A full explanatory series for causes of delayed pregnancy and treatment

Part One:

Definition of pregnancy delay and a brief summary of the fertilization journey

The delay in pregnancy is defined as the inability of a couple who live with one another and practice married life regularly for more than one year to have a successful pregnancy. The rate of pregnancy delay is about 10% -15%.

Types First, the couple did not have any children

Secondary that the couple had children before but they had a problem delayed pregnancy later. The pregnancy is a result of a mature ovum that will be fertilized by a sperm in the fallopian tube, then the fertilized ovum begins to divide and after 5-7 days the fertilized ovum leaves the fallopian tube to reach the uterine cavity and implants itself in the lining of the uterus. At this moment the pregnancy begins.

The second part:

Reasons of delayed pregnancy

There are many reasons that lead to delayed pregnancy and are divided into

• Reasons that are wife related ranging between 25 – 37%
• Reasons that are husband related and the proportion of these causes 15-25%
• unknown  causes of delayed pregnancy 25%
• And can be the cause of both spouses and the incidence of the occurrence of 21-38%

Reasons for the wife delay

1. Weakness or lack of ovulation: Ovulation is the maturation of the egg in the ovary and its arrival to the size of 18-24 mm and then the eruption of the external wall and liberation from the ovary and then enter the Fallopian tube where it remains in the tube until the sperm reaches

Causes of weak ovulation

•  Polycystic ovary syndrome (COPD): polycystic ovary syndrome (COPD) is characterized by cyclic menstruation disorders and period-to-cycle spacing, which can be considered a sign of ovulation weakness (although regularity of the cycle cannot be used as definitive evidence of ovulation). And the appearance of hair in places not desirable. Causes of polycystic ovaries can be mostly genetic and can occur without causes. • Pituitary gland problems: The pituitary gland is a small gland that is almost the size of the pea. It’s very important presence lies at the bottom of the brain and is responsible for the secretion of hormones that stimulate the activation and maturation of the ovum. Whether high pituitary hormones (such as early ovarian failure or certain genetic diseases affecting ovarian growth) or decreased (as in the case of some genetic diseases, which leads to the reduction of the level of pituitary hormones and therefore the interruption of the cycle for long periods and severe weakness of ovulation.
• High prolactin hormone: prolactin hormone is a hormone secreted from the pituitary gland, which stimulates the secretion of milk in the period of lactation. In some cases the increased secretion of prolactin hormone and without periods of breastfeeding can be caused by enlargement of the pituitary gland or the causes are unclear. The symptoms of high prolactin hormone is the discharge of fluids from the nipple, the interruption of the course may be without symptoms and is discovered during the routine examination.

• Thyroid problems: Thyroid gland is located in front of the neck, thyroid hormones are responsible for metabolism and the burning of energy in the body. Thyroid gland is one of the reasons to be affected by ovulation and its symptoms are feeling tired and inability to perform daily events as well as irregular cycle and weight gain. The reasons for the decrease activity of the gland are either due to the immune system diseases or caused by the removal of the gland due to the presence of tumors , whether benign or malignant ones. In contrast, increased activity of the gland also may lead to weak ovulation.

Diagnosis: Diagnosis of the weakness of ovulation by: Following the size of the egg in the days of ovulation by ultrasound examination /abdominal or vaginal sonar.The testing hormones in blood and a package of hormone work up must be done in the second or third day of the menstrual cycle and some hormones on day 21.Magnetic resonance imaging (MRI) in case of doubt hypertrophic pituitary gland or suspected tumors. Treatment: After the diagnosis of ovulation weakness is treated by the activation of the ovum, whether buy tablets or injections, with following-up the size of the egg and must be treated exclusively under the supervision of a specialized doctor.

2. Problems in the uterus:

The uterus is the last stop of pregnancy where the fertilized ovum implants itself in the lining of the uterus, and is called the nesting process. On this basis, the presence of any congenital abnormalities in the uterus may lead to delayed pregnancy by blocking the process of nesting such as a barrier in the uterus or the division of the uterus or horn like uterus so that it is small and for the development of the fetus.

On the other hand, the presence of uterine fibroid may lead to delayed pregnancy, especially if the location was in the underlining of the uterus or was too large or pushing the lining of the uterus, which prevents the process of nesting.

Diagnosis: Diagnosis should be done through ultrasound examination / sonar two-dimensional and three-dimensional and hysterosalpingectomy

Treatment: In the case of polyps or polyps or uterine barrier treatment can be by surgery either by open surgery or by endoscopy.

3. Problems of tubes / Fallopian tubes The percentage of tube problems is about 20% of the causes of delayed pregnancy and is in the form of blockage or swelling with the accumulation of fluid inside the tube to prevent the arrival of sperm to the egg or prevent the descent of fertilized egg to the uterus. The main causes of this condition are inflammation, especially so-called pelvic inflammatory disease and also migration of the lining or presence of cysts on the ovary.Diagnosis: It should be done by radiography or through endoscopy Treatment: Some cases of blockage can be treated with laparoscopic surgery. If surgery not possible or not feasible. The only solution would be IVF .

Problems with the husband

The reasons can be divided as follows:

•  Pituitary dysfunction: such as some genetic diseases that cause a defect in the stimulating hormones affecting the production of sperms• Testicular dysfunction: undescended testes. The presence of severe infections during puberty, e.g. mumps, which is an infection of the gland under the ear. In addition the problem of varicose and also exposure to radiation and chemical substances.
• Problems with sperm transmission: Exposure to genital infections and trauma can be one of the most important causes of obstruction, in addition to some genetic cases that tubes are not developed well for sperm movement.
• Smoking, addiction to alcohol and drugs as well as weight gain and wearing tight clothes

Diagnosis

The problems of infertility in men  are diagnosed through

• Examination of semen is done by collecting sperm sample after abstinence from intercourse for 3-5 days and is preferred to give the sample at the place of examination and avoid using any soap and creams during collection.
• Examination of hormones in the blood or conduct sonar ultrasound examination in some cases for the purpose of confirming the diagnosis and giving appropriate treatment.
• Treatment of infections under the supervision of a specialist doctor
• Treatment of hormone dysfunction under the supervision of a specialist doctor.
• Treatment of varicose veins surgically when needed.
• Use some supplements containing vitamin A and zinc
• Change lifestyle by leaving smoking, exercising daily and eating healthy eating vegetables, fruits, drinking water and avoid wearing tight clothes
• Some cases of low sperm count or lack of movement or a large number of deformities artificial insemination by IVF needs to be carried out.