What causes infertility in girls. Infertility in women - modern methods of treating pathology. How to start testing for infertility

To prevent infertility at an early stage, a woman needs to know the symptoms of infertility or other diseases that can lead to it. After all, we all know that a disease diagnosed in time gives more chances for successful treatment without consequences.

According to statistics, the number of cases of female infertility in our country is steadily growing year by year. About 20% of the female population of Russia in reproductive age cannot have children. There are many reasons for female infertility. According to the WHO classification, there are exactly 22 such reasons. In men, there are fewer causes of infertility, there are 16 of them. To understand the symptoms of infertility in women, you need to understand a little about the types and causes of this insidious disease. So, let's begin.

Types of infertility

The scientific name for female infertility is infertility (from Latin infertilis - infertile). Such a terrible diagnosis is made for a woman if during the year with regular sexual intercourse, she cannot become pregnant or bear a child (miscarriage occurs).

There are several types of female infertility:

• primary infertility;
• secondary;
• absolute infertility;
• relative.

Primary type of female infertility- this is infertility in a woman who has not previously given birth. According to statistics, her endocrine system, which works in violation, is to blame for this. Possible hormonal imbalance.

secondary view- infertility in a woman who has previously given birth. Also, this type of female infertility applies to those women who have had a miscarriage. With a secondary form of infertility after the birth of the first child or miscarriage, re-pregnancy does not occur. Basically, in 85% of cases, the causes are diseases of the genital organs.

Diagnosis absolute infertility put on a woman who does not have a fallopian (uterine) tube or uterus.

Temporary(another relative name) infertility in a woman means that there are factors preventing pregnancy. This type of infertility is very common in women who have had an abortion before.

Causes of female infertility

Around age 36, a woman's ovaries begin to produce fewer eggs. This means that it will become more difficult to get pregnant, and the likelihood of congenital pathologies in the child also increases.

insulin resistance This is one of the most common causes of female infertility. This happens due to the fact that in the female body the metabolism is disturbed due to the excess of the normal level of insulin in the body. The adrenal glands begin to produce more insulin than necessary. For this reason, a hormonal imbalance occurs in the female body, male hormones begin to be produced in large quantities.

Here are the main causes of female infertility:

1. Age.
2. Bad habits.
3. Excess weight or its lack. If a woman is overweight, this may mean that there is a hormonal disorder. Such a violation of the hormonal background is one of the causes of female infertility.
4. Frequent stress. At the moment of severe stress, the hormone prolactin begins to be produced in very large quantities, the hormonal balance is disturbed.
5. Exceeding the norm of the hormone prolactin. If the rate of this hormone is exceeded, it can affect the production of substances by the pituitary gland, which are necessary for the successful fertilization of the egg.
6. Blockage or very poor patency of the fallopian (fallopian) tubes. If the tubes are blocked, then the sperm will not be able to get to the egg to fertilize it.
7. A woman cannot bear a child. It happens that fertilization is successful, but after a miscarriage occurs, as a result of a malfunction in the body (genetic disorders, hormonal, etc.).
8. Chlamydia. This is a sexually transmitted infectious disease.
9. Polycystic ovaries. This is a common chronic female disease. The cause of the disease is in the change and abnormal structure of the gonads. With this disease, the hormonal background is disturbed, there is no ovulation.
10. Uterine fibroids are benign tumors in the uterus. If a woman has uterine fibroids, this means that the chances of a successful conception are reduced. Even if conception has occurred, the likelihood of a miscarriage is high.
11. Spikes. Adhesions in the pelvic area can lead to infertility. Such adhesions appear as a result of previous operations or inflammations. It is more difficult for sperm to get to the egg due to adhesions in the pelvic area.
12. Endometriosis - with this disease in the uterus, the mucous membrane (endometrium) is greatly enlarged. With endometriosis, the fallopian tubes can stick together and block the access of sperm to the egg.

Be sure to watch this very helpful video:

Symptoms of female infertility

It is very important to recognize the first symptoms of infertility. After all, diseases detected at an early stage are more successfully treated. If a woman suffers from infertility, then the first symptoms may begin to appear already from the moment of puberty.

