Most of these signs can be detected on their own, for this it is enough to be attentive to yourself.

If pregnancy does not occur within 18 - 24 months of regular unprotected sex, this means that one of the partners is infertile. characteristic of men and women equally. There are many signs of infertility. Starting from hormonal disruptions in the body's work, ending with psychological factors. Only a specialist will be able to correctly identify the cause of such an unpleasant failure of the reproductive system.

Talking about signs of infertility in women, it should be noted that among them there are many external manifestations - the doctor pays special attention to them at the first examination of the patient. Unfortunately, women themselves very rarely attach importance to the first signs of infertility.

1. For example, violation of the menstrual cycle often indicates problems with ovulation. A cycle that lasts more than forty or less than 20 days is considered incorrect. In this case, the likelihood of no ovulation is high. Seeing a doctor is a must! If a woman turns to a specialist in a timely manner, ovarian diseases, such as premature exhaustion syndrome, resistant ovarian syndrome, and others, are certainly easier to identify in the initial, unreleased stage.

2. Hirsutism... Excessive male hair growth in a woman - above the upper lip, on the trunk, etc. - unambiguously indicates an excess of male sex hormones. And if there is practically no hair in the area of ​​the armpits and pubis, this is a sign of a small amount of estrogen.

3. Excessively oily skin and acne, difficult to treat, signal an excess of androgens - male sex hormones.

4. Hyperprolactinemia... The appearance of such a violation indicates an excessive content of prolactin in the body - a hormone that is produced by a special gland of the brain - the pituitary gland. An increase in prolactin levels suppresses ovulation, thereby contributing to a woman's infertility.

5. Drastic weight loss... Usually, women who exhaust themselves with all kinds of diets forget that subcutaneous fat is the nutrient for the ovaries. It is from it that the body produces estrogen, which is so necessary for the growth and development of follicles. Women, especially carefully getting rid of every milligram of subcutaneous fat, are very susceptible to amenorrhea.

6. No less dangerous for a woman's health is obesity, especially when the weight exceeds the 100 kg mark. In this case, not only the reproductive system suffers, but also a number of cardiovascular diseases (hypertension and varicose veins, for example) join.

8. Spontaneous abortion... If the pregnancy has been interrupted for no apparent reason more than twice, this is an obvious sign, no less formidable than infertility.

Infertility in women is a fairly common problem. However, many experts do not consider infertility to be a disease. This, in their opinion, is amenable to correction of impairment of reproductive function. Cases when its restoration is impossible are quite rare.

Female infertility- a type of gynecological disease in which a woman, with regular unprotected intercourse, does not become pregnant for 1 to 2 years. Infertility can be caused by mental disorders of one of the partners, the presence of inflammatory processes in the body, pathological changes in the reproductive system. Diagnosis of the alleged disease should be carried out by an experienced gynecologist. He, with the help of the tests carried out, will be able to determine fertility problems, if any. The main thing to remember is that many problems in the gynecological health of a woman can be eliminated if you turn to a specialist in time.

What does “infertility in women” mean?

A woman may think about the possibility of a diagnosis of infertility, provided that for 12 months with regular and unprotected intercourse with the same partner, she fails to become pregnant. But do not immediately panic, since for the development of absolute infertility in the reproductive system of a woman, irreversible anatomical changes must occur, in which the conception of a child becomes completely impossible. These include the absence of some genital organs: ovaries, fallopian tubes, uterus, as well as violations of their functional purpose. If infertility is of the "relative" type, then most likely the causes of its occurrence can be successfully eliminated with the help of medicine.

Gynecologists distinguish between primary and secondary forms of infertility. Infertility is called primary if the woman has never been pregnant. Accordingly, secondary infertility occurs only in those women who cannot get pregnant again.

The problem of infertility is quite common among married couples. Today, up to 15% of families are faced with infertility. In no case can only the woman be blamed. Up to 40% of cases in a married couple are infertile. Male health problems include abnormalities in ejaculation, defective sperm, impotence. The rest of the reasons for the impossibility of conceiving a child fall on the shoulders of a woman. When a married couple encounters a problem of infertility, each of the spouses must be examined.

The mental mood of each partner should not be ignored either. It is so laid down by nature that one sexual intercourse is not enough. For a fruitful conception, a positive attitude and desire from each of the partners is required. An often unfavorable social situation can also lead to infertility in the family.

What causes of female infertility is determined by gynecology?

