Infertilidad

Definición y Epidemiología

Definición

La infertilidad se define como la incapacidad de una pareja para concebir después de 12 meses de relaciones sexuales regulares, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria casos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum que la mujer es < 35 años de edad o después de 6 meses de relaciones regulares en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pareja, cuando la mujer es > 35 años de edad.

Epidemiología

• Fecundidad normal (la probabilidad de que un ciclo resulte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un embarazo):
  • 25% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria 1ros 3 meses
  • 15% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria meses 4 a 12
  • Aproximadamente 80%–90% de las parejas saludables concebirán al AL Amyloidosis cabo de 12 meses.
• Prevalencia de infertilidad primaria en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres:
  • 15–34 años de edad: 7%–9%
  • 35–39 años de edad: 25%
  • 40–44 años de edad: 30%

Etiología y Fisiopatología

Para lograr el embarazo, la mujer debe estar ovulando con trompas de Falopio permeables y un útero receptivo, mientras que el hombre debe producir esperma que sea capaz de fertilizar el ovocito.

Etiologías de las parejas

• Etiología femenina aislada: 37%
• Etiología masculina aislada: 8%
• Tanto etiologías femeninas como masculinas: 35%
• Infertilidad inexplicable: 5%
• Las etiologías exactas a menudo son difíciles de determinar a menos que estén presentes factores absolutos de infertilidad (e.g., obstrucción tubárica bilateral).
• Las parejas a menudo tienen más de una etiología contribuyente.

Etiologías femeninas y fisiopatología

Las causas de la infertilidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las mujeres se pueden categorizar como disfunción ovulatoria, factores tubáricos y factores uterinos.

Revisión del eje hipotálamo-hipófisis-ovario:

Disfunción ovulatoria:

• Tipos de disfunción:
  • Oligoovulación: ovulación poco frecuente
  • Anovulación: ausencia de ovulación
• Hipogonadismo hipogonadotrópico:
  • Fisiopatología:
    • El hipotálamo no funciona correctamente.
    • ↓ hormona liberadora de gonadotropina (GnRH) → ↓ hormona foliculoestimulante ( FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle) → ↓ maduración de ovocitos → anovulación
  • Ejemplos:
    • Amenorrea hipotalámica funcional: por exceso de ejercicio, trastornos de la alimentación, estrés
    • Hipogonadismo hipogonadotrópico idiopático ( IHH IHH Primary Amenorrhea, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés): deficiencia congénita de la GnRH, como en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el síndrome de Kallmann ( IHH IHH Primary Amenorrhea asociado con anosmia Anosmia Complete or severe loss of the subjective sense of smell. Loss of smell may be caused by many factors such as a cold, allergy, olfactory nerve diseases, viral respiratory tract infections (e.g., COVID-19), aging and various neurological disorders (e.g., Alzheimer disease). Cranial Nerve Palsies)
    • Síndrome de Sheehan: hipopituitarismo causado por isquemia durante la hemorragia posparto
    • Enfermedad infiltrativa (e.g., sarcoidosis Sarcoidosis Sarcoidosis is a multisystem inflammatory disease that causes noncaseating granulomas. The exact etiology is unknown. Sarcoidosis usually affects the lungs and thoracic lymph nodes, but it can also affect almost every system in the body, including the skin, heart, and eyes, most commonly. Sarcoidosis)
    • Masas de la región selar
    • Silla turca vacía
• Disfunción ovulatoria normogonadotrópica normoestrogénica:
  • Fisiopatología:
    • GnRH y estrógenos normales, pero ↓ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle
    • A menudo oligomenorrea y ↑ andrógenos
  • Ejemplos:
    • SOP
    • Hiperplasia suprarrenal congénita no clásica
    • Síndrome de Cushing
• Hipogonadismo hipergonadotrópico:
  • Fisiopatología
    • Los LOS Neisseria ovarios no responden a la FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle.
    • ↑ GnRH → ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle → ovarios que no responden → anovulación
  • Ejemplo: insuficiencia ovárica primaria
    • Síndrome de Turner
    • Permutación FMR1
    • Autoinmune
    • Quimioterapia
    • Radioterapia
• Otras etiologías de la disfunción ovulatoria:
  • Envejecimiento de ovocitos
  • Hiperprolactinemia
  • Hipotiroidismo
  • Tumores secretores de estrógenos o de andrógenos:
    • Tumores del estroma de los LOS Neisseria cordones sexuales
    • Tumores suprarrenales
    • ↑ Estrógenos o andrógenos → ↓ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle

