Infertility in women - causes, symptoms, diagnosis and treatment

Female infertility - Manifest lack of pregnancy for 1.5 - 2 years and a woman, living a regular sexual life without contraception. There are absolute infertility associated with irreversible pathological conditions, exclusive conception (malformations of female genitalia), and relative infertility amenable to correction. Also distinguish between primary (if a woman did not have any pregnancy) and secondary infertility (if there was a history of pregnancy). Female infertility is a serious psychological trauma for men and for women.

  • Causes of female infertility
  • Infertility Diagnosis
  • Female Infertility Treatment
  • Infertility in women - Treatment

  • Infertility in women

    anomalies of genitals). With relative infertility reasons it caused, can be subjected to medical correction.

    Also distinguish primary infertility - in the absence of a history of a woman is pregnant, and secondary - if you can not re-occurrence of pregnancy. Infertility in marriage occurs in 10-15% of couples. Of these, 40% of infertility cases the causes are rooted in the male (impotence, defective sperm, ejaculation disorders), the remaining 60% - it's about female infertility. The causes of infertility can be a violation related to health of one spouse or both of them, so you need a survey of each of the partners. In addition to factors of physical health, infertility can result in marital mental and social disadvantage. To choose the right tactics treatment of infertility is necessary to determine the reasons why he had been summoned.

    increased secretion of prolactin;
  • pituitary tumor formation;
  • various forms of violations of the menstrual cycle (amenorrhea, oligomenorrhea, etc.), caused by the violation of the hormonal regulation;
  • birth defects genital anatomy;
  • bilateral tubal obstruction;
  • endometriosis;
  • adhesions in the pelvis;
  • acquired malformations of the genital organs;
  • tuberculous lesion genitals;
  • systemic autoimmune diseases;
  • negative postcoital test;
  • psychosexual disorders;
  • unknown cause of infertility.

  • Depending on the reasons that lead women to problems with conception, classify the following forms of female infertility:

  • The endocrine (or hormonal) form of infertility
  • Tuboperitoneal form of infertility
  • The mother form of infertility
  • Infertility caused by endometriosis
  • Immune infertility form
  • Infertility of unknown origin

  • The endocrine form of infertility is caused by a violation of the hormonal regulation of the menstrual cycle, ovulation provides. For endocrine infertility is characterized by anovulation, t. E. Lack of ovulation due to absenteeism nevyzrevaniya egg or ovum from the follicle. This can be caused by injury or diseases of the hypothalamic-pituitary region, excessive secretion of the hormone prolactin, polycystic ovary syndrome, progesterone deficiency, tumor and inflammatory lesions of the ovary, and so on. D.

    Tubal infertility form occurs in cases where there are anatomical obstacles in the way of promotion for the egg fallopian tubes into the uterus, t. E., Both fallopian tubes are absent or are impassable. In peritoneal infertility obstruction does not occur in the fallopian tubes themselves, and between the tubes and the ovaries. Tuboperitoneal infertility usually occurs as a result of adhesive processes or atrophy of the cilia inside the pipe to ensure the promotion of the egg.

    The masterbatch form of infertility is caused by anatomical (congenital or acquired), uterine defects. Congenital uterine anomalies are its underdevelopment (hypoplasia), doubling the presence of saddle uterus or intrauterine septum. Acquisition of uterine defects are intrauterine adhesions or scar deformity, tumor. Acquired uterine malformations develop as a result of intrauterine interventions, which include surgical abortion - abortion.

    Infertility caused by endometriosis is diagnosed in approximately 30% of women suffering from this disease. The mechanism of the impact of endometriosis on infertility completely unclear, but it can be stated that the areas of endometriosis and ovarian tubes inhibit normal ovulation and egg movement.

    The emergence of forms of immune infertility due to the presence of sperm antibodies in women, that is, specific immunity produced against sperm or embryo. In more than half of cases, infertility is not caused by a single factor, but a combination of 2-5 or more reasons. In some cases, the causes of the infertility remains unknown, even after a full examination of the patient and her partner. Infertility of unknown origin found in 15% of the surveyed couples.

    consulting gynecologist. Important is the collection and evaluation of information about the patient's general and gynecological health. At the same time clarified:

  • Complaints (health, the duration of the absence of pregnancy, pain, its location and connection with menstruation, changes in body weight, the presence of secretions from the breast and reproductive tract, and psychological climate in the family).
  • Family and hereditary factors (infectious and gynecological diseases in the mother, and the next of kin, the age of the mother and father at the birth of the patient, the state of their health, bad habits, number of pregnancies and births to mothers and their course, the health and age of the husband).
  • the patient's disease (previous infection, including sex, surgery, trauma, gynecological and comorbidities).
  • The character of menstrual function (age at first menstrual period, the assessment of regularity, duration, painful menstruation, the amount lost by the menstrual blood, the duration of existing violations).
  • Assessment of sexual function (age of onset of sexual activity, number of sexual partners and marriage, the nature of sexual relations in marriage - libido, frequency, orgasm, discomfort during intercourse, previously used methods of contraception).
  • Childbearing (availability and number of pregnancies, especially their occurrence, outcome during childbirth, the presence of complications in childbirth and after).
  • Methods of examination and treatment, if they were carried out earlier, and their results (laboratory, endoscopic, radiological and functional methods of examination, medication, surgical, physical therapy and other treatments and tolerability).