Here are the main symptoms and signs:

1. Menarche (first menstrual bleeding) begins after 16 years of age.
2. Small or very large amount of discharge during menstruation.
3. Painful menstruation.
4. Pathologies of the genital organs (congenital and acquired).
5. A long menstrual cycle that occurs irregularly can be a symptom of female infertility.
6. Diseases of a chronic nature.
7. Diseases of the CNS (central nervous system).
8. Diseases and infections of the genitourinary system.
9. Too low or too much weight (less than 44 and more than 89 kg.).

Excess weight or lack of it is one of the causes of female infertility. You need to switch to proper nutrition.

The very first symptoms of a woman's problems are menstruation, which can be heavy or small, painful and irregular. Therefore, it is very important to pay special attention to this.

There are also secondary manifestations and signs of female infertility:

• increased hairline, especially on the face or back. This symptom may indicate a hormonal imbalance. There are more male hormones than necessary;
• acne and severe acne is also a symptom of female infertility. This happens, among other things, due to an overabundance of the male hormone;
• sparse hair in the pubic area or in the armpits. This could mean low levels of the female hormone estrogen.

For example, if a woman has a period of breastfeeding, infertility can also be observed. This is due to the fact that during lactation, the hormone prolactin begins to be produced in a woman. Prolactin suppresses the production of eggs by the ovaries during breastfeeding. Therefore, the hormonal background for successful conception and pregnancy must be normal and balanced.

How to treat?

The main and most important task in the treatment of female infertility is the restoration of the reproductive function of the female body. For successful treatment, the doctor must understand what is the cause of this disease. The symptoms, tests and external examination of the patient can help the doctor in this. After the conducted examinations and analyzes, the forthcoming method of treating the identified infertility will already be clear.

We have listed the most common female diseases leading to infertility. In total, according to the WHO classification, there are 22 such reasons. Only the most common ones are indicated here. Therefore, it is so important to undergo an examination by a gynecologist in order to establish the cause of infertility. There is no need to delay the examination, especially if you have not been able to get pregnant for more than a year.

Here are the main treatments:

1. Restoring ovarian function with hormonal therapy.
2. Treatment of a disease that caused infertility in a woman. These can be chronic diseases that can have a negative impact on the reproductive system.
3. Another effective way is insemination. Insemination is the artificial introduction of sperm into the uterine cavity. This method can be used for immunological infertility (you can read and watch a video about it). The probability of successful conception with this method is about 15%.
4. IVF (in vitro fertilization). This modern and reliable method of treatment (overcoming) of infertility, both male and female. With IVF, the fertilization of the egg occurs outside the female body using ICSI, PICSI or IMSI methods. After that, the already fertilized egg is implanted in the uterus. The success rate in this case is about 60%. You can learn more about IVF about IMSI, PIKSI and ICSI.
5. Donor egg. This method is used if the patient's eggs cannot be fertilized.
6. Surrogate motherhood is another method of overcoming (treating) infertility, in which the mother's egg is fertilized with the husband's sperm and the embryo is transferred into the uterus of a surrogate mother.

As it has now become clear, in the arsenal of doctors there are many means, methods of treatment and overcoming female infertility. All these methods are applied individually, depending on the situation.

Alternative treatment for female infertility

Alternative treatment comes down to general health promotion in general. The goal is to improve the functioning of the immune system and the emotional state of the expectant mother. A properly selected course of alternative treatment for female infertility will significantly increase the chances of a successful conception and a normal pregnancy.

Acupuncture can help with female infertility.

Alternative treatment will enhance the effect of the standard medical treatment of infertility if these two approaches are used simultaneously.

Here are alternative infertility treatments:

1. homeopathic remedies. Natural as well as natural substances will help restore the normal ovulation cycle and improve the psycho-emotional state of the expectant mother;
2. massage (reflexology). Special massage procedures at special points on the heels will improve the functioning of the reproductive system of a woman suffering from infertility;
3. Acupuncture allows you to stimulate the resumption of the work of the female body by inserting needles into the points of the energy centers of the body.

Important! Do not forget that such a serious disease as female infertility can only be treated under the supervision of a specialist. Do not self-medicate. Alternative methods can only be used with the permission of your healthcare provider.

