Most marriages between a man and a woman involve the future appearance of children in the family, and very often the reason for the breakdown of relationships is infertility.

The inability to conceive may be due to anatomical reasons, gynecological diseases and psychological factors.

Finding out the cause of infertility is the first stage that helps bring the birth of the long-awaited baby closer.

What is female infertility

Infertility is otherwise referred to as infertility, which means a pathological disorder of reproductive function, expressed in the inability to conceive and bear a child.

The diagnosis of female infertility is given to patients of reproductive age who do not become pregnant after one to two years of regular sexual relations without the use of contraceptives.

Infertility can be primary or secondary, that is, it arose after the first successful birth. According to statistics, problems with conception occur in approximately 14% of couples. And it’s not always the woman’s fault alone. In order to establish the true reason for the lack of pregnancy, both partners need to be examined.

How serious is the problem?

Several hundred and even decades ago, infertility in women, and even more so in men, was rare. Currently, infertility is becoming a serious problem for many families.

Scientists associate the increase in the number of infertile women primarily with sexual liberation, as a result of which sexually transmitted infections are widespread, causing serious damage to the health of men and women.

In 60% of cases, in a married couple wanting to conceive a child, the woman turns out to be infertile. But problems with conception can also be associated with a man’s reproductive function. Very often during the diagnostic process it turns out that both sexual partners have infertility.

The disease is not considered an independent pathology; the following predispose to its development:

• hormonal imbalances;
• diseases of the genital organs and vital systems of the body; neurological disorders;
• chronic intoxication.

Female infertility mainly occurs after inflammatory diseases of the pelvic organs.

Special clinics and family reproduction centers deal with this issue. There is a special field in medicine - reproductology, the main activity of which is to establish the cause of infertility and treat identified pathologies.

ART techniques – assisted reproductive technologies – are widely used in practice. These include the widely known IVF method; the in vitro fertilization procedure is constantly being improved, which makes it possible to achieve better results.

Modern fertility centers are equipped with innovative equipment that is used for constant monitoring of embryos. Thorough Analysis gradual development embryos helps to select the most viable ones for transfer, which greatly increases the chances of successful IVF.

It is advisable for married couples who are faced with the absence of pregnancy to contact specialized fertility clinics. A powerful diagnostic base and modern medical equipment help qualified doctors determine the main cause of infertility and, if possible, eliminate its effect on the body.

Timely contacting fertility centers in most cases guarantees pregnancy after natural treatment.

Center for Family Planning and Reproduction from the inside.

What causes infertility

The process of the appearance of offspring, laid down by nature, occurs through the interaction of female and male reproductive cells. At ovulation, the egg leaves the ovary and begins to move towards the uterus through the fallopian (uterine) tubes. The male reproductive organs produce sperm - ejaculate, consisting of seminal fluid and sperm.

After sexual intercourse, the sperm moves through the vagina to the fallopian tubes. When an egg is encountered in this place, fertilization occurs and an embryo begins to form.

Gradually, the embryo moves into the uterine cavity, where it is implanted in the wall of the organ for further development. Female infertility is a pathology in which a failure occurs at one of the stages in the scheme described above.

In 36% of cases, infertility in women is associated with ovulation disorders. In 30% of recorded cases, infertility occurs due to obstruction of the fallopian tubes. In 18% of cases, problems with conception are associated with endometriosis. And in about 10%, the main cause of infertility in women cannot be identified.

Forms of infertility

It is customary to distinguish several types of infertility. They differ in the mechanism of development and the conditions contributing to the occurrence of pathology.

Relative and absolute

Infertility can either be eliminated during treatment or remain forever.

Highlight:

• RELATIVE INFERTILITY. Reproductive function is restored after correction of hormonal levels, normalization of metabolism or surgical intervention. This type of infertility currently includes the absence fallopian tubes, since in this case the woman has a chance to become pregnant using IVF;
• ABSOLUTE. Conception is impossible due to congenital anomalies in the development of the female reproductive system, as a result of incurable diseases and disorders that cannot be corrected.

Primary and secondary

Infertility can be:

• PRIMARY - the woman has never been pregnant.
• SECONDARY. Conception does not occur after a woman has become pregnant.

According to the mechanism of occurrence

There are:

• PURCHASED. Infertility develops after infectious diseases, injuries, pathologies of the endocrine and reproductive systems not related to heredity;
• CONGENITAL. Pregnancy is impossible due to abnormal development of the reproductive system or genetic diseases.

Degrees of pathology

There are three degrees of infertility:

• FIRST DEGREE. It is indicated if the patient complains of lack of conception, but there have been no pregnancies in the past. Causes of grade 1 infertility – acquired or congenital pathology of the reproductive system;
• SECOND DEGREE is secondary infertility. The woman who came to us about not being pregnant already has children. At this degree, infertility can be temporary, that is, successfully eliminated by medication or surgical methods, or absolute;
• THIRD DEGREE OF INFERTILITY- complete sterility. It is indicated when pregnancy is impossible due to the absence of ovaries or uterus, or due to congenital anomalies in the structure of the genital organs.

Signs

The defining sign of infertility is the absence of conception when several conditions are met:

• A woman has regular sex life;
• The sexual partner does not have reproductive disorders;
• Contraceptives are not used;
• The woman is of reproductive age (20-45 years).

There is no specific sign of female infertility, but there may be indirect signs; they are established through questioning, examination and diagnostic procedures.

Physical symptoms of female infertility include:

• Obesity or, conversely, too low weight (normally, a woman’s body mass index should be between 20-26 units);
• A condition of the skin that indicates endocrine disorders, for example, male pattern hair growth;
• Underdeveloped mammary glands;
• Pain and detection of lumps in the pelvic organs during a gynecological examination.

When identifying an anamnesis, it is clarified whether there have been infectious and severe inflammatory diseases or surgical operations on the pelvic organs in the past. Infertility may be indicated by disturbances in the menstrual cycle - scanty or heavy periods, their complete absence and pain during menstruation.

A number of signs of infertility are revealed only during diagnostic procedures. These are hormonal imbalances identified by ultrasound and CT scans, abnormalities in the development of the reproductive system, brain tumors that interfere with the production of hormones necessary for conception.

Causes

Female infertility is caused by dozens of different reasons. And during the examination, the main one must be established, since the effectiveness of therapy depends on this.

Physiological factors of infertility:

• IMPAIRMENT OF THE FALLOPY TUBES OR THEIR DAMAGE. Pathology occurs after inflammatory processes, against the background of infectious and sexually transmitted diseases, due to complications after operations. If the patency of the tubes is impaired, the process of joining the egg with the sperm is unlikely;
• ENDOMETRIOSIS. The growth of the inner layer of the endometrium inside and outside the uterus occurs due to genetic disorders, hormonal changes and decreased immune function. An overgrown mucous layer can block the fallopian tubes, preventing full ovulation;
• MYOMA. Benign muscle formation on the walls of the uterus appears as a result of an increase in the level of estrogen, which can be caused by stress, frequent abortions, genetic predisposition, or pathological changes in metabolic processes. Myoma manifests itself as abnormalities menstrual cycle, pain, sometimes heavy bleeding. The disease leads to both early miscarriages and the inability to conceive;
• ANOMALIES OF UTERUS DEVELOPMENT. At the stage of formation of internal organs, a female fetus may have various disorders, causing the appearance of a bicornuate and unicornuate uterus, septum in its cavity, and infantilism. Anomalies in the structure of the uterus lead to the fact that the fertilized egg cannot implant in the cavity - spontaneous abortion occurs;
• SCREENING PROCESSES. Caused by inflammatory diseases and surgical operations. The presence of scars in the walls of the fallopian tubes prevents the passage of sperm;
• INFLAMMATORY DISEASES. Female infertility is most often associated with the influence of bacteria transmitted during sexual intercourse - chlamydia, gonococci, trichomonas, ureaplasmosis. Infections lead to inflammation of the ovaries, tubes, uterus, and cervical canal.

Other reasons:

• AGE . In girls, about 300 thousand viable eggs are formed in the ovaries by the time of puberty. As they grow older, their DNA is disrupted, that is, natural aging occurs and the ability to merge with sperm decreases. Egg aging begins after 30 years and peaks after 40;
• OVERWEIGHT OR THIN. The more adipose tissue in the body, the more testosterone and estrogen are produced - hormones that, when produced in excess, can cause gynecological diseases. If you are underweight, on the contrary, less hormones are produced and the eggs stop maturing;
• PSYCHOEMOTIONAL EXHAUSTION. Long-term stress leads to a decrease in estrogen, which prevents eggs from maturing and disrupts the process of attachment of the embryo to the walls of the uterus. Due to emotional overload, the tone of the tubes with the uterus may also increase, which interferes with the advancement of sperm and eggs;
• CONGENITAL PATHOLOGIES. A number of genetic diseases disrupt the process of conception or provoke miscarriages early stages. The group of such diseases includes Shereshevsky-Turner syndrome (the main symptom is the absence of menstruation), adrenogenital syndrome, polycystic disease;
• IMMUNOLOGICAL PATHOLOGIES. Some women may develop antibodies to sperm in the cervical canal. The process of implantation of the embryo in the uterine cavity can also be disrupted due to improper functioning of the immune system;
• PSYCHOLOGICAL FACTORS. Pregnancy as a danger to the body can be perceived on a subconscious level. A woman may be afraid of childbirth itself, changes in appearance and habits, and possible illnesses. The brain regards internal signals as a denial of conception, so pregnancy does not occur.

