Female infertility symptoms. Causes of infertility in women, diagnosis and treatment

02.07.2020

Most young couples plan to have children. Some postpone the acquisition of offspring at the time when they can achieve material well-being. Others dream of becoming parents in the first year of marriage. If there is a problem with conception or a woman constantly has miscarriages, she and her husband are very worried, they begin to think about the causes and what treatment will help achieve the desired result. Often, after examination and elimination of pathologies in the reproductive organs, she manages to get rid of infertility and give birth to a healthy baby.

Content:

Types of female infertility

A woman is considered infertile if she is unable to conceive or bear a child for a year, provided that she has regular sex and does not intentionally use contraceptives. At the same time, she is aged 20-45 years, it is known for sure that her sexual partner is capable of childbearing (if necessary, this is established using semen analysis).

At the age of less than 20 years, pregnancy may not occur due to the incompleteness of puberty. After 45 years, the absence of pregnancy is usually associated with the approach of menopause, the depletion of the egg supply in the ovaries, and the predominance of anovulatory cycles.

Classification of infertility

Examining the patient, the gynecologist first of all finds out how long the woman does not get pregnant, what symptoms she has. There are the following types of infertility:

Primary infertility- this is when there is no pregnancy within a year after the onset of sexual activity (for example, due to a violation of the shape and size of the uterus). Secondary infertility- means the absence of pregnancy in a woman who already has a child.
Relative infertility. This condition is treatable, after the causes are eliminated, reproductive ability is restored. Absolute infertility. The onset of pregnancy is impossible in principle (a woman has irreversible pathologies in the reproductive organs).
congenital infertility- pathologies leading to the impossibility of conception (for example, ovarian cysts) occur even during the period prenatal development. Acquired infertility appears as a result of disorders that arose during puberty or in subsequent years.

In turn, both congenital and acquired infertility can be removable or irreversible.

Voluntary and involuntary infertility

Sometimes pregnancy does not occur due to the conscious suppression of the ability to conceive. In this case, they say that voluntary or forced infertility is observed. Voluntary infertility. The woman herself takes measures to prevent pregnancy. For this, she constantly uses contraceptives.

Comment: You need to know that long-term hormonal contraception can really lead to the disappearance of menstruation, the onset of early menopause and infertility. After 37 years, the probability of conception decreases many times over. The risk of having a child with genetic pathologies increases.

Forced infertility. Contraception is used as a forced measure to prevent conception if pregnancy may threaten the health or life of a woman.

Video: What is female infertility, causes, who is at risk

Causes of female infertility, signs of pathologies

Infertility in women is due to the inability to fertilize a mature egg in the fallopian tube. This happens in the following cases:

After leaving the ovary (ovulation), the egg for some reason fails to get into the fallopian tube.
Male sperm cannot enter the uterus or fallopian tubes, or the quality is too low.
Fertilization occurs normally, but there are pathologies in the uterus that make it impossible to secure the embryo in its wall and complete development. As a result, pregnancy is constantly interrupted at an early stage.

The cause of such situations is usually hormonal disorders in the body of a woman, developmental pathologies or diseases of the uterus and ovaries.

Hormonal disorders

Pregnancy occurs only in the presence of cycles with normal maturation of follicles and subsequent ovulation. At the same time, processes associated with changes in the ratio of estrogens and progesterone sequentially occur in each phase. In turn, the production of these substances is regulated by pituitary hormones (follicle-stimulating and luteinizing).

Other endocrine organs (thyroid gland, adrenal glands, etc.) are also involved in creating a general hormonal background. The cause of infertility in women is often a hormonal failure associated with a violation of their functioning.

Too much prolactin. The hormone is produced in the pituitary gland. This substance is responsible for the development of the mammary glands and other sexual characteristics, and also affects the production of progesterone (“pregnancy hormone”). Excess production of prolactin leads to a decrease in the level of other pituitary hormones (FSH and LH) and, accordingly, to a violation of the production of female hormones. For this reason, there is no ovulation, amenorrhea occurs, which leads to infertility. The causes of hyperprolactinemia can be diseases of the pituitary, pancreas and thyroid glands.

Hyperandrogenism. An excess of male sex hormones in a woman's body leads to the disappearance of menstruation and a change in appearance according to male type, infertility.

Polycystic ovaries. Many cysts form in the ovaries, they increase significantly in size. Despite the fact that the follicles mature, ovulation does not occur. The cycle is lengthened, menstruation can come with significant interruptions. There are pains in the lower abdomen, body weight increases. Increases the level of male hormones in the blood.