Today, unfortunately, a disease called infertility is very common. The reasons for women can be very diverse. The prerequisites for the development of female infertility are:

• increased and overactive secretion of prolactin;
• the formation of a tumor in the pituitary gland;
• any menstrual irregularities such as oligomenorrhea and amenorrhea, formed on the basis of hormonal disorders;
• congenital defects of the reproductive system;
• tubal obstruction on both sides;
• endometriosis;
• the presence of adhesions in the pelvic cavity;
• acquired pathologies of the functioning of the genital organs;
• inflammatory and tuberculous lesions of the reproductive system;
• diseases and weakening of the immune system;
• negative postcoital test;
• disturbances in the mental perception of sexual intercourse.

On the basis of the listed prerequisites leading to disorders in the conception of a child, the following forms of infertility are distinguished:

• Hormonal or endocrine form;
• Tubal-peritoneal form;
• Uterine form;
• Endometriotic form;
• Immune form.

Endocrine infertility speaks of the unhealthy functioning of hormonal regulation of the complete menstrual cycle, with the help of which ovulation occurs. Hormonal infertility in women is accompanied by anovulation. With this form of infertility, ovulation is absent, since the egg does not have time to mature or the mature egg does not leave the follicle. This is typical in diseases of the hypothalamic-pituitary region and the presence of injuries, overactive secretion of the hormone prolactin, the development of polycystic ovary syndrome, progesterone deficiency, inflammatory and tumor lesions of the ovaries, etc.

Infertility of the tubo-peritoneal form is caused by anatomical pathologies that occur on the way the egg moves along the thin fallopian tubes into the uterine cavity. In this case, both fallopian tubes must be either completely impassable, or simply absent. Peritoneal infertility is accompanied by the formation of obstructions between the ovaries and fallopian tubes. This form of infertility develops in the presence of adhesions or atrophy of the cilia inside the fallopian tube, which, in normal position, are involved in the movement of the egg.

Uterine infertility occurs with anatomical defects of the uterus, which can be either congenital or acquired. Diseases such as congenital uterine abnormalities are:

• hypoplasia - underdevelopment of the uterus during the formation of the body;
• doubling of the uterus - the presence of an intrauterine septum or saddle uterus.

Acquired uterine defects include:

• tumors;
• cicatricial deformity;
• intrauterine synechia.

All acquired uterine defects arise as a result of surgical interventions in the uterine system.

Endometriotic infertility is characteristic of 30% of women suffering from this disease. The fact is that the endometriotic areas in the ovaries and fallopian tubes do not allow to fully carry out the ovulation process and to carry out the movement of the egg.

The form of immune infertility is the presence in the female body of a large number of antisperm bodies. This is a specific type of immunity that is produced by the body against the embryo or sperm.

Very rarely, with a full examination, it is possible to detect only one pronounced form of infertility in a woman. Basically, there is a combination of several.

Unfortunately, medicine is not yet able to 100% determine the causes of infertility. Today, a very common problem called infertility in women, the causes of which are still subject to detailed study. For 15% of women suffering from the disease, the reasons for the formation of the diagnosis remain unknown to science.

Infertility diagnostics

Infertility examination is performed using a complex group of methods. The first method is a detailed survey of the patient. The study of the problem begins with this method. Every woman who is faced with a suspicion of infertility should receive a full consultation with a gynecologist. The doctor must skillfully collect all the necessary information and draw up a detailed description of the patient's state of health. At this stage, the answers to the following questions are clarified:

1. Complaints. The general well-being of the client is determined, the time frame of negative attempts to get pregnant, whether there are any pains in the genital area, features of the menstrual cycle, unusual discharge from the genital tract and mammary glands, the psychological mood of the family.
2. Family health history. The genetic characteristics of the patient's health are being clarified. These include gynecological or infectious diseases of the mother and blood relatives, the age category of the parents at the time of the patient's birth is calculated, their health status at the time of conception, the specifics of the course of pregnancy are clarified, the bad habits of the parents are clarified, their negative impact on the formation of a healthy fetus in the mother's womb is predicted and dr.
3. Patient's medical history. These include diseases that leave a mark on human health: infections of various types, traumatic injuries, pathologies.
4. Features of the menstrual cycle. The age-related characteristics of the formation of menstrual flow by the body are clarified, an assessment of the duration, regularity, volume, soreness, etc. is performed.
5. Development of sexual function. The patient finds out the age at which she began to have sexual intercourse, the conditions under which the first sexual intercourse took place, the number of partners, the patient's attitude to sexual relations in marriage, the feelings experienced during intercourse, the methods of contraception that were used throughout life.
6. Fertility. The history of each past pregnancy, complications are clarified, each labor activity is analyzed, all complications are studied.
7. History of infertility treatment in the past, if this issue was relevant in the past.

After receiving subjective information about the state of health from the patient, the doctor conducts an objective examination. It is of two types: special and general.

