home Audience 12 Diagnosis of infertility. Genetic testing for infertility. Laboratory diagnostic methods for female infertility

Diagnosis of infertility. Genetic testing for infertility. Laboratory diagnostic methods for female infertility

Diagnosis of infertility includes:

Initial medical history collection of an infertile couple
. general physical examination
.
. hormonal examination
. reproductive system
. examination for
. tubal patency
. spouse's spermogram
. Shuvarsky test (compatibility of spouses)
. examination

Diagnosis of female infertility- taking into account the capabilities and equipment of the clinic “ New life”, in 2-3 months you can identify the cause and develop a plan effective treatment married couple prepare for pregnancy.

Patients who have already undergone examinations in other clinics bring the conclusions of previous examinations and treatment.

Basic criteria for assessing the fertility of a married couple:

Regular menstrual cycle
- presence of ovulation (ovulatory menstrual cycle),
- fertile sperm from the husband/partner (more than 20 million sperm in 1 ml. Motility more than 50%, no more than 85% deformed sperm)
- patent fallopian tubes, normal shape of the uterus, absence of endometrial pathology.

That’s probably all you need to get pregnant on your own.

However, if you have been trying to get pregnant for a whole year, calculating ovulatory days, doing tests, but pregnancy does not occur, then it is better for you to contact our clinic.

Initial appointment with an obstetrician-gynecologist (reproduction specialist) to diagnose infertility:

Collecting anamnesis of the examined couple (questioning about previous diseases, operations, development in childhood, heredity, etc.)
. Physical examination (height, weight, examination and palpation of the mammary glands, percussion, palpation, etc.),
. Gynecological examination - examination in mirrors on a chair, bimanual examination of organs pelvis,
. Hormonal examination (to identify or exclude endocrine factors),
. Immunological examination (if indicated, immunogram, HLA typing of histocompatibility class 2, etc.),
. Ultrasound of the pelvis,
. Examination of smears at the purity level, hidden infections, sowing, cytological scraping from the cervix and central canal,
. Study of fallopian tube patency (hysterosalpingography, echography),
. husband/partner,
. Blood test for antibodies to viruses (both spouses)

These studies will help assess the condition and performance of reproductive organs.

Diagnostics- is more complex and lengthy than that of, this is due to the fact that some studies are carried out on certain days of the menstrual cycle.

For example, we cannot conduct and test tubal patency during the same menstrual cycle.

We cannot see the egg visually because it is very small, whereas sperm analysis can immediately determine a man's fertility.

Diagnosis of male infertility- if any abnormalities in sperm parameters are detected, the man must undergo examination by.

A woman is diagnosed with infertility when she is unable to become pregnant after a year of unprotected sexual intercourse.

According to statistics, more than 10% of married couples worldwide suffer from infertility, while this disease Both men and women are susceptible. According to official information from the Centers for Disease Control and Prevention, 1/3 of diagnoses are associated with female infertility, 1/3 with male infertility, and other cases of infertility are caused by joint factors from both partners. Exact number It is quite difficult to determine, but percentage this is approximately 20% of couples.

The influence of age onfertility

All women are born with a certain number of eggs. Thus, as a result of the reproductive process, the number and quality of eggs will decrease. Consequently, the probability of having a child decreases by 3% to 5% per year after age 30. It should be understood that a particular decline in fertility is observed to a much greater extent after the age of 40 years.

Symptoms of infertility in women

The main symptom of infertility is the inability of a couple to become pregnant. There are a number of factors, the two most important of which are:

1. Menstrual cycle: either too long (35 days or more) or too short (less than 21 days).

2. Irregular or absent menstruation as one of the signs of lack of ovulation.

When to see a doctor about infertility

When to seek help depends, in part, on your age. If you are under 30, most doctors recommend trying to get pregnant for a year before starting testing or treatment. If your age is between 35 and 40 years, you should discuss your problems with your doctor after six months of trying. If you are over 40 years old, then treatment should be started immediately.

Causes of female infertility

Female infertility can be caused by a number of the following factors:

Damage to the fallopian tubes, which carry eggs from the ovaries to the uterus, can prevent contact between the egg and sperm. Pelvic infections, endometriosis, and pelvic surgery can cause scarring as well as damage to the fallopian tubes. Hormonal reasons, due to which some women have problems with ovulation. Synchronous hormonal changes leading to the release of the egg from the ovary, as well as thickening of the endometrium (uterine mucosa) - lead to the fact that fertilization of the egg does not occur. These problems can be detected through basal body temperature charts, blood tests to detect hormone levels. A small group of women may have a cervical structure that prevents sperm from passing through the cervix.

This problem can usually be resolved with a preliminary examination and a minor surgical procedure. In approximately 20% of married couples, the cause of infertility cannot be determined even with the use of modern methods research.

Also common diagnostic tests are hysterosalpingography and laparoscopy, which can be helpful in detecting scar tissue and uterine obstructions.