What is Prolactinoma

The term prolactinoma in medicine refers to a tumor localized in the pituitary gland (anterior lobe) and producing large quantities of the hormone prolactin. The neoplasm is benign and occurs almost 10 times more often in women of reproductive age compared to men.

Symptoms of prolactinoma in women - milk production in the absence of pregnancy, irregular menstrual cycle. In advanced cases – headaches, decreased visual function.

Excessive production of prolactin by the tumor leads to suppression of estrogenogenesis in women, which in turn causes anovulation and infertility.

Hormonal infertility

In order for the egg to mature and leave the ovary in a timely manner, it is necessary that the balance of sex hormones, such as progesterone, estrogen, luteinizing and follicle-stimulating hormones, be constant in the female body.

Female infertility is possible if there are hormonal disorders such as:

Endocrine infertility

It is caused by a complex of hormonal disorders, as a result of which the regularity of ovulation is disrupted or it is completely absent. The reasons are disruptions in the functioning of the thyroid gland, gonads, and disorders in the hypothalamic-pituitary regulation.

Treatment of endocrine infertility begins with eliminating the root cause of the pathology. Correction of identified disorders and normalization of hormone levels make it possible to achieve conception naturally in 70-80 cases out of a hundred. If the desired result cannot be achieved, then the woman is offered IVF.

Tubal infertility

Caused by obstruction of the fallopian tubes - functional or organic. There are no specific signs indicating tubal infertility.

The diagnosis is made on the basis of ultrasound, hysterosalpingoophoria. Treatment can be medicinal and surgical - the woman is prescribed hydrotubation, reconstructive plastic surgery, transcatheter normalization of tubal patency.

Uterine infertility

Pregnancy is impossible due to pathologies of the uterus. Causes: abnormal location of the organ, fibroids, and developmental defects. Uterine fibroids are the cause of primary infertility in every third patient. To confirm the diagnosis, ultrasound and hysteroscopy are prescribed.

Infertility caused by fibroids is usually temporary. After removal of the benign tumor and appropriate drug treatment, the woman successfully becomes pregnant and carries a child.

Polycystic

It is detected in 4-8 patients under the age of 40 out of a hundred examined. Polycystic disease can also develop in girls adolescence. In the initial stages, the disease can be successfully treated medications or through operations.

Effect of contraception

The opinions of gynecologists regarding the use of hormonal contraceptives in women with infertility vary. Some doctors prescribe oral contraceptives for the subsequent development of the “rebound effect” - after discontinuation of drugs that block fertilization, estrogen production increases sharply, which increases the chances of conception.

But also in the literature there are cases of the development of temporary or permanent infertility after long-term use of hormonal contraceptives.

The negative effects of hormones can be prevented if their use is coordinated with a gynecologist. It is also necessary to remember that contraceptives need to be constantly changed, and then their use will not cause pathology.

Causes of secondary infertility

If a woman who applies for an inability to get pregnant has previously successfully carried and given birth to one or more children, then she is diagnosed with secondary infertility. The most likely causes of pathology in this situation are past infectious and non-infectious diseases of the reproductive system, hormonal imbalances.

Influence of factors

Female infertility is almost always caused by many factors; in medicine they are grouped according to existing homogeneous characteristics, these are:

• Anatomical localization of disorders that cause female infertility;
• The nature of the pathophysiological processes occurring in the body - endocrine disruptions, immunological rejection of sperm;
• Genetic abnormalities that interfere with the fusion of germ cells;
• Features of psychosomatics of women of reproductive age;
• The influence of male causes of infertility.

Cervical (cervical) factor

For fertilization to occur successfully, it is necessary that only active and viable sperm penetrate the uterus. The path of their advancement begins with the cervical canal, which secretes a special secret or otherwise cervical mucus.

It fills the cervical canal of the uterus and is a complex substance consisting of proteins, gland secretions, water, leukocytes, and dead cells.

The resulting porous plug performs the most important function - it prevents the passage of infectious microorganisms and sedentary sperm into the uterus.

Normally, the mucous secretion changes its viscosity depending on the days of the menstrual cycle. At a certain period, the viscosity of the mucus decreases and an environment favorable for sperm movement is created.

At this time, cervical mucus retains only defective male cells, thus the egg is protected from unhealthy conception. But sometimes the density of the plug does not decrease even on days favorable for conception, that is, the ability of sperm to enter the uterus is lost.

The inability of active male cells to penetrate through the mucus plug is called cervical factor infertility. There are several reasons for changes in mucus viscosity:

• Hormonal changes;
• Microflora disturbance;
• Inflammatory processes in the cervix.

Tubal infertility factor

A mature cell moves through the fallopian tubes due to their peristalsis and the movement of the epithelial cilia located on the mucous layer. Damage to the ciliated epithelium interferes with the normal attachment of the fertilized egg and provokes the development of an ectopic pregnancy.

But the greatest likelihood of infertility is associated with partial or complete obstruction of the fallopian tubes, which is usually referred to as the tubal factor of lack of pregnancy.

Fallopian tube obstruction varies depending on its location:

• In the distal section – the area of ​​the fallopian tube funnel;
• In the proximal part (uterine tube);
• All along the fallopian tubes.

Obstruction can also be complete or partial. Causes: spasm or blockage of pipes resulting from the formation of tumors, inflammatory processes, and adhesions. Obstruction of the tubes with the accumulation of transudate in them is referred to in medicine as hydrosalpinx; the disease develops as a complication of salpingitis, salpingoophoritis, adnexitis (inflammation of the ovaries and ligaments).

Fallopian tube obstruction can cause pain in the lower abdomen. It is detected using hysterosalpingoophoria and laparoscopy.

Tubal-peritoneal factor

All internal organs are protected from contact and possible fusion with neighboring organs and the abdominal wall using the mesentery. This is a special serous membrane, divided into two parts:

• PARIETAL LEAF. Internal organs are protected from contact with the peritoneum from the inside;
• VISCERAL LEAF. All abdominal organs, including the uterus and tubes, are attached to it.

A number of pathogenic factors lead to the formation of adhesions between the fallopian tubes, peritoneum or neighboring organs. As a result of this, the physiological mobility of the fallopian tubes is lost, their blood supply and innervation are disrupted, that is, they cease to fully perform their functions. This infertility is called tubal peritoneal.

Causes of pathology:

• Chronic inflammatory processes in the pelvic organs (most often they are caused by sexually transmitted infections);
• Complications after surgery and abortion.

The disease manifests itself as a violation of the menstrual cycle, chronic pain.

Immunological factor

Normally, the penetration of seminal fluid with sperm into the cervical canal should not lead to the production of specific antibodies or otherwise ASAT. But sometimes sperm rejection is detected at the immunological level; the causes of this pathology have not been fully established.

Theories are given according to which the production of antibodies occurs as a result of rejection reactions developing according to type 2 allergic reactions. The protective functions of the mucous membranes may be reduced due to a decrease in the amount of mucus, which often occurs in degenerative-inflammatory diseases.

A woman’s body can also produce antiovarian antibodies, that is, they destroy her own eggs. The reasons for the appearance of such immunological changes are complex, but autoimmune pathologies in the early stages of their development can be successfully corrected.

Diagnostics

The problem of female infertility is dealt with by gynecologists and specialized specialists - reproductive specialists.

Diagnosis begins with identifying complaints, the duration of the period of attempts to conceive, a history of gynecological, genetic diseases, operations, the nature of menstrual periods and sexual life. External and internal inspection is carried out.

Diagnosis of infertility includes:

All of the above examinations are minimally traumatic for the patient. Hysteroscopy and laparoscopy are performed in a hospital setting, but the woman is discharged home after one or two days.

Lab tests

Laboratory diagnosis of infertility:

• Checking hormonal levels. On days 5-7 of the cycle, the levels of testosterone, cortisone, prolactin are assessed, and on days 20-22 tests for progesterone are taken. In case of infertility, hormonal tests are prescribed, based on artificial stimulation or inhibition of a number of hormonal processes in the body;
• Detection of sexually transmitted infections;
• Determination of the presence of antibodies to sperm in cervical mucus and blood, tests for compatibility with a sexual partner;
• Genetic analysis of abnormalities that can cause infertility.

