female infertility. Absolute and relative infertility: what is the difference

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. It is important to collect and evaluate 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).
Family 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 of 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, nature of 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 administration 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 - SAT) 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 the inner surface of the 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 developing a postoperative adhesive process. 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 the right selection and observance of 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:

;

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 treatments.

03.03.2009

Infertility cannot be regarded as a purely medical problem. It concerns all fundamental spheres of family life: psychological, emotional, social. The number of childless couples in need of help is constantly growing. The causes of infertility are varied. They can be divided into objective and subjective. Objective factors include environmental pollution, a stressful lifestyle, malnutrition, lack of rest and physical activity, and subjective ones - families often decide to postpone the birth of a child for later, women take contraceptives for several years, and terminate pregnancy.

Modern science has taken a huge step forward in recent decades. Thanks to the latest discoveries, thousands of families have overcome the problem of childlessness and found the joy of motherhood and fatherhood.

Relative and absolute infertility

Infertility is considered both relative and absolute. Relative infertility refers to reversible problems associated with conception and childbirth, while absolute infertility is an irreversible condition that does not give a chance to have children.

The term "relative infertility" is used in cases where a married couple for two years, without using contraceptives, lives a regular sexual life, but pregnancy does not occur. Relative infertility is potentially reversible with more or less success, it all depends on the causes of occurrence, it is treatable. Absolute infertility is a completely different matter. If the reason is the physiology of one of the partners - for example, a woman does not have a uterus or a man does not develop spermatozoa, then only then they speak of absolute infertility. Doctors diagnose “absolute infertility” only in exceptional cases, because the rapid development of science makes it possible to solve this problem as well (in vitro fertilization, surrogate motherhood, etc.).

Theoretically, every woman is able to give birth to a child in the period from the first to the last menstruation. But the conception of a child is most likely if ovulation occurs regularly. This time begins a few years after puberty and ends a few years before menopause.

What is the reason?

The problem of infertility affects both partners. It is known that in 45% of cases the cause is a man, 45% - a woman and the remaining 10% - both or the cause cannot be determined.

The process of giving birth to a child is very complicated and consists of many periods, each of which may experience failures. At the first stage, an egg develops in the ovary of a woman, and spermatozoa develop in the testicles of a man. The egg is released from the ovary at the time of ovulation, and the sperm at the time of ejaculation. The egg and sperm must be in the fallopian tube at the same time for fertilization to occur. Then the fertilized egg begins to divide, and the embryo develops. Then it is introduced into the mucous membrane of the uterus. The process of development of the embryo must proceed successfully - until the very moment of birth. The slightest violation of at least one of its phases can make pregnancy and childbirth impossible.

female infertility

The causes of female infertility can be different, for example, metabolic disorders (diabetes, obesity, hypothyroidism - decreased thyroid function). The normal activity of the pituitary gland is very essential - this is the organ that controls the hormonal balance of the body. The pituitary gland is responsible for the functionality of the thyroid gland and the adrenal cortex, hypofunction and hyperfunction of which can lead to reproductive system disorders.

Infertility can be caused by diseases of the female genital organs: vagina (congenital malformations, inflammation, antibodies to spermatozoa in vaginal discharge), cervix (congenital malformations, tumors) or polyps. There are known malformations of the body of the uterus - for example, a bicornuate uterus, adhesions in its cavity, tumors, endometrial diseases or an abnormal reaction to hormonal influences - all this prevents the embryo from gaining a foothold in the mucous membrane and developing properly. Transferred inflammatory processes often lead to insufficient patency of the fallopian tubes, to a violation of their contractile activity. The ovaries of a woman, which are responsible for the formation of an egg, may be underdeveloped, in which case the eggs do not develop correctly. In chronic inflammatory processes, the maturation and release of germ cells is delayed, and as a result of tumors and cysts, ovarian tissues are reborn.

Psychological and emotional factors have a significant influence. Prolonged stress and nervous tension disturb the hormonal balance of a woman and often cause infertility.

male infertility

Male infertility has two main causes. The first is that normal sexual intercourse is not performed, the second is the inability to fertilize. The latter can be caused by violations of spermatogenesis by the testicles, diseases of the spermatic cords, malfunctions of the immune system, for example, the body produces antibodies against its own spermatozoa). In order for fertilization to occur, spermatozoa must meet certain parameters in terms of the quality of the genetic material, structure, quantity, viability and mobility. Much also depends on the composition of the seminal fluid, the patency of the seminiferous tubules and the vas deferens.

