Married for many years but infertile, the truth behind it is too scary

There are many reasons for infertility, which can be found on the Internet, in magazines or in hospital health education leaflets. They are nothing more than problems with bad sperm, fallopian tubes, ovaries or uterus. Immunity, thyroid, pituitary gland, and physical constitution may sometimes be involved. If all of these have been checked but nothing is found, both the doctor and the patient will be more or less confused at this time, because they don't know the reason and there is no definite rule as to what to do next. Therefore, they often change the combination of ovulation drugs (just like changing the menu, there are four combinations reported in the literature) to increase the ovulation rate and pregnancy rate. If that doesn't work, artificial insemination or in vitro fertilization are used. But the last two methods are not a panacea. They cost money, but the results are sometimes disappointing. Of course, doctors will also feel regretful. They have clearly placed well-cultivated embryos or screened semen into the uterus, but they just don't implant. So many doctors use large amounts of progesterone, whether injected, inserted or taken orally, and give them to patients in an attempt to reduce the failure rate. But in the end, the satisfaction level of success did not increase much, which was strange. Therefore, the team was divided into two groups, one team focused on basic medical research, and the other team focused on the structure of the uterus. In this way, chronic endometritis was brought up.

Experts have found that among patients whose IVF failed, some suffered from chronic endometritis, and 15-56% of patients with consecutive miscarriages were infected with chronic endometritis. This ratio shocked everyone. Because as early as 35 years ago (1978), experts had written about the relationship between chronic endometritis and infertility, but most doctors ignored this warning, including me, because they felt it was not the main issue. Also, because infertility medicine was taking off at the time, everyone's attention was focused on ovulation, artificial insemination and test tubes, and they all felt that these were the mainstream. Over the past few decades, these have indeed made great progress, but implantation failure or consecutive miscarriages are still a shadow. At first, everyone believed that a large number of ovulation injections would damage the quality of the endometrium and was the main cause of failure, so a large amount of progesterone was used to consolidate the endometrium. Later, it was discovered that this was not ideal, and then I thought of the warnings of my predecessors. Further research results revealed the relationship between chronic inflammation of the endometrium and miscarriage and implantation.

A 37-year-old lady, who looked quite good, had been married for 5 years but still had no news of pregnancy. She had visited many hospitals and had undergone artificial insemination twice in April and May this year but still failed. She was transferred to me in August. Blood test results showed that her prolactin was too high, so she took drugs to lower prolactin. After her condition returned to normal, she planned to get pregnant in September, but failed. In October, she was given ovulation drugs again, but at the same time, she was asked to have a hysteroscopy, which revealed chronic endometrial inflammation. So she was immediately given 14 days of antibiotic treatment and was told that someone had reported the relationship between endometrial inflammation and infertility (only then was she willing to take the medicine). After that, she tested her eggs and arranged the time for intercourse as planned. The day before yesterday, her period was several days late. She said she didn't dare to take the pregnancy test by herself, so she felt more at ease coming to the clinic. The pregnancy test result was positive, and she couldn't believe her ears. I showed her the test paper, and there were two thick black lines in front of her. She burst into tears, and of course I was very happy because I could help.

Chronic endometrial inflammation rarely has obvious symptoms. Sometimes there is abdominal pain, bloating, excessive vaginal discharge, or abnormal bleeding. However, at that time everyone would think it was pelvic inflammation or vaginitis, etc., and rarely would they directly think of endometrial inflammation. If it is really endometrial inflammation, it is not considered a serious illness and can be cured by taking medicine. In addition, the endometrium is inside the uterus, so it is not easy to detect its abnormalities, which increases people's negligence. What we want to emphasize here is that relying solely on ultrasound, whether vaginal or abdominal, for diagnosis is very inaccurate.

Chronic endometrial inflammation can destroy a high proportion of the endometrium, making it prone to miscarriage, artificial insemination and in vitro fertilization failure, and premature birth. However, experts have pointed out that if the disease is discovered promptly and antibiotics are given for 2 weeks, most of the endometrial mass will return. This is reassuring news. After 5 years of marriage, my stomach still didn’t move. I went to the hospital for a check-up and I regretted it so much!

There are two ways to diagnose whether there is endometrial inflammation. One is to perform a curettage to see if there are inflammatory cells (plasma cells) in the endometrium. The accuracy is very high, but curettage is too troublesome and patients may be afraid. Therefore, it is currently recommended to perform a flexible hysteroscopy. It is very simple and does not require anesthesia. If it is fast, the examination can be completed within 10 minutes. The accuracy can reach 90%, but this depends on the doctor's experience. In the past, infertility doctors would only request this test after a failed pregnancy, but now they recommend doing it earlier. I also think that it is the right approach to do it only after all the tests are finalized.

As to whether the pregnancy rate increases after antibiotic treatment, many literatures indicate that it does.

Where do the bacteria in the uterine cavity come from? Although systemic diseases or abdominal diseases can affect the uterus, research results show that the majority of cases come from the vagina. Therefore, if a woman has bacterial vaginosis or excessive leucorrhea, she should seek immediate treatment to prevent vaginal bacteria from entering the uterus and damaging it.

Many women believe that fallopian tube photography is sufficient to diagnose whether the uterine cavity is normal. In fact, this is wrong. To understand the uterine cavity, a flexible hysteroscopy is necessary.