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

But sometimes waiting is drawn up, the long-awaited pregnancy does not occur, and people begin to worry, and whether it is a sign of infertility. Unfortunately, in some cases, this is true. It should be borne in mind that the reproductive function of the woman has been declining over the years, so the ladies of middle-aged for conception may need more time than young girls.

Infertility 1 degree in women

This diagnosis is made in the event that a woman cannot conceive a child and never before pregnant.

Primary infertility in women has the following reasons:

• Endometriosis. In this case, there is a violation of hormonal exchange, immune shifts, adhesions formation, and so on. All these pathological changes and lead to the impossibility of conception.
• Abortions. Artificial pregnancy interruption can cause the development of a number of complications that lead to infertility.
• Hormonal disorders which develop after emergency protection against pregnancy with the help of large doses of hormones.
• Inflammatory diseases Bodies of the reproductive system.
• The consequences of operational interventions on genitals.
• Immune associated with violation of the process of fertilization, damage to sperm or eggs.
• Idiopathic, the reasons for which cannot be installed.
• Hormonal disorders at which no ovulation occurs.

Primary infertility: treatment

After a visit to the reproductologist, you must pass a number of analyzes. Women with secondary infertility examination is required in order to find out the reason for the fertility disturbance.

If the disease is caused by endocrine disorders, then it is necessary to conduct their correction. If the reason is the inflammatory diseases of the genital organs caused by microorganisms, then the conduct of antifungal, antiviral or antibacterial treatment is shown.

For the treatment of infertility, you can contact the Altravit clinic. Highly qualified reproductologists work here. The most modern methods of treating infertility are available, including auxiliary reproductive technologies.

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Secondary infertility in women

If a woman had previously had at least one pregnancy (even if it was not overdue) and cannot become pregnant, the secondary or infertility of the 2 degrees is diagnosed.

The causes of its development are:

• Age reduction of fertility. The reproductive function of women begins for 30 years, and after 35 years already 25% of women are fruitless. The reason for this is accumulated chronic diseases, as well as chromosomal changes in the eggs that make the birth of a healthy child impossible. That is why in women of middle-aged miscarriage more often than young girls.
• Complications after gynecological operations, abortions and childbirth. Heavy childbirth, incorrect abortions, scraping and so on can cause damage to the endometrium and cause infertility (secondary or primary).
• Violation of hormonal background. It is quite often precisely endocrine disorders (ovarian dysfunction, thyroid diseases, and so on) become the reason that 2 degrees are developing in infertility in women.
• Gynecological diseases. Such pathology as cervicitis, vaginal dysbiosis, ooforite, salpintingitis and endometrite can lead to problems with conception. In addition, there may be various tumors in reproductive organs (polyps, cysts, mioma and so on).
• Incompatibility of partners. To date, the exact causes of immunological incompatibility of spouses are not installed. Interestingly, such incompatibility may not immediately, and after the birth of one or even several children. Treatment of incompatibility often does not give results, therefore, the family pair has to resort to Help Help.
• Lifestyle. Chronic stresses, bad habits, improper nutrition and lifestyle can also lead to the development of a state when a pair cannot conceive a child

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Inability to adult organism to produce offspring.

The problem of infertility has long been familiar to mankind - with ancient times a woman who is not able to conceive and having tolerance was considered defective. In Roman law, a divorce with barren spouses was allowed, and the rulers in Russia referred to their wives in the monasteries.

Back in the past century it was believed that only a woman was to blame in a childless marriage. The development of science has given an understanding that men may suffer from infertility. The successes of medicine, the growth of well-being, an increase in life expectancy led to the desire of people to have their own children, despite the problems with health. At the same time, the deterioration of ecology, chronic stress, changing the life rhythm and the revision of family values \u200b\u200b(when career is put at the head of the corner, and the planning of the offspring is postponed to not the youngest age) affect the deterioration of the ability to conceive. Therefore, the problem of infertility today is rather sharp. Medicine offers many ways to treat from hormone therapy before surgery. And when all means are already tested, and there is no result, Eco comes to the rescue.

Infertility in women is a serious problem with many married couples. According to statistics, about 60% of all problems with conception is explained by women's diseases. Depending on whether pregnancy was in the past, distinguish:

• Primary infertility, in which a woman living regular sexual life has never become pregnant.
• Secondary infertility, when pregnancy was previously observed and, perhaps, there are already children.

The reasons due to which the difficulty with conception and having to-wear may be divided into several groups:

• Problems with uterine pipes - a violation of passability due to adhesions, which appear due to injuries, inflammatory diseases, operations. The consequence of obstruction can be an ectopic pregnancy, which threatens the life of a woman and is treated with the removal of the pipe along with the embryo - and this significantly worsens the chances of the following successful pregnancy.
• Infertility for diseases of the endocrine system, entailing a violation of the ripening of eggs.
• Gynecological diseases - the pathology of the cervix, sex infections, endometriosis, etc.
• The cause of infertility in women is also early aging of the reproductive system, exhaustion of ovarian and climax. As a rule, menstruation continues up to 50-55 years, but sometimes they can completely stop at 40 years and even earlier.
• The problem of infertility can have a psychological reason when stress, experiences, permanent finding in oppressed state and fears prevent pregnancy.
• Immunological incompatibility - in cervical mucus of a woman formed antispermal antibodies (asat) that kill spermatozoa. AsaT can both form in men, and then they violate the quality of sperm.
• Development anomalies, in which pregnancy is absolutely impossible - for example, when the patient has no reproductive organs from birth or underdeveloped.

Sometimes it is impossible to establish the cause of female infertility, and then it is called idiopathic - it happens almost 25% of all cases. However, this does not mean that there are no problems - simply the available methods of diagnosis and therapy are not yet able to identify and eliminate diseases that prevent pregnancy.

Infertility in men

It has long been mistakenly believed that the inability to conceive and endure a child is the trouble of women. In fact, infertility in men occurs hardly is not the same as often - about 45% of cases of reproductive problems accounted for their share. The cause of the failure is the violation of the mobility and the viability of spermatozoa, the reduction of their quantity, obstacles to the path of ejaculation, and contribute to this many diseases and adverse factors. What is infertility in men?

• Secretorial, when the quality and amount of sperm worsens.

It is possible to treat it with the help of medicines and hormones.

• Obstructive.

It is related to the violation of the patency of the seedy ways due to injury, damage during surgery on other organs, tuberculosis, syphilis and inflammation of the appendage of eggs leading to the gluing of the ducts and the impossibility of spermatozoa to go into seed bubbles.

• Immunological

The cause of immunological infertility in men is the production of antibodies to its own spermatozoa. In the normal state of sperm is not affected by the cells of the immune system, since they have a special biological barrier (hematotestical). When this barrier is broken due to injuries and infections, antisperm antibodies attack spermatozoa, gluing them and immobilizing.

• Relative

Relative infertility in men attributes its kinds when the survey did not reveal significant problems, but his pregnancy does not come to his partner. The reason for this is, as a rule, stress and experiences. The treatment of male infertility is a psychotherapist.

The main symptom of infertility is not advancing pregnancy in a couple of fertile age, if the favorable conditions for conception are observed:

• Full rejection of all contraceptive means.
• Sexual contacts occur often (at least several times a week).
• Men have no problems with sperm quality.

As a rule, infertility does not have any specific signs, and it is possible to suspect it in indirect symptoms and manifestations of diseases that lead to problems with conception and having to-wear:

• The deviation in the menstrual cycle indicates problems with ovulation (for example, a cycle of less than 20 days is usually annevulatory). Timely appeal to the doctor allows you to cure a provoking disease failure at an early stage.
• An indirect symptom of infertility can be an excessive growth of hair cover on the body and face, as well as the lack of hair in the pubic zone and armpits - all this indicates an excess of androgens ("male hormones). About the excessive secretion of Androgen also says oily skin with acne.
• Hyperprolactinemia, or excessive production prolactin, hypophysome manifested by the absence of menstruation and release of milk from the mammary glands outside pregnancy and lactation.
• Venusical diseases may cause inflammation in a small pelvis and violation of phallopy pipes.
• Insufficient weight, sharp weight loss leads to a decrease in estrogen production, due to which follicles develop. The result of the unlimited anti-kilograms becomes the absence of menstruation and the inability to become pregnant. The bad and the second option, when the lady suffers obesity - in this case, the production of "female" hormones is disturbed, cardiovascular diseases develop.
• Medical abortions that disturb the integrity and quality of the inner mucosa of the uterus are caused by infertility of the uterus - the embryo can not attach on a thin damaged endometrial.
• The usual misunderstanding, when the miscarriages happen several times in a row, is a sign of female infertility and indicates hormonal deviations, hemostasis disruption, problems with endometrial.

