According to WHO statistics, approximately every seventh family faces the problem of infertility. Infertility refers to the inability of a sexually active married couple of childbearing age to reproduce. This diagnosis is made if pregnancy does not occur after a year of sexual activity without using any contraceptives. About half of such cases occur in primary infertility, when a woman has never become pregnant. Secondary include problems with reproduction if there has already been a pregnancy, even if it was ectopic, frozen, or with an early miscarriage.

The main causes of infertility are associated with hormonal and anatomical pathologies of various origins. For example, due to menstrual dysfunction, ovulation does not occur, or the underdevelopment of the uterus makes embryo implantation impossible. There are many reasons for this, and they can be combined with each other.

Modern research in gynecology has shown that types of infertility can be grouped according to different signs. First of all, these are primary and secondary infertility. Each of them is divided into several types.

1. Depending on the gender of the partner with fertility problems, male, female, and combined infertility are distinguished.
2. Depending on the ability to correct the causes, infertility is divided into absolute and relative.
3. Depending on the type of violation reproductive system infertility happens:

• endocrine;
• pipe;
• associated with endometriosis
• immunological,
• psychological;
• unknown etiology.

Primary infertility in women and men

Primary infertility It occurs as often in men as in women. This diagnosis can be made if one or more partners with whom they had unprotected sexual intercourse never became pregnant. The causes of this condition can be different, congenital and acquired. For example, this may include:

• abnormalities of the genital organs (cryptorchidism, absence, underdevelopment of the testicles or seminal ducts, hypospadias);
• genetic pathologies;
• varicocele;
• infectious diseases(STDs, epididymitis, mumps);
• endocrine disorders.

Treatment of primary infertility should be aimed at eliminating its cause. It is usually possible to achieve conception naturally if you eliminate the infectious factor, correct hormonal levels, and correct some abnormalities surgically.

Unfortunately, even with the modern level of development of medicine, not all pathologies can be cured, especially if we're talking about about congenital absence of an organ, chromosomal changes. In such cases, assisted reproductive technologies will come to the rescue.

The causes of primary infertility in women, as well as in men, are associated with congenital and acquired anatomical features, hormonal imbalance, and STIs. The list will be somewhat wider, due to more complex structure female reproductive system.

Rarely, there are cases of such type as combined infertility, when both partners simultaneously have any problems with fertility. If the causes have been established and infertility treatment has been carried out in a timely manner in full, then the woman’s chances of becoming a mother increase sharply.

Congenital pathology of anatomical structure

Primary infertility in women can be absolute due to birth defects development of the sexual sphere associated with the absence of:

• uterus;
• ovaries;
• fallopian tubes.

Pathologies of the structure of the uterus (hypoplasia, intrauterine septum, bicornuate uterus, organ duplication) or fallopian tubes(their doubling, fusion, underdevelopment). Because of this, the meeting of the egg and sperm is impossible, that is, the possibility of natural fertilization is completely excluded.

Diagnosis of primary infertility

The diagnosis of primary infertility is made to a patient who complains of the absence of pregnancies during regular sexual activity, after a series of diagnostic studies. The doctor conducts an anamnesis, an external examination, assessing the condition of the skin, hair, subcutaneous fat layer, breasts, and genitals. A number of laboratory tests are carried out instrumental examinations, including minimally invasive diagnostic operations.

Secondary infertility in women

If a woman cannot conceive for more than a year, but she previously had a pregnancy, regardless of its completion, then we are talking about secondary infertility. Its varieties in women are associated with factors such as:

• tubal obstruction;
• infectious inflammatory processes;
• hormonal disorders, in particular polycystic ovary syndrome and early menopause;
• biological incompatibility of partners;
• endometriosis;
• psychological problems.

Tubal obstruction

After gynecological operations, including abortions, inflammation of the uterus and appendages, adhesions occur in the fallopian tubes. Their inner surface as if glued together, fused. The lumen is blocked. Due to obstruction of the tubes, sperm do not reach the egg, and conception does not occur. The adhesive process can spread to the pelvic organs; this type of infertility is called tubo-peritoneal.

Inflammatory diseases of the pelvic organs

The onset and normal development of pregnancy is prevented by infections that cause inflammatory diseases of the uterus, cervix, tubes or ovaries. These could be STDs, including sexually transmitted diseases, tuberculosis and others. The causative agents are:

The infection can enter, for example, the ovaries through sexual contact, during gynecological procedures, during childbirth, menstruation, or through blood flow from another diseased organ. More often, women with chronic stress, weakened immunity, and leading a promiscuous sex life suffer from diseases of the genital area.

Infectious processes can act as a factor in infertility. Thus, inflammation of the cervix changes the properties of mucus cervical canal, it becomes too thick, which prevents the transport of sperm into the woman’s uterus. When the ovaries become inflamed, their functioning is disrupted, problems with ovulation appear, and the menstrual cycle is disrupted. Inflammation of the uterus affects normal work endometrium, to which the fertilized egg attaches.

The danger of sexually transmitted infections is that in about half of the cases they are asymptomatic or have mild symptoms. Neglected infections without proper treatment with antibiotics become chronic, sluggish and lead to adhesions of the pelvic organs, causing infertility.

Endocrine infertility

Hormonal imbalances in the body are another common cause of infertility. They are caused by dysfunction of the endocrine glands involved in the functioning of the reproductive system and reproduction of offspring: the ovaries, hypothalamus, pituitary gland, thyroid gland and adrenal glands.

The main symptom indicating an endocrine imbalance will be a violation menstrual cycle up to the complete absence of menstruation (amenorrhea), as a result of which ovulation does not occur. Failures in the body of this kind cause:

• head injuries;
• brain tumors;
• obesity;
• dramatic weight loss in a short time;
• hypo- and hyperfunction of the thyroid gland, adrenal glands;
• ovarian neoplasms;
• stress;
• genetic abnormalities;
• somatic diseases.

For example, the pituitary gland produces the hormone prolactin. When its level in a woman’s blood increases, the onset and development of pregnancy is impossible. Fortunately, endocrine infertility can be treated using replacement therapy. After adjustment hormonal levels 7-8 out of 10 women manage to get pregnant.

Polycystic ovary syndrome

Variety endocrine pathology is polycystic ovary syndrome (polycystic ovary syndrome, PCOS). The disease is widespread. In about a quarter of women who have problems conceiving, it acts as the main factor in infertility. With this diagnosis, the ovaries visually become similar to a bunch of grapes. Many small cystic formations appear in them. These are immature follicles. Patients, along with cycle disruptions, experience excess hair growth, multiple acne, obesity, skin pigmentation, increased insulin levels, and metabolic disorders.

Immunological infertility

If a woman cannot become pregnant for a year or more, all known variants of infertility have been excluded during examination, then it is recommended to conduct a postcoital analysis for the presence of antisperm antibodies in the couple’s blood. A positive result may indicate that sperm are destroyed in the body of a man (more often) or a woman, as a result of which fertilization does not occur.

There is also genetic incompatibility between men and women. In such cases, conception occurs, but the mother’s body begins to reject the fetus, and it dies. During the first pregnancy, the risk of rejection is minimal, but increases with each subsequent pregnancy.

Immunological incompatibility is one of the rarest and most difficult to treat types of infertility.