Insufficiency of the corpus luteum. This temporary gland is formed in the ovaries immediately after ovulation. Its function is to produce progesterone. The cause of the underdevelopment of the corpus luteum may be a malfunction of the pituitary gland or genetic reproductive disorders. The consequence of this condition is the underdevelopment of the endometrium and infertility. The embryo cannot stay in the uterus and dies.

Premature menopause. Too early ovarian failure occurs. The production of female sex hormones sharply decreases, the cycles become anovulatory, menstruation comes with long interruptions, and then disappears altogether. A woman develops symptoms such as hot flashes, osteoporosis, decreased libido.

Violation of the shape and structure of the uterus and appendages

Often, developmental pathologies or diseases of the uterus and ovaries become the cause of infertility. They are manifested by various menstrual disorders.

Obstruction of the fallopian tubes. When adhesions are formed, the tubal canal becomes overgrown. As a result, an obstacle appears in the path of the egg. Even if the lumen is partially overgrown, then due to damage to the cilia on the walls of the tubes, the fetal egg cannot move into the uterine cavity, an ectopic pregnancy occurs. The most common cause of adhesion formation is inflammation or damage to the tubes. If the process is one-sided, then pregnancy is possible. The most severe is the situation in which both pipes overgrow.

Endometriosis. With this disease, the endometrium grows and spreads beyond the uterine cavity. Particles of the mucous membrane enter the neck, on the ovaries. Due to the overlap of the neck or cavity of the organ, sperm cannot enter the tubes. Ovarian cysts that form as a result of endometriosis can interfere with the entry of eggs into them. In the presence of such a disease, about 30% of women suffer from infertility.

Myoma of the uterus. A benign tumor that forms in the uterine cavity often blocks the entrance to the tubes, making it difficult for sperm to enter them. If conception occurs, then a miscarriage is likely.

Inflammatory and infectious diseases. Inflammation of the uterus and appendages occurs as a result of bacteria entering them in an ascending way, as well as during curettage. Infection with certain types of pathogens occurs exclusively during sexual contact (venereal disease). After inflammatory processes scars remain in the uterus and on the ovaries, adhesions form. The development of the endometrium is disrupted, the composition of the mucus produced by the glands of the cervix changes. All this leads to infertility.

Improper development of the reproductive organs. Infertility in women may be the result of a congenital imbalance in the size of the body of the uterus, its cervix and tubes. It is possible to form partitions separating the cavity of the organ (bicornuate uterus). The small volume and change in the shape of the uterus cause the impossibility of conception, termination of pregnancy.

Malformations of the genital organs can also be acquired. The cause of their occurrence is trauma, damage during abortion or childbirth. The formation of the organs of the reproductive system is disrupted if a girl suffers from severe infectious diseases during the period of sexual development.

Factors contributing to infertility

Depending on the causes, gynecologists divide infertility into the following types:

endocrine (hormonal);
pipe;
uterine;
endometriosis;
immune (associated with autoimmune diseases);
psychogenic.

Aging contributes to the development of infertility female body, autoimmune diseases, hormonal imbalance. Weak physical development and excessive thinness are often the first signs of underdevelopment of the reproductive organs. An obsessive desire to lose weight (anorexia), adherence to a strict diet leads to amenorrhea and the complete disappearance of childbearing ability.

An important reason for the impossibility of conception is often psychological stress. Sometimes an impatient desire to give birth to a child, worries about the fact that pregnancy does not occur in any way lead to inexplicable infertility.

Note: There are cases when a desperate couple adopts someone else's child, after which she has her own baby. When a woman calms down mentally and ceases to listen intensely to the state of her body, her reproductive function is restored.

Diagnostics

It begins with a study of the prehistory of infertility. The doctor asks the patient about the diseases she has suffered, the methods of treatment, about what drugs the woman is currently using, and also about the nature of her menstrual cycle.

The causes of possible pathologies in a patient suffering from infertility are established visually by the type of physique, the presence or absence of facial and body hair. Signs of the presence or absence of ovulation are established (by the type of pharynx of the cervix, the nature of changes in the vaginal mucus). The data obtained by the woman herself by drawing up a graph of basal temperature are taken into account.

The contents of a smear from the cervix are analyzed (for microflora, cellular composition). A culture is done to determine the type of bacteria that caused the inflammation.

If immune infertility is suspected, a postcoital test is done on the 12-14th day of the cycle (cervical mucus is examined for the content of antibodies to spermatozoa).

A blood test is carried out by PCR to detect latent infections according to their genetic characteristics. Blood tests for ovarian and pituitary hormones are carried out at various periods of the cycle in order to notice abnormalities and find out their cause.