Causes of infertility

In men's infertility are to blame:

• Infectious sexually transmitted diseases.

No less problems delivers infectious vapotitis, causing inflammation of one or immediately two testicles. Therefore, boys must be put against him vaccine to avoid infection.

• Varicocele.

Varicose veins of the vein eggs and seed rope, which is why the temperature rises inside the egg, the secretion of sperm and their quality suffer. Varicocele initially does not have symptoms, and only in the late stage, the scrotum can be hurting. Create the disease can be surgically. After the operation, the characteristics of sperm are improved, and it becomes possible to conceive.

• Injuries and congenital pathologies.

Another possible reason for infertility - injuries and congenital pathologies of the structure of the genital organs (cryptorchism and twisted eggs). When cryptorchism, the testicles are outside the scrotum in the newborn: they can be located in the abdomen, subcutaneously on the pubis and in other places. In the standard case, cryptorchism is diagnosed in infancy, at the same time they make an operation to bring eggs to the scrotum.

• Hormonal disorders.

For example, the lack of testosterone secretion leads to problems with the erection and secretion of sperm.

Prostatitis, urethritis breaks the process of sperm production, worsen its quality.

• Immune violations

When the body generates antibodies to its own spermatozoa, which entails their immobility.

• Violations in the sexual sphere.

Impotence, premature ejaculation can also cause infertility in men.

• Bad habits.

Tobacocking, alcoholism, narcotic dependence, reception hormones in order to gain a good physical form, abuse of tight clothing, hot baths, bath and sauna.

• Adverse living conditions

Signs of infertility can be observed in those who live in the region with a bad environment or working in harmful chemical production - all this worsens the quality of sperm.

• Stresses and overwork.

Stresses, insomnia and overwork also negatively affect the male reproductive function - therefore it is useful to be able to fully rest and restore forces.

The problem of infertility in women requires to look for ways to treat him. To do this, it is necessary to clearly understand what and how it can affect the ability to conceive and dry the child:

• The age of the future mother.

After 35 years, fertility is rapidly decreasing due to the fact that chromosomes in egg cell are destroyed.

• Insufficient or overweight.

The cause of infertility may be obesity or dystrophy, since the amount of fatty tissue in the body affects the production of estrogen, and therefore on the menstrual cycle.

• Infections.

Inflammation in a small pelvis - sexually transmitted infections lead to inflammatory diseases of the reproductive organs, and this disrupts the patency of the uterine pipes, affects the attachment and tooling the fetus.

• Hormonal violations.

Infertility in women is caused by hormonal violations, due to which no ovulation occurs, hormones are not produced to preserve pregnancy, the endometrium of the desired quality does not grow. Hormonal imbalance often leads to the development of ovarian polycystosis, when the body is not able to work out mature eggs, and cysts with liquid inside are formed in their place. The pathology of the thyroid gland, the violation of the secretion of "male" hormones can also cause infertility.

• Endometriosis.

Endometriosis is a disease in which endometrium cells of the inner layer of the uterus are abandoned and expanded, due to which the patency of the uterine pipes is disturbed and ovulation is difficult. In addition, there are studies proving the negative impact of foci of endometriosis on spermatozoa.

• Immune reasons.

In some women, cervical mucus contains antibodies that are degrading with spermatozoa viability. A sign of infertility in this case - a long time not coming pregnancy at the apparent well-being with health from both partners.

• Harmful habits (smoking, alcohol, caffeine abuse in large doses), the effects of chemicals when working in harmful production affect the reproductive sphere and reduce fertility.

Factors increasing the likelihood of infertility

With signs of infertility today faces up to 30% of pairs, and therefore the problem of fertility has become an urgent problem for health and the public. The number of people who suffer from diseases affecting the ability to conceive and endure the child increases. This is especially true for those who live in large cities and large industrial areas.

One of the main factors of infertility - pipe-peritoneal - leads among the remaining causes of disruption of fertility and is a consequence of transferred genital infections. Doctors associate this with rawness of sexual contacts, early start of intimate life, low literacy of young people in matters of safe contraception.

In infertility statistics, the increased activity of the population in moving, long-term separation of spouses, a large number of divorces and a frequent change of sexual partners affects the increased public activity. Negatively affects the negative contraception, the self-treatment of gynecological diseases instead of appealing to the doctor - as a result, women develop inflammation of the ovaries and the inner cavity of the uterus, the erosion of the cervix, endometrite and endometriosis.

The life scenario, full stress and experiences, lack of sleep and overload, leads to a change in the hormonal background, endocrine disorders, ovulation disorder, exacerbates common diseases that may interfere with conception.

Another problem associated with infertility is that the couples turn to the doctor only in late fertilous age (from 35-40 years), when there are not so many times for treatment, the ovarian reserve is exhausted, the spermogram is bad, and the body is burdened by others diseases. Therefore, doctors remain anything else, how to offer Eco with a donor egg or sperm, which is far from moral and ethical considerations, many couples do not want to grow only half the "their" child.

The disease is infertility is mysterious in that it is often not clear why the pair cannot become pregnant - in this case it is called idiopathic (inexplicable). The diagnosis can be exhibited when a man and a woman passed a complete list of surveys, and no pathology was revealed, but pregnancy does not occur more than a year of regular intimate relations without contraception. A woman should have a healthy uterus and phallopy tubes, absent asat and endometriosis. A man must have a good sperm and a negative analysis for the presence of antispermal bodies in the blood.

What could be a factor of infertility unclear genesis?

• Genetic disorders in the egg cell.
• Annovulation by an unidentified reason.
• The lack of the satellite tube of the egg.
• The inability of the spermatozoa to certain biochemical reactions and penetration into an egg cell.
• Termination of embryo division, the impossibility of attaching it to the uterus wall.

How to be when the doctor reports signs of infertility of unclear genes? There are several options:

• Waiting - it is offered if the woman did not reach 30 years, and there is a reserve of time for attempts to natural conception.
• Stimulation of ovulation by drugs.
• Artificial insemination.
• Extracorporeal fertilization.

Types of infertility

Primary infertility

Infertility in women is called primary when it was previously never pregnant in any form (even with an ectopic attachment of the embryo, fetaling, miscarriage or abortion), has regular sexual relationships without protection for at least one year, and it cannot become pregnant .

About the primary infertility in men speak when not in one intimate connection none of his partner was pregnant from him in the absence of protection facilities.

Secondary infertility

Secondary infertility (2 degree) means that the woman in the past had pregnancy and, perhaps she already has children, but she cannot conceive at the moment. It would seem if before you managed to get pregnant, why not get now? There is a lot of reasons:

• Age - the ability to conceive is steadily declining after the achievement of 35 years, and the first signs of worsening fertility appear when a woman is marked with 30.
• Secondary infertility may be a consequence of constant emotional stress, stress, chronic fatigue accumulating years.
• Hormonal disorders (polycystic ovarian syndrome, adrenogenital syndrome, etc.), disease of the endocrine and immune system.
• Gynecological problems - inflammation or infectious diseases of the genital organs, misa, adhesion process and obstruction of uterine pipes.
• The secondary infertility of the uterus lead gynecological interventions (abortions, scraping), because of which endometrium is damaged and thinned, and the fruit egg can not attach to the wall.

Secondary infertility in men means that for a long time, conception does not occur due to the male factor, while in previous connections the partner had children, or a pregnancy fell from him. The reason for the second degree of infertility can be:

• Inflammatory diseases of the genitourinary system.
• Varicocele.
• Injuries and surgical operations on the scrotum.
• Immune and hormonal disorders.

1 degree of infertility

The infertility of the 1st degree is characterized by the impossibility of conceiving the child by any time throughout the previous life. Do not panic - this does not mean that the children will never be. Most diseases caused by infertility can be cured:

• Infections and inflammatory diseases of the small pelvis organs.
• Hormonal deviations.
• Violation of blood flow in the uterine cavity.
• Problems in the endocrine system and hemostasis.
• Immune violations.
• Gynecological diseases (endometriosis, mioma, ovarian cysts and cervical cervicals).
• Disturbances of spermatogenesis and infectious diseases in men, the formation of asat.