Endometriosis

Pathological growth of the inner mucous membrane of the uterus is the cause of associated primary or secondary infertility. The endometrium has the ability to take root, reaching other organs and tissues. Can spread throughout the body through blood and lymph flow. Problems with conception arise for two reasons.

1. Adhesive process in the tubes and uterus, due to chronic inflammation in places of endometriotic lesions.
2. Problems with egg maturation, its quality and ovulation in the presence of endometrial tissue on the ovaries.

Early menopause

Early menopause, or exhausted ovarian syndrome, refers to rare reasons infertility. It is diagnosed when a woman under or after 40 years of age stops having periods and develops characteristic symptoms, such as hot flashes, sudden withering of the skin, weakness, irritability, pressure surges, heart pain.

Among the factors for the development of pathology, gynecologists identify:

• genetic predisposition;
• intrauterine damage to ovarian tissue;
• autoimmune disorders;
• dysfunction of the hypothalamus;
• infectious diseases;
• stress.

Premature menopause is characterized by a decrease in the size of the ovaries and the complete absence of follicles in them. Lack of egg maturation makes conception impossible. Assisted reproductive technologies (ART) are usually used as a treatment method.

Psychological infertility

If a couple has undergone all types of examinations, doctors do not find any obstacles to conceiving a child, and the desired pregnancy does not occur, then one should think about psychological infertility. The trigger can be a chronic stressful situation. There were cases when excessive focus on a cherished desire did not allow the dream to come true, and as soon as the woman switched her attention to something else, the test showed two stripes.

The causes of psychological infertility may lie in the subconscious. For example, reluctance to give birth to a specific man, fear of childbirth. Psychotherapeutic methods are used for treatment.

Secondary male infertility and its features

A couple should think about secondary male infertility if the man has suffered a genital injury, any disease, conception does not occur, but the partner has previously had a pregnancy with any outcome. The diagnosis is confirmed after full examination, which includes semen analysis, blood tests, ultrasound and scrotal Doppler.

Prerequisites for the occurrence of pathology:

• STI;
• history of viral diseases (flu, herpes, etc.);
• endocrine pathologies;
• varicocele;
• surgical operations on the genitals;
• regular intake of alcohol, anabolic steroids, narcotic substances;
• smoking;
• exposure to high temperatures on the testicles (working in a hot shop, visiting a bathhouse, sauna, too hot water while taking a bath);
• strict diets and stress.

All these factors influence the quantity, transport of sperm produced, and its quality. Sperm do not enter the ejaculate or are not viable, which makes the process of fertilization impossible.

Diagnosis of secondary infertility

Various types of infertility in women can be combined with each other, as well as with male infertility in different combinations. The most common pathologies inflammatory in nature. That's why primary diagnosis aimed at searching for infections and their causative agents.

Women should begin the examination by visiting a gynecologist; consultation with a urologist or andrologist for men. A number of laboratory diagnostic measures include ultrasound, hardware, instrumental examination of the uterus and appendages, blood tests for hormone levels. The results obtained will help to find the causes of childlessness in order to select the most effective therapy.

General principles of infertility treatment

There are many types of female infertility, each of them requires a specific treatment regimen. Therapy aimed at recovery reproductive health, is selected individually, depending on the reasons that violated it.

The treatment provided can be broadly divided into two types.

1. Conservative - taking various medications, including hormonal ones, physiotherapy. So, for infections, the patient is prescribed antibiotics, and for endocrine imbalance, replacement therapy is selected.
2. Surgical, including surgical, minimally invasive, laparoscopic, endoscopic intervention. For example, there is no point in treating the symptoms of tubal infertility without surgery.

It makes sense to turn to alternative methods, for example, etc. Currently, the Internet is replete with many advertisements for various food supplements that help get rid of infertility. Reviews speak of the positive effect of these drugs, but this does not yet indicate a proven clinical effect.

A combination of methods is possible. For example, after surgery, antibacterial and anti-inflammatory drugs are prescribed. Or, on the contrary, after drug treatment of the infection, an operation is performed to eliminate adhesions.

If traditional methods did not lead to positive result, then modern assisted reproductive technologies such as IVF, ICSI and others can help a childless couple.

Currently a large number of married couples face the problem of infertility. The diagnosis of primary infertility is made when no conception occurs within one year, despite the active sexual life of a man and a woman without the use of contraceptives.

What is primary infertility?

• primary;

These types of infertility occur in both. As for women, primary infertility is diagnosed in cases where there has not been a single pregnancy. Therefore, secondary infertility is the inability to get pregnant a second time.

Primary infertility in women

So, what is primary infertility? Primary infertility (1st degree infertility) is the inability to produce offspring of a mature organism, due to congenital or acquired diseases of the reproductive system.

The causes of primary infertility in women are pathologies and diseases of the genital area. Pathologies include:

• uterine fibroids;
• cervical erosion;
• cysts;
• various gynecological diseases.

Another pathology that interferes with conception is ovarian pathology. With this pathology, the follicle does not function properly and the egg does not mature. The manifestation of such problems is accompanied by the absence of menstruation or heavy and prolonged discharge during it.

The diagnosis of primary first-degree infertility occurs after abortion or any other method of terminating the first pregnancy. Abortion provokes hormonal disbalance body, which interferes with conception. Also, conception does not occur after diseases and injuries to the internal genital organs, which a woman could receive during an abortion. Another cause of infertility can be adhesions of the fallopian tubes. In this case, the path for the egg to the uterus is closed, it cannot be fertilized.

Lack of ovulation

• - this is the formation of a healthy egg, ready for fertilization. Its absence may be caused by a hormonal imbalance in a woman’s body. Signs of ovulation disorders include irregular menstrual cycles and heavy bleeding. This can be corrected with drug therapy.

"Worn out" egg

• As a woman ages, the egg loses its quality characteristics. Especially in women over forty, the egg becomes abnormal. In this case, the issue of replenishing the family can only be resolved through surrogacy or transplantation of a healthy donor egg.

Endometriosis

• A disease characterized by the growth of endometrial tissue outside the uterus. The main symptom is the presence of severe pain during menstruation. This disease is dangerous for miscarriages. It can be cured with surgical intervention. The surgeon removes harmful tissue, which increases the patency of the fallopian tubes.

Poor patency of the fallopian tubes

• The cause may be an inflammatory process or a disease that is sexually transmitted.

Polycystic ovary syndrome

• The presence of cysts in the ovary, which provoke hormonal imbalance in the body. Which subsequently causes a delay in the menstrual cycle and ovulation. With polycystic disease, body weight may increase, hair growth will accelerate, and acne may appear. Treatment for this disease involves taking medications that promote ovulation.

Primary infertility in men can be caused by the following reasons:

1. Presence of urinary tract infections. During the inflammatory process, antibodies are produced, which lead to antisperm immunity. Inflammation is caused by various fungi, viruses and bacteria, which cause sperm to stick together. Before starting treatment, it is necessary to find the source, which is not always possible.
2. The cause of infertility can also be the expansion of the veins of the seminal canal, that is. The cause of infertility is overheating of the testicles, an autoimmune reaction against sperm. Varicocele is the most common.
3. Genetic anomalies. Availability genetic defects aggravates the possibility of surrogate pregnancy, since anomalies can be passed on to the unborn child. Heredity plays a big role important role in this matter.
4. Systemic diseases are also causes of infertility in men. Namely, liver cirrhosis, tuberculosis, diabetes, bronchial asthma and various diseases respiratory tract, cranial – brain injuries, diseases of the gastrointestinal tract, especially diseases of the pancreas, hormonal changes.
5. Availability bad habits. Alcohol, tobacco and drug addiction.
6. Strong radiation, contact with chemicals harmful substances, bad ecology.
7. Stress, overwork, poor nutrition also affect male sex hormones.

