The cause of the disease is female infertility. Causes of infertility in women and methods of treatment

Infertility is the absence of pregnancy for any reason after 1 year of sexual activity without the use of contraceptive methods or after 6 months if the woman is over 35 years old. According to Rosstat, more than 3% of women in Russia of reproductive age (from 20 to 44 years old) suffer from infertility after the first birth, and almost 2% are not able to give birth at all.

There are many reasons that interfere with conception or gestation: from health problems to psychological factors. Male infertility can also occur, but due to the complexity of the female reproductive system, most infertile marriages are associated with malfunctions in the woman's body. In most cases, the cause of the absence of pregnancy can be identified and corrected with medication or surgery, but there are also unidentified factors.

The normal process of reproduction requires the interaction of male and female germ cells. During the release of the egg from the ovaries, it then moves through the fallopian tubes to the uterus. The male reproductive organs produce sperm.

The sperm and egg usually meet in the woman's fallopian tube where fertilization takes place. The embryo is implanted in the uterine cavity for further development. Female infertility is when, for some reason, this circuit fails.

The most common problems leading to infertility are violations of the ovulation process (in 36% of cases), (30%), endometriosis (18%). Unknown causes of infertility remain in 10% of women.

Hormonal infertility

A delicate balance of female sex hormones (estrogen, progesterone, luteinizing hormone, follicle-stimulating hormone) is necessary for the timely maturation and release of the egg from the ovary.

The following hormonal disorders can cause infertility:

Polycystic ovaries. Due to an excess of male hormones or hypersecretion of insulin by the pancreas, many follicles form in the ovaries, but none of them mature and release an egg, that is, ovulation does not occur. The ovaries increase in size up to 2-6 times, the monthly cycle lengthens, some periods may be missed. 70% of women diagnosed with PCOS are overweight.
Resistance (resistance) to insulin, often associated with polycystic disease. The hormone insulin, produced by the pancreas, is responsible for delivering sugar from the blood to the body's cells. If the cells stop taking it, more insulin is released in response to the increase in blood sugar. According to studies, resistance is associated with an increased number of male genital organs - hyperandrogenism. The causes of cell resistance to insulin are malnutrition, stress, and a sedentary lifestyle.
Increased amount of male hormones. Irregular or even absent periods may indicate hyperandrogenism. Excess male hormones suppress the functioning of the ovaries, up to the cessation of ovulation and lead to infertility. Hyperandrogenism also causes a strong growth of body hair, acne, a coarsening of the voice and a change in the male figure.
An excess of the hormone prolactin produced by the pituitary gland (hyperprolactinemia). Problems in the functioning of the gland occur due to impaired blood supply, genetic causes, injuries, medication, and meningitis. Characteristic signs of the disease are the appearance of milk in the breast and violations of the monthly cycle. Mastopathy, growth of the mammary glands, bone fragility, and a decrease in sexual desire are also observed. Prolactin is a hormone of nursing mothers, it is because of it that many of them do not ovulate and menstruate. An increase in this hormone in other women is usually associated with thyroid dysfunction (hypothyroidism).
Premature menopause. The average age of onset of menopause is 50 years, but due to autoimmune or genetic disorders, diseases of the reproductive system, unhealthy lifestyle, smoking and other reasons, 1% of women experience menopause before the age of 40. The production of female hormones decreases, ovarian function and fertility gradually fade away.
Insufficiency of the corpus luteum. The corpus luteum is a temporary gland that occurs instead of the follicle that released the egg. The hormone of the gland, prolactin, stimulates the preparation of the uterus for fixing a fertilized egg in it. If it is not enough, fixation does not occur and pregnancy does not occur, but if implantation occurs, a miscarriage soon occurs. Conditions of insufficiency of the corpus luteum - genetic disorders, ovarian pathologies (polycystic ovary syndrome, cancer), malfunctions of the pituitary gland.

Physiological factors of infertility

Damage to the fallopian tubes or lack of patency. It is in the fallopian tubes that fertilization takes place after the release of the egg from the ovary and connection with the spermatozoon, therefore, if they are obstructed, fertilization is impossible. The tubes can be damaged as a result of inflammation, after viral or bacterial infections, sexually transmitted diseases, complications from surgery, when adhesions or scarring occur.
Endometriosis. Due to genetic factors, the pathology of immune and hormonal processes, the uterine mucosa is formed in inappropriate places inside and outside the reproductive tract. Endometriosis can block the fallopian tubes and prevent ovulation, leading to infertility. Signs of this disease are pain, heavy and painful periods.
Myoma of the uterus. It is believed that the cause of fibroids (a benign growth on the uterus, consisting of muscle tissue) is an increase in estrogen levels. Risk factors - genetic predisposition, metabolic disorders, stress, abortion. Myoma makes itself felt with the help of heavy menstruation, cycle disorders, pain. The consequences of the appearance of the tumor depend on its size and location, in some cases it causes infertility, miscarriages or pregnancy complications.
Adhesions and anomalies in the shape of the uterus (one-horned and two-horned, the presence of a septum, uterine infantilism). The cause of adhesions and fusion of the walls of the uterus are inflammatory processes, trauma and endometriosis, and structural pathologies are caused by genetic causes. The consequence of these problems is most often spontaneous abortion, since the fertilized egg cannot gain a foothold in the uterus.
Scarring of the cervix or abnormalities of its shape. Adhesions and scars on the cervix - a consequence of surgery or infection. Because of this, spermatozoa do not pass into the fallopian tubes and infertility occurs. A deformity of the cervix or changes in the composition of the cervical mucus can also make it difficult for sperm to travel.
Inflammation of the pelvic organs. The reason for this may be infections caused by several types of bacteria, in particular, sexually transmitted infections (STDs) - gonorrhea, chlamydia, ureaplasmosis, and many others. Factors that increase the risk of infection are sex without a condom and changing sexual partners. Pathogenic bacteria can enter the body during intrauterine manipulations, during menstruation, in the postpartum period, since at this time the effectiveness of natural defense mechanisms decreases. Infections can cause inflammation of the tubes and ovaries (salpingoophoritis) in combination with inflammation of the uterus (endormetritis), as well as inflammation of the cervix (cervicitis). The diseases are characterized by abdominal pain, unusual discharge (including uncharacteristic periods), ulcers, spots, itching, and soreness of the genitals.

Other reasons

Age. By the time of puberty, a woman's ovaries contain about 300,000 eggs. Over time, they age - DNA is damaged, since the system for its restoration works worse with age. Accordingly, their quality decreases - suitability for fertilization and development of the embryo. This process becomes noticeable after 30 years, and when a woman turns 35-40, aging accelerates.
Overweight or underweight. An excess amount of adipose tissue in the body threatens hormonal disruptions - an increase in the amount of estrogen and testosterone, which threatens gynecological diseases up to infertility. Obese women may become pregnant under the influence of drugs, but often there are problems with the bearing and development of the child. Underweight (BMI less than 18.5) also leads to disruption of the endocrine system, but hormones are produced less than necessary for the normal functioning of the reproductive system, eggs stop maturing.
Stress, nervous exhaustion, chronic fatigue. Stress is the cause of hyperprolactinemia and a decrease in the level of estrogen in the blood, which affects the possibility of maturation of the egg and its attachment to the uterine wall. Another consequence of emotional overload is spasms and muscle contractions, which leads to hypertonicity of the uterus and fallopian tubes, which prevents conception.
congenital disorders. Stein-Leventhal syndrome (provokes polycystic ovary syndrome), adrenogenital syndrome (impaired functioning of the adrenal glands and increased levels of androgens), Shereshevsky-Turner syndrome (absence of menstruation), bleeding disorders and some other disorders are of a genetic nature and interfere with conception or cause early miscarriages.
Immunological factors. The presence of anti-sperm antibodies in the cervical mucus can lead to infertility. In other cases, the mother's immune system prevents the embryo from attaching to the uterine wall and thus causes a miscarriage.
psychological reasons. In some cases, a woman subconsciously perceives pregnancy as a danger. This can be caused by moral trauma, fear of changes in life or appearance, fear of childbirth. The brain controls all processes in the body, so a negative psychological attitude leads to infertility.

Forms of infertility

There are several types of infertility, differing in conditions and mechanism of occurrence.

Depending on the possibility of eliminating the causes that caused problems with conception, and the chances of a subsequent pregnancy, there are:

relative infertility, when after taking medication, normalizing hormonal levels or metabolism, surgery to restore reproductive function or other treatment, conception can occur;
absolute, in this case, due to congenital factors, incurable diseases or disorders, pregnancy that occurs naturally is impossible.

In some cases, after the first pregnancy (successful or unsuccessful), a woman cannot conceive again for various reasons, but often the first pregnancy does not occur. Depending on this, there are:

primary infertility (lack of pregnancy);
secondary infertility (there are cases of pregnancy in the anamnesis).

According to the mechanism of occurrence:

acquired infertility occurs due to injuries, infections, diseases of the reproductive and endocrine systems that are not associated with a genetic factor;
congenital - hereditary diseases, developmental anomalies.

For the reasons that caused it, infertility is divided into the following types:

tubal (associated with obstruction of the fallopian tubes);
endocrine (caused by disorders of the endocrine glands);
infertility due to uterine pathologies;
peritoneal, when adhesions in the pelvic organs interfere with conception, but the fallopian tubes are passable;
immunological infertility is caused by the formation of antibodies to sperm in the female body;
infertility due to endometriosis;
idiopathic (of unknown origin).

Diagnostics

The causes of female infertility are varied, often to find out it is necessary to undergo a large number of examinations.

To diagnose the presence and cause of female infertility, a consultation with a gynecologist or reproductologist is necessary. He must find out from the patient whether she has complaints of pain, discharge, the duration of unsuccessful attempts to get pregnant, the presence of genetic or infectious diseases, surgeries, complications, the nature of menstruation and sexual life. Also, the doctor performs an examination both external - to assess the physique, the presence of excess body hair, skin condition, and gynecological, including checking the condition of the internal genital organs.

There are a number of functional tests offered to determine the causes of infertility:

cervical index, which involves the evaluation of cervical mucus to determine the level of estrogens;
building a basal temperature curve, which allows you to evaluate the fact and time of ovulation;
postcoital test, when the activity of spermatozoa in the cervix is studied and the presence of antibodies to sperm is established.

To find out the causes of infertility, the following tests are offered:

For laboratory diagnosis of infertility, the hormonal background is first checked. In particular, this is an assessment of the level of testosterone, prolactin, cortisol on days 5–7 of the cycle, progesterone on days 20–22, hormonal tests, when indicators are evaluated after stimulation or inhibition of various hormonal processes based on their response.
An STD test is mandatory.
The study of the content of antibodies to sperm in the blood and cervical mucus is an immunogram, analysis of vaginal secretions and compatibility tests.
Genetic analysis of chromosomal abnormalities leading to infertility.

