only in the field of the right ovary?

Question 2: whether it is necessary to try or taste one more AI with it is grown up DF in the left ovary? (pipes checked 3 times - US, GSG, kimopertubatsija by air - always one result - are freely passed or taken freely place;freely passable).



In advance many thanks.



Yours faithfully,

Natalia.

[boris]

By results of GSG solderings in an abdominal cavity are revealed. How they look or appear on a picture?

I think, that it is better to entrust interpreting data GSG to your doctor.



Whether can be so, what solderings are localized only in the field of the right ovary?

Quite probably that it is more expressed spechnyj process on the right.



Question 2: whether it is necessary to try or taste one more AI with it is grown up DF in the left ovary? (pipes checked 3 times - US, GSG, kimopertubatsija by air - always one result - are freely passed or taken freely place;freely passable).

It seems to me, it is meaningful or to change tactics of treatment, or to expand volume of inspection (I have in view of carrying out of a laparoscopy)