Preventive measures

To protect yourself from such an ailment as infertility, you need to constantly “listen” to your body and carry out prevention. To prevent female infertility, it is important to fulfill the following conditions:

1. Rid yourself of bad habits.
2. Do not allow stressful situations, only calmness.
3. Proper nutrition without diets.
4. Hygiene.
5. Don't allow abortion.

If the female body works like a clock, then there should be no problems with conceiving and bearing a baby. Ideally, it is not necessary to allow the development of the disease, than to treat it for a long time and persistently. The right way of life has not yet killed anyone, but only made them stronger, healthier and better.

Be sure to watch this video, the doctor talks about female infertility, its symptoms and treatment:

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According to the latest statistics, about 3% of Russian women aged 20 to 45 have difficulty conceiving after their first birth, and 2% live with diagnosed infertility. Why does pathology appear and how to determine infertility in women? We will try to answer these and other questions in the article.

Reasonable fears about infertility should appear in the fair sex if, with regular intimate life without the use of contraceptive methods, pregnancy does not occur within 12 months or six months if the woman is over 35 years old.

Causes of infertility in women

All the factors that prevent the conception or successful bearing of a child cannot be immediately listed. The female body is a complex multi-level system that can fail for both physiological and psychological reasons. Of course, a certain number of infertility cases occur among men, but due to the difficult activity of the female reproductive system, the vast majority of couples cannot become parents precisely because of a malfunction in the woman's body.

Hormonal infertility in women

The egg matures in time and leaves the ovary due to the harmonious balance of estrogen, progesterone, luteinizing and follicle-stimulating hormones. When the fine ratio of these substances is violated, they speak of hormonal infertility.

The following hormonal disruptions can cross out dreams of a child:

• polycystic ovaries. With this disease, a large number of follicles appear in the ovaries, none of which matures, therefore, the egg is not released and ovulation does not occur. The size of polycystic ovaries is 3-6 times larger than normal, the duration of the menstrual cycle increases, while menstruation does not differ in regularity;
• insensitivity of the body to insulin. This condition often accompanies polycystic ovaries. Recent studies have confirmed that resistance to pancreatic hormone almost always develops due to hyperandrogenism - a high level of male sex hormones in the female body. In addition, pathology can develop on the basis of an unhealthy diet, stress and a sedentary lifestyle;
• excess male sex hormones. Hyperandrogenism inhibits the activity of the ovaries and prevents ovulation. With this disorder, a woman has irregular periods or their complete absence, strong body hair, acne, coarsening of the voice and a male-type figure;

• elevated levels of the hormone prolactin. Normally, the body actively produces this substance during lactation, however, the presence of large portions of prolactin in the blood in the absence of pregnancy leads to serious violations of the menstrual cycle, up to the complete cessation of menstruation;
• premature menopause. The physiologically reasonable time for the onset of menopause in women is 50 years, however, genetic disorders, autoimmune disorders and chronic diseases of the organs of the reproductive system reduce this period to 40 years. Accordingly, the synthesis of female hormones necessary for conception, ovarian activity and fertility fade prematurely;
• insufficiency of the corpus luteum. This gland is formed at the site of the follicle, from which the egg is ready for fertilization. It produces the hormone prolactin, which prepares the uterus for implantation of the embryo. Prolactin deficiency leads to the fact that the embryo either does not attach at all, or dies due to miscarriage.

Physiological infertility

Unfortunately, the causes of female infertility are not limited to hormonal factors. There are many physiological disorders that prevent a woman from experiencing the joy of motherhood. We list the most common pathologies affecting the female reproductive system:

• obstruction or injury of the fallopian tubes - occurs due to inflammatory reactions, infections of a viral or bacterial nature, sexually transmitted diseases, adhesions and scars after a surgical operation;
• endometriosis - doctors see the cause of this disorder in genetic "breakdowns", disturbances in the functioning of the immune and endocrine systems;
• uterine fibroids - a benign clot of muscle tissue appears on the uterus due to an increased level of estrogen in the female body. At risk are women who have had an abortion, severe stress, as well as those of the fair sex who now and then face metabolic disorders;

• adhesions and congenital anomalies in the structure of the uterus are another serious obstacle to motherhood. Adhesions are formed as a result of endometriosis, mechanical damage to the internal genital organs, and severe inflammation. Pathologies such as a unicornuate, bicornuate, or "baby" uterus arise on genetic grounds;
• inflammatory diseases of the pelvic organs - the result of various bacterial infections, in particular sexually transmitted infections (for example, gonorrhea, chlamydia).