Special Studies

To determine the causes of infertility, a man and a woman need to consult a specialist who will determine the cause of this problem. The woman will have to undergo a gynecological examination, evaluate the monthly cycle, make bacteriological cytological and analyses, ultrasound diagnostics, laparoscopy and hysteroscopy, and sometimes hysterosalpingography. In a man, the genitals are examined, the level of hormones is determined, the seminal fluid and spermatozoa, chromosomes are tested, in some cases it is necessary to do a testicular biopsy. If the partners do not reveal abnormalities, they will be offered immunological tests in order to find out whether the husband's spermatozoa are able to penetrate the wife's cervical mucus, whether they are destroyed by specific antibodies. All studies take a lot of time, but they allow you to accurately determine the cause of infertility and prescribe the necessary treatment.

Treatment

The treatment for infertility depends on the cause. Psychotherapy helps those who have an emotional problem. In case of thyroid dysfunction, hormonal treatment is needed. Surgical intervention is prescribed for anatomical pathologies: tumors, adhesions, obstruction of the tubes. If the cause of infertility is the lack of ovulation in a woman or an insufficient number of sperm in a man, hormonal stimulation is suggested. Inflammatory processes of the cervix or vagina require antibiotic treatment. The last method, and sometimes the last chance for many couples, is assisted reproductive technologies: insemination (the husband's prepared seed is introduced into the uterus) and artificial insemination (fertilization "in vitro", or "in vitro"). The main essence of in vitro fertilization is that an egg is taken from a woman, and sperm from a man, they combine in the laboratory, and at the stage of a zygote (fertilized cell) or embryo they are introduced into the endometrium. The success of this treatment method is estimated at 25%.

The main thing is not to deviate from the intended goal and believe in a positive result of treatment and the onset of pregnancy! Therefore, believe that everything will work out. And want a baby!

In the modern rhythm of life, sometimes women do not pay due attention to their health. At first, everyone tries not to notice the problems, and when the doctors diagnose “Infertility”, they begin to complain about their fate. Modern medicine has come a long way. It helps to cope with all terrible diseases. It is worth studying in order what infertility is and how it manifests itself.

Detailed description of the diagnosis

Infertility is the inability of a couple to conceive a child naturally through regular and unprotected intercourse. Doctors make such a diagnosis if a woman is not able to conceive for one or more years. In the medical environment there is such a thing as absolute infertility. It is expressed not only in one inability to become pregnant, but also in the presence of irreversible anatomical changes. But first things first.
There are statistics that have impressive performance. For example, in the United States every fifth couple suffers from infertility. In Russia, the diagnosis is made by 10-15% of families. In 40% of couples, male infertility is to blame. It occurs for a number of reasons, for example:

infectious diseases;
seminiferous tubules are impassable;
hormonal imbalance;
low potency;
psychological disorders associated with the lack of potency.

Types of infertility

Experts divide infertility into two groups. One of them is called absolute. It is placed when there are irreversible anatomical changes in the female body and it is simply impossible to conceive a child naturally:

absence of ovaries and fallopian tubes;
no uterus;
poorly developed genitals.

If we single out absolute infertility as a separate phenomenon, then we can distinguish a number of main types of infertility:

male;
feminine;
combined;
incompatibility of a man and a woman;
endometriosis;
obscure or idiopathic infertility.

There are separate subspecies of female infertility, namely:

tubal infertility;
tubal-peritoneal;
endocrine.

Specialists highlight infertility cycle. It can be temporary or permanent. The first includes small changes in the body associated with a change in the time zone or with a sharp change in climate.
It is worth considering in detail each of the presented species.

Combined infertility

The problem of infertility in this case is associated with health disorders of both the male and female body. In such cases, specialists suggest being treated together with their partner.

Female and male incompatibility

Husband and wife are absolutely healthy, but conception does not occur. The answer lies in the incompatibility of the spouses, which is called biological or immunological. The causes of infertility lie in the production of antibodies. They are produced in the male and female body. It happens like this:

Antibodies in the male body accumulate in semen.
Female antibodies are concentrated in the mucous membrane of the cervical canal.
In turn, they completely block
work of male antibodies.

Incompatibility can manifest itself in Rhesus conflict. Before planning a child, you can undergo a diagnosis and identify if there is incompatibility in the couple. There are the following methods for this:

Postcoital test. It should be taken in the middle of the menstrual cycle, when a woman is ovulating. To do this, examine the posterior fornix of the vagina and the cervical canal.
Test for sperm permeability during ovulation. To do this, they are placed in the cervical canal of a woman.
Determination of sperm activity in the cervical canal.

