Causes of infertility in women. The main causes of female infertility. Modern methods of overcoming the problem of infertility
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Most young married couples are planning to have children. Some people put off having children until they can achieve material well-being. Others dream of becoming parents in the first year of marriage. If there is a problem with conception or a woman constantly has miscarriages, she and her husband are very worried and begin to think about the reasons and what treatment will help achieve the desired result. Often, after examination and elimination of pathologies in the reproductive organs, she manages to get rid of infertility and give birth to a healthy baby.
Content:
Types of female infertility
A woman is considered to be infertile if she is unable to conceive or carry a child for a year, provided she regularly has sex and deliberately does not use contraceptives. Moreover, she is aged 20-45 years, it is known for sure that her sexual partner is capable of childbearing (if necessary, this can be established using sperm analysis).
At the age of under 20 years, pregnancy may not occur due to incomplete puberty. After 45 years, lack of pregnancy is usually associated with the approach of menopause, depletion of the supply of eggs in the ovaries and the predominance of anovulatory cycles.
Classification of infertility
When examining a patient, the gynecologist first finds out how long the woman has not become pregnant and what symptoms she has. There are the following types of infertility:
- Primary infertility– this is when there is no pregnancy within a year after the start of sexual activity (for example, due to a violation of the shape and size of the uterus). Secondary infertility– means the absence of pregnancy in a woman who already has a child.
- Relative infertility. This condition is treatable, and after eliminating the causes, reproductive ability is restored. Absolute infertility. Pregnancy is impossible in principle (the woman has irreversible pathologies in the reproductive organs).
- Congenital infertility– pathologies leading to the impossibility of conception (for example, ovarian cysts) arise during the period of intrauterine development. Acquired infertility appears as a result of disorders that arose during puberty or in subsequent years.
In turn, both congenital and acquired infertility can be removable or irreversible.
Voluntary and forced infertility
Sometimes pregnancy does not occur due to deliberate suppression of the ability to conceive. In this case, they say that there is voluntary or forced infertility. Voluntary infertility. The woman herself takes measures to prevent pregnancy. To do this, she constantly uses contraceptives.
Comment: You need to know that long-term hormonal contraception can actually lead to the disappearance of menstruation, the onset of early menopause and infertility. After 37 years, the likelihood of conception decreases many times. The risk of having a child with genetic pathologies increases.
Involuntary infertility. Contraception is used as a forced measure to prevent conception if pregnancy may threaten the health or life of a woman.
Video: What is female infertility, causes, who is at risk
Causes of female infertility, signs of pathologies
Infertility in women is explained by the inability to fertilize a mature egg in the fallopian tube. This happens in the following cases:
- After leaving the ovary (ovulation), the egg for some reason fails to enter the fallopian tube.
- A man's sperm cannot penetrate the uterus or fallopian tubes or its quality is too low.
- Fertilization occurs normally, but there are pathologies in the uterus that make it impossible for the embryo to attach to its wall and develop fully. As a result, pregnancies are constantly terminated early.
The cause of such situations is usually hormonal disorders in the woman’s body, developmental pathologies or diseases of the uterus and ovaries.
Hormonal disorders
Pregnancy occurs only in the presence of cycles with normal maturation of follicles and subsequent ovulation. Moreover, in each phase, processes associated with changes in the ratio of estrogen and progesterone occur sequentially. In turn, the production of these substances is regulated by pituitary hormones (follicle-stimulating and luteinizing).
Other endocrine organs (thyroid gland, adrenal glands, etc.) also participate in creating the general hormonal background. The cause of infertility in women is often a hormonal imbalance associated with impaired functioning.
Excess prolactin. The hormone is produced in the pituitary gland. This substance is responsible for the development of mammary glands and other sexual characteristics, and also affects the production of progesterone (“pregnancy hormone”). Excessive production of prolactin leads to a decrease in the level of other pituitary hormones (FSH and LH) and, accordingly, to a disruption in the production of female hormones. For this reason, there is no ovulation, amenorrhea occurs, which leads to infertility. The causes of hyperprolactinemia can be diseases of the pituitary gland, pancreas and thyroid glands.
Hyperandrogenism. Excessive content of male sex hormones in a woman’s body leads to the disappearance of menstruation and a change in appearance to the male type, the appearance of infertility.
Polycystic ovary syndrome. Many cysts form in the ovaries and they increase significantly in size. Although the follicles mature, ovulation does not occur. The cycle lengthens, periods may come with significant interruptions. Pain appears in the lower abdomen, body weight increases. The level of male hormones in the blood increases.
Insufficiency of the corpus luteum. This temporary gland is formed in the ovaries immediately after ovulation. Its function is to produce progesterone. The cause of underdevelopment of the corpus luteum may be a malfunction of the pituitary gland or genetic reproductive disorders. The consequence of this condition is underdevelopment of the endometrium and infertility. The embryo cannot stay in the uterus and dies.
Premature menopause. Ovarian function declines too early. The production of female sex hormones sharply decreases, cycles become anovulatory, periods come with long breaks, and then disappear altogether. A woman experiences symptoms such as hot flashes, osteoporosis, and decreased libido.