Main factors causing female infertility

- Ovulation disorders. Ovulation disorders, in which ovulation occurs extremely rarely or does not occur at all, occur in 25% of infertile couples. This may be caused by deficiencies in the regulation of sex hormones by the hypothalamus or pituitary gland, or problems in the ovaries themselves.

- Polycystic ovary syndrome (PCOS). In PCOS, complex changes occur in the hypothalamus, pituitary gland and ovaries, leading to hormonal imbalances that affect ovulation. PCOS is associated with insulin resistance, obesity, and abnormal hair growth on the face and body. Today it is the most common cause of female infertility in the world.

- Dysfunction of the hypothalamus. The two hormones responsible for stimulating ovulation each month—follicle-stimulating hormone (FSH) and luteinizing hormone (LH)—are produced by the pituitary gland in a specific pattern during the menstrual cycle. Increased physical or emotional stress, significant gain or loss of body weight, can disrupt the balance in hormone production and affect ovulation. The main symptom of this problem is irregular or absent menstruation.

- Premature ovarian failure. This disorder is usually caused autoimmune reaction, when your body mistakenly attacks ovarian tissue or when you lose eggs prematurely due to genetic problems, environmental factors such as chemotherapy. This results in a loss of the ovary's ability to produce eggs, as well as a decrease in estrogen production before the age of 40.

- Excess prolactin. Rarely, there are cases where the pituitary gland can cause excess prolactin production (hyperprolactinemia), which reduces estrogen production and can cause infertility. This is most often due to problems in the pituitary gland, but can also be due to medications you have taken for a medical condition.

- Damage to the fallopian tubes (tubal infertility). If the fallopian tubes are damaged or blocked, sperm cannot penetrate the egg and facilitate its fertilization. Causes of blocked or damaged fallopian tubes may include:

Inflammatory diseases pelvic organs, infection of the uterus or fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections.
- Previous surgery in abdominal cavity or pelvic area, including operations related to ectopic pregnancy.
- Pelvic tuberculosis, which is the main cause of tubal infertility throughout the world.

- Endometriosis. Endometriosis occurs when tissue that normally develops in the uterus begins to grow elsewhere. This additional tissue growth and subsequent surgical removal can lead to the formation of scars, which can impair the elasticity of the fallopian tube, thereby complicating fertilization. It can also affect the lining of the uterus, interfering with the development of a fertilized egg.

- Cervical fibroids. Uterine fibroids are a benign tumor of the muscular layer of the uterus. The development of fibroids, as a rule, occurs quite slowly: one muscle cell, for reasons not yet studied, begins to divide, creating tumor muscle cells, which form a node - a fibroid, as a result of which the likelihood of miscarriage increases.

- Changes and abnormalities of the cervix. Benign polyps or tumors found in the uterus can also affect fertilization by blocking the fallopian tubes or interfering with sperm penetration. However, many women with fibroids or polyps can become pregnant.

- Unexplained infertility. In some cases, the causes of infertility are simply impossible to determine. There is a possibility that this is due to a combination of several minor factors of both partners. But it is not excluded that this problem It may resolve itself over time.

Risk factors for female infertility

Let's look at some factors that contribute to a high risk of infertility:

- Age. As age increases, the quality and quantity of women's eggs begins to decline. Around age 35, the rate of follicle loss accelerates, resulting in fewer and poorer eggs, making conception more difficult with an increased risk of miscarriage.

- Smoking. In addition to damaging the cervix and fallopian tubes, smoking increases the risk of miscarriage and ectopic pregnancy. As a result, the ovaries deplete prematurely, losing eggs, thereby reducing your ability to become pregnant. This is why it is very important to quit smoking before starting fertility treatment.

- Weight. If you are overweight or, conversely, underweight, this may also interfere with normal ovulation. It is necessary to achieve mass index healthy body(BMI) to increase ovulation frequency and increase the likelihood of pregnancy.

- Sexual history. Sexually transmitted infections such as chlamydia and gonorrhea can certainly cause damage to the fallopian tubes and fallopian tube. Having unprotected sex with multiple partners increases your chances of getting infected venereal diseases, which can lead to fertility problems later.

- Alcohol. Excessive use Alcohol consumption is directly associated with an increased risk of ovulation disorders and endometriosis.

Scheduling a doctor's visit

To identify and assess the degree of infertility, it is necessary to undergo comprehensive examination see an endocrinologist who specializes in reproductive diseases that prevent couples from conceiving. Your doctor will likely want you and your partner to determine in advance possible reasons infertility. Here are the most common examples of questions for which you need to prepare answers in advance:

Schedule of menstrual cycles and their symptoms over several months. Use a calendar to mark when your period begins and ends, and write down the days you and your partner have had sex.

Make a list of the medications, vitamins, herbs, or other supplements you take. Include dosage and frequency.