If the couple lives in adverse conditions, and the factor of infertility are stress, lack of sleep, hard work and emotional burnout, help get pregnant can simple normalization of the regime and good rest.

2 degree of infertility

The second degree of infertility is a secondary form, in which people cannot conceive a child, despite pregnancy in the past. There are a lot of reasons:

• Reducing fertility with age, early climax in women.
• Violation of spermatogenesis.
• Gynecological diseases (moma, endometriosis, inflammation of appendages, etc.).
• Hormonal disorders.
• Immune deviations.
• Diseases of the thyroid gland.
• Complications after previous pregnancy and childbirth, as well as after abortion.
• Unhealthy lifestyle, bad habits.

Depending on what caused the second degree of infertility, a special treatment is appointed one or both spouses. The chance of conception after treatment is high, and if pregnant failed, auxiliary reproductive technologies will come to the aid - artificial insemination, eco, surrogate motherhood.

3 Degree of infertility

The term "third degree of infertility" is practically not used in medicine. He means that a person will never be able to conceive and give birth to a child. It happens in the case of the innate absence of ovaries and uterus, testicles. As a rule, it happens extremely rarely, and even then the options remain becoming parents - resort to donor egg or sperm, surrogate motherhood. In other cases, opportunities for treatment are even greater, and their effectiveness is higher. Therefore, doctors are not taken to argue that the third degree of infertility is forever. The development of science and medicine gives hope that already incurable diseases will be cured tomorrow, and problems with conception are solved.

Diagnosis of infertility

Collection of anamnesis and inspection with infertility signs

Diagnosis of the disease of infertility begins with the collection of anamnesis and medical examination. Based on this, the doctor may assume the cause of problems and draw up a list of further surveys.

Anamnesis may be:

General when the doctor finds out the state of health in general, learns about the presence of common diseases, general health, possible fluctuations in weight, blood sugar levels and blood pressure. Doctors may be interested in certain infertility factors: bad habits, exposure to stress, working conditions (severe physical work, contacts with harmful substances, etc.).

Gynecological - here the doctor finds out:

• At what age the first menstruation has come, what duration has a cycle now, whether it is accompanied by pain, what is the nature of the selection.
• When a woman starts sex life. With which regularity leads it now. Whether discomfort is experiencing during sex.
• How long does the pregnancy, there were before abortions, miscarriages, are there children.
• What kind of contraception was used earlier.
• How much time it took for the onset of previous pregnancy, and how it took. Whether complications happened during childbirth.
• Are there any pain and separation from the genitals, were diagnosed before and now infection and developmental anomalies were diagnosed.
• Whether operations were carried out on reproductive organs, if injuries happened.
• What a survey and treatment for gynecological diseases was prescribed to a woman earlier.
• Whether the spouse has been treated for male infertility, and with what result.

During the inspection, the gynecologist estimates the general condition and determines the visual symptoms of infertility:

• The condition of the mammary glands, their development and availability.
• Character of hair cover (on male or female type).
• Type of physique.
• The development of the genital organs and their pathology.
• The presence of rashes on the skin and mucosa of genitals, which may indicate infections.

In addition, the doctor examines the condition of the skin of the face, palpates the pancreas, belly and inguinal region, measures blood pressure and temperature.

The second step in the diagnosis of infertility - General analyzes:

• General blood analysis.
• Blood test for HIV and hepatitis.
• Blood test for a group and a rhesus factor.
• Blood tests and strokes for PCR diagnostics of bargaining infections.
• Hemostasiogram to identify violations in the rolling system of blood (they may cause infertility).
• Definition of a lupus anticoagulant, antibodies to phospholipids.
• Analysis on antispermal antibodies in cervical mucus, sperm and blood.

To diagnose male infertility, the partner must hand over the spermogram - the study of sperm to determine its fertilizing ability and detecting diseases of the urogenital system. The result can be as a normal number of sperms of the right form (normozoocompermium) and the complete absence of sperm in seminal fluid (azoospermia), as well as an increase in the amount of morphologically incorrect cells.

Hormone Level Analyzes

To determine the causes of the disease, infertility, patients need to pass a number of analyzes on the level of hormones. A specific list of research is determined by the attending physician on the basis of the history of the disease:

Sex hormones

During the diagnosis of infertility, it is necessary to determine the quantity:

• FSH is a follicularity hormone that affects the ripening of eggs, the secretion of estrogen and progesterone.
• LG - luteinizing hormone produced by the pituitary gland and ensures the secretion of progesterone the ovaries.
• Prolactin responsible for ripening follicles and ovulation.
• Testosterone - "Male" sex hormone, which must be present in a small amount.
• 17-op-progesterone indicating the presence of a hereditary disease - adrenogenital syndrome, in which an increased amount of androgens is synthesized with adrenal glands.
• Progesterone - hormone responsible for the normal amount and growth of endometrial inside the uterus.
• Estrogen (estradiol), ensuring the ripening of follicles and eggs, ripening endometrial and its preparation for the implantation of the fetal egg.
• Antimulller hormone (AMG), showing the stock of follicles in the ovaries.

In order for the analyzes to be informative, and the diagnosis of infertility is competent, the blood for sex hormones should be passed on certain days of the cycle:

• On 2-3rd - amg, prolactin, FSH, LH.
• On the 8-10th - 17-OP, testosterone.
• At the 19-21st - estradiol, progesterone.

Hormones bark of adrenal glands

Hormones of adrenal cortex are also important for the diagnosis of female infertility, because they affect the ovulation and the production of cervical mucus:

• Dae-sulfate (regulates the functioning of the ovaries).
• DGA-S - "Male" hormone responsible for secondary sex signs. It indirectly indicates an excessive body of body.
• Cortisol
• 17-COP (determined in the urine) - this is also a "male" hormone, and the excess of its level over the norm indicates gynecological problems.

The hormones of the thyroid gland affect the development of follicles and ovulation. It is necessary to take the analysis in a calm state, and on the eve I should avoid stress and cancel sports workouts. To identify the cause of the disease of infertility will help:

• Tyroxin T4.
• Triiodothyronine T3.
• Thyroid-stimulating hormone.

Hardware and instrumental diagnostics

Diagnosis of infertility through special devices and tools includes:

• Ultrasound procedure

Allows you to estimate the size and position of the uterus, its necks and appendages, see the state of the endometrium. Polyps, spikes, tumors, endometriosis, mioma, endometrial hyperplasia, inflammation of appendages, cysts, breaks, and ovarian inflammation are pre-diagnosed on the ultrasound. Special ultrasound research - Follicleometry - makes it possible to evaluate the maturation and development of follicles throughout the menstrual cycle.

• Colposcopy.

Inspection of the vagina with an optical device Colposcope, which allows you to identify erosion, cervicitis, tumor diseases.

• Diagnostic scraping of the uterine

The diagnostic scraping of the uterine cavity is necessary when it is necessary to histologically check the state of the endometrium and understand whether its growth in the day of the menstrual cycle corresponds.

• Tuberculosis samples (manta, diaskin test, light radiography) and crossing menstrual blood for the presence of koche sticks.

It is often obscured by infertility in the disease with genital tuberculosis, therefore, for the diagnosis of pathology, it is necessary to carry out X-ray of the lungs in combination with the samples (manta, diaskin-test) and the backed menstrual blood, mucus, the contents of the uterine cavity.

• Hysterosalpingography (GSSG)

X-ray examination of the uterus and pipes, which makes it possible to see the abnormalities of the structure of the uterus, tumors, spikes, evaluate the passability of phallopy pipes.

• Radiography

If the symptoms of infertility indicate the defeat of the pituitary gland (a woman outside the lactation period is formed milk in lactic glands, there are no menstruation), it is necessary to make a Turkish saddle and skull radiography.

If other methods of diagnosing infertility disease did not help accurately determine the problem, a woman is prescribed an operational examination by hysteroscopy or laparoscopy.

Hysteroscopy.