Violation of the shape and structure of the uterus and appendages
Often the cause of infertility is developmental pathologies or diseases of the uterus and ovaries. They are manifested by various menstrual disorders.
Obstruction of the fallopian tubes. When adhesions form, the tubal canal becomes fused. As a result, an obstacle appears in the path of the egg. Even if the lumen is partially closed, then due to damage to the cilia on the walls of the tubes, the fertilized egg cannot move into the uterine cavity, and an ectopic pregnancy occurs. The cause of adhesions is most often inflammation or damage to the pipes. If the process is one-sided, then pregnancy is possible. The most severe situation is when both pipes become overgrown.
Endometriosis. With this disease, the endometrium grows and spreads beyond the uterine cavity. Particles of the mucous membrane end up in the cervix, on the ovaries. Due to the blockage of the cervix or organ cavity, sperm cannot penetrate the tubes. Ovarian cysts formed as a result of endometriosis can prevent eggs from reaching them. With this disease, approximately 30% of women suffer from infertility.
Uterine fibroids. A benign tumor that forms in the uterine cavity often blocks the entrance to the tubes, making it difficult for sperm to enter them. If conception occurs, there is a high probability of miscarriage.
Inflammatory and infectious diseases. Inflammation of the uterus and appendages occurs as a result of bacteria entering them through the ascending route, as well as during curettage. Infection with some types of pathogens occurs exclusively during sexual contact (sexually transmitted diseases). After inflammatory processes in the uterus and ovaries, scars remain and adhesions form. The development of the endometrium is disrupted, the composition of the mucus produced by the glands of the cervix changes. All this leads to infertility.
Improper development of reproductive organs. Infertility in women can be the result of a congenital imbalance in the size of the body of the uterus, its cervix and tubes. The formation of partitions separating the organ cavity (bicornuate uterus) is possible. Small volume and changes in the shape of the uterus cause the impossibility of conception and termination of pregnancy.
Malformations of the genital organs can also be acquired. The cause of their occurrence is trauma, damage during abortion or childbirth. The formation of the organs of the reproductive system is disrupted if a girl suffers severe infectious diseases during puberty.
Factors contributing to infertility
Depending on the causes, gynecologists divide infertility into the following types:
- endocrine (hormonal);
- pipe;
- uterine;
- endometriosis;
- immune (associated with autoimmune diseases);
- psychogenic.
The development of infertility is facilitated by the aging of the female body, autoimmune diseases, and hormonal imbalance. Poor physical development and excessive thinness are often the first signs of underdevelopment of the reproductive organs. An obsessive desire to lose weight (anorexia), adherence to a strict diet leads to amenorrhea and the complete disappearance of childbearing ability.
An important reason for the inability to conceive is often psychological stress. Sometimes an impatient desire to give birth to a child, worries about the fact that pregnancy does not occur lead to unexplained infertility.
Note: There are cases when a desperate couple adopts someone else's child, after which she gives birth to her own baby. When a woman calms down mentally and stops listening intently to the state of her body, her reproductive function is restored.
Diagnostics
It begins with studying the background of infertility. The doctor asks the patient about the diseases she has suffered, treatment methods, what medications the woman is currently using, as well as the nature of her menstrual cycle.
The causes of possible pathologies in a patient suffering from infertility are determined visually by body type, the presence or absence of facial and body hair. Signs of the presence or absence of ovulation are established (by the appearance of the cervical pharynx, the nature of changes in vaginal mucus). The data obtained by the woman independently by drawing up a basal temperature chart is taken into account.
The contents of the cervical smear are analyzed (for microflora, cellular composition). A culture is performed to determine the type of bacteria that caused the inflammation.
If immune infertility is suspected, a postcoital test is done on days 12-14 of the cycle (cervical mucus is examined for the content of antibodies to sperm).
Blood testing is carried out using the PCR method to detect hidden infections based on their genetic characteristics. Blood tests for ovarian and pituitary hormones are carried out at various periods of the cycle to notice deviations from the norm and find out their cause.
Examination of the uterus, ovaries and pelvic organs is carried out using ultrasound. X-rays of the skull can detect diseases of the hypothalamic-pituitary system. Hysterosalpingography (x-ray of the uterus using a contrast agent) is used to study the condition of the organ, detect tumors and obstruction of the fallopian tubes.
Hysteroscopy is performed to examine the inner surface of the uterus and detect polyps and tumors. Curettage and subsequent histological examination of the material makes it possible to determine the cause of endometrial underdevelopment.
If necessary, diagnostic laparoscopy is prescribed, with the help of which pathologies in the uterus and ovaries are detected. The presence of endometriosis is established.
Treatment
The choice of treatment methods depends on the type of infertility, the presence of certain pathologies, their severity and location. Treatment is carried out using conservative or surgical methods. The possibility of IVF is being studied.
For endocrine infertility It is recommended to take measures to normalize weight through diet and exercise. Therapy with hormonal drugs is carried out to eliminate hormonal imbalance in women and stimulate the functioning of the ovaries. The treatment process is monitored using ultrasound and blood tests.