Infertility tests

Functional tests:

• CERVICAL INDEX– assessment of the level of estrogen in cervical mucus;
• BUILDING A CHART OF BASAL TEMPERATURE. Carried out to determine the time of ovulation;
• POSTCOITAL TEST. It is carried out after sexual intercourse - sperm activity is determined in the cervix and antibodies are detected.

Hormonal tests make it possible to detect disturbances in one of the parts of the reproductive sphere and their reaction to synthetic hormones.

Prescribed:

• PROGESTERONE TEST. It is carried out using Norkolut. Using this test, the saturation of the body with estrogen in patients with amenorrhea and the response of the endometrium to progesterone are determined;
• CYCLIC TEST (ESTROGEN-GESTAGEN). The reception of the endometrium to hormones is determined. They use Silest, Triziston, Non-Ovlon, Gravistat;
• CLOMIPHENE TEST. Assesses the level of disorders in the hypothalamic-pituitary-ovarian complex;
• METOCLOPLRAMIDE TEST. Determines the ability of the pituitary gland to produce prolactin;
• DEXAMETHASONE TEST. Prescribed to patients with high levels of male hormones to determine at what stage there is a disorder (at the level of the ovaries or adrenal glands).

The diagnosis of female infertility is made only after evaluating all the examination results. It is on the basis of the data obtained that the treatment regimen is selected.

Treatment methods

In cases of relative female infertility, drug and surgical treatment methods are prescribed. In case of absolute infertility, alternative options are used - assisted reproductive technologies (ART).

Drug therapy

Drug therapy mainly helps to normalize ovulation, which is disrupted due to hormonal shifts. Steroids can be used either alone or in combination with surgical treatment and with ICSI and IVF methods.

Most often, hormonal correction is carried out using drugs such as:

• SEROPHEN AND CLOMID. Stimulate ovulation by increasing the production of hormones necessary for egg maturation;
• INJECTED HORMONES. Follicle-stimulating hormone, human chorionic gonadotropin, menopausal gonadotropin and a number of other hormones are used. They are administered in injections at certain intervals. Compared to Clomid and Serophene, they are more effective, but they are also much more expensive. Typically used to stimulate ovulation in patients preparing for IVF;
• UTROZHESTAN. Contains progesterone, prepares the uterus for the attachment of a fertilized egg;
• DUPHASTON. Helps eggs implant in the walls of the uterus;
• BROMOCRYPTINE. Blocks the secretion of prolactin;
• WOBENZYM. Increases the overall resistance of the body, therefore complements anti-inflammatory therapy;
• TRIBESTAN. Normalizes the amount of follicle-stimulating hormone and estrogen in the body.

Surgical methods of treatment

Surgical intervention for female infertility is most effective if it is prescribed at the initial stage of the pathology. In case of infertility, depending on the cause of the disease, the following is carried out:

• REMOVAL OF FIBROIDS, POLYPS, CYSTS. Helps clear the paths for the passage of eggs and sperm, improves ovulation. During the operation, biomaterial is necessarily taken for histology;
• SURGICAL TREATMENT OF ENDOMETRIOSIS. Surgery is prescribed if conservative therapy does not lead to the desired result, and the disease leads to dysfunction of the urinary organs and occurs with intense pain;
• RESTORATION OF THE patency of previously ligated fallopian tubes. Some women decide to undergo tubal ligation for sterilization purposes. To restore their patency, surgery is necessary, but its outcome is determined by the duration of medical sterilization and the condition of the fallopian tubes;
• SALPINGOLYSIS – dissection and removal of adhesions located on the walls of the fallopian tubes. The operation can be performed traditionally or using laparoscopy;
• SALPINGOSTOMY. The patency of the fallopian tube is restored by removing the section of the organ with obstruction and subsequent connection of the remains of the tube.

VRT

Assisted reproductive technologies are based on the fertilization of an egg with a full-fledged sperm outside the patient’s body. First, the egg is removed from the ovaries through surgery, then it is used in the laboratory and placed in the uterus.

Types of ART:

• IVF. The most common fertilization technique;
• ICSI - intracytoplasmic sperm injection. It is more often used if the man in a couple is infertile. The sperm is placed on the egg and fertilization occurs independently;
• GIFT and ZIFT. These terms refer to the transfer of embryos into the fallopian tubes. Several eggs and sperm are taken from sexual partners and introduced into the fallopian tube either together (GIFT) or already in the form of fertilized zygotes (ZIFT). The procedure is carried out under ultrasound guidance, the germ cells are introduced through the cervix or through the abdominal wall. The techniques are effective if the patency of the fallopian tubes is preserved;
• SPERM INSEMINATION. The sperm of the husband or donor is used. Sperm are introduced into the uterus or vagina;
• SURROGACY. Women who have no uterus resort to him. A healthy egg is taken from the patient’s ovaries, fertilized with the sperm of the future father, and placed in the uterus of a woman who is ready to bear someone else’s child.

ART can also lead to complications - the development of allergies to drugs to stimulate ovulation, ovarian hyperstimulation, multiple pregnancies, bleeding and inflammatory processes.

ECO

The term IVF refers to the artificial fertilization of a healthy egg in a test tube, that is, outside the patient’s body. IVF consists of several stages, each of which determines the success of the baby’s birth:

Two weeks after embryo transfer, an hCG test is prescribed, and based on its results, pregnancy is determined. We suggest using .

In vitro fertilization does not cause any abnormalities in pregnancy; it proceeds in the same way as one that occurs naturally. The birth takes place as usual.

If the first IVF attempt was not successful, then there is every chance of getting pregnant with a second attempt.

Prevention

Infertility is most often a consequence of infectious and inflammatory processes in the genital organs. Therefore, if you experience discomfort, pain, unusual discharge, or irregularities in the menstrual cycle, you should not delay your visit to the doctor.

You should definitely visit a gynecologist once a year, even if there are no obvious health problems. This will make it possible to treat incipient diseases at the earliest stage of their development.

Fertility is affected by diet. There should be no shortage of vitamins and microelements in the body. Both excessive thinness and obesity have a negative impact on the possibility of conception. The chances of pregnancy are lower for women who smoke and drink alcohol, so you need to get rid of bad habits.

What helps you get pregnant

Successful pregnancy is possible in case of female infertility only if the woman, after examination, undergoes the prescribed therapy. But you can promote conception on your own; the following techniques help:

• OVULATION TEST. Favorable days For conception, 3-4 days before ovulation and two days after it are considered. In women with 28-day cycles, ovulation occurs on the 14th day, and in women with a 30-day cycle, on the 16th day. Ovulation can be determined using a special pharmacy test and a basal temperature measurement schedule;
• FOLLICULOMETRY. Mature follicles are visible on ultrasound. To “catch” them, the examination will need to be done repeatedly;
• CORRECT POSITION AFTER SEXUAL INTERACT. You can put a pillow under your hips or take a birch tree pose for 10-15 minutes;
• After fertilization, it is advisable to remain in bed for two weeks, which increases the chances of the embryo implanting in the uterus;
• After sexual intercourse, there is no need to carry out hygiene procedures for two to three hours.

We suggest using .

A positive attitude, support from a partner and loved ones also contribute to pregnancy.

What to do if you suspect infertility

• Do not determine the cause of infertility yourself, based on data from the Internet and thematic forums;
• Identify the cause of infertility with the help of a reproductive specialist and prescribed examinations. The sexual partner also needs a comprehensive examination;
• Complete the prescribed treatment.

Modern assisted reproductive technologies help women become pregnant even in particularly difficult cases of infertility. If infertility is detected, there is no need to despair - correctly selected therapy helps many couples become parents and pregnancy can occur more than once if desired.

History: I became a mother myself, although even IVF was impossible.

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

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

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

Infertility can also be absolute or relative. With the first type, pregnancy is impossible due to the fact that the woman does not have ovaries or a uterus. With relative infertility, conception can occur provided that the necessary medical procedures are carried out.

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

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

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

Infertility may be caused by genetic reasons . Most often, chromosomal abnormalities manifest as miscarriages. If a woman has spontaneous abortion several times in a row in the early stages, then it is necessary to undergo a genetic examination.

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

Immunological Infertility in women is a peculiar reaction of their body. He perceives male sperm entering the uterus as a foreign body. The body of the fair sex begins to produce antibodies, due to which the male reproductive cells die, and fertilization does not occur.

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

Causes

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

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

Let's consider each of the above reasons.

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

In 25% of cases, infertility occurs due to absence of fallopian tubes or due to their obstruction. Blockages in the tubes prevent the passage of eggs and sperm. Obstruction occurs due to various diseases (for example, chlamydia, trichomoniasis, salpingoophoritis, gonorrhea, endometriosis).