Based on all the findings, experts make a diagnosis. For the reliability of the analyzes, it is recommended to refuse the use of hormonal drugs in the month in which you will undergo the examination.

endometriosis

This is a common gynecological disease. It may appear as:

dizziness;
heavy discharge during the menstrual cycle;
severe pain in the lower abdomen during intercourse.

If such symptoms are observed, this does not mean that there is endometriosis. It is sometimes difficult to establish on ultrasound. Patients may experience outbreaks of aggression, tearfulness, an unbalanced state of mind. The doctor will make an accurate diagnosis only after a complete clinical and ultrasound examination. Infertility in women associated with endometriosis is not due to the disease itself, but to concomitant disorders and failures. These include:

violation of ovulation;
the formation of adhesions on the ovaries and fallopian tubes;
violation of the integument of the mucous membrane of the uterus and its inferiority.

Endometriosis can lead to relative infertility. The disease can be overcome by treatment. It includes:

hormone therapy;
radon baths;
radiation therapy;
surgery.

The treatment of endometriosis can take from several weeks to six months. It all depends on the degree of the disease.

idiopathic infertility

In most cases, it is diagnosed in women whose age has passed over 40 years. An idiopathic type of infertility disease is confirmed only by a complete study, which shows the following:

regular ovulation;
normal hormonal background;
uterus without pathologies;
no adhesions on the ovaries;
lack of antibodies;
postcoital test is positive.

A man must have the following indicators:

good spermogram;
antibody test is negative.

Spouses should not have infectious diseases that are sexually transmitted. And, of course, there should be regular intercourse during ovulation for at least a year.
If a married couple does not have children for about a year, then they are given this type of infertility. There are reasons why doctors make this diagnosis:

violations in the work of the endocrine and reproductive systems have not been established;
constant menstruation and ovulation;
good patency of the fallopian tubes;
good cervix;
no genetic diseases.

In these cases, experts strongly recommend paying attention not to their physical condition, but to their psychological state. There is no treatment for the disease. To get pregnant, you can resort to the following methods:

Insemination. The doctor will insert the sperm into the uterine cavity using a catheter. This method is considered close to natural conception.
Stimulation of ovulation. With the help of drugs, the doctor promotes the maturation of several follicles. Then everything is simple. You can try to get pregnant naturally or resort to insemination.
Artificial insemination. The embryo is grown in a special laboratory under certain conditions. Then it is transferred to the uterus. There are big disadvantages: the load of drugs on the body, premature birth and miscarriages. And the cost of the procedure is not suitable for every family.
The use of vitamins and trace elements.

tubal infertility

This is the most common type of disease among women. Infertility of the uterus occurs due to obstruction of the fallopian tubes. There are several reasons why the disease develops:

endometriosis;
abortion;
sexually transmitted infections;
myoma;
adhesions in the pelvis.

Infertility can be diagnosed by one of the following methods:

X-ray of the fallopian tubes. For this, a contrast agent is injected.
Ultrasound procedure. A special substance is injected and the examination begins.

Tubal-peritoneal infertility

This disease is classified into two main subspecies:

disruption of the fallopian tubes - hypertonicity, tone, discoordination;
damage to the fallopian tubes - adhesions, sterilization, complete obstruction.

Women experience symptoms such as:

disruption of the intestines;
pain in the lower abdomen;
dysmenorrhea or dyspareunia.

The disease can be diagnosed in several ways:

Ultrasound examination of the pelvic organs.
X-ray of the uterine cavity.
Laparoscopy.

In addition to all the types of disease presented, psychological infertility can also occur. No procedures and medicines will help here. You need the help of a qualified psychologist. A couple should go to his consultations together.

The main degrees of infertility

Many experts advise not to panic ahead of time and seek help from doctors only after a year of constant attempts to get pregnant. Because most often it happens that conception does not occur for other reasons, for example:

bad ecology;
constant stress at work and at home;
malnutrition;
diets and more.

If a married couple cannot have children for more than a year, then it is worth visiting a clinic. The first thing that doctors will begin to identify is the degree of infertility. To date, there are two:

primary;
secondary.

First degree

This disease applies not only to women, but also to men. It is generally accepted that first-degree infertility occurs only in those patients who have never been pregnant. If we draw a parallel with the spouse, then the first degree of infertility occurs only in men from whom none of the partners became pregnant.

Second degree

Such infertility is put on women who have been pregnant at least once. This does not take into account their outcome, which could end:

childbirth;
miscarriage;
abortion;
ectopic pregnancy.

Secondary infertility in men is put in a similar way. If at least one other woman became pregnant from him, then he has a second degree of the disease.