  • Methods of physical examination in the diagnosis of infertility

    physical examination methods are divided into general and specific:

    general survey methods in the diagnosis of infertility allow to assess the overall condition of the patient. These include inspection (determination of body type, evaluation of skin and mucous membranes, the nature of hair distribution, condition and degree of development of the mammary glands), palpation study of the thyroid gland, stomach, measurement of body temperature, blood pressure.

    Methods of special gynecological examination of patients with infertility are many and include laboratory, functional, instrumental and other tests. At gynecological examination estimated body hair, especially the structure and development of external and internal genital organs, ligaments, discharge from the genital tract.
    : From functional tests following are the most common in the diagnosis of infertility.
  • construction and analysis of the temperature curve (based on basal body temperature measurement data) - allow to assess the hormonal activity of the ovaries and ovulation commission;
  • definition cervical index - to determine the quality of cervical mucus on a scale that reflects the degree of saturation of estrogen the body;
  • postkoitusny (postcoital) test - carried out in order to study the activity of sperm in the cervical secretions and determine the presence of sperm bodies.

  • From diagnostic laboratory methods of the greatest importance for infertility have a study of hormones in blood and urine. Hormonal Tests should not be performed after the Breast and gynecological examinations coitus immediately after morning awakening, as the level of certain hormones, especially prolactin, thus may vary. It is better to spend hormonal tests several times to obtain more reliable results. When infertility informative following hormonal studies:

  • Studies DHEA-S (DHEA sulfate) and 17-keto steroids in the urine - to evaluate the function of the adrenal cortex;
  • Study prolactin, testosterone, cortisol, thyroid hormones (TK, T4 TSH) in the blood plasma at 5-7 days of the menstrual cycle - to assess their impact on the follicular phase;
  • study of progesterone in blood plasma at 20-22 days of the menstrual cycle - to assess the functioning of ovulation and corpus luteum;
  • Study level follicle, luteinizing hormone, prolactin, estradiol, and others. for violations of menstrual function (oligomenorrhea and amenorrhea).

  • In the diagnosis of infertility is widely used hormonal tests allow to define more precisely the status of individual units of the reproductive system and its response to the reception of a hormone. The most common infertility spend:

  • progesterone assay (with norkolutom) - in order to clarify the level of saturation of the body with estrogen and amenorrhea endometrial response to progesterone;
  • cyclic or estrogen-progestin trial with one of the hormones: Gravistat, non-ovlon, marvelon, Ovidon, Femoden, Silest, Desmoulins, triziston, trikvilar - to determine the reception of the endometrium to hormones, steroids;
  • klomifenovuyu sample (with clomiphene) - to assess the interaction of the hypothalamic-pituitary-ovarian system;
  • test with metoclopramide - to determine prolaktinosekretornoy ability of the pituitary gland;
  • test with dexamethasone - in patients with a high content of male sex hormones to identify the source of their generation (the adrenal glands or ovaries).

  • For the diagnosis of immune infertility forms are being identified content of sperm antibodies (specific antibodies to sperm - ASAT) in the blood and the patient's cervical mucus plasma. Of particular importance for infertility is screened for genital infections (chlamydia, gonorrhea, mycoplasmosis, trichomoniasis, herpes, cytomegalovirus, etc), Affecting women's reproductive function. Informative diagnostic methods for infertility are radiography and colposcopy.

    Patients with infertility caused by intrauterine adnations or adhesive obstruction of pipes, shown conducting a survey for tuberculosis (lung X-ray, tuberculin test, hysterosalpingoscopy, the study of the endometrium). To eliminate neuroendocrine disease (pituitary lesions) patients with disruption of the menstrual rhythm is carried out X-ray of the skull and sella. The range of diagnostic procedures for infertility colposcopy necessarily included to detect signs of erosion, cervicitis endocervicitis and serving the manifestation of a chronic infection.

    With hysterosalpingography (rengenogrammy uterus and fallopian tubes) revealed abnormalities and tumors of the uterus, intrauterine adhesions, endometriosis, blocked fallopian tubes, adhesions often causes infertility. Conducting Ultrasound allows you to explore the permeability of winding tubes. To clarify the status of the endometrium is performed diagnostic curettage of the uterus. The resulting material was subjected to histological examination and conformity assessment of changes in the endometrium of the menstrual cycle day.

    Surgical methods of diagnosing infertility

    For surgical infertility diagnosis methods include hysteroscopy and laparoscopy. Hysteroscopy - This endoscopic examination of the uterus using an optical device, the hysteroscope introduced through the outer cervix. In accordance with the recommendations of WHO - the World Health Organization introduced a modern gynecology hysteroscopy conduct a mandatory diagnostic standard for patients with uterine form of infertility.

