Female infertility is a type of gynecological disease in which a woman with regular unprotected sexual intercourse does not become pregnant for 1-2 years. Infertility can be caused by mental disorders of one of the partners, the presence of inflammatory processes in the body, pathological changes in the reproductive system. Diagnosis of the suspected disease should be carried out by an experienced gynecologist. He will be able to identify fertility problems with the help of the tests carried out, if there are any. The main thing to remember is that many problems with a woman’s gynecological health can be eliminated if you contact a specialist in time.
The content of the article:
What does “infertility in women” mean?
What are the causes of female infertility determined by gynecology?
Infertility diagnosis
Treatment of female infertility
Infertility in women
What does “infertility in women” mean?
A woman may think about the possibility of a diagnosis of infertility, provided that for 12 months with regular and unprotected sexual intercourse with the same partner, she does not manage to get pregnant. But do not panic right away, because for the development of absolute infertility in a woman’s reproductive system, irreversible anatomical changes must occur, in which conception of a child becomes completely impossible. These include the absence of some genitals: ovaries, fallopian tubes, uterus, as well as violations of their functional purpose. If infertility belongs to the “relative” type, then most likely the causes of its occurrence can be successfully eliminated with the help of medicine.
Gynecologists distinguish between primary and secondary forms of infertility. Primary infertility is called provided that the woman has never been pregnant. Accordingly, secondary infertility occurs only in those women who cannot get pregnant again.
The problem of infertility is quite common among married couples. Today, up to 15% of families face infertility. In no case can you blame only the woman. Up to 40% of cases in a married couple, a man turns out to be infertile. Problems of men’s health include disorders in ejaculation, defective sperm, impotence. The rest of the reasons for the inability to conceive a child falls on the shoulders of a woman. When a married couple encounters a problem of infertility, each of the spouses must undergo an examination.
Do not ignore the mental mood of each of the partners. It is so laid down by nature that one sexual act is not enough. A fruitful conception requires a positive attitude and desire of each of the partners. Often a dysfunctional social situation can also cause infertility in the family.
What are the causes of female infertility determined by gynecology?
Today, unfortunately, a disease called infertility is very common. The reasons for women can be very diverse. Prerequisites for the development of female infertility are:
increased and hyperactive prolactin secretion;
the formation of a tumor in the pituitary gland;
any menstrual cycle disorders such as oligomenorrhea and amenorrhea, formed on the basis of hormonal disorders;
congenital defects of the reproductive system;
pipe obstruction on both sides;
endometriosis;
the presence of adhesions in the pelvic cavity;
acquired pathologies of the functioning of the genitals;
inflammatory and tuberculous lesions of the reproductive system;
diseases and weakening of the immune system;
postcoital test with a negative result;
disorders in the mental perception of sexual acts.
Based on the listed prerequisites that lead to violations during conception of a child, the following forms of infertility are distinguished:
Hormonal or endocrine form;
Tubal-peritoneal form;
Uterine form;
Endometriosis form;
The immune form.
Infertility of the endocrine form indicates an unhealthy functioning of the hormonal regulation of the full menstrual cycle, through which ovulation occurs. Hormonal infertility in women is accompanied by anovulation. In this form of infertility, ovulation is absent, since the egg does not have time to mature or the formed mature egg does not exit from the follicle. This is typical for diseases of the hypothalamic-pituitary region and the presence of injuries, hyperactive secretion of the hormone prolactin, the development of polycystic ovary syndrome, progesterone deficiency, inflammatory and tumor lesions of the ovaries, etc.
Tubal-peritoneal infertility is caused by anatomical pathologies that occur on the way of moving an egg through thin fallopian tubes into the uterine cavity. In this case, both fallopian tubes should be either completely impassable, or simply absent. Peritoneal infertility is accompanied by the formation of obstacles between the ovaries and fallopian tubes. This form of infertility develops in the presence of adhesions or with atrophy of the cilia inside the fallopian tube, which, with a normal location, are engaged in the movement of the egg.
Infertility of the uterine form occurs with anatomical defects of the uterus, which can have both congenital and acquired character. Congenital uterine abnormalities are diseases such as:
hypoplasia — underdevelopment of the uterus during the formation of the body;
doubling of the uterus — the presence of an intrauterine septum or saddle uterus.
Acquired uterine defects include:
tumors;
scarring;
intrauterine synechia.
All acquired uterine defects arise as a result of surgical interventions in the uterine system.
Infertility of the endometriotic form is characteristic of 30% of women suffering from this disease. The fact is that the endometriotic areas in the ovaries and fallopian tubes do not allow the ovulation process to be fully carried out and the egg cell to be moved.
The form of immune infertility consists in the presence of a large number of antisperm bodies in the female body. This is a specific type of immunity that is produced by the body against the embryo or sperm.
Very rarely, with a full examination, it is possible to detect only one pronounced form of infertility in a woman. Basically, there is a combination of several.
Unfortunately, medicine is not yet able to 100% determine the causes of infertility. Today, a very common problem called infertility in women, the causes of which are still subject to detailed study. For 15% of women suffering from the disease, the reasons for the formation of the diagnosis remain unknown to science.