It is worth remembering that in the first and second degree spouses can be absolutely healthy. Accordingly, the case may be completely different reasons, for example, incompatibility. And in this case, IVF helps many couples.
Also, in single women, a third degree of infertility can be observed. It's just the inability to get pregnant, in any way available. The way out for such couples, in whom I diagnose such a serious disease, is surrogate motherhood.

Causes of female and male infertility

It is difficult to answer the question: Why am I infertile?". There are a number of reasons for this, which experts establish during the survey.

Causes of the disease of the first degree

The female and male bodies are different. Hence, the causes of infertility will vary. If the spouse was diagnosed with the first degree of the disease, it means that the following was found:

ovulation is rare and inconsistent;
ovaries are absent or improperly developed;
gynecological diseases that in every possible way oppose natural conception;
pathology was found in the fallopian tubes;
the uterus is poorly developed or the cervical canal is impassable;
pathology of the immune system;
serious deviations in the structure of chromosomes, in these cases, the eggs that are fertilized are simply not viable.

Additionally, for each woman, this list can be replenished depending on the state of the body and overall health in general.
If the spouse was diagnosed with the first degree of infertility, then the following reasons were identified:

pathology of the genital organs, which may be congenital or acquired;
genital trauma;
hormonal imbalance;
genetic diseases;
poor functioning of the immune system.

Also, male infertility of the first degree may be due to the following reasons:

obstruction of the seminal ducts;
spermatozoa are not produced.

If the couple has passed the examination completely, in which no problems have been identified, the matter may be for another reason. Namely, in immunological infertility. In order for doctors to confirm their diagnosis, they conduct a MAP test. It aims to detect antibodies in blood and semen. It is impossible to take away from attention the fact that the first degree of infertility can be hidden:

in the abuse of drugs and alcohol;
taking medications;
bad environment;
infectious diseases;
chronic diseases of the genitourinary system.

Causes of the disease of the second degree

If a woman was diagnosed with the second degree of the disease, then most often this is due to a serious hormonal failure. Among other things, there are several causes of female infertility of the second degree:

myoma;
cyst;
poor nutrition and debilitating diets;
complicated previous births;
frequent ectopic pregnancies.

The reasons may not be hidden in diseases. One of these types is abortion. It is complicated by the fact that complications could begin during the procedure and the doctor could not provide qualified assistance. Even medical abortion cannot guarantee that everything will be successful.
After an abortion, experts recommend undergoing a good rehabilitation, otherwise endometriosis may begin, which will not immediately manifest itself, but in the future will adversely affect the condition of the internal organs.
Not only abortion affects the state of health. The second degree of infertility is given to women who have constant stress, early menopause.
As for the causes of male infertility of the second degree,
then almost everything is identical with the first:

infection of the genitourinary system;
varicose veins on the testicle;
liver disease, asthma, tuberculosis, traumatic brain injury, diabetes mellitus;
radiation and chemotherapy;
disturbed hormonal background;
obstruction of the seminal ducts.

If a man has taken steroids, tranquilizers and other similar drugs, then the risk of acquiring a second degree is high. The signs of infertility are many-sided and are determined individually in each individual case.

Symptoms of male and female infertility

As you can see, there are many reasons for infertility. This includes not only serious illnesses, but also constant stress, an unhealthy lifestyle, and even improper tight underwear. It is worth talking separately about how the symptoms of infertility manifest themselves in the female and male body separately.

Signs of a female disease

Specialists automatically put infertility to a woman if after 1-2 years of attempts to conceive did not happen. But as it turned out, in fact, this is not the only symptom:

Amenorrhea. Absence of menses. A healthy and strong woman has only three stages when there are no periods: before puberty, pregnancy, menopause. Everything else is not considered normal and should be treated. In some cases, a failure in menstruation occurs due to the use of birth control pills, patches and injections.
Irregular menstruation. This leads to the fact that ovulation does not occur. The egg is unable to mature normally and cannot be fertilized.
early health problems. These include chronic inflammation of the pelvic organs, diseases of the nervous system, ovarian pituitary gland.
Pathology of the structure of internal organs. These are mostly innate consequences. And here it’s not just about getting pregnant, sometimes it’s impossible to have sexual intercourse for purely mechanical reasons.
Age. This is of course a subjective assessment of infertility, but still in some cases it is taken into account. Thus, every girl who has not reached puberty can be considered barren. In the medical environment, it is generally accepted that it is difficult for a woman after 35 to conceive a child. But still, it is worth considering the characteristics of each organism separately.