Psychological infertility in women

To get pregnant, it is not always enough to have perfect physical data. According to doctors, the number of cases of so-called psychological infertility is growing every year. When a woman's conscious desire to have children comes into conflict with her subconscious fears and problems, it becomes difficult to conceive. Psychosomatics of infertility in women most often arises on the basis of:

• fear of loss of attractiveness due to pregnancy;
• fear of difficult childbirth;
• fear of becoming pregnant due to a miscarriage or the birth of a stillborn child in the past;
• conflicts and misunderstandings in the family;
• manic desire to have a baby;
• fear of losing time spent on pregnancy and raising a baby;
• tactless pressure from relatives and friends;
• fear of possible injuries and pain during childbirth;
• lack of confidence in the mother's vocation;
• psychological trauma in childhood;
• fear of radical change;
• bad relationship with your own mother.

The problem of psychological infertility must be solved together with a competent specialist - a psychotherapist or psychiatrist. Ordinary doctors are powerless here, since other physiological abnormalities in women are often not found. Pregnancy comes as soon as the expectant mother curbs her inner "demons".

Other causes of female infertility

There are a number of factors that prevent a woman from becoming pregnant, despite the fact that they are only indirectly related to reproductive processes:

What is infertility in women

Depending on the causes and conditions of development, female infertility is divided into several types.

According to the complexity of eliminating the cause that caused the pathology, and the degree of probability of conceiving a child in the future, infertility can be:

• relative. Drug treatment, successful correction of hormonal levels and metabolism, surgery to restore childbearing function sooner or later leads to the fertilization of the egg and successful implantation of the embryo;
• absolute. A woman will not be able to get pregnant naturally, no matter what methods of treatment she uses.

Also distinguished:

• primary infertility in women - having decided to become a mother for the first time, a woman cannot become pregnant;
• secondary infertility in women - in the past there was a pregnancy (successful or unsuccessful).

According to the conditions of development, infertility can be acquired and congenital.

For the reasons that formed the basis of the pathology, there are:

• endocrine infertility in women (impaired activity of the endocrine glands);
• tubal infertility, when conception is impossible due to impaired patency of the fallopian tubes;
• infertility due to uterine pathologies;
• infertility due to endometriosis;
• peritoneal infertility, when tubal patency is in order, but adhesions or scars in the pelvic organs prevent conception;
• immunological infertility, when the female body "protests" against pregnancy, producing antibodies in response to the appearance of spermatozoa or an embryo;
• idiopathic infertility, when the cause of the pathology after all types of examination remains unclear.

Diagnosis of infertility in women

Modern medicine has a large set of diverse diagnostic methods to determine whether a woman is infertile or not. The need to seek professional help arises in women after the appearance of obvious signs of infertility - the absence of pregnancy for 12 months of regular attempts to conceive a child, the absence of menstruation or an irregular monthly cycle, various "female" diseases.

To find out what tests are given for infertility in women, you need to come for a consultation with a gynecologist or reproductologist. The following tests help to establish the real cause of infertility:

• checking the hormonal background for the level of hormones that are directly related to conception. These are testosterone, prolactin, cortisol and progesterone;
• collection of biological material for analysis for diseases transmitted through sexual contact;
• immunogram - checks for the presence and evaluates the activity of antibodies to spermatozoa in the blood and mucus of the cervical canal;
• genetic analysis of chromosomal "breakdowns".

In addition to laboratory tests, a woman will have to undergo several examinations:

• Ultrasound for the study of the pelvic organs, assessment of the development of ovulation and the maturation of follicles;
• hysterosalpingography to assess the condition of the internal organs of the reproductive system by x-ray. Such a diagnostic method is no less informative than ultrasound;
• x-ray of the skull to exclude tumor formations and pathologies of the pituitary gland;
• colposcopy to detect symptoms of ectopia and cervicitis, which are usually accompanied by a strong inflammatory process;
• hysteroscopy, which is performed under general anesthesia. A hysteroscope inserted through the vagina displays the actual position and condition of the internal genital organs and mucous membranes;
• laparoscopy to examine the pelvic organs with special optical instruments through a miniature incision in the abdomen.