Tubal infertility in women. The main treatment method is surgical removal of adhesions and other tumors through laparoscopy. When both tubes are completely closed, it is usually recommended to use artificial insemination methods. In this case, depending on the condition of the ovaries, the patient’s own eggs or donor eggs are taken.
Violation of the shape of the uterus. In this case, laparotomy metroplasty is performed - surgical restoration of the shape of the organ, removal of partitions and scars in the cavity.
For endometriosis Laparoscopic removal of foci of endometrial growth is performed in combination with hormonal therapy.
Polycystic disease. To make pregnancy possible, the first step is to eliminate endocrine disorders and menstrual disorders. Ovulation is stimulated by medication using the drugs Clomiphene or Metmorphine.
If conservative treatment is not successful, surgical operations are performed using laparoscopy. It is possible to perform a wedge-shaped resection of the part of the ovary affected by cysts. Sometimes decortication is performed, removing the surface (cortical layer) and subsequent hormonal stimulation of the growth of follicles capable of ovulation.
An effective method is cauterization - cutting the cysts in the ovaries using a laser knife. Once their contents are removed, they disappear and healthy tissue is formed.
The method of electrothermocoagulation is also used. In order for the eggs to leave the ovary, small holes are made in it.
The key to effective treatment is early consultation with a doctor and identification of the cause of infertility. Timely relief from gynecological and endocrine diseases and control of body weight can increase the chances of successful conception.
Video: Examination of women and treatment for infertility
According to statistics, approximately a third of women become pregnant within three months of the start of regular family intimate relationships, two thirds - in the next 7 months, 10% - after about 12 months.
Therefore, in medicine, one year is considered a sufficient period for assessing the fertility of a couple and suspecting infertility. Not in all cases, fertility problems are associated with pathology of the woman’s reproductive system. This may be incompatibility of partners, infertility in a man.
Types of infertility
There are 2 main types of infertility in girls:
- Primary (absolute) - a rare form, the cause of which in most cases is underdevelopment of the genital organs, structural anomalies, absence of the uterus and/or appendages, endocrine disorders (60%). This diagnosis is given to women who have never been pregnant.
- Secondary (relative) – there were one or more pregnancies, even if they did not end in delivery, but at a particular moment pregnancy does not occur with normal fertility in the partner. The cause in 90% of cases is diseases of the reproductive system, of which 65% are due to obstruction of the fallopian tubes.
Depending on the etiology, infertility is distinguished:
- Immunological.
- Trubnoye.
- Uterine.
- Endocrine.
- Psychological.
- Genetic.
Each form is characterized by its own signs of infertility, features of the process, and treatment methods.
Causes
Infertility occurs in women for the following reasons:
- Hormonal imbalances– the most common cause of problems with conception in girls. The following symptoms may indicate endocrine changes: a stable basal temperature indicates a lack of ovulation, problems with the menstrual cycle. It is also worth paying attention to increased oiliness of the skin, excessive hair growth in places unusual for a woman.
- Infectious factor– infections of the genital tract and organs can occur latently for a long time, meanwhile having a destructive effect on reproduction. HPV, ureaplasma, cytomegalovirus, and chlamydia are especially dangerous. Inflammation leads to tissue scarring and adhesions, causing tubal obstruction, making conception impossible.
- Gynecological diseases– a common cause of infertility in women. Intrauterine polyps, endometrial growth (endometriosis), benign formations, cysts. Problems with the genitals can be suspected by a significant increase in pain during menstruation, discharge outside the cycle, spotting, or bleeding after intimate contact.
- Dysfunction of the gonads, which can happen for various reasons.
- Constant stressful situations can lead to so-called psychological infertility. A woman's body cannot bear a child under stress, so conception does not occur. But even if fertilization is successful, it is unlikely that you will be able to carry and give birth to a baby without health problems. Another stress reaction will most likely lead to a miscarriage.
- Frequent dieting and thinness– both excess body weight and its deficiency can cause infertility. If you are extremely thin (less than 50 kg, depending on your height), menstrual function is usually disrupted, or you have your period, but there is no ovulation. The reason for this is metabolic and hormonal imbalance caused by poor nutrition.
- Genetic factor may play a role in the development of infertility. A debilitating diet, smoking, taking alcohol and certain medications, and radiation can initiate and trigger the mechanisms of gene mutation. Genetic causes may be suspected after several miscarriages.
- Tumors and developmental abnormalities of the hypothalamic-pituitary system. The adenohypophysis (anterior lobe) produces hormonal substances that affect the synthesis of sex hormones.
In all cases, you need to undergo consultations with highly specialized specialists and a comprehensive examination.
Clinical manifestations
Signs of infertility in women are very diverse, most often it is a complex of symptoms:
- Menstrual cycle disorders are most often expressed in cycle irregularity, heavy or scanty periods, cessation of discharge, and increased pain. Some girls mistake the cessation of menstruation for pregnancy, but amenorrhea is characteristic of many diseases, both gynecological and endocrine.
- Pain in the lower abdomen, radiating to the lower back and anus, an unpleasant odor and unusual color of discharge may indicate an inflammatory process.