Signs of male infertility

The body of the spouse can also fail. The main symptom is the absence of pregnancy in the wife after a year of trying. But this is not the only symptom:

It is worth considering more seriously if no partner has ever become pregnant from unprotected contact.
The reproductive organs are not developed.
Lack of sperm or a small amount of it. As a rule, this indicates obstruction of the seminiferous tract or hormonal imbalance. This is where you first need to pay attention to your wardrobe. Tight trousers and underwear are strictly contraindicated. With such clothes, you can doom your husband to heat castration, but everything is fixable.
Serious diseases carried by the body.

In some cases, men are given several stages of infertility at once, but all of them are eliminated and curable at an early stage.
These symptoms are not a reason to self-diagnose and self-medicate. At the slightest suspicion, it is better to consult a doctor. The infertility clinic will conduct a complete examination, and only then, based on the tests, will give a complete conclusion and prescribe treatment.

disease factors

Infertility- this is a many-sided disease and the cause of the occurrence is most often difficult or impossible to establish. Studies have shown that infertility factors are grouped according to several criteria:

anatomical localization;
pathophysiological processes;
genetic abnormalities;
psychosomatic state of a woman;
impact of male infertility.

In order to somehow understand all the complex concepts, it is worth talking about everything separately.

cervical factor

For fertilization to be successful, about 10 million sperm must enter. In order for them to be able to freely get inside, the following is necessary:

sperm activity;
chemical properties of cervical mucus.

If a woman has pathologies, then these are the results of the following:

hormonal disbalance;
inflammation in the cervix;
violation of the microflora on the walls of the uterus.

Pipe factor

Tubes are needed to transport a mature egg to the uterine cavity. Movement occurs as a result of:

peristaltic movements of the cilia, which are located on the tubes;
the flickering of these cilia, which create the movement of the tubular fluid.

If the cilia are damaged, then there is a risk that the pregnancy will be ectopic. The greatest negative phenomenon occurs due to complete or partial obstruction of the pipes. This phenomenon is varied:

obstruction in the region of the far and near fallopian tube;
throughout its entire length.

This infertility factor may appear due to the formation of adhesions or various tumors. Accompanied by severe pain in the abdomen.

cervical factor

In the center of the uterus is a pharynx that connects it to the vagina. It contains cervical mucus, which must be available for the penetration of sperm. If this does not happen, then this is cervical infertility. To diagnose it, a woman is sent for a colposcopy. There is an opportunity to clarify the situation with the help of tests. They include:

study of mucus for biochemical and rheological properties;
postcoital test;
test to determine the periovulatory test.

In order for the results to show a true situation, you need to trust experienced laboratory doctors who must determine the favorable time for research.

Tubal-peritoneal factor

If infertility occurred due to this factor, then most likely this happened for the following reasons:

inflammation of the pelvic organs;
serious complications after abortion.

Additionally, the disease manifests itself in the following form:

violation of the patency of the pipes;
in the pelvis there was an accumulation of a large number of adhesions;
violation of the monthly cycle;
the pain syndrome passes into the chronic stage.

Immunological factor

In the normal case, the female body does not react in any way to the interference of foreign bodies that are in the sperm. The manifestation of such a phenomenon as sperm rejection has not been fully studied by scientists. It's more like an allergic reaction.
Doctors are trying to cure such infertility by adjusting the immune system.
The female body is an unpredictable thing, so sometimes there are cases when the body rejects its own mature egg. In this case, conception is possible only after examination and treatment by an immunologist.

endocrine factor

A common type of disease that occurs due to hormonal imbalance. As a result, the woman has irregular periods. The main violations occur for the following reasons:

traumatic brain injury;
damage to the ovaries and adrenal glands;
poor functioning of the thyroid gland;
the amount of estrogen in a woman's body is too low;
hormonal disorder;
underdevelopment of the birth canal.

If a woman has a violation in the monthly cycle, then it is worth undergoing an examination for the work of the endocrine system. This is especially necessary for patients who are obese or malnourished. But in most cases, such hormonal infertility is treated quickly.

Psychological factor

Stress is the scourge of the 21st century. With its help, there is an instant destruction of the hormonal background. In the form of infertility, they manifest themselves in each case individually. The main sources of stress are:

a huge and daily flow of negative information;
frequent emotional upheavals;
lack of confidence in your spouse or yourself;
physiological reactions of the body.

Oddly enough, but these signs lead to infertility. Here you need to either correct the oppressive situation, or go with your spouse to an experienced psychologist. He will help to establish the causes and correct further actions.

genetic factor

The absence of a long-awaited pregnancy can be caused by some genetic abnormalities. Namely:

excess male hormones;
growth of the walls of the uterus;
premature menopause;
primary amenorrhea.