Treatment methods

Currently, there are several methods for treating primary infertility in men. Methods include:

• therapeutic treatment. This is a treatment using radiation therapy, chemotherapy, hormonal therapy, and tranquilizers, antihypertensive drugs, drugs, nitrofurans, anabolic steroids and many other medicines;
• surgical interventions and removal inguinal hernia, defects and injuries of the scrotum, operations on bladder and varicocele, etc.
• – This is extra corporal fertilization. Eighty out of a hundred couples resort to this method of solving the problem. It is valued for its safety and effectiveness.

Diagnosis of primary infertility

To diagnose infertility, a specialist will first order an examination. The examination includes a series of tests, identifying hereditary characteristics and anomalies.

After all the tests have been completed, the doctor must find out what kind of life the patient leads, in what conditions he lives and works. And only after examining all the tests and collected information does he make a conclusion. And if the diagnosis of primary infertility is confirmed, the specialist will prescribe a specific treatment.

Thanks to modern medicine, it has become possible to overcome primary infertility. Of course, it is not always possible to carry and give birth to a child yourself, but this can also be solved with the help of surrogacy.

Surrogacy is now very popular and does not pose any danger. The main thing is, if you want to start a family, have children, do not waste precious time.

There is no need to be afraid of anything, you just need to consult a doctor and follow all his recommendations step by step and unquestioningly. And then you will be one step closer to your dream. Dream of becoming happy parents! Take care of yourself and watch your health!

Video: How to treat primary and secondary infertility

Female infertility is the inability of a woman to conceive during her childbearing years.

ICD-10 code

N97 Female infertility

Epidemiology

The frequency of infertile marriages is 15–17%, of which female infertility accounts for 40–60%. The most common forms of female infertility are tubo-peritoneal (50–60%) and anovulatory (endocrine) (30–40%) forms, as well as external genital endometriosis (25%); combined forms of infertility account for 20–30%. In 2–3% of cases, the cause of infertility cannot be determined.

In every part of the reproductive system of the male and female body, problems can occur. pathological processes, violating complex biological mechanism their work and leading to infertility.

There are primary and secondary infertility. Primary infertility is infertility in women (or men) who have regular sexual intercourse without protection and without pregnancy (in men, infertile sperm). Secondary infertility is the absence of pregnancy (the ability to fertilize in men) within a year of regular sexual activity after previous pregnancies. Absolute infertility is infertility associated with the absence or abnormal development of the genital organs.

Availability of one of the partners various forms infertility is defined as combined infertility, the presence of infertility factors in both partners - a combined form of infertility in a couple.

One of the most important problems in gynecology and reproductive medicine is infertile marriage. Infertile marriage, which accounts for 15% of married couples in Russia, is associated with the problem of a childless future for millions of citizens, the decline and loss of the nation’s gene pool. Maybe. this problem is more pressing than many others in medicine, because only after the birth of a person can we talk about the importance and significance of providing him with this or that medical care.

• Reproduction is the property of reproducing similar individuals, ensuring continuity and continuity of life.
• Reproductive health – defined by WHO as the absence of reproductive system diseases or disorders reproductive function if it is possible to carry out reproductive processes with complete physical, mental and social well-being.
• Sexual health is a combination of physical, emotional and social aspects of sexual life that positively enriches the personality, promotes mutual understanding and love.
• Family planning is a set of socio-economic, legal, and medical measures aimed at giving birth to healthy children desired by the family, preventing abortions, maintaining reproductive health, and achieving harmony in marriage.
• Fertility is the ability to reproduce offspring.
• Sterility is the lack of ability to reproduce offspring.
• Infertile marriage – absence of pregnancy for 12 months. regular sexual activity without the use of any contraception, provided that the spouses (sexual partners) are of childbearing age (WHO).

Causes of infertility in women

Female infertility can be a consequence of many diseases and conditions.

Primary infertility in women

• Genital infantilism, developmental anomalies of the female genital organs.
• Dysregulation hormonal function ovaries, functional insufficiency of the gonads.
• Diseases of the uterus and uterine appendages that prevent pregnancy.

Secondary infertility in women

• Inflammatory diseases of the female genital organs, complications after abortion, IUD.
• Diseases of the endocrine system.
• Tumors of the genital organs.
• Ectopic pregnancy.
• Somatic diseases(tuberculosis, collagenosis, blood diseases, etc.).
• Traumatic injuries vagina, cervix, perineum.
• Chronic intoxication (alcohol, nicotine, heavy metal salts, etc.).
• Industrial and professional factors (microwave field, low doses of ionizing radiation).
• Poor nutrition.

The main cause of female infertility is inflammatory diseases of the female genital organs or their consequences (in 60-70% of cases). Among the inflammatory processes, infertility is most often accompanied by inflammation of the uterine appendages, which causes obstruction of the fallopian tubes and various disorders functional state ovaries.

Especially often, obstruction of the fallopian tubes occurs with gonorrheal salpingitis, but it can also be a consequence nonspecific inflammation. Infertility often occurs after an abortion or pathological birth. The consequence of abortion can be salpingitis with the development of obstruction of the fallopian tubes and damage to the uterine mucosa

Salpingitis leads not only to obstruction of the fallopian tubes, but also to disruption of their motor activity, to dystrophic changes mucous membrane of the fallopian tube, preventing fertilization.

With inflammation of the ovaries, ovulation may be disrupted, due to which the egg does not enter the abdominal cavity, and if adhesions form around the ovary (in the case of normal ovulation), it cannot enter the tube. In addition, oophoritis can disrupt endocrine function ovaries.

The role of endocervicitis in the etiology of infertility is significant, since they change the function of the epithelium of the cervical canal. Colpitis can also be a cause of infertility (changes in the properties of vaginal fluid due to various diseases can lead to the death of sperm).

In the etiology of infertility, endocrine disorders occur in 40-60% of cases. In this case, the function of the ovaries can be disrupted primarily, which is observed with abnormal development of the genital organs or with damage to the follicular apparatus of the ovaries due to previous infectious diseases or intoxications (the process of egg maturation and ovulation is disrupted, the hormonal function of the ovaries, necessary for maturation, transport of the egg and its fertilization).

Infantilism and hypoplasia of the genital organs can cause infertility in women. At the same time, both anatomical and functional features reproductive system associated with sexual underdevelopment (long narrow vagina with shallow rear arch, narrow cervical canal, decreased hormonal function of the ovaries, inferior cyclic processes in the endometrium, dysfunction of the fallopian tubes, etc.).

Ovarian function may change secondary to diseases of the pituitary gland, thyroid gland, and adrenal glands. Infertility is caused by diseases such as myxedema, hypothyroidism, severe forms diabetes mellitus, Itsenko-Cushing's disease, obesity, etc.

Infertility can be caused by injuries and displacement of the genital organs ( old gap perineum, gaping of the genital fissure, pubescence of the vaginal walls, kinks and displacements of the uterus, eversion of the cervix, genitourinary fistulas, synechiae of the uterine cavity, fusion of the cervical canal).