- History of thyroid disease.
- Sudden weight loss to critical levels or rapid weight gain leading to obesity.
- Acne, excessive sebum production.
- Undeveloped mammary glands.
- Hair growth on the face, chest, abdomen, shoulders.
- Chronic pathologies not related to the gynecological sphere.
- Episodes of infertility in close blood relatives.
The most basic sign of infertility is the failure to become pregnant within a year with regular unprotected sex, if the partner’s spermogram is within the normal range.
A characteristic manifestation of infertility is anovulation, which can be determined not only by special tests and the level of basal temperature, but also by a number of signs. The absence of ovulation may be indicated by pain in the projection of the ovaries, changes in the quantitative and qualitative characteristics of menstrual flow, increased sexual excitability, and tension in the mammary glands.
An unstable psycho-emotional background does not contribute to conception. Stress leads to hormonal dysfunction, which causes infertility. This causes the woman to feel strongly about her inability to get pregnant, which leads to even more stress and a vicious circle.
According to statistics, approximately 30% of couples cannot have a child due to a psychogenic factor.
You shouldn’t worry that you can’t have a new family member naturally, but go to specialists and figure out the problem with their help. The main thing is to be scrupulous about your health, pay attention to changes in the state of physiology and psyche, do not miss signs of possible infertility and promptly contact professionals who can help.
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If signs of infertility are detected, they first contact a gynecologist, who conducts an initial gynecological examination, collects anamnesis, clarifies complaints, and prescribes diagnostics. During a physical examination, the doctor evaluates the development of the mammary glands, body mass index, and the condition of the skin and hair. Finds out whether there is male-pattern hair growth, breast lumps, or severe acne. When examined on the chair, the gynecologist may suspect inflammation of the genital organs, the presence of formations, polyps, cysts, and see changes in the endometrium.
On your first visit to the antenatal clinic, the doctor, according to indications, may perform a colposcopy - an examination of the internal reproductive organs using an optical device. The study allows you to identify endocervicitis, erosion, localization of the inflammatory focus, take a smear and a fragment of a biopsy for histological analysis. Based on the results of a microscopic examination of a smear, one can judge the presence of an infection, including a hidden one. Some infectious diseases, including STDs, can be asymptomatic, leading to infertility. In this case, early diagnosis will allow you to choose adequate treatment, get rid of the cause of infertility and get pregnant after the recovery period.
Ultrasound diagnostics allows you to assess the health of a woman’s genital organs, parameters of the uterus, the state of the endometrium, the functioning of the gonads, identify muscle nodes, inflammation, adhesions, scar tissue, organ deformation, cystic changes, papillomatous or space-occupying formations and other pathological factors that are potentially the cause of infertility.
If the initial examination and ultrasound did not provide information about the causes of infertility, then an in-depth examination is prescribed according to the indications.
Diagnostic options:
- Hormonal panel– allows you to identify failures in the functioning of endocrine organs and assess the ovarian reserve.
- Contrast X-ray examination– the condition of the fallopian tubes is assessed for obstruction. Laparoscopy may be prescribed for the same purpose.
- Hysteroscopy is a therapeutic and diagnostic procedure, during which you can not only examine the internal organs in detail, but also, if necessary, remove a polyp or adhesions.
- Genetic screening– carried out when a genetic etiology of infertility is suspected. A geneticist must consult both partners.
- MRI, PET/CT – performed if pituitary tumors or other problems with the pituitary gland and hypothalamus are suspected.
Going through the entire range of diagnostic procedures does not always provide information about the causes of infertility.
If the partner is healthy and the spermogram is normal, then an immunological compatibility test is indicated. This is done by an indirect method using a blood test or a direct method in a man by analyzing seminal fluid. In case of incompatibility, specific antibodies will be detected in the biomaterials.
If you have symptoms of infertility, you can contact the AltraVita specialized center, undergo a full examination, receive information on diagnostic results as soon as possible, and discuss the situation with a gynecologist and other highly specialized specialists who see you at the clinic. AltraVita doctors have extensive practical experience in helping couples with infertility; they will be able to select the most effective treatment program.
If infertility does not respond to conservative therapy, one of the methods of artificial insemination may be offered. All procedures for diagnosing infertility and using reproductive technologies are carried out at AltraVita by highly qualified specialists who do not consider infertility as a final “sentence”.
Approximately 15% of married couples in Russia are diagnosed with infertility. According to the World Health Organization, a marriage is considered infertile in which pregnancy does not occur within a year of regular sexual activity without the use of contraception.
Unfortunately, for many couples the path to the birth of a long-awaited child can be very long. Expert of the educational program “Happiness of Motherhood for Every Woman!” Antonina Kozlova, Ph.D., reproductive specialist at the MirA Medical Center:
“One of the most common causes of female infertility is damage or obstruction of the fallopian tubes, preventing the egg from meeting the sperm and the subsequent transport of the already fertilized egg to the uterus. In addition, dysfunction of the fallopian tubes due to previous inflammatory diseases or impaired production can also lead to this sex hormones.