Using general methods and approaches, a woman's health condition is diagnosed. The general examination is focused on determining the body type, assessing the condition of the mucous membranes and skin, the nature of the hairline in intimate places, the general condition of the development of the mammary glands. In addition, an examination of the thyroid gland is mandatory, the abdominal cavity is studied, observations of the temperature regime of the body and pressure are carried out.

The methods of the spectrum of special examinations of infertility include specific studies of functional, laboratory, instrumental tests.

The most common functional tests for diagnosing infertility include:

• the creation of a temperature curve, with the help of which the moment of ovulation and the activity of the ovaries are determined;
• determination of the cervical index, which reflects the quality of cervical mucus, the level of estrogen in the body;
• postcoital test, in which the activity of the functionality of spermatozoa is studied and the ability of the female body to antisperm defense is determined.

The main attention during the performance of laboratory diagnostic methods for studying the causes of infertility is drawn to the hormonal content of blood and urine. Hormone tests are not recommended immediately after examinations by a mammologist or gynecologist, after intercourse or waking up in the morning, because the level of prolactin can be significantly changed. Hormone tests are usually performed several times to ensure the reliability of the diagnostic results. In cases of infertility, the following tests are usually the most effective:

• study of the level of DHEA-S and 17-ketosteroids in urine - based on the results obtained, the function of the adrenal cortex is assessed;
• a study of the levels of testosterone, prolactin, thyroid hormones, cortisol - the analysis is performed based on the diagnosis of plasma in the blood at the end of the first week of the menstrual cycle. This examination helps to determine the assessment of the effect of the listed hormones on the follicular phase;
• diagnostics of the level of progesterone in the blood plasma at the end of the 3rd week of the menstrual cycle, with the help of which the functioning of the corpus luteum and the effectiveness of the ovulation process are assessed;
• diagnostics of the level of follicle-stimulating hormone, prolactin, luteinizing hormone, estradiol, which is significantly manifested in menstrual irregularities.

Today, hormonal tests are also very common, with the help of which a more accurate and precise study of the state of health of individual links of the reproductive system is carried out, their reactions and mutual tolerance with individual hormones are determined. These include when diagnosing infertility:

• progesterone test, which helps to determine the level of estrogen in the patient's body with amenorrhea, and also to find out the behavior of the endometrium when progesterone is administered;
• estrogen-gestagenic or cyclic test for interaction with only one hormonal drug;
• the clomiphene test is used to assess the level of interaction between the hypothalamic-pituitary-ovarian system;
• test with metoclopramide, which helps to find out the prolactin-secreting ability of the pituitary gland;
• a test with dexamethasone, is used for patients in whose body there is an increased content of male sex hormones.

Colposcopy and radiography are very productive methods for determining infertility. In order to determine neuroendocrine pathology in a woman with an irregular and disturbed menstrual cycle, an X-ray of the skull is given. When diagnosing signs of endocervitis, erosion, they turn to colposcopy to determine a chronic infectious process. X-rays of the fallopian tubes and uterus are performed on the basis of hysterosalpingography. With its help, tumors of the uterus and anomalies in the development of the female genital organs are determined.

With the help of ultrasound, information is obtained about the patency of the fallopian tubes. Also, when examining infertility, diagnostic curettage of the uterine cavity is practiced, with the help of which the levels of changes in the endometrium are examined before each menstrual cycle.

Another group of infertility diagnostics is surgical methods. These include laparoscopy and hysteroscopy. Hysteroscopy is called endoscopic diagnosis of the uterine cavity based on an optical apparatus, a hysteroscope, the introduction of which occurs through the external uterine pharynx. The World Health Organization has classified hysteroscopy among the mandatory standards for the diagnosis of women suffering from uterine infertility.

For hysteroscopy studies, reference is made to the following indications:

• infertility of various forms: primary or secondary, miscarriages before the first birth;
• suspicions of endometrial polyps, hyperplasia, anomalies of the uterus, intrauterine adhesions, adenomyosis;
• knocked down menstrual cycle, unplanned bleeding from the uterine cavity, heavy menstruation;
• fibroids in the uterine cavity.

With the help of hysteroscopy, an internal examination of the uterine cavity, cervical canal, orifices of the uterine lips is performed, and the endometrium is assessed.

Laparoscopy is called an endoscopic method, which is used to diagnose the pelvic cavity and adjacent organs using precise optical equipment. The device is inserted through a micro-incision in the abdominal wall. This method is highly accurate up to 100%. Laparoscopy is very demanding on the conditions of its conduct. For its passage, stationary conditions and general anesthesia are required.

Laparoscopy is mainly used for the following indications:

• infertility of various forms: primary and secondary;
• ovarian apoplexy, ectopic pregnancy, uterine perforation;
• endometriosis;
• obstruction of the fallopian tubes;
• cystic changes in the ovaries;
• uterine fibroids;
• adhesive processes;
• cyst.