Treatment of infertility in women

As soon as an objective reason is established that prevents the couple from having offspring, the woman will be prescribed medical or surgical treatment.

Therapeutic treatment of infertility in women

Injections and fertility pills for women are prescribed when ovulatory processes require correction due to hormonal failure. The modern pharmaceutical market offers the widest range of drugs to restore female reproductive function. We list the most common of them:

1. Serofen and Clomid. Tablets contribute to the development of ovulation, stimulating the body to produce substances necessary for the maturation of the egg - gonadotropins, follicle-stimulating and luteinizing hormones.
2. Various hormonal drugs in the form of injections. Basically, doctors work with preparations of human chorionic gonadotropin, follicle-stimulating hormone, human menopausal gonadotropin, gonadoliberin. Practice shows that hormone-based drugs are more effective than other drugs in tablet form. Hormones are prescribed to stimulate ovulation and before IVF.
3. Utrozhestan. Progesterone in the basis of the drug helps the uterus to prepare for the attachment of a fertilized egg.
4. Duphaston. The active components of the drug are directly involved in the implantation of the egg to the wall of the uterus.
5. Bromocriptine. The drug prevents the production of excessive doses of prolactin in the body of a woman.
6. Tribestan. Taking the medicine, you can reduce the levels of estrogen and follicle-stimulating hormone to the required norm.

Surgical treatment of infertility in women

An operative method of infertility correction allows you to solve many issues, but this approach is relevant only at the first stage of treatment. Surgical treatment of female infertility is resorted to in the following situations:

• the need to get rid of polyps, fibroids or cysts. The extracted tissue must be biopsied to rule out the presence of malignant cells;
• treatment of advanced endometriosis, when the situation can no longer be corrected with pills;
• restoration of patency of sealed or previously tied fallopian tubes. This operation is of a high degree of complexity, and its success depends primarily on the period of blocking of the pipes and their present condition;
• excision of adhesions on the fallopian tubes.

With absolute infertility, doctors tell the patient about alternative ways to become a mother - there is always a chance to get pregnant with the help of assisted reproductive medicine.

Treatment of infertility in women with folk remedies

Phytotherapists offer their own methods of restoring the female reproductive system. As a rule, traditional medicine recipes are used in parallel with the main treatment program. Most often, the greatest hopes are placed on herbs for infertility for women.

The main and auxiliary infusions, which are used in combination, have an excellent stimulating effect.

To prepare the main collection, take the following ingredients:

• cuff grass yellow-green;
• boron uterus;
• plantain leaf;
• stinging nettle leaves in 2 parts;
• sage;
• elecampane rhizome;
• chamomile flowers;
• yarrow 1 part.

Mix ingredients and pour 1 tbsp. l. collection 1.5 tbsp. cold water. Boil the solution, and then reduce the heat to a minimum and cook for 5 minutes. After 1 hour, when the product is infused, pour it through a fine sieve. Ready infusion is taken during the day 3 times, 15 minutes before sitting at the table.

To prepare an auxiliary infusion, you will need the following herbs:

• motherwort herb - 3 parts;
• valerian root - 2 parts;
• lavender inflorescences;
• sweet clover yellow 1 part.

Prepare the infusion as described above. Drink the remedy 100 ml 1 - 1.5 hours before going to bed.

How to treat infertility in women with these infusions? It will take a very long time to prepare and take herbal infusions, right up to the very conception. At the same time, the main and auxiliary means stop drinking 3 days before the expected menstruation and resume 2 to 3 days after they end.

This is just one alternative treatment for infertility in women. How many of them, in fact, even experienced phytotherapists will not be able to calculate. A woman should voice all her thoughts about the treatment of infertility with folk remedies to the doctor.

To experience the joy of motherhood, the fair sex must take care of their health from their youth. Successful conception is provided by normally functioning ovaries, fallopian tubes, uterus and the entire endocrine system as a whole. Violation of the work of at least one component in this chain can lead to problems with the onset of pregnancy. It is also necessary to contact specialists if the issue of infertility is not raised, but there are alarming risk factors in the form of irregular periods, frequent inflammation of the external and internal genital organs, ectopic pregnancy.

