Infertility is not only a medical but also an important social problem. It treats women and men alike and thus is a couple problem. Infertility is called infertility. An infertile patient cannot have a child without medical help. Most patients are subfertile or have impaired fetal function. Closely related to infertility are spontaneous abortions. The problem of pregnancy losses when the pregnancy is terminated prematurely.
Infertility means the absence of pregnancy for a year after a couple has regular, unprotected (coitus without the use of contraceptives) sexual intercourse.
The infertility rate is consistently high, averaging 10-15%, which means that every 5.6 couples face this problem.
What are the main causes of infertility?
The causes of infertility are many. It can be caused independently by male and female problems or by a combination of both. Barren marriage
About 30-40% are caused only by the male factor, 30-40% – only by the female factor, in other cases both are combined.
The male factor implies a decrease in the number of sperm, reduced mobility, pathology or no sperm at all – azoospermia.
The main causes of infertility in women are the so-called. Tubo-peritoneal and endocrine factors. These are the absence of ovulation, infrequent and incomplete ovulation, closed tubes of the uterus or their functional insufficiency, healing process, endometriosis, pathologies of the uterus – fibroids (fibroids (myoma), cavities and others.
The cause of infertility may be incompatibility between the couple. At this time, the female body produces antibodies against the male germ cells – sperm, which cause their death in the cervical mucus.
The cause of infertility may be related to infrequent sexual contact due to decreased libido and impotence.
What effect does age have on fetal function?
The age of a woman and a man negatively affects reproductive function. As a woman gets older, her ability to conceive decreases. A healthy fertile woman of 25 years needs 2-3 months to get pregnant, while in the case of a woman 35 years and older it takes 6 months or more to get pregnant. The main reason is the decrease in the number and quality of eggs with increasing age, increase in the incidence of endometriosis, uterine pathologies, which in itself negatively affects the function of the uterus.
This is a general view, however. Healthy babies are usually born as a result of pregnancies of older mothers.
Does stress cause infertility?
Stress is not an independent cause of infertility. However, in some concomitant pathologies, such as anorexia nervosa, hormonal changes and ovulation disorders occur.
Stress is an important condition that accompanies infertility, which always needs proper management.
When and to whom should a woman consult a doctor because of infertility?
Since this problem affects both women and men equally, it is necessary for the couple to consult a reproductive specialist at the same time.
Reproductologist This is a specialist who manages pathologies of reproductive function in women and men.
When a couple suspects that they have a certain problem, it is obvious they should immediately consult a reproductive specialist.
If a woman does not have a regular menstrual cycle this may indicate anovulation. Painful, prolonged menstruation, pain in the lower abdomen, painful sexual intercourse, raises suspicion of endometriosis, inflammatory diseases.
Age is very important. Statistically, if a young healthy couple becomes pregnant in the first 6 months, it may take 1-2 years for a couple over the age of 35 to get pregnant. It is generally accepted that in the absence of specific complaints, it is necessary to see a doctor after one year due to infertility. The older couple should catch the spare earlier, already after 6 months.
How is fertilization done?
Pregnancy occurs as a result of the fusion of female and male gametes – the egg and the sperm. In the first half of the menstrual cycle, the follicle matures in the ovary, where the egg is placed, and the egg is released from the mature follicle in the middle, a process called ovulation. From the ovulated follicle in the second half of the menstrual cycle a yellow body is formed, which in case of fertilization helps to maintain the pregnancy. After ovulation, the egg is captured by the fallopian tubes through its fallopian tubes. Meeting of the egg and sperm – fertilization takes place in the middle-ampullary part of the fallopian tube. After a few days, the fertilized egg moves into the uterine cavity and attaches to the inner membrane – the endometrium.
Violation of any stage in this process causes problems with childbearing.
What tests should a couple take to determine the causes of infertility?
Examining men is relatively simple and does not require much time. Sperm analysis is done at the initial stage. The doctor evaluates the spermogram, in case of changes further research is needed – hormonal, inflammatory, immune factors.
In women, we primarily ovulate. The simplest test for this is the so-called. Basal thermometry – measuring the temperature in the back of the body in the morning, at the same time, before getting out of bed. Normally in the first half of the menstrual cycle the rectal temperature is less than 37 degrees, after ovulation it rises sharply, by 4-6 degrees, becomes more than 37 degrees and persists for 10-12 days. The day before menstruation falls again.
“Basal thermometry” does not always allow us to accurately assess ovulation, so it is necessary to carry out ultrasound monitoring of ovulation, during which we observe the maturation of the follicle – its size, the thickness of the inner membrane of the uterus – endometrium, we detect fluid after ovulation. To assess corpus luteum function, we measure progesterone levels in the blood along with basal body temperature.
In case of deviations, to determine the causes, we start a hormonal study, which is determined by a reproductive specialist.
In general, a woman’s appearance, skin structure is a mirror of her hormonal profile, so an experienced reproductive specialist can accurately assess a woman’s hormonal status. For example, obesity, acne, oily or dry skin, so-called “dirty elbows”, pink stretch marks, local dark pigmentation of the skin in certain areas – “black acanthosis”, excess weight and obesity indicate various hormonal disorders. That often these problems manifest themselves in adolescence. Timely treatment is an important prevention of infertility).
Ultrasound examination, including 4D ultrasound, is needed to assess the condition of the uterus and ovaries, their size, structure, fibroids (myomas), cysts, polyps, etc. Diagnosis.
It is necessary to examine the permeability of the fallopian tubes. The most informative for this purpose is hysterosalpingography – X-ray examination of the uterus and fallopian tubes, during which we assess the shape of the uterine cavity, the passage of the fallopian tubes, the presence of healing in the pelvic cavity. Echohysterosalpingography may also be performed.
In case of pathological changes, closed tubes, healing, we first study the infectious factors-sexually transmitted infections-chlamydia, ureaplasma, mycoplasma. The cause of anatomical changes in the reproductive organs can also be endometriosis, uterine septum, submucosal node.
It should be noted that chronic inflammation of the uterus, endometrium, ovaries and fallopian tubes is an important factor in infertility.
What does a couple incompatibility mean and how is it diagnosed?
If a woman has a normal ovulation, the fallopian tubes of the uterus, a man does not have normal sperm and pregnancy, the so-called Postcoital – Matching test. 1-2 days before ovulation 6-12 hours after coitus, mucus is taken from the cervix of the woman, where the number and movement of sperm are assessed. It is also possible to determine the level of antisperm antibodies in the blood and semen.
What should we do if a woman and a man have all the indicators normal and pregnancy still does not occur?
In such a case, a diagnosis of infertility of unknown genesis is heard and laparoscopy and hysteroscopy must be performed. It is not uncommon for endometriosis to be detected at this time.
2 years of ineffective treatment during infertility is already indicative for diagnostic laparoscopy.
When is artificial insemination done?
The same artificial in-vitro fertilization has absolute indications when pregnancy by any other method can not stand in any way. This is due to the obstruction of the fallopian tubes, severe disorders of the spermogram, due to the scarce reserve of follicles in the ovary, when a woman has limited time, unexplained infertility. In the case of developmental abnormalities, genetic pathologies, poor quality eggs and other severe cases, it is necessary to use various in vitro fertilization programs.
What advice would you give to couples who