One of the main advantages of laparoscopy is the bloodlessness of the operation. After such a surgical intervention, there are no scars on the patient's body, and there are also no unpleasant pains.

Endoscopic methods of surgery refer to low-traumatic methods for examining the genital cavity, which manage to combine the effectiveness of diagnosing infertility, which has become widespread for use for women of reproductive age suffering from infertility problems.

Treatment of female infertility

Treatment of female infertility is based on detailed diagnostic indications. Correctly identified causes of infertility in a woman will help develop an effective approach to restoring the patient's health.

Female infertility is treated on the basis of two main therapeutic methods:

• Renewal of the reproductive characteristics of the female body through the use of surgical or conservative methods.
• Turning to alternative additional reproductive technologies in the absence of the possibility of natural conception.

Endocrine infertility requires stimulation of the ovaries and correction of hormonal disorders. In such a situation, the stabilization of weight indicators with the help of physical activity and diet therapy is referred to as a non-drug form of treatment. Drug treatment is based on the use of hormone therapy. With the help of ultrasound monitoring, the maturation of the follicle is constantly monitored. It is very important to carefully follow the requirements and prescriptions for hormonal treatment. Then 80% of patients suffering from endocrine infertility will be able to become pregnant.

Infertility of the tubo-peritoneal form is treated by restoring good patency of the fallopian tubes. Treatment is performed primarily with laparoscopy. The method is 40% effective. If the desired result is not achieved, gynecologists are advised to turn to artificial insemination.

Uterine infertility is treated on the basis of reconstructive plastic surgery. In this case, the chance of getting pregnant naturally increases by 20%. In case of a negative result of applying the method, gynecologists are advised to resort to the services of professional surrogacy.

Endometriotic infertility can be treated using laparoscopic endocoagulation. When treating with this method, it is possible to find out pathological foci and remove them. The result achieved with the help of laparoscopy is consolidated with additional drug treatment. The effectiveness of treatment is characterized within 40%.

Infertility of the immunological form is treated by artificial insemination. The method is based on insemination with the husband's sperm. Thus, contact with the immune system of the female body in the cervical canal is avoided. The effectiveness of the method is equal to 40%.

But, unfortunately, not all forms of infertility lend themselves to such a detailed study and understanding of their nature of occurrence. And if the cause of infertility is not known, then the possibilities of prescribing rational and effective treatment are limited. In such cases, doctors suggest resorting to methods of artificial insemination. In addition, medicine has identified the following indications:

• absence of fallopian tubes or tubal obstruction;
• condition after the use of surgical methods and laparoscopy for endometriosis;
• negative result in the treatment of endocrine infertility;
• absolute male infertility;
• complex cases of uterine infertility;
• depletion of ovarian function;
• pathologies in which pregnancy is practically impossible.

The main methods for carrying out artificial insemination include:

• intrauterine insemination with donor sperm (husband's sperm);
• intracellular injection of sperm inside the egg;
• in vitro fertilization method;
• surrogacy.

Remember that both partners must be involved in fertility treatment. The effectiveness of treatment directly depends on the age indicators of both spouses. More importance is given to the woman's age. At the first sign of infertility of any form, you should immediately seek the advice of an experienced doctor. It is very important for a woman not to lose faith in herself and her partner, because a lot is fixated on the mood. Many forms of infertility have already been overcome, so it is worth trying to solve the problem.

According to average statistics, more than 3% of women of childbearing age suffer from infertility after the first successful childbirth (medical abortions, spontaneous expulsion of the fetus are not included in them), about 2% have never become pregnant, the possibility of carrying and subsequent birth of a baby is not even considered for them. What are the main causes of infertility in women?

Health problems and psychological factors interfere with conception and subsequent gestation. Infertility is registered in both sexes, but more often the reason for childless marriages is abnormalities in women.

The reason for the absence of the long-awaited conception is determined in the clinic, with the help of specialized diagnostics. In some cases, the pathology can be corrected with the help of drugs or surgery, but sometimes doctors cannot determine the root causes of infertility.

Etiology of the development of pathology

Depending on the alleged underlying causes that caused the development of the problem with normal conception, it is customary to distinguish:

• relative factor - when there is a percentage of conception after taking special medications, normalizing hormonal levels and metabolism, performed surgical intervention to restore reproductive function;
• absolute - pregnancy is impossible due to congenital malformations of the female genital organs, diseases that cannot be treated, or other disorders.