Infertility in some cases is accompanying symptom for endometriosis, tumors of the female genital organs

General diseases and intoxications (tuberculosis, syphilis, alcoholism, etc.), as well as malnutrition, vitamin deficiency, mental illness cause complex disorders leading to disruption of ovarian function, which can also result in infertility.

The cause of infertility is immunological factors (the formation of antibodies to sperm in a woman’s body).

Frequency of identification of various factors of reproductive dysfunction in married couples.

It should be taken into account that among women suffering from infertility, more than 60% have two or more factors affecting fertility.

Pathological cervical mucus

Abnormal cervical mucus can impair fertility by inhibiting penetration or increasing sperm destruction. Normally, cervical mucus changes from thick, impenetrable to thinner, clearer and more stretchable due to increasing levels of estradiol over time. follicular phase menstrual cycle. Abnormal cervical mucus may remain impenetrable to sperm by the time of ovulation or may cause sperm destruction by facilitating the influx of vaginal bacteria (eg, as a result of cervicitis). Sometimes abnormal cervical mucus contains antibodies to sperm. Abnormal mucus rarely significantly impairs fertility, except in cases of chronic cervicitis or cervical stenosis as a result of treatment for cervical intraepithelial neoplasia.

Women are screened for cervicitis and cervical stenosis. If they do not have any of these disorders, then a postcoital examination is performed cervical mucus for the purpose of identifying infertility.

Reduced ovarian reserve

Reduced ovarian reserve is a decrease in the number or quality of oocytes, leading to decreased fertility. Ovarian reserve may begin to decline at age 30 or earlier and declines rapidly after age 40. Ovarian lesions also reduce reserve. Although older age is a risk factor for decreased ovarian reserve, both age and decreased ovarian reserve are themselves indicators of infertility and lead to lower treatment success.

Tests for reduced ovarian reserve are indicated for women over 35 years of age who have undergone ovarian surgery or have had no effect from ovarian stimulation with exogenous gonadotropins. Diagnosis can be suggested by detecting FSH levels greater than 10 mIU/mL or estradiol levels less than 80 pg/mL per day three times during the menstrual cycle. The diagnosis can be made when a woman is prescribed clomiphene 100 mg orally once a day on days 5-9 of the menstrual cycle (clomiphene citrate is confirmed by a test). A significant increase in FSH and estradiol levels from days 3 to 10 of the cycle indicates a decrease in ovarian reserve. In women over 42 years of age or with reduced ovarian reserve, donor oocytes can be used.

Other causes of female infertility

• Problems with ovulation

A menstrual cycle lasting less than twenty-one days and more than thirty-five may signal the inability of the egg to be fertilized. If ovulation does not occur, the ovaries are not able to produce mature follicles and, accordingly, eggs that can be fertilized. This is one of the most common causes of female infertility.

• Ovarian dysfunction

Disturbances in the production of hormones in the hypothalamus-pituitary axis can sometimes cause problems with the functioning of the ovaries. Luteotropin and follitropin are produced either in very large or in very small quantities, and their ratio is also disturbed, and, as a result, the follicle does not mature enough, the egg turns out to be non-viable or does not mature at all. The cause of such dysfunction may be head injury, tumor, or other disorders in the lower cerebral appendage.

• Hormonal disbalance

Hormonal imbalance in the body can lead to the disappearance of menstruation or unripeness of the egg. This disorder has many causes, including genetic predisposition, previous infectious diseases, weakening immune system, endocrine diseases, surgical interventions and injuries to the abdominal organs and genitourinary system.

• Genetic predisposition

Female infertility can be caused by genetic factors, hereditary predisposition, in which the egg cannot mature.

• Polycystic ovary syndrome

With polycystic disease, the production of follitropin decreases, while the level of luteotropin, estrogen and testosterone remains normal or exceeds it. There is an opinion that a reduced level of follitropin provokes insufficient development of follicles that are produced by the ovaries. As a result of this, the formation of multiple follicular cysts (up to six to eight millimeters) occurs, which are diagnosed by ultrasound. The affected ovary is usually enlarged and a capsule forms on its surface white, through which the egg cannot pass, even if it is mature.

• Cervical canal disorders

As a result of such disorders, sperm are not able to penetrate the uterine mucosa, which causes their death.

• Cervical erosion

The cause of female infertility can be a pathology such as erosion - ulcerative formations on the mucous membrane of the cervix, which can be congenital or occur due to infections and injuries. The development of pathology is facilitated by hormonal disorders, disruption of the menstrual cycle, earlier onset of sexual relations, lack of a permanent sexual partner, and weak immunity. As a rule, this pathology is asymptomatic and is determined during examination by a gynecologist. Sometimes there may be a brownish discharge from the genitals and pain during intercourse.

• Scars on the lining of the ovaries

This pathology causes the ovaries to lose the ability to produce follicles, resulting in no ovulation. Scars can appear after operations (for example, when removing cysts) and infectious pathologies.

• Unruptured follicle syndrome

At this syndrome a mature follicle does not rupture and turns into a cyst. The causes of this disorder may be hormonal problems, compaction of the ovarian capsule or pathology of its structure. However, this phenomenon has not been fully studied.

• Endometriosis

With this disease, endometrial cells begin to grow and form polyps that penetrate not only the fallopian tubes and ovaries, but into the abdominal cavity. This disease prevents the egg from maturing and prevents its fusion with the sperm, and in the case of fertilization, it prevents the egg from attaching to the uterine wall.

• Psychological factor

Frequent stressful situations can lead to disruption of natural physiological functions, which affects Negative influence on the fertilization process. TO psychological factors Also include female infertility of unknown origin (in approximately ten percent of couples no disorders causing female infertility are found).

• Pathology of the uterine structure

Any deformation of the uterus has an effect similar to an IUD - it prevents the egg from attaching to the endometrium. Such pathologies include polyps and uterine fibroids, endometriosis, as well as congenital structural pathologies.

Diagnosis of infertility in women

When conducting diagnostics, it is necessary to examine both partners, regardless of the complaints. First of all, it is necessary to exclude the presence of sexually transmitted diseases, hereditary pathologies and diseases of the endocrine system. After all the necessary information about the presence or absence of concomitant diseases has been collected, the patient is examined for secondary sexual characteristics, a rectal examination and an examination of the pelvic organs are performed.

TO diagnostic procedures also includes hysterosalpingography (performed on the sixth to eighth day from the start of the cycle). Using hysterosalpingography, the condition of the uterine cavity and tubes is determined. They are filled through the cervical canal contrast agent. If the fallopian tubes have normal patency, then this solution is not retained in them and penetrates into the abdominal cavity. Hysterosalpingography can also be used to diagnose other uterine pathologies. To diagnose the disease, ultrasound biometry of follicle growth is also used (on the eighth to fourteenth day of the cycle), hormonal studies (luteotropin, follitropin, testosterone - on the third to fifth day of the cycle), on the nineteenth to twenty-fourth day of the cycle, the level of progesterone is determined, two to three the day before the onset of menstruation, an endometrial biopsy is performed.

Diagnosis of an infertile marriage involves examination of both sexual partners, diagnostic measures must be carried out in full to identify all possible factors infertility in both women and men.

