CAMAGÜEY.- The World Health Organization (WHO) establishes the classification and management of infertility. In the first group are women who do not ovulate and a significant number of them respond to endocrine disorders; in a second place organic alterations are collected in the fallopian tubes, the cervix, the uterus and the ovaries; in the third, those of immunological causes.

In some, it is never known what causes it and they are called idiopathic (unknown) causes, they even maintain the results of normal investigations, but do not achieve pregnancy.

The explanation was made known by Dr. Plácido Luaces Sánchez, specialist in 1st Grade of Endocrinology and Assistant Professor of the Ana Betancourt maternal and child hospital, in Camagüey, and also deputy director of the institution, who added: “From the aforementioned classification establishes the protocol of care for the infertile couple due to endocrine causes, and there is a group of women who have ovulatory disorders

This Infertile Family Care Program consists of three levels. The primary is when they are captured in their Health area, with their family doctor and nurse and a work team where the couple's disorder is classified.

"In women with menstrual disorders, such as amenorrhea (lack of menstruation), oligomenorrhea (irregularly), especially those who have it after 35 days or before 21, it means that they do not have adequate ovulation. The normal pattern is from 21 days to 35.

"Those couples who cannot conceive their child are examined in primary health care and immediately referred to secondary care to be evaluated and the study begins."

- From the endocrine point of view, how does infertility behave?

—Ovulation disorders today constitute between 30 and 40% of the cause of infertility in women, which means that endocrine difficulties have a high prevalence in this sense and we classify them in the first group with hypothalamic-pituitary failure, these are the governing glands of the menstrual cycle in which the hypothalamus, pituitary and ovaries participate. In a woman, this axis works well for her, it is like a watch.

"Those who keep their menstrual cycles up to date and these are announced by their body, for example, for pain in the breasts, headache, discomfort in the legs, among others, that has a 99.9% of ovulation, this is why it gives us the certainty that the axis that I mentioned is working properly, although there are other tests to know if she ovulates, but the only sure sign is pregnancy ”.

—What about the hormones?

—We can indicate tests to know the levels of progesterone that give us the measure of whether or not there was ovulation, even if it is positive it tells us if it passed with quality, which is something important because there are those who ovulate with luteal insufficiency because ovulation has the follicular stage, which is when the endometrium prepares with the incidence of estrogens (hormones), and the other is that of progesterone, which is the formation of the corpus luteum that prepares the endometrium for nesting.

"That is why if a phase is insufficient there will be an inadequate nesting, which can cause repeat abortions or not get pregnant."

- Is the basal temperature check still being carried out to know the moment of ovulation?

—Yes, that is a traditional method, that is, from the middle of the cycle there is an increase of 0.5 degrees in temperature, it indicates that she ovulated with a luteal phase (time between ovulation and the start of the next menstruation) appropriate and that can achieve her pregnancy.

—What causes hypothalamic-pituitary failure?

—There are many causes, they are not the most frequent and they are related to the hormones that participate in follicular stimulation.

- Where is there a higher incidence of ovulatory disorders?

—In the pituitary dysfunction and there we find the polycystic ovary syndrome and this is the most frequent entity in the reproductive stage of women and is the one that causes infertility.

—What are the indications of these cases?

—They are women who have menstrual disorders and unlike others, these begin with adolescence and in almost all cases from the first menstruation.

"Sometimes many months go by without menstruation and in other cases they are very abundant; they reach the age of 20 with these problems. When doing an ultrasound, we see the ovaries enlarged (polycystic ovary morphology) with innumerable cysts or follicles, all due to below 10 millimeters and that associated with a disorder called hyperandrogenism that can be biochemical. It is when the alteration of elevated androgens is detected in the woman and she has too many hairs on her body, something important to determine the diagnosis.

"Polycystic ovary syndrome, which was discovered in 1937, at that time was only known with the conviction of large and polycystic ovaries, today we know that there is a metabolic disorder underlying, hence it is a metabolic endocrine disease".

—How do you deal with the above?