Hysteroscopy is an inspection of the uterine cavity and a cervical canal under anesthesia by an optical device (hysteroscope). The hysteroscope is introduced through the cervix, without punctures and cuts. The procedure allows you to identify the causes of infertility of the uterus - cysts, polyps, check the quality of the endometrium, take it a fragment for histological examination. At the same time, on hysteroscopy you can remove small neoplasms - that is, the manipulation is not only diagnostic, but also therapeutic nature. An indication for carrying out:

• Primary and secondary infertility.
• Unsuccessful eco in the past.
• Myoma, germinating into the inner cavity of the uterus.
• Suspections for diseases and anomalies leading to infertility of uterus - polyps, adenomyosis, the pathology of the structure and development of the body.
• Disturbance of the cycle (abundant monthly, bleeding between menstruation).

Laparoscopy

Laparoscopy is an endoscopic examination of the small pelvis organs under general anesthesia. Today, this type of diagnosis is recognized as the Gold Standard, giving almost 100%. The surgeon through a special optical device-laparoscope sees everything with its own eyes, and not guided by the results of non-invasive surveys, which are often subjective. Laparoscopy allows not only to diagnose, but also to treat - for one reception you can cut the spikes, restore pipes, remove the foci of endometriosis. The study is carried out by introducing laparoscopic devices through small cuts of the abdominal wall, so healing after the operation passes quickly and painlessly, does not cause negative consequences in the form of an adhesive process.

An indication for research are:

• The establishment of the cause of primary and secondary infertility.
• Endometriosis.
• Cysts, twisted and gap (apoplexy) ovaries.
• Ectopic pregnancy.
• Pipe obstruction.
• Myoma uterus.
• Spikes in the abdominal cavity and small pelvis.

Treatment of infertility

Treatment of male infertility is based on the following principles:

• His spouse should have problems with conception and having to wear. If they are, a woman must be treated, and its treatment program needs to be coordinated with the program of examination and the treatment of her husband.
• An unfavorable factors that prevent the onset of pregnancy should be excluded: a rare sex life, stress, heavy working conditions, drug intake (if they are not vital).
• If the reason is established, the treatment of male infertility is to eliminate it. When it is not established why sperm has poor quality, only means for improving blood microcirculation and metabolism, vitamins, and tall drugs are prescribed.
• Inflammatory diseases of the urinary organs require the appointment of sanitation drugs, depending on which pathogen is revealed. Treatment should be both spouses to exclude the possibility of re-infecting each other.
• Varicocele needs to be treated by the operation, regardless of the severity of the disease. Surgical treatment requires and uncomplicated excretory azoospermia, when sperm is produced in the testicles, but do not fall into the seed fluid.
• The treatment of immune infertility in men requires special methods (plasmapheresis, removal of antibodies from genitals, drugs to reduce the production of ASAT). If it does not help, the pair recommends Eco with pre-cleaning of sperm from the "nylip" antibodies.
• Treatment of infertility in men due to sexual dysfunction involves conservative treatment and work with a psychotherapist.
• Treatment of male infertility due to hormonal disorders should correspond to individual characteristics. The feasibility of treating hormones is determined by the type of disease and the specific situation. If the therapy is still appointed, it should continue at least 70-75 days, which corresponds to the spermatozoa development cycle.

Sometimes the problem of male infertility is impossible to solve conservatively or surgically, and then modern reproductive technologies come to the rescue:

• PEA, Mesa, Teze

With complicated azoospermia, when it is impossible to restore the subtleties of the seed-handing channels, a procedure for producing sperm from the appendage or the eagle itself is assigned (the techniques have the name of the ore, mesa, thesis). Then spermatozoa is used in the ECO procedure.

• Artificial insemination

The sperm is introduced into the vagina or the uterus in such a way that it falls on the neck of the neck (with a natural sexual intercourse, only its small amount falls there). The probability of conception after such manipulation increases several times. An indication for insemination is to reduce the number of mobile spermatozoa in the ejaculate.

Fertilization of the woman's egg sperm spermatozoids in laboratory conditions, followed by the transfer of the embryo to the uterus cavity. Eco is shown in the poor quality of sperm, when the number of live moving sperm is extremely small.

The intraplasmic injection of the spermatozoa - refers to the auxiliary methods used during ECO. The essence of the method is that a spermatozoa, selected by an embryologist visually, is introduced into the cytoplasm of the cell with a special pipette. In this case, almost fixed spermatozoa can be used.

• Pixes

High-quality selection of spermatozoa for ICSI procedure. The embryologist finds the best (most mobile, mature and correctly formed) spermatozoa and checks its chemical biological characteristics using pixie cups. In these cups there are special media containing hyaluronic acid. The nature is intended so that the acid is involved in the selection of sperm during fertilization - the receptors of high-quality male cells are sensitive to Hyaluron. The interaction of a sperm with Haluron in the cups indicates that it has properly working receptors, and fertilization will be successfully. After that, sperm is injected into the cytoplasm of the cell, that is, they perform the ICSI procedure.

Treatment of female infertility

To cure female infertility, you need to establish its cause and try to eliminate it. Unfortunately, it is not always possible. Therefore, infertility treatments are:

• An attempt to restore fertility with the help of conservative or surgical methods.
• Auxiliary reproductive technologies if the previous treatment did not help or a pair cannot physically conceive a natural way.

What methods are used to treat female infertility?

• If the reason for endocrine disorders, hormonal treatment and ovarian stimulation is carried out. In addition to drugs, a woman is recommended to normalize weight and engage in physical education. Shown and physiotherapy.
• Infertility for uterine pipe diseases is treated, as a rule, surgically - the laparoscopic operation allows you to restore the permeability of 35-40% of cases. If it did not help, the patient is offered by the ECO program.
• Endometriosis involves carrying out laparoscopy and causing foci, and then a short course prescribed medications to secure the result (drugs causing artificial climax (IR) and impeding endometrial growth). It is necessary to try to get pregnant after exiting IR until the endometriosis recurrenced.
• Infertility of the uterus (severe malformations of development) requires operations on the reconstruction of the authority. If it is impossible, a woman can use the service of surrogate motherhood.
• Treatment of immunological infertility, when Asaat was found in cervical mucus, begins with barrier contraception for up to six months. Then use preparations to reduce the production of antibodies. If this did not give the desired effect, the pair recommends an artificial insemination, in which the sperm passes the cervical canal and does not feel a negative impact from Asat.

When the reason for infertility is not installed, the methods of HRD (auxiliary reproductive technologies) are going to move:

• Intrauterine insemination.
• Eco (with Ixi, Pixie and other ways to improve the efficiency of the procedure).
• Surrogacy.

When eco is applied

At first, the method of extracorporeal fertilization was developed to eliminate one cause of infertility - problems with pipes. Gradually, the list of readings for Eco has expanded, and includes:

• Pipe pathology, which can be congenital or acquired, to be a consequence of ectopic pregnancy, inflammation, endometriosis, abdominal operations.
• Polycystic ovarian - a disease in which the ovaries contain many cysts with liquid content. The level of men's hormones in the body of a woman in this case is increased, and therefore there are failures of the menstrual cycle (amenorrhea), abundant hair growth on the chest and face, obesity. Sometimes patients occur strong uterine bleeding. Treatment of the disease is carried out first conservatively (hormones) or operational (ovarian resection, cruise migation). Eco when infertility due to polycystosis is prescribed when the remaining methods of therapy are exhausted, and pregnancy has not come.
• Endometriosis is a disease, the essence of which consists in the growth of endometrial cells in the fallopian tubes or abdominal cavity. Along the endometrium, only the inner uterine surface should be submitted. Its distribution beyond the uterus leads to infertility due to the fact that the ripening of eggs and ovulation is disturbed, the patency of the pipes is reduced - because endometrium foci contribute to the formation of adhesions. As in the case of polycystic ovarian, Eco with infertility due to endometriosis is appointed when the possibilities of drug (hormonal) and surgical treatment are exhausted, and did not bring the expected result.
• The age of patients can be a hindrance for the onset of natural pregnancy due to changing the properties of egg cells. Auxiliary reproductive technologies (Eco with Ixi, Hetching) allow you to overcome these problems.
• Annovulation in the absence of an effect from therapeutic treatment, stimulation of ovulation and artificial intrauterine insemination is also an indication for ECO.
• Infertility of unclear genes, in which the clear cause of difficulties with the onset of pregnancy is not defined.
• Male infertility associated with a decrease in fertilizing sperm ability. Auxiliary reproductive technologies (Eco with aspiration of sperm from the appendages of eggs or their extraction from eggs, Ixi - the introduction of a spermatozoa in an egg) increase the chances of the occurrence of pregnancy.