• number and outcomes of previous pregnancies: spontaneous and induced abortions, including criminal ones; ectopic pregnancy, hydatidiform mole, number of living children, postpartum and post-abortion complications;
• duration of primary or secondary infertility;
• contraceptive methods used and duration of their use after last pregnancy or with primary infertility;
• systemic diseases: diabetes, tuberculosis, diseases of the thyroid gland, adrenal cortex, etc.;
• drug treatment that can have a short-term or long-term negative effect on the ovulation process: cytotoxic drugs and x-ray therapy of the abdominal organs; psychopharmacological agents such as tranquilizers;
• operations that could contribute to the occurrence of infertility: appendectomy, wedge resection of the ovaries, operations on the uterus and others; flow postoperative period;
• inflammatory processes in the pelvic organs and sexually transmitted diseases, type of pathogen, duration and nature of therapy;
• endometrioid disease;
• character vaginal discharge, examination, treatment (conservative, cryo- or electrocoagulation);
• the presence of discharge from the mammary glands, their connection with lactation, duration;
• production factors and the environment - epidemic factors; alcohol abuse, taking toxic drugs, smoking, etc.;
• hereditary diseases taking into account first and second degree relatives;
• menstrual and ovulatory history; polymenorrhea; dysmenorrhea; first day of last menstruation;
• sexual function, pain during sexual activity (dyspareunia).

Objective examination

• height and body weight; weight gain after marriage, stressful situations, climate change, etc.;
• development of the mammary glands, the presence of galactorrhea;
• hair growth and the nature of its distribution; skin condition (dry, oily, aspae vulgaris, stretch marks);

Examination of body systems:

• measurement blood pressure;
• X-ray of the skull and sella turcica;
• fundus and visual fields.

Gynecological examination data

When conducting gynecological examination the day of the cycle corresponding to the date of the study is taken into account. The degree and features of the development of the external genitalia, the size of the clitoris, the nature of hair growth, features of the vagina, cervix, uterus and appendages, the condition of the uterosacral ligaments, the presence and nature of discharge from the cervical canal and vagina are assessed.

Colposcopy or microcolposcopy is a mandatory method of examination during the first examination of the patient; it allows identifying signs of colpitis, cervicitis, endocervicitis and cervical erosion, which can cause infertility and be a sign chronic infection genitals.

Laboratory and instrumental examination methods

Great value in correct positioning Diagnosis of infertility in a woman requires additional laboratory and instrumental examination methods. Compliance with the timing of the main methods of examining women allows you to avoid false-positive and false-negative results of these studies. WHO recommends the following frequency and timing of laboratory examination of women with infertility:

• tests functional diagnostics– 2-3 cycles;
• hormonal studies (LH, FSH, prolactin, testosterone, DHEA) on the 3rd–5th day of the menstrual cycle; in the middle of the cycle and in the second phase;
• hysterosalpingography on days 6–8 of the menstrual cycle; kypertubation – on the days of ovulation;
• Ultrasound biometry of follicle growth on days 8-14 of the menstrual cycle;
• immunological tests - on the 12-14th day of the menstrual cycle.

Immune forms of infertility are caused by the appearance of antisperm antibodies, more often in men and less often in women.

One test that suggests immunological incompatibility is the postcoital test (PCT), known as the Sims-Hooner test or Shuvarsky test. The test allows you to indirectly judge the presence of antisperm antibodies. The most significant clinical manifestation of immunological disorders is the presence of specific antibodies to sperm. In women, antisperm antibodies (ASAT) may be present in serum, cervical mucus, and peritoneal fluid. The frequency of their detection ranges from 5 to 65%. The examination of a married couple should include the determination of antisperm antibodies already in the first stages and primarily in the husband, since the presence of antisperm antibodies in the ejaculate is evidence of the immune factor of infertility.

Postcoital test (Shuvarsky-Sims-Huner test) - is carried out to determine the number and motility of sperm in the cervical mucus. Before the post-coital test, partners should abstain from sexual activity for 2-3 days. Advancing sperm can be detected in cervical mucus within 10-150 minutes. after sexual intercourse. The optimal interval before the test should be 2.5 hours. Cervical mucus is collected with a pipette. If, with normozoospermia, 10–20 advancing sperm can be seen in each field of view, then the cervical factor as a cause of infertility can be excluded.

Determination of antisperm antibodies in women in the mucus of the cervical canal: on preovulatory days, mucus is collected from the cervical canal for the quantitative determination of antibodies of three classes - IgG, IgA, IgM. Normally, the amount of IgG does not exceed 14%; IgA – 15%; IgM - 6%.

• laparoscopy to determine the patency of the fallopian tubes - on the 18th day of the menstrual cycle;
• determination of progesterone levels on the 19-24th day of the menstrual cycle;
• endometrial biopsy 2-3 days before the start of menstruation.

A comprehensive clinical and laboratory examination of women in infertile marriages allows us to identify the following causes of infertility:

• Sexual dysfunction.
• Hyperprolactinemia.
• Organic disorders of the hypothalamic-pituitary region.
• Amenorrhea with elevated FSH levels.
• Amenorrhea with normal estradiol levels.
• Amenorrhea with reduced estradiol levels.
• Oligomenorrhea.
• Irregular menstrual cycle and/or anovulation.
• Autovulation during regular menstruation.
• Congenital anomalies of the genital organs.
• Bilateral obstruction of the fallopian tubes.
• Adhesive process in the pelvis.
• Endometrioid disease.
• Acquired pathology of the uterus and cervical canal.
• Acquired disorders of fallopian tube patency.
• Tuberculosis of the genital organs
• Iatrogenic causes (surgical interventions, medications).
• Systemic reasons.
• Negative postcoital test.
• Unidentified causes (when laparoscopy was not performed).
• Infertility of unknown origin (using all examination methods, including endoscopic).

Treatment of infertility in women

Treatment of female infertility, first of all, should be aimed at eliminating main reason, which provokes problems with reproductive function, as well as the correction and elimination of any accompanying pathologies. Simultaneously with the main treatment, restorative procedures and psychocorrection are carried out. Treatment for women must be comprehensive in order to resume normal functioning reproductive system.

In case of tubal obstruction, anti-inflammatory therapy is carried out, which is aimed not only at eliminating the inflammatory process and restoring the patency of the fallopian tubes, but also at activating the functions of the hypothalamus-pituitary-ovarian system. Physiotherapeutic methods of treatment include radon or hydrogen sulfide baths, usage therapeutic mud. To correct the functioning of the body's immune system, it is prescribed antihistamines(suprastin, tavegil, diphenhydramine), immunomodulatory drugs. Treatment is carried out with small doses of drugs for two to three months or loading doses for a week.

Women with obstruction or complete absence of the fallopian tubes, as well as the presence of diseases such as polycystic disease, endometriosis, etc., may be offered the technique of in vitro fertilization. The woman is prescribed medications to enhance the growth and maturation of eggs. Then the mature eggs are removed with a special needle and fertilization is carried out in vitro. On the third to fifth day, the embryos are placed in the uterus, and the patient is prescribed special medications to ensure that the embryos take root. Two weeks after the procedure, a blood test is ordered to determine whether a pregnancy is developing. At the fifth or sixth week, an ultrasound examination is performed.

It should be noted that female infertility is caused by more than twenty reasons. Consequently, in order to carry out correct treatment, a thorough and sometimes lengthy examination is necessary in order to identify the reasons that prevent a woman from becoming pregnant. Only after detailed and full diagnostics The attending physician can prescribe qualified treatment, which is strictly individual in each case.

The goal of treating infertility in women is to restore reproductive function.

