Infertility. Primary infertility in women Primary and secondary infertility statistics

The birth of a child is one of the most joyful events in the life of any family.

But sometimes the wait is delayed, the long-awaited pregnancy does not occur, and people begin to worry if this is a sign of infertility. Unfortunately, in some cases this is true. It should be borne in mind that the reproductive function of a woman decreases over the years, so middle-aged ladies may need more time to conceive than young girls.

1st degree infertility in women

Such a diagnosis is made if a woman cannot conceive a child and has never been pregnant before.

Primary infertility in women has the following causes:

Endometriosis. With this disease, there is a violation of hormonal metabolism, immune changes, the formation of adhesions, and so on. All these pathological changes and lead to impossibility of conception.
Abortions. Artificial termination of pregnancy can cause the development of a number of complications that lead to infertility.
hormonal disorders, that develop after emergency contraception with high doses of hormones.
Inflammatory diseases bodies reproductive system.
The consequences of surgical interventions on the genitals.
Immune, associated with a violation of the fertilization process, damage to sperm or eggs.
Idiopathic, the causes of which cannot be established.
hormonal disorders, in which ovulation does not occur.

Primary infertility: treatment

After a visit to a reproductive specialist, it is necessary to pass a series of tests. For women with secondary infertility, an examination is required in order to find out the cause of fertility problems.

If the disease is caused by endocrine disorders, then it is necessary to correct them. If the cause is inflammatory diseases of the genital organs caused by microorganisms, then antifungal, antiviral or antibacterial treatment is indicated.

For the treatment of infertility, you can contact the AltraVita clinic. Highly qualified reproductologists work here. Most available modern methods infertility treatment, including assisted reproductive technologies.

Secondary infertility in women

If a woman has previously had at least one pregnancy (even if it did not end in childbirth) and cannot become pregnant, then secondary or grade 2 infertility is diagnosed.

The reasons for its development are:

Age-related decline in fertility. The decline in reproductive function in women begins as early as 30 years old, and after 35 years, 25% of women are already infertile. The reason for this is the accumulated chronic diseases, as well as chromosomal changes in the eggs, which make it impossible to give birth to a healthy child. That is why middle-aged women have more miscarriages than young girls.
Complications after gynecological operations, abortions and childbirth. Difficult childbirth, improper abortions, curettage, and so on can damage the endometrium and cause infertility (secondary or primary).
Violation of the hormonal background. Quite often, it is endocrine disorders (ovarian dysfunction, thyroid disease, and so on) that cause grade 2 infertility in women to develop.
Gynecological diseases. Pathologies such as cervicitis, vaginal dysbacteriosis, oophoritis, salpingitis and endometritis can lead to problems with conception. In addition, various tumors in the reproductive organs (polyps, cysts, fibroids, and so on) can be the cause.
Partner incompatibility. To date, the exact causes of immunological incompatibility of spouses have not been established. Interestingly, such incompatibility may not occur immediately, but after the birth of one or even several children. Treatment of incompatibility often fails, so couples have to resort to ART.
Lifestyle. Chronic stress, bad habits, not proper nutrition and lifestyle can also lead to the development of a condition where a couple cannot conceive a child

Infertile marriage is the absence of pregnancy in a woman of childbearing age within 1 year of regular sexual activity without the use of any contraceptives. The frequency of infertile marriage, according to various sources, ranges from 10 to 20%.

The cause of infertility may be disorders in the reproductive system in one or both spouses. In 45% of cases, infertility is associated with disorders in the female genital area, in 40% - men, in other cases, infertility is due to disorders in both spouses.

In women, primary infertility is distinguished - the absence of a history of pregnancy and secondary, when infertility was preceded by at least one pregnancy.

Primary and secondary infertility can be relative, if the restoration of reproductive function is possible, and absolute - if it is impossible to get pregnant naturally (absence of the uterus, ovaries, some malformations of the genital organs). Infertile spouses should be examined simultaneously.

Types of infertility

male infertility

The causes of male infertility can be secretory (violation of spermatogenesis) and excretory (violation of sperm excretion) factors. Male infertility is more often caused by varicocele, inflammatory diseases, malformations, endocrine disorders. The frequency of infertility of unknown etiology in men reaches 15-25%.

The examination of a man begins with a semen analysis. Ejaculate for research is obtained by masturbation after 2-3 days of abstinence. In the study of sperm, the volume of the ejaculate, the total number of spermatozoa, their mobility and morphology are evaluated, pH, sperm viscosity, white blood cell count and other indicators are determined.

Sperm motility is assessed in four categories:

a - fast linear progressive movement;

b - slow linear and non-linear progressive movement;

c - no progressive movement or movement in place;

d - spermatozoa are immobile.

The most common terminology when evaluating spermogram parameters:

Normospermia - indicators within the normal range;

Aspermia - lack of ejaculate (semen volume 0 ml);

Azoospermia - the absence of sperm in the ejaculate;

Oligozoospermia - spermatozoa less than 20 × 106 / ml;

Asthenozoospermia - motile spermatozoa less than 25% of category a or less than 50% of category a + b;

Teratozoospermia - less than 14% of spermatozoa of normal morphology;

Oligoastenoteratozoospermia is a combination of three variants of pathology.

If a sperm pathology is detected, a consultation with a urologist-andrologist is indicated for further examination and treatment. With normal spermograms, other studies are not carried out in a man.

female infertility

Female infertility is the inability of a woman of reproductive age to conceive.

The main causes of female infertility:

Psychogenic factors;

Violation of ovulation (endocrine infertility) (35-40%);

Tubal-peritoneal factor (20-30%);

Various gynecological diseases (15-25%);

Immunological causes (2%).

Psychogenic factors of infertility. Conflict situations in the family, at work, dissatisfaction with sexual life, as well as an insistent desire to have a child or, conversely, fear of pregnancy can cause ovulation disorders that mimic endocrine infertility. Similarly, vegetative disorders induced by stressful situations can lead to discoordination of the smooth muscle elements of the fallopian tubes, and, consequently, to functional tubal obstruction.

Endocrine infertility is associated with a violation of the ovulation process: anovulation, luteal phase deficiency menstrual cycle, syndrome of luteinization of a non-ovulating follicle.

Anovulatory infertility can occur when any level of the reproductive system is affected. The most common causes of anovulation are hyperandrogenism, hyperprolactinemia, hypoestrogenism, metabolic disorders (obesity, severe underweight), as well as Itsenko-Cushing's disease and syndrome, hypo- and hyperthyroidism.

Insufficiency of the luteal phase of the menstrual cycle (NLF) is associated with hypofunction of the corpus luteum of the ovary, leading to insufficient secretory transformation of the endometrium. Infertility in NLF is caused by a violation of embryo implantation or early spontaneous miscarriage, when the pregnancy is terminated before the delay of menstruation.

NLF occurs as a result of dysfunction of the hypothalamic-pituitary-ovarian system after injuries, neuroinfections, stress; as a result of hyperandrogenism; hypo- or hyperthyroidism; hyperprolactinemia; inflammatory processes.

Non-ovulating follicle luteinization syndrome (LNF syndrome) is the premature luteinization of a preovulatory follicle without ovulation. The reasons for the luteinization of a non-ovulating follicle have not been established.

Tubal and peritoneal infertility

Tubal infertility is associated with a violation of the functional activity of the fallopian tubes or their organic damage. A change in the function of the fallopian tubes is noted against the background of stress, impaired synthesis of prostaglandins, sex steroids, an increase in the content of metabolites of prostacyclin, thromboxane A2, as well as hyperandrogenism.

Organic damage to the fallopian tubes leads to their obstruction. The cause of this pathology is the transferred inflammatory diseases of the genital organs (gonorrhea, chlamydia, tuberculosis, etc.), surgical interventions on the internal genital organs, endometriosis of the fallopian tubes and other forms of external endometriosis.

Peritoneal infertility is caused by adhesions in the area of the uterine appendages. It occurs as a result of inflammatory diseases of the genital organs, after surgical interventions on the organs of the abdominal cavity and small pelvis.