    Indications for hysteroscopy are:

  • Infertility primary and secondary, habitual miscarriage;
  • suspected hyperplasia, endometrial polyps, intrauterine adhesions, abnormality of the uterus, adenomyosis, etc .;
  • menstrual rhythm, heavy menstruation, acyclic bleeding from the uterus;
  • fibroids growing in the uterus;
  • unsuccessful IVF attempts, and so on. d.

  • Hysteroscopy allows you to consistently inspect inside the cervix, uterus, its front, rear and side surfaces of the right and left the mouth of the fallopian tubes, to assess the condition of the endometrium and to identify abnormal formation. Hysteroscopic study is usually performed in a hospital under general anesthesia. During hysteroscopy the doctor can not only see the inner surface of the uterus, but also to remove some tumors or take a fragment of endometrial tissue for histological analysis. After hysteroscopy statement is made in the minimum (from 1 to 3 days) time.

    Laparoscopy is an endoscopic examination of organs and pelvic cavity through optical devices introduced through micro-incision anterior abdominal wall. The accuracy of laparoscopic diagnosis of close to 100%. As with hysteroscopy can be performed for infertility diagnostic or therapeutic purposes. Laparoscopy is performed under general anesthesia in a hospital.

    The main indications for laparoscopy in gynecology are:

  • Infertility primary and secondary;
  • ectopic pregnancy, ovarian apoplexy, uterine perforation and other urgent conditions;
  • obstruction of the fallopian tubes;
  • endometriosis;
  • uterine fibroids;
  • cystic changes of ovaries;
  • adhesions in the pelvis, and others.

  • The indisputable advantages of laparoscopy are bloodless operation, the absence of expressed pain and rough seams in the postoperative period, the minimum risk of postoperative adhesions process. Usually 2-3 days after laparoscopy the patient to be discharged from the hospital. Surgical endoscopic procedures are less traumatic, but highly effective in diagnosing infertility and its treatment, and widely used for examination of women of reproductive age.

    assisted reproductive technologies in cases where natural conception impossible.

    When endocrine infertility form the correction of hormonal disorders and stimulation of the ovaries. For non-medicated type of correction are normalized weight (obesity) by diet therapy and increased physical activity, physiotherapy. The main type of drug treatment of endocrine infertility is hormonal therapy. The process of follicle maturation is monitored by ultrasound and monitoring of the dynamics of blood hormone levels. With proper selection and compliance with hormone treatment in 70-80% of patients with this form of infertility comes baabelt.

    When tubal-peritoneal form of infertility treatment is to restore order to the Fallopian tubes using laparoscopy. The effectiveness of this method in the treatment of tubal peritoneal infertility is 30-40%. When long-existing pipe or an adhesive obstruction after failure before the operation, it is recommended in vitro fertilization. In embryological stage possible cryopreservation of embryos for their possible use, if necessary, re-IVF.

    In cases where the mother form of infertility - anatomical defects of its development - are carried out reconstructive plastic surgery. The probability of pregnancy in these cases is 15-20%. At impossibility of surgical correction of uterine infertility (absence of the uterus, expressed her malformations) and self-bearing pregnant women use the services of surrogate motherhood, embryos when replanting is carried in the womb held a special selection of a surrogate mother.

    Infertility caused by endometriosis, treated with laparoscopic endokoagulyatsii, during which removed the pathological lesions. Result laparoscopy fixed rate of drug therapy. The percentage of pregnancy is 30-40%.

    Immunological infertility is commonly used artificial insemination through artificial insemination with the husband. This method allows you to bypass the immune barrier of the cervical canal and contributes to pregnancy in 40% of cases of immune infertility. Treatment unidentified forms of infertility is the most difficult problem. Most often in these cases, resorted to the use of auxiliary methods of reproductive technology. In addition, the indications for IVF are:

  • tubal obstruction or absence of fallopian tubes;
  • condition after drug therapy and therapeutic laparoscopy for endometriosis;
  • unsuccessful treatment of endocrine forms of infertility;
  • absolute male infertility;
  • depletion of ovarian function;
  • some cases of uterine form of infertility;
  • associated pathology in which pregnancy is not possible.

  • The main methods of artificial insemination are:

  • method of intrauterine insemination with sperm donor or a husband's sperm (IISD, IISM);
  • in vitro fertilization (IVF) method;
  • intracellular sperm injection into the oocyte (ICSI method IMSI);
  • the use of donor eggs or donor embryos;
  • surrogacy.

  • The effectiveness of infertility treatment affects the age of both spouses, especially women (chance of pregnancy decreases sharply after 37 years). Therefore, to start infertility treatment should be as early as possible. And you should never be discouraged and lose hope. Many forms of infertility amenable to correction by conventional or alternative therapies.