Factores tubáricos:

• Impiden que los LOS Neisseria espermatozoides lleguen al AL Amyloidosis óvulo debido a:
  • Oclusión (generalmente por adherencias)
  • Inflamación
• Causas:
  • Enfermedad inflamatoria pélvica (EIP): causada por clamidia o gonorrea
  • Hidrosálpinx
  • Endometriosis Endometriosis Endometriosis is a common disease in which patients have endometrial tissue implanted outside of the uterus. Endometrial implants can occur anywhere in the pelvis, including the ovaries, the broad and uterosacral ligaments, the pelvic peritoneum, and the urinary and gastrointestinal tracts. Endometriosis: problemas de fertilidad debido a las adherencias tubáricas y a la inflamación
  • Cirugía tubárica previa
  • Embarazo ectópico previo
  • Infecciones no tubáricas:
    • Apendicitis
    • Enfermedad inflamatoria intestinal
    • Tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis pélvica

Factores uterinos:

• Deterioro de la implantación debido a:
  • Problemas mecánicos
  • ↓ Receptividad endometrial
• Causas:
  • Leiomiomas (fibromas uterinos) que comprimen la cavidad uterina
  • Pólipos endometriales
  • Sinequias (tejido cicatricial de una cirugía previa)
  • Anomalías müllerianas (e.g., útero tabicado)
  • Estenosis cervical

Etiologías masculinas y fisiopatología

Trastornos endocrinos y sistémicos:

• Causas congénitas/genéticas:
  • Hipogonadismo hipogonadotrópico idiopático/Síndrome de Kallmann
  • Defectos genéticos que afectan a las gonadotropinas
• Condiciones adquiridas que conducen a disfunción hipotalámica o hipofisiaria:
  • Masas de la región selar
  • Enfermedad infiltrativa (e.g., sarcoidosis Sarcoidosis Sarcoidosis is a multisystem inflammatory disease that causes noncaseating granulomas. The exact etiology is unknown. Sarcoidosis usually affects the lungs and thoracic lymph nodes, but it can also affect almost every system in the body, including the skin, heart, and eyes, most commonly. Sarcoidosis)
  • Hiperprolactinemia (e.g., medicamentos)
  • Trastornos de la tiroides
  • Síndrome de Cushing
  • Tumores secretores de hormonas
• Enfermedad sistémica
• Obesidad (puede ↓ testosterona y función testicular)

Defectos testiculares en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la espermatogénesis:

• Definiciones:
  • Azoospermia Azoospermia A condition of having no sperm present in the ejaculate (semen). Infertility: ausencia de espermatozoides en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el eyaculado
  • Oligozoospermia Oligozoospermia Infertility: ↓ recuento de espermatozoides
    • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el 80% de los LOS Neisseria hombres infértiles
    • La causa más común de infertilidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hombres
  • Astenozoospermia: ↓ motilidad espermática
  • Teratozoospermia Teratozoospermia Conditions in which sperm show abnormal morphology. Infertility: ↑ número de espermatozoides con morfología anormal
• Causas genéticas:
  • Síndrome de Klinefelter (47, XXY XXY Klinefelter syndrome is a chromosomal aneuploidy characterized by the presence of 1 or more extra X chromosomes in a male karyotype, most commonly leading to karyotype 47,XXY. Klinefelter syndrome is associated with decreased levels of testosterone and is the most common cause of congenital hypogonadism. Klinefelter Syndrome): una de las causas más comunes de hipogonadismo primario en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum hombres
  • Microdeleciones del cromosoma Y
  • Criptorquidia: testículos no descendidos
• Causas adquiridas:
  • Varicocele Varicocele A condition characterized by the dilated tortuous veins of the spermatic cord with a marked left-sided predominance. Adverse effect on male fertility occurs when varicocele leads to an increased scrotal (and testicular) temperature and reduced testicular volume. Varicocele, Hydrocele, and Spermatocele: dilatación del plexo pampiniforme
  • Infección:
    • Paperas
    • Tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis
    • Lepra
    • Gonorrea y clamidia
  • Quimioterapia
  • Radioterapia
• Muchos casos son idiopáticos

Trastornos del transporte espermático y disfunción sexual:

• Anomalías congénitas, disfunción u obstrucción de:
  • Epidídimo
  • Vasos deferentes
  • Conductos eyaculatorios
• Disfunción sexual:
  • Disfunción eréctil
  • Disfunción eyaculatoria

Diagnóstico

Evaluación de la mujer

Clínica:

Antecedente menstrual cuidadoso: los LOS Neisseria ciclos regulares con molimina (sensibilidad mamaria cíclica y dolor Dolor Inflammation ovulatorio) sugieren fuertemente la ovulación.