Infertility in gynecological diseases is associated with a violation of the implantation of the embryo in the uterine cavity with intrauterine septa and synechia, endometriosis, uterine myoma with a submucosal location of the node, endometrial polyps.

The cause of immune infertility is the formation of antisperm antibodies in a woman (in the cervix, endometrium, fallopian tubes), leading to phagocytosis of spermatozoa.

In 48% of infertile women, one cause of infertility is identified, while the rest have a combination of two or more causes.

Infertility diagnostics

Examination of women with infertility begins with anamnesis, which specifies the nature of the menstrual function (menarche, regularity of the cycle and its violations, intermenstrual discharge, painful menstruation), the number and outcome of previous pregnancies, the duration of infertility, the contraceptive methods used and the duration of their use. When studying sexual function, they find out if there is pain during intercourse, the regularity of sexual activity.

Pay attention to extragenital diseases (diabetes mellitus, tuberculosis, pathology of the thyroid gland, adrenal glands, etc.) and previous operations that contribute to the appearance of infertility (surgery on the uterus, ovaries, fallopian tubes, urinary tract, intestines, appendectomy).

Clarify the gynecological history: the presence of inflammatory processes of the pelvic organs and sexually transmitted diseases (causative agent, duration and nature of therapy), diseases of the cervix and their treatment (conservative, cryo- or laser therapy, radio- and electroconization).

Psychogenic factors are identified, as well as bad habits (smoking, drinking alcohol, drugs), which can lead to infertility.

During an objective examination, it is necessary to measure the height, body weight of the patient, calculate the body mass index (BMI). Normally, it is 20-26 kg / m2. In case of obesity (BMI>30 kg/m2), it is necessary to establish the time of its onset, possible causes and the rate of weight gain.

Pay attention to the skin (dry, wet, oily, acne, stretching strips), the state of the mammary glands (development, discharge from the nipples, seals and volumetric formations). It is advisable to perform an ultrasound of the mammary glands to exclude tumor formations.

Be sure to conduct a microscopic examination of smears from the cervical canal, vagina and urethra. If necessary, perform PCR - a study for the presence of infection, sowing on the microflora and sensitivity to antibiotics.

At the same time, the patient is being examined according to functional diagnostic tests for 3 consecutive menstrual cycles (basal thermometry, “pupil” symptom, CPI, etc.).

Examination of patients with infertility of any etiology also includes a consultation with a therapist to identify contraindications to pregnancy. If signs of endocrine and mental diseases, as well as malformations are found, consultations of the relevant specialists are prescribed: endocrinologists, psychiatrists, geneticists.

endocrine infertility. Examination of patients with anovulatory infertility begins with the exclusion of organic pathology at all levels of regulation of menstrual function. For this purpose, x-rays of the skull are performed with visualization of the Turkish saddle, MRI of the brain, examination of the fundus and visual fields, ultrasound of the pelvic organs, thyroid gland, and adrenal glands.

To identify the functional pathology of the reproductive system, EEG, REG are performed, the concentration in the blood of hormones of the anterior pituitary gland (FSH, LH, prolactin, TSH, ACTH), ovarian hormones (estradiol, progesterone), thyroid hormones (T3, T4), adrenal glands ( cortisol, testosterone, DHEA-C).

Insufficiency of the luteal phase is manifested by a shortening of the 2nd phase of the menstrual cycle (less than 10 days) and a decrease in the temperature difference in both phases of the cycle (less than 0.6 ° C) according to basal thermometry. The diagnostic criterion for luteal phase deficiency is a decrease in the level of progesterone in the blood. The study is carried out on the 7-9th day of the rise in rectal temperature (corresponding to the 21-23rd day of the menstrual cycle).

The diagnosis of LNF-syndrome is established by dynamic ultrasound. During the menstrual cycle, the growth of the follicle to the preovulatory one is noted, followed by wrinkling - the “follicle plateau effect”.

When diagnosing tubal-peritoneal infertility, it is necessary to exclude, first of all, inflammatory diseases of the genital organs. For this purpose, a bacterioscopic, bacteriological study, PCR is carried out.

To exclude tubal infertility (determining the patency of the fallopian tubes), hydrosonography, laparoscopy with chromosalpingoscopy with methylthioninium chloride (methylene blue), salpingoscopy (less often, hysterosalpingography) are currently more often used.

The most informative and reliable method for diagnosing peritoneal infertility is laparoscopy.

In women with gynecological diseases, hysteroscopy and separate diagnostic curettage of the uterine mucosa are performed to exclude intrauterine pathology for diagnostic purposes. In case of detection of intrauterine pathology during hysteroscopy, it is possible to remove synechiae, septa, endometrial polyps, submucosal myomatous nodes.

Immunological infertility is diagnosed only after exclusion of tubal peritoneal, endocrine infertility and intrauterine pathology. After eliminating the factors described above, they proceed to the postcoital test.

The postcoital test allows you to evaluate the interaction of sperm and cervical mucus, is carried out in the middle of the cycle, usually on the 12-14th day. Microscopic examination of cervical mucus after coitus determines the presence and motility of spermatozoa. The test is positive if there are 5-10 actively motile spermatozoa in clear mucus without leukocytes. If immobile spermatozoa are found, the test is considered doubtful, in the absence of spermatozoa, it is negative. If the spermatozoa are immobile or make pendulum movements, the test is repeated.

Patients with psychogenic infertility are prescribed a consultation with a psychoneurologist. The specialist can apply tranquilizers, sedatives, as well as psychotherapeutic methods. In some cases, such therapy is effective without the use of ovulation stimulants.

Treatment of endocrine infertility. If an organic pathology of the brain is detected, a consultation with a neurosurgeon is indicated.

Functional disorders require adequate treatment of the identified endocrine pathology to normalize the hormonal status. With functional hyperprolactinemia or pituitary microprolactinomas, treatment with dopaminomimetics (Dostinex, bromocriptine) is indicated.

When obesity is extremely important correction of body weight. Sometimes only a decrease in body weight, especially with pituitary obesity, leads to the normalization of the release of gonadotropins.

Treatment of the underlying disease is supplemented with drugs that stimulate ovulation. Monophasic estrogen-progestin hormonal contraceptives(COC) is prescribed for 2-3 consecutive cycles. After the abolition of COCs, ovulation in the ovaries is restored - the “rebound effect”.

The drug clomiphene is prescribed from the 5th to the 9th day of the menstrual cycle. As an antiestrogen, clomiphene blocks estrogen receptors in the hypothalamus. After its cancellation, the release of FSH and LH increases, which contributes to the maturation of the follicle and the onset of ovulation.

Currently, exogenous gonadotropins (FSH, LH, hCG) are widely used to stimulate ovulation. Against the background of the use of drugs containing FSH and LH, in the 1st phase of the cycle, the growth and maturation of the dominant follicle in the ovary occurs, and intramuscular administration of hCG in the middle of the cycle promotes ovulation. In some cases, stimulation of ovulation begins with the initial suppression of endogenous gonadotropins. For this purpose, a-GnRH is used.

Ovulation stimulants are used not only for endocrine infertility, but also as an independent therapy in infertile women with ovulatory disorders for an unidentified cause.

Women with endocrine infertility who have not become pregnant within one year after hormonal therapy are recommended laparoscopy to exclude obstruction of the fallopian tubes, hysteroscopy to exclude intrauterine pathology.

Treatment of tubal peritoneal infertility. To restore the anatomical patency of the fallopian tubes, operative laparoscopy is indicated (or laparotomy - in the absence of the possibility of endoscopy). If the fimbrial sections of the fallopian tubes are sealed, fimbriolysis is performed. With peritoneal infertility, adhesions are separated and coagulated according to indications. At the same time, comorbidities (endometrioid heterotopias, subserous myomatous nodes, ovarian retention formations) are eliminated.

Currently, if the fallopian tubes are damaged in the isthmic and interstitial sections, they are removed, and subsequently IVF is performed.