Examination of the uterus, ovaries and pelvic organs is carried out using ultrasound. X-ray of the skull allows you to detect diseases of the hypothalamic-pituitary system. Hysterosalpingography (x-ray of the uterus using a contrast agent) is used to study the state of the organ, detect tumors and obstruction of the fallopian tubes.

Hysteroscopy is performed to examine the inside of the uterus, to detect polyps and tumors. Curettage and subsequent histological examination of the material makes it possible to determine the cause of underdevelopment of the endometrium.

If necessary, a diagnostic laparoscopy is prescribed, with the help of which pathologies in the uterus and ovaries are detected. The presence of endometriosis is established.

Treatment

The choice of methods of treatment depends on the type of infertility, the presence of certain pathologies, their severity and location. Treatment is by conservative or surgical methods. The possibility of IVF is being studied.

With endocrine infertility it is recommended to take measures to normalize weight through diet and exercise. Hormonal therapy is carried out to eliminate hormonal failure in women and stimulate the ovaries. The treatment process is monitored by ultrasound and blood tests.

Tubal infertility in women. The main method of treatment is the surgical removal of adhesions and other neoplasms through laparoscopy. With complete fusion of both tubes, it is usually recommended to use artificial insemination methods. At the same time, depending on the condition of the ovaries, the patient's own eggs or donor eggs are taken.

Violation of the shape of the uterus. In this case, laparotomy metroplasty is performed - surgical restoration of the shape of the organ, elimination of partitions and scars in the cavity.

With endometriosis laparoscopic removal of foci of endometrial growth is performed in combination with hormonal therapy.

Polycystic. In order for the onset of pregnancy to become possible, first of all, the elimination of endocrine disorders and menstrual disorders is carried out. Drug stimulation of ovulation is carried out with the help of drugs Clomiphene or Metmorphine.

If conservative treatment fails, laparoscopic surgery is performed. It is possible to perform a wedge-shaped resection of the part of the ovary affected by cysts. Sometimes decortication is carried out, removal of the surface (cortical layer) and subsequent hormonal stimulation of the growth of follicles capable of ovulation.

An effective method is cauterization - incision of cysts in the ovaries with a laser knife. After removing their contents, they disappear, healthy tissue is formed.

The method of electrothermocoagulation is also used. In order for the eggs to leave the ovary, small holes are made in it.

The key to the effectiveness of treatment is an early visit to the doctor and the establishment of the cause of infertility. Timely getting rid of gynecological and endocrine diseases, controlling body weight can increase the chances of successful conception.

Video: Examination of women and treatment for infertility

(female infertility) is the impossibility of conception during the year of regular penetration, viable and active spermatozoa, naturally or artificially, into the reproductive organs of a woman of puberty. Infertility is also diagnosed if the pregnancy always ends in miscarriages. Up to 20% of couples are infertile.
Infertility in women should not be confused with non-carrying of a pregnancy, when a mature oocyte is successfully fertilized by a spermatozoon, but the pregnancy ends, at the stage of embryogenesis, in miscarriage or abortion.

A woman is not considered infertile if her partner is found to have non-viable, weak spermatozoa by laboratory methods, or they are completely absent.

The problem of infertility. The problem of infertility is now much more serious than it used to be, several centuries ago. The sexual revolution carries a serious responsibility, if only because it spreads infectious diseases. And young people no longer want to have children, the delay in pregnancy is growing more and more. If we take all infertile couples as 100%, then in 33.3% the man is infertile, in another 33.3% the woman is infertile, and in the remaining couples, both partners are infertile.

The causes of infertility can be malformations in the development of the reproductive system, dysfunction of the genital organs, severe intoxication and general diseases of the body, as well as mental and neurological disorders. Infertility does not belong to the group of independent diseases, it always appears as a result of various diseases organism. The main cause of female infertility is inflammatory diseases.

Physiology of monthly cycles

Infertility can be with disturbed and normal monthly cycles. The natural monthly cycle of a woman, lasting 21-35 days, consists of three consecutive phases.

1. Follicular phase - egg maturation (not less than 7 and not more than 22 days)

2. The ovulatory phase of maturation and release of a mature oocyte, the onset of the fertile period.

3. Luteal - phase of the corpus luteum, catabolism (from 13 to 15 days).

A few days before and after ovulation is called the fertile period (phase) - this is the time of the greatest probability of conception. Up to this point and after pregnancy cannot occur! However, it must be understood that different women this phase occurs at different periods of menstruation. If the cycle is not resolved by pregnancy, then the body, under the influence of estrogens, prepares for the next cycle.