The woman will be asked to undergo the following examinations:

ultrasound. Allows you to see violations of the pelvic organs, uterine fibroids, assess the structure of the uterus, ovaries, fallopian tubes and their patency. You can also evaluate the processes of ovulation and maturation of follicles.
Hysterosalpingography (HSG)- Examination of the internal genital organs using x-rays. The contrast agent injected by the gynecologist gives an informative picture of the state of the uterus, fallopian tubes, and ovaries.
Skull x-ray, since the cause of infertility may be a malfunction of the pituitary gland or its tumor.
Colposcopy, including examination of the vagina and cervix by introducing a colposcope - a special device consisting of a binocular and a lighting device. This study allows you to identify signs of erosion and cervicitis - signs of the inflammatory process.
Hysteroscopy. It is performed under general anesthesia using an optical instrument of a hysteroscope inserted through the vagina. It makes it possible to visually assess the cervical canal, uterine cavity, fallopian tubes, and also take the uterine mucosa for analysis.
Laparoscopy- This is a check of the pelvic organs with optical equipment through a micro-incision on the abdomen. Like hysteroscopy, this is a low-traumatic operation, after 1-3 days the patient can leave the hospital.

Treatment

The decision on the methods and the need for treatment is made after all examinations and the establishment of the causes of infertility. If it is relative, therapeutic or surgical methods of treatment are used, absolute (incurable) infertility requires alternative solutions to the problem - assisted reproductive technologies.

Medical treatment

Infertility drugs are mainly prescribed to correct ovulation disorders in patients due to hormonal problems. This method is used as the first treatment option for many patients, often used after surgery or in combination with IVF and ICSI.

There is a wide range of drugs. The most common ones are:

Clomid and Serofen. These drugs are taken in the form of tablets and stimulate the process of ovulation, forcing the production of hormones necessary for the maturation of the egg, the hypothalamus (gonadotropin hormones) and the pituitary gland (follicle-stimulating and luteinizing hormones).
Hormone injections: human chorionic gonadotropin (hCG), follicle stimulating hormone (FSH), human menopausal gonadotropin (hMG), gonadoliberin (Gn-RH), gonadoliberin agonist (GnRH agonist). Hormones are given by injection at regular intervals. These drugs are more effective and more expensive than Clomid and Serofen. They are generally used to induce ovulation and subsequent IVF.
Utrozhestan- a drug containing progesterone and stimulating the preparation of the uterus for egg implantation.
Duphaston due to the content of dydrogesterone, it helps the fertilized egg to attach to the uterus.
Bromocriptine inhibits the production of prolactin.
Wobenzym It is prescribed for inflammations and infections, as it increases the body's resistance.
Tribestan normalizes the level of estrogen and follicle-stimulating hormone.

Surgery

Surgery can solve a number of issues, but it is used only in the initial stage of infertility treatment for several reasons.

These can be the following types of operations:

Removal of polyps, fibroids, cysts Removal of excess or abnormal tissue in the uterine or ovarian cavity can improve ovulation and clear the way for sperm and egg to reunite. The excised tissues are always sent for biopsy to check for malignant cancers.
Surgical treatment of endometriosis. The operation is prescribed when conservative methods of infertility treatment do not help, and the disease leads to severe pain and disruption of the urinary system.
Restoration of ligated fallopian tubes. For sterilization purposes, women's fallopian tubes may be cut or soldered. The reverse process - the restoration of their patency - is a serious surgical operation, the successful outcome of which depends on the method and prescription of blocking the pipes and their condition.
Salpingolysis- removal of adhesions on the fallopian tubes.
Salpingostomy- to restore the patency of the fallopian tube, the area with impaired patency is removed, and the remains of the tube are connected.

These operations are performed using hysteroscopy or laparoscopy, but when removing large cysts, fibroids, extensive endometriosis, a laparotomy is used when a large incision is made on the abdomen.

Assisted Reproductive Technologies (ART)

In ART, an egg is fertilized by a sperm outside the body. The ART procedure is based on the surgical removal of an egg from the ovaries, combining it with sperm in the laboratory and returning it to the patient's body or transplanting it to another woman. Mostly in vitro fertilization (IVF) is used.

The success of the operation varies depending on many conditions, including the cause of infertility and the age of the woman. According to statistics, after the first IVF protocol, pregnancy occurs in 40% of women under the age of 35 and gradually decreases to 2% in those over 44 years of age.

ART can be expensive (only free IVF is covered by the MHI policy) and time-consuming, but it allows many couples to have children.

Types of ART:

ECO- the most effective and common form of ART. With the help of drugs, superovulation is caused in a woman (the maturation of several eggs), which are then combined with the man's sperm under special conditions, and after fertilization they return to the patient's uterus. The seed material may belong to the husband, or it may be donor - cryopreserved.
ICSI(Intra Cytoplasmic Sperm Injection - intracytoplasmic sperm injection) is often used for couples with male factor infertility. One healthy sperm is placed in the egg, unlike IVF where they are placed in a petri dish together and fertilization occurs on its own.
Embryo transfer (gametes) into the fallopian tubes- GIFT and ZIFT. The embryo is transferred into the fallopian tubes instead of the uterus.
Insemination with husband's sperm (IMS) or insemination with donor's sperm (IDS) is used when vaginal ejaculation is impossible, "bad" spermatozoa, the use of cryopreserved seminal material. Spermatozoa are transferred into the vagina or directly into the uterine cavity.
Surrogacy offered to women who do not have a uterus. The patient's egg is fertilized with the husband's sperm and transferred to the uterus of a surrogate mother - the woman who will bear the child.

Complications in the use of ART can be an allergy to drugs for stimulating superovulation, ovarian hyperstimulation syndrome, inflammation and bleeding.

If, as a result of long treatment and numerous attempts to have a baby, including using assisted reproductive methods, pregnancy does not occur, do not despair. Those couples who are confident in their desire to have a child may consider adoption.

The adoption process requires the collection of a large number of documents and often a long selection of candidates. There are also risks of ignorance about the child's genetics or lack of understanding if an older child is adopted, so this decision requires a balanced approach.

In order to conceive and bear a child, a woman needs healthy ovaries, fallopian tubes, uterus, endocrine system. Disruption of any of these organs can contribute to infertility. It is wise to seek medical attention if risk factors are present - irregular menstruation, endometriosis, ectopic pregnancy, PCOS, pelvic inflammatory disease, and others.

To establish the causes of infertility, a lot of tests and examinations are required, including studies for hormonal and genetic disorders, the search for pathologies of the genital organs and infectious diseases. In most cases, infertility can be cured with medication (mainly hormonal agents), surgery, or assisted reproductive technology. The latter give a chance to those couples who, due to health problems, are unable to have children naturally.

Olga Rogozhkina

midwife

If within 12 months a woman has not become pregnant with regular unprotected intercourse, then she is diagnosed with infertility. Why is this time allotted for a possible conception? The 12-month period is clarified by statistics: it has been proven that 30% of women were able to become pregnant in the first 3 months of open sexual activity, 60% - over the next 7 months, 10% - after 11-12 months from the start of pregnancy planning. It turns out that one year is enough to confirm the fertility of a woman. Modern medicine is able to solve the issue of female infertility in most situations. A reproductive specialist helps to identify the type of infertility and choose options for solving this problem.

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The inability of an adult organism to produce offspring.

The problem of infertility has long been familiar to mankind - since ancient times, a woman who is not capable of conception and bearing has been considered inferior. Divorce from barren spouses was allowed in Roman law, and rulers in Russia exiled their wives to monasteries.

Even in the last century, it was believed that only the woman was to blame for a childless marriage. The development of science has made it clear that men can also suffer from infertility. The advances in medicine, the growth of prosperity, the increase in life expectancy have led to the desire of people to have their own children, despite health problems. At the same time, environmental degradation, chronic stress, a change in the rhythm of life and a revision of family values (when a career is put at the forefront, and offspring planning is postponed to a not very young age) affect the deterioration in the ability to conceive. Therefore, the problem of infertility today is quite acute. Medicine offers many ways to treat it - from hormone therapy to surgery. And when all the means have already been tested, and there is no result, IVF comes to the rescue.

Infertility in women is a serious problem faced by many couples. According to statistics, about 60% of all problems with conception are due to female diseases. Depending on whether there were previous pregnancies, there are:

Primary infertility, in which a woman living a regular sexual life has never become pregnant.
Secondary infertility, when pregnancies were previously observed and, possibly, there are already children.

The reasons for which there is difficulty with conception and bearing can be divided into several groups:

Problems with the fallopian tubes - impaired patency due to adhesions that appear as a result of injuries, inflammatory diseases, operations. The consequence of obstruction can be an ectopic pregnancy, which threatens the woman's life and is treated by removing the tube along with the embryo - and this significantly worsens the chances of a successful next pregnancy.
Infertility in diseases of the endocrine system, entailing a violation of the maturation of eggs.
Gynecological diseases - pathologies of the cervix, genital infections, endometriosis, etc.
The cause of infertility in women is also early aging of the reproductive system, depletion of the ovaries and menopause. As a rule, menstruation continues until the age of 50-55, but sometimes they can completely stop at 40 or even earlier.
The problem of infertility can have a psychological cause, when stress, anxiety, constant depression and fears prevent pregnancy.
Immunological incompatibility - in the cervical mucus of a woman, antisperm antibodies (ASAT) are formed that kill spermatozoa. ASAT can also be formed in men, and then they disrupt the quality of sperm.
Developmental anomalies in which pregnancy is absolutely impossible - for example, when the patient has no or underdeveloped reproductive organs from birth.

Sometimes it is impossible to establish the cause of female infertility, and then it is called idiopathic - this happens in almost 25% of all cases. However, this does not mean that there is no problem - just the available methods of diagnosis and therapy are not yet able to identify and eliminate diseases that prevent pregnancy.

Infertility in men

It has long been mistakenly believed that the inability to conceive and bear a child is a misfortune for women. In fact, infertility in men is almost as common - about 45% of reproductive problems occur in their share. The cause of the failure is a violation of the mobility and viability of spermatozoa, a decrease in their number, obstacles to ejaculation, and many diseases and adverse factors can contribute to this. What is infertility in men?

Secretory, when the quality and quantity of sperm deteriorates.

It can be treated with medications and hormones.

Obstructive.

It is associated with a violation of the patency of the vas deferens due to trauma, damage during surgery on other organs, tuberculosis, syphilis and inflammation of the epididymis, leading to gluing of the ducts and the inability of spermatozoa to enter the seminal vesicles.