Infertility diagnosis
Infertility examination is performed using a complex group of methods. The first method is a detailed survey of the patient. With this method, the study of the problem begins. Every woman who is faced with suspected infertility should receive a full consultation with a gynecologist. The doctor must skillfully collect all the necessary information and make a detailed description of the patient’s state of health. At this stage, the answers to such questions are found out:
Complaints. The general well-being of the client is determined, the time frame of negative attempts to get pregnant, whether there are any pains in the genital area, features of the menstrual cycle, unusual discharge from the channels of the genital tract and mammary glands, the psychological mood of the family.
The history of family health. The genetic features of the patient’s health are being clarified. These include gynecological or infectious diseases of the mother and blood relatives, the age category of the parents is calculated at the time of the patient’s birth, their state of health during conception is clarified, the peculiarities of pregnancy, the harmful habits of the parents are clarified, their negative impact on the formation of a healthy fetus in the womb of the mother is predicted, etc.
The patient’s medical history. These include diseases that leave a mark on human health: infections of various types, traumatic injuries, pathologies.
Features of the menstrual cycle. Age-related features of the formation of menstrual secretions by the body are clarified, duration, regularity, volume, soreness, etc. are evaluated.
Development of sexual function. The patient finds out the age at which she began to live a sexual life, the conditions under which the first sexual intercourse took place, the number of partners, the patient’s attitude to sexual relations in marriage, the sensations experienced during sexual intercourse, methods of contraception that were used throughout her life.
Childbearing. The history of each past pregnancy, complications are found out, each labor activity is analyzed, all complications are studied.
The history of infertility treatment earlier, if this issue was relevant in the past.
After receiving subjective information about the patient’s state of health, the doctor conducts an objective examination. It can be of two types: special and general.
With the help of general methods and approaches, a diagnosis of a woman’s health is made. The general examination is focused on determining the type of physique, assessing the condition of the mucous membranes and skin, the nature of the hair in intimate places, the general state of the development of the mammary glands. In addition, an examination of the thyroid gland is necessarily carried out, the abdominal cavity is studied, observations of the temperature regime of the body, pressure are carried out.
The methods of the spectrum of special infertility examinations include specific studies of functional, laboratory, instrumental tests.
The most common functional tests in the diagnosis of infertility include:
creating a temperature curve that determines the moment of ovulation and ovarian activity;
determination of the cervical index, which displays the quality of cervical mucus, the level of estrogens in the body;
a postcoital test, in which the activity of sperm functionality is studied and the ability of the female body to antisperm protection is determined.
The main attention during the implementation of laboratory diagnostic methods to study the causes of infertility is drawn to the hormonal content of blood and urine. Hormonal tests are not recommended to be carried out immediately after examinations by a mammologist or gynecologist, after sexual intercourse or morning awakening, because the indicator of prolactin levels can be significantly changed. Hormonal tests are usually carried out several times in order to ensure the reliability of diagnostic results. With infertility, such tests are usually the most effective:
examination of the level of DHEA-C and 17-ketosteroids in urine — based on the results obtained, the function of the adrenal cortex is evaluated;
the study of the levels of testoteron, prolactin, thyroid hormones, cortisol — the analysis is performed based on the diagnosis of plasma in the blood at the end of the first week of the menstrual cycle. This examination helps to determine the assessment of the effect of these hormones on the follicular phase;
diagnosis of progesterone levels in blood plasma at the end of the 3rd week of the menstrual cycle, which is used to assess the functioning of the corpus luteum and the effectiveness of the ovulation process;
diagnosis of the level of follicle-stimulating hormone, prolactin, luteinizing hormone, estradiol, which is significantly manifested in menstrual disorders.
Hormonal tests are also very common today, with the help of which a more accurate and precise study of the state of health of individual parts of the reproductive system takes place, their reactions and mutual intolerance with individual hormones are determined. Such in the diagnosis of infertility include:
progesterone test, which helps to determine the level of estrogens in the patient’s body with amenorrhea, as well as to find out the behavior of the endometrium when administered progesterone;
estrogen is a progestogenic or cyclic test for interaction with only one hormonal drug;
the clomiphene sample is used to study the assessment of the level of interaction of the hypothalamic-pituitary-ovarian system;
a test with metoclopramide, which helps to find out the prolactinosecret ability of the pituitary gland;
the test with dexamethasone is used for patients in whose body there is an increased content of male sex hormones.
Colposcopy and radiography are very productive methods for determining infertility. In order to determine neuroendocrine pathology in a woman with an irregular and disturbed menstrual cycle, an X-ray of the skull is given. When diagnosing signs of endocervitis, erosion, they turn to the method of colposcopy in order to determine the chronic infectious process. Radiography of the fallopian tubes and uterus is performed on the basis of hysterosalpingography. With its help, tumors of the uterus and abnormalities of the development of a woman’s genitals are determined.