The basic principle of infertility treatment is early detection its causes and sequential stages of treatment.

Modern highly effective methods of treating infertility include medications and endoscopic methods and methods of assisted reproductive technologies. Moreover, the latter are the final stage of infertility treatment or an alternative to all existing methods.

Treatment tactics depend on the form and duration of infertility, the patient’s age, and the effectiveness of previously used treatment methods. If absent for 2 years positive effect traditional treatment It is advisable to use methods of assisted reproductive technologies.

The choice of treatment methods for infertility and determining their sequence in each specific case depend on factors such as the duration of the disease, the severity of changes in the fallopian tubes, the degree of spread adhesive process, age and somatic condition of the patient.

Treatment of tubo-peritoneal infertility

Treatment of tubal infertility with organic lesions Fallopian tubes are quite complicated. Among conservative methods, the priority today is complex anti-inflammatory, absorbable treatment, carried out against the background of an exacerbation of the inflammatory process. The therapy carried out consists of inducing an exacerbation of the inflammatory process according to indications, followed by complex antibacterial and physiotherapy, and sanatorium-resort treatment.

Reconstructive tubal microsurgery introduced into gynecological practice in the 60s of the 20th century, became a new stage in the treatment of tubal infertility, allowing operations such as salpingo-ovariolysis and salpingostomatoplasty. Improvements in endoscopic technology have made it possible to perform these operations during laparoscopy in some cases. This method allows you to diagnose other pathologies of the pelvic organs: endometriosis, uterine fibroids, cystic ovarian formations, polycystic ovaries, etc. The possibility of simultaneous surgical correction of the pathology identified during laparoscopy is very important.

Treatment of endocrine infertility

Therapy prescribed to patients with endocrine forms of infertility is determined by the level of damage to the system hormonal regulation ovulation process. Based on a certain level, the following groups of patients with hormonal forms of infertility are distinguished:

1st group – extremely polymorphic, conditionally united common name– “polycystic ovary syndrome.” This group is characterized by an increase in LH in the blood, normal or increased FSH levels, an increase in the ratio of LH and FSH, normal or reduced level estradiol.

Treatment must be individualized and may consist of several stages:

• the use of estrogen-gestagen drugs according to the “rebound effect” principle;
• the use of indirect stimulants of ovarian function - clomiphene citrate (clostilbegit).

In the presence of hyperandrogenism, it is prescribed in combination with dexamethasone;

• the use of direct ovarian stimulants - Metrodin HG.

Group 2 – patients with hypothalamic-pituitary dysfunction.

Women with various menstrual cycle disorders (luteal phase deficiency, anovulatory cycles or amenorrhea), with pronounced secretion of estrogen by the ovaries and low levels of prolactin and gonadotropins. The sequence of use of drugs that stimulate ovulation in this group of patients is as follows: gestagen- estrogen drugs, clomiphene citrate (clostilbegit), possibly in various combinations with dexamethasone, parlodel (bromocriptine) and/or hCG. If ineffective - menopausal gonadotropins, hCG.

Group 3 – patients with hypothalamic-pituitary insufficiency. Amenorrheic women who have little or no estrogen ovarian origin; Prolactin levels are not elevated and gonadotropin levels are low or unmeasurable. Treatment is possible only with menopausal gonadotropins HCG or LH-RH analogues.

Group 4 – patients with ovarian failure. In amenorrheic women whose ovaries do not produce estrogens, gonadotropin levels are very high. To date, treatment of infertility in this group of patients is unpromising. Hormone replacement therapy is used to relieve subjective sensations in the form of hot flashes.

Group 5 – women who are determined high level prolactin. This group is heterogeneous:

• patients with hyperprolactinemia in the presence of a tumor in the hypothalamic-pituitary region. Women with various menstrual cycle disorders (luteal phase deficiency, anovulatory cycles or amenorrhea), prolactin levels are increased, there is a tumor in the hypothalamic-pituitary region. In this group of patients, patients with microadenomas of the pituitary gland should be distinguished, for whom treatment with parlodel or norprolact is possible with careful supervision of an obstetrician-gynecologist, neurosurgeon and ophthalmologist, as well as patients with macroadenomas of the pituitary gland, who should be treated by a neurosurgeon, performing either radiotherapy of the pituitary gland or removal of the tumor;
• patients with hyperprolactinemia without damage to the hypothalamic-pituitary region. Women with menstrual cycle disorders similar to the subgroup with clear production of estrogens of ovarian origin, increased prolactin levels. The drugs of choice for this form are parlodel and norprolact.

Treatment of immunological infertility

To overcome the immune barrier of cervical mucus, the following are used: condom therapy, nonspecific desensitization, some immunosuppressants and methods of assisted reproduction (artificial insemination with the husband's sperm).

Assisted reproduction methods

In cases where the treatment of infertility in a married couple using conservative therapy methods and, if necessary, surgical treatment does not bring the desired results, it is possible to use assisted reproduction methods. These include:

• Artificial insemination (AI):
  • husband's sperm (IISM);
  • donor sperm (IISD).
• In Vitro Fertilization:
  • with embryo transfer (IVF PE);
  • with oocyte donation (IVF OD).
• Surrogacy.

The use and application of these methods is in the hands of specialists in reproductive and family planning centers, however, practitioners must know the possibilities of using these methods, indications and contraindications for their use.

Assisted reproductive technologies involve manipulating sperm and eggs in vitro to create an embryo.

Assisted reproductive technologies (ART) can lead to multiple pregnancies, but the risk is lower than with controlled ovarian hyperstimulation. If the risk of genetic defects is high, then the embryo must be examined for defects before implantation.

In vitro fertilization (IVF) can be used to treat infertility due to oligospermia, sperm antibodies, tubal dysfunction or endometriosis, as well as unexplained infertility. The procedure involves controlled ovarian hyperstimulation, oocyte retrieval, fertilization, embryo culture, and embryo transfer. For ovarian hyperstimulation, clomiphene can be prescribed in combination with gonadotropins or gonadotropins alone. GnRH agonists or antagonists may often be prescribed to prevent premature ovulation.

After sufficient follicular growth, hCG is prescribed to induce final follicular maturation. 34 hours after use of hCG oocytes are collected using follicle puncture, transvaginally under ultrasound guidance, or less commonly laparoscopically. Oocyte insemination is carried out in vitro.

The sperm sample is usually washed several times with tissue culture medium and concentrated to increase sperm motility. Additionally, sperm is added, then the oocytes are cultured for 2-5 days. Only one or a few of the resulting embryos are placed in the uterine cavity, minimizing the chance of developing a multi-embryonic pregnancy, which is highest with in vitro fertilization. The number of embryos transferred is determined by the woman's age and likely response to in vitro fertilization (IVF). Other embryos can be frozen in liquid nitrogen and transferred to the uterus in a subsequent cycle.

Gamete Into Fallopian Tube Transfer (GIFT) is alternative method IVF, but is used infrequently in women with unexplained infertility or normal tubal function in combination with endometriosis. Several oocytes and sperm are obtained in the same way as with IVF, but the transfer is performed transvaginally under ultrasound guidance or laparoscopically to the distal portions of the fallopian tubes where fertilization occurs. The success rate is approximately 25-35% in most fertility centers.