Classification of infertility

Infertility may be:

primary - pregnancy has never occurred (congenital gynecological anomalies) or (complications on the female genital organs) before or after menarche (first cycle);

secondary, after the first successful pregnancy, the impossibility of repeated fertilization, can be absolute (incurable) or relative (curable).

In separate sources devoted to studies of the physiology and pathophysiology of the female genital area, the concept is supplemented by the following types of infertility.

Physiological. The norm is early infertility (before puberty), and postmenopausal infertility (after).

Voluntary. Otherwise, they call consciously chosen infertility - the use of (drug) drugs or physical (spiral, other) means.

Temporary. It may be the result of prolonged stress, weakening of the body after or during the period of illness, some authors refer to temporary infertility as lactational infertility - inhibition of ovulation in the early period of regular breastfeeding.

Constant. Removal of the female genital organs, complete or partial, is the result of surgical intervention.

An important sign indicating infertility in a woman is the inability to get pregnant for a year or more, if there are favorable conditions for conception, namely:

regular sexual intercourse;

sexual partner with a good spermogram;

complete, prolonged rejection of contraceptives;

the age of the woman is from 20 to 45 years.

Infertility does not have a pathognomonic (leading) sign, often asymptomatic, or has indirect symptoms. Signs of infertility are established during the collection of anamnesis, examination, physical, laboratory, instrumental studies.

Anamnesis. Establish clear symptoms associated with a violation of regular cycles: long, short, painful, profuse, with extraneous secretions. It is possible to assume infertility on the basis of establishing indirect symptoms characteristic of infectious, non-infectious and surgical diseases.

Physical examination

During physical examinations in the clinic, possible signs of infertility are:

body mass index less than or greater than 20-26;

condition of the skin and derivatives with signs of endocrine disorders;

unsatisfactory degree of development, mammary glands;

signs of soreness, seals in the projection of the female pelvic organs, with bimanual gynecological palpation;

signs of gynecological diseases detected when examining the cervix, using a vaginal mirror, colposcopy.

Laboratory and instrumental methods

Signs, possibly indicating infertility, are established in the process of laboratory and instrumental studies, with:

infectious screening for STIs;

hormonal screening to rule out endocrine infertility;

Ultrasound of the female pelvic organs, thyroid gland - hormonal infertility;

hysterosalpingography (HSG) - X-ray exclusion of symptoms of obstruction of the fallopian tubes;

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The desire to create a family, to raise a child is inherent in a girl from birth, is approved, supported by society, and the inability to conceive and give birth to a child is always a complete surprise for a woman.

A family without a child is considered incomplete, and spouses have to withstand pressure from relatives and society as a whole. And, although the couple does everything to recover, efforts are not always successful.

Problems with conception, according to statistics, are experienced by every third married couple, 15% of women cannot have their own children. The reason for the impossibility of having a child can be female and male infertility. Distinguish:

primary infertility - pregnancy without contraception did not occur within 1 year;
secondary - pregnancy occurred;
absolute - the inability to have children for anatomical reasons.

The most common causes of primary infertility are:

uterine tumors;
cyst, inflammation of the ovaries;
absence or irregular flow of menstruation;
appendicitis;
age - after 35 years, the fertility of a woman sharply decreases, by the age of 40 only 15% of women are able to give birth to a healthy child.

With secondary infertility, the following are added:

sexually transmitted infectious diseases;
endometritis;
artificial termination of pregnancy, ectopic pregnancy;
usage hormonal contraceptives, spirals.

Predisposing social factors are:

smoking;
alcohol consumption;
professional hazards;
stay in areas increased level ionizing radiation;
the action of drugs with hormonal activity;
cadmium, mercury, chromium, nickel compounds formed during the combustion of organic carbohydrates in the inhaled air;
stress.

Causes of infertility

endocrine infertility

The absence of conception in this type of infertility is caused by hormonal disorders in the process of maturation of the egg, its release into the fallopian tubes (ovulation). The ovulation process is regulated at several levels:

pituitary-hypothalamus-ovarian system;
thyroid gland;
adrenal cortex.

Violation of the synthesis of hormones at one of the levels leads to irregular menstruation, their complete absence. Hormonal status can be disturbed by stress, hard physical work, thyroid disease, and diabetes.

One of the options for endocrine infertility is an excess of male sex hormones. A sign of the disease is male pattern hair, in which:

at the back of the head, the hairline descends low;
there are bald patches on the forehead;
hair growth on the face is noted;
on the chest, around the nipples;
on the inside hips;
on the back.

Endocrine infertility is caused by a short luteal phase in the monthly cycle, progesterone deficiency in its second half. The occurrence of hormonal failure contribute to thyroid disease, inflammation of the appendages.