Pruebas de laboratorio:

• Día 3 del ciclo FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle, LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y estradiol Estradiol The 17-beta-isomer of estradiol, an aromatized C18 steroid with hydroxyl group at 3-beta- and 17-beta-position. Estradiol-17-beta is the most potent form of mammalian estrogenic steroids. Noncontraceptive Estrogen and Progestins:
  • ↓ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle con ↓ estrógenos → amenorrea hipotalámica funcional
  • Relación LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle: FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle > 2 con estrógeno normal → SOP
  • ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle con ↓ estrógenos → insuficiencia ovárica primaria
  • ↓ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle con ↑ estrógenos → tumor Tumor Inflammation secretor de estrógenos
• Progesterona del día 21 del ciclo: ↑ progesterona en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la fase lútea confirma la ovulación
• Hormona antimülleriana:
  • Prueba de reserva ovárica
  • ↓ hormona antimülleriana → insuficiencia ovárica primaria
• Otras anomalías hormonales que contribuyen a la disfunción ovulatoria:
  • ↑ Prolactina → hiperprolactinemia
  • ↑ Hormona estimulante de la tiroides (TSH) → hipotiroidismo
  • ↑ Testosterona → SOP

Imagenología:

• Ultrasonido:
  • Recuento de folículos antrales (evaluación de la reserva ovárica)
  • Leiomiomas
  • Ovarios de apariencia poliquística
  • Tumores de ovario
• Ultrasonido con infusión de solución salina:
  • Inyección de solución salina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cavidad uterina para distenderla durante el ultrasonido
  • Para diagnosticar pólipos, tabiques uterinos, sinequias
• Histerosalpingografía:
  • Inyección de tinte en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la cavidad uterina bajo fluoroscopia
  • El “llenado y derrame” bilateral de colorante confirma la permeabilidad tubárica.
  • Algunas anomalías uterinas pueden ser visibles.

Cirugía:

• Histeroscopia:
  • Una alternativa al AL Amyloidosis ultrasonido con inyección de solución salina
  • Permite diagnóstico y tratamiento simultáneos.
• Laparoscopia con cromopertubación
  • Inyección de tinte a través de tubos para evaluar la permeabilidad
  • Permite la evaluación y el tratamiento de la endometriosis Endometriosis Endometriosis is a common disease in which patients have endometrial tissue implanted outside of the uterus. Endometrial implants can occur anywhere in the pelvis, including the ovaries, the broad and uterosacral ligaments, the pelvic peritoneum, and the urinary and gastrointestinal tracts. Endometriosis y algunas adherencias pélvicas.

Evaluación de los LOS Neisseria hombres

Análisis de semen:

• Volumen
• pH pH The quantitative measurement of the acidity or basicity of a solution. Acid-Base Balance
• Concentración
• Conteo
• Motilidad
• Morfología
• Recuento de leucocitos
• Aglutinación

Laboratorio e imágenes si el análisis de semen es anormal:

• FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle, LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y testosterona total matinal:
  • ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle con ↓ testosterona → hipogonadismo hipergonadotrópico (defectos testiculares)
  • Normal o ↓ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle con ↓ testosterona → hipogonadismo hipogonadotrópico (defectos hipotalámicos o hipofisarios)
  • FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle normal con ↑ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle y testosterona → resistencia androgénica parcial
  • ↓↓ LH LH A major gonadotropin secreted by the adenohypophysis. Luteinizing hormone regulates steroid production by the interstitial cells of the testis and the ovary. The preovulatory luteinizing hormone surge in females induces ovulation, and subsequent luteinization of the follicle. Luteinizing hormone consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle con ↑ masa muscular → sospecha de abuso de andrógenos
• Pruebas genéticas (si se sospechan anomalías):
  • Cariotipo → Síndrome de Klinefelter
  • Microdeleciones del cromosoma Y
  • Mutaciones del regulador de la conductancia transmembrana de la fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans quística (CFTR, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés) → fibrosis Fibrosis Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. Bronchiolitis Obliterans quística
• Ultrasonido escrotal y transrectal: vesículas seminales dilatadas → obstrucción de vías eyaculatorias