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Infertility

The inability of an adult organism to produce offspring.

Infertility

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

Even in the last century, it was believed that only the woman was to blame for a childless marriage. The development of science has made it clear that men can also suffer from infertility. The advances in medicine, the growth of prosperity, the increase in life expectancy have led to the desire of people to have their own children, despite health problems. At the same time, environmental degradation, chronic stress, a change in the rhythm of life and a revision of family values ​​(when a career is put at the forefront, and offspring planning is postponed until a young age) affect the deterioration of the ability to conceive. Therefore, the problem of infertility today is quite acute. Medicine offers many ways to treat it - from hormone therapy to surgery. And when all the means have already been tested, and there is no result, IVF comes to the rescue.

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

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

The reasons due to which there is difficulty with conception and gestation can be divided into several groups:

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

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

Infertility in men

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

• Secretory, when the quality and quantity of sperm deteriorates.

It can be treated with medications and hormones.

• Obstructive.

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

• Immunological

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

• Relative

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

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

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

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

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

Causes of infertility

In male infertility are to blame:

• Infectious diseases, sexually transmitted.

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

• Varicocele.

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

• Trauma and congenital pathologies.

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

• Hormonal disorders.

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

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

• immune disorders

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

• Violations in the sexual sphere.

Impotence, premature ejaculation can also cause infertility in men.

• Bad habits.

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

• Unfavorable living conditions

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

• Stress and overwork.

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

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

• The age of the expectant mother.

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

• Underweight or overweight.

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

• Infections.

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

• Hormonal disorders.

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

• Endometriosis.

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

• immune causes.

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

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

Factors that increase the likelihood of infertility

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

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

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

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

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

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

What can be a factor of infertility of unknown origin?

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

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

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

Types of infertility

Primary infertility

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

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

Secondary infertility

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

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

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

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

1 degree infertility

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

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

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

2nd degree of infertility

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

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

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

3 degree infertility

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

Diagnosis of infertility

History taking and examination for signs of infertility

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

History may be:

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

Gynecological - here the doctor finds out:

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

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

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

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

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

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

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

Tests for hormone levels

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

sex hormones

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

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

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

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

Hormones of the adrenal cortex

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

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

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

• Thyroxine T4.
• Triiodothyronine T3.
• Thyroid-stimulating hormone.

Hardware and instrumental diagnostics

Diagnosis of infertility through special devices and tools includes:

• Ultrasound procedure

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

• Colposcopy

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

• Diagnostic curettage of the uterine cavity

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

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

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

• Hysterosalpingography (HSSG)

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

• Radiography

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

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

Hysteroscopy

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

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

Laparoscopy

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

The indications for the study are:

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

Infertility treatment

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

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

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

• PESA, MESA, TESE

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

• artificial insemination

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

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

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

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

Treatment of female infertility

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

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

What methods are used to treat female infertility?

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

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

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

When is IVF applied?

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

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

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

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

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

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

Cultivation (culturing) of embryos begins the day after the puncture of the follicles. First, the embryologist evaluates the fact of fertilization, the signs of which can be observed 17-18 hours after the union of male and female cells. Then the doctor observes the process of division of the embryos for 3-5 days, selects among them the most promising and without genetic abnormalities, and determines the best time for transplantation into the uterus. As a rule, embryos that have reached the blastocyst stage have the best chances - and this happens on the 5th day.

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

Period after IVF

Treatment of infertility through IVF has two outcomes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It often happens that a woman who lives a regular sexual life without contraception cannot conceive for a long time. She may begin to doubt that this joyful event will ever happen at all, but you should not rush to conclusions. You need to know what are the signs of infertility in women who will give a signal that there is a need for examination, establishing an accurate diagnosis and its causes.

It is important to understand that not all couples have a baby. "by magic wand", therefore, after making a diagnosis, it is worth being treated, if possible, and then your baby’s laughter will soon sound in the house.

What is infertility?

Doctors say that a person is infertile if, in the presence of a regular intimate life and the absence of contraception, there is no pregnancy within 1 year. But the reasons for this may be different, so you should not immediately talk about infertility.