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

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

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

The list of reasons causing infertility does not end here. There are other problems that prevent the development of an interesting situation.

Signs of infertility in a woman

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

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

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

The above symptoms may be associated with serious diseases that prevent the fertilization of an egg by a sperm. For example, menstruation may be absent due to ovarian dysfunction or hormonal imbalance. Very often, the menstrual cycle is disrupted due to prolonged use of contraceptives or emergency contraception. It is impossible to do without the help of a specialist.

Diagnosis of infertility

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

Doctors diagnose the inability to have children only after a complete assessment of the woman’s health. Don't be alarmed if experts can't find the exact cause. It may take quite a long time to figure it out.

The process of diagnosing pathology consists of the following stages:

1. Taking anamnesis.
2. Gynecological examination.
3. Laboratory tests.
4. Primary assessment of the ability to ovulate.
5. Endoscopic diagnostics.

Let's take a closer look at them.

1. Taking an anamnesis when making a diagnosis

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

The specialist asks the following questions:

• when did your first period come;
• how many days is the menstrual cycle, is it regular;
• are there any delays;
• what is the duration of menstruation;
• what is the nature of monthly allocations;
• Is there intermenstrual bleeding?

The specialist will also ask several questions about your sex life. He will ask when you had first sex, whether sexual intercourse is regular, what contraception was used, whether sexually transmitted infections have been diagnosed in the past, whether pregnancy has occurred before, whether abortions have been performed, whether miscarriages have occurred.

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

2. Gynecological examination

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

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

3. Laboratory tests

An important stage in diagnosing infertility is taking laboratory tests for infertility in women. The results make it possible to find out the reason for the inability to conceive a child. Women undergo general blood and urine tests. Specialists, examining biological fluids, determine the levels of sex hormones.

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

In the process of diagnosing infertility, tests are prescribed for sexually transmitted infections (chlamydia, mycoplasma, candidiasis, streptococci, staphylococci, etc.). They must be tested, since these diseases affect fertility and prevent the fertilization of an egg by a sperm.

4. Initial assessment of ovulation ability

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

Thanks to these simple measures, you can find out whether a representative of the fair sex releases a mature egg from the ovary in each menstrual cycle. Some women do not ovulate. In some cases, this process occurs very rarely.

5. Endoscopic diagnosis

To confirm infertility, endoscopic diagnosis is performed. Procedures such as laparoscopy and hysteroscopy are prescribed. Thanks to them you can find out real reasons infertility.

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

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

Infertility treatment

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

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

Modern methods of overcoming the problem of infertility

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

• IVF – in vitro fertilization;
• ICSI – intracytoplasmic sperm injection;
• insemination.

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

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

The next method of artificial insemination is ICSI . Intracytoplasmic sperm injection can be performed for undiagnosed egg pathologies. The essence of the procedure is to introduce a male reproductive cell into a female one using a special micro-tool. The embryo obtained in this way is placed in the uterus.

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

According to average statistical data, more than 3% of women of childbearing age suffer from infertility after the first successful birth (medical abortions and spontaneous expulsion of the fetus are not included in them), about 2% have never become pregnant, the possibility of bearing and subsequent birth of a baby is not even considered for them. What are the main causes of infertility in women?

Health problems and psychological factors interfere with conception and subsequent pregnancy. Infertility is registered in both sexes, but more often the cause in childless marriages is abnormalities in the woman.

The reason for the lack of long-awaited conception is determined in a clinical setting, using specialized diagnostics. In some cases, the pathology can be corrected with medications or surgery, but sometimes doctors cannot determine the root causes of infertility.

Etiology of pathology development

Depending on the supposed root causes that caused the development of problems with normal conception, it is customary to distinguish:

• relative factor - when there is a percentage of conception occurring after taking special medications, normalization of hormonal levels and metabolism, surgical intervention performed to restore reproductive function;
• absolute – pregnancy is impossible due to congenital anomalies of the female genital organs, diseases that cannot be treated, or other disorders.

In some cases, after the first conception (ending in childbirth or medical, spontaneous abortion), a woman cannot become pregnant again. Certain reasons do not allow the female body to become pregnant for the first time. Against the background of these violations, there are:

• – absence of any conception;
• – the anamnestic data contains information about previously recorded conceptions.

According to the mechanism of formation, division occurs:

• congenital – associated with a hereditary-genetic factor (with existing pathologies in the family) and abnormal intrauterine development of the fetus (underdevelopment of the female genital organs).
• acquired - all diseases acquired during life that are not associated with a genetic factor: trauma, infectious and inflammatory processes, pathologies of the endocrine and reproductive systems.

Some experts divide the lack of conception according to the immediate factors of its occurrence:

• tubal – registered with absolute or partial obstruction of the fallopian tubes;
• endocrine – occurs when the functionality of the endocrine glands is disrupted;
• uterine – develops due to pathological conditions of the uterus;
• peritoneal – against the background of adhesive processes in the pelvic organs, which prevent conception (fallopian tubes remain healthy);
• immunological – formed when the female body forms specific antibodies to male germ cells;
• idiopathic - established after diagnosis, but the root cause of the pathology remains unclear.

Hormonal disorders

For the timely maturation of the egg and its release from the body of the ovary, the body produces various types of sex hormones:

• estrogen;
• progesterone;
• follicle-stimulating;
• luteinizing.

Polycystic ovary syndrome

It occurs due to an excess amount of male sex hormones, with parallel large-scale production of insulin. Against the background of their increased number, a large number of follicles are formed in the body of the ovaries, none of which fully mature.

The mechanism for releasing the egg does not occur, nor does the process of ovulation. The body of the ovary increases in volume two to six times, the duration of the menstrual cycle lengthens in time, and regulative omissions occur. Most females with polycystic disease experience increased body weight.

Insulin resistance

Resistance of the female body to the hormone is often recorded in polycystic ovary syndrome. Produced by the pancreas, it is responsible for delivering glucose from the bloodstream to cellular structures.

When cellular metabolism is disrupted, glucose levels increase sharply, and insulin production increases accordingly. Factors that lead to the development of the process:

• incorrect diet, with a large intake of carbohydrates and sugars;
• frequent stress;
• sedentary lifestyle, excluding any physical activity.

Excess of male hormones

Unstable menstruation or its absence indicates hyperandrogenism. The functionality of the ovaries is suppressed by an excessive amount of male hormones, the cycle is disrupted until complete absence. With severe development of the pathology, infertility occurs. The presence of hyperandrogenism can be determined by certain signs:

• increased body hair growth;
• acne;
• lowering the tone of the voice closer to a man’s;
• change in figure according to the characteristics of the opposite sex.

Pituitary gland disorders

Deviations in the functionality and normal performance of the gland appear against the background of various disorders:

• problems with local blood circulation;
• reasons of genetic origin;
• previous injuries;
• taking medications;
• available in the anamnestic data of meningitis.

As the disease develops, a number of characteristic signs develop:

• the presence of milk-like contents in the mammary glands;
• disruption of the normal menstrual cycle;
• mastopathy;
• untimely enlargement of the mammary glands;
• increased fragility of bone tissue;
• decreased desire for a sexual partner.

Prolactin, produced by the pituitary gland, is considered a hormone of nursing mothers. Due to its appearance in the body, ovulation and the menstrual cycle stop. An increased amount of it in the body of nulliparous women is associated with a malfunction of the thyroid gland - hypothyroidism.

Early menopause

Average statistical data indicate that the onset of menopause occurs at the age of 50 years. Certain factors contribute to a reduction in the functionality of the reproductive system:

• autoimmune diseases;
• disorders of genetic etiology;
• various diseases of the genital organs;
• wrong lifestyle;
• chronic nicotine addiction.

All of the above reasons cause the onset of menopausal changes in women who are forty years old. A decrease in the production of female sex hormones and loss of ovarian function are recorded in 1% of females. Opportunities for childbearing fade and infertility sets in.

Lack of corpus luteum

At the site of the follicle that released the egg, a corpus luteum appears. This is a temporary gland responsible for the production of prolactin, the main hormone of the corpus luteum. Prolactin stimulates the preparation of the walls of the uterus for the implantation of a fertilized egg in them.

If its quantity is insufficient, consolidation does not occur and the desired pregnancy does not occur. In some cases, consolidation occurs, but then spontaneous abortion develops. For the occurrence of a pathological condition, the following prerequisites are necessary:

• congenital genetic abnormalities;
• pathological disruptions in the functionality of the ovaries - polycystic syndrome, malignant neoplasms;
• dysfunction of the pituitary gland.

Physiological disorders

The second type of deviation occurs in various diseases of the female reproductive system. Each of the disorders has its own underlying causes and symptomatic signs.