With the help of ultrasound, information about the patency of the fallopian tubes is obtained. Also, when examining infertility, diagnostic curettage of the uterine cavity is practiced, with the help of which the levels of changes in the endometrium are examined before each menstrual cycle.
Surgical methods are another group of infertility diagnostics. These include laparoscopy and hysteroscopy. Hysteroscopy is called endoscopic diagnosis of the uterine cavity based on an optical device-a hysteroscope, the introduction of which occurs through the external uterine pharynx. The World Health Organization has included hysteroscopy in a number of mandatory diagnostic standards for women suffering from uterine infertility.
For conducting hysteroscopy studies , the following indications are referred to:
infertility of various forms: primary or secondary, miscarriages before the first birth;
suspected endometrial polyps, hyperplasia, uterine malformations, intrauterine fusion, adenomyosis;
disrupted menstrual cycle, unplanned bleeding from the uterine cavity, copious menstruation;
fibroids in the uterine cavity.
With the help of hysteroscopy, an internal examination of the uterine cavity, the cervical canal, the mouths of the uterine lips is performed, the endometrium is evaluated.
Laparoscopy is called an endoscopic method, which is used to diagnose the pelvic cavity and adjacent organs with the help of precise optical equipment. The device is inserted through a micro-incision of the abdominal wall. This method is particularly accurate to 100%. Laparoscopy is very demanding to the conditions. For its passage, inpatient conditions and general anesthesia are required.
Laparoscopy is mainly used for such indications:
infertility of different forms: primary and secondary;
ovarian apoplexy, ectopic pregnancy, uterine perforation;
endometriosis;
obstruction of the fallopian tubes;
cystic ovarian changes;
uterine fibroids;
adhesive processes;
cyst.
One of the main advantages of laparoscopy is the bloodlessness of the operation. After such a surgical intervention, there are no scars on the patient’s body, and there are also no unpleasant pains.
Endoscopic methods of surgery are low-traumatic methods of examination of the genital cavity, which manage to combine the effectiveness of infertility diagnosis, which has given widespread use for women of reproductive age suffering from infertility problems.
Treatment of female infertility
The treatment of female infertility is based on detailed diagnostic indications. Correctly elucidated causes of infertility in a woman will help to develop an effective approach to restoring the patient’s health.
Female infertility is treated on the basis of two main therapeutic methods:
Renewal of the reproductive characteristics of the female body through the use of surgical or conservative methods.
Appeal to alternative additional reproductive technologies in the absence of the possibility of conception naturally.
Endocrine infertility requires ovarian stimulation and correction of hormonal disorders. In such a situation, the non-drug form of treatment includes the stabilization of weight indicators with the help of physical activity and diet therapy. Drug treatment is based on the use of hormone therapy. With the help of ultrasound monitoring, constant monitoring of the maturation of the follicle is carried out. It is very important to carefully follow the requirements and prescriptions for hormonal treatment. Then 80% of patients suffering from endocrine infertility will be able to get pregnant.
Tubal-peritoneal infertility is treated by restoring good patency of the fallopian tubes. Treatment is performed mainly by laparoscopy. The method is 40% effective. If the desired result is not achieved, gynecologists advise to turn to artificial insemination.
Infertility of the uterine form is treated on the basis of reconstructive plastic surgery. In this case, the chance of getting pregnant naturally increases by 20%. In case of a negative result of using the method, gynecologists advise resorting to the services of professional surrogacy.
Endometriotic infertility can be cured using laparoscopic endocoagulation. When treated with this method, it is possible to find out the pathological foci and remove them. The result achieved with the help of laparoscopy is fixed by additional medical treatment. The effectiveness of treatment is characterized within 40%.
Infertility of the immunological form is treated by artificial insemination. The method is based on insemination with the husband’s sperm. Thus, contact with the immune system of the female body in the cervical canal is avoided. The effectiveness of the method is equal to 40%.
But, unfortunately, not all forms of infertility lend themselves to such a detailed study and understanding of their nature of occurrence. And if the cause of infertility is not known, then the possibilities of prescribing rational and effective treatment are limited. In such cases, doctors suggest resorting to artificial insemination methods. In addition , the following indications have been determined by medicine:
absence of fallopian tubes or tubal obstruction;
the condition after the use of surgical methods and laparoscopy regarding endometriosis;
a negative result in the treatment of endocrine infertility;
absolute male infertility;
complex cases of uterine infertility;
depletion of ovarian functions;
pathologies in which pregnancy is practically impossible.
The main methods for carrying out artificial insemination include:
insemination with donor sperm (husband’s sperm) intrauterine;
intracellular injection of sperm into the egg;
method of in vitro fertilization;
surrogate motherhood.
Remember that both partners should take part in infertility treatment. The effectiveness of treatment directly depends on the age indicators of both spouses. More importance is given to the age of the woman. At the first signs of infertility of any form, you should immediately seek advice from an experienced doctor. It is very important for a woman not to lose faith in herself and her partner, because a lot of things are fixated on the mood. Many forms of infertility have already been defeated, so it’s worth trying to solve the problem.
