Female infertility is quite a multifaceted and much more complex problem,
The female body must not only produce eggs, but also create the necessary conditions for the normal course of childbirth and pregnancy. Any, even minor changes in a woman’s reproductive system can make childbirth problematic. A qualified gynecologist-endocrinologist talks about the causes of obstruction for conception and the methods of correcting them:
– First of all, I wonder in what cases the specialists talk about the infertility of couples?
– Infertility is diagnosed when there is no childbirth, no pregnancy occurs within 1 year after the start of regular, unprotected sex life. According to the UK National Institutes of Health, infertility can be diagnosed in women aged 35-36 after 6 months of regular – 2-4 times a week after unprotected sex.
We first talk about infertility when a woman has never been pregnant. Infertility is secondary when a woman has been pregnant in the past, it does not matter if it was in the uterine cavity or outside it – in one of the tubes of the uterus, but then the fetus was not repeated.
– What are the causes of both primary and secondary infertility?
– In modern medicine there is a very large range of contraceptives, which can be selected individually to avoid unwanted pregnancies for each patient. Nevertheless, abortions are still the most common cause of secondary infertility.
Unfortunately, for most of our patients, it is difficult to explain why they do not become pregnant several times after a terminated pregnancy.
Abortion often damages the uterine wall and develops endometritis, an inflammatory process that prevents a fertilized egg from attaching to the uterine wall. In addition, premature termination of pregnancy quite often develops hormonal imbalance, the recovery of which is quite a difficult and time-consuming process.
1. 25-40% of infertility is caused by endocrine problems, in particular, in order to conceive a fetus, it is necessary for the body to work in a rather complex system: CNS – hypothalamus – pituitary – ovaries – thyroid gland – adrenal gland, when one of the links of this system is out of order Problems with ovulation (mature egg coming out of a transparent follicle):
- Anovulatory cycle – at this time the follicle matures, but ovulation does not occur and a yellow body does not form. This is characteristic of polycystic ovary syndrome.
- Hyperprolactinemia – An increase in the hormone prolactin in the blood, which prevents ovulation.
- Functional disorders of the thyroid gland: hyper- and hypothyroidism.
- Hyperandrogenism (excessive production of male hormones in the female body) – pneumonia (acne), acne, etc.
- Production of a small amount of the hormone progesterone, resulting in a cycle of ovulation, but no corpus luteum development.
2. Among the causes of female infertility are also anomalies and traumas of female genital development – underdeveloped, small uterus – infantilism, hypoplasia, pseudohermaphroditism and many more. Uterine abnormalities – retroversion, hyperaneflexia, retrodeviation, ie. Sharp deviations of the body of the uterus and its cervix forward or backward when a fold or angle of the uterus is formed, which in turn prevents sperm from entering the uterine cavity.
3. 40-50% infertility is associated with damage to the fallopian tubes (ovarian tubes), their blockage, impermeability. Inflammatory processes, such as salpingitis (inflammation of the fallopian tubes), salpingo-oophoritis (inflammation of the fallopian tubes and ovaries), as well as surgical interventions in the abdomen or pelvis, heal the ovary, which disrupts their function – to carry the egg.
4. Premature ovarian syndrome – In this case, the reserve of eggs in the ovaries is minimal.
5. Pathologies of the uterus and cervix – fibromyoma, endometriosis, adenomyosis, polyps. Narrowing of the cervix or the production of insufficient secretion. These diseases, on the one hand, create mechanical resistance to the movement of the sperm, and on the other hand, create unfavorable conditions for implantation.
6. Extragenital diseases – diabetes, tuberculosis, osteomyelitis, typhoid, conjunctivitis, nephritis and many more.
7. Past Venereal Diseases or Sexually Transmitted Infections (Viruses): Chlamydia, Toxoplasmosis, Mycoplasmosis, Cytomegalovirus, Honorrhea. These viruses are tested for genotyping, as these infections can lead to congenital anomalies in the fetus and newborn and often lead to early termination of pregnancy. I would like to point out that very often the diagnosis and treatment of these infections will be enough for the desired pregnancy.
8. Overweight (obesity) or underweight – not infrequently the cause of infertility.
9. Immunological infertility 2-5% – incompatibility between women and men. In this case, antisperm antibodies are produced in the sperm of a woman in the blood of her husband, and antibodies are developed in the blood of the man against his own sperm.
10. Chronic intoxications in both couples – alcohol, nicotine, drugs, as well as radiation, chemotherapy.
11. Genetic anomalies – chromosomal diseases, the existence of which is unknown to couples. The reason for termination of pregnancy very often is chromosomal aberration or numerical and structural changes of chromosomes. Of course, such patients are under the supervision of a gynecologist and a geneticist at the same time.