Abnormalities in the fallopian tubes

Complete or partial obstruction of the fallopian tubes interferes with normal fertilization. In a healthy woman, the egg unites with the male reproductive cells in them, after the first one leaves the body of the ovary. Fallopian tube damage is often the result of:

• inflammatory processes in their body;
• existing viral and bacterial diseases;
• diseases transmitted through sexual contact;
• complications after surgical procedures;
• with formed and scar tissue.

Endometriosis

The inner lining of the uterine body is lined with endometrium; as abnormalities develop, the mucous membrane begins to grow inside and outside the reproductive tract. The main causes of endometriosis are considered to be genetic abnormalities in the body.

Excess tissue can block the exits of the fallopian tubes, causing ovulation problems and subsequent infertility. The disease is recognized by its symptomatic manifestations:

• pain in the lower abdomen;
• increased amount of discharge;
• pain during menstruation.

Benign neoplasms

An increase in the quantitative indicators of estrogen can lead to the appearance of fibroids in the uterine body. The benign type of tumor consists of muscle tissue and manifests itself with existing abnormalities:

• hereditary predisposition - if there are cases of fibroids in the uterine body in the family, there is a high percentage of occurrence in subsequent generations;
• various deviations in normal metabolism;
• constant stress, psycho-emotional stress;
• medical and criminal abortions.

Presumable symptoms of its appearance:

• excessively heavy menstruation;
• menstrual irregularities;
• painful sensations during menstruation.

In complex cases, it can cause childlessness, spontaneous abortions, or complicated conditions during pregnancy that threaten the life of the fetus.

Uterine abnormalities

After inflammatory processes, trauma and endometriosis, adhesive processes occur in the body of the uterus, changing and merging the walls of the organ. The pathological structure of the uterus is caused by disorders of intrauterine development of genetic etiology:

• uterine infantilism - underdevelopment of the female organ, which remains the size of a child;
• the presence of an additional partition that is not present in normal development;
• unicornuate or bicornuate uterus.

With existing pathologies, any pregnancy ends in spontaneous abortion in the early stages. The fertilized egg cannot attach to the wall of the organ, which causes abortion.

Changes in the cervix

After surgery or against the background of infectious processes, after healing, various adhesions and scars form on the cervix. Artificial narrowing interferes with the normal passage of male reproductive cells into the fallopian tubes, causing infertility. Congenital or acquired deformation of the organ, various deviations in the composition of the cervical mucous secretion complicate the process of penetration of sperm into the body of the uterus.

Inflammatory processes in the pelvis

They occur when pathogenic microflora penetrates the organs of the reproductive system. Significant amount falls on diseases transmitted through sexual contact and provoked by:

• chlamydia;
• ureaplasma;
• gonococci;
• Trichomonas, etc.

The risk of infection increases if the rules of safe contact are violated - intercourse without using condoms, frequent change of sexual partners. Pathogenic microorganisms may also appear:

• during intrauterine operations, in violation of the rules of septic and antiseptic;
• during menstruation – insufficient hygiene;
• in the postpartum period.

Infectious processes cause various diseases:

• salpingoophoritis - a process of inflammation in the ovaries and fallopian tubes;
• endormetritis - an inflammatory process in the uterus;
• cervicitis – inflammation of the cervix.

Symptoms:

• pain in the lower abdomen;
• non-standard discharge;
• untimely menstruation;
• feeling of constant itching;
• pain in the genital area.

During a gynecological examination, specialists record the formation of spots and ulcerations on the mucous membranes.

Other causes of infertility in women

The following pathologies do not fall under the standard classification and do not occur due to disruptions of the hormonal system or physiological disorders.

Age period

By the time the female reproductive system reaches full puberty, there are about 300 thousand eggs in the body of the ovaries. As time passes, they are susceptible to aging - their internal DNA is damaged.

Against the background of gradual aging, the quality indicators of eggs decrease—suitability for fertilization and further development of the embryo. The process begins after the 30th birthday, and after 25-40 years, aging begins to progress at a faster rate.

Body mass

Excess or underweight leads to a variety of diseases, including pathologies of the reproductive system. An excess of adipose tissue provokes the formation hormonal type deviations - an increase in the numerical content of both male and female sex hormones.

Under their influence, gynecological diseases begin, leading to the development of infertility. When treating overweight women with medications, conception occurs, but often ends with problems with pregnancy (spontaneous abortion and intrauterine development).

Lack of weight, compared to a normal body index, causes disruption of the functionality of the endocrine department. Decreased performance leads to reduced production of necessary hormones, followed by non-ripening of eggs.

Immunological causes

With normal functionality, a woman’s autoimmune system does not respond to the introduction of a foreign type of protein - seminal fluid, male germ cells. It does not produce specific antibodies and does not destroy sperm. The reasons why seminal fluid is rejected by immunological agents have not been fully determined.

It is assumed that the appearance of specific antibodies in response to sperm occurs like a standard allergic reaction. The typical barrier properties of mucous membrane secretions are disrupted due to a decrease in its volume in the internal areas of the female genital organs.

Another factor in the occurrence of pathology of conception includes the production by the woman’s body of specific agents on her own eggs. This problem is dealt with exclusively by immunologists - the root causes of the pathology in which self-destruction occurs are not fully understood.

All autoimmune non-standard processes, in the early stages of occurrence, are easily treatable. With advanced forms, the prognosis is not so favorable. It is possible to develop an absolute type of infertility.

Psychological reasons

A complex mechanism for stabilizing the psychological state is driven by hormonal metabolism. It is pointless to look for frequent preconditions for psycho-emotional deviations as the root causes of infertility - each organism reacts to external stimuli in its own way. All sources of stress can be summarized:

• as an overabundance of negative information coming from outside;
• emotional reactions of the body in response to negativism;
• physiological or pathological responses of the female body to psychological discomfort.

The chronic version of psycho-emotional outbursts causes a gradual depletion of the defense system and adaptation mechanisms. All structural units responsible for bioregulation change their functionality and begin to work in a pathological direction.

Psychological prerequisites conceal altered physiological processes - disturbances in the functionality of the hormonal system. To influence psychological variants of infertility, you should:

1. Stop the sources of psycho-emotional conflicts and switch to other activities. Hobbies, timely rest, long walks, sports and a lot of positive emotions can return hormonal levels and mental balance to a state of balance. Experts say that families with a low level of intelligence do not have problems conceiving, unlike females with a high level of intelligence. social status. The latter often suffer from contrived stress, which leads to the development of infertility.
2. For expectant mothers, it will be useful to contact a professional psychologist. Not all types of psycho-emotional disorders can be overcome on your own. A specialist will be able to regulate outbursts of emotions and direct the general state in the right direction. At detailed analysis life situations the true root causes of psychological infertility are determined.

Use of contraceptives

Proponents of hormonal contraceptives are confident that when they are used and subsequently discontinued, a sharp release of estrogen occurs, stimulating the possibility of becoming pregnant.

Opponents cite examples of cases where fertility is compromised due to the use of contraceptives - either permanently or temporarily.

If you listen to both opinions, then the truth is always in the middle.

If you follow all the recommendations of your gynecologist, avoid negative influence constant use of hormonal contraception, then planning the future baby will be successful. By combining different contraceptive options, the chances of normal fertilization increase several times.

To prevent the formation of infertility in a timely manner, it is necessary to follow several simple rules.

In Russia, the frequency of marriages in which there are no children, due to any medical reasons, that is, infertile marriages, is 8–19%. The female factor accounts for 45% of infertile marriages. The causes of infertility in women are very numerous, but in most cases, infertility can be overcome thanks to the huge strides forward of modern medicine.

Classification of infertility

How to determine infertility? Infertility is said to occur when a woman of childbearing age is unable to become pregnant within a year with regular sexual activity and without the use of contraceptive methods. Female infertility is classified according to the following factors:

Development mechanism

Depending on the mechanism of occurrence, infertility is divided into congenital and acquired.

History of pregnancy

If a woman who is sexually active has not had any pregnancies in the past, they speak of primary infertility. In the case of a history of pregnancies, regardless of their outcome (abortion, miscarriage or childbirth), they speak of secondary infertility. There are no degrees of infertility, as many sites on the Internet indicate. The degree of the disease means the severity of its manifestation (mild, moderate or moderate), and infertility is either present or not.

Possibility of pregnancy

In this case, infertility is divided into absolute and relative.
With absolute infertility a woman will never be able to become pregnant naturally due to the presence of irreversible pathological changes in the reproductive system (no uterus and ovaries, no fallopian tubes, congenital malformations of the genital organs).

Relative infertility implies the possibility of restoring fertility in a woman after treatment and elimination of the cause that caused infertility. Currently, the distinction between relative and absolute infertility is somewhat arbitrary due to the use of new treatment technologies (for example, in the absence of fallopian tubes, a woman can become pregnant through in vitro fertilization).