In some cases, after the onset of the first conception (ending in childbirth or medical, spontaneous abortion), a woman cannot become pregnant again. Certain reasons do not allow the female body to become pregnant for the first time. Against the background of these violations, they are distinguished:

• - the absence of any conception;
• - in the anamnestic data there is information about previously recorded conceptions.

According to the mechanism of formation, division occurs:

• congenital - associated with a hereditary genetic factor (with existing pathologies in the family) and abnormal intrauterine development of the fetus (underdevelopment of the female genital organs).
• acquired - all diseases obtained during life that are not associated with a genetic factor: trauma, infectious and inflammatory processes, pathologies of the endocrine and reproductive systems.

Some experts subdivide the absence of conception according to the direct factors of occurrence:

• tubal - recorded with absolute or partial obstruction of the fallopian tubes;
• endocrine - occurs when the functionality of the endocrine glands is impaired;
• uterine - develops due to pathological conditions of the uterus;
• peritoneal - against the background of adhesions in the pelvic organs, which prevent conception (the fallopian tubes remain healthy);
• immunological - formed when the female body forms specific antibodies to male germ cells;
• idiopathic - it is established after diagnosis, but the root cause of the pathology remains unclear.

Hormonal Disorders

For the timely maturation of the egg and its release from the body of the ovary, the body produces various types of sex hormones:

• estrogen;
• progesterone;
• follicle-stimulating;
• luteinizing.

Polycystic ovary

It occurs due to an excess amount of male sex hormones, with a parallel large-scale production of insulin. Against the background of their increased number, a large number of follicles are formed in the body of the ovaries, none of which fully matures.

The mechanism of release of the egg does not occur, as well as the process of ovulation. The ovarian body increases in volume two to six times, the duration of the menstrual cycle lengthens in time, there are gaps in the regulation. The majority of females with polycystic disease have an increased body weight.

Insulin resistance

The resistance of the female body to the hormone is often recorded in polycystic ovary disease. Produced by the pancreas, it is responsible for the delivery of glucose from the bloodstream to cellular structures.

With a violation of cellular metabolism, the numerical indicators of glucose increase sharply, respectively, the production of insulin increases. Factors that lead to the development of the process:

• improper diet, with a large intake of carbohydrates and sugars;
• frequent stress;
• a sedentary lifestyle, with the exception of any physical activity.

Excess male hormones

Unstable or absent periods indicate hyperandrogenism. The functionality of the ovaries is suppressed by the excess amount of male hormones, the cycle is disrupted up to complete absence. With severe development of pathology, infertility occurs. It is possible to determine the presence of hyperandrogenism by certain criteria:

• increased body hair growth;
• acne;
• lowering the tone of the voice closer to masculine;
• change in figure based on the opposite sex.

Pituitary gland disorders

Deviations in the functionality and normal performance of the gland appear against the background of various disorders:

• problems with local blood circulation;
• causes of genetic origin;
• previously received injuries;
• taking medications;
• available in the history of meningitis.

With the development of the disease, a number of characteristic signs develop:

• the presence of milk-like contents in the mammary glands;
• violations of the normal cycle of menstruation;
• mastopathy;
• untimely enlargement of the mammary glands;
• increased fragility of bone tissue;
• decrease in attraction to a sexual partner.

Prolactin, produced by the pituitary gland, is considered a hormone for nursing mothers. Due to its appearance in the body, ovulation and the menstrual cycle stop. Its increased amount in the body of nulliparous people is associated with a malfunction of the thyroid gland - hypothyroidism.

Early menopause

Average statistical data indicate that the onset of menopause occurs at the age of 50 years. Certain factors contribute to a reduction in the functionality of the reproductive system:

• autoimmune diseases;
• violations of genetic etiology;
• various diseases of the genital organs;
• wrong lifestyle;
• chronic addiction to nicotine.

All of the above reasons cause the onset of menopausal changes in women who are over forty years old. A decrease in the production of female sex hormones, the extinction of the functionality of the ovaries is recorded in 1% of the female sex. Fertility diminishes and infertility sets in.

Lack of corpus luteum

In place of the follicle that released the egg, a corpus luteum appears. It is a temporary gland responsible for the production of prolactin, the main hormone of the corpus luteum. Prolactin stimulates the preparation of the walls of the uterus for the fixation of a fertilized egg in them.

With its insufficient amount, consolidation does not occur and the desired pregnancy does not occur. In some cases, consolidation occurs, but then a spontaneous abortion develops. For the occurrence of a pathological condition, prerequisites are necessary:

• congenital genetic abnormalities;
• pathological failures in the functionality of the ovaries - polycystic syndrome, malignant neoplasms;
• disturbances in the performance of the pituitary gland.

Physiological disorders

The second type of deviation is formed in a variety of diseases of the female reproductive system. Each of the disorders has its own root causes and symptomatic signs.