Hormonal reasons explain the absence of rupture of the follicle, the release of an egg from it, and the absence of ovulation. A frequent problem that causes the absence of pregnancy is a violation of the functions of the ovaries, insufficient thickness of the endometrium.

endometriosis

Endometriosis is a disease in which the lining of the uterus grows into other organs of the body. This violation occurs at any age, but more often after 25 years, and is found in 2/3 of women with infertility.

Growth of endometrial cells form foci in the small pelvis, affect the growth, maturation of eggs in the ovary, and prevent the embryo from attaching to the uterine wall. The focus of endometriosis in the fallopian tube prevents the fertilization of the egg by the sperm during ovulation.

Ovulation disorder

If the duration of the menstrual cycle exceeds 35 days or less than 3 weeks, then the egg develops with disturbances. She does not mature, is not capable of fertilization.

This is a common cause of hormonal infertility. The examination reveals a violation of the production of hormones at all stages of the formation of the egg. The problem of infertility may be ovarian dysfunction, the production of many non-functional follicles with the occurrence of polycystic disease.

The absence of ovulation is observed with early menopause, caused by unclear reasons before the onset of 45 years. The disease is rare, treated with hormonal drugs.

Obstruction of the fallopian tubes

Violation of the patency of the fallopian tubes is an obstacle to the fertilization of the egg and causes infertility in 30% of cases. Obstruction occurs when:

adhesive process after inflammation, abortion, complicated childbirth;
insufficient activity of the tubes with a lack of hormones progesterone and estrogen.

The causes of obstruction are adhesions caused by infection or endometriosis.

Inflammatory diseases

Up to 25% of problems with conception occur due to inflammatory diseases of the reproductive organs. Purulent inflammation of the appendages provoke adhesions in the small pelvis.

Adhesions, which are threads of connective tissue, arise as a result of penetration into the ovaries, fallopian tubes of chlamydial, tuberculosis infection. The adhesive process deforms the fallopian tubes, disrupts their patency.

Commissural filaments can motionlessly connect the fallopian tube and ovary to each other at the point of their contact, which makes it impossible for the egg to enter the fallopian tube.
The adhesive process can completely cover the tube and ovary, cause an infectious process in the tube, the formation of scar tissue.

In 1 case, the edge fringes of the pipe are damaged, the functions of which cannot be restored.

In case 2, the probability of egg fertilization is higher and depends on the severity of the adhesive process. In addition, the probability of conception is determined by the degree of damage to the cilia that line the tube and guide the sperm and the fertilized egg during movement.

In the event of the disappearance of the ciliated layer in the fallopian tube, scars form in its place; when the egg and sperm merge, the embryo does not descend into the uterus, but remains in the tube, which causes an ectopic pregnancy.

Adhesive processes can be caused by inflammatory diseases of the urethra, external genitalia. Secondary infertility rarely causes genital tuberculosis.

Tuberculosis bacillus often affects the fallopian tubes and endometrium. The disease is asymptomatic, causes irreversible changes in the fallopian tubes, and causes infertility.

Immunological diseases

The state of the immune system affects the functions of the reproductive system, and with a decrease in the barrier function of immunity, difficulties arise with conception, bearing a child, and lead to infertility.

Up to 2% of all infertile women suffer from immune infertility, this disease manifests itself in various forms:

"gluing" of spermatozoa in the genital tract;
destruction of spermatozoa by antibodies;
the impossibility for the embryo to implant in the endometrium.

The cause of infertility in 30% of cases is the production of antibodies to one's own cells. The most common reason for the lack of conception is the development of:

antibodies to the ovaries - antiovarian antibodies;
to spermatozoa - antisperm antibodies.

The production of anti-ovarian antibodies often causes idiopathic infertility, is detected in polycystic ovaries, endometriosis, and reduces the likelihood of pregnancy in the IVF program.

Antisperm antibodies are not an independent cause of infertility, but reduce the likelihood of its onset. The local immunity of the vaginal mucosa perceives spermatozoa as a foreign object.

Seminal fluid should provide suppression of local immunity of the vaginal mucosa. If this does not happen, the spermatozoa lose their mobility and the ability to fertilize the egg.

Uterine infertility

Congenital features of the genital organs, poor nutrition, past illnesses in childhood lead to uterine defects that prevent conception. Changes in the uterus prevent the attachment and development of the embryo.

Common disorders that cause infertility include a bicornuate, infantile, saddle uterus, a congenital septum in this organ, scars, and fusion of the walls.

Cervical infertility

In the cervical mucus of the cervix, sperm can be up to 7 days. All this time, the humoral factors of the mucus maintain the viability of the spermatozoa.