You should not rush to conclusions, because a year is an approximate period. Nevertheless, in cases where conception does not occur for a long time, it is worth contacting a doctor.

There are such forms of this problem:

1. Primary. They talk about him if there has never been a conception;
2. Secondary. This refers to a history of pregnancy. At the same time, it does not matter whether it was worn out or for some reason frustrated;
3. Relative. Such a diagnosis is made if conception is impossible due to any diseases that prevent it from happening. But you can identify the problem, eliminate it through treatment and give birth to a baby;
4. Absolute. It is caused by pathologies that cannot be treated. Because of them, conception is impossible.

During the examination, the following types of infertility can be detected:

• Pipe. Adhesions, fluid filling and other diseases can occur in the fallopian tubes;
• Royal. The most common cause is endometriosis, in which cells grow in excess, filling the abdominal cavity, cervix, and other organs;
• Hormonal. Violation of the background leads to a number of diseases, and it is caused by improper activity of the ovaries. Usually the result is the absence or extremely rare occurrence of ovulation in girls and women;
• Idiopathic. They talk about him when no pathologies are detected, everything is in order with the woman’s health, and conception does not occur for uncertain reasons;
• Psychological. This is also a rather serious kind of problem. It can be caused either by fear of pregnancy and childbirth, or, conversely, by a strong desire to give birth to a baby.

signs

Almost all of the symptoms of infertility appear at a young age. That is why it is so important from the very beginning of puberty for a girl to monitor her health.

What are the signs of infertility in women and young girls?

1. The first menstruation began later than 16 years;
2. Excessive thinness caused by malnutrition, constant adherence to strict diets, improper or poor diet;
3. Incorrect structure of the reproductive organs. As a rule, such pathologies include tortuous fallopian tubes, absence or dysfunction of one or both ovaries, uterine hypoplasia;
4. Menstruation is scanty and does not last enough time (normal periods last about 3-7 days);
5. Irregularity of the menstrual cycle;
6. Cycle too long (usually more than 40 days).

Causes

All of these signs have reasons related to the structure and functioning of the female body.

Thus, women are at risk:

• Suffering from inflammation in the reproductive organs;
• who have been diagnosed with sexually transmitted infections;
• Surviving the removal of one or both ovaries at once;
• Having violations in the structure of the reproductive organs;
• who have been diagnosed with obstruction of the fallopian tubes.

It is not uncommon for a hormonal imbalance to be the cause of the lack of pregnancy. The main symptom of hormonal disorders is irregular periods, and their consequence and another of the signs is the absence of ovulation.

Often provoking factors are numerous abortions, so when you visit a doctor, you must inform him about them.

Ovulation

In 25% of cases, its absence is the cause of infertility. Usually a normal menstrual cycle indicates that ovulation occurs on time, but there are exceptions to this rule. In some cases, ovulation does not occur in every cycle, but this is not a sign of such a phenomenon as infertility.

1. The easiest way to determine it at home is to measure basal temperature. It rises on the day when the follicle ruptures, and before the onset of menstruation, the temperature decreases. If conception has occurred, it will remain high.
2. Tests are also used to independently determine ovulation. You can track ovulation with the help of ultrasound.
3. If the formed follicle has not ruptured, a follicular cyst may form, which may come out with the next menstruation, or may remain in the ovary.

In the latter case, or in the case of frequent relapses caused by hormonal imbalance, infertility may develop.

Diagnostics

A thorough examination will make it possible not only to establish the cause of the impossibility of conception, but also to get rid of the problem.

• If you notice the first signs of infertility, and this is usually a violation of the menstrual cycle, consult a doctor. The sooner you do this, the sooner you can deal with the phenomenon.
• To find out the reasons, a urine and blood test is performed. The level of hormones and sugar is detected, and an analysis is carried out for the presence of genital infections.
• In addition, ultrasound, manual examination, MRI, colposcopy are done.

Only on the basis of this complex of research methods, the doctor makes a diagnosis and develops a line of treatment.

male infertility

There are cases when a woman who considered herself unable to conceive becomes pregnant after she changes her partner. Most likely, her previous partner had problems associated with male infertility, but his signs were not noticed.