Bring your previous medical records. Your doctor will want to know what tests you've had and what treatments you've already tried.

Think about what are the most important questions you want to ask.

Here are some basic questions you can ask your doctor:

When and how often should we have intercourse if we want to conceive?
- What lifestyle changes can we make to improve our chances of getting pregnant?
- What medications can be purchased affordably to improve the ability to conceive?
- Which side effects Can the prescribed medications cause this?
- What treatment do you recommend in our situation?
-What is your level of success in helping couples achieve pregnancy?
- Do you have brochures or other printed materials that you can provide to us?
- What sites do you recommend visiting?

Don't hesitate to ask your doctor to repeat information or ask additional questions.

Some potential questions your doctor may ask:

How long have you been trying to get pregnant?
- How often do you have sexual intercourse?
-Have you never been pregnant before? If so, what was the outcome of this pregnancy?
- Have you had pelvic or abdominal surgery?
- Have you been treated for any gynecological diseases?
- At what age did menstruation first begin?
- On average, how many days pass between the start of one menstrual cycle and the start of the next?
- Have you encountered premenstrual symptoms such as: breast tenderness, bloating or cramps?

Diagnosis of female infertility

The standard fertility rate includes physical, medical indicators, as well as the sexual histories of both partners. Men undergo a semen analysis, which evaluates the number and movement of sperm. They look at the percentage of active sperm and their level of movement. Often, it is not possible to determine the specific cause of the disorder. But there is a theory that a very low sperm count may be due to genetics - abnormalities in the Y chromosome.

The first thing a doctor checks in women is whether ovulation is occurring. This can be determined using a blood test that detects and shows the level female hormones, ultrasound of the ovaries or an ovulation test kit, which is used at home. You should also pay attention to the menstrual cycle, as irregular cycle may be the main reason for failure to ovulate.

- Ovulation test. You can easily perform an ovulation test at home, which detects the surge in luteinizing hormone (LH) that occurs before ovulation. If you haven't received positive results, it is necessary to take a blood test for progesterone, a hormone produced after ovulation, and document the onset of ovulation. Other hormone levels, such as prolactin, can also be confirmed by a blood test.

- Testing ovarian reserve. This testing helps determine the quality and quantity of eggs available for ovulation. Usually, this study women at risk of egg loss are undergoing, including women over 35 years of age.

- Study on hormone levels. Other hormonal tests will allow you to determine the levels of ovulatory hormones, as well as hormones thyroid gland and pituitary hormones that control reproductive processes.

- Visual tests. A pelvic ultrasound examines the cervix in detail or shows fallopian tube disease. Often used to see details inside the uterus that are not visible on regular ultrasounds.

- Laparoscopy. This minimally invasive surgery involves making a small incision under your belly button through which a thin catheter with a device is inserted to examine your fallopian tubes, ovaries and uterus. Laparoscopy can detect endometriosis, scarring, blocked fallopian tubes, and problems with the ovaries and uterus. In this procedure, a laparoscope (a thin tube equipped with a fiber-optic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope allows the doctor to look outside the uterus, ovaries and fallopian tubes to detect growths, as in endometriosis. The doctor may also check to see if the fallopian tubes are open.

- Genetic testing. Genetic testing helps determine whether genetic defect in the chromosomes, which led to infertility.

- Hysterosalpingography. This procedure involves an ultrasound or x-ray of the reproductive organs, in which dye or saline is injected into the cervix through the fallopian tubes. This allows you to determine whether the fallopian tubes are open or not.

Treatment of infertility in women

Female infertility can be treated in several ways, including:

- Laparoscopy. Women who have been diagnosed with tubal or pelvic diseases or defects may undergo surgery to restore reproductive organs or try to conceive through in vitro fertilization (IVF). Using a laparoscope inserted through an incision in the navel will remove scar tissue, ovarian cysts, and also restore patency of the fallopian tubes.

A hysteroscope is placed into the uterus through the cervix and is used to remove polyps, fibroids, scar tissue, and to open blocked fallopian tubes.

- Drug therapy. Women suffering from ovulation problems may be prescribed medications such as clompiphene (Clomid, Serophene) or gonadotropins (such as Gondal F, Follistim, Humegon and Pregnyl), which can lead to ovulation.
Metformin (Glucophage) is another type of drug that helps restore or normalize ovulation in women who have insulin resistance and/or polycystic ovary syndrome.

Intrauterine insemination refers to a procedure in which sperm is taken from a partner during maturation, washed with a special solution to isolate healthy, non-defective sperm, and then placed in the uterus at ovulation. The sperm is introduced through the cervix using a thin plastic catheter. This procedure can be performed in combination with the previously listed drugs that stimulate ovulation.

- In vitro fertilization (IVF). IVF refers to a method in which the resulting embryo is kept in an incubator where it develops for 2-5 days, after which the embryo is then inserted into the uterus for further development.