Genetic infertility has been little studied by scientists. But if there is a desire to consult and exclude all possible diseases, then you should consult a geneticist.

Diagnosis of male and female infertility

If after 12 months the long-awaited pregnancy of the spouses has not occurred, then a diagnosis is made - a barren marriage.
To begin treatment, specialists must correctly diagnose. On the way to the birth of a baby, both parents must undergo a comprehensive examination. Many doctors advise first of all to send your husband to the clinic. There are a number of reasons for this:

in half of the cases, it is male infertility that affects conception;
it is easy to diagnose and treat.

In addition, the cost of the examination is much lower, which is affordable for many families. There is a specific list where all tests for infertility are collected:

urologist consultation;
blood test for sex hormones;
spermogram;
Ultrasound of the prostate;
analysis for infectious diseases.

If the diagnosis did not reveal any deviations from the norm, then it is worth examining the woman. The list of analyzes is much larger than that of men, but there are plenty of difficulties with the body. Here is a detailed list:

initial appointment with a gynecologist;
blood test for female sex hormones;
taking a smear from the cervical canal;
blood test for HIV infection;
thyroid examination;
a blood test for the work of hormones in the thyroid gland;
ultrasound examination of all organs of the small pelvis;
analysis for the presence of infections;
colposcopy, ultrasound of the uterus and tubes;
sperm and cervical mucus compatibility test;
determination of karyotypes of both spouses.

In order for the gynecologist to put infertility as a diagnosis, it is worth telling all the details and little things. Do not hide the number of all pregnancies, abortions and miscarriages. The specialist needs to know the following points:

physiological and psychological changes that have occurred;
sudden weight loss or gain;
what kind of contraceptives did you use;
how much you can not get pregnant;
Are you worried about pain during sexual intercourse and all other details that at first glance seem like ordinary trifles.

After the doctor has diagnosed infertility, he will begin a serious fight with the problem.

Treatment of female infertility

When the doctor fully assesses the state of health and has all the tests, he begins infertility treatment. To begin with, eliminate the primary causes. Namely:

restoration of the reproductive system of a woman in a conservative or surgical way;
the use of technological functions, if conception by an independent way is completely impossible.
It is worth talking about methods more specifically.

hormone therapy

This method is used in the treatment of hormonal infertility. To normalize the hormonal background of the patient, doctors prescribe special drugs. In some cases, therapy helps to cope when ovarian infertility is detected. This method stimulates the production of eggs.

Anti-inflammatory treatment

These procedures are aimed at combating infectious diseases that are sexually transmitted. It is they who prevent the conception of a child. Treatment is entirely with medication.

Laparoscopy

If adhesions, cysts are detected and it is necessary to restore the patency of the fallopian tubes, then this procedure is used. Laparoscopy for infertility is a therapeutic diagnostic operation. With the help of a microcamera, the true reason is established, due to which pregnancy does not occur. Immediately carry out immediate elimination of the cause.
Most often, this method is used for infertility of unknown origin. The operation is harmless and has no side effects.

Insemination into the intrauterine cavity

If the doctors established the incompatibility of the spouses, then this method is carried out. This is done simply: on the selected day, processed sperm is injected into the woman's uterus. And you can wait for the results.

In Vitro Fertilization (IVF)

The procedure takes place entirely in the laboratory. To do this, an egg is fertilized in a special environment. The grown embryo is placed in the uterus and waiting for its development. This method is considered the most effective, which helps with all types of infertility.
If a married couple cannot have children for a long time, then do not despair. Even the most unusual methods are used.

Folk recipes for infertility

There are some tinctures and decoctions that will help saturate the body with nutrients and nutrients. In this procedure, the main thing is to believe in what you accept, and then the treatment of infertility with folk remedies will be successful.

Recipe 1
A useful tincture is prepared from the following ingredients:

1 liter of freshly squeezed viburnum juice;
2 kg of sugar;
glass of water;
juice of one lemon.

To mix everything. Take the remedy three times a day. To do this, a tablespoon of medicine is stirred in a glass of boiled water.

Recipe 2

1 teaspoon ground calamus roots;
a glass of boiling water.

Calamus is poured with water and insisted. It is recommended to use once a day before meals. Preferably half an hour.

Recipe 3
Our grandmothers also used sea buckthorn juice. It is enough to drink a glass once a day. The course of treatment is recommended to continue for one month.
But do not forget that it is better to consult a gynecologist in medical institutions.