Duration of infertility

In terms of duration, infertility can be temporary, due to the action of certain factors (prolonged stress, weakening of the body during or after illness), permanent (when the cause cannot be eliminated, for example, removal of the ovaries or uterus) and physiological, due to transient physiological factors (prepubertal, postmenopausal period and period of breastfeeding).

Etiopathogenesis (causes and mechanism of development)

There are infertility due to anovulation (endocrine), tubal and peritoneal, uterine and cervical (various gynecological diseases in which there are anatomical and functional disorders of the endometrium or cervical mucus), immunological and psychogenic infertility, as well as infertility of unknown origin.

And as separate forms of infertility:

• Voluntary - the use of contraceptives due to the reluctance to have not only a second or third, but also a first child.
• Forced - taking certain measures to prevent births (for example, the presence of a serious illness in a woman, in which pregnancy significantly increases the chances of its worsening and the risk of death).

Causes

Signs of infertility in women are caused by the reasons that led to the woman’s inability to become pregnant. Loss of fertility is determined by the following factors:

Ovulation disorder

Infertility caused by anovulation develops when there is a disruption at any level of the relationship between the hypothalamus, pituitary gland, adrenal glands and ovaries and develops with any endocrine pathologies.

Tubal-peritoneal infertility

Tubal infertility is spoken of when there is an anatomical obstruction of the fallopian tubes or when their functional activity is impaired (organic and functional infertility of tubal origin). The prevalence of sexually transmitted infections, indiscriminate change of sexual partners and early sexual activity, deteriorating environmental conditions contribute to an increase in the number of inflammatory diseases of the reproductive organs, including inflammation of the tubes.

The formation of connective tissue cords (adhesions) in the pelvis after an infectious process or as a result of genital endometriosis leads to fusion of the uterus, ovaries and tubes, the formation of constrictions between them and causes peritoneal infertility. 25% of cases of infertility in women (obstruction of the fallopian tubes) are associated with tuberculosis of the female genital organs.

Psychogenic infertility

As a rule, long-acting psychogenic factors affect the activity of the tubes, which leads to disruption of their peristalsis and infertility. Constant conflicts in the family and at work, dissatisfaction with social status and financial situation, feelings of loneliness and inferiority, hysterical states during the next menstruation can be combined into “pregnancy expectation syndrome.” Infertility is often observed in women who passionately dream of having a child or, conversely, are terribly afraid of becoming pregnant.

Infertility, which developed as a result of various gynecological diseases

This group of factors includes various diseases that make ovulation or subsequent implantation of a fertilized egg impossible. First of all, these are uterine factors: uterine fibroids and polyps, adenomyosis, endometrial hyperplastic processes, the presence of intrauterine synechiae or Asherman's syndrome (numerous curettages and abortions), complications after childbirth and surgical interventions, endometritis of various etiologies and chemical burns of the uterus.

Cervical causes of infertility include:

• inflammatory changes in cervical mucus (vaginal dysbiosis, urogenital candidiasis)
• anatomically altered cervix (after childbirth or abortion or congenital): cicatricial deformity, ectropion
• as well as background and precancerous processes - erosion, dysplasia.

Also, infertility of this group of reasons may be due to the subserous node of the uterus, which compresses the tubes, cysts and tumors of the ovaries, abnormalities in the development of the uterus (intrauterine septum, - “children’s” uterus), incorrect position of the genital organs (excessive bending or bending of the uterus, prolapse or prolapse uterus and/or vagina).

Infertility caused by immunological factors

Problems leading to the development of infertility include immunological factors, which are caused by the synthesis of antibodies to sperm, usually in the cervix, and less often in the uterine mucosa and fallopian tubes.

Factors that significantly increase the risk of infertility:

• age (the older a woman gets, the more various somatic and gynecological diseases she accumulates, and the condition of her eggs worsens significantly);
• stress;
• insufficient and malnutrition;
• excess weight or deficiency (obesity or weight loss diets, anorexia);
• physical and sports activities;
• bad habits (alcohol, drugs and smoking);
• the presence of hidden sexually transmitted infections (chlamydia, ureaplasma, human papillomavirus and others);
• chronic somatic diseases (rheumatism, diabetes, tuberculosis and others);
• living in megacities (radiation, water and air pollution from industrial waste);
• character type (emotionally labile, unbalanced women) and mental health status.

Frequency of occurrence

According to statistics, the incidence of certain forms of infertility has been determined:

• hormonal infertility (anovulatory) reaches 35 – 40%;
• infertility caused by tubal factors is 20–30% (according to some data, reaches 74%);
• the share of various gynecological pathologies accounts for 15–25%;
• immunological infertility is 2%.

But it is not always possible to establish the cause of infertility even when using modern methods examinations, so the percentage of so-called unexplained infertility is 15–20.

Diagnostics

Diagnosis of infertility in the weaker sex should begin only after establishing sperm fertility (spermogram) in a sexual partner. In addition, it is necessary to treat inflammatory vaginal and cervical diseases. Diagnosis should begin no earlier than 4–6 months after therapy. Examination of women unable to become pregnant begins at the outpatient stage and includes:

History taking

The number and outcomes of pregnancies in the past are determined:

• induced abortions and miscarriages
• the presence/absence of criminal abortions is specified
• also
• the number of living children is determined, how the post-abortion and postpartum periods proceeded (were there any complications).

The duration of infertility, both primary and secondary, is specified. What methods of birth control were used by the woman and the duration of their use after a previous pregnancy or in case of primary infertility.

The doctor determines the presence of:

• systemic diseases (thyroid pathology, diabetes, tuberculosis or others)
• Is the woman currently undergoing any drug treatment drugs that negatively affect ovulatory processes (taking cytostatics, x-ray therapy of the abdominal organs, treatment with neuroleptics and antidepressants, antihypertensive drugs such as reserpine, methindole, which provoke hyperprolactinemia, treatment with steroids).

Surgical interventions that may have contributed to the development of infertility and the formation of adhesions are also identified:

• wedge resection of the ovaries
• appendix removal
• operations on the uterus: myomectomy, caesarean section and on the ovaries with tubes
• operations on the intestines and organs of the urinary system.

The transferred ones are specified:

• inflammatory processes of the uterus, ovaries and tubes
• also infections that are sexually transmitted, the type of pathogen identified, how long the treatment lasted and what its nature was
• The nature of vaginal leucorrhoea and cervical disease is determined, and what method of treatment was used (conservative, cryodestruction or electrocoagulation).
• The presence/absence of discharge from the nipples (galactorrhea, lactation period) and the duration of discharge are determined.

The effect of production factors and the condition are taken into account environment, bad habits. The presence of hereditary diseases in first- and second-degree relatives is also determined.

Menstrual history must be checked:

• When did menarche (first menstruation) occur?
• Is your cycle regular?
• Is there amenorrhea and oligomenorrhea?
• intermenstrual discharge
• painful and heavy periods
• dysmenorrhea.

In addition, sexual function is studied, whether sexual intercourse is painful, what type of pain (superficial or deep), whether there is bleeding after coitus.

Objective examination

During a physical examination, the body type is determined (normosthenic, asthenic or hypersthenic), height and weight change and the body mass index is calculated (weight in kg / height in square meters). Weight gain after marriage, stress, changes in climatic conditions, etc. is also specified. The condition of the skin (dry or moist, oily, combination, the presence of acne, stretch marks), the nature of hair growth is assessed, the presence of hypertrichosis and hirsutism is determined, the time of appearance of excess hair growth.

The mammary glands and their development, the presence of galactorrhea, and tumor formations are examined. Bimanual gynecological palpation and examination of the cervix and vaginal walls are performed in speculums and colposcopically.

An examination by an ophthalmologist is prescribed to determine the condition of the fundus and. The therapist provides a conclusion allowing/prohibiting pregnancy and childbirth. If necessary, consultations with specialists (psychiatrist, endocrinologist, geneticist and others) are prescribed.

Functional diagnostic tests

In order to determine the functional state of the reproductive sphere (hormonal study), functional diagnostic tests are used, which help to identify the presence or absence of ovulation and evaluate the female body:

• calculation of the karyopyknotic index of the vaginal epithelium (KPI, %)
• identification of the “pupil” phenomenon - gaping of the external pharynx during the ovulatory phase;
• measurement of the tension length of the cervical mucus (reaches 8 0 10 cm in the ovulatory stage);
• measurement and graphing of basal temperature.

Laboratory research

Laboratory tests for infertility include infectious and hormonal screening. In order to detect infections, the following are prescribed:

• smear on the vaginal microflora, urethra and cervical canal;
• cytology smear from the cervix and cervical canal;
• smear from the cervical canal and PCR to diagnose chlamydia, cytomegalovirus and herpes simplex virus;
• inoculation of vaginal contents and cervical canal on nutrient media - identification of microflora, ureaplasma and mycoplasma;
• blood tests for syphilis, viral hepatitis, HIV infection and rubella.