Treatment of immunological infertility. To achieve spontaneous pregnancy, the patient is treated for a latent infection of the genital tract. Then, within 2-3 days before ovulation, preparations of pure estrogens are prescribed, it is recommended to use a condom for at least 6 months (weakening of the sensitization of a woman's immunocompetent cells to sperm antigens with prolonged absence of contact). After the termination of mechanical contraception, pregnancy often occurs.

The ineffectiveness of the treatment is the basis for the use of assisted reproductive technologies - artificial insemination with the husband's sperm. Sperm is injected into the uterus using a syringe with a special tip (it is possible to use donor sperm if the husband's sperm is inferior and with the consent of the spouses) or IVF is used.

In vitro fertilization and artificial insemination in the treatment of female and male infertility

Artificial insemination is the introduction of the husband's or donor's sperm into the uterine cavity in order to induce pregnancy.

Insemination is carried out on an outpatient basis 2-3 times on the 12-14th day of the menstrual cycle (with a 28-day cycle).

Donor sperm is obtained from men under the age of 36, physically and mentally healthy, without hereditary diseases. It is desirable that blood relatives of the donor have no history of fetal developmental disorders and spontaneous abortions.

The pregnancy rate after artificial insemination is 10-20%. The course of pregnancy and childbirth is similar to that of natural conception, and fetal malformations are recorded no more often than in the general population.

In vitro fertilization (IVF) - fertilization of eggs in vitro, cultivation and transfer of the resulting embryos to the uterus.

Currently, IVF is carried out with the use of ovulation inducers in order to obtain a sufficient number of mature oocytes. Assisted reproductive technologies allow the use of cryopreservation programs not only for sperm, but also for oocytes and embryos, which reduces the cost of subsequent IVF attempts.

The standard IVF procedure includes several stages. First, the activation of folliculogenesis in the ovaries is carried out using superovulation stimulators according to various schemes. Regardless of the choice of scheme, the principle of stimulation is the same: the initial suppression of endogenous gonadotropins against the background of the use of a-GnRH, followed by stimulation of superovulation with exogenous gonadotropins. The next step is to puncture all follicles with a diameter of more than 15 mm under the control of ultrasound scanning of the ovaries. The resulting oocytes are introduced into a special medium containing at least 100,000 spermatozoa. After culturing the embryos for 48 hours, 1-2 embryos are transferred into the uterine cavity using a special catheter; remaining embryos with normal morphology can be cryopreserved for use in repeated IVF attempts.

With IVF with single spermatozoa, intracytoplasmic sperm injection for fertilization of oocytes (Intra Cytoplasmic Sperm Injection - ICSI) is possible.

In ICSI, a single spermatozoon is introduced micromanipulatively under visual control into a mature oocyte at the metaphase II stage of meiotic division. The rest of the procedures are similar to IVF.

With azoospermia, methods are used within the framework of the IVF + ICSI program, which allow obtaining spermatozoa from the epididymis or testis.

In some cases, during IVF, it is advisable to perform prenatal genetic diagnosis (PGD). A genetic study of embryonic cells is carried out at the risk of chromosomal abnormalities, suspected monogenic diseases (cystic fibrosis, myelosensory deafness, etc.), as well as women with Rh-negative blood, whose husbands are bizygous for RhD.

A complication of IVF is ovarian hyperstimulation syndrome. Ovarian hyperstimulation means a complex of pathological symptoms (appearance of pain in the abdomen, in some cases a picture of an "acute abdomen" develops). At the same time, many follicles in both ovaries are preparing for ovulation, which leads to their pronounced increase. Treatment consists of dehydration, infusion therapy (plasma).

Surgical treatment of ovarian hyperstimulation syndrome is indicated for signs of internal bleeding due to ovarian rupture. The volume of surgical intervention should be sparing, with maximum preservation of the ovarian tissue. With hyperstimulation, it is quite difficult to suture a torn ovary and stop the bleeding. Sometimes you have to pack a ruptured ovary according to Mikulich.

Features of the course and management of pregnancy after IVF are due to the high probability of its interruption, miscarriage and the development of severe forms of gestosis. The frequency of these complications depends primarily on the nature of infertility (female, combined or male), as well as on the characteristics of the IVF procedure performed. In children born with IVF, the frequency of congenital anomalies is not higher than in the general population of newborns. The frequency of multiple pregnancy in in vitro fertilization is 25-30%.

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The real scourge of gynecology is infertility. Symptoms of this diagnosis are manifested in the inability of a woman to become pregnant within 1 year of active sexual activity with a healthy man without the use of contraception. Primary infertility is the inability of a woman to become pregnant from the beginning of her reproductive years. That is, conception never occurred. Unfortunately, this diagnosis is not rare for modern couples. A woman with 1st degree infertility has neither the experience of pregnancy nor a single child yet. The suppressed feeling of the impossibility of becoming a mother causes only apathy for everything that happens around. But do not despair. Today, there are not many diseases left that forever deprive a woman of the opportunity to find parental happiness. This article presents the main causes and methods of treatment for primary infertility.

Causes of infertility of the 1st degree. Treatment

A woman is not able to conceive a child subsequently due to congenital or acquired pathology, as well as due to experienced infectious diseases of the internal genital organs. For example, among the pathologies that develop in women are uterine fibroids, cervical erosion, cysts and other gynecological diseases. Ovarian pathologies are also very common. When the ovarian follicles do not work properly, there can be problems with the maturation of the egg. Such diseases are manifested by a prolonged absence of menstruation and prolonged bleeding when they appear.

Infertility of the 1st degree can occur after the termination of the first pregnancy in a woman. As a result of abortion, the female hormones produced during the process of conception and the formation of the fetus turned out to be unnecessary and provoked a hormonal failure in the body.

Another cause of primary infertility in this case is the possible traumatization of the internal genital organs due to abortion. Adhesions that cause obstruction of the fallopian tubes are possible. Because of this, the egg simply cannot pass into the uterine cavity and be fertilized. Read more about all the causes of infertility below.

Ovulation does not occur. The hormonal failure that occurs in the body of a woman prevents the release of a healthy egg. This is manifested by a failure of menstruation, an abnormal amount of bleeding. Treatment consists in therapy with medications that stimulate ovulation.
Poor quality egg. The older the woman, the worse the quality of the egg becomes. In women who want to become pregnant after age 40, the egg that is released may be abnormal. The way out of the situation: a surrogate mother or implantation of an egg from a donor.
Endometriosis. The disease consists in the growth of endometrial tissue outside the uterus. Endometriosis is manifested by rather painful sensations during menstruation. Is fraught with miscarriages. Treatment is surgical only. The overgrown tissue is removed and the patency of the fallopian tubes is restored.
. Obstruction is said to be when the egg is unable to reach the uterus. In this way, the sperm will not reach the egg. Infertility of the 1st degree in women of this nature can be the cause of inflammatory processes in the genital organs, as well as sexually transmitted infections.
Polycystic ovaries. Multiple cysts in the ovaries cause a hormonal imbalance, a delay in menstruation, and, consequently, ovulation. Polycystic disease is manifested by an unexpected increase in body weight, rapid growth of body hair, and acne. Treatment consists of taking drugs that stimulate ovulation.

Diagnosis performed by a specialist will help to find out the cause and begin to determine the path of treatment. Primary infertility can be overcome. Modern medicine is able to work miracles in the truest sense of the word. An extreme solution to the problem of infertility of the 1st degree may be IVF or surrogacy. A good mood, the belief that everything will work out and the fulfillment of all the requirements of the attending physician - these are the components of success on the path to motherhood.

Obstetrician-gynecologist Andreeva O.V. speaks of the primary

Today, the problem of primary infertility is very relevant. Do not worry if you cannot get pregnant within two to three months of an active sexual life without using contraceptives. The diagnosis of “primary infertility” is made by doctors to women who have not had a single conception since the beginning of the reproductive life period. Before finding out the causes of the disease and developing the correct and effective treatment for infertility, it is also necessary to undergo an examination of the partner, since one of the reasons that it is not possible to conceive a child may be low sperm motility or a decrease in the concentration of sperm in a man.