How is the treatment of infertility eco-method? The essence of the technology is to stimulate ovulation of several eggs at a woman, puncture of the resulting eggs and fertilizing their sperm of her husband in laboratory conditions. The resulting embryos for 3-5 days are developed in special incubators under the supervision of doctors, and then they are transferred to the uterine cavity. Each of the steps is important to achieve the final result.

To stimulate ovulation, special hormonal drugs, accelerating the growth and ripening of follicles and eggs, are used. To monitor the process of ripening cells and the endometry state, the doctor prescribes laboratory tests (control of the level of estradiol, progesterone and LH) and ultrasound.

The puncture of ripe follicles is carried out under intravenous anesthesia. A disposable needle with suction is connected to a special ultrasound sensor, and then it is injected alternately through the vagina alternately into all follicles, and they suck their contents. The liquid obtained as a result of puncture transmits embryosologists to prepare for fertilization.

Fertilization can occur both independently - an embryologist only connects the treated spermatozoa and egg (ECO) and the ICSI - the spermatozooid method is introduced directly into the egg. Ixi is used, as a rule, when the quality of sperm is bad, and the fertilizing ability of it is reduced. In addition, when infertility, men use other modern methods - IMS (spermatozoa injection in egg cytoplasm) and pixie (additional selection of sperm before Icsi).

The cultivation (cultivation) of embryos begins the day after the follicle puncture. At first, the embryologist assesses the fact of fertilization, the signs of which can be observed in 17-18 hours after the connection of men's and female cells. The doctor then observes the process of dividing the embryos for 3-5 days, it allocates the most promising and non-genetic deviations among them, and determines the best time for transplanting to the uterus. As a rule, the best chances are embryos who have reached the stages of blastocysts - and this happens on the 5th day.

The transfer of embryos and their implantation is the most exciting stage of treating infertility with Eco, because it is then it becomes clear whether the doctors manage to make another married couple happy. Immediately the transfer of embryos to the uterine cavity occurs with the help of thin soft tubes (catheters) under the control of the ultrasound - it allows them to put them in a comfortable place in the uterus. Before it is possible to pass hCG and learn the results of Eco, a woman is prescribed drugs to maintain pregnancy early.

Period after eco

For infertility treatment through eco has two outcome.

Successful when pregnancy comes, and a happy family leaves the clinic to prepare for the birth of a long-awaited baby. You can find out whether Eco has been possible, after 14 days after the transfer of embryos to the uterine cavity, passing the blood test to the HCG. A little later, the presence of arrival embryos in the uterus must be confirmed on the ultrasound, and then turn to the gynecologist for pregnancy. Check out the child after Eco at first requires hormone therapy, the purpose of which is to maintain a sufficient level of progesterone. Therefore, signs of pregnancy can be more pronounced and specific, compared with the usual conception. What points to an interesting position:

• Strong nausea and vomiting (toxicosis).
• Irritability and insomnia.
• Breast swelling.
• Increase basal temperature.
• Sensitivity to smells.
• Moderate pain at the bottom of the abdomen, in the lower back and the sacr.
• Headaches.

Unsuccessful - pregnancy has not come. Why does it happen?

• Ovulation happened before the follicles were punctured.
• Failed to extract high-quality eggs during puncture.
• No fertilization occurred.
• Fertilized cell ceased to share and evolve.
• The embryo implantation did not occur after transferring the uterus.

Unsuccessful Eco, although he strikes the mental state of a couple suffering from infertility, gives doctors a lot of useful information:

• As ovarian ovarian stimulation responded.
• Why the egg cell fertilized.
• What quality were embryos.
• How endometrium grew.
• Whether implantation happened, and whether the embryo continued to develop further.

It is very important to study the circumstances of failure, because the tactics of further treatment of infertility depends on this - does it make sense to make re-eco, what changes to the program need to be made, which should be carried out additionally from the procedures. So, if the pregnancy ceased to develop at the implantation stage, solve the problem in some cases may the procedure of the hatching, when the elastic shell is pierced or cut off, so that the embryo can "hatch" and attached to the endometry.

Pregnancy after infertility can have specific complications that are a consequence of deviations in health.

The consequence of hormonal disorders is the threat of miscarriage and undeveloped pregnancy at an early term. This is due to existing ovarian pathology, which provokes a disadvantage or surplus of hormone secretion.

The obstruction of the uterine pipes, the adhesion process in a small pelvis can cause an ectopic pregnancy, breaking the pipe and powerful intraperous bleeding, threatening women's life. Therefore, after a positive pregnancy test, you need to go on an ultrasound and make sure that the fruit egg is in the uterine cavity, and not attached to the pipe.

Immune problems lead a pair to the procedure of artificial insemination or eco to avoid contact of spermatozoa with cervical mucus. Therefore, in this case, there is practically no complications during pregnancy, if a woman has no other diseases.

The violation of the production of spermatozoa can cause a genetic disorder in the embryo - "bad", a defective sperm with a fusion with an egg carrying incorrect genetic information and chromosomal disorders, which is why the embryo stops developing on an early term. Sometimes pregnancy is still preserved, but the child can die immediately after birth, or have a hard disease. To avoid such an outcome, it is recommended to undergo all planned screening ultrasound, where you can identify pathology in a timely manner.

Previous gynecological diseases - a frequent cause of pregnancy complications after infertility:

• Previously transferred sex infections can escalate by the reduction of immunity, and this leads to intrauterine fetal infection.
• If the pregnancy proceeds against the backdrop of the Moma of the uterus, it may interfere with the implantation of the embryo, and later it is to promote the rapid growth of myomatous node, as well as his edema and necrosis. If the placenta is attached to a myomatous node or a header after removing such an assembly, intrauterine hypoxia and the delay in the development of the fetus, the threat of interrupting pregnancy is possible.
• Inflammation of the appendages of the uterus, its mucous membrane, cervical erosion, transferred to the scraping of the inner cavity of the uterus may cause an abnormal attachment of the placenta - low or overlapping inner zev, and this often leads to premature detachment and bleeding.

Anomalous placentating and infectious diseases are a risk factor for the development of fetoplacentage insufficiency, in which a child in the mother's womb does not receive the desired amount of nutrients and oxygen. Pregnancy after infertility in this case is complicated by hypotrophy (lag behind the body weight) and kid hypoxia.

Infertility is a disease that usually does not bring physical suffering, but "kills" the family morally. It is hard to live with the thought that everyone has long been happy parents around, and someone has to go from one clinic to another. But do not despair. Medicine is developing rapidly and offers all new treatments. It is necessary to gain patience, listen to all the advice of doctors, look for "their" doctor who can be trusted - and then be sure to be lucky!

Nowadays, many women suffer from infertility. The reasons for infertility can be the most different. In most cases, to diagnose infertility and establish its exact cause is extremely difficult. What are the main causes of infertility in women?

There is a theory that a couple may have to start the children in 7 years after the start of attempts. Although before that, the line is often able to disagree faster due to the lack of children than something happens.

Infertility is not a disease, but may be caused by the disease. Infertility, incl. Female, divide to primary (first degree) and secondary (second degree). But at the same time it may be caused by similar causes (except for abortion).

Primary infertility (first degree) - Woman never could have children, but secondary (second degree) - A woman has children, or was once pregnant (at least once), but because of some changes, this opportunity disappeared.

Therefore, the obvious cause of secondary infertility in women can only be called an abortion, which led to complications. And all the others can not be so categorically divided, because before the emergence of these reasons, the woman could also not be pregnant.

The main causes of female infertility (primary and secondary)

Abortions - Reason for Secondary Infertility

In some cases, frequent, poor-quality abortions also negatively affect further pregnancies, becoming the cause of infertility. Statistics show that women who are making repeatedly abortion, more often suffer from infertility as a result of infections, damage to the walls of the uterus and ovarian tissues when performing abortions.

It is an unsuccessful abortion that can lead to most of the reasons below.

The obstruction of the uterine pipe

The obstruction of the uterine pipes is a consequence of concomitant gynecological problems and relatively often acts as infertility. With confidence, it can be said that infertility in the obstruction of uterine pipes is nothing but the impossibility of "meeting / merging" sperm with an egg. The obstruction of the uterine pipes may be a consequence of abortion, inflammatory diseases, tuberculosis of the genital organs.