Immunological

The cause of immunological infertility in men is the production of antibodies to their own spermatozoa. In the normal state, sperm are not affected by cells of the immune system, as they have a special biological barrier (hematotesticular). When this barrier is breached due to injury and infection, antisperm antibodies attack the spermatozoa, sticking them together and immobilizing them.

Relative

Relative infertility in men includes such types of it when the examination did not reveal significant problems, but the pregnancy of his partner does not occur. The reason for this is, as a rule, stress and anxiety. A psychotherapist is engaged in the treatment of male infertility of this form.

The main symptom of infertility is a non-pregnancy in a couple of fertile age, if favorable conditions for conception are met:

Complete rejection of all contraceptives.
Sexual contacts occur frequently (at least several times a week).
The man has no problems with sperm quality.

As a rule, infertility does not have any specific signs, and it can be suspected by indirect symptoms and manifestations of diseases that lead to problems with conception and gestation:

A deviation in the menstrual cycle indicates problems with ovulation (for example, a cycle of less than 20 days is usually anovulatory). A timely visit to a doctor allows you to cure the disease that provokes a failure at an early stage.
An indirect symptom of infertility can be excessive hair growth on the body and face, as well as the absence of hair in the pubic area and armpits - all this indicates an excess of androgens ("male" hormones). Oily skin with acne also speaks of excessive secretion of androgens.
Hyperprolactinemia, or excessive production of prolactin by the pituitary gland, is manifested by the absence of menstruation and the release of milk from the mammary glands outside of pregnancy and lactation.
Sexually transmitted diseases can cause inflammation in the pelvis and obstruction of the fallopian tubes.
Underweight, sudden weight loss leads to a decrease in estrogen production, due to which follicles develop. The result of an immoderate struggle with extra pounds is the absence of menstruation and the inability to get pregnant. The second option is also bad, when the lady is obese - in this case, the production of “female” hormones is disrupted, and cardiovascular diseases develop.
Medical abortions that violate the integrity and quality of the internal mucosa of the uterus cause uterine infertility - the embryo cannot attach to the thin damaged endometrium.
Recurrent miscarriage, when miscarriages occur several times in a row, is a sign of female infertility and indicates hormonal abnormalities, impaired hemostasis, problems with the endometrium.

Causes of infertility

In male infertility are to blame:

Infectious diseases, sexually transmitted.

No less problems are caused by infectious parotitis, which causes inflammation of one or two testicles at once. Therefore, boys must be vaccinated against him to avoid infection.

Varicocele.

Varicose veins of the testicle and spermatic cord, due to which the temperature inside the testicle rises, the secretion of sperm and their quality suffer. Varicocele initially has no symptoms, and only at a late stage can the scrotum grow and hurt. The disease can be cured surgically. After the operation, the characteristics of sperm are improved, and conception becomes possible.

Trauma and congenital pathologies.

Another possible cause of infertility is trauma and congenital pathologies of the structure of the genital organs (cryptorchidism and testicular torsion). With cryptorchidism, the testicles are located outside the scrotum in a newborn: they can be located in the abdomen, subcutaneously on the pubis, and in other places. In the standard case, cryptorchidism is diagnosed in infancy, at the same time an operation is performed to bring the testicles into the scrotum.

Hormonal disorders.

For example, a lack of testosterone secretion leads to problems with erection and sperm secretion.

Prostatitis, urethritis disrupt the process of sperm production, worsen its quality.

immune disorders

When the body produces antibodies to its own sperm, which entails their immobility.

Violations in the sexual sphere.

Impotence, premature ejaculation can also cause infertility in men.

Bad habits.

Tobacco smoking, alcoholism, drug addiction, taking hormones in order to get fit, abuse of tight clothes, hot baths, baths and saunas.

Unfavorable living conditions

Signs of infertility can be observed in those who live in a region with poor ecology or work in hazardous chemical production - all this worsens the quality of sperm.

Stress and overwork.

Stress, insomnia and overwork also negatively affect male reproductive function - therefore, it is useful to be able to fully relax and recuperate.

The problem of infertility in women requires looking for ways to treat it. To do this, you need to clearly understand what and how can affect the ability to conceive and bear a child:

The age of the expectant mother.

After 35 years, fertility rapidly decreases due to the fact that the chromosomes in the eggs are destroyed.

Underweight or overweight.

The cause of infertility can be obesity or dystrophy, since the amount of fatty tissue in the body affects the production of estrogen, and hence the menstrual cycle.

Infections.

Inflammation in the pelvis - sexually transmitted infections lead to inflammatory diseases of the reproductive organs, and this disrupts the patency of the fallopian tubes, affects the attachment and bearing of the fetus.

Hormonal disorders.

Infertility in women is caused by hormonal disorders, due to which ovulation does not occur, hormones are not produced to maintain pregnancy, and the endometrium of the desired quality does not grow. Hormonal imbalance often leads to the development of polycystic ovaries, when the body is not able to produce mature eggs, and cysts with fluid inside form in their place. Pathologies of the thyroid gland, impaired secretion of "male" hormones can also cause infertility.

Endometriosis.

Endometriosis is a disease in which the endometrioid cells of the inner layer of the uterus are outside of it and grow, which disrupts the patency of the fallopian tubes and makes ovulation difficult. In addition, there are studies proving the negative impact of endometriosis foci on spermatozoa.

immune causes.

In some women, cervical mucus contains antibodies that have a detrimental effect on sperm viability. A sign of infertility in this case is a long-term pregnancy with apparent well-being in health for both partners.

Bad habits (smoking, alcohol, caffeine abuse in large doses), exposure to chemicals while working in hazardous industries affect the reproductive sphere and reduce fertility.

Factors that increase the likelihood of infertility

Today, up to 30% of couples face signs of infertility, and therefore the problem of fertility has become an urgent problem for health care and the public. The number of people who suffer from diseases that affect the ability to conceive and carry a child is increasing. This is especially true for those who live in large cities and large industrial areas.

One of the main factors of infertility - tubal-peritoneal - leads among other causes of fertility disorders and is a consequence of sexual infections. Doctors attribute this to the promiscuity of sexual contacts, early onset of intimate life, low literacy of young people in matters of safe contraception.

The growth of statistics on infertility is influenced by the increased activity of the population in moving, long-term separation of spouses, a large number of divorces and frequent changes of sexual partners. The neglect of contraception, self-treatment of gynecological diseases instead of going to the doctor negatively affects - as a result, women develop inflammation of the ovaries and the internal cavity of the uterus, erosion of the cervix, endometritis and endometriosis.

A life scenario full of stress and worries, lack of sleep and overload leads to changes in hormonal levels, endocrine disorders, ovulation disorders, exacerbates common diseases that can prevent conception.

Another problem associated with infertility is that couples turn to the doctor only at a late fertile age (from 35-40 years), when there is not much time left for treatment, the ovarian reserve is depleted, the spermogram is poor, and the body is burdened with other factors. diseases. Therefore, doctors have no choice but to offer IVF with a donor egg or sperm, which, for moral and ethical reasons, does not suit everyone - many couples do not want to raise only half of "their" child.

The disease of infertility is mysterious in that it is often not clear why a couple cannot become pregnant - in this case it is called idiopathic (inexplicable). The diagnosis can be made when a man and a woman have undergone a complete list of examinations, and no pathology has been identified, but pregnancy has not occurred for more than a year of regular intimate relationships without contraception. A woman should have a healthy uterus and fallopian tubes, be free of ASAT and endometriosis. A man must have a good spermogram and a negative analysis for the presence of antisperm bodies in the blood.

What can be a factor of infertility of unknown origin?

Genetic disorders in the egg.
Anovulation for unknown reason.
Lack of capture of the fallopian tube by the egg.
The inability of the sperm to certain biochemical reactions and penetration into the egg.
Termination of the division of the embryo, the impossibility of attaching it to the wall of the uterus.

What to do in the case when the doctor reports signs of infertility of unknown origin? There are several options:

Waiting - it is offered if the woman is under 30 years old, and there is a margin of time for natural conception attempts.
Stimulation of ovulation with medications.
Artificial insemination.
In vitro fertilization.

Types of infertility

Primary infertility

Infertility in women is called primary when she has never been pregnant in any form (even with an ectopic attachment of an embryo, fetal death, miscarriage or abortion), has regular unprotected sexual relations for at least one year, and at the same time cannot become pregnant .

They speak of primary infertility in men when none of his partners was pregnant by him in any intimate relationship in the absence of contraceptives.

Secondary infertility

Secondary infertility (grade 2) means that a woman has had pregnancies in the past and may already have children, but she cannot conceive at the moment. It would seem that if you managed to get pregnant before, why is it not working now? There are many reasons:

Age - Fertility declines steadily after age 35, and the first signs of fertility deterioration appear when a woman turns 30.
Secondary infertility may be the result of constant emotional stress, stress, chronic fatigue, accumulated over the years.
Hormonal disorders (polycystic ovary syndrome, adrenogenital syndrome, etc.), diseases of the endocrine and immune systems.
Gynecological problems - inflammation or infectious diseases of the genital organs, fibroids, adhesions and obstruction of the fallopian tubes.
Gynecological interventions (abortions, curettage) lead to secondary infertility of the uterus, due to which the endometrium is damaged and thinner, and the fetal egg cannot attach to the wall.

Secondary infertility in men means that for a long time conception does not occur due to the male factor, while in previous relationships the partner had children, or a pregnancy occurred from him. The cause of the second degree of infertility can be:

Inflammatory diseases of the genitourinary system.
Varicocele.
Trauma and surgery on the scrotum.
Immune and hormonal disorders.

1 degree infertility

Infertility of the 1st degree is characterized by the impossibility of conceiving a child even once throughout the previous life. Do not panic - this does not mean at all that there will never be children. Most of the diseases that cause infertility can be cured:

Infections and inflammatory diseases of the pelvic organs.
Hormonal deviations.
Violation of blood flow in the uterine cavity.
Problems in the endocrine system and hemostasis.
Immune disorders.
Gynecological diseases (endometriosis, fibroids, ovarian and cervical cysts).
Violations of spermatogenesis and infectious diseases in men, the formation of ASAT.

If a couple lives in unfavorable conditions, and stress, lack of sleep, hard work and emotional burnout are a factor in infertility, a simple normalization of the regimen and good rest can help get pregnant.

2nd degree of infertility

The second degree of infertility is a secondary form of infertility in which people cannot conceive a child, despite past pregnancies. There are many reasons for this:

Decreased fertility with age, early menopause in women.
Violation of spermatogenesis.
Gynecological diseases (fibroids, endometriosis, inflammation of the appendages, etc.).
Hormonal disorders.
immune deviations.
Diseases of the thyroid gland.
Complications after previous pregnancy and childbirth, as well as after abortion.
Unhealthy lifestyle, bad habits.