The main causes of the disease

There are many causes of primary infertility. All problems associated with the occurrence of the disease should be considered. The main problems are: violation of the menstrual cycle, pathology of the genital organs, hormonal disorders, injuries, cysts, etc. All these causes and many other factors affect the inability to become pregnant.

To eliminate violations of the menstrual cycle, you should pay attention to the general condition of the body. Chronic diseases, stress, an improper diet or difficult living conditions significantly affect the menstrual cycle, but if the health status improves, the periods are restored.

Due to chronic diseases or inflammatory processes in the genitals, fallopian tubes, ovaries, as well as surgical interventions, adhesions, cicatricial changes in tissues occur, which adversely affect the patency of the fallopian tubes. During the examination, doctors determine the degree of this pathology and prescribe methods of treatment.

Hormonal disorders also significantly affect the onset of pregnancy. Long-term use of contraceptive drugs, which include a large number of hormones, leads to the inability to become pregnant for a long period.

Attention should be paid to one more important reason primary infertility: it. As a result of this pathology, ovulation is disturbed. With polycystic, hormonal failure occurs, a delay in menstruation.

Treatment methods for primary infertility

For the treatment of primary infertility, surgical methods, conservative therapy, and medications are used. With hormonal disorders, drugs are used that eliminate hormonal imbalances, bringing hormone levels back to normal.

Modern surgery allows for endoscopic operations, after which the body quickly recovers. Surgery is the most effective treatment for this pathology.

Infectious diseases of the genital organs are treated with medications, while both partners undergo treatment. The drug is prescribed by a doctor depending on the causative agent of the infection.

Treatment of inflammatory processes includes several auxiliary techniques. These are physiotherapy, massage, acupuncture, etc.

In the case when treatment with various methods is ineffective, doctors recommend alternative modern methods of artificial insemination.

The reproductive health of a woman depends on preventive measures. From the very beginning of the reproductive life period, women should remember the basic rules, the implementation of which prevents the onset of primary infertility. Particular attention is required to observe sexual culture, basic rules of personal hygiene - this will minimize the risk of inflammatory processes in the genital organs, prevent unwanted pregnancy, thereby preventing abortions, and also protect yourself from hypothermia.

Treatment of primary infertility requires patience and a thorough medical examination. It is very important to find out the cause of the disease as early as possible and conduct effective therapy, the result of which is a long-awaited and desired pregnancy.

First-degree infertility or primary infertility is a serious problem in modern world. The main symptom is the inability of a married couple to conceive a child for twelve months, provided that they had a regular sexual life without protection. When talking about primary infertility, this means that a woman, from the beginning of her reproductive development, has never been able to get pregnant. And unfortunately, this diagnosis is not so rare.

Many, having heard about primary infertility, fall into depression, apathy, but modern medicine has stepped forward so much that the chance of getting pregnant or just having your own child is increasing every day. And in this article we will look at what leads to primary infertility and how it is treated.

What is primary infertility in women

There are congenital pathologies, as a result of which a woman is not able to become pregnant. For example, pathologies include erosion of the cervix, fibroids, cysts, etc. Problematic ovaries are widespread, and if the work of the ovarian follicles is disrupted, then the maturation of the egg becomes problematic, with deviations from the norm. These diseases can occur if the patient has had no periods for a long time, or vice versa, with their excessive duration.

Primary infertility in women

Abortions are common in women. After all, those hormones that were produced during the conception of a child, as well as during the formation of the fetus, are no longer needed, and a failure occurs in the body.

Often, it is scraping during an abortion that leads to injuries to the genital organs, resulting in adhesions that lead to obstruction of the fallopian tubes. Therefore, the egg simply cannot get into the uterus for implantation to occur.

Causes of primary infertility

Lack of ovulation. The reason for this is a hormonal failure, a violation of menstruation, heavy bleeding, or vice versa, their absence for a sufficiently long time leads to the fact that a healthy egg cannot come out. This is usually treated with medication to restart a woman's normal ovulation cycle.
Endometriosis disease occurs when the endometrial cells of the uterus grow outside the uterus. Women usually feel a painful appearance this disease especially during menstruation. It is during endometriosis that the number of miscarriages increases. This disease is treated only surgically, removing unnecessary tissue and restoring the patency of the fallopian tubes.
With age, the quality of the egg is deteriorating, and it is becoming increasingly difficult for women after forty to become pregnant, and there is a risk of all sorts of pathologies. In this case, a surrogate mother or the introduction of an egg from a donor is recommended.
Poor patency of the fallopian tubes This is when the sperm cannot reach the egg. Doctors say that with first-degree infertility, inflammation in the genital organs and infections can be the cause of obstruction.
polycystic. During this disease, a large number of cysts appear on the walls of the ovaries, which causes hormonal failure, failure of the menstrual cycle, and the absence of ovulation. Symptoms of polycystic disease - increased vegetation on the body, rashes, weight gain. Polycystic disease is treated medically.

Nevertheless, only a specialist can correctly diagnose the disease, and determine the nature of its course, and prescribe high-quality and correct treatment. To date, type 1 infertility is treatable, and there are a huge number of ways. And in the case of an extremely difficult course of infertility, there is an option with IVF or surrogate motherhood. Therefore, do not lose faith in yourself and in medicine, go for it, and you will succeed!

The diagnosis of "infertility" is made if within 1 year, with regular attempts to conceive a child, pregnancy has not occurred. There are 2 forms of infertility: 1 and 2 degrees.

Primary infertility is the inability to conceive a child at the beginning of the reproductive age (from 20 to 27 years). The problem is complicated by the deterioration of the mental state of the woman, and when trying to get pregnant, any disorders only worsen the situation.

Primary infertility in women is a fairly common factor. With the correct diagnosis of the disease that caused infertility, competent treatment and restoration of the reproductive system is possible.

Types and signs

There are several types and subspecies of infertility. Two main forms: primary and secondary (acquired, resulting from injuries or inflammatory processes).

There are 2 other varieties: absolute and relative. Absolute infertility is the complete inability to become pregnant due to the absence of a uterus and ovaries in a woman. With a relative chance of conceiving a child, there are considerable, for this you only need to perform some operations. Primary infertility can be divided into 5 types:

Normogonadotropic anovulatory or endocrine infertility occurs due to diseases of the thyroid gland and sex glands. Their work is the regulation of the menstrual cycle, so any deviation can lead to complex hormonal disruptions. Anovulatory normagonadotropic infertility does not allow ovulation to occur or makes this process rare and inferior. There are 3 reasons why anovulatory infertility occurs:

Disorders in the work of the hypothalamus and pituitary gland: weight loss, stress, bleeding are observed. If the cause is a prolactinoma (tumor), with proper treatment, fertility will be restored.
Polycystic ovary syndrome: there is an excess of estrogens. If the form of the disease is severe, then the probability of restoring the reproductive system is low.
Ovarian exhaustion is the most difficult stage in which the chances of getting pregnant are reduced to almost zero.

Tubal-peritoneal - caused by obstruction of the fallopian tubes. Adhesions form in the fallopian tubes and ovaries, so pregnancy does not occur until the channels are cleared. This procedure is usually done with a surgical method called laparoscopy. A microscopic instrument in the cavity of the pipes expands the channels and cleans them from adhesions. If the form of the disease is severe and the tubes are practically impassable, doctors recommend refraining from laparoscopy and trying to conceive a child using IVF, including surrogacy.
Genetic - caused by chromosomal abnormalities. Manifested by frequent miscarriages. Doctors recommend genetic testing if there have been 2 miscarriages in a row.
Immunological - observed with a special activity of antisperm antibodies that disrupt the ability of sperm to be fertile. Most often, immunological infertility of the 1st degree occurs due to the incompatibility of cervical mucus and seminal fluid. During ovulation, the ovaries produce special substances that coat the cervix with mucus. Because of it, sperm cannot approach the uterus and die, and the egg is never fertilized. To establish the immunological form, women conduct a postcoital test immediately after intercourse. The test helps determine cervical mucus and determine the cause of difficult conception.
Infertility caused by artificial termination of pregnancy. Abortions negatively affect the state of hormonal processes and often provoke adhesions in the fallopian tubes. Even a mini-abortion can subsequently interfere with a planned pregnancy. If the endometrium is damaged, the egg will not be able to attach to the uterus. Pregnancy will not occur until the endometrium is fully restored.