With an increase in the acidity of cervical mucus, the presence of antisperm antibodies, spermatozoa are immobilized and die.

Psychological causes of childlessness

The birth of a child may be hindered by subjective factors that are not supported by any medical reasons. Such a phenomenon is caused psychological reasons, usually seen in women.

The woman's brain perceives the fear of an unplanned pregnancy as an order and obeys it. The mechanism of psychogenic infertility is not fully understood, but consultations with a psychotherapist usually eliminate this cause and return the woman's reproductive ability.

Idiopathic causes

In percentage terms, the number of infertile couples due to idiopathic (unexplained) infertility decreases as diagnostic opportunities expand. Sometimes the cause of futile attempts to conceive a child is the excessive foresight of a woman who, after each sexual intercourse, douches with antiseptics, fearing infection.

Such cases are easily resolved in a confidential conversation with a gynecologist in a antenatal clinic. They will also do everything necessary to find the cause of infertility and restore reproductive health.

female infertility- is manifested by the absence of pregnancy for 1.5 - 2 years or more in a woman living a regular sexual life, without the use of contraceptives. There are absolute infertility associated with irreversible pathological conditions that exclude conception (anomalies in the development of the female genital area), and relative infertility that can be corrected. They also distinguish between primary (if a woman has not had a single pregnancy) and secondary infertility (if there was a history of pregnancy). Female infertility is a severe psychological trauma for both men and women.

General information

Diagnosis infertility” is placed on a woman on the basis if she does not become pregnant for 1 year or more with regular sexual relations without using contraceptive methods. They speak of absolute infertility if the patient has irreversible anatomical changes that make conception impossible (lack of ovaries, fallopian tubes, uterus, serious anomalies in the development of the genital organs). With relative infertility, the causes that caused it can be subjected to medical correction.

Infertility caused by endometriosis is diagnosed in approximately 30% of women suffering from this disease. The mechanism of the effect of endometriosis on infertility is not completely clear, however, it can be stated that endometriosis sites in the tubes and ovaries prevent normal ovulation and the movement of the egg.

The occurrence of an immune form of infertility is associated with the presence of antisperm antibodies in a woman, that is, a specific immunity produced against spermatozoa or an embryo. In more than half of cases, infertility is caused not by a single factor, but by a combination of 2-5 or more causes. In some cases, the causes of infertility remain unidentified, even after a complete examination of the patient and her partner. Infertility of unknown origin occurs in 15% of surveyed couples.

Diagnosis of infertility

Questioning method in the diagnosis of infertility

To diagnose and identify the causes of infertility, a woman needs a consultation with a gynecologist. Importance has the collection and evaluation of information about the general and gynecological health of the patient. This reveals:

Complaints (well-being, duration of absence of pregnancy, pain syndrome, its localization and connection with menstruation, changes in body weight, the presence of secretions from the mammary glands and genital tract, the psychological climate in the family).
Familial and hereditary factors (infectious and gynecological diseases in the mother and close relatives, the age of the mother and father at birth of the patient, their state of health, the presence bad habits, the number of pregnancies and childbirth in the mother and their course, the health and age of the husband).
Patient's diseases (past infections, including sexual, operations, injuries, gynecological and concomitant pathology).
The nature of the menstrual function (age of the onset of the first menstruation, assessment of the regularity, duration, pain of menstruation, the amount of blood lost during menstruation, the prescription of existing disorders).
Assessment of sexual function (age of onset of sexual activity, number of sexual partners and marriages, character sexual relations in marriage - libido, regularity, orgasm, discomfort during intercourse, previously used methods of contraception).
Childbearing (the presence and number of pregnancies, the characteristics of their course, the outcome, course of childbirth, the presence of complications in childbirth and after them).
Methods of examination and treatment, if they were carried out earlier, and their results (laboratory, endoscopic, radiological, functional methods of examination; medical, surgical, physiotherapeutic and other types of treatment and their tolerability).

Methods of objective examination in the diagnosis of infertility

Methods of objective examination are divided into general and special:

Methods of general examination in the diagnosis of infertility allow assessing the general condition of the patient. They include examination (determination of body type, assessment of the condition of the skin and mucous membranes, the nature of hair growth, the condition and degree of development of the mammary glands), palpation of the thyroid gland, abdomen, measurement of body temperature, blood pressure.