After monitoring to confirm the maturation of the eggs, they are collected using a vaginal ultrasound probe. Sperm are also collected, washed and added to the eggs under “in vitro” conditions. A few days later, the embryos, or fertilized eggs, are returned to the uterus using an intrauterine catheter.

Any additional eggs or embryos may be frozen for future use with the consent of the spouses.

ICSI. Intracytoplasmic sperm injection is also used for problems associated with lack of fertilization. This is a method in which a pre-selected viable sperm is injected into the egg “manually” under a microscope using special microsurgical instruments. With ICSI, only one sperm is required for each mature egg.

- Egg donation. Egg donation can help women who do not have normally functioning ovaries but who still have a healthy uterus to achieve pregnancy. Egg donation involves the collection of eggs, also called oocytes, from the ovary of a donor who has undergone ovarian stimulation using special hormonal drugs. The donor's eggs are placed with the partner's sperm for in vitro fertilization, after which the fertilized eggs are transferred to the recipient's uterus.

Drug therapy and artificial insemination may increase the likelihood of occurrence long-awaited pregnancy in women diagnosed with infertility of unknown origin.

Risks of using drugs to treat infertility in women

Using fertility drugs may carry some risks, such as:

Multiple pregnancy. Oral medications carry a fairly low risk for singleton pregnancies (less than 10 percent), with the main increase in risk for twins. Injectable drugs carry the greatest risk for conceiving twins, triplets or more ( multiple pregnancy higher order). Therefore, the more fruits you carry, the greater the risk premature birth, low weight at birth and problems associated with later development.

Ovarian hyperstimulation syndrome. Usage injectable drugs to increase ovulation, can lead to ovarian hyperstimulation syndrome, in which your ovaries can become swollen and cause painful sensations. Signs and symptoms usually last a week and include: abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, these symptoms may last up to several weeks.

Long-term risks of developing ovarian tumors. Most studies have shown that women who use drugs to induce pregnancy are unlikely to have long-term risks. However, some studies suggest that women who take hormonal medications for 12 months or more without successful pregnancy may have an increased risk of developing borderline ovarian tumors. later life. Just like women who have never been pregnant, they are susceptible increased risk ovarian tumors, so it may be related to the underlying problem rather than the treatment.

Surgical treatment of female infertility

Some surgical procedures can correct problems or significantly improve female fertility. Let's look at the main ones:

Laparoscopic or hysteroscopic surgery. Surgery can remove or correct abnormalities that reduce the chances of pregnancy. Using this method, you can correct the shape of the uterus, remove the effects of endometriosis and some types of fibroids. This will certainly improve your chances of achieving pregnancy. If a woman has previously had a tubal ligation for permanent contraception, the operation will help restore her ability to conceive. Your doctor can determine whether you are a good candidate for this or whether you need to resort to in vitro fertilization(ECO).

Emotional support

The process of treating female infertility can be physically and emotionally draining. To cope with the ups and downs of mood, multiple testing, and the treatment process itself, doctors unanimously tell their patients: “Be prepared.”

Maximum information. Ask your doctor to explain in detail the steps of the therapy you have chosen so that you and your partner can be as prepared as possible for each one. Understanding the process will help reduce your anxiety.

Support from loved ones. Although infertility is a deeply personal issue, reach out to your partner, close family members or friends for support. Online support groups are common these days and will allow you to remain anonymous while you discuss issues related to infertility. Feel free to contact for professional help, if the emotional burden becomes too much for you or your partner.

Moderate exercise and healthy eating will help improve appearance and keep you on your toes despite fertility problems.

Prevention of infertility in women

If you're planning on getting pregnant soon in the future, you can improve your chances of normal fertility by following a few important recommendations:

Maintaining normal weight. Women, both overweight and underweight, are at increased risk of ovulation problems. If you need to lose weight, do so in moderation. Strenuous, intense exercise for more than seven hours a week has been shown to be associated with decreased ovulation.

Quit smoking. Tobacco has negative impact on your fertility, not to mention your overall health and the health of your unborn child. If you smoke and are planning a pregnancy, then it's time to quit. addiction right now.

Avoid drinking alcohol. Alcohol abuse can lead to decreased fertility. Any alcohol consumption can affect the health of the developing fetus. If you are planning to become pregnant, avoid alcohol, and do not drink alcohol during pregnancy.

Reducing stress. Some studies have shown that couples experiencing psychological distress had poorer outcomes during fertility treatment. If you can, find a way to reduce the stress in your life before you try to get pregnant.

Limit caffeine. Some doctors suggest limiting caffeine intake to less than 200 to 300 milligrams per day.

Diagnosis of infertility in the whole family is a proven process. Since, as a rule, the woman is the first to show concern, it is gynecologists who have developed plans for a step-by-step diagnosis of infertility.