Also known is the concept of idiopathic infertility. This term doctors call the inability of a woman to become pregnant for unknown reasons. Both partners undergo a full examination, but no abnormalities in the body are found.

This is the most difficult form, because doctors cannot determine what needs to be treated to restore the reproductive system.

Causes of infertility

You can determine why pregnancy does not occur by some signs:

unpleasant odor from the vagina;
grayish discharge;
frequent gripping pains in the lower abdomen;
itching in the genital area;
discomfort during intercourse, pain;
disturbed menstrual cycle;
menstruation lasting less than 3 or more than 7 days;
delay in menstruation (also does not always indicate pregnancy).

All these signs indicate some reason that prevents a woman from becoming pregnant. The main factors of infertility of the 1st degree include:

Endometriosis.
Obstruction in the fallopian tubes.
Increased secretion of prolactin.
Amenorrhea.
Spikes.
Defects in the organs of the reproductive system.
Psychosexual disorders.
Inflammation in the pelvic organs.
Hormonal imbalance.

Separately, it is worth mentioning a medicine that often becomes a provocateur of infertility - Postinor.

Postinor

This is a powerful remedy that should only be used in extreme cases: a torn condom during intercourse, rape, unsafe sex, etc. This medicine is used in really emergency situations, but many girls use it as a regular contraceptive. This approach leads to infertility.

Postinor - provocateur of infertility

The remedy must be taken immediately after unprotected intercourse, within 72 hours. One pack contains 2 tablets to be taken consecutively. The first tablet - in the next hour or two, the second - 12 hours after the first. The sooner the medicine is taken, the lower the risk of becoming pregnant. If used improperly, infertility can occur after postinor.

The medicine deals the strongest blow to the body and depletes the functions of the ovaries. With regular use of the drug, the reproductive system completely dies. Postinor and infertility are indeed connected, but if you use it strictly according to the instructions, the body will not be damaged.

Postinor after ovulation slows down the movement of the egg and sperm.

Cervical factor infertility

Cervical factor infertility is a violation in the cervix, due to which fertilization does not occur. There are 2 forms of deviations:

Poor quality of the composition of the cervical mucus.
Narrowed cervical canal.

Treatment of the cervical factor is related to the cause of its manifestation. The most common: hormonal failure, poor microflora of the cervix, inflammatory processes. After establishing the diagnosis, the doctor prescribes complex therapy, which includes taking restorative drugs and a special diet.

Treatment and prevention

Before prescribing treatment, the doctor conducts a complete examination of the patient for all forms of infertility. All methods are aimed at restoring the reproductive functions of the body. Both medicines and surgical instruments can be used here. Depending on the type of infertility, therapy is established:

With endocrine, hormonal correction is prescribed, stimulating the work of the ovaries. If there are physiological abnormalities, they are eliminated: normalization of weight, maintaining proper nutrition. Hormone therapy helps the follicles to mature properly, while the level of hormones in the blood is controlled.
If the problem is in the fallopian tubes, treatment is aimed at improving their patency (laparoscopy method).
Endometriosis is eliminated in the same way. The chance of pregnancy is 40%.
With immunological infertility, preference is given to the method of artificial insemination. In this case, the father's sperm is injected into the uterine cavity using a special tube. This option allows sperm to bypass the immune barrier and quickly enter the egg.
It is most difficult to formulate a treatment for an indeterminate cause of infertility. In this case, the patient is prescribed various procedures, examination for all known factors of infertility.

To maintain the reproductive system, every woman needs infertility prevention.

As a rule, it includes regular visits to the gynecologist (1-2 times a year), going to the doctor at the first symptoms of any disease, proper nutrition, personal hygiene, use of contraceptives only on the advice of a doctor.

According to WHO statistics, approximately one in seven families is faced with the problem of infertility. Infertility refers to the inability of a sexually active couple of childbearing age to reproduce. Such a diagnosis is made if pregnancy does not occur after a year of sexual activity without the use of any contraceptives. About half of these cases are due to primary infertility, when a woman's pregnancy has never occurred. The secondary includes problems with reproduction, if the pregnancy has already been, even if it is ectopic, frozen, with an early miscarriage.

The main causes of infertility are associated with hormonal and anatomical pathologies of various origins. For example, due to a violation of the menstrual function, ovulation does not occur, or the underdevelopment of the uterus makes it impossible to implant the embryo. There are many reasons for this, and they can be combined with each other.

Modern research in gynecology has shown that types of infertility can be grouped according to different criteria. First of all, it is primary and secondary infertility. Each of them is divided into several types.

Depending on the sex of the partner who has problems with fertility, there are male, female, combined infertility.
Depending on the ability to correct the causes, infertility is divided into absolute and relative.
In connection with the type of violations of the reproductive system, infertility occurs:

endocrine;
pipe;
associated with endometriosis
immunological,
psychological;
unexplained etiology.

Primary infertility in women and men

Primary infertility in men is as common as in women. Such a diagnosis can be made if one or more partners with whom unprotected sex has never become pregnant. The causes of this condition can be different, congenital and acquired. For example, this can include:

anomalies of the genital organs (cryptorchidism, absence, underdevelopment of the testicles or seminal ducts, hypospadias);
genetic pathologies;
varicocele;
infectious diseases (STDs, epididymitis, parotitis);
endocrine disorders.

Treatment of primary infertility should be aimed at eliminating its cause. It is usually possible to achieve conception in a natural way if the infectious factor is eliminated, the hormonal background is corrected, and some anomalies are corrected by surgery.

Unfortunately, even with the current level of development of medicine, not all pathologies can be cured, especially when it comes to the congenital absence of an organ, chromosomal changes. In such cases, assisted reproductive technologies will come to the rescue.

The causes of primary infertility in women, as well as in men, are associated with congenital and acquired anatomical features, hormonal imbalance, STIs. The list will be somewhat wider, due to the more complex structure of the female reproductive system.

Rarely, but there are cases of such a type as combined infertility, when both partners at the same time have any problems with fertility. If it was possible to establish the causes, and the treatment of infertility was carried out in a timely manner in full, then the chances of a woman to become a mother increase dramatically.

Congenital pathology of the anatomical structure

Primary infertility in women can be absolute due to congenital malformations of the genital area associated with the absence of:

uterus;
ovaries;
fallopian tubes.

The pathology of the structure of the uterus (hypoplasia, intrauterine septum, bicornuate uterus, doubling of the organ) or the fallopian tubes (their doubling, fusion, underdevelopment) can also interfere with conception. Because of this, the meeting of the egg and sperm is not feasible, that is, the possibility of natural fertilization is completely excluded.

Diagnosis of primary infertility

The diagnosis of primary infertility is made to a patient who complains about the absence of pregnancies with regular sexual activity, after a series of diagnostic studies. The doctor conducts an anamnesis, an external examination, assessing the condition of the skin, hairline, subcutaneous fat layer, breasts, and genital organs. A number of laboratory and instrumental examinations are carried out, including minimally invasive diagnostic operations.

Secondary infertility in women

If a woman cannot conceive for more than a year, but she has previously had a pregnancy, regardless of its completion, then we are talking about secondary infertility. Its varieties in women are associated with factors such as:

tubal obstruction;
infectious and inflammatory processes;
hormonal disorders, in particular, polycystic ovary syndrome and early menopause;
biological incompatibility of partners;
endometriosis;
psychological problems.

Fallopian tube obstruction

After undergoing gynecological operations, including abortions, inflammation of the uterus and appendages, adhesions appear in the fallopian tubes. Their inner surface, as it were, sticks together, grows together. The light is blocked. Due to obstruction of the tubes, spermatozoa do not reach the egg, conception does not occur. The adhesive process can spread to the pelvic organs, this type of infertility is called tubal-peritoneal.