Disturbances in the fallopian tubes

Complete or partial obstruction of the fallopian tubes interferes with normal fertilization. In a healthy woman, the ovum is connected to the male reproductive cells in them, after the first leaves the body of the ovary. Damage to the fallopian tubes is often the result of:

• inflammatory processes in their body;
• existing viral, bacterial diseases;
• diseases transmitted through sexual contact;
• complications after performed surgical procedures;
• with the formed and scar tissue.

Endometriosis

The inner lining of the body of the uterus is lined with endometrium; with the development of abnormalities, the mucous membrane begins to grow inside and outside the reproductive tract. The main causes of endometriosis are considered to be genetic abnormalities in the body.

Excess tissue can block the outlet from the fallopian tubes, causing impaired ovulation and subsequent infertility. The disease is recognized by its symptomatic manifestations:

• painful sensations in the lower abdomen;
• increased amount of discharge;
• pain during the moments of menstruation.

Benign neoplasms

An increase in the quantitative indicators of estrogen can lead to the appearance of fibroids in the body of the uterus. A benign type of tumor consists of muscle tissue and manifests itself with existing abnormalities:

• hereditary predisposition - when there are cases of fibroids in the body of the uterus in the family, there is a large percentage of occurrence in subsequent generations;
• various deviations in the normal metabolism;
• constant stress, psycho-emotional overstrain;
• medical and criminal abortions.

Suspected symptoms of its appearance:

• excessively heavy menstruation;
• menstrual irregularities;
• painful sensations during menstruation.

In difficult cases, it can cause childlessness, spontaneous abortions or complications during pregnancy that threaten the life of the fetus.

Uterine abnormalities

After inflammatory processes, traumatization and endometriosis, adhesions occur in the body of the uterus, changing and splicing the walls of the organ. The pathological structure of the uterus is caused by disorders of intrauterine development of genetic etiology:

• uterine infantilism - underdevelopment of the female organ that remains in the size of the child;
• the presence of an additional partition that is not available in the normative development;
• one-horned or two-horned uterus.

With the existing pathologies, any pregnancy ends in spontaneous abortion in the early stages. The fertilized egg cannot be fixed on the wall of the organ, which is the reason for the termination of pregnancy.

Changes in the cervix

After surgery or against the background of infectious processes, after healing, various adhesions and scars form on the cervix. Artificial constriction interferes with the normal passage of male germ cells into the fallopian tubes, causing the onset of infertility. Congenital or acquired deformation of the organ, various deviations in the composition of the cervical mucous secretion complicate the process of penetration of spermatozoa into the body of the uterus.

Inflammatory processes in the small pelvis

They arise when pathogenic microflora penetrates into the organs of the reproductive system. A significant number is accounted for by diseases transmitted through sexual contact and provoked by:

• chlamydia;
• ureaplasma;
• gonococci;
• Trichomonas, etc.

The risk of infection increases if the rules of safe contacts are violated - intercourse without the use of condoms, frequent change of sexual partners. Pathogenic microorganisms can also appear:

• during intrauterine operations, in violation of the rules of septic and antiseptics;
• at the time of menstruation - insufficient hygiene;
• in the postpartum period.

Infectious processes cause various diseases:

• salpingo-oophoritis - the process of inflammation in the ovaries and fallopian tubes;
• endormetritis - an inflammatory process in the uterus;
• cervicitis is an inflammation of the cervix.

Symptoms:

• painful sensations in the lower abdomen;
• non-standard selection;
• untimely passing menstruation;
• feeling of constant itching;
• pain in the genital area.

Specialists during a gynecological examination record the formation of spots and ulcerations on the mucous membranes.

Other causes of infertility in women

The following pathologies do not fall under the standard classification and do not occur when the hormonal system or physiological disturbances occur.

Age period

By the time of full-fledged puberty of the female reproductive system, there are about 300 thousand eggs in the body of the ovaries. Over time, they are prone to aging - their internal DNA is damaged.

Against the background of gradual aging, the quality indicators of oocytes decrease - the suitability for fertilization and further development of the embryo. The process begins after the onset of the 30th birthday, and after 25-40 years, aging begins to progress at a faster rate.

Body mass

Excess or underweight leads to a variety of diseases, including pathologies of the reproductive system. An overabundance of adipose tissue provokes the formation of hormonal-type abnormalities - an increase in the number of both male and female sex hormones.

Under their influence, gynecological diseases begin, leading to the development of infertility. When women with overweight women are treated with medications, conception occurs, but often ends with problems with gestation (spontaneous abortion and intrauterine development).