The first stage of the examination includes studies that allow you to pay attention to all aspects of fertility in both women and men. Further, in-depth examination depends on the identified features.

Screening for sexually transmitted infections and bacterial flora.
Blood hormones: prolactin, testosterone, AT-TPO, T4 St. , TSH, AT-TG, DHEA, LH, FSH. Read more about this in the article “We take hormonal tests"
A man must have his sperm analyzed.

In addition to those listed, the doctor may prescribe other tests and studies, depending on the general health of the spouses and the disorders identified in them.

IN last decades examination of men is given first place. The reason is simple: men account for the same number of cases of infertility as women, and at the first stage the man is only required to submit sperm for analysis. The test procedure is simple and painless (masturbation), the result is obtained in 1-2 hours, the spermogram is very informative.

If abnormalities are detected in sperm, men undergo further examination and treatment parallel with your wife, which allows you to speed up the onset of pregnancy.

Compatibility test sperm and cervical mucus(postcoital test). The test is carried out to identify the CERVICAL FACTOR of infertility, when normal sperm is immobilized in the cervix. 5-6 hours after intercourse, mucus is taken from the woman’s vagina and cervix. Sperm motility is determined under a microscope. If they are less mobile in the cervix than in a regular spermogram given men, then draw a conclusion about negative impact cervical mucus.

In addition to the studies described, doctors usually refer the patient to ultrasonography (Ultrasound). This very technically complex and very simple in appearance study allows you to see with your own eyes many disorders of the structure of the genital organs. Using ultrasound, you can identify congenital abnormalities of the structure of the uterus, fibroids, endometriosis, the presence or absence of pregnancy in the uterus, ectopic pregnancy, structural abnormalities of the ovaries, the presence and size of the follicle and egg. Ultrasound is harmless and can be performed regularly if necessary. Modern devices and the use of a vaginal sensor allow you to avoid the unpleasant detail of preparing for an ultrasound - overflow Bladder.

Laparoscopy - modern operation, without which many achievements in the fight against infertility would be impossible. During laparoscopy, a thin needle is inserted into the abdominal cavity, through which a flexible probe equipped with optics is passed. The uterus, tubes and ovaries are examined through a probe. outside, can carry out surgical intervention- cut adhesions, remove the capsule from the ovaries, remove uterine fibroids (there are cases where fibroids weighing more than 2 kg were removed by laparoscopy!).
In this case, complications are practically excluded, patients regain working capacity in the shortest possible time, and internal damage is minimal.

X-ray of the skull and sella turcica. This study is carried out if the doctor suspects the presence of a pituitary tumor or receives high levels of the hormone prolactin in blood. Prolactin is produced by the pituitary gland and is responsible for the formation of milk in nursing mothers. Currently, such research is almost never carried out, since changes in the pituitary gland occur against the background of a large tumor. Initial changes are determined in a more modern way - computed tomography.

The studies described can only be the beginning a long process as a result of which the cause (or causes) of infertility in a given couple will be established.

When starting an examination for infertility, spouses should think about the fact that as the years go by, age increases, and the chances decrease. Long-term diagnostics carried out in fits and starts in different medical institutions, no plan, no consideration individual characteristics reduces the chances of successful subsequent treatment.

At the MAMA Clinic you can undergo a full examination to find out the causes of infertility or clarify the diagnosis. You can discuss the required scope of examination with the Clinic’s doctor at your initial appointment.

Take the first step - make an appointment!

*1. Collection of somatic, gynecological and reproductive history.
2. General inspection.
3. Gynecological examination.
4. Husband's spermogram.
5. General clinical examination (general blood test, biochemical, coagulogram, RW, HIV, HbsAg, blood test for glucose, blood group and Rh factor, general urinalysis).
6. Screening for STIs.
7. Ultrasound of the pelvic organs.
8. Colposcopy.
9. Hysterosalpingography.
10. Functional diagnostics ovarian activity:
♦ basal temperature 2-3 months;
♦ hormonal colpocytology every week;
♦ daily study of the phenomenon of mucus arborization;
♦ Ultrasound on the 12-14-16th day of the cycle (follicle diameter is determined);
♦ determination of the levels of estrogens, testosterone, prolactin, FSH, LH in blood plasma;
♦ the level of progesterone in the blood and pregnanediol in the urine on days 3-5 of mensis, in the middle of the cycle and in phase 2;
♦ level of 17-KS in urine 2 times a month.
11. Hormonal tests.
12. Additional Research according to indications:
a) hormonal examination: cortisol, DHEA-S (dehydroepiandrosterone sulfate), insulin, T3, T4, TSH, antibodies to thyroglobulin;
b) immunological tests(a later source describes the inappropriateness of these tests, see classification of infertility Gynecology - national manual edited by V.I. Kulakov, G.M. Savelyeva, I.B. Manukhin 2009):
postcoital Shuvarsky-Guner test (see section " Immunological infertility»).
determination of antisperm antibodies in women in the mucus of the cervical canal is carried out on preovulatory days - the levels of Ig G, A, M are determined;
Kurzrock-Miller test - penetration of sperm into the cervical mucus of a woman during ovulation;
Friberg test - determination of antibodies to sperm using a microagglutination reaction;
Kremer's test - detection of local antibodies in a partner during contact of sperm with cervical mucus;
Izojima immobilization test.
13. Examination by a mammologist, mammography.
14. X-ray of the sella turcica and skull.
15. Examination of the fundus and visual fields.
16. Hysteroscopy
17. Laparoscopy.