Inflammatory diseases of the pelvic organs

The onset and normal development of pregnancy is prevented by infections that cause inflammatory diseases of the uterus, cervix, tubes or ovaries. It can be STDs, including venereal, tuberculosis and others. The causative agents are:

The infection can get, for example, into the ovaries through sexual contact, when performing gynecological procedures, during childbirth, menstruation, with blood flow from another diseased organ. More often women with chronic stress, weakened immune systems, leading promiscuous sex life suffer from diseases of the genital area.

Infectious processes can act as a factor in infertility. So, inflammation of the cervix changes the properties of the mucus of the cervical canal, it becomes too thick, which prevents the transport of sperm into the woman's uterus. With inflammation of the ovaries, their functioning is disrupted, problems with ovulation appear, and the menstrual cycle gets lost. Inflammation of the uterus affects the normal functioning of the endometrium, to which the fertilized egg is attached.

The danger of genital infections is that in about half of the cases they are asymptomatic or with erased symptoms. Launched infections without proper antibiotic treatment turn into a chronic, sluggish form and lead to adhesions of the pelvic organs, causing infertility.

endocrine infertility

Hormonal disruptions in the body are another common cause of infertility. They are caused by dysfunction of the endocrine glands involved in the work of the reproductive system and the reproduction of offspring: the ovaries, hypothalamus, pituitary gland, thyroid gland and adrenal glands.

The main symptom indicating an endocrine imbalance will be a violation of the menstrual cycle up to the complete absence of menstruation (amenorrhea), as a result of which ovulation does not occur. Failures in the body of such a plan cause:

head injury;
brain tumors;
obesity;
dramatic weight loss in a short time;
hypo- and hyperfunction of the thyroid gland, adrenal glands;
neoplasms of the ovaries;
stress;
genetic abnormalities;
somatic diseases.

For example, the pituitary gland produces the hormone prolactin. When its level in the blood of a woman rises, the onset and development of pregnancy is impossible. Fortunately, endocrine infertility is treated with replacement therapy. After adjusting the hormonal background, 7-8 women out of 10 manage to get pregnant.

Polycystic ovaries

A type of endocrine pathology is polycystic ovary syndrome (polycystic, PCOS). The disease is widespread. In about a quarter of women who have problems with conception, it acts as the main factor in infertility. With this diagnosis, the ovaries visually become similar to a bunch of grapes. Many small cystic formations appear in them. These are immature follicles. In patients, along with cycle failures, excessive hair growth, multiple acne, obesity, skin pigmentation, increased insulin levels, and metabolic disorders are noted.

Immunological infertility

If a woman cannot become pregnant for a year or more, all known variants of infertility are excluded during the examination, then it is recommended to conduct a postcoital analysis for the presence of antisperm antibodies in the couple's blood. A positive result may indicate that spermatozoa are destroyed in the body of a man (more often) or a woman, as a result of which fertilization does not occur.

There is also a genetic incompatibility between a man and a woman. In such cases, conception occurs, but the mother's body begins to reject the fetus, and it dies. With the first pregnancy, the risk of rejection is minimal, but increases with each subsequent.

Immunological incompatibility is one of the rarest and most difficult to treat types of infertility.

endometriosis

Pathological growth of the internal mucous membrane of the uterus is the cause of associated primary or secondary infertility. The endometrium has the ability to take root, falling on other organs and tissues. It can be carried throughout the body with blood and lymph flow. Problems with conception arise for two reasons.

Adhesions in the tubes and uterus, due to chronic inflammation in places of endometriotic lesions.
Problems with the maturation of the egg, its quality and ovulation in the presence of endometrial tissue on the ovaries.

early menopause

Early menopause, or emaciated ovary syndrome, is a rare cause of infertility. It is diagnosed if a woman under or after 40 years of age stops having periods and has such characteristic symptoms as hot flashes, sudden skin fading, weakness, irritability, pressure surges, pain in the heart.

Among the factors in the development of pathology, gynecologists distinguish:

genetic predisposition;
intrauterine damage to ovarian tissue;
autoimmune disorders;
dysfunction of the hypothalamus;
infectious diseases;
stress.

Premature menopause is characterized by a decrease in the size of the ovaries and the complete absence of follicles in them. The lack of maturation of the egg makes conception impossible. As a method of treatment, assisted reproductive technologies (ART) are usually used.

Psychological infertility

If the couple has passed all types of examinations, doctors do not find any obstacles to conceiving a child, and the desired pregnancy does not occur, then you should think about psychological infertility. The trigger mechanism can be a chronic stressful situation. There were cases when excessive focusing of thoughts on a cherished desire did not allow a dream to come true, and as soon as a woman switched her attention to something else, the test showed two stripes.

The causes of psychological infertility may lie in the subconscious. For example, unwillingness to give birth from a particular man, fear of childbirth. For treatment, methods of psychotherapeutic influence are used.

Secondary male infertility and its features

A couple should think about secondary male infertility if a man has suffered a trauma to the genitals, any disease, conception does not occur, but at the same time the partner had a pregnancy with any outcome. The diagnosis is confirmed after a complete examination, within which a semen analysis, blood tests, ultrasound and doppler of the scrotum are mandatory.

Prerequisites for the occurrence of pathology:

STD;
a history of viral diseases (flu, herpes, etc.);
endocrine pathologies;
varicocele;
surgical operations on the genitals;
regular intake of alcohol, anabolics, narcotic substances;
smoking;
exposure to high temperatures on the testicles (work in a hot shop, visiting a bath, sauna, too hot water while taking a bath);
strict diets and stress.

All these factors affect the quantity, transport of produced sperm, and its quality. Spermatozoa do not enter the ejaculate or are not viable, which makes the fertilization process impossible.

Diagnosis of secondary infertility

Various types of infertility in women can be combined with each other, as well as with male infertility in different combinations. The most frequent pathologies of an inflammatory nature. Therefore, the primary diagnosis is aimed at finding infections and their pathogens.

Women need to start the examination with a visit to a gynecologist, a consultation with a urologist or andrologist - for men. A number of laboratory diagnostic measures include ultrasound, hardware, instrumental examination of the uterus and appendages, blood tests for hormone levels. The results obtained will help to find the causes of childlessness for the selection of the most effective therapy.

General principles of infertility treatment

Types of female infertility are numerous, each of them requires a specific treatment regimen. Therapy aimed at restoring reproductive health is selected individually, depending on the reasons that violated it.

Treatments can be broadly divided into two types.

Conservative - reception various medicines, including hormonal, physiotherapy. So, in case of infections, the patient is prescribed antibiotics, and in case of endocrine imbalance, substitution therapy is selected.
Operative, including surgical, minimally invasive, laparoscopic, endoscopic intervention. For example, it makes no sense to treat the symptoms of tubal infertility without surgery.

It makes sense to turn to alternative methods, for example, and so on. Currently, the Internet is replete with many ads for various food supplements that help get rid of infertility. Reviews speak of the positive effect of these funds, but this does not yet indicate a proven clinical effect.

A combination of methods is possible. For example, after surgery, antibacterial and anti-inflammatory drugs are prescribed. Or, on the contrary, after drug treatment of the infection, an operation is performed to eliminate adhesions.

If traditional methods did not lead to positive result, then modern assisted reproductive technologies, such as IVF, ICSI and others, are capable of helping a childless couple.

Alena Strazdina
obstetrician-gynecologist, reproductologist at Lode Medical Center

Infertility has long been considered not as a diagnosis, but as a condition. So this is precisely the condition in which, despite regular sex life without using any methods of contraception, pregnancy does not occur within 12 months. Of course, the doctor can come to this conclusion much earlier. For example, if there are problems such as polycystic ovary syndrome, genetic diseases, indications of serious surgical interventions on the pelvic organs, and so on.

Distinguish primary infertility(when a woman has never been pregnant during her lifetime) and secondary infertility(when there was at least one pregnancy after all).

Sometimes the true reason is a mystery to the doctors themselves

The factors leading to the problem under discussion can be very different. For example, if we talk about endocrine infertility, then this is the impossibility of pregnancy due to the lack of ovulation, a violation of the luteal phase of the cycle caused by changes in the normal secretion of hormones in the blood, or a violation of sensitivity to the effects of hormones of target organs - the ovaries and uterus.