Another serious reason is disturbances in the menstrual cycle and egg maturation. If a woman has irregular or absent menstruation, there is a reason for examination. Ovulation disorders are often associated with hormonal imbalances. Fortunately, it is not difficult to diagnose, and treatment is simple and quite effective.
The next factor is various lesions of the uterus, as a result of which the physiological process of implantation, or engraftment, of the embryo is disrupted. Such lesions of the uterus include: uterine fibroids, endometrial polyps, adhesions in the uterine cavity, congenital deformities, and sometimes the complete absence of the reproductive organ.
In addition, changes in the composition of cervical mucus (produced in the cervix) may also affect your ability to conceive.
Separately, it is necessary to note the importance of the woman’s age. This is especially true now, when there has been a change in women’s reproductive behavior. Modern ladies are trying to first make a career, secure a stable social position, and then give birth to a child. But we must not forget that after 35 years of age, female fertility (the ability to conceive) begins to decline sharply, the chances of getting pregnant are 2 times lower than at 20 years old, and by the age of 40 the probability of spontaneous pregnancy is only 10% compared to 20 years old. summer age.
A factor that should also not be forgotten, especially for young people who are keen on various diets, is weight. Significant deviations from normal body weight, whether overweight or underweight as a result of sudden weight loss, can lead to decreased fertility and sometimes infertility in both women and men. According to one study, 12% of primary infertility is associated with weight problems.
Thus, a woman's fertility can be affected by various factors such as: sexually transmitted diseases, stress, sexual disorders and some common diseases.
Infertility is not just a female factor
It so happened that infertility was previously considered an exclusively female problem. However, today in 30% of married couples infertility is associated with disorders in the woman’s body, and in the other 30% - in the man’s body. In another 30% of couples, the cause of infertility is a combination of disorders in both partners. In 10% of cases, the cause of infertility cannot be identified. may be caused by various diseases that ultimately lead to deterioration in sperm quality, up to the complete absence of sperm, and ejaculation disorders.
Infertility is curable!
But even if you have heard the diagnosis of infertility, do not despair! Modern medicine now offers many methods to conceive a child. The main thing is not to waste time and contact specialists on time.
When a couple goes to a clinic specializing in sterility, an examination begins to identify the causes of infertility. The initial examination must provide answers to 3 main questions:
- Does a woman ovulate and how regularly?
- Is a man's sperm capable of fertilization?
- Are a woman's fallopian tubes patent? Are there other anatomical obstacles to the passage of sperm to the egg and fertilization?
The examination of spouses is carried out simultaneously. Only after excluding pathology in a man is a diagnosis of infertility in a woman made.
If the initial examination does not reveal the cause of infertility, additional tests and diagnostic procedures may be needed. Sometimes the traditional battery of diagnostic tests fails to make a diagnosis for both partners. Then they resort to additional examinations, such as transvaginal ultrasound, hysteroscopy, laparoscopy, endometrial biopsy, and immunological test.
Taking into account the medical history and examination of both spouses, consultation and treatment can be prescribed not only from gynecologists, andrologists, reproductive specialists, but also from other specialists (endocrinologist, neurologist, therapist, psychotherapist).
Based on the results of the examination, a treatment method is selected for this couple:
- drug correction of hormonal and immunological disorders;
- surgery;
- a combination of surgical and medical methods;
- the use of assisted reproductive technologies (intrauterine husband or donor, in vitro fertilization with subsequent transfer of embryos into the uterine cavity).
Hormonal drugs, endoscopic methods, and IVF are modern, highly effective methods of treating infertility, which are links in one chain, the ultimate goal of which is the restoration of reproductive ability.
The IVF procedure includes several stages:
- Ovarian stimulation. During 1 menstrual cycle, a woman matures one egg. Retrieving multiple eggs increases the chances of IVF success.
- Receiving an egg by puncturing the follicles. The puncture is performed through the vagina under ultrasound control.
- Fertilization of eggs with sperm in a special nutrient medium.
- Cultivation of the obtained embryos in a special medium.
- Transfer of embryos into the uterine cavity.
To increase the chances of IVF success, 2-3 embryos are transferred into the uterine cavity.
The success of IVF depends on many factors: the response of the ovaries to stimulation, the receipt of “high-quality” eggs capable of fertilization, the ability of sperm to penetrate the egg, the development of the resulting embryo, the readiness of the uterine mucosa to accept the embryo, attachment (implantation) to the uterine wall and further development embryo.
To date, the overall effectiveness of infertility treatment is more than 50%.
The use of modern techniques makes it possible to establish the cause in 99.6% of married couples within 2-3 months of examination and to restore fertility in 70% of couples within 12-15 months.
But, despite the available medical capabilities, the main thing is not to miss your chance to become parents and see a doctor on time! By working together you will achieve the desired result!
To achieve their goal of becoming parents, spouses require patience, mutual understanding, strict adherence to all recommendations and complete trust in the doctor. Only together with a specialist will you be able to go from the first visit to the clinic to that desired moment when your baby is born. Tatyana Yanochkina, head of the IVF department of the Health Clinic: “The main thing is not to lose heart, not to panic, if a woman stops fighting, the possibilities of medicine are limited. And no doctor will cure if the person does not want it. In addition, between the doctor and the patient There must be complete trust and mutual understanding, only then can a positive result be expected.”