Depending on what caused the second degree of infertility, one or both spouses are prescribed special treatment. The chance of conception after treatment is high, and if it was not possible to get pregnant, assisted reproductive technologies will come to the rescue - artificial insemination, IVF, surrogacy.

3 degree infertility

The term "third degree of infertility" is practically not used in medicine. It means that a person will never be able to conceive and give birth to a child. This happens in the case of congenital absence of the ovaries and uterus, testicles. As a rule, this happens extremely rarely, and even then there are options to become parents - to resort to a donor egg or sperm, surrogate motherhood. In other cases, there are even more opportunities for treatment, and their effectiveness is higher. Therefore, doctors do not undertake to assert that the third degree of infertility is forever. The development of science and medicine gives hope that tomorrow incurable diseases will be cured, and problems with conception will be solved.

Diagnosis of infertility

History taking and examination for signs of infertility

Diagnosis of infertility disease begins with the collection of anamnesis and medical examination. Based on this, the doctor can suggest the cause of the problems and make a list of further examinations.

History may be:

General, when the doctor finds out the state of health in general, learns about the presence of common diseases, general well-being, possible fluctuations in weight, blood sugar and blood pressure. Doctors may be interested in some factors of infertility: bad habits, exposure to stress, working conditions (hard physical labor, contact with harmful substances, etc.).

Gynecological - here the doctor finds out:

At what age did the first menstruation occur, how long is the cycle now, is it accompanied by pain, what is the nature of the discharge.
When a woman began to have sex. With what regularity does it now. Whether experiencing discomfort during sex.
How long does pregnancy not occur, have there been abortions, miscarriages before, are there children.
What type of contraception was previously used.
How long did it take for a previous pregnancy to occur and how did it go. Have there been complications during childbirth?
Whether there are pains and discharges from the genital organs, whether infections and developmental anomalies have been diagnosed before and now.
Whether operations were performed on the reproductive organs, whether there were injuries.
What examination and treatment for gynecological diseases was prescribed to a woman earlier.
Has the spouse been treated for male infertility, and with what result.

During the examination, the gynecologist assesses the general condition and determines the visual symptoms of infertility:

The state of the mammary glands, their development and the presence of secretions.
The nature of the hairline (male or female type).
Body type.
The development of the genital organs and their pathology.
The presence of rashes on the skin and mucous membranes of the genitals, which may indicate infections.

In addition, the doctor examines the condition of the skin of the face, palpates the pancreas, abdomen and inguinal region, measures blood pressure and temperature.

The second step in the diagnosis of infertility is general tests:

General blood analysis.
Blood test for HIV and hepatitis.
Blood test for group and Rh factor.
Blood tests and smears for PCR diagnostics of TORCH infections.
Hemostasiogram to detect disorders in the blood coagulation system (they can be the cause of infertility).
Determination of lupus anticoagulant, antibodies to phospholipids.
Analysis of antisperm antibodies in cervical mucus, semen and blood.

To diagnose male infertility, a partner must pass a spermogram - a study of sperm to determine its fertilizing ability and identify diseases of the genitourinary system. The result can be either a normal number of sperm cells of the correct form (normozoospermia), or a complete absence of spermatozoa in the seminal fluid (azoospermia), as well as an increase in the number of morphologically abnormal cells.

Tests for hormone levels

To determine the causes of infertility, patients need to pass a series of tests for hormone levels. A specific list of studies is determined by the attending physician based on the medical history:

sex hormones

During the diagnosis of infertility, it is necessary to determine the amount of:

FSH is a follicle-stimulating hormone that affects the maturation of eggs, the secretion of estrogen and progesterone.
LH is a luteinizing hormone produced by the pituitary gland and ensures the secretion of progesterone by the ovaries.
Prolactin, which is responsible for the maturation of follicles and ovulation.
Testosterone is a "male" sex hormone that should normally be present in small amounts.
17-OP-progesterone, indicating the presence of a hereditary disease - adrenogenital syndrome, in which the adrenal glands synthesize an increased amount of androgens.
Progesterone is a hormone responsible for the normal amount and growth of the endometrium inside the uterus.
Estrogen (estradiol), which ensures the maturation of follicles and eggs, the maturation of the endometrium and its preparation for implantation of the fetal egg.
Anti-Müllerian hormone (AMH), showing the supply of follicles in the ovaries.

In order for the tests to be informative, and for the diagnosis of infertility to be competent, blood for sex hormones must be taken on certain days of the cycle:

On the 2nd-3rd - AMH, prolactin, FSH, LH.
On the 8-10th - 17-OP, testosterone.
On the 19-21st - estradiol, progesterone.

Hormones of the adrenal cortex

The hormones of the adrenal cortex are also important for diagnosing female infertility, because they affect ovulation and the production of cervical mucus:

DEA sulfate (regulates the functioning of the ovaries).
DHA-S is the "male" hormone responsible for secondary sexual characteristics. Its increase is indirectly indicated by excessive body hair.
Cortisol
17-KS (determined in urine) is also a “male” hormone, and its excess above the norm indicates gynecological problems.

Thyroid hormones affect the development of follicles and ovulation. You need to take the analysis in a calm state, and on the eve you should avoid stress and cancel sports training. To identify the cause of infertility will help:

Thyroxine T4.
Triiodothyronine T3.
Thyroid-stimulating hormone.

Hardware and instrumental diagnostics

Diagnosis of infertility through special devices and tools includes:

Ultrasound procedure

Allows you to assess the size and position of the uterus, its cervix and appendages, to see the state of the endometrium. Ultrasound preliminarily diagnoses polyps, adhesions, tumors, endometriosis, fibroids, endometrial hyperplasia, inflammation of the appendages, cysts, ruptures and inflammation of the ovaries. A special ultrasound examination - folliculometry - makes it possible to assess the maturation and development of follicles during one menstrual cycle.

Colposcopy

Inspection of the vagina with an optical instrument colposcope, which allows to detect erosion, cervicitis, tumor diseases.

Diagnostic curettage of the uterine cavity

Diagnostic curettage of the uterine cavity is necessary when it is necessary to check the condition of the endometrium histologically and to understand whether its growth corresponds to the day of the menstrual cycle.

Tuberculosis tests (Mantoux, diaskin test, lung x-ray) and menstrual blood cultures for the presence of Koch's bacillus.

Often there is infertility in the disease of genital tuberculosis, therefore, to diagnose the pathology, it is necessary to conduct an x-ray of the lungs in combination with samples (Mantoux, Diaskin test) and back culture of menstrual blood, mucus, and the contents of the uterine cavity.

Hysterosalpingography (HSSG)

X-ray examination of the uterus and tubes, which makes it possible to see anomalies in the structure of the uterus, tumors, adhesions, to assess the patency of the fallopian tubes.

Radiography

If the symptoms of infertility indicate damage to the pituitary gland (a woman outside the lactation period produces milk in the mammary glands, there are no periods), an x-ray of the Turkish saddle and skull should be taken.

If other methods of diagnosing infertility disease did not help to accurately determine the problem, a woman is prescribed an operative examination through hysteroscopy or laparoscopy.

Hysteroscopy

Hysteroscopy is an examination of the uterine cavity and cervical canal under anesthesia using an optical device (hysteroscope). The hysteroscope is inserted through the cervix, without punctures or incisions. The procedure allows you to identify the causes of uterine infertility - cysts, polyps, check the quality of the endometrium, take its fragment for histological examination. At the same time, small neoplasms can be removed on hysteroscopy - that is, the manipulation is not only diagnostic, but also therapeutic. Indications for carrying out are:

Primary and secondary infertility.
Failed IVF in the past.
Myoma growing into the internal cavity of the uterus.
Suspicion of diseases and anomalies leading to uterine infertility - polyps, adenomyosis, pathologies of the structure and development of the organ.
Violation of the cycle (heavy periods, bleeding between periods).

Laparoscopy

Laparoscopy is an endoscopic examination of the pelvic organs under general anesthesia. Today, this type of diagnostics is recognized as the "gold standard", giving almost 100%. The surgeon sees everything with his own eyes through a special optical device - a laparoscope, and is not guided by the results of non-invasive examinations, which are often subjective. Laparoscopy allows not only to diagnose, but also to treat - at one time, you can cut adhesions, restore the patency of the pipes, and remove foci of endometriosis. The study is carried out by introducing laparoscopic instruments through small incisions in the abdominal wall, so healing after surgery is quick and painless, does not cause negative consequences in the form of adhesions.

The indications for the study are:

Establishing the cause of primary and secondary infertility.
Endometriosis.
Cysts, torsion and rupture (apoplexy) of the ovaries.
Ectopic pregnancy.
Tubal obstruction.
Myoma of the uterus.
Adhesions in the abdominal cavity and small pelvis.

Infertility treatment

The treatment of male infertility is based on the following principles:

His wife should not have problems with conception and bearing. If they are, the woman should be treated, and her treatment program should be coordinated with the program of examination and treatment of her husband.
Unfavorable factors preventing the onset of pregnancy should be excluded: rare sex life, stress, difficult working conditions, medication (if they are not vital).
If the cause is established, the treatment for male infertility is to eliminate it. When it is not established why the sperm is of poor quality, only means are prescribed to improve blood microcirculation and metabolism, vitamins and general strengthening drugs.
Inflammatory diseases of the genitourinary organs require the appointment of sanitizing drugs, depending on which pathogen is identified. Treatment should be carried out by both spouses to exclude the possibility of re-infecting each other.
Varicocele should be treated through surgery, regardless of the severity of the manifestation of the disease. Surgical treatment is also required for uncomplicated excretory azoospermia, when sperm are produced in the testicles, but do not enter the seminal fluid.
Treatment of immune infertility in men requires special methods (plasmapheresis, removal of antibodies from the genital organs, drugs to reduce the production of ASAT). If this does not help, the couple is recommended IVF with preliminary cleaning of spermatozoa from "adhering" antibodies.
Treatment of infertility in men due to sexual dysfunction involves conservative treatment and work with a psychotherapist.
Treatment of male infertility due to hormonal disorders should be tailored to the individual. The expediency of hormone treatment is determined by the type of disease and the specific situation. If therapy is nevertheless prescribed, it should not last less than 70-75 days, which corresponds to the cycle of sperm development.

Sometimes the problem of male infertility cannot be solved conservatively or surgically, and then modern reproductive technologies come to the rescue:

PESA, MESA, TESE

In case of complicated azoospermia, when it is impossible to restore the patency of the vas deferens, a procedure is prescribed for obtaining spermatozoa from the epididymis or the testicle itself (the methods are called PESA, MESA, TESE). The spermatozoa are then used in the IVF procedure.

artificial insemination

Sperm is introduced into the vagina or uterine cavity in such a way that it falls on the area of \u200b\u200bthe throat of the cervix (during natural intercourse, only a small amount of it gets there). The probability of conception after such manipulation increases several times. The indication for insemination is a decrease in the number of motile spermatozoa in the ejaculate.