Tubal-peritoneal factor infertility is characterized by impaired patency or peristalsis (contractile movements) of the fallopian tubes of a woman, as well as the presence of an adhesive process in the small pelvis.

As a separate factor, infertility caused by endometriosis. It leads to a decrease in the quality of oocytes and ovarian reserve, a violation of the process of fertilization and peristalsis of the fallopian tubes, and so on.

About immunological factor infertility is said if a man has a large number of spermatozoa loaded with antisperm antibodies. To identify such a situation, a man needs to pass a MAP test.

Violation of spermogram indicators indicates the presence of male factor of infertility

In 10-15% of cases, the cause of infertility remains unknown. The methods that exist in clinical practice today do not always give an unambiguous answer. Man is a complex being. It also happens that no obvious diseases have been identified, both the man and the woman are healthy, but for some reason pregnancy does not occur.

Even if there are no ovaries or fallopian tubes, pregnancy is possible

In most cases, infertility treatment begins with conservative (drug) therapy. But there are a number of indications in which it is realistic to fulfill a dream only with the help of IVF. These are conditions in which pregnancy cannot occur without the use of assisted reproductive technologies (absolute indications) or when their use will give the most favorable result (relative indications).

An absolute indication is, for example, the absence of fallopian tubes (due to surgery). That is, these are, as a rule, very serious reasons that the couple cannot fix.

However, most indications for IVF are still relative. Even if a woman has practically no ovaries or they have ceased to function due to diseases, but there is a uterus, the possibility of pregnancy remains. In this case, it is possible to carry out a program using donor oocytes (obtaining eggs from a donor woman, subsequent fertilization in the laboratory and transplantation into the body of a recipient woman). In severe sperm pathology in men, programs are carried out using donor sperm.

In our country, it is allowed to conduct surrogacy programs for women who do not have a uterus or when, for a number of other reasons, pregnancy is impossible.

The list of contraindications for pregnancy is quite large.

There are situations where pregnancy poses a high health risk. The Decree of the Ministry of Health No. 54 lists all contraindications to IVF programs. As a rule, these are those diseases in which pregnancy is contraindicated. These include: severe connective tissue diseases, tuberculosis, syphilis, thrombosis, severe forms of diabetes mellitus, diseases of the central nervous system - the list is quite long.

- If there is a problem with conception, probably, first a woman without a partner turns to specialists?

Yes, after all, women usually look for a problem in themselves. But from my own experience, I can say that lately more and more people come to the reception in pairs. And, of course, this is correct.

About 40% of the total statistics are accounted for male infertility

- But still, in whom infertility occurs more often: in men or in women?

Currently, the combined factor of infertility is becoming the most common, when both partners have health problems that prevent conception. If you still choose between the sexes, women are diagnosed with this more often. But somewhere around 40% of the total statistics falls on male infertility, and this is a high figure.

What are the most common causes of male infertility?

Violation of the hormonal regulation of spermatogenesis, the functioning of the thyroid gland, diseases of the scrotum, problems with blood vessels that led to malnutrition of the testicles, severe general diseases.

Therapy in the treatment of malignant diseases can also adversely affect spermatogenesis. Even harmful working conditions sometimes contribute to the problem. For example, frequent interaction with toxic substances, work in conditions of high temperature, and so on.

- And what role do bad habits play in the overall unfavorable picture?

Big. By the way, it has been scientifically proven that non-smoking men have much less problems with conception than smokers. For women, smoking is at risk of miscarriage. But, like alcohol, nicotine is only an additional aggravating, and not the main factor in infertility.

Sometimes some inexplicable forces take over

- Were there any surprising cases in your practice?

I think every reproductive doctor has such stories. I can cite as an example a case when a woman was operated on three times due to endometriosis, an IVF program was carried out, only one embryo was obtained, and the patient became pregnant on the first attempt. Today, the couple is raising a wonderful boy.

You should never despair. No matter how literate we, doctors, may be, to date, far from all the mechanisms of reproduction in the human body have been studied. Perhaps there really are forces that contribute to the final success or failure. After all, it happens that even if all the procedures of the same IVF were successful and, it would seem, the result is simply obliged to please, at the last moment something breaks down.

By the way, sometimes the problem lies not at all in poor health. Psychological barriers are also a serious obstacle. It is known that the regulation of the menstrual cycle in women is closely interconnected with the central nervous system. Stressful situations negatively affect any processes in the body.

As a doctor, I am against a healthy couple at the very start of pregnancy planning, when they have just begun an open intimate life, “fixated” on this issue: they constantly took ovulation tests, calculated auspicious days, and even hours for sexual intercourse and fearfully awaited the days of menstruation. People are not machines. Everything has its time. Don't rush and don't worry too much.

In the end, you can turn to a psychologist. There are things that are difficult to entrust to both relatives and the doctor. But sometimes you just need to get rid of accumulated internal problems, pour out your soul to someone. And then everything will definitely work out.

Photo: Olga Chertkova

According to statistics, today every 7 May couple cannot get pregnant. They have to go through a huge amount of all kinds of research for several months and even years, to be treated in order to conceive a long-awaited child. At the same time, doctors distinguish between secondary and primary infertility, which can be diagnosed in both men and women. However, not everyone understands what kind of pathology it is and whether a full recovery is possible.

According to medical terminology, primary infertility is a pathological inability to conceive a child from the very beginning of reproductive age. This diagnosis is made if the couple does not become pregnant within 1 year with unprotected sex, while conception has never occurred before. Pathology does not depend on sexual characteristics (that is, both women and men can suffer from it). However, the reasons for it can be completely different.

Medical educational program. The diagnosis of primary infertility can also be referred to as infertility of the first degree.

The reasons

First you need to find out the causes of primary infertility - the factors that make it impossible to conceive. And it will be different for men and women.

Among women

Underdevelopment of the female genital organs, which is called infantilism.
Anomalies of the uterus or its incorrect position.
Weakening of the functions of the gonads.
Infection of the genital tract with various kinds of infections.
Inflammation in the genitals.
Diseases of the uterus: fibroids, cysts, erosion, endometriosis (is it possible to get pregnant with endometriosis, read).
Any pathology of the ovaries, a violation of their functionality: polycystic, lack of ovulation.
Hormonal failure that prevents the maturation of a healthy egg.
Poor-quality egg due to aging of the body. After age 40, eggs may be abnormal.
Blockage of the fallopian tubes, when a healthy egg cannot reach the uterus.
Regular use of emergency contraceptives. The same famous "Postinor" contains a very large dose of hormones that interferes with the fertilization of the egg in the future.

In men

Infectious diseases. Inflammation is facilitated by the activation of various fungi, viruses, bacteria, due to which the spermatozoa stick together and become unproductive.
Poor patency of the seminal tract.
The production of antibodies to spermatozoa.
Varicocele - dilated veins of the seminal canal.

General

The causes of primary infertility, common to men and women, are also:

Wrong, unhealthy lifestyle: poor diet, lack of physical activity, various dependencies(alcoholic, narcotic, tobacco), etc.
Unfavourable conditions environment- poor environmental conditions.
Constant stress.
Serious congenital or acquired pathologies (health problems). Such systemic diseases as cirrhosis of the liver, diabetes, tuberculosis, bronchial asthma, traumatic brain injury.
Genetic anomalies of a hereditary nature.
Radiation, constant or prolonged contact with harmful chemicals.

It is important to identify all these adverse factors in order to eliminate them in a timely manner - this will be the main course of treatment. But first you need to make sure that we are talking about primary infertility, and not about some other pathology.

Keep in mind! Young couples downplay the role of stress in the process of conceiving a child. In the presence of persistent depression, the possibility of becoming pregnant is significantly reduced.

Symptoms

The main symptom of primary infertility is the absence of pregnancy during the year with constant sexual activity and the absence of contraception. All other signs may be implicit and indicate other diseases and pathologies, therefore, it is required to identify additional, more accurate symptoms from a doctor during examination.