Hormonal disorders

Problems of hormonal violations can also cause female infertility. Usually, the hormonal imbalance is evidenced by reinforced hair growth, sharp increase or weight loss, irregular menstruation, emotional disorders. Consultation in the endocrinologist will help determine the likelihood of a hormonal background failure and in time to take appropriate measures, including comprehensive treatment.

Myoma

This is a fibrous benign and most common tumor of the uterus. It occurs in the muscle tissue of the uterus and can develop on the outer or inner part of the uterus. Myoma itself is not dangerous in itself, but its presence of a woman trying to get pregnant can seriously prevent conception.

Endometriosis

Endometriosis is characterized by disorders in the uterine cavity. During the disease, the fabric of the mucous membrane of the uterus (endometrial) comes out, as if moving, beyond the uterus to other organs of the pelvic region. Long-term non-cured endometriosis can cause infertility in a woman. Its signs are painful and abundant menstruation with blood clots and painful sexual acts. The treatment of endometriosis is carried out by surgical or therapeutic paths.

Polycystic ovarian

The main cause of ovarian polycystosis is an increase in the production of female organism. Polycystic ovarian affects the formation of a mature egg and for the general state of women's health. In time, not cured, launched disease, inevitably leads to infertility.

Disruption of ovulation

The causes of incorrect or absent ovulation may vary under the influence of hormonal disorders, diseases affecting metabolism, diabetes, an unhealthy lifestyle. Medical examination will answer the question of when ovulation is expected, why it is absent, and what reasons contribute to this. The period of ovulation is the only period in each month in which a woman can conceive a child. That is why the absence of ovulation and the unidentified causes of its violations can lead to a long infertility.

Inflammation of genital organs

Fulfillment infection can be facilitated by sexually transmitted diseases (STDs). They are the cause of inflammation, impede conception and in the absence of treatment lead to infertility. Diseases such as gonorrhea and syphilis have a serious impact on fertility of women. Inflammation of the genital organs can lead to an internal scarring or blockage of phallopy pipes, which in the future, causeing infertility, make it impossible to occur in pregnancy. Even innocuous white discharge for a long time from genitals can lead to fertility issues.

Diseases cervical cervix

The cervical cancer has a close relationship between inflammatory processes in the vagina and changes in the epithelium in the uterus. The epithelium structure is very important for the movement of spermatozoa to the egg. All diseases of the vagina, including the erosion of the cervix, inhibit the process of changing the tissue structure and can lead to infertility.

These are the most common reasons that may lead to infertility in women. It is possible that such reasons can be significantly larger, because some reasons for infertility caused by complications of other diseases of the female sexual sphere are hidden and do not know about themselves. Treatment of infertility includes a number of surveys, among which the consultations of the gynecologist, urologist, genetics, endocrinologist and other specialists are required.

Antispermal antibodies

This is a specific state in which the body begins to destroy spermatozoa itself. Relatively common cause of infertility. The immune system is known to respond to external factors that are dangerous for the normal functioning of the body. Sperm is protected, but in some cases self-destruction to their organism may begin.

The reasons for the formation of antispermal antibodies can be a lot, and they must be installed by the attending physician. Most often - this is the presence of any violations of either benign formations that are described in other reasons given here. For example, benign education, inflammatory processes. Antispermal antibodies can also be generated by a male organism (review.

The inability of a woman to conception from the very beginning of the reproductive period. Primary infertility criteria are unsuccessful attempts to get pregnant during the year of regular sex with a healthy partner without using contraception. To identify the reasons for primary infertility, a complete gynecological examination is carried out (inspection, functional tests, ultrasound, analyzes for infections and hormones, UZGSS and GSG, hysteroscopy, laparoscopy). Treatment - drug or surgical elimination of primary infertility factors; If it is impossible to natural conception - the use of eco or surrogate motherhood services.

General

Primary infertility is the impossibility of the occurrence of pregnancy associated with congenital or transferred to the beginning of the sex life of the pathology of the female organism. The concepts of "infertility" and "childlessness" should be differentiated: in the first case we are talking about complete infertility (the absence of pregnancies in any form - uterine and ectopic), in the second - about the inability of a woman to endure pregnancy and complete it with the birth of a viable fetus (in this category Cases of ectopic pregnancy, spontaneous miscarriage, stillbest, etc.). According to researchers for 2010, 1.5% of women aged from 20 to 44, and in Russia - 1.9% of women of the same age range suffers in the world in primary infertility, and 1.9% of women of the same age range. It is believed that the primary violations of the childbearing function in women are 1,5-2 times more often than secondary.

Classification of primary infertility

Some disorders of the menstrual function (for example, the anovulatory menstrual cycles) are not accompanied by any external features: menstruation occur during the expected period, proceed with the usual duration and with moderate blood loss. In this case, the inability of a woman to conception becomes the only symptom of primary infertility. The psychological aspect of the primary infertility of any genesis is associated with dissatisfaction due to the unrealized maternal potential, which is accompanied by the development of neurosis, depression, understated self-esteem, a decrease in social activity. According to statistics, childless marriages decay more than those in which children were born.

Diagnostics of primary infertility

Patients who applied with complaints about the absence of pregnancies examine on an extended scheme. When you first visit, clinical and anamnestic data is specified to the gynecologist, and inspected. It turns out the common and gynecological history, the nature of the menstrual function, as long as unsuccessful attempts of conception are noted. Objective examination includes a determination of growth, weight, BMI; evaluation of the collaboration and status of the mammary glands; Conduct a rectal or bimanual study. Already at this stage, sexual infantilism, abnormalities of the structure of genitals can be suspected or identified.

The second stage of the examination of women with primary infertility is made using laboratory and instrumental techniques. Tests of functional diagnostics (colpocytology, the study of the cervical mucus, the analysis of the graphic temperature graph) help estimate the nature of the menstrual cycle. In addition, to study the functional state of the reproductive system, it is advisable to examine hormonal status, the most important indicators of which are the levels of prolactin, gonadotropins (FSH and LH), estradiol, testosterone, cortisol, thyroid hormones (TSH, T3, T4) and others. All patients are expedient to investigate The smear on the flora, according to the testimony to carry out a bacteriological study of separated from the genital tract, PCR and ELISA.

The informativeness of the ultrasound of the bodies of the small pelvis is difficult to overestimate in the diagnosis of the defects of the structure, the vatabotia changes, the volume formations of the uterus and ovaries. Folliculose is used to track follicularogenesis and ovulation. In the diagnosis of primary uterine and tubular infertility is invaluable the role of UZGSS and hysterosalpingography. Endovideosurgical study (laparoscopy) is usually carried out at the final stage of diagnostics. Assiversal reproductive technologies. It should be noted that in some cases (for example, in the absence of ovaries and the uterus), the birth of his own child becomes impossible, so a woman is recommended to resort to surrogate maternity services using donor oocytes or adoption.

Treatment of primary endocrine infertility varies depending on the nature of the violation. Patients with obesity are prescribed dietary correction, dosage physical activity, medication treatment. Primary infertility associated with genital infantilism requires the appointment of cyclic hormone therapy with estrogens and gestages, vitaminotherapy, physiotherapy (electrophoresis on OMT, gynecological massage, balneoprocessor). When anneviation caused by hyperprolactinemia, the reception of bromcripline preparations is prescribed, etc. In polycystic changes in the ovaries, they resort to their wedge-shaped resection or cauterization. If, after the measures taken, the pregnancy does not occur, medication stimulation of ovulation on generally accepted protocols can be applied.

Treatment of pipe infertility can be conservative and surgical. At the first stage, physiotherapy is used, treatment with natural factors; Enzymotherapy, anti-inflammatory and immunomodulatory therapy are carried out; Hydrotubation is performed using enzymes and corticosteroids. In the absence of the expected effect, laparoscopic adhesiolysis, salpingctomy, plastic of uterine pipes are carried out.

In the immunological form of primary infertility for 4-6 months, it is recommended to use condoms; In some cases, pregnancy is achieved only with the help of artificial insemination, excluding contact of sperm with cervical mucus. With all the forms of primary infertility, regardless of the reasons, psychotherapy, phytotherapy, igloreflexotherapy is shown. An alternative method for restoring fertility If it is impossible to conceive a natural way, it is eco.