DIAGNOSIS OF INFERTILITY

At the first stage, the patient undergoes a preliminary examination at a clinic. Already at this stage it is possible to carry out effective treatment of some forms of female infertility, mainly associated with ovulatory disorders or gynecological diseases, not accompanied by occlusion of the fallopian tubes and amenable to correction in an outpatient setting.

The second stage involves performing specialized studies prescribed according to indications (endoscopic, non-invasive hardware and hormonal) and treatment using both conservative and surgical (laparotomy, laparoscopic, hysteroscopic) methods, and ART. The latter include artificial insemination and IVF, performed in various modifications. Assistance with the use of specialized diagnostic and medical procedures render in gynecological departments multidisciplinary hospitals, at the clinical bases of departments and research institutes, as well as in public or private centers that simultaneously use both endosurgical methods and ART.

ANAMNESIS

When a patient first contacts her about infertility, women are interviewed according to a specific scheme recommended by WHO:

number and outcome of previous pregnancies and births, post-abortion and postpartum complications, number of living children;
duration of infertility;
methods of contraception, duration of their use;
diseases (diabetes, tuberculosis, pathology of the thyroid gland, adrenal glands, etc.);
drug therapy (use of cytotoxic drugs, psychotropic and tranquilizing drugs);
operations accompanied by the risk of developing adhesive process(surgeries on the uterus, ovaries, fallopian tubes, urinary tract and kidneys, intestines, appendectomy);
inflammatory processes in the pelvic organs and STIs; type of pathogen, duration and nature of therapy;
diseases of the cervix and the nature of the treatment used (conservative, cryo or laser therapy, electrocoagulation, etc.);
the presence of galactorrhea and its connection with lactation;
epidemic, production factors, bad habits(smoking, alcohol, drug addiction);
hereditary diseases in relatives of the 1st and 2nd degree of kinship;
menstrual history (age of menarche, nature of the cycle, nature of cycle disorders, presence of intermenstrual discharge, painful menstruation);
sexual dysfunction (superficial or deep dyspareunia, contact bleeding).

PHYSICAL INVESTIGATION

Body type, height and weight are determined by calculating the body mass index (body weight, kg/height2, m2; normally 20–26). If obesity is present (body mass index >30), the time of its onset, possible causes and rate of development are determined.
Assess skin condition and skin(dry, wet, oily, presence acne, stretch marks), the nature of hair growth, the presence of hypertrichosis and its degree (according to the D. Ferriman, J. Galwey scale). In case of excess hair growth, the time of its appearance is specified.
The condition of the mammary glands is studied (degree of development, presence of discharge from the nipples, space-occupying formations).
Bimanual gynecological examination, speculum examination of the cervix and colposcopy are used.

The polyclinic examination also includes a physician’s opinion on the possibility of pregnancy and childbirth. When identifying clinical signs of endocrine and mental illness or other somatic diseases, as well as developmental defects, consultations with specialists of the relevant profile are prescribed - endocrinologists, psychiatrists, geneticists, etc.

LABORATORY STUDIES FOR INFERTILITY

During infectious screening, the following is performed:

examination of the flora of the urethra, cervical canal and the degree of vaginal cleanliness;
cytological examination of smears from the cervix;
smear from the cervical canal to detect chlamydia, HSV, CMV using PCR;
testing for infections using the cultural method (seeding the contents of the vagina and cervical canal to determine the microflora, the presence of ureaplasma and mycoplasma);
blood test for hepatitis B and C, syphilis, HIV infection, rubella.

If an infection caused by these pathogens is detected in a patient, appropriate etiotropic therapy is carried out, followed by a follow-up examination. In this case, patients can be referred for specialized treatment under the supervision of a dermatovenerologist (gonorrhea, syphilis), immunologist (HIV infection).

Hormonal screening during a standard outpatient examination aims to confirm/exclude endocrine (anovulatory) infertility. In patients with disorders of menstrual and ovulatory functions, hormones are examined, deviations in the content of which can cause such disorders.

The use of specialized hormonal and instrumental diagnostic methods identifying the reasons for the identified hormonal imbalance(for example, conducting various hormonal tests, using CT of the sella region, ultrasound of the thyroid gland, etc.) is within the competence of gynecologists and endocrinologists, who also determine the need and nature of therapy for such disorders.