Among women:

prolonged absence of menstruation, constant disruptions in the menstrual cycle, prolonged bleeding during menstruation are signs of hormonal failure;
painful periods may indicate endometriosis;
large (or small) body weight, fast growth body hair, acne - symptoms of polycystic;
foul-smelling discharge.

For men:

pain when urinating;
obesity;
pain and burning in the scrotum, discomfort during walking, increased sweating, sexual dysfunction - symptoms of varicocele.

If a couple aged 20 to 40 years have regular sexual intercourse during the year with a complete, long-term rejection of contraceptives, but they do not end in pregnancy, while conception did not occur before, we can talk about primary infertility. If there are also the above additional symptoms, the risk of confirmation of the diagnosis increases. However, final conclusions can be made only after laboratory diagnostics.

Stubborn statistics. About 15% of couples are infertile. In 40% of cases, the cause is a male factor, in 50% a female factor, and only in 10% both are diagnosed.

Diagnostics

Extended diagnosis of primary infertility includes a number of activities. This is the collection of data in the anamnesis (questioning patients, studying the histories of their diseases), physical examinations (examination, palpation), laboratory techniques.

Physical examination

The body mass index is outside the normal range (20-26).
Skin condition indicates endocrine disorders.
Underdevelopment of the mammary glands in women.
Soreness, seals in the genital area during gynecological palpation.
Examination of the cervix using colposcopy or a vaginal speculum.

Laboratory methods

Infectious screening for STIs (sexually transmitted infections).
Hormonal screening to exclude primary.
Ultrasound of the pelvis, thyroid gland.
Hysterosalpingography (HSG) - X-ray of the fallopian tubes.
MRI for a tumor in the brain that inhibits the production of hormones.
Spiral computed tomography (SCT) of the pelvic organs helps to identify anatomical primary infertility.
Laparoscopy (examination of the abdominal organs) finds adhesions, tumors, ovarian cysts.
Hysteroscopy (examination of the uterine cavity).

As a result of all these studies, one of the partners is diagnosed with primary infertility and appropriate treatment is prescribed.

Useful advice. Do not refuse laboratory methods for diagnosing primary infertility, which the doctor will offer you. Sometimes the cause of the pathology is a disease that is accidentally detected and has never manifested itself before.

Medical treatment

The main drug treatment of primary infertility is to eliminate the disease or pathology that provokes it.

anovular

Anovulation (non-release of an egg from an ovary) is treated as follows:

correction of hormonal changes;
stimulation of ovulation;
support for the II phase of menstruation.

In this case, after the onset of pregnancy, hormone therapy continues.

Infectious-dependent

Treatment of primary infertility dictated by an infectious and inflammatory process involves the use of the following drugs:

broad-spectrum antibiotics, taking into account microorganisms that are pathogens;
vitamins;
immunostimulating agents;
hormonal agents.

Adhesive

With adhesive obstruction of the fallopian tubes, laparoscopic intervention is indicated.
Plastic surgery - to eliminate deformities of the fallopian tube.

Endometriosis-associated

Carrying out complex therapy, which is aimed at eliminating violations.
Treatment of hormonal disorders: combined oral contraceptives, progestogens, antigonadotropins, gonadoliberin agonists.
Dissection of adhesions.
Stimulation of ovulation.
Support for the II phase of menstruation.

immune, idiopathic

Assisted reproduction methods.

If the cause of primary infertility is unrecoverable (genetic disease, age, etc.), doctors may suggest extreme measures for the couple:

IVF - in vitro fertilization.
Surrogacy.

In each case, the question of prescribing a drug to eliminate primary infertility is assigned individually. Self-medication with folk methods is possible only with the permission of the doctor after determining the cause of the pathology. On the advice of a friend or acquaintances, it is strictly forbidden to use this or that recipe with herbs.

It is a fact! If you have been diagnosed with primary infertility, be sure to find out its type. The most difficult case, difficult to treat, is idiopathic primary infertility.

Alternative treatment

Red brush root

Primary infertility is not only a scourge of our time. This disease took married couples for many centuries. In the absence of the proper level of medicine, it was necessary to look for some folk methods of treating this defect: after all, the desire to have a child was above all. As a result, people were poisoned, died, trying to pick up this or that remedy. And someone was successfully cured. Some Methods traditional medicine to date, approved by clinical trials and do not pose a danger if they are correctly and competently used.

red brush

It normalizes local immunity, helps to cure primary immunological infertility, reduces the amount of androgens that prevent conception. Boil a tablespoon of the root in 300 ml of boiling water, leave for an hour. Drink 100 ml three times a day on an empty stomach. The course of treatment is 1.5 months.

royal jelly

Royal jelly heals the body, puts in order the endocrine background, promotes regular ovulation. Take 100 mg three times a day, completely dissolving. The course is from 4 to 6 months.

mother carnation

Promotes the regularity of the menstrual cycle, eliminates erratic intermenstrual bleeding. Infuse two tablespoons in 300 ml of boiling water for 1 hour. Drink a tablespoon four times a day. Course - 1 month.

Plantain seeds

They treat adhesions, inflammation of the appendages, immunological infertility, low sperm motility. Steam half a tablespoon of seeds with 200 ml of boiling water, boil for 5 minutes over low heat, strain. Drink 2 tablespoons a day. There is one strict contraindication - thrombosis.

Geranium oil

It has anti-inflammatory, antitumor, anti-edematous action. Relieves depression, stress and psychogenic primary infertility. Pour vegetable oil (250 ml) into a jar filled with fresh geranium flowers (50 g). Insist 14 days in complete darkness. Dissolve 4 drops of cooked geranium oil in 100 ml of warm water, add a tablespoon of honey, drink before meals twice a day. The course of treatment is 2 months.

upland uterus

The upland uterus normalizes the hormonal background, treats endometriosis, relieves inflammatory diseases of the uterus. Contraindication - low level estrogen. It is recommended to start therapy on the 3rd-7th day of the cycle. It is purchased in a pharmacy in the form of a tincture. It is taken 40 drops three times a day, when diluted with water. The course of treatment is six months. Breaks are made during menstruation.

Sage

Sage contains hormone-like substances similar to estrogens. So this plant actively stimulates the work of the ovaries, accelerates the maturation of the follicles. Steam 1 tablespoon with a glass of boiling water. Infuse for 20 minutes, strain. Drink 100 ml three times a day on an empty stomach. The course of treatment is 3 months.

Leeches

Hirudotherapy affects the immune system, normalizes the circulatory system, has a resolving and anti-inflammatory effect. Treatment is carried out exclusively by a specialist. Leeches are placed on the sacrum and lower abdomen. The course of therapy - 10-15 sessions.

Honey tampons for women successfully cope with uterine inflammation, erosion, tumors, adhesions. Put them on at night, clean in the morning. Course - 15 times.

Would you like to support the main course of primary infertility treatment? folk remedies? In this case, inform your doctor about this and listen to what he tells you. You may have to give up some of the recipes you found. But sometimes the gynecologist can suggest something else, also from herbalists, but more suitable in your case.

With the active treatment of pathology with medications and folk remedies, the prognosis can be the most favorable. And in order for the long-awaited pregnancy to come as quickly as possible, you must always remember about preventive measures.

Curious fact. Doctors say that the missionary position, which many people neglect, increases the chances of getting pregnant.

Prevention

To maintain reproductive health, you need to regularly carry out preventive measures so that the problem of primary infertility does not concern you. What is needed for this?

Treat any disease in both partners.
Normalize menstruation.
Prevent unwanted pregnancies using safe methods.
Don't allow abortion.
Avoid hypothermia.
Observe a sexual culture that reduces the risk of inflammation of the female genital area.
Timely treatment and observation by a gynecologist.

Undoubtedly, primary infertility is a serious problem that has severe consequences(medical and social). Therefore, it is strongly recommended to start a diagnostic search as early as possible, clarifying possible cause pathology. Having found out the underlying disease, in most cases, doctors conduct a very effective treatment that guarantees a full recovery.