Fertilization of a woman's egg with the husband's spermatozoa in the laboratory, followed by the transfer of the embryo into the uterine cavity. IVF is indicated for poor sperm quality, when the number of live motile sperm is extremely small.

Intraplasmic sperm injection is one of the auxiliary methods used during IVF. The essence of the method is that the sperm, visually selected by the embryologist, is introduced into the cytoplasm of the cell with a special pipette. In this case, a practically immobile spermatozoon can be used.

pixie

Qualitative selection of spermatozoa for the ICSI procedure. The embryologist finds the best (most mobile, mature and correctly formed) sperm and checks its chemical and biological characteristics using PICSI cups. These cups contain special media containing hyaluronic acid. By nature, it is conceived in such a way that the acid is involved in the selection of sperm during fertilization - the receptors of high-quality male cells are sensitive to hyaluron. The interaction of the sperm with hyaluron in the cups indicates that it has properly functioning receptors and fertilization will occur successfully. After that, the sperm is injected into the cytoplasm of the cell, that is, the ICSI procedure is performed.

Treatment of female infertility

To cure female infertility, you need to establish its cause and try to eliminate it. Unfortunately, this is not always possible. Therefore, the areas of infertility treatment are:

An attempt to restore fertility using conservative or surgical methods.
Assisted reproductive technology if previous treatment has not worked or the couple is physically unable to conceive naturally.

What methods are used to treat female infertility?

If the cause is endocrine disorders, hormonal treatment and ovarian stimulation are performed. In addition to medications, a woman is recommended to normalize weight and exercise. Shown and physiotherapy.
Infertility in diseases of the fallopian tubes is usually treated surgically - laparoscopic surgery can restore patency in 35-40% of cases. If this does not help, the patient is offered an IVF program.
Endometriosis involves laparoscopy and cauterization of the foci, and then a short course of medication is prescribed to consolidate the result (drugs that cause artificial menopause (IC) and prevent the growth of the endometrium). You need to try to get pregnant after leaving the EC, until the endometriosis has recurred.
Infertility of the uterus (severe malformations) requires operations to reconstruct the organ. If this is not possible, a woman can use the service of surrogate motherhood.
Treatment of immunological infertility, when ASAT are found in the cervical mucus, begins with barrier contraception for up to six months. Then drugs are used to reduce the production of antibodies. If this does not give the desired effect, the couple is recommended artificial insemination, in which the sperm bypasses the cervical canal and is not adversely affected by ASAT.

When the cause of infertility is not established, ART methods (assisted reproductive technologies) are used:

Intrauterine insemination.
IVF (with ICSI, PICSI and other ways to increase the effectiveness of the procedure).
Surrogacy.

When is IVF applied?

At first, in vitro fertilization was developed to eliminate one cause of infertility - a problem with the tubes. Gradually, the list of indications for IVF has expanded, and includes:

Tubal pathology, which may be congenital or acquired, is a consequence of ectopic pregnancy, inflammation, endometriosis, and abdominal surgery.
Polycystic ovaries is a disease in which the ovaries contain many cysts with liquid contents. In this case, the level of male hormones in the woman's body is increased, and therefore there are menstrual irregularities (amenorrhea), abundant hair growth on the chest and face, and obesity. Sometimes patients experience severe uterine bleeding. Treatment of the disease is carried out first conservatively (with hormones) or operatively (ovarian resection, cauterization of cysts). Eco for infertility due to polycystic is prescribed when other methods of therapy have been exhausted, and pregnancy has not occurred.
Endometriosis is a disease, the essence of which is the growth of endometrial cells in the fallopian tubes or abdominal cavity. Normally, the endometrium should line only the inner uterine surface. Its spread outside the uterus leads to infertility due to the fact that the maturation of eggs and ovulation is disturbed, the patency of the tubes decreases - after all, endometrioid foci contribute to the formation of adhesions. As in the case of polycystic ovaries, IVF for infertility due to endometriosis is prescribed when the possibilities of medical (hormonal) and surgical treatment have been exhausted and have not brought the expected result.
The age of the patients can become an obstacle to the onset of a natural pregnancy due to changes in the properties of the eggs. Assisted reproductive technologies (IVF with ICSI, hatching) can overcome these problems.
Anovulation in the absence of the effect of therapeutic treatment, ovulation stimulation and artificial intrauterine insemination is also an indication for IVF.
Infertility of unknown origin, in which a clear cause of difficulties with the onset of pregnancy has not been determined.
Male infertility associated with a decrease in the fertilizing ability of sperm. Assisted reproductive technologies (IVF with aspiration of sperm from the epididymis or their extraction from the testicle, ICSI - the introduction of sperm into the egg) increase the chances of pregnancy.

How is infertility treated using the eco-method? The essence of the technology is to stimulate the ovulation of several eggs in a woman at once, puncture the resulting eggs and fertilize them with the husband's sperm in the laboratory. The resulting embryos develop in special incubators for 3-5 days under the supervision of doctors, and then they are transferred to the uterine cavity. Each of the stages is important to achieve the final result.

To stimulate ovulation, special hormonal preparations are used that accelerate the growth and maturation of follicles and eggs. To control the process of cell maturation and the condition of the endometrium, the doctor prescribes laboratory tests (monitoring the level of estradiol, progesterone and LH) and ultrasound.

Puncture of mature follicles is performed under intravenous anesthesia. A disposable suction needle is connected to a special ultrasound probe, and then it is inserted through the vagina one by one into all the follicles, and their contents are sucked out. The fluid obtained as a result of the puncture is transferred to embryologists to prepare for fertilization.

Fertilization can occur both independently - the embryologist only connects the processed spermatozoa and eggs (IVF), or by ICSI - the spermatozoon is injected directly into the egg. ICSI is used, as a rule, when the quality of sperm is poor and its fertility is reduced. In addition, other modern methods are used for infertility in men - IMSI (injection of sperm into the cytoplasm of the egg) and PICSI (additional sperm selection before ICSI).

Cultivation (cultivation) of embryos begins the day after the puncture of the follicles. First, the embryologist evaluates the fact of fertilization, the signs of which can be observed 17-18 hours after the union of male and female cells. Then the doctor observes the process of division of the embryos for 3-5 days, highlights the most promising among them and does not have genetic abnormalities, and determines the best time for transplantation into the uterus. As a rule, embryos that have reached the blastocyst stage have the best chances - and this happens on the 5th day.

Embryo transfer and implantation is the most exciting stage of infertility treatment with IVF, because it is then that it becomes clear whether the doctors managed to make another married couple happy. Embryos are directly transferred into the uterine cavity using thin soft tubes (catheters) under ultrasound control - this allows them to be placed in a place convenient for implantation in the uterus. Before it is possible to take hCG and find out the results of IVF, a woman is prescribed drugs to maintain an early pregnancy.

Period after IVF

Treatment of infertility through IVF has two outcomes.

Lucky when pregnancy comes, and the happy family leaves the clinic to prepare for the birth of the long-awaited baby. You can find out if IVF succeeded already 14 days after the transfer of embryos into the uterine cavity by passing a blood test for hCG. A little later, the presence of accustomed embryos in the uterus must be confirmed by ultrasound, and then contact a gynecologist for pregnancy management. Carrying a child after IVF at first requires hormone therapy, the purpose of which is to maintain a sufficient level of progesterone. Therefore, the signs of pregnancy may be more pronounced and specific compared to conventional conception. Which points to an interesting situation:

Severe nausea and vomiting (toxicosis).
Irritability and insomnia.
Breast swelling.
Increase in basal body temperature.
Sensitivity to odors.
Moderate pain in the lower abdomen, in the lower back and sacrum.
Headaches.

Unsuccessful - pregnancy did not occur. Why does it happen?

Ovulation happened before the follicles were punctured.
It was not possible to extract high-quality eggs during puncture.
Fertilization did not occur.
The fertilized cell ceased to divide and develop.
There was no implantation of the embryo after transfer to the uterine cavity.

Failed IVF, while a blow to the mental state of a couple suffering from infertility, gives doctors a lot of useful information:

How did the ovaries react to ovulation stimulation?
Why didn't the egg get fertilized?
What quality were the embryos.
How did the endometrium grow?
Whether implantation happened, and whether the embryo continued to develop further.

It is very important to study the circumstances of failure, because the tactics of further infertility treatment depend on it - whether it makes sense to do repeated IVF, what changes to the program need to be made, which of the procedures need to be carried out additionally. So, if the pregnancy has stopped developing at the implantation stage, the hatching procedure can solve the problem in some cases, when the non-elastic shell of the fetal egg is pierced or incised so that the embryo can “hatch out” and attach to the endometrium.

Pregnancy after infertility can have specific complications, which are the result of deviations in health.

The consequence of hormonal disorders is the threat of miscarriage and non-developing pregnancy in the early stages. This is due to the existing pathology of the ovaries, which provokes a lack or excess secretion of hormones.

Obstruction of the fallopian tubes, adhesive process in the small pelvis can cause an ectopic pregnancy, rupture of the tube and powerful intra-abdominal bleeding that threatens the woman's life. Therefore, after a positive pregnancy test, you need to go for an ultrasound and make sure that the fetal egg is in the uterine cavity, and has not attached to the tube.

Immune issues lead couples to undergo artificial insemination or IVF to avoid sperm coming into contact with cervical mucus. Therefore, in this case, there are practically no complications during pregnancy if the woman has no other diseases.

Violation of sperm production can cause a genetic disorder in the embryo - a “bad”, defective sperm cell, when fused with an egg, carries incorrect genetic information and chromosomal abnormalities, due to which the embryo stops developing at an early stage. Sometimes pregnancy still persists, but the child may die immediately after birth, or have a severe illness. In order to avoid such an outcome, it is recommended to undergo all planned screening ultrasounds, on which pathology can be detected in a timely manner.

Previous gynecological diseases are a common cause of pregnancy complications after infertility:

Previously transferred sexual infections can worsen due to a decrease in immunity, and this leads to intrauterine infection of the fetus.
If the pregnancy proceeds against the background of uterine fibroids, in the early period this may interfere with the implantation of the embryo, and in the late period it may contribute to the rapid growth of the myomatous node, as well as its swelling and necrosis. If the placenta attaches to a myomatous node or scar after removal of such a node, intrauterine hypoxia and fetal growth retardation are possible, the threat of termination of pregnancy.
Inflammation of the uterine appendages, its mucous membrane, erosion of the cervix, past curettage of the internal cavity of the uterus can cause abnormal attachment of the placenta - low or overlapping the internal pharynx, and this often leads to premature detachment and bleeding.