INSTRUMENTAL RESEARCH IN INFERTILITY

At the outpatient diagnostic stage causal factors In case of infertility, ultrasound of the pelvic organs is mandatory. It is also advisable to prescribe an ultrasound of the mammary glands to clarify their condition and exclude tumor formations.

HSG still continues to be prescribed to patients with suspected tubal or intrauterine factors of infertility. The study is carried out on the 5th–7th day of the cycle with a regular rhythm of menstruation and oligomenorrhea, with amenorrhea - on any day. It should be noted that when assessing the patency of the fallopian tubes, the total number of discrepancies between the results of HSG and laparoscopy, supplemented by intraoperative chromosalpingoscopy with methylene blue, can reach almost 50%, which very clearly demonstrates the unsatisfactory diagnostic potential of HSG when studying the condition of the fallopian tubes. It follows from this that an accurate diagnosis of TPB, with an understanding of the nature and severity of tubal changes, can be made only on the basis of laparoscopy with chromosalpingoscopy data. As for the diagnostic significance of GHA, in our opinion, this method turns out to be more suitable for identifying intrauterine pathology (see “ Uterine forms infertility"), but not TPB.

CT or MRI of the skull and sella turcica is prescribed for patients with endocrine (anovulatory) infertility associated with hyperprolactinemia or pituitary insufficiency ( low level FSH), which makes it possible to identify micro and macroprolactinomas of the pituitary gland, as well as the “empty” sella syndrome.

For patients with suspected surgical pathology of the internal genital organs, a spiral CT scan of the pelvis may be prescribed. This method allows you to obtain a large amount of information about the anatomy of the internal genital organs, which is of great value when planning the nature and volume surgical intervention. MRI of the pelvic area is also used for the same purpose. However, it must be taken into account that MRI, compared to spiral CT, has less diagnostic potential and requires more time to obtain images.

Ultrasound of the thyroid gland is prescribed to patients with endocrine infertility against the background of clinical signs of hyper or hypothyroidism, abnormal values of thyroid hormone levels and hyperprolactinemia. Ultrasound of the adrenal glands is performed in sick women with clinical signs of hyperandrogenism and high levels of adrenal androgens. For a more reliable diagnosis, such patients are advised to undergo a CT scan of the adrenal glands. Laparoscopy is indicated for patients with suspected TPB (according to medical history, gynecological examination and ultrasound of the pelvic organs). Women with reliably established diagnosis endocrine infertility, laparoscopy is recommended after a year of unsuccessful hormonal therapy, since the absence of pregnancy during this period with adequately selected treatment (ensuring the restoration of ovulatory function) indicates the possible presence of TPB.

Laparoscopy is also indicated for infertile patients with a regular ovulatory cycle, who have no signs of LLP at the initial examination, but remain infertile after using ovulation inducers in 3–4 cycles.

Laparoscopy not only provides the most accurate diagnosis of the patient’s tubal and/or peritoneal factors of infertility, but also allows for low-traumatic correction of identified disorders (separation of adhesions, restoration of fallopian tube patency, coagulation of endometrioid heterotopias, removal of subserous and intramural fibroids and ovarian retention formations).

Hysteroscopy is prescribed:

with dysfunctional uterine bleeding varying intensity;
if intrauterine pathology is suspected (according to a survey, gynecological examination and ultrasound of the pelvic organs).

Using hysteroscopy, it is possible to diagnose GPE and endometrial polyps, submucosal myomatous nodes, adenomyosis, intrauterine synechiae, chronic endometritis, foreign bodies and uterine malformations. When performing hysteroscopy, separate diagnostic curettage walls of the uterine cavity and cervical canal. Under the control of hysteroscopy, it is possible to perform surgery almost any intrauterine pathology.

During the initial examination, women simultaneously undergo a sperm analysis of their spouse (partner) to exclude male factor infertility. If there are changes in the spermogram, the patient undergoes an examination by an andrologist, based on the results of which they decide whether to choose either methods for restoring natural male fertility or IVF to overcome infertility in a given couple. In addition to a spermogram, when screening for male factor infertility, it is also advisable to use the MART test, which makes it possible to detect male antisperm antibodies. Normal MARTest<30%. Увеличение показателей МАРтеста >30% indicates the presence of an immune form of infertility in the husband and serves as an indication for the use of artificial insemination with pre-treated sperm, or IVF in the treatment of such couples.

Patients with infertility due to suspected surgical gynecological pathology (occlusion of the fallopian tubes, peritoneal adhesions, intrauterine synechiae or uterine malformations, ovarian cysts, severe myomatous or endometrioid process) after the initial outpatient examination are referred to specialized institutions, where the nature of the existing disorders is clarified and, if necessary, traditional surgical or endoscopic (hystero and laparoscopy) treatment methods can be used.