12. The diagnosis of hereditary thrombophilia is of great importance. It is a pathology of hemostasis (coagulation system), found in 0.1-0.5%, which is caused by genetic factors. Risk groups include individuals who have had close relatives under the age of 40 with thrombosis, thromboembolism, stroke, heart attack, miscarriage, stillbirth, fetal developmental delay.
13. Finally, psychogenic factors in 3-5% and unexplained or unexplored causes in 5-15%.
– What can you tell us about the first steps that should be taken to start infertility treatment?
– First of all, every woman should know that waiting for more than a year is not allowed.
Most of our patients want to achieve the desired goal fairly quickly, betraying their willpower, and after 3-4 years (sometimes more) of infertility, they lose a lot of patience in 1-2 months and the treatment does not end.
Examining and diagnosing infertility, determining the cause of infertility is no less difficult than the process of self-treatment.
Before the examination it is necessary to rule out problems on the part of men, which are found in 40% of infertility. The examination begins with a spermogram. If abnormalities are detected, treatment is started. No less important during infertility is the surgical treatment of varicocele, the dilated veins of the testicles, after which pregnancy occurs.
– How do you start diagnosing female infertility and what studies are needed to determine the cause?
– The examination begins with an ultrasound examination of the small pelvic organs. Also required:
- Research of the follicular apparatus
- Assessment of hormonal status of women and men
- Thyroid examination:
- Diagnosis of egg reserve by antimuller hormone
- Genotyping of sexually transmitted infections
- Examination of the fallopian tubes and uterine cavity. To diagnose tubal permeability, we perform hydrosonography – a mixture of saline, antibiotics and hormones is inserted into the uterine cavity under ultrasound control
Laparoscopy is both a diagnostic and, in many cases, a method of treatment, ie in most cases pregnancy occurs after laparoscopy.
Hysteroscopy – Examination of the uterine cavity with a hysteroscope – allows polypectomy and removal of myoma nodes.
– Naturally, after determining the cause, you start treatment, what are the modern methods of treating female infertility?
– The method of treatment determines the disorders identified as a result of diagnostic studies.
These may be: correction of hormonal background, induction of ovulation (stimulation). We use endoscopic methods: laparoscopy and hysteroscopy, the efficiency of which reaches 30-40% and must be performed in a hospital.
We use insemination when couples are incompatible. It is the artificial insertion of sperm directly into the uterine cavity. Of course, the effectiveness of the method increases as a result of the procedure performed for at least 2-3 cycles. Insemination may be performed on an outpatient basis, ie the patient will be discharged home in a few hours.
There are auxiliary methods that are successfully used in complex treatment, such as physiotherapy and hirudotherapy.
Physiotherapy and hirudotherapy in combination, along with other treatment prescriptions, often give the desired result – “two red lines”.
– In recent years, infertility treatment with assisted reproductive technologies has become quite active, if you can explain to our readers what they are.
– Auxiliary reproductive technologies – artificial or in vitro fertilization – this is the final stage of infertility treatment, we use it as an alternative to all existing methods.
If you do not get a positive result within 2 years after treatment with standard methods, it is advisable to resort to in vitro fertilization. At this time all the stages of fertilization and early development of the embryo take place outside the female body.
According to the International Organization for the Advancement of Reproductive Technologies (ICMART), up to 5 million people are born in vitro fertilized worldwide.
As for your own methods:
1. In vitro fertilization and embryo transfer;
2. Injection into the cytoplasm of an oocyte – injection of sperm into the egg shell.
3. Donation – i.e. Use of donor (other) egg and sperm.
4. Getting the desired result with the help of a surrogate mother, ie. Genetically the baby belongs to the infertile couple, they are its biological parents, only the development of the fetus takes place in the body of another woman.
5. Cryopreservation of sperm and eggs, ie storage for a certain period of time, which allows their use after years.
The variety of causes of infertility, as well as the often coexistence of several causes, complicates the choice of treatment tactics. Especially when the couple has a combination of several factors of infertility, so successful treatment depends on the accuracy and quality of the examination, the psycho-emotional mood and attitude of the couple themselves.
Couples who face the problem of infertility, if we do not take into account the material problems, are emotionally very tired and often have a feeling of hopelessness. My request would be: Be optimistic before starting the examinations and treatment, since the mental state of the patient is of great importance to get the desired result. You may have to undergo the same test, but believe me, without it the treatment process will not be complete.