Breakfit marriage is the lack of pregnancy in a woman of childbearing age for 1 year of regular sexual life without the use of any contraceptive means. The frequency of fruitless marriage, according to various sources, ranges from 10 to 20%.

The cause of infertility may be violations in the sexual system at one or both of the spouses. In 45% of cases, infertility is associated with violations in the sexual sector of a woman, 40% of men, in other cases, infertility is due to violations from both spouses.

Women distinguish primary infertility - lack of pregnancy in history and secondary when infertility preceded at least one pregnancy.

Primary and secondary infertility can be relative if the restoration of the reproductive function is possible, and absolute - if it is impossible to become pregnant in a natural way (no uterine, ovaries, some vices of the development of genital organs). Fancy spouses must be examined simultaneously.

Types of infertility

Male infertility

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

The examination of the men start with sperm analysis. Ejaculatte for research is obtained by masturbation after 2-3 days of abstinence. In the study of sperm, the volume of ejaculate is evaluated, the total number of spermatozoa, their mobility and morphology, determine the pH, the viscosity of sperm, the number of leukocytes and other indicators.

The mobility of spermatozoa is estimated at four categories:

a - fast linear progressive movement;

b - slow linear and nonlinear progressive movement;

c - progressive movement is not or movement in place;

d - spermatozoa motionless.

The most frequent terminology in the evaluation of the spermogram indicators:

Nommospermia - indicators within the normal range;

Aspermia - no ejaculate (sperm volume 0 ml);

Azoospermia - the absence of sperm in ejaculate;

Oligozoospermia - spermatozoa less than 20 × 106 / ml;

Asthenozoospermia - mobile spermatozoids less than 25% category A or less than 50% of the category A + B;

Teratozoospermia - less than 14% spermatozoa of normal morphology;

Oligo-beastheratozoospermia is a combination of three pathology options.

When identifying sperm pathology, consultation of urologist-andrologist is shown for further surveys and treatment. With normal indicators of the spermogram of other studies, men are not carried out.

Female infertility

Female infertility - the inability of a woman of reproductive age to conception.

The main causes of female infertility:

Psychogenic factors;

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

Pipecitoneal factor (20-30%);

Various gynecological diseases (15-25%);

Immunological reasons (2%).

Psycho factors infertility. Conflict situations in the family, at work, dissatisfaction with sexual life, as well as an insistent desire to have a child or, on the contrary, fear of pregnancy can cause disorders of ovulation, imitating endocrine infertility. Similarly inducing in stressful situations, vegetative disorders can lead to the discoordination of smooth muscle elements of uterine pipes, and therefore, to functional pipe obstruction.

Endocrine infertility is associated with a violation of the ovulation process: anointulation, lack of a lutein phase of the menstrual cycle, the luteinization syndrome of the non-bullying follicle.

Anguulatory infertility may occur with the defeat of any level of the reproductive system. The most frequent causes of annovation: hyperandrogenation, hyperprolactinemia, hypooestrogenation, exchange disorders (obesity, pronounced body weight deficiency), as well as disease and syndrome of Izeno-Cushing, hypo and hyperthyroidism.

The lack of lutein phase of the menstrual cycle (NLF) is associated with the hypobofunction of the yellow bodies, leading to insufficient secretory transformation of the endometrium. Infertility with NLF is caused by implantation implantation or early spontaneous miscarriage when the pregnancy is interrupted before menstruation delay.

NLF arises due to the dysfunction of the hypothalamic-pituitary-ovarian system after injuries, neuroinfection, stress; as a result of hyperandrode; hypo- or hyperthyroidism; hyperprolactinemia; inflammatory processes.

The luteinization syndrome of the non-unifying follicle (LTF syndrome) is premature luteinization of the preventive follicle without ovulation. The reasons for the luteinization of the non-unifying follicle are not installed.

Pipe and peritoneal infertility

Pipe infertility is associated with a violation of the functional activity of uterine pipes or their organic lesion. The change in the uterine pipe function is observed against the background of stress, the synthesis of prostaglandins, genital steroids, an increase in the content of prostacycline metabolites, thromboxane A2, as well as at hyperandrode.

Organic lesion of uterine pipes leads to their obstruction. The cause of this pathology is the inflammatory diseases of the genital organs (gonorrhea, chlamydia, tuberculosis, etc.), operational interventions on internal genital organs, endometriosis of uterine pipes and other forms of external endometriosis.

Peritoneal infertility is due to the adhesive process in the field of uterine appendages. It arises due to inflammatory diseases of the genital organs, after operational interventions on the abdominal organs and a small pelvis.

In infertility in the gynecological diseases is associated with implantation implantation in the uterine cavity with intrauterine septum and syneficides, endometriosis, uterine uterus with submucose node location, endometrial polyps.

The cause of immune infertility is the formation of a woman of antispermal antibodies (in the cervix, endometrials, uterine pipes), leading to phagocytosis of spermatozoa.

In 48% of fruitless women reveal one reason for infertility, the rest is a combination of two reasons and more.

Diagnosis of infertility

The examination of women with infertility begins from the collection of anamnesis, in which the nature of the menstrual function (menarche, the regularity of the cycle and its disorders, intermenstrument discharge, painful menstruation), the number and outcome of previous pregnancies, the duration of infertility, the contraceptive methods and the duration of their use are clarified. When studying sexual function, find out whether there is no pain during sexual intercourse, the regularity of sexual life.

Pay attention to extragenital diseases (diabetes mellitus, tuberculosis, pathology of the thyroid gland, adrenal glands, etc.) and transferred operations that contribute to the appearance of infertility (operations in the uterine, ovaries, uterine pipes, urinary tracts, intestines, appendectomy).

Specify the gynecological history: the presence of inflammatory processes of small pelvis organs and sexually transmitted diseases (pathogen, duration and nature of therapy), cervical disease and their treatment (conservative, cryo or laser therapy, radio and electroconization).

Present psychogenic factors, as well as bad habits (smoking, drinking alcohol, drugs), which can lead to infertility.

In an objective examination, it is necessary to measure the growth, body weight of the patient, calculate the body mass index (BMI). Normally, it is 20-26 kg / m2. When obesity (BMI\u003e 30 kg / m2), it is necessary to establish its start time, possible causes and speed of increasing body weight.

Pay attention to the skin (dry, wet, fatty, angry rash, stretching stripes), the condition of the mammary glands (development, discharge from nipples, seals and volumetric education). It is advisable to perform the ultrasound of the mammary glands to eliminate tumor formations.

A microscopic study of smears from the cervical canal, vagina and urethra are carried out. If necessary, PCR is carried out - a study for the presence of infection, sowing microflora and sensitivity to antibiotics.

In parallel, the patient undergoes a survey on tests of functional diagnostics for 3 consecutive menstrual cycles (basal thermometry, symptom of "pupil", KPI, etc.).

The examination of patients with infertility of any etiology also includes consultation therapist to identify contraindications for pregnancy. When the signs of endocrine and mental diseases are found, as well as developmental malformations, they prescribe consultations of relevant specialists: endocrinologists, psychiatrists, genetics.

Endocrine infertility. The examination of patients with annevulatory infertility is beginning with the exception of organic pathology at all levels of the regulation of the menstrual function. For this purpose, the skull radiography with the visualization of the Turkish saddle, the MRI of the brain, the study of the eye doves and fields of view, ultrasound of the small pelvis, thyroid gland, adrenal glands.

To identify the functional pathology of the reproductive system, EEG, RG, determine the concentration in the blood of the hormones of the front lobe of the pituitary gland (FSH, LH, Prolactin, TG, ACTH), ovarian hormones (estradiol, progesterone), thyroid hormones (T3, T4), adrenal glands ( Cortisol, testosterone, DGEA-C).

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

The diagnosis of LNF syndrome is set at a dynamic ultrasound. During the menstrual cycle, the growth of the follicle is noted to the preventive, followed by wrinkling - the "Follicle Plate-Effect".

In the diagnosis of pipe and peritoneal infertility, it is necessary to be excluded primarily inflammatory diseases of the genital organs. For this purpose, bacterioscopic, bacteriological examination, PCR are carried out.

To eliminate pipe infertility (determining the patency of the uterine pipes), the hydrosonography, laparoscopy with chromosalpingoscopy with methyltonine chloride (methylene blue), salpingoscopy (less often - hysterosalpingography) is more often used.