Methods of special gynecological examination of patients with infertility are numerous and include laboratory, functional, instrumental and other tests. During a gynecological examination, hair growth, structural features and development of the external and internal genital organs, ligamentous apparatus, and discharge from the genital tract are assessed. Of the functional tests, the most common in the diagnosis of infertility are the following:

construction and analysis of the temperature curve (based on basal temperature measurement data) - allow you to evaluate the hormonal activity of the ovaries and the occurrence of ovulation;
determination of the cervical index - determination of the quality of cervical mucus in points, reflecting the degree of saturation of the body with estrogens;
postcoitus (postcoital) test - is carried out to study the activity of spermatozoa in the secretion of the cervix and determine the presence of antisperm bodies.

Of the diagnostic laboratory methods, studies of the content of hormones in the blood and urine are of the greatest importance for infertility. Hormonal tests should not be performed after gynecological and mammological examinations, sexual intercourse, immediately after waking up in the morning, since the level of some hormones, especially prolactin, may change. It is better to conduct hormonal tests several times to obtain a more reliable result. In case of infertility, the following types of hormonal studies are informative:

study of the level of DHEA-S (dehydroepiandrosterone sulfate) and 17-ketosteroids in the urine - allows you to evaluate the function of the adrenal cortex;
study of the level of prolactin, testosterone, cortisol, thyroid hormones (T3, T4, TSH) in blood plasma on days 5-7 of the menstrual cycle - to assess their effect on the follicular phase;
a study of the level of progesterone in the blood plasma on days 20-22 of the menstrual cycle - to assess ovulation and the functioning of the corpus luteum;
study of the level of follicle-stimulating, luteinizing hormones, prolactin, estradiol, etc. in case of menstrual dysfunction (oligomenorrhea and amenorrhea).

In the diagnosis of infertility, hormonal tests are widely used to more accurately determine the state of individual parts of the reproductive apparatus and their response to the intake of a particular hormone. Most often in infertility is carried out:

progesterone test (with norkolut) - in order to determine the level of saturation of the body with estrogen in amenorrhea and the reaction of the endometrium to the introduction of progesterone;
cyclic or estrogen-gestagenic test with one of the hormonal drugs: gravistat, non-ovlon, marvelon, ovidon, femoden, silest, demulen, trisiston, triquilar - to determine the reception of the endometrium to steroid hormones;
clomiphene test (with clomiphene) - to assess the interaction of the hypothalamic-pituitary-ovarian system;
a test with metoclopramide - to determine the prolactin secretory capacity of the pituitary gland;
a test with dexamethasone - in patients with an increased content of male sex hormones to identify the source of their production (adrenal glands or ovaries).

For the diagnosis of immune forms of infertility, the content of antisperm antibodies (specific antibodies to spermatozoa - ASAT) in the blood plasma and cervical mucus of the patient is determined. Of particular importance in infertility is the examination for sexual infections (chlamydia, gonorrhea, mycoplasmosis, trichomoniasis, herpes, cytomegalovirus, etc.), affecting the reproductive function of women. Informative diagnostic methods for infertility are radiography and colposcopy.

Patients with infertility due to intrauterine adhesions or adhesive obstruction of the tubes are shown to be examined for tuberculosis (radiography of the lungs, tuberculin tests, hysterosalpingoscopy, endometrial examination). To exclude neuroendocrine pathology (pituitary lesions), patients with disturbed menstrual rhythm undergo an x-ray of the skull and sella turcica. The complex of diagnostic measures for infertility necessarily includes colposcopy to identify signs of erosion, endocervicitis and cervicitis, which are a manifestation of a chronic infectious process.

With the help of hysterosalpingography (x-ray of the uterus and fallopian tubes), abnormalities and tumors of the uterus, intrauterine adhesions, endometriosis, obstruction of the fallopian tubes, adhesions, which are often the causes of infertility, are detected. An ultrasound scan allows you to examine the patency of the fallopian tubes. To clarify the state of the endometrium, a diagnostic curettage of the uterine cavity is performed. The resulting material is subjected to histological examination and assessment of the correspondence of changes in the endometrium to the day of the menstrual cycle.

Surgical methods for diagnosing infertility

Surgical methods for diagnosing infertility include hysteroscopy and laparoscopy. Hysteroscopy is an endoscopic examination of the uterine cavity using an optical device-hysteroscope, inserted through the external uterine os. In accordance with the recommendations of the WHO - World Health Organization, modern gynecology has introduced hysteroscopy into the mandatory diagnostic standard for patients with uterine infertility.

Indications for hysteroscopy are:

primary and secondary infertility, habitual miscarriages;
suspicions of hyperplasia, endometrial polyps, intrauterine adhesions, anomalies in the development of the uterus, adenomyosis, etc.;
violation of the menstrual rhythm, heavy menstruation, acyclic bleeding from the uterine cavity;
fibroidsgrowing into the uterine cavity;
unsuccessful IVF attempts, etc.