Side effects during treatment

There are no contraindications to infertility treatment. All side effects that occur are temporary and then easily pass by themselves. Basically, such actions occur when taking medications that are prescribed for IVF or ICSI. The most common occurrences:

mood swings;
nausea;
dizziness;
increased sweating;
anxiety;
migraine.

It is worth remembering that treatment leads to some undesirable consequences.

Complications during treatment

If a couple wants to conceive a child, then she undergoes treatment. If a woman undergoes IVF, then her chances of getting pregnant increase. As a gift for their patience and efforts, a couple can receive several accustomed embryos. This is considered a multiple pregnancy. Here, doctors note the following complications:

difficult childbirth;
high blood pressure;
premature birth;
miscarriages.

Fertility doctors warn that the development of intrauterine pregnancy during IVF is much higher than in other cases. This can be identified by the following symptoms:

sharp pains in the lower abdomen;
vaginal bleeding;
brown and red discharge.

For IVF and ICSI procedures, you need to remove the egg. During the procedure, there is a risk of infection, which is further treated only with antibiotics.

As you can see, infertility is not a final verdict. It is not only possible, but it must be treated. In the past, an unborn child is infertility in the future.

Absolute infertility as a diagnosis is made in the case of a pathology that completely annuls the reproductive function of a man or woman, and cannot be treated. But the conclusion of doctors should not be taken as the final verdict, since current medical practice proves the opposite, allowing a significant part of completely infertile couples to become pregnant and give birth to children.

Factors of absolute female infertility

dysfunction of the ovaries;
complete or partial obstruction of the fallopian tubes;
congenital or acquired pathologies in the uterine cavity;
hormonal problems;
incompatibility of partners (unexplained reactions of the immune system of women, rejecting the sperm or embryo);
anomalies in the eggs, which leads to the non-viability of embryos that die in the first weeks of fertilization.

Causes of absolute male infertility

The following factors are talking about:

the absolute impossibility of ejaculation (ejaculation) or the eruption of sperm into the bladder (retrograde ejaculation);
oligospermia - small volumes of sperm (semen less than 2 ml);
a very small number of spermatozoa in seminal fluid or their absence;
obstruction of the streams that remove the seed;
asthenozoospermia - poor sperm motility;
a significant number of spermatozoa that deviate from the norm;
immunological problem of producing antibodies against their spermatozoa.

Great hopes for the procedure of artificial insemination (in vitro fertilization -). If the fallopian tubes, where the collision of the sperm and the egg occurs, as well as their further passage to the uterus, are completely absent in the woman, then test-tube fertilization, with the subsequent addition of the embryo.

In a situation where it is impossible for a woman to bear a child, surrogacy is considered the best option, when another woman carries an absolutely related child for the couple. The IVF procedure helps to carry out the following: to select a female egg, a man's seminal fluid and combine them by placing them in a special test tube - an incubator. Already on the 5-6th day, you can implant the embryo into the uterus of the future surrogate mother.

Photo: IVF method for absolute infertility

If the male sperm is not capable of fertilization through a number of factors, use is acceptable, but at the same time, the child will be only partially genetically native. Understanding the situation, many future parents agree to the procedure and are satisfied.

There are also extremely difficult situations in case of impossibility of stimulating ovulation in a woman in order to extract an egg, and the development of germ cells is impaired in a man. In such circumstances, one of the options is possible: giving up the idea of becoming a father and mother or adopting a child.

Although the procedure is quite complicated both legally and psychologically, but if you think about it, you can realize how important it is to share warmth and family comfort with another disadvantaged child, saving him from a difficult life in orphanages. Very often, the reception can be completely hidden even from relatives, so as not to injure children in the future.

But in any case, couples who are ready for adoption need psychological support from specialists and relatives, this will help maintain balance, understanding in the family, and most importantly, make the best decision in such a complex problem.

Video: infertility. Infertility treatment - ART, ICSI, IVF

Aromatherapy treatment

Particularly relevant to this treatment in case of menstrual irregularities, rose essential oil tones the uterus and ovaries. Jasmine oil acts similarly, the first one has a normalizing effect on the hormonal state and cycle, the second one relaxes and soothes.

He also recommends the following procedure, this is not aromatherapy, but it has a preventive and therapeutic effect. A small amount of dried St. John's wort is needed, it is set on fire, and the aroma is inhaled daily for 20 minutes. Perhaps the use of incense sticks, but with caution and not more than 3 per day.

Treatment of infertility, both medical and folk methods, should be characterized by complexity, i.e., first of all, you need to get rid of smoking, alcohol or other bad habits.

Unfortunately, such changes occur on the part of the future mother much more often than on her husband. Although it is hard to believe, but this minor step very significantly raises the couple's chances of being able to conceive.