Abnormal placentation and infectious diseases are a risk factor for the development of fetoplacental insufficiency, in which the child in the womb does not receive the right amount of nutrients and oxygen. Pregnancy after infertility in this case is complicated by malnutrition (lag in body weight) and hypoxia in the baby.

Infertility is a disease that usually does not bring physical suffering, but "kills" the family morally. It's hard to live with the thought that everyone around you has long become happy parents, and someone has to go from one clinic to another. But do not despair. Medicine is developing rapidly and offers new ways of treatment. It is worth being patient, listening to all the advice of doctors, looking for "your" doctor who you can trust - and then you will definitely be lucky!

Unfortunately, not all women can experience the happiness of motherhood. Some married couples are faced with a terrible diagnosis of "infertility", which sounds like a sentence from the mouth of a doctor. What causes infertility in women? Is it really because of him that the fair sex will never be able to have children? Is treatment possible? Let's find the answers to these questions.

The term "infertility" refers to the inability of the fair sex to have children. Doctors make this diagnosis in cases where a woman lives a regular sexual life for a year, does not use contraception, and attempts to conceive a child are unsuccessful.

Depending on the presence of pregnancies in the past, infertility in women is divided into two types: primary(infertility of the 1st degree) and secondary(infertility of the 2nd degree). The diagnosis of "primary infertility" is made to those people who have never had a pregnancy before. The cause may be heredity, the presence of congenital disorders (for example, an irregular shape of the uterus). Secondary infertility is an acquired problem. It occurs due to the flow of any pathological processes in the female body.

Also infertility can be absolute or relative. In the first variety, pregnancy is impossible due to the fact that the woman has no ovaries or uterus. With relative infertility, conception can occur provided that the necessary medical manipulations are carried out.

There is another classification. There are the following main types of infertility:

endocrine (hormonal);
genetic;
tubal-peritoneal;
immunological;
after an abortion.

Endocrine (hormonal) infertility in women is diagnosed in cases where there are deviations in the functioning of the thyroid gland, sex glands. Their improper functioning leads to disruption of the hormonal mechanisms that regulate the menstrual cycle. Endocrine infertility can have different forms, but they all share one symptom - the irregularity of ovulation or its complete absence.

Infertility may be caused by genetics . Most often, chromosomal abnormalities are manifested by miscarriages. If a woman in the early stages had a spontaneous abortion several times in a row, then in this case it is necessary to undergo a genetic examination.

Tubal-peritoneal infertility is a fairly common problem. The inability to have children may occur due to the formation of adhesions, an inflammatory process in the fallopian tubes caused by infection in them.

Immunological infertility in women is a kind of reaction of their body. He perceives the male sperm that has entered the uterus as a foreign body. In the body of the fair sex, antibodies begin to be produced, due to the action of which the male germ cells die, and fertilization does not occur.

One of the most common causes of infertility is abortions . They disrupt the hormonal processes that occur in the female body, provoke the formation of adhesions. Why can infertility occur after an abortion? The fact is that during this medical procedure, the layer of the endometrium can be irreparably damaged. Because of this, the fertilized egg will not be able to attach to the wall of the uterus, and pregnancy will not occur.

Causes

The inability to conceive a child can be due to various reasons. Here are the main ones:

improper functioning of the ovaries or their absence;
obstruction or absence of the fallopian tubes;
condition of the uterus
condition of the cervix.

Let's look at each of the above reasons.

Very often, signs of infertility in women occur due to abnormalities in the functioning of the ovaries or because of their absence. These paired sex glands play a very important role. The ovaries produce progesterone and estrogen - two sex hormones that affect the reproductive health of the fair sex. If the balance of progesterone and estrogen is disturbed, then there will be problems with conception. In addition, infertility can be caused by the lack of ovulation.

In 25% of cases, infertility is due to absence of fallopian tubes or because of their obstruction. A blockage in the tubes prevents the egg and sperm from moving forward. Obstruction is formed due to various diseases (for example, due to chlamydia, trichomoniasis, salpingo-oophoritis, gonorrhea, endometriosis).

Approximately 5% of infertility symptoms in women are caused by condition of the uterus . This organ is designed to bear a child. Due to the irregular shape of the uterus, pregnancy may not occur. Various diseases of the cavity of this organ can also lead to infertility.

The ability to have children is also affected by condition of the cervix . In a healthy woman, this canal is covered with cervical mucus, which promotes the movement of spermatozoa into the uterine cavity. Diseases, infections negatively affect the physicochemical properties of mucus. Promotion of spermatozoa becomes difficult.

It is also worth noting that a bad habit can lead to infertility - smoking . Nicotine negatively affects the female body, destroys eggs. Smoking and infertility in women are interrelated concepts. Modern scientists conducted a study, the results of which showed that the more a woman smokes, the less likely she is to conceive a child. Under the influence of nicotine, reproductive function worsens.

The list of causes of infertility does not end there. There are other problems that prevent the onset of an interesting situation.

Signs of infertility in a woman

Its main symptom is that pregnancy does not occur for a long period of time. At the same time, the fair sex should lead a full sexual life and not resort to contraception. If fertilization does not occur, then both partners should visit a doctor and undergo an examination no earlier than 1 year after they started trying to conceive a baby.

You can contact a specialist much earlier if a woman has noticed strange symptoms:

vaginal discharge with an unpleasant odor;
itching in an intimate place;
pain in the lower abdomen;
discomfort that occurs during and after intercourse;
lack of menstruation;
irregular menstrual cycle;
long (more than 7 days) or too short (1-2 days) periods.

The above symptoms may be inherent in serious diseases that prevent the fertilization of the egg by the sperm. For example, menstruation may be absent due to ovarian dysfunction, hormonal failure. Very often, the menstrual cycle is disrupted due to prolonged use of contraceptives, taking emergency contraceptives. It is impossible to do without the help of a specialist here.

Diagnosis of infertility

If pregnancy has not occurred within a year with regular attempts to conceive a child, and the exact cause of infertility is unknown, then you need to visit a gynecologist or contact a family planning center and undergo an examination for infertility in women. In general, different doctors can deal with problems with conception: gynecologists, endocrinologists, sex therapists. It depends on the causes of infertility.

Doctors diagnose the impossibility of having children only after a complete assessment of the woman's health. Do not be afraid if experts cannot find the exact cause. It may take quite a long time to figure it out.

The process of diagnosing pathology consists of the following steps:

Collection of anamnesis.
Gynecological examination.
Laboratory analyses.
Primary assessment of the ability to ovulate.
Endoscopic diagnostics.

Let's consider them in more detail.

1. Collecting anamnesis when making a diagnosis

A test for infertility in women is not just one procedure, but a combination of various tests and examinations. The first stage of diagnosis is the collection of anamnesis. The doctor talks with the patient, finding out information that is significant for making a diagnosis.

The specialist asks the following questions:

when the first menstruation came;
how many days is the menstrual cycle, is it regular;
Are there any delays?
what is the duration of menstruation;
what is the nature of the monthly allocations;
Are there intermenstrual bleeding?

Also, the specialist will ask a few questions about sexuality. He will ask when the first sex was, whether sexual intercourse is regular, what contraceptives were used, whether sexually transmitted infections were diagnosed in the past, whether there was a pregnancy before, whether abortions were performed, whether miscarriages occurred.

There is no need to be afraid of the doctor, to be shy to answer the questions asked, to hide some information. Only he can understand the problem, find the causes of infertility and help fulfill the dream of conceiving a child.

2. Gynecological examination

After collecting an anamnesis, a gynecological examination is performed. First of all, the condition of the external genitalia is assessed. Then the internal genital organs are examined. Mirrors allow the doctor to examine the mucous membrane of the vagina, the cervix, to suspect pathological changes due to which pregnancy may not occur.

Also, during a gynecological examination, the condition of the mammary glands is assessed, anthropometric data (height, weight) are measured. In addition, the correspondence of secondary sexual characteristics to age is determined.

3. Laboratory tests

An important step in the diagnosis of infertility is the delivery of laboratory tests for infertility in women. The results provide an opportunity to find out the reason for the inability to conceive a child. Women take general blood and urine tests. Specialists, examining biological fluids, determine the levels of sex hormones.

Particular attention is paid to estradiol, which is one of the estrogens. This hormone affects the functioning of the ovaries, the process of ovulation. The amount of progesterone, luteinizing and follicle-stimulating hormones is also estimated. They affect the functioning of the corpus luteum, the maturation of the egg and its functional state.

In the process of diagnosing infertility, tests are prescribed for sexual infections (chlamydia, mycoplasmas, candidiasis, streptococci, staphylococci, etc.). They must be passed, as these diseases affect fertility and prevent the fertilization of the egg by the sperm.

4. Initial assessment of the ability to ovulate

Research on female infertility is carried out not only by specialists. The patient is also involved. The woman is encouraged to measure her basal temperature daily and do ovulation tests.

Thanks to these simple measures, it is possible to find out whether a woman releases a mature egg from the ovary in each menstrual cycle. Some women do not ovulate. In some cases, this process occurs very rarely.

5. Endoscopic diagnostics

To confirm infertility, endoscopic diagnostics is performed. Procedures such as laparoscopy and hysteroscopy are prescribed. Thanks to them, you can find out the true causes of infertility.

Laparoscopy is a modern surgical method, thanks to which it is possible to detect pathologies that interfere with conception, and immediately remove the detected neoplasms, that is, to treat infertility in women. The main tool is a telescopic tube. It's called a laparoscope. This instrument is equipped with a video camera. The laparoscope is inserted inside through punctures in the wall of the peritoneum.

Hysteroscopy is a diagnostic procedure that allows the doctor to examine the walls of the uterine cavity using a hysteroscope and perform diagnostic or surgical manipulations. Thanks to hysteroscopy, you can detect various pathologies of the uterus, eliminate them, remove endometrial polyps and foreign bodies.

Infertility treatment

If, during the examination, specialists determined that the reproductive functions of the woman, as well as her husband, are normal, then the couple is recommended to conduct a “planned intercourse”. Perhaps pregnancy does not occur due to incorrectly calculated ovulation or due to missing favorable days for conception. The doctor will tell you which day is best to plan sexual intercourse.

Various drugs are used to treat primary or secondary infertility in women. They can only be prescribed by a doctor, depending on the reason why a woman cannot have children. If infertility is caused by a hormonal failure, then hormonal drugs are prescribed that normalize the functioning of the ovaries and stimulate the production of female germ cells. This method of treatment is very popular, since many women have a hormonal background (there are thyroid diseases, menstrual irregularities are observed). Hormonal preparations give a good effect. After a course of treatment, pregnancy quickly occurs. The disadvantages of the funds are that they have side effects (weight may increase, dryness in the vagina may occur, etc.).