Hysteroscopy allows you to sequentially examine the inside of the cervical canal, the uterine cavity, its anterior, posterior and lateral surfaces, the right and left mouths of the fallopian tubes, assess the condition of the endometrium and identify pathological formations. A hysteroscopic examination is usually performed in a hospital under general anesthesia. During hysteroscopy, the doctor can not only examine inner surface uterus, but also remove some neoplasms or take a piece of endometrial tissue for histological analysis. After hysteroscopy, discharge is made in the minimum (from 1 to 3 days) terms.

Laparoscopy is an endoscopic method of examining the organs and cavity of the small pelvis using optical equipment inserted through a micro-incision of the anterior abdominal wall. The accuracy of laparoscopic diagnosis is close to 100%. Like hysteroscopy, it can be performed for infertility for diagnostic or therapeutic purposes. Laparoscopy is performed under general anesthesia in a hospital setting.

The main indications for laparoscopy in gynecology are:

primary and secondary infertility;
ectopic pregnancy, ovarian apoplexy, uterine perforation and other medical emergencies;
obstruction of the fallopian tubes;
endometriosis;
uterine fibroids;
cystic changes in the ovaries;
adhesions in the pelvis, etc.

The indisputable advantages of laparoscopy are the bloodlessness of the operation, the absence of severe pain and rough sutures in the postoperative period, and the minimal risk of postoperative adhesions. Usually, 2-3 days after the laparoscopy, the patient is subject to discharge from the hospital. Surgical endoscopic methods are less traumatic, but highly effective both in diagnosing infertility and in its treatment, therefore they are widely used to examine women of reproductive age.

Treatment of female infertility

The decision on the treatment of infertility is made after receiving and evaluating the results of all examinations and establishing the causes that caused it. Usually, treatment begins with the elimination of the primary cause of infertility. Therapeutic methods used for female infertility are aimed at: restoring the patient's reproductive function by conservative or surgical methods; the use of assisted reproductive technologies in cases where natural conception is not possible.

With the endocrine form of infertility, hormonal disorders are corrected and the ovaries are stimulated. Non-drug types of correction include weight normalization (in case of obesity) through diet therapy and increased physical activity, physiotherapy. The main type of drug treatment of endocrine infertility is hormonal therapy. The process of maturation of the follicle is controlled by ultrasound monitoring and the dynamics of hormones in the blood. With proper selection and implementation hormonal treatment 70-80% of patients with this form of infertility become pregnant.

With tubal-peritoneal infertility, the goal of treatment is to restore the patency of the fallopian tubes using laparoscopy. The effectiveness of this method in the treatment of tubal-peritoneal infertility is 30-40%. With long-term adhesive obstruction of the tubes or with the ineffectiveness of a previous operation, artificial insemination is recommended. At the embryological stage, cryopreservation of embryos is possible for their possible use if repeated IVF is necessary.

In cases of uterine form of infertility - anatomical defects in its development - reconstructive plastic surgery is performed. The probability of pregnancy in these cases is 15-20%. If it is impossible to surgically correct uterine infertility (absence of the uterus, pronounced malformations of its development) and self-bearing a pregnancy by a woman, they resort to the services of surrogate motherhood, when embryos are transferred into the uterus of a surrogate mother who has undergone a special selection.

Infertility caused by endometriosis is treated with laparoscopic endocoagulation, during which pathological foci are removed. The result of laparoscopy is fixed by a course of drug therapy. The pregnancy rate is 30-40%.

With immunological infertility, artificial insemination is usually used by artificial insemination with the husband's sperm. This method allows you to bypass the immune barrier of the cervical canal and promotes pregnancy in 40% of cases of immune infertility. Treatment of unidentified forms of infertility is the most difficult problem. Most often, in these cases, they resort to the use of assisted reproductive technologies. In addition, indications for artificial insemination are:

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The effectiveness of infertility treatment is affected by the age of both spouses, especially women (the probability of pregnancy decreases sharply after 37 years). Therefore, infertility treatment should be started as early as possible. And you should never despair and lose hope. Many forms of infertility can be corrected with traditional or alternative ways treatment.

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, which 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:

Primary. They talk about him if there has never been a conception;
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;
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;
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?

The first menstruation began later than 16 years;
Excessive thinness caused by malnutrition, constant adherence to strict diets, improper or poor diet;
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;
Menstruation is scanty and does not last enough time (normal periods last about 3-7 days);
Irregularity of the menstrual cycle;
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.

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.
Tests are also used to independently determine ovulation. You can track ovulation with the help of ultrasound.
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 changing partners. Most likely, her previous partner had problems associated with male infertility, but his signs were not noticed.