It should be noted that when deciding on the possibility of treating infertility in an outpatient setting (including after operations aimed at eliminating a particular gynecological pathology and restoring natural fertility), any conservative therapy should not exceed 2 years. If infertility persists during this period, the patient should be referred to an ART center without delay. This position is also argued by the fact that the age factor, starting from the age of 35, has an increasing adverse effect on the results of treatment using any ART methods. In this group of patients, unlike younger patients, the outpatient stage of infertility treatment associated with the use of various kinds means and methods aimed at achieving pregnancy naturally should not be used at all.

After a woman contacts the clinic, she must undergo a series of necessary tests.

Lab tests

Testing for infertility in women is a complex laboratory tests And diagnostic procedures aimed at identifying the causes of infertility. When you first contact a doctor, a medical history is collected and the patient is thoroughly examined. At this stage of the examination, the specialist assesses the condition of the woman’s reproductive organs for erosions and inflammatory processes. Further activities are related to instrumental and laboratory methods.

Blood analysis. The study of clinical and biochemical blood parameters is necessary to determine the general state of health. The amount in the patient's blood is determined total protein, bilirubin, ALT, AST, creatinine, urea and glucose. Blood is also tested for infections and viruses: syphilis, hepatitis, HIV. To exclude endocrine cause Infertility tests are carried out to determine the level of hormones: prolactin, AMH, FSH, LH, progesterone, TSH, 17-OPK, testosterone and others. Hormone testing should be carried out on the 2-5th day from the start of menstruation. Separately, blood is donated to determine the group and Rh factor.
General analysis urine - prescribed to determine the functional functioning of the kidneys.
. Very often it is not possible to get pregnant due to the presence of infections in the woman’s body. Damage to the mucous membrane of the cervix and uterine cavity infectious nature creates unfavorable conditions for the development of pregnancy. To identify them and subsequently treat or exclude this problem, several tests are prescribed. Most often, such tests reveal diseases that are initially asymptomatic: gonorrhea, herpes virus, chlamydia, trichomoniasis, ureaplasmosis. In addition to the blood test, smears are taken from the vagina and cervical canal.
Postcoital analysis - determination of the number of sperm and their motility in the cervical mucus of the cervix. This important research shows the ability of sperm to interact with the egg. For fertilization to occur, conditions are necessary for sperm to penetrate through the cervical mucus. It is best to carry out the test during the periovulatory period of the cycle; before the examination, the presence of sexually transmitted infections should be excluded. We recommend.

After laboratory tests, the woman is prescribed instrumental studies.

Instrumental studies

These tests are carried out using specialized equipment and can confirm the suspected diagnosis.

1. . The method allows you to visually determine the cause of infertility, which may be neoplasms of the reproductive organs. Using ultrasound you can find out:

cervical condition;
size and condition of the uterus;
condition of the ovaries;
structure and condition of the endometrium;
condition of the fallopian tubes.

During the examination, you can identify polyps and cysts that interfere with getting pregnant. In addition to neoplasms, ultrasound helps diagnose hydrosalpinx - the presence of fluid in the fallopian tubes. Elimination of these pathologies is a step towards treating infertility. It is better to conduct the study in phase I of the cycle.

2. – method of ultrasound checking the condition of the endometrium and patency of the fallopian tubes using saline solution. It is carried out on days 6-14 of the cycle (can be carried out on any day, but in the second phase of the cycle the presence of an already existing pregnancy cannot be ruled out).

inside

quick method

long stay

histological examination

vaginal medications

WITH full list tests for IVF can be found.

Tests for infertility in women in our clinic are carried out as quickly as possible and are accompanied by necessary consultations specialists. Once the cause is identified, based on the test results obtained, a diagnosis is made and treatment is prescribed.

Name of service	Price
Initial consultation with a gynecologist-reproductologist	3,000 rubles
Initial consultation with a gynecologist-reproductologist with ultrasound	3,900 rubles
Repeated consultation with a gynecologist-reproductologist	1,300 rubles
Repeated consultation with a gynecologist-reproductologist with ultrasound	2,200 rubles
Initial consultation with an obstetrician-gynecologist	2,400 rubles
Repeated consultation with an obstetrician-gynecologist	1,900 rubles
Ultrasound of the pelvic organs	1,500 rubles
Abdominal ultrasound	2,100 rubles
Ultrasound of the prostate and bladder	1,600 rubles
Ultrasound of the kidneys and bladder	1,800 rubles
Ultrasound of the kidneys, prostate and bladder	2,000 rubles
Ultrasound of the thyroid gland	1,600 rubles
Ultrasound of the mammary glands	1,800 rubles
Ultrasound lymph nodes	1,250 rubles
Colposcopy	1,400 rubles
Office hysteroscopy	17,500 rubles
Diagnostic hysteroscopy (without the cost of histological examination)	19,500 rubles
Operative hysteroscopy (without the cost of anesthesia and histological examination)	24,500 rubles