Modern methods of overcoming the problem of infertility

Modern medicine works wonders. The problem of infertility can be overcome by resorting to methods of artificial insemination:

IVF - in vitro fertilization;
ICSI - intracytoplasmic sperm injection;
insemination.

The fair sex, in which the egg for some reason cannot meet with the sperm (for example, in the absence of fallopian tubes or their pathological structure), can use IVF services.

The essence of the procedure is that the eggs are taken from the woman, and the spermatozoa from the man. Female germ cells are inseminated with spermatozoa and placed in a special incubator. Then the finished embryo is delivered to the uterus, where it attaches to the wall and begins to grow. IVF can help with primary infertility in women. Also, this method of artificial insemination fulfills the dreams of a child in many of the fair sex, suffering from secondary infertility.

The next method of artificial insemination is ICSI . Intracytoplasmic sperm injection can be performed for undiagnosed egg pathologies. The essence of the procedure is to lead the male germ cell into the female cell with the help of a special microtool. The resulting embryo is placed in the uterus.

If pregnancy does not occur due to the special composition of the cervical mucus, due to vaginismus or due to other problems, then in such cases you can choose insemination - another method of artificial insemination. In this procedure, spermatozoa are collected from a man, which are then introduced by a doctor into the uterus using a catheter.

Infertility is the absence of pregnancy within a year of regular sexual activity. Infertility is primary, that is, when a woman has never been pregnant, and secondary - a couple already has children, but at the moment it is not possible to get pregnant.

To understand what can cause infertility, you need to know what stages the process of conceiving a child consists of. The conception process includes:

- the production of germ cells in a woman (eggs) and in a man (spermatozoa);

- movement of spermatozoa through the genital tract and fallopian tubes;

- transfer of the embryo to the uterus and its attachment.

If at least one of these stages is violated, infertility occurs.

If the production of spermatozoa is impaired, they are not mobile enough or their number is less than normal, then male infertility occurs. If the process of ovulation (the release of an egg from the ovary) is disturbed, the fallopian tubes are blocked, or the mucous membrane of the uterus (endometrium) is of poor quality, then female infertility occurs.

In some cases, the female and male factors of infertility are combined, that is, reproductive dysfunction is present in both partners.

Causes of infertility in women.

Depending on what caused infertility, these types of infertility in women are distinguished.

Ovarian or endocrine infertility. The cause of such infertility is a violation of ovulation, which is often accompanied by a violation of the menstrual cycle, amenorrhea (absence of menstruation), oligomenorrhea (short and rare, with an interval of more than 40 days, menstruation).

Under the influence of childbirth, abortion, miscarriage, infections, stress, trauma and other factors, the function of the hypothalamus and pituitary gland (brain regions that regulate the endocrine system and produce certain hormones) is disrupted. As a result, the normal menstrual cycle is disrupted, ovulation either does not occur at all, or the eggs are defective.

Ovulation disorders are also caused by an increased level of male hormones, hypo- or hyper-function of the thyroid gland, excess or lack of adipose tissue in a woman.

Also, the cause of ovarian infertility can be premature aging of the ovaries or premature menopause, which are manifested by the following disorders.

Violation of the division and growth of follicles. Reason: genetic, chromosomal, autoimmune diseases, viral damage to the ovaries, elevated levels of the hormone prolactin, radiation exposure.

Violation of the function of the follicle - the follicle does not break and the egg does not come out due to a deficiency of certain hormones.

Disorders where the cause of aging is unknown, such as resistant ovarian syndrome, which is characterized by first shortening and then disappearance of menstruation.

Tubal infertility. The sperm reaches the egg through the fallopian tube, fertilization takes place there, and then the embryo, again through the tube, moves into the uterine cavity.

Congenital absence of the fallopian tubes, surgical interventions in the pelvic area, which result in mechanical damage to the tubes or the development of adhesions, damage to the lining of the fallopian tube due to gonorrhea or chlamydial infection are the causes of tubal infertility in women.

Cervical infertility - this is a violation of the function of the cervical mucus, through which spermatozoa must pass. To get into the uterus, and then into the fallopian tubes, spermatozoa must pass through the cervix. After treatment (cold, cauterization) of the cervix, insufficient mucus production may be observed. Also, mucus can have an aggressive environment for spermatozoa.

Uterine infertility. Congenital (bicornuate or unicornuate uterus, the presence of partitions inside the uterus) and acquired diseases of the uterus (fibromatous nodes, polyps) are the cause of uterine infertility.

peritoneal infertility is tumors, adhesions, infections of the abdominal organs, which lead to dysfunction of the reproductive organs. Such infertility is rare.

Causes of infertility in men.

Anomalies in the development of the testicles. The most common cause of infertility in men is varicocele - an enlargement of the veins of the testicles, in which their work is disrupted and spermatozoa are damaged. Often there are injuries and defects of the genital organs, for example, undescended testicles into the scrotum, testicular torsion.

Infectious and inflammatory diseases , especially those that are sexually transmitted (gonorrhea, syphilis, chlamydia). A disease such as mumps or mumps can negatively affect the reproductive function of men.

Hormonal disorders , low levels of the male hormone testosterone, problems with the thyroid gland.

Sexual violations such as erection problems, premature ejaculation and others.

Negative influence of external factors : low or high temperatures, radiation, as well as the use of drugs, alcohol, nicotine, taking certain medications.

Only a doctor can determine the cause of infertility after an examination. It is necessary to seek medical help if pregnancy does not occur within a year of open sexual activity, and if there are factors predisposing to infertility, for example, operations on the reproductive organs or congenital defects of the uterus, then earlier.

The couple should be examined by an infertility specialist, as conventional obstetricians and gynecologists do not have sufficient experience in diagnosing and treating infertility. It is better to immediately contact a human reproduction center or a fertility clinic.

female infertility- a type of gynecological disease in which a woman with regular unprotected intercourse does not become pregnant within 1 to 2 years. Infertility can be caused by mental disorders of one of the partners, the presence of inflammatory processes in the body, pathological changes in the reproductive system. Diagnosis of the alleged disease should be carried out by an experienced gynecologist. With the help of the tests performed, he will be able to determine fertility problems, if any. The main thing to remember is that many problems in the gynecological health of a woman can be eliminated if you turn to a specialist in time.

What does "female infertility" mean?

A woman may think about the possibility of a diagnosis of infertility, provided that for 12 months with regular and unprotected intercourse with the same partner, she fails to become pregnant. But do not immediately panic, because for the development of absolute infertility in the reproductive system of a woman, irreversible anatomical changes must occur, in which the conception of a child becomes completely impossible. These include the absence of some genital organs: ovaries, fallopian tubes, uterus, as well as violations of their functional purpose. If infertility is classified as “relative”, then most likely the causes of its occurrence can be successfully eliminated with the help of medicine.

Gynecologists distinguish between primary and secondary forms of infertility. Primary infertility is called when the woman has never been pregnant. Accordingly, secondary infertility occurs only in those women who cannot become pregnant again.

The problem of infertility is quite common among couples. Today, up to 15% of families experience infertility. By no means should the woman be blamed. Up to 40% of cases in a married couple, the man is infertile. Men's health problems include disorders in ejaculation, defective sperm, impotence. The rest of the reasons for the inability to conceive a child falls on the shoulders of the woman. When a married couple encounters the problem of infertility, each of the spouses must undergo an examination.

Do not ignore the mental mood of each of the partners. So nature has laid down that one sexual intercourse is not enough. A fruitful conception requires a positive attitude and the desire of each of the partners. Often a dysfunctional social situation can also cause infertility in the family.

What are the causes of female infertility determined by gynecology?

Today, unfortunately, a disease called infertility is very common. The reasons for women can be very diverse. Prerequisites for the development of female infertility are:

increased and hyperactive secretion of prolactin;
tumor formation in the pituitary gland;
any menstrual disorders such as oligomenorrhea and amenorrhea, formed on the basis of hormonal disorders;
congenital defects of the reproductive system;
tubal obstruction on both sides;
endometriosis;
the presence of adhesions in the pelvic cavity;
acquired pathologies of the functioning of the genital organs;
inflammatory and tuberculous lesions of the organs of the reproductive system;
diseases and weakening of the immune system;
postcoital test with a negative result;
disorders in the mental perception of sexual acts.

Based on the listed prerequisites that lead to violations during the conception of a child, the following forms of infertility are distinguished:

Hormonal or endocrine form;
Tubal-peritoneal form;
Uterine form;
Endometrial form;
immune form.

Infertility of the endocrine form indicates an unhealthy functioning of the hormonal regulation of the full menstrual cycle, with the help of which ovulation occurs. Hormonal infertility in women is accompanied by anovulation. With this form of infertility, ovulation is absent, since the egg does not have time to mature, or a mature egg is not released from the follicle. This is typical for diseases of the hypothalamic-pituitary region and the presence of injuries, hyperactive secretion of the hormone prolactin, the development of polycystic ovary syndrome, progesterone deficiency, inflammatory and tumor lesions of the ovaries, etc.

Infertility of the tubal-peritoneal form is caused by anatomical pathologies that occur on the way of the egg moving through the thin fallopian tubes into the uterine cavity. In this case, both fallopian tubes must be either completely impassable, or simply absent. Peritoneal infertility is accompanied by the formation of obstructions between the ovaries and fallopian tubes. This form of infertility develops in the presence of adhesive formations or in the atrophy of the cilia inside the fallopian tube, which, when normally located, are involved in the movement of the egg.

Infertility of the uterine form occurs with anatomical defects of the uterus, which can be both congenital and acquired. Congenital uterine anomalies are considered diseases such as:

hypoplasia - underdevelopment of the uterus during the formation of the body;
doubling of the uterus - the presence of an intrauterine septum or saddle uterus.

Acquired uterine defects include:

tumors;
cicatricial deformity;
intrauterine synechia.

All acquired uterine defects occur as a result of surgical interventions in the uterine system.

Infertility of the endometriotic form is typical for 30% of women suffering from this disease. The fact is that the endometriosis areas in the ovaries and fallopian tubes do not allow to fully carry out the process of ovulation and carry out the movement of the egg.

A form of immune infertility is the presence in the female body of a large number of antisperm bodies. This is a specific type of immunity that is produced by the body against the embryo or sperm.

Very rarely, with a full examination, it is possible to detect only one pronounced form of infertility in a woman. Basically, there is a combination of several.

Unfortunately, medicine is not yet able to 100% determine the causes of infertility. Today, a problem called infertility in women is very common, the causes of which are still subject to detailed study. For 15% of women suffering from the disease, the reasons for the formation of the diagnosis remain unknown to science.