Antonina Kozlova,
Ph.D., doctor-reproductologist of the Medical
center "MirA", educational program expert
"The happiness of motherhood is for every woman!"
Currently, the problem of infertility in women is very relevant. Every sixth couple in the country faces the problem of conceiving a child. And the reason is not always related to the female body; quite a lot of men are faced with the diagnosis of infertility.
At the same time, it should be noted that the risk group in this case consists of women and men who have crossed the threshold of 30 years. This is due to the fact that with age, especially a woman’s body is faced with the influence of harmful environmental factors, but also diseases, in particular those affecting the genital area, as well as accumulated mutations.
It is generally accepted that as a woman ages, her fertility gradually decreases. This can be explained by the fact that the ovarian reserve in a woman’s body does not change from the moment of her conception, that is, disturbances in it can occur even before the moment of birth.
Currently, there is even a separate specialty that deals with problems with conception in couples, this is reproductology. To give birth to a child in such a couple, attempts are made at detailed diagnostics, as well as artificial methods of insemination. They have gained great popularity among married couples.
What is infertility?
Infertility is a pathological condition that develops as a result of the inability to develop pregnancy in a couple subject to regular sexual activity without the use of barrier methods.
In this case, it should be taken into account that such a diagnosis is established if pregnancy does not develop for a year or more.
A shorter period of time is not legitimately taken into account for such a diagnosis, unless a thorough examination of the couple has been carried out and the impossibility of independent fertilization of one of the spouses or the reasons why pregnancy will not occur in this couple have been identified.
Main reasons
There are many reasons for infertility.
In the primary process, this is most often:
![](https://i0.wp.com/woman-centre.com/wp-content/uploads/2017/12/women-besplodie.jpg)
Signs of infertility in women
The main sign of infertility is the absence of pregnancy. Based on the reason that contributed to it, additional symptoms may be added.
Types of infertility in women
Primary and secondary
- Primary infertility This is a type in which a woman does not become pregnant at all. In this case, it should be taken into account that pregnancies should include not only cases of the birth of a child, but also all cases in which conception occurred, but pregnancy did not develop until the moment of birth.
- Secondary infertility - a pathological condition in which pregnancy does not occur for a year or more, but before that the woman has a history of fertilization of the egg. These cases do not always end in childbirth; these are miscarriages, frozen and ectopic pregnancies.
Absolute and relative
You should also distinguish between absolute and relative infertility:
- In the first case, pregnancy cannot occur. These are genetic pathologies, organ underdevelopment, etc. In this situation, treatment will be futile.
- While in the case of relative, various treatment methods can be undertaken. Usually this is the prescription of hormonal drugs, anti-inflammatory therapy, as well as surgical methods.
Immunological
Immunological. This is one of the most severe and difficult to eliminate types of inability to get pregnant. It can occur in both men and women. Among female representatives, this problem occurs much more often.
This type is formed due to a disorder in the immune system in which specific antibodies are produced that prevent fertilization.
This substance is called antisperm. It can be contained in various biological fluids, not only in sperm and vaginal secretions, but also in blood serum and the vas deferens.
With the development of new research methods, it has been proven that this problem occurs in more than a fifth of all couples. But not everyone is considered infertile.
It all depends on the concentration of antibodies, and they can act on any stages necessary for fertilization:
- First of all, on the part of the male body, they violate the integrity, structure and functionality of sperm.
- Having already penetrated the female body, antibodies can attach to them against the background of their good quality and make it difficult for sperm to penetrate through the secretion of cervical mucus, as well as disrupt the processes of catapultation into the egg and prevent the process of fertilization.
Even with the development of the fertilization process, the further development of pregnancy is disrupted, so difficulties arise with the implantation of the embryo to the uterine wall and the formation of a full-fledged fetal membrane.
The quality of the formed embryo is much lower in the presence of antisperm antibodies in the body, its viability is reduced. Any provoking pathological factor provokes the development of spontaneous miscarriage. This type is formed due to disturbances in immune response processes.
The protective functions of sperm are disrupted and they lose their ability to mimic. Any organism, especially a woman’s, begins to perceive it as a foreign substance that gets inside and forms pathogenicity factors. The formation of suppressive bodies and a smaller number of helpers occurs.
Sperm begin to come into direct contact with substances that are part of the immune system. In order for the male body to produce substances against its own cells, exposure to an unfavorable factor is necessary.
These can be traumatic effects, surgical interventions, inflammation, infectious processes caused by both specific and nonspecific pathogens, various anomalies in the structure of the organ of the reproductive system, as well as a malignant process.
Tubal infertility
Tubal infertility. This is one of the options for the impossibility of pregnancy associated with the development of the inability of sperm to penetrate the egg.
At the same time, about half of all women who are diagnosed with the impossibility of fertilization suffer from this problem. It can be both primary and secondary. Most often this is secondary infertility in mature women.