Tratamiento

Factores de estilo de vida

• Frecuencia coital de cada 1–2 días alrededor de la ovulación
• Cesación de tabaquismo
• Limitar el consumo excesivo de alcohol y cafeína
• Lubricantes que favorecen la fertilidad (muchas marcas comunes inhiben la motilidad de los LOS Neisseria espermatozoides)
• Pérdida de peso en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de obesidad o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum mujeres con sobrepeso
• Aumento de peso para mujeres con bajo peso
• Reducir las toxinas ambientales: pesticidas, solventes de limpieza y metales pesados

Corrección quirúrgica de anomalías uterinas

• Fibromas
• Pólipos
• Sinequias
• Tabiques

Inducción de la ovulación, hiperestimulación ovárica e inseminación

• Requisitos:
  • Ovarios capaces de funcionar normalmente
  • Trompas permeables
  • Esperma
• Letrozol:
  • Inhibidor de la aromatasa que ↓ estrógeno → ↓ inhibición hipofisiaria → ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle
  • Se utiliza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la disfunción ovulatoria normogonadotrópica normoestrogénica
  • No aprobado por la FDA, pero considerado como terapia de 1ra línea
  • ↓ Tasa de gemelos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum comparación con citrato de clomifeno
• Citrato de clomifeno:
  • Modulador selectivo del receptor Receptor Receptors are proteins located either on the surface of or within a cell that can bind to signaling molecules known as ligands (e.g., hormones) and cause some type of response within the cell. Receptors de estrógenos → ↓ inhibición hipofisaria → ↑ FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle
  • Se utiliza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la disfunción ovulatoria normogonadotrópica normoestrogénica
  • El tratamiento clásico todavía se usa, pero ya no es la 1ra línea.
• Gonadotropinas inyectables (e.g., FSH FSH A major gonadotropin secreted by the adenohypophysis. Follicle-stimulating hormone stimulates gametogenesis and the supporting cells such as the ovarian granulosa cells, the testicular sertoli cells, and leydig cells. Fsh consists of two noncovalently linked subunits, alpha and beta. Within a species, the alpha subunit is common in the three pituitary glycoprotein hormones (TSH, LH, and FSH), but the beta subunit is unique and confers its biological specificity. Menstrual Cycle):
  • Alto riesgo de embarazos múltiples, incluidos embarazos múltiples de grandes cantidades
  • Se utiliza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la recuperación de óvulos antes de la fertilización in vitro y el hipogonadismo hipotalámico.
  • Requiere monitoreo con ultrasonidos frecuentes.
• Otros tratamientos médicos:
  • Agentes sensibilizantes a la insulina:
    • Metformina
    • Utilizados en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con sobrepeso con resistencia a la insulina y SOP en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum combinación con otros agentes inductores de la ovulación
  • Agonistas de la dopamina:
    • Bromocriptina
    • Cabergolina
    • Se utiliza para ↓ los LOS Neisseria niveles de prolactina en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la hiperprolactinemia.
• Inseminación intrauterina
  • Inyección en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el útero de una muestra de semen procesado
  • A menudo combinada con la inducción de la ovulación para ↑ las tasas de embarazo

Fertilización in vitro

• Para pacientes con:
  • Inducción de ovulación/inseminación intrauterina fallida
  • Enfermedad tubárica grave
  • Edad avanzada
• Procedimiento:
  • Los LOS Neisseria ovocitos se extraen quirúrgicamente mediante guía por ultrasonido.
  • La fecundación se produce a través de:
    • Introducción de espermatozoides a partir de una muestra de semen
    • Inyección intracitoplasmática de espermatozoide
  • Los LOS Neisseria embriones se cultivan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum una placa de Petri y se reimplantan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el endometrio.
• Opciones adicionales a menudo combinadas con la fertilización in vitro:
  • Diagnóstico genético preimplantacional: tamizaje de blastocistos para detectar euploidía o un defecto genético específico antes de la reimplantación
  • Inyección intracitoplasmática de espermatozoide:
    • Inyección de un solo espermatozoide en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un ovocito recuperado
    • Se utiliza en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con motilidad o morfología anormal de los LOS Neisseria espermatozoides.

Otras opciones de fertilidad

• Gametos de donantes (óvulos o espermatozoides)
• Embriones de donantes
• Portadoras gestacionales
• Adopción