Diagnosis of infertility

Infertility examination is performed using a complex group of methods. The first method is a detailed survey of the patient. With this method, the study of the problem begins. Every woman who is faced with suspected infertility should receive a full consultation with a gynecologist. The doctor must skillfully collect all the necessary information and draw up a detailed description of the patient's state of health. At this stage, the answers to the following questions are clarified:

Complaints. The general well-being of the client is determined, the time frame for negative attempts to get pregnant, whether there are any pains in the genital area, the features of the menstrual cycle, unusual discharge from the genital tract and mammary glands, the psychological mood of the family.
History of family health. The genetic characteristics of the patient's health are being clarified. These include gynecological or infectious diseases of the mother and blood relatives, the age category of the parents at the time of the patient’s birth is calculated, their state of health at the time of conception, the characteristics of the course of pregnancy are clarified, bad habits of the parents are clarified, their negative impact on the formation of a healthy fetus in the mother’s womb is predicted, and others
Patient's medical history. These include diseases that leave a mark on human health: infections of various types, traumatic injuries, pathologies.
Features of the menstrual cycle. The age-related features of the formation of menstrual flow by the body are clarified, an assessment is made of the duration, regularity, volume, soreness, etc.
The development of sexual function. The patient finds out the age at which she began to live sexually, the conditions under which the first sexual intercourse took place, the number of partners, the patient's attitude to sexual relations in marriage, the sensations experienced during intercourse, the methods of contraception that were used throughout life.
Fertility. The history of each past pregnancy, complications is clarified, each labor activity is analyzed, all complications are studied.
History of infertility treatment before, if this issue was relevant in the past.

After receiving subjective information about the state of health from the patient, the doctor conducts an objective examination. It is of two types: special and general.

With the help of general methods and approaches, a diagnosis of the state of a woman's health is made. The general examination is focused on determining the type of physique, assessing the condition of the mucous membranes and skin, the nature of the hairline in intimate places, and the general condition of the development of the mammary glands. In addition, an examination of the thyroid gland is mandatory, the abdominal cavity is studied, observations are made of the temperature regime of the body, pressure.

The methods of the spectrum of special examinations of infertility include specific studies of functional, laboratory, instrumental tests.

The most common functional tests in the diagnosis of infertility include:

creation of a temperature curve, which determines the moment of ovulation and ovarian activity;
determination of the cervical index, which displays the quality of cervical mucus, the level of estrogen in the body;
postcoital test, which studies the activity of the functionality of spermatozoa and determines the ability of the female body to antisperm protection.

The main attention during the performance of laboratory diagnostic methods for studying the causes of infertility is drawn to the hormonal content of blood and urine. Hormonal tests are not recommended immediately after examinations by a mammologist or gynecologist, after sexual intercourse or morning awakening, because the prolactin level can be significantly changed. Hormonal tests are usually carried out several times for the purpose of reliable diagnostic results. In case of infertility, the following tests are usually the most effective:

study of the level of DHEA-S and 17-ketosteroids in the urine - based on the results obtained, an assessment of the function of the adrenal cortex is performed;
study of the levels of testosterone, prolactin, thyroid hormones, cortisol - the analysis is performed on the basis of the diagnosis of plasma in the blood at the end of the first week of the menstrual cycle. This examination helps to clarify the assessment of the effect of these hormones on the follicular phase;
diagnosis of the level of progesterone in the blood plasma at the end of the 3rd week of the menstrual cycle, which assesses the functioning of the corpus luteum and the effectiveness of the ovulation process;
diagnosis of the level of follicle-stimulating hormone, prolactin, luteinizing hormone, estradiol, which is significantly manifested in menstrual irregularities.

Today, hormonal tests are also very common, with the help of which a more accurate and clear study of the health status of individual parts of the reproductive system takes place, their reactions and mutual tolerance with individual hormones are determined. These in the diagnosis of infertility include:

progesterone test, which helps to determine the level of estrogen in the patient's body with amenorrhea, as well as to find out the behavior of the endometrium with the introduction of progesterone;
estrogen-gestagenic or cyclic test for interaction with only one hormonal drug;
clomiphene test is used to study the assessment of the level of interaction of the hypothalamic-pituitary-ovarian system;
a test with metoclopramide, which helps to determine the prolactin secretion ability of the pituitary gland;
a test with dexamethasone is used for patients in whose body there is an increased content of male sex hormones.

Colposcopy and radiography are very productive methods for determining infertility. In order to determine the neuroendocrine pathology in a woman with an irregular and disturbed menstrual cycle, an x-ray of the skull is given. When diagnosing signs of endocervitis, erosion, they turn to the method of colposcopy in order to determine a chronic infectious process. Radiography of the fallopian tubes and uterus is performed on the basis of hysterosalpingography. With its help, tumors of the uterus and anomalies in the development of the genital organs of a woman are determined.

With the help of ultrasound, information is obtained about the patency of the fallopian tubes. Also, when examining infertility, diagnostic curettage of the uterine cavity is practiced, with the help of which the levels of changes in the endometrium are examined before each menstrual cycle.

Another group of infertility diagnostics are surgical methods. These include laparoscopy and hysteroscopy. Hysteroscopy is called endoscopic diagnosis of the uterine cavity based on an optical apparatus-hysteroscope, the introduction of which occurs through the external uterine os. The World Health Organization has classified hysteroscopy as one of the mandatory diagnostic standards for women suffering from uterine infertility.

For hysteroscopy studies refer to the following indications:

infertility of various forms: primary or secondary, miscarriages before the first birth;
suspicions of endometrial polyps, hyperplasia, anomalies in the development of the uterus, intrauterine adhesions, adenomyosis;
disrupted menstrual cycle, unplanned bleeding from the uterine cavity, heavy menstruation;
myoma in the uterine cavity.

With the help of hysteroscopy, an internal examination of the uterine cavity, cervical canal, orifices of the uterine lips is carried out, and the endometrium is assessed.

Laparoscopy is an endoscopic method used to diagnose the pelvic cavity and adjacent organs using precise optical equipment. The device is inserted through a micro-incision in the abdominal wall. This method is particularly accurate up to 100%. Laparoscopy is very demanding in terms of conditions. It requires hospitalization and general anesthesia.

Laparoscopy is mainly used for the following indications:

infertility of various forms: primary and secondary;
ovarian apoplexy, ectopic pregnancy, uterine perforation;
endometriosis;
obstruction of the fallopian tubes;
cystic changes in the ovaries;
uterine fibroids;
adhesive processes;
cyst.

One of the main advantages of laparoscopy is the bloodlessness of the operation. After such a surgical intervention, there are no scars on the patient's body, and there are also no unpleasant pains.

Endoscopic methods of surgery are low-traumatic methods for examining the genital cavity, which manage to combine the effectiveness of diagnosing infertility, which has become widely used for women of reproductive age suffering from infertility problems.

Treatment of female infertility

Treatment of female infertility is formed on detailed diagnostic indications. Correctly ascertaining the causes of infertility in a woman will help develop an effective approach to restoring the health of the patient.

Female infertility is treated on the basis of two main treatment methods:

Restoration of the reproductive characteristics of the female body through the use of surgical or conservative methods.
Turning to alternative additional reproductive technologies in the absence of the possibility of conception in a natural way.

Infertility of the endocrine form requires ovarian stimulation and correction of hormonal disorders. In such a situation, the non-drug form of treatment includes the stabilization of weight indicators with the help of physical activity and diet therapy. Medical treatment is based on the use of hormonal therapy. With the help of ultrasound monitoring, constant monitoring of the maturation of the follicle is carried out. It is very important to carefully follow the requirements and prescriptions for hormonal treatment. Then 80% of patients suffering from the endocrine form of infertility will be able to become pregnant.

Tube-peritoneal infertility is treated by restoring good patency of the fallopian tubes. Treatment is mainly performed by laparoscopy. The method is effective by 40%. If the desired result is not achieved, gynecologists advise turning to artificial insemination.

Infertility of the uterine form is treated on the basis of reconstructive plastic surgery. In this case, the chance of getting pregnant naturally increases by 20%. With a negative result of applying the method, gynecologists advise resorting to the services of professional surrogate motherhood.

Endometriosis infertility can be cured using laparoscopic endocoagulation. With this method of treatment, it is possible to identify pathological foci and remove them. The result achieved with the help of laparoscopy is fixed by additional medical treatment. The effectiveness of treatment is characterized within 40%.

Infertility of the immunological form is treated by artificial insemination. The method is based on insemination with the husband's sperm. Thus, contact with the immune system of the female body in the cervical canal is avoided. The efficiency of the method is equal to 40%.

But, unfortunately, not all forms of infertility lend themselves to such a detailed study and understanding of their nature of occurrence. And if the cause of infertility is not known, then the possibilities of prescribing rational and effective treatment are limited. In such cases, doctors suggest resorting to methods of artificial insemination. In addition, the following indications are defined by medicine:

absence of fallopian tubes or tubal obstruction;
condition after the use of surgical methods and laparoscopy regarding endometriosis;
negative result in the treatment of infertility of the endocrine form;
absolute male infertility;
complex cases of infertility of the uterine form;
depletion of ovarian function;
pathologies in which pregnancy is practically impossible.

The main methods for carrying out artificial insemination include:

insemination with donor sperm (husband's sperm) intrauterine;
intracellular injection of sperm into the egg;
in vitro fertilization method;
surrogacy.

Remember that both partners should be involved in infertility treatment. The effectiveness of treatment directly depends on the age indicators of both spouses. More importance is given to the age of the woman. At the first signs of infertility of any form, you should immediately seek advice from an experienced doctor. It is very important for a woman not to lose faith in herself and her partner, because a lot is fixated on the mood. Many forms of infertility have already been defeated, so it is worth trying to solve the problem.

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The cause of the disease is female infertility. Causes of infertility in women and methods of treatment

Hormonal infertility

Physiological factors of infertility

Other reasons

Forms of infertility

Diagnostics

Treatment

Medical treatment

Surgery

Assisted Reproductive Technologies (ART)

Useful video about solving the problem of female infertility

Infertility in men

Causes of infertility

Factors that increase the likelihood of infertility

Types of infertility

Primary infertility

Secondary infertility

1 degree infertility

2nd degree of infertility

3 degree infertility

Diagnosis of infertility

History taking and examination for signs of infertility

Tests for hormone levels

sex hormones

Hormones of the adrenal cortex

Hardware and instrumental diagnostics

Hysteroscopy

Laparoscopy

Infertility treatment

Treatment of female infertility

When is IVF applied?

Period after IVF

Causes

Signs of infertility in a woman

Diagnosis of infertility

Infertility treatment

Modern methods of overcoming the problem of infertility

Causes of infertility in women.

Causes of infertility in men.

What does "female infertility" mean?

What are the causes of female infertility determined by gynecology?

Diagnosis of infertility

Treatment of female infertility

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