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

In women with gynecological diseases, to exclude ins-uterine pathology with a diagnostic purpose, hysteroscopy and separate diagnostic scraping of the uterine mucous membrane are carried out. In case of detection of intrauterine pathology during hysteroscopy, it is possible to remove synechia, partitions, endometrial polyps, submucose myomatous nodes.

Immunological infertility is diagnosed only after the exclusion of pipecitonal, endocrine infertility and intrauterine pathology. After the exclusion of the factors described above, the postcoital test is proceeded.

The postcoital test allows you to assess the interaction of sperm and cervical mucus, is carried out in the middle of the cycle, usually on the 12-14th day. With a microscopic examination of the mucus of the cervix, after a koitus, the presence and mobility of spermatozoa determine. The test is positive if there are 5-10 active moving spermatozoa in transparent mucus without leukocytes. In the detection of fixed spermatozoa, the test is considered doubtful, in the absence of spermatozoa - negative. If spermatozoids are still or performing pendulum movements, the test is re-carried out.

Patients with psychogenic infertility are appointed consultation of the psychoneurologist. A specialist can apply tranquilizers, sedatives, as well as psychotherapeutic methods. In some cases, similar therapy is effective without applying ovulation stimulants.

Treatment of endocrine infertility. When identifying organic brain pathology, a neurosurgeon consultation is shown.

Functional disorders require adequate treatment of detected endocrine pathology to normalize hormonal status. With functional hyperprolactinemia or pituitary microprolactine, the treatment of dupamicimetics (reaches, bromocriptine) is shown.

In obesity, body mass correction is extremely important. Sometimes only a decrease in body weight, especially with pituitary obesity, leads to normalization of gonadotropin selection.

Treatment of the main disease is complemented by drugs stimulating ovulation. Monophase estrogen-gestagenic hormonal contraceptives (Kok) are prescribed for 2-3 consecutive cycles. After canceling Kok, the recovery of ovulation in the ovaries is "Rebaunt-Effect".

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

Currently, exogenous gonadotropins (FSH, LH, XG) 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 ripening of the dominant follicle in the ovary occurs, and the intramuscular administration of the XG in the middle of the cycle contributes to ovulation. In some cases, the stimulation of ovulation begins with the initial suppression of endogenous gonadotropins. For this purpose, A-GNVG is used.

Ovulation stimulants are used not only with infertility endocrine, but also as independent therapy in fruitless women with ovulatory violations by an unaffected reason.

Women with endocrine infertility, not pregnant during one year after hormone therapy, recommend laparoscopy to eliminate uterine pipes, hysteroscopy to eliminate intrauterine pathology.

Treatment of pipecitonal infertility. For the restoration of the anatomical passability of the uterine pipes, operational laparoscopy (or laparotomy - in the absence of endoscopy is not possible). If the fimbrial departments of the uterine pipes are posted, fimbriolysis is carried out. With peritoneal misfortune, the spikes are divided and coagulate according to indications. In parallel, the concomitant pathology (endometrioid heterotopia, subseroic myomatous nodes, retention formations of ovaries) are eliminated.

Currently, during the defeat of the uterine pipes, they are deleted in the Istimical and interstitial departments, and in the subsequent spending Eco.

Treatment of immunological infertility. To achieve spontaneous pregnancy, the patient is treated with latent sex tract infection. Then, for 2-3 days before ovulation, pure estrogen preparations are prescribed, it is recommended to use a condom for at least 6 months (weakening of the sensitization of immunocompetent cells of a woman to sperm antigens with a long lack of contact). After the cessation of mechanical contraception, pregnancy often comes.

The ineffectiveness of the treatment is the basis for the use of auxiliary reproductive technologies - artificial insemination of sperm of her husband. The cum is introduced into the uterus with a syringe with a special tip (it is possible to use donor sperm with the inferiority of the sperm of her husband and with consent to this spouses) or use ECO.

Extracorporeal fertilization and artificial insemination in the treatment of female and male infertility

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

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

Donor cum is obtained from men under 36 years old, physically and mentally healthy, without hereditary diseases. It is desirable that blood relatives of the donor in history have no data on the violation of the development of the fetus and spontaneous abortions.

The frequency of pregnancy after artificial insemination is 10-20%. The course of pregnancy and giving birth is similar to those with natural conception, and the malformations of the fetus are registered not more often than in the overall population.

Extracorporal fertilization (ECO) - fertilization of eggs in vitro, cultivation and transfer of the resulting embryos in the uterus.

Currently, ECO is carried out using ovulation inducers to get quite a lot of mature oocytes. Auxiliary reproductive technologies allow you to use cryopreservation programs not only sperm, but also oocytes and embryos, which reduces the cost of subsequent eco attempts.

The standard ECO procedure includes several steps. First, the folliclegenesis is activated in the ovaries using supervolting stimulants in various schemes. Regardless of the selection of the scheme, the principle of stimulation is single: the initial suppression of endogenous gonadotropins against the background of the use of A-Gengg, followed by the stimulation of supervision of exogenous gonadotropins. The next step is carried out puncture of 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 environment containing at least 100 thousand spermatozoa. After the cultivation of embryos for 48 hours, with a special catheter, 1-2 embryos to the uterine cavity are transferred; The remaining embryos with normal morphology can be croconservations for use in eco attempts.

When eco, single spermatozoids are possible intracitoplasmic injection of spermatozoa for fertilization of oocytes (ICSI INTRA CYTOPLASMIC SPERM INJECTION - ICSI).

At ICSI, the micromabular administration of a single spermatozoa is carried out under visual control into a mature oocyte, which is in the metaphase stage II of the division of MEIOS. The remaining stages of the procedures are similar to Eco.

With azoospermia, methods are used within the framework of the Eco + ICSI program, allowing to obtain spermatozoa from epididium or eggs.

In some cases, when conducting Eco, it is advisable to perform prenatal genetic diagnostics (PGD). The genetic study of the embryo cells is carried out at the risk of the appearance of chromosomal anomalies, suspicion of monogenic diseases (fibrous disease, myelosensory deafness, etc.), as well as women with rhesus-negative blood, the husbands of which are bricks on RHD.

Complication of Eco is the syndrome of the ovarian hyperstimulation. Under the hyperstimulation of the ovaries imply a complex of pathological symptoms (the appearance of abdominal pain, in some cases the picture of the "acute abdomen" is developing). At the same time, many follicles in both ovaries are prepared for ovulation, which leads to their pronounced increase. Treatment is to conduct dehydration, infusion therapy (plasma).

Surgical treatment of ovarian hyperstimulation syndrome is shown in the signs of internal bleeding due to the ovarian break. The volume of operational intervention must be gentle, with the maximum preservation of the ovarian tissue. With hyperstimulation, impose seams on the broken ovary and stop the bleeding is quite difficult. Sometimes it is necessary to tampony the broken ovary according to Mikulich.

Features of the course and maintenance of pregnancy after ECO are due to the high probability of its interrupt, non-leaving and developing heavy 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 procedure of ECO. In children born using Eco, the frequency of congenital anomalies is not higher than in the overall population of newborns. The frequency of multipleness with an extracorporeal fertilization is 25-30%.

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Consultation on the treatment of traditional Eastern Medicine (point massage, manual therapy, acupuncture, phytotherapy, Taoist psychotherapy and other non-medical treatment methods) are held in the Central District of St. Petersburg (7-10 minutes walk from Vladimirskaya / Dostoevskaya metro station), from 9.00 to 21.00, without lunch and weekends.

It has long been known that the best effect in the treatment of diseases is achieved with the combined use of "Western" and "Eastern" approaches. The treatment time is significantly reduced, the likelihood of recurrence of the disease is reduced.. Since the "Eastern" approach besides the technician aimed at the treatment of a major disease, much attention pays "cleaning" of blood, lymphs, vessels, ways of digestion, thoughts, etc. - often it is even a necessary condition.

Consultation is carried out for free and does not oblige you to anything. On it all data from your laboratory and instrumental research methods is extremely desirable. Over the past 3-5 years. Spending only 30-40 minutes of your time you will learn about alternative methods of treatment, find out how can I increase the effectiveness of already designated therapyAnd, most importantly, how you can independently deal with the disease. You may be surprised - how everything will be logically built, and understanding of the essence and reasons - the first step towards a successful problem solving!