Occurs due to many reasons:
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Currently, the most popular and effective way to make a diagnosis is hysterosalpingography, in which a contrast agent is injected through the uterine cavity and its passage through the fallopian tubes is checked.
In some cases, the process can only be one-sided, most often this is associated with pelvic masses, as well as previous operations on the fallopian tubes (for example, ectopic pregnancy).
Treatment is predominantly surgical; if the cause is identified as an infection, then anti-inflammatory treatment is also prescribed.
Royal
Uterine type of infertility. This is another type of infertility that is caused by pathology of the main reproductive organ of a woman.
It is the uterus that plays one of the main roles in childbirth; it is the receptacle for the fruit. In this case, fertilization may occur, but the implantation process does not occur.
Most often these are anatomical defects in the cavity. This is a less common type, occurring mainly in women as a variant of the primary one.
Young women deal with this problem; in most cases, this problem can be associated with other pathologies of the reproductive sphere:
![](https://i0.wp.com/woman-centre.com/wp-content/uploads/2017/12/menstruation-matka.jpg)
Endocrine
Endocrine infertility. This is one of the most difficult to treat types of infertility, which is formed due to disruption of the glands, mainly internal secretion.
Causes:
![](https://i0.wp.com/woman-centre.com/wp-content/uploads/2017/12/endokrinnoe-besplodie.jpg)
Polycystic
Polycystic disease. This condition is multifactorial and reflects pathology on the part of the ovaries. In this case, most often this is a manifestation of a genetic defect.
It occurs in no more than a fifth of all women who turn to reproductive specialists or gynecologists with problems of not getting pregnant.
Polycystic disease is usually considered an endocrine cause of infertility. The pathology is characterized by an increased content of androgens, which are male sex hormones, in the bloodstream, as well as changes in the regularity
menstrual cycle, lack of egg maturation and, consequently, ovulatory processes. Other metabolic changes also appear.
There are several types of ovarian changes:
![](https://i2.wp.com/woman-centre.com/wp-content/uploads/2017/12/olikistoz-1.jpg)
This is a common pathology, which is accompanied by the release of the mucous membrane of the uterine cavity - the endometrium - beyond its anatomical boundaries.
Normally, this layer is also called functional, since it changes depending on hormonal levels and is exfoliated during menstruation.
In addition, it is the site where implantation of the fertilized egg occurs during pregnancy.
With endometriosis, tissue spreads not only to the area of the uterus, but also to any other organ of both the reproductive system and those located in the abdominal cavity. As a result of serious dyshormonal disorders, the formation of an egg does not occur and ovulation does not occur.
As a result of the above factors, the process of pregnancy is impossible. With the development of endometriosis, localized in the body of the uterus, even in the initial stages, fertilization of a mature egg is possible, but due to disturbances in the structure of the organ, the process of implantation of the fertilized egg does not occur.
The cause of the development of endometriosis is still poorly understood. Quite a lot of theories have been put forward, in some cases it is the transfer of menstrual blood with endometrial cells to other areas, or a genetic predisposition.
Genetic
This is the rarest form of this disease. It manifests itself as a congenital pathology, which can be associated with mutational processes in chromosomes.
They can occur equally in both male and female organisms. It is either a disease transmitted by inheritance or a pathology that develops during pregnancy.
This may be the impact of harmful factors that caused mutations, as well as diseases of the mother or father, which led to inferior formation of the egg or sperm.
This type of infertility is incurable. If it is associated with partial underdevelopment of the reproductive system, in some cases it can be corrected. But in cases of gene mutations or the complete absence of some genes, the situation is irreversible.
In cases of severe abnormalities in the genetic apparatus, clinical changes can be seen. But in most cases, infertility is diagnosed after lengthy examinations and exclusion of all possible causes.
Psychological
This type is quite rare and is associated with changes at the mental level. This problem occurs in women.
The age group that is susceptible to it can be completely different; most of the identified cases are young women planning pregnancy for the first time.
It is expressed by disorders that arise at the subconscious level, when a woman preparing to become a mother does not want to realize it, or is not yet ready for this step.
Internal conflicts are formed, as well as unconscious fears associated with the difficulties of motherhood and the subsequent birth of a child.
They arise against the background of complete physical health; after a complete diagnosis of the body, no objective reasons for the formation of infertility are found. But nevertheless, with prolonged exposure to the factor, disruption of the endocrine system can occur.
This picture is reversible; in most cases, working with a professional psychologist is sufficient.
The most common type of infertility is primary. The reasons leading to its development include endocrine and uterine reasons.
Diagnosis of infertility
This is a rather complex process that begins with interviewing the patient and finding out the exact complaints. Great importance is given to clarifying the possible causes leading to this pathology, as well as the medical history.
You should ask if there have been any cases of infertility in the family. In most cases, the doctor is interested in determining menstrual function, symptoms of hormonal disorders, as well as drawing up a general impression of the woman’s development.
After this, an inspection is carried out, both external and specialized. It is necessary to assess the condition of the genital organs, exclude organic pathologies, as well as inflammatory processes.