An additional problem is excess weight, which reduces the possibility of getting pregnant and leads to other diseases. On the contrary, physical training will be a good helper during childbirth.

Traditional healers and healers pay special attention to the need for a girl to constantly monitor her health from a young age, the need to dress warmly in long enough clothes, and constantly conduct sports training or exercise. This list is a good addition at all stages of fertilization, pregnancy and childbirth.

For positive results of traditional methods of treatment, you need to eat right, taking into account gender, age and type of activity, but the right diet can only be compiled by specialists.
In general, traditional medicine strongly recommends that you start consuming more foods that contain vitamin E, namely: eggs, green onions, sunflower seeds, liver, corn, etc.
Additionally, you need to increase the amount of useful macro- and microelements: iodine, iron, magnesium, potassium, etc. Their optimal source is seaweed.
To improve the reproductive function of a man, it is important to eat protein foods, as well as use some seasonings that increase potency - cloves, coriander, pepper.

Photo: The Importance of Good Nutrition and Lifestyle

Traditional medicine

Traditional medicine uses different ones in the treatment of infertility, but the following can be called the most optimal and uncomplicated:

it is necessary to pour 1 teaspoon of plantain into 250 ml of boiling water and take the infusion throughout the day;
5 tablespoons of wormwood pour 500 ml of vodka, leave for 3 weeks, shaking occasionally, strain and take 1 tablespoon 4 times a day before meals;
boil unripe nettle seeds with wine and drink 1 tablespoon daily before meals;
Adonis herbs take 1 tablespoon and brew 250 ml of boiling water, leave for 2 hours, wrap the dishes with a decoction, drink 3 times a day;
mix alcohol and water in equal parts, add 100 g of crushed leuzea roots, leave for 1.5 months, take 20 drops three times a day for two months (except for the summer period).

Infertility is the absence of pregnancy for one year, subject to regular unprotected sex. This state can be absolute or relative. What's the Difference?

Absolute infertility is a diagnosis that is made against the background of the presence of congenital anomalies in the development of the genital organs. The consequences of serious injuries and surgical operations are also considered.

This type of infertility can occur in women and men. It develops under the influence of certain factors. Some causes can be eliminated through treatment, but there are other situations that cannot be corrected.

Female absolute infertility - causes

Violation of the ovaries or their absence. A similar diagnosis is often made in the presence of polycystic ovary syndrome. Also taken into account is the depletion of the ovaries and the formation of cysts on them.
Uterine diseases or absence of an organ. Since there is no pregnancy without a uterus, the concept of absolute infertility is appropriate in this case. Treatment of this pathology is not provided. Uterine diseases include endometriosis, endometritis, and uterine fibroids.
Obstruction of the fallopian tubes or their complete absence. If there is no fallopian tube, then the egg will not be able to get to the uterus, where, in fact, fertilization should occur. Tubal obstruction can be a congenital or acquired feature. In the second case, adhesions and inflammatory diseases can lead to this problem.
The production of an insufficient amount of hormones may be due to a malfunction of the ovaries, hypothalamus or pituitary gland.
Absolute infertility in women is also immunological infertility, resulting in the rejection of spermatozoa or the embryo when trying to implant it into the walls of the uterus.

Chromosomal diseases that affect the change in eggs. Even if fertilization occurs, the embryo does not survive. A woman may not even notice such a state.

Absolute infertility can be explained by anovulation. It is important to answer the doctor's questions: how often do menstruation pass, are there any pains, what is the nature of blood loss.

Absolute infertility in a man - causes

Such a diagnosis is made in the presence of the following problems:

Oligospermia - the production of an insufficient amount of sperm;
Retrograde ejaculation, no ejaculation;
Too low sperm motility. For this reason, the male sex cells cannot reach the egg;
Obstruction of the vas deferens;
Sperm of low quality with the content of pathological or chromosomal abnormalities of spermatozoa;
A small amount or complete absence of spermatozoa in the semen;
Immunological infertility, in which antibodies are produced against their own cells.

What are the treatments?

To know what methods of treatment can be used, you need to understand absolute infertility - what it is and what caused this condition. Such doctors can help to understand the reasons: a gynecologist, an andrologist and an endocrinologist.

Usually, for the treatment of this type of infertility, surgical intervention is used, in which a woman undergoes manipulations with the fallopian tubes, and for men - with the vas deferens. After such treatment, the couple can have one child.

Depending on the complexity of the situation, treatment may be hormonal.

If the above therapeutic methods did not work, then the only way out of the situation would be artificial insemination. Sometimes you have to use the services of a surrogate mother.