Intracytoplasmic sperm injection is used when other technologies have failed, and also in cases where severe sperm dysfunction has been noted. The sperm is injected into the oocyte, then the embryo is cultured and transferred in the same way as in in vitro fertilization (IVF). In 2002, more than 52% of all artificial cycles in the United States were performed by intracytoplasmic sperm injection. More than 34% of induced cycles resulted in pregnancies, in which 83% of cases resulted in live births.

Other procedures include a combination of in vitro fertilization and gamete intrafallopian transfer (GIFT), the use of donor oocytes, and frozen embryo transfer to a surrogate mother. Some of these technologies have moral and ethical problems (for example, the legality of surrogacy, selective reduction in the number of implanted embryos in multi-embryonic pregnancies).

We can talk about infertility if a woman does not become pregnant after having regular sexual intercourse without using contraception for a year. In 40% of cases it is associated with diseases in men, in 45% - in women. In the remaining 15 out of 100 cases of infertility, both partners have a cause.

This is a condition when a woman has never become pregnant in her life, subject to regular sexual contact and in the absence of contraception. With secondary infertility, a woman previously had a pregnancy, but subsequently, as a result of some disease, the ability to bear a child disappeared. Among all infertile women, the primary form is observed in 60%, the secondary form – in 40%.

Primary female infertility can be relative or absolute. In the first case, pregnancy is possible; in the second - conception and gestation in natural conditions don't happen. A typical example of relative primary infertility in a woman is the absence of children in a marriage with an infertile man.

What causes infertility in women?

The main causes of primary infertility are associated with anatomical disorders in the structure of the genital organs:

• infantilism (underdevelopment);
• congenital developmental anomalies;
• incorrect position of the uterus;
• sexually transmitted infections.

In addition, this form of pregnancy pathology may be associated with disruption of the ovaries, changes in ovulation and the menstrual cycle.

Inflammatory processes in the genital tract, tumors, intoxications, endocrine and other serious diseases most often cause secondary infertility.

Primary infertility is a pathology that can occur as a result of psycho-emotional changes. , in which the egg is not capable of fertilization, appear due to prolonged stress, conflicts in the family, dissatisfaction intimate life. They can be triggered by a fear of pregnancy or, on the contrary, a passionate desire to have a child.

In addition to suppressing ovulation, these factors contribute to the release of stress hormones and change the activity of the autonomic nervous system. As a result, the contractile activity of the fallopian tubes is disrupted and functional tubal obstruction is formed. This combination of disorders of ovulation and the functioning of the uterine appendages is difficult to diagnose.

The unrealized desire to become a mother leads to chronic nervous tension and further reduces the likelihood of fertilization. This is how a “vicious circle” of infertile marriage is formed.

Factors that can provoke primary infertility in women:

• diseases of the endocrine glands;
• damage to the fallopian tubes or peritoneum;
• gynecological diseases;
• immune incompatibility.

Endocrine disorders can cause primary infertility if they appear at a young age before the first pregnancy. They are associated with a violation of the ovulatory cycle, which occurs for one of the following reasons:

• insufficiency of the luteal phase during the menstrual cycle;
• luteinization of the follicle without ovulation.

Anovulation is the absence of egg maturation, which can be caused by pathology of the pituitary gland, hypothalamus, ovaries, and adrenal glands. The absence of ovulation is caused by an increase in the content of male sex hormones in the blood - androgens, prolactin; lack of female sex hormones - estrogens; overweight or malnourished. Anovulatory infertility can be caused by Cushing's syndrome or disease, as well as diseases of the thyroid gland with impaired production of thyroid hormones (hypo- or hyperthyroidism).

Hormonal imbalances are often associated with traumatic brain injury, encephalitis, and long-term stress. In addition to anovulation, they can provoke insufficiency of the luteal phase of the menstrual cycle. At the same time, the ovaries do not provide the production of hormones responsible for preparing the endometrium of the uterus for pregnancy. The mucous membrane of the uterus does not thicken, as a result, the embryo formed during conception cannot attach to it. Spontaneous termination of pregnancy occurs even before the expected delay of menstruation.

Sometimes the follicle in which the egg matures prematurely turns into corpus luteum, and ovulation does not occur. The reasons for this condition are unknown.

Damage to the fallopian tubes or peritoneum is more typical for secondary infertility. It can cause initial inability to become pregnant if the disease develops in a girl or teenager.

Dysfunction of the fallopian tubes, which is not accompanied by structural changes in these organs, can occur against the background of stress, increased concentrations of androgens in the blood, as well as during chronic inflammatory processes in the body, in which the content of prostacyclins increases.

The main cause of primary tubal infertility is tuberculosis of the reproductive system.

Peritoneal infertility can appear as a result of severe adhesions in the abdominal cavity. Such adhesions form after extensive surgery on the abdominal organs.

Gynecological diseases most often lead to secondary infertility; the primary form of pathology is caused by abnormalities in the development of the uterus.

IN in rare cases the cause of infertility is the production of female body antibodies that destroy the sperm of the sexual partner (). However, it has been established that such immunoglobulins can also be detected in a compatible couple. Therefore, the determination of antisperm antibodies in clinical practice not used.

One cause of pathology is detected in only 48% of women; in other cases, primary infertility of combined origin is registered. This must be taken into account when planning a pregnancy. How later woman decides to become pregnant, the more likely she is to “accumulate” several risk factors for infertility.

Diagnostics

In order to make a diagnosis of primary infertility, the doctor must question and examine the patient.

The following questions are clarified:

• at what age did menstruation begin?
• how long does the cycle last, do periods begin regularly;
• Is there any bleeding between periods?
• painful menstruation;
• whether the woman has had a pregnancy in the past;
• contraception used and duration of its use;
• duration of infertility;
• regularity of sexual activity.

The doctor looks for signs of diseases of other organs: diabetes, tuberculosis, diseases of the adrenal glands and thyroid gland. The patient is asked about possible psychogenic factors.

During an external examination, attention is paid to excess body weight, skin condition, the presence of acne, and facial hair.

It is also performed on gynecological organs. For 3 months, a woman should measure her basal temperature. A study of smears from the vagina and the surface of the cervix is ​​carried out. If necessary, a culture for microflora, polymerase is prescribed chain reaction to identify possible infectious factors.

If endocrine infertility is suspected, it is necessary to find the affected link in the “hypothalamus-pituitary-ovarian” system. For this purpose, radiography, computer or magnetic resonance imaging of the skull and sella turcica are prescribed, the fundus of the eye is examined, and an ultrasound scan of the thyroid gland, ovaries and adrenal glands is performed.

Hormonal levels are analyzed in detail:

• follicle-stimulating hormone;
• luteinizing hormone;
• prolactin;
• thyroid-stimulating hormone;
• adrenocorticotropic hormone;
• estradiol;
• progesterone;
• thyroxine and triiodothyronine;
• cortisol;
• testosterone;
• DHEA-S.

With concomitant obesity, a glucose tolerance test is prescribed to detect diabetes mellitus.

Luteal phase deficiency is diagnosed by measuring basal temperature. With this pathology, the second phase of the cycle is shortened to 10 days, and the temperature difference before and after ovulation does not exceed 0.6˚C. The diagnosis is confirmed when a decreased level of progesterone is detected one week after ovulation (day 21 of the cycle).

Luteinization of a non-ovulated follicle is recognized by repeated ultrasound. According to this study, the follicle initially increases in size, then its growth stops. Ovulation does not occur, the follicle shrinks.