After this, laboratory and instrumental diagnostic methods begin to be used by exclusion:
- Functional diagnostic tests are one of the most labor-intensive, but at the same time effective methods for assessing the reproductive system. They are used to exclude possible organic reasons for the absence of pregnancy, as well as the male factor. Tests are of the following types:
- One of the main laboratory tests is to exclude sexually transmitted infections. To do this, smears are taken in various ways. The most common is a flora smear, which can detect trichomonas and gonococci. Pathogens such as chlamydia, mycoplasma, ureaplasma, cytomegalovirus, and the causative agent of herpes simplex pose a great danger. To do this, the resulting material is examined using polymerase chain reaction. In some cases, blood sampling may be required for testing:
One of the main studies is the ultrasound method. In this case, after excluding organic pathologies, it is necessary to evaluate the condition of the endometrium and ovaries. These are the main points on which the onset of pregnancy depends. It is recommended to scan several times per cycle to more accurately assess endometrial and follicular growth. But if this is not possible, then an ultrasound is performed on the day of expected ovulation, this time period is calculated by the doctor, but in a normal cycle it is 12-16 days from the start of menstruation. At this time, the egg matures and is subsequently released.
- Colposcopic examination. The cervix is examined under magnification using a microscope. For a more accurate assessment, it is carried out with the application of iodine and vinegar reagents.
If endometrial pathology is suspected, a diagnostic curettage of the uterine cavity is performed, as well as an aspirate is taken from its cavity. This is necessary for diagnosing the cellular composition. This is a universal and very useful method that is used for infertility. First of all, it is used to clarify the cause of the development of this pathology. The uterine cavity and fallopian tube patency are assessed. It is also possible to identify pathologies associated with anatomical defects or the presence of functional causes leading to the impossibility of implantation of the fertilized egg. Hysteroscopy is now quite common because it is highly accurate. Included in one of the standards for diagnosing infertility.
Treatment
Treatment of tubal infertility
The main ways to eliminate this problem are surgical methods. The method will depend on the specific reason for the development of this type of infertility.
![](https://i0.wp.com/woman-centre.com/wp-content/uploads/2017/12/lechenie-trub.jpg)
Treatment of endocrine infertility
It begins with possible compensation of endocrine pathologies, possible replacement therapy.
If necessary, it is possible to begin stimulating the ovulatory process and the maturation of a morphologically functional egg.
In addition, it is possible to prescribe funds that regulate higher-lying departments.
For large formations that are hormonally active and contribute to the development of endocrine infertility, surgical removal is possible.
In addition, other hormonal medications may be used for other types of endocrine problems.
Treatment of uterine and cervical infertility
In cases where problems such as uterine fibroids are identified, hormonal medications and surgical methods can be used.
Endometriosis is a form of infertility in which the only way to eliminate it is a hormonal course or continuous treatment.
One of the latest ways to eliminate anatomical defects of the uterine cavity is laser reconstruction of the uterine cavity.
In the case of an inflammatory process, medications are prescribed to eliminate the lesion or reduce its activity.
Treatment of immunological infertility
Condom therapy
Provides for the complete exclusion of any contact of sperm with the female body.
Therefore, all sexual acts must be protected.
The duration of this treatment should be at least six months.
This increases sensitivity to sperm. And in the future, the couple has a high probability of conceiving a child.
Hyposensitization
This group of drugs helps reduce the sensitivity of the immune system. As a result of these mechanisms, less and reduced antibody production occurs. The course is prescribed for a week on the date of expected ovulation.
Intrauterine insemination
This method eliminates the contact of sperm with cervical mucus. There is a preliminary purification of the liquid from antigens and its direct introduction into the uterine cavity.
ECO
If the above methods are ineffective, IVF (in vitro fertilization) begins to be used.
In this case, an artificial fusion of a previously obtained egg and sperm is carried out.
Which, after being grown in the laboratory under artificial conditions to a certain size, are transplanted into the already prepared cavity of the woman’s uterus.
Drugs for the treatment of infertility
There are several types of drugs that can be used for treatment. These drugs may be classified as hormonal or anti-inflammatory drugs.
There are no specialized groups; they are all based on the treatment of the etiopathogenetic cause that caused it.
Assisted reproductive technologies
The following reproductive technologies can be used:
![](https://i1.wp.com/woman-centre.com/wp-content/uploads/2017/12/artificial-insemination.jpg)
Folk remedies for the treatment of infertility in women
There are no specific remedies aimed at treating female infertility. Therefore, in most cases, women who cannot get pregnant resort to using universal remedies that are effective for diseases of the reproductive organs.
Such means include:
![](https://i1.wp.com/woman-centre.com/wp-content/uploads/2017/12/polyn-3.jpg)
Prevention of infertility
It must be remembered that absolute infertility is difficult to prevent, since this problem is irreparable. Therefore, it makes no sense to resort to various procedures.
But the prevention of primary and secondary infertility, which are relative, occupies a special place in gynecology:
![](https://i0.wp.com/woman-centre.com/wp-content/uploads/2017/12/beremennaya-i-vrach.jpg)