Hormonal testing is performed on an outpatient basis to confirm/exclude anovulatory infertility. The function of the adrenal cortex is calculated by the level of excretion of DHEA-C and 17 ketosteroids (in urine). If the cycle is regular, testosterone, cortisol and the content of thyroid hormones in the blood are prescribed in the first phase of the cycle (5 – 7 days). In the second phase, it is assessed to determine the fullness of ovulation and the functioning of the corpus luteum (days 20–22).

To clarify the state of various components of the reproductive system, hormonal and functional tests are carried out:

• a test with progesterone allows you to identify the level of estrogen saturation in case of amenorrhea and the adequacy of the reaction of the uterine mucosa to progesterone exposure, as well as the peculiarity of its desquamation with a decrease in progesterone levels;
• cyclic test with combined oral contraceptives (Marvelon, Silest, Logest);
• a test with clomiphene is carried out in women with an irregular cycle or amenorrhea after artificially induced menstruation;
• a test with metoclopramide (cerucal) allows you to differentiate hyperprolactin conditions;
• test with dexamethasone - necessary for increased levels of androgens and determination of the source of their formation (ovaries or adrenal glands).

If the patient has pronounced anatomical changes in the tubes or the presence of intrauterine synechiae is suspected, she must be examined for tuberculosis (tuberculin tests, x-rays of the lungs, hysterosalpingography and bacterial examination of the endometrium obtained by curettage are prescribed).

Instrumental research

All women with suspected infertility are prescribed a pelvic ultrasound. Primarily to identify malformations, tumors, polyps of the cervix and uterus and other anatomical pathologies. Secondly, an ultrasound performed in the middle of the cycle allows you to identify the presence and size of the dominant follicle (in case of endocrine infertility) and measure the thickness of the endometrium in the middle of the cycle and a couple of days before menstruation. Ultrasound of the thyroid gland (if gland pathology and hyperprolactinemia is suspected) and mammary glands is also indicated to exclude/confirm tumor formations. Ultrasound of the adrenal glands is prescribed for patients with clinical hyperandrogenism and high levels of adrenal androgens.

If the rhythm of menstruation is disturbed, X-rays of the skull and sella turcica are taken to diagnose neuroendocrine diseases.

Hysterosalpingography helps diagnose uterine developmental anomalies, submucosal fibroids and endometrial hyperplastic processes, the presence of adhesions in the uterus and tubal obstruction, adhesions in the pelvis and isthmic-cervical insufficiency.

If immunological infertility is suspected, a postcoital test is prescribed (approximate day of ovulation, 12–14 days of the cycle), which detects specific antibodies in the cervical fluid to sperm.

An endometrial biopsy, which is obtained during diagnostic curettage, is prescribed in the premenstrual period and is carried out only according to strict indications, especially for those patients who have not given birth. Indications are suspicion of endometrial hyperplasia and infertility of unknown origin.

Endoscopic examination

One of the methods of endoscopic examination is. Indications for hysteroscopy:

• disturbance of the rhythm of menstruation, dysfunctional uterine bleeding;
• contact bleeding;
• suspicion of intrauterine pathology (Asherman syndrome, internal endometriosis, submucosal myomatous node, chronic inflammation of the uterus, foreign bodies in the uterus, polyps and endometrial hyperplasia, intrauterine septum).

If a surgical gynecological pathology is suspected, women with infertility (after a preliminary outpatient examination) are referred to laparoscopy. Diagnostic laparoscopy allows almost 100% of detection of pathology of the pelvic organs (genital endometriosis, space-occupying formations of the uterus and ovaries, pelvic adhesions, inflammatory process of the uterus and appendages). For endocrine infertility, laparoscopy is indicated after 1.5 - 2 years of hormonal treatment and no effect.

Laparoscopic intervention is performed in phase 1 or 2 of the cycle, depending on the expected disease. During the operation, the volume and quality of the peritoneal fluid, the ovaries, their size and shape, the color and patency of the fallopian tubes, the assessment of the fimbriae and peritoneum of the small pelvis are assessed, endometrioid heterotopias and peritoneal defects are identified.

Treatment of infertility in women depends on the form of the disease and the cause that led to the loss of fertility:

Infertility treatment - tubo-peritoneal infertility

Therapy begins with the prescription of conservative methods, and treatment should be comprehensive and step-by-step. If there is functional tubal infertility, psychotherapy, sedative and antispasmodic drugs and anti-inflammatory treatment are indicated. At the same time, correction of hormonal changes is carried out. If an STI is detected, the prescription of antibiotics is indicated, taking into account the sensitivity of the identified pathogens to them, immunotherapy, as well as absorbable treatment: local in the form of tampons and hydrotubations and the prescription of biostimulants and enzymes (lidase, trypsin, Wobenzym), corticosteroids. Hydrotubation can be performed with antibiotics, enzymes and corticosteroids (hydrocortisone).

After a course of anti-inflammatory treatment, physiotherapeutic methods are prescribed:

• , enzymes and biostimulants;
• ultraphonophoresis (using lidase, hyaluronidase, vitamin E in an oil solution);
• electrical stimulation of the uterus and appendages;
• irrigation of the vagina and cervix with hydrogen sulfide and arsenic waters;
• massage of the uterus and appendages;
• mud applications.

3 months after the course of treatment, hysterosalpingography is repeated and the condition of the tubes is assessed. If obstruction of tubes or adhesions is detected, therapeutic laparoscopy is indicated, which in the postoperative period is supplemented with physiotherapeutic methods and drugs to stimulate ovulation. The following microsurgical operations are performed using laparoscopy:

• salpigolysis – eliminate kinks and curvatures of the tubes by separating the adhesions around them;
• fimbryolysis – the fimbriae of the tube are freed from adhesions;
• salpingostomatoplasty – a new hole is created in a tube with a closed ampullary end;
• salpignosalpingoanastamosis - removal of part of an obstructed tube followed by end-to-end stitching;
• transplantation of a tube if it is obstructed in the interstitial region into the uterus.

If peritoneal infertility (adhesive process) is detected, separation and coagulation of adhesions is performed. If concomitant pathology is detected (endometrioid lesions, subserous and interstitial myomatous nodes, ovarian cysts), it is eliminated. The chances of pregnancy after microsurgical treatment are 30–60%.

If fertility has not been restored within two years after conservative and surgical treatment, IVF is recommended.

Endocrine infertility

How to treat endocrine infertility depends on the type and location of the pathological process. For women with anovulatory infertility and concomitant obesity, weight is normalized by prescribing a low-calorie diet for 3 to 4 months, physical exercise and taking orlistat. You can also take sibutramine, and if glucose intolerance is impaired, metmorphine is recommended. If pregnancy does not occur within a specified period of time, ovulation stimulants are prescribed.

In the case of diagnosed scleropolycystic ovarian disease (PCOS), the treatment algorithm includes:

• drug correction of hormonal disorders (hyperandrogenism and hyperprolactinemia), as well as therapy for excess weight and impaired glucose tolerance;
• if pregnancy does not occur during treatment, ovulation inducers are prescribed;
• if conservative treatment has not had an effect within 12 months, laparoscopy is indicated (resection or cauterization of the ovaries, exclusion of tuboperitoneal infertility).

If the patient has regular menstruation, normally developed genital organs, and the levels of prolactin and androgens are normal (endometriosis is excluded), the following therapy is carried out:

• single-phase COCs are prescribed according to a contraceptive scheme, in a course of 3 months and breaks between courses of 3 months (total number - 3 courses, duration of treatment 15 months) - the method is based on the rebound effect - stimulation of the production of own hormones by the ovaries after discontinuation of COCs and restoration of ovulation ( if there is no effect, ovulation inducers are prescribed);
• stimulation of ovulation is carried out with clostilbegit, human chorionic gonadotropin and progesterone (clostilbegit is taken 50 mg once a day during the first 5 days of the cycle, and to consolidate the effect, human chorionic gonadotropin is prescribed intramuscularly on the 14th day of the cycle) - the duration of treatment is 6 cycles in a row;
• stimulation of ovulation with FSH preparations (Metrodin, Gonal-F) from the first day of the cycle for 7–12 days until the maturation of the main follicle (ultrasound monitoring is required), the course is 3 months;
• stimulation of ovulation with FSH and LH drugs (pergonal, humegon) and the administration of human chorionic gonadotropin (pregnyl).

At the same time, immunomodulators (levamisole, methyluracil), antioxidants (vitamin E, unithiol) and enzymes (Wobenzym, Serta) are prescribed.