Lack of weight, compared with a normal body index, causes disruption of the functionality of the endocrine region. A decrease in efficiency leads to a decrease in the production of necessary hormones, followed by non-maturation of eggs.

Immunological causes

With normal functionality, the autoimmune system of a woman does not respond to the introduction of a foreign type of proteins - seminal fluid, male germ cells. It does not produce specific antibodies and does not kill sperm. The reasons for the rejection of semen by immunological agents are not fully determined.

It is assumed that the appearance of specific antibodies in response to spermatozoa occurs as a standard allergic reaction. The typical barrier properties of the mucous secretion of the membranes are violated due to a decrease in its volume in the internal areas of the female genital organs.

Another factor in the onset of the pathology of conception is the production of specific agents by the woman's body for her own eggs. This problem is dealt exclusively with immunologists - the root causes of pathology, in which self-destruction occurs, are not fully understood.

All autoimmune non-standard processes, in the early stages of onset, are easily treatable. With advanced forms, the prognosis is not so favorable. The development of an absolute type of infertility is possible.

Psychological reasons

A complex mechanism for stabilizing the psychological state triggers hormonal exchanges. It is pointless to look for frequent prerequisites for psychoemotional deviations as the root causes of infertility - each organism reacts to external stimuli in its own way. All sources of stress can be summarized:

• as an overabundance of negative information coming from outside;
• emotional reactions of the body in response to negativism;
• physiological or pathological responses of the female body to psychological discomfort.

The chronic variant of psycho-emotional outbursts causes a gradual depletion of the defense system and adaptation mechanisms. All structural units responsible for bioregulation change their functionality and begin to work in a pathological direction.

Psychological prerequisites hide in themselves altered physiological processes - violations of the functionality of the hormonal system. To influence the psychological options for infertility, you should:

1. Stop the sources of psycho-emotional conflicts, switch to other activities. Hobbies, timely rest, long walks, sports and a lot of positive emotions can return hormonal levels and mental balance to a state of balance. Experts argue that families with a low level of intelligence do not have problems with conception, in contrast to females with a high social status. The latter often suffer from contrived stresses, which leads to the development of infertility.
2. For expectant mothers, it will be useful to contact a professional psychologist. Not all types of psychoemotional deviations can be overcome on their own. The specialist will be able to regulate outbursts of emotions, direct the general condition in the right direction. With a detailed analysis of life situations, the true root causes of psychological infertility are determined.

Contraceptive use

Proponents of hormonal contraceptives are sure that when they are used and then canceled, there is a sharp release of estrogen, which stimulates the possibility of getting pregnant.

Opponents cite examples of cases where fertility is threatened by the use of contraceptives - at a permanent or temporary level.

If you listen to both opinions, then the truth is always in the middle.

If you follow all the recommendations of the gynecologist, avoid the negative impact of the constant use of hormonal contraception, then planning for the future baby will be successful. By combining different contraceptive options, the chances of normal fertilization increase several times.

To prevent the formation of infertility in a timely manner, several simple rules must be followed.

Female infertility- manifested by the absence of pregnancy for 1.5 - 2 years or more in a woman living a regular sex life, without the use of contraceptives. Allocate absolute infertility associated with irreversible pathological conditions that exclude conception (anomalies in the development of the female genital area), and relative infertility, amenable to correction. They also distinguish between primary (if the 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 put to a woman on the basis that for 1 year or more with regular sexual intercourse without the use of methods of contraception, she does not become pregnant. They speak of absolute infertility if the patient has irreversible anatomical changes that make conception impossible (absence of ovaries, fallopian tubes, uterus, serious anomalies in the development of the genital organs). In case of relative infertility, the reasons that caused it can be subject to medical correction.

Infertility due to endometriosis is diagnosed in about 30% of women with endometriosis. The mechanism of influence of endometriosis on infertility is completely unclear, however, it can be stated that areas of endometriosis in the tubes and ovaries impede normal ovulation and the movement of the egg.

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

Infertility diagnostics

Survey 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. At the same time, it becomes clear:

1. Complaints (health, 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, psychological climate in the family).
2. Family and hereditary factors (infectious and gynecological diseases in the mother and close relatives, the age of the mother and father at the 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).
3. Diseases of the patient (past infections, including genital infections, operations, trauma, gynecological and concomitant pathology).
4. The nature of the menstrual function (the age of the onset of the first menstruation, assessment of the regularity, duration, soreness of menstruation, the amount of blood lost during menstruation, the duration of existing violations).
5. Assessment of sexual function (age at the onset of sexual activity, the number of sexual partners and marriages, the nature of sexual relations in marriage - libido, regularity, orgasm, discomfort during intercourse, previously used methods of contraception).
6. Fertility (presence and number of pregnancies, peculiarities of their course, outcome, course of childbirth, the presence of complications during childbirth and after them).
7. Methods of examination and treatment, if they were carried out earlier, and their results (laboratory, endoscopic, radiological, functional examination methods; medical, surgical, physiotherapeutic and other types of treatment and their tolerance).