Tubal-peritoneal and gynecological infertility is most often secondary. To diagnose it use:

• hysterosonography;

Using these methods it is possible to find structural changes, preventing the development of pregnancy. The same studies are often prescribed for primary infertility.

One of best methods studies that reveal a violation of the structure of the genital organs are spiral CT scan pelvic organs. Magnetic resonance imaging of this area is also used, but its diagnostic value is somewhat lower.

To diagnose immunological infertility, a postcoital test is performed. To do this, determine the number and nature of sperm movements in the cervical mucus on days 12-14 of the cycle. If sperm are immobile or undetectable, this may be a sign of immune incompatibility between sexual partners.

In rare cases, the content of antisperm antibodies is determined in the blood or cervical mucus; however, this test is nonspecific and should not be used.

Simultaneously with the examination, the woman takes a semen analysis from her partner to rule out male infertility.

Treatment

Therapy begins with attempts to normalize emotional condition patients. A consultation with a medical psychologist or psychotherapist is scheduled. In some cases, an examination by a psychiatrist and a prescription may be useful. sedatives or tranquilizers. Sometimes these measures help solve the problem of infertility without stimulating ovulation.

It is important to normalize body weight. In some cases, weight loss contributes to pregnancy, since this normalizes the production of gonadotropic hormones of the pituitary gland.

If sexually transmitted infections are detected, the woman is prescribed appropriate antibiotics.

If the cause of infertility is a pituitary tumor, the woman is referred to a neurosurgeon. Functional hormonal disorders require the prescription of appropriate medications.

If the cause of infertility is infantilism, the patient is prescribed physiotherapy and gynecological massage. In the first phase of the cycle, you should take B vitamins, folic acid in case of primary infertility, it is necessary to prevent congenital pathology in the fetus. In the second phase, vitamins A and E are shown. In addition, a course of treatment is prescribed oral contraceptives. If these measures do not help, ovulation is stimulated, and if this is ineffective, assisted reproductive technologies are used.

For endocrine infertility, ovulation stimulation is often used. This treatment of primary infertility is carried out using the following drugs:

• monophasic combined oral contraceptives for 3 cycles;
• Clomiphene from 5 to 9 days of the cycle;
• preparations of gonadotropins (follicle-stimulating, luteinizing hormones followed by the introduction of human chorionic gonadotropin).

Stimulation of ovulation is a complex procedure, its plan is formed individually for each patient. What helps one woman may only hurt another. Therefore, on all questions related to this treatment method, you need to personally consult with a qualified gynecologist.

If pregnancy does not occur within a year of treatment, the patient is referred for laparoscopy.

They are treated using laparoscopic intervention, for example, cutting adhesions in the abdominal cavity. In case of severe tubal obstruction, it is carried out, and IVF is used to achieve pregnancy.

If diagnosed immunological infertility, the couple is recommended to use contraception using condoms for six months. Within 3 days before ovulation, the patient is prescribed estrogen drugs. After stopping barrier contraception, the desired pregnancy often occurs.

Primary infertility in men requires, first of all, stopping smoking, drinking alcohol, normalizing the regime and physical activity. The patient is examined by an andrologist, after which appropriate therapy is prescribed. In case of pathology of the vas deferens, it is proposed to take sperm directly from the epididymis or the testicle itself, followed by artificial insemination (introduction into the woman’s uterus).

If therapy is ineffective within 2 years, assisted reproductive technologies are used - artificial insemination or . If a woman is already 35 years old at the time of diagnosis of primary infertility, conservative treatment methods should not be used at all. In these cases, it is necessary to use assisted reproductive technologies as early as possible.

The success of treatment depends on many factors and cannot be predicted in advance. It must be remembered that the psychological state of a woman is very important in her fertility. On average, as a result of treatment with ovulation stimulation, pregnancy occurs within a year in approximately half of patients with primary infertility. The prognosis is worse for diseases such as and accompanied by a lack of maturation of eggs and menstruation. In this case, modern medical technologies help.

Male infertility

If the couple does not have children, both partners must be examined.

Primary male infertility may be caused by the following reasons:

• varicocele;
• orchitis suffered in childhood, for example, with mumps(pig);
• abnormalities in the development of the reproductive system;
• endocrine diseases in a child or adolescent.

The main method for diagnosing this condition is. This biological fluid is examined according to a protocol approved by the World Health Organization. An andrologist or urologist should interpret the results obtained.

If the spermogram is within the normal range, the man is considered healthy. If abnormalities are detected, the patient is prescribed a urological examination. Sometimes consultation with an endocrinologist or geneticist is necessary.

First degree infertility or primary infertility is a serious problem in modern world. The main symptom is the inability of a married couple to conceive a child for twelve months, provided that they had regular sex life without protection. When they talk about primary infertility, this means that a woman has never been able to become pregnant since the beginning of her reproductive development. And unfortunately, this diagnosis is not so rare.

Many, having heard about primary infertility, fall into depression and apathy, but modern medicine has stepped forward so much that the chance of getting pregnant or simply having your own child is increasing more and more every day. And in this article we will look at what leads to primary infertility and how it is treated.

What is primary infertility in women

There are congenital pathologies that result in a woman being unable to become pregnant. For example, pathologies include cervical erosion, fibroids, cysts, etc. Problematic ovaries are common, and if the functioning of the ovarian follicles is disrupted, then the maturation of the egg becomes problematic, with deviations from the norm. These diseases can occur if the patient has not had periods for a long time, or, conversely, if they last too long.

Primary infertility in women

Abortions are common among women. After all, those hormones that were produced during the conception of a child, as well as during the formation of the fetus, turn out to be no longer necessary, and a malfunction occurs in the body.

Often, it is curettage during an abortion that leads to injuries to the genital organs, resulting in adhesions that lead to obstruction of the fallopian tubes. Therefore, the egg simply cannot enter the uterus for implantation to occur.

Causes of primary infertility

• Lack of ovulation. The reason for this is hormonal imbalance, irregular menstruation, heavy bleeding or, conversely, the absence of bleeding for quite a long time, leading to the fact that a healthy egg cannot be released. This is usually treated with medication to restore the woman's normal ovulation cycle.
• Endometriosis disease occurs when the endometrial cells of the uterus grow outside the uterus. Women usually feel the painful onset of this disease, especially during menstruation. It is during endometriosis that the number of miscarriages increases. This disease is treated only surgically, removing unnecessary tissue and restoring the patency of the fallopian tubes.
• With age, the quality of the egg deteriorates, and it becomes increasingly difficult for women after forty to become pregnant, and there is a risk of all sorts of pathologies. In this case, a surrogate mother or the implantation of an egg from a donor is recommended.
• Poor patency of the fallopian tubes– this is when the sperm cannot reach the egg. Doctors say that in case of first degree infertility, the cause of obstruction may be inflammatory processes in the genital organs and infections.
• Polycystic. During this disease, a large number of cysts appear on the walls of the ovaries, which causes hormonal disruption, disruption of the menstrual cycle, and lack of ovulation. Symptoms of polycystic disease are increased body hair, rashes, weight gain. Polycystic disease is treated with medication.

However, only a specialist can correctly diagnose the disease, determine the nature of its course, and prescribe quality and correct treatment. Today, type 1 infertility is treatable, and there are a huge number of methods. And in case of extremely complex infertility, there is an option with IVF or surrogacy. Therefore, do not lose faith in yourself and in medicine, go for it, and you will succeed!