For regular periods and underdevelopment of the genital organs, the following treatment regimen is prescribed:

• cyclic hormone therapy with estrogens (microfollin) and gestagens (pregnin, norkolut) for a course of 6–8 months;
• vitamin therapy according to the phases of the menstrual cycle for the same period (in the first phase, vitamins B1 and B6, folic acid, in the second phase, vitamins A and E, and throughout the course of rutin and vitamin C);
• physiotherapy (electrophoresis with copper in the first phase and with zinc in the second);
• gynecological massage (up to 40 procedures);
• stimulation of ovulation with clostilbegit and human chorionic gonadotropin.

Women who cannot become pregnant due to hyperprolactinemia are prescribed drugs that suppress prolactin synthesis, restore the cycle (eliminating anovulation and increasing estrogen levels) and fertility, and reduce the symptoms of hypoestrogenism and hyperandrogenism. Such medications include parlodel, abergine, quinagomide and cabergoline. It is also recommended to take a homeopathic remedy - mastodinon.

Hyperandrogenism of ovarian and adrenal origin is treated for six months with dexamethasone, and if ovulation is restored, then ovulation is stimulated (clostilbegit, human chorionic gonadotropin, FSH and hCG or FSH, LH and hCG).

Treatment of infertility in patients with hypergonadotropic amenorrhea (resistant ovarian syndrome and exhausted ovarian syndrome) is unpromising. The prognosis for other forms of endocrine infertility is quite favorable; in approximately half of the cases, patients become pregnant within six months of ovulation-stimulating treatment (in the absence of other infertility factors).

Uterine and cervical infertility

Patients who cannot become pregnant due to hyperplastic processes of the endometrium (hyperplasia and polyps) and who do not have other factors of infertility are given treatment aimed at eliminating the pathologically altered uterine mucosa and normalizing hormonal and metabolic processes in the body. In the case of glandular cystic hyperplasia, curettage of the uterine cavity is carried out, followed by the administration of estrogen-gestagen drugs (3 - 4 months), and in case of relapse of the disease, hormonal treatment continues for 6 - 8 months. Uterine polyps are removed using hysteroscopy and then the endometrium is scraped out. Hormonal therapy is prescribed when polyps are combined with endometrial hyperplasia.

The choice of treatment method for patients with uterine fibroids depends on the location and size of the node. The submucosal myomatous node is removed hysteroscopically (hysteroresectoscopy), interstitial and subserous nodes no more than 10 cm are removed laparoscopically. Laparotomy is indicated for large uterine sizes (12 weeks or more) and atypical location of the nodes (cervical, isthmus). After conservative myomectomy, gonadotropin-releasing hormone agonists (Zoladex) are prescribed for 3 cycles. If a woman does not become pregnant within 2 years after myomectomy, she is referred for IVF. During the waiting period, ovulation is stimulated.

Treatment of patients with intrauterine synechiae consists of their hysteroscopic dissection and the administration of cyclic hormone therapy after the intervention for a period of 3 to 6 months. To reduce the chances of re-formation of adhesions in the uterine cavity, an IUD is inserted for at least a month. The prognosis for this disease is quite complex and is directly proportional to the degree and depth of damage to the basal layer of the endometrium.

In case of malformations of the uterus, plastic surgery is performed (dissection of the intrauterine septum or metroplasty of a bicornuate uterus or existing two uteruses).

Treatment of cervical infertility depends on the cause that caused it. In the case of anatomical defects, reconstructive plastic surgery is performed on the cervix; if polyps of the cervical canal are identified, they are removed, followed by curettage of the canal mucosa. When underlying diseases and endometrioid heterotopias are identified, anti-inflammatory therapy is prescribed, followed by laser or cryodestruction. At the same time, ovarian function is normalized with the help of hormonal drugs.

Immunological infertility

Treatment of immunological infertility is a complex task. Treatment is aimed at normalizing the immune status and suppressing the production of antisperm antibodies (ASAT). To overcome this form of infertility, the following methods are used:

Condom therapy

This method of treatment requires the complete exclusion of unprotected sexual intercourse (condoms are used) between partners. The effectiveness depends on the duration of compliance with the condition; the longer there is no contact, the higher the likelihood of desensitization (sensitivity) of the woman’s body to the components of her husband’s sperm. Condom therapy is prescribed for at least six months, after which they try to conceive a child naturally. The effectiveness of treatment reaches 60%.

Hyposensitizing therapy

Antihistamines are used (tavegil, suprastin), which reduce the body's response to histamine: relax smooth muscles, reduce capillary permeability and prevent the development of tissue edema. Glucocorticoids are also prescribed in small doses, which inhibit the formation of antibodies. The course of treatment is designed for 2 - 3 months, the medications are taken by the woman 7 days before ovulation.

In addition to taking antihistamines and glucocorticoids, it is recommended to prescribe antibiotics (the presence of a latent infection increases the secretion of antisperm antibodies). The effectiveness of this method of therapy is 20%.

Intrauterine insemination

Quite an effective method of treatment (40%). The essence of the method is the collection of seminal fluid, its special purification from surface antigens, after which the sperm is introduced into the uterine cavity (sperm bypass the cervical canal).

ECO

If all of the above methods for treating immunological infertility are ineffective, in vitro fertilization is recommended.

Traditional methods of treatment

The effectiveness of traditional treatment for infertility has not been proven, but doctors allow the use of herbal medicine as an addition to the main method of treatment. For tubo-peritoneal infertility, the following preparations are recommended:

• Collection No. 1

Mix and grind 100 gr. dill seeds, 50 gr. anise seeds, 50 gr. celery and the same amount of stinging nettle. Add half a liter of honey, stir and take 3 tbsp three times a day. spoons.

• Collection No. 2

For 20 minutes in a liter of water, boil 10 tablespoons of plantain leaves over low heat, then add a glass of honey and boil for another 10 minutes, cool the broth and then strain, drink 1 tablespoon three times a day.

• Collection No. 3

Three times a day, drink a tablespoon of plantain syrup (collection No. 2), and after 10 minutes, drink 75 ml of herbal decoction: geranium leaves, epiploin root, hair-like ossicle, shepherd's purse, hop cones, flowers and leaves of the common cuff . To prepare the decoction 2 tbsp. spoons, pour half a liter of water, boil for 15 minutes over low heat and strain.

It is also allowed to take herbs for infertility in the form of decoctions and teas that are rich in phytohormones, but under the supervision of a doctor: sage leaves and plantain seeds, knotweed and St. John's wort, marin root, ramshia herb. A large number of phytohormones are found in black cumin oil and ginger, in herbs and.

Question answer

What is needed for pregnancy?

In order for pregnancy to occur, several conditions are necessary. Firstly, a dominant follicle must mature in the ovary, after which the rupture of the egg is released and enters the abdominal cavity, and then penetrates the fallopian tube. Secondly, nothing should interfere with the advancement of the egg in the abdominal cavity and tube (adhesions, tube torsion). Thirdly, sperm must freely penetrate into the uterine cavity, and then into the tubes, where fertilization of the egg will occur. And lastly, the endometrium must be prepared (secretory and proliferative transformation) for implantation of a fertilized egg.

Where should you start testing for infertility?

The examination, of course, needs to begin with donating the husband’s sperm and conducting a spermogram analysis, since often the husband or both spouses are “to blame” for an infertile marriage.

Is the exact cause of infertility always determined?

Sadly, this is not always the case, even despite the use of new examination methods. If the factor of infertility is unclear, it is possible to prescribe a trial course of treatment, and depending on its results, the diagnosis is clarified, and the treatment itself may change.

What are the symptoms of infertility in women?

In addition to the absence of pregnancy for a year, a woman may be bothered by irregular menstruation, intermenstrual bleeding or spotting, pain in the lower abdomen during or on the eve of menstruation, dry skin, excess hair growth and acne.

If menstruation is painful, does it lead to infertility?

Painful menstruation in no way indicates a woman’s fertility, but rather indicates that ovulation has occurred. But if pain bothers you during and after sexual intercourse and does not decrease by the end of menstruation, then endometriosis, uterine fibroids, chronic endometritis and other gynecological pathologies should be excluded.

Will a woman necessarily become pregnant with twins or triplets after undergoing hormonal infertility treatment?

This is not at all necessary, although taking hormones stimulates ovulation and the simultaneous maturation and fertilization of several eggs is possible.

Is it always possible to get pregnant after infertility treatment?

Unfortunately, no method of infertility treatment has a 100% guarantee of pregnancy. Restoring fertility depends on many factors: the age of the spouses, the presence of somatic diseases and bad habits, the form of infertility, and other things. And even assisted reproductive technologies cannot guarantee 100% pregnancy.

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:

1. 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.
2. 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 long time proceed hidden, 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 under stress carry a child, 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 a woman strong feelings about the fact that she is not able 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.

Get an expert opinion

Leave your e-mail and we will tell you how to get properly examined and begin treatment

Survey

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 the 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 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”.