Objective examination methods in the diagnosis of infertility

Objective examination methods are divided into general and special:

General examination methods in the diagnosis of infertility make it possible to assess the general condition of the patient. They include examination (determination of the body type, assessment of the condition of the skin and mucous membranes, the nature of hair growth, the state and degree of development of the mammary glands), palpation of the thyroid gland, abdomen, measurement of body temperature, blood pressure.

The 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 and developmental features of the external and internal genital organs, the 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 the measurement data of the basal temperature) - allow you to assess the hormonal activity of the ovaries and the completion 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 - performed to study the activity of sperm in the secretion of the cervix and to 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 in 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 carry out hormonal tests several times to obtain a more reliable result. In case of infertility, the following types of hormonal studies are informative:

• a study of the level of DHEA-S (dehydroepiandrosterone sulfate) and 17-ketosteroids in the urine - allows you to assess the function of the adrenal cortex;
• study of the level of prolactin, testosterone, cortisol, thyroid hormones (TZ, T4, TSH) in the blood plasma on the 5-7th day of the menstrual cycle - to assess their effect on the follicular phase;
• a study of the level of progesterone in the blood plasma on the 20-22 day 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 disorders (oligomenorrhea and amenorrhea).

In the diagnosis of infertility, hormonal tests are widely used, which make it possible to more accurately determine the state of individual links of the reproductive apparatus and their response to the intake of one or another hormone. Most often, in case of infertility, they carry out:

• progesterone test (with norkolut) - in order to find out the level of saturation of the body with estrogens in amenorrhea and the reaction of the endometrium to the introduction of progesterone;
• a cyclic or estrogen-gestagenic test with one of the hormonal drugs: gravistat, non-ovlon, marvelon, ovidone, femoden, selest, demulene, trizistone, tricvilar - to determine the endometrium's reception of steroid hormones;
• clomiphene test (with clomiphene) - to assess the interaction of the hypothalamic-pituitary-ovarian system;
• test with metoclopramide - to determine the prolactinosecretory capacity of the pituitary gland;
• test with dexamethasone - in patients with an increased content of male sex hormones to identify the source of their production (adrenal glands or ovaries).

To diagnose immune forms of infertility, the content of antisperm antibodies (specific antibodies to sperm cells - ASAT) in the patient's blood plasma and cervical mucus is determined. Of particular importance in infertility is examination for genital infections (chlamydia, gonorrhea, mycoplasmosis, trichomoniasis, herpes, cytomegalovirus, etc.), which affect the reproductive function of a woman. 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 (X-ray of the lungs, tuberculin tests, hysterosalpingoscopy, endometrial examination). To exclude neuroendocrine pathology (lesions of the pituitary gland), an X-ray of the skull and Turkish saddle is performed in patients with disturbed menstrual rhythm. The complex of diagnostic measures for infertility necessarily includes a colposcopy to detect 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 investigate the patency of the coiled tubes. To clarify the state of the endometrium, 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 hysteroscope, inserted through the external uterine pharynx. 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:

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

Hysteroscopy allows you to consistently examine the inside of the cervical canal, the uterine cavity, its anterior, posterior and lateral surfaces, the right and left orifices of the fallopian tubes, assess the state 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, the discharge is made in the shortest possible time (from 1 to 3 days).

Laparoscopy is an endoscopic method of examining the organs and cavity of the small pelvis using optical equipment introduced through a micro-incision of the anterior abdominal wall. The accuracy of laparoscopic diagnostics 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:

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

The indisputable advantages of laparoscopy are the bloodlessness of the operation, the absence of severe pain and rough seams in the postoperative period, the minimum risk of developing an adhesive postoperative process. Usually, 2-3 days after the laparoscopy, the patient must be discharged from the hospital. Surgical endoscopic methods are low-traumatic, but highly effective both in the diagnosis of 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 reasons that caused it. Usually, treatment begins with the elimination of the primary cause of infertility. Therapeutic techniques 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 impossible.

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

In the case of tubo-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 tuboperitoneal infertility is 30-40%. With long-term adhesive obstruction of the tubes or with ineffectiveness of a previously performed 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 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 a uterus, pronounced malformations of its development) and self-bearing pregnancy by a woman, they resort to surrogacy services, when embryos are transplanted into the uterus of a surrogate mother who has undergone a special selection.

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

In case of 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 methods of reproductive technologies. In addition, indications for artificial insemination are:

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