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What is the main cause of early menopause?
By Dr. José Luis Gómez Palomares. Last Update: 01/16/2020

Early menopause or early ovarian failure consists of the termination of ovarian activity before the age of 40. It occurs in about 1% of women. In most cases, 63% of cases, as indicated by the Spanish Association for the Study of Menopause, the cause is unknown.

The second most common cause of early ovarian failure is genetics, while other causes of premature ovarian failure are: chemotherapy or radiotherapy treatments in women with oncological processes, endometriosis, metabolic or autoimmune diseases or infections.

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Despite normozoospermia we aren't able to get pregnant. Which other tests could we get done?
By Dr. José Luis Gómez Palomares. Last Update: 01/09/2020

As stated in the Manual of Andrology of the Spanish Society of Fertility: "although the results of semen analysis can give us information about problems in the function of the male genital organs, they do not allow us to determine with certainty whether an individual is fertile or not". So, if the semen analysis is normal, should other tests be performed? In the initial assessment of a couple with reproductive dysfunction, no. The seminogram is more a tool to guide treatment than to reach a diagnosis.

It is true that there are other complementary tests that can help to study the semen in greater depth, such as the study of the double-stranded DNA fragmentation of the spermatozoa. This type of test promises to advance in the evaluation of the male but even so, we insist, they are not indicated in the initial study of a couple with reproductive dysfunction. Even if you have normozoospermia.

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In what situations is it strictly necessary to perform a salpingectomy?
By Dr. José Luis Gómez Palomares. Last Update: 01/09/2020

Salpingectomy is the surgical removal of one or both fallopian tubes.

In medicine, there is not always data to support diagnostic or therapeutic behavior. This is not the case when, in the context of the study of reproductive dysfunction, a hydrosalpinx appears.

A hydrosalpinx is the dilation of the fallopian tube due to the presence of fluid inside it. When diagnosed, salpingectomy before in vitro fertilization treatment improves the chances of achieving a pregnancy. This is according to the review carried out by the Cochrane Library, probably the most rigorous and reliable organization of researchers when making recommendations in health sciences.

Therefore this would be a case where salpingectomy would be highly advisable. This is what science says but the Law makes clear the right to patient autonomy. The law says: "Any action in the field of health of a patient needs the free and voluntary consent of the affected person, once, received the information provided in Article 4, has assessed the options specific to the case". Because of this bioethical principle of autonomy, the patient can decide, even though she knows that the prognosis of the in vitro fertilization treatment worsens, not to undergo a salpingectomy. The concept of "strictly necessary" is therefore relegated to what the patient, properly informed, decides.

When does the endometrium become receptive?
By Dr. José Luis Gómez Palomares. Last Update: 01/09/2020

The endometrium is receptive when the embryo can adhere to the endometrial cells and then be introduced into their thickness. Classically, this process was said to occur between days 20 and 24 of a normal 28-day cycle.

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