—It even reaches their lifestyles because many of them are obese embarazo and the first thing is to improve their nutrition and even, many when losing weight by 10% of their real weight can only ovulate and, of course, they are controlled hemo-chemical because some have an overlapping diabetes or pre-diabetes or another metabolic problem linked to insulin, these are pathogenic factors that cause endocrine difficulties and constitute up to 80% of consultations in this specialty

"These ladies are studied the hormonal markers, insulin´s, androgenic profile ..., then the change of lifestyle and the correct therapeutic plan are indicated. If they obey the dietary hygiene guidelines, they have a good prognosis. "

—What can guide the younger ones?

—To see their doctor from an early age. That allows us to be assisted in time and they respond very well.

—Are there no other endocrine disorders?

—Yes, of course, they are the primary causes. They have to do with genetic disorders in the ovary that are not common, such as: early menopause, early ovarian failure, just to mention a few, and have a specific management in each woman. In most of them, the treatment is in high-tech assisted reproduction because they require a larger treatment. Reason why after diagnosis these cases are referred to the tertiary level, the Institutes, in Havana.

- From the point of view of endocrinology, how are men valued?

—It occupies an important part in sperm quality, which is one of the most common problems. The spermogram continues to be the cornerstone for guidance on fertility in men. It is given by the number of sperm and their mobility. Today it is normal with less amount than a few years ago and he can achieve pregnancy in his partner. He may also have azoospermia (endocrine or urologic lack of sperm), although it is less common.

"The loss of sperm quality is the most detected in these patients, with a vital influence on some risk factors."

—Can you mention some of these risk factors?

—Smoking addiction, alcoholism, drug addiction, contact with chemical products, heat excess, work as a driver, use of the bicycle by the signature of the saddle. There are events that produce micro-trauma at the site where sperm mature.

“We have a series of tests that improve sperm quality and we apply sperm training, that is, we place the sperm in the woman's vagina, among other methods within our reach.

"Infertility of endocrine cause in this program when women and men unite can occupy up to 50%, which is why we follow a significant number of couples with indications and treatments to achieve that precious thing that is conceiving a child”.

- Are endocrine disorders more frequent in women or men?

—Women's are the ones that affect reproduction the most.

—The woman has to ovulate, find the ovum and the sperm in the fallopian tubes, that these are permeable and can nest. It is up to us as endocrinologists to know the ovulation part.

—What is the optimal age to go through all these studies if necessary?

—Age is one of the great challenges we have in consultation. Many women postpone their pregnancies until they reach certain conditions of life and it is very logical, and after 30 years they are at the expense of some thyroid dysfunction diseases and of the others mentioned so they are at a disadvantage.

- If a woman knows that she has endocrine problems, what would be the recommended age?

—Before the age of 30, between the ages of 23 and 30, those who have this type of disorder should seek consultation. This prevents age from being another risk factor in itself. After the age of 37 there is an exponential fall in the ovarian reserve and it is one of the obstacles to remain in a state of pregnancy, therefore she must go to egg donation, which is the donation of eggs from a relative, for example.

—Does age influence men?

—Of course, they must have no more of 50 years old.

—Is it related to genetics?

—Yes, especially in men, it is related to sperm motility. In both sexes it is also found out if there are infertile people in their families.

—Can infertility be prevented?

—Yes, because many of the obstacles to achieving pregnancy are related to sexually transmitted infections, germs that attack a woman's genital tract, especially the fallopian tubes, and over time lead them to not to be functional and there are obstructed, and so on other stumbling blocks. For this reason, these events must be avoided from a very young age and that sexual relations are safe.

"It is well demonstrated that these repeated infections lead to inflammations that later affect the desire to conceive a child and, of course, avoid toxic habits, obesity, stress".

- Are there indicative records of the number of infertile couples?

—It is stated that the infertile couple is between 12 and 14% of reproductive age and they are classified as such because they have unprotected, frequent sexual relations (no less than three times a week), stable for a year.

—How do the people of Camagüey get to these consultations?

—Because of the different levels of care, something that is well structured in the country, those who present the aforementioned symptoms are referred to the secondary level, while those with menstrual problems also do not have to wait even that year or those who are over 25 years of age, at six months without achieving it is another criterion to attend these types of consultations.

“If she does not achieve it at the primary level, she goes to secondary level, and if she does not achieve it in two years, she is referred to the tertiary one. And the good news is that soon in Camagüey we will have all three levels of care. This is a program prioritized by the authorities of the country”.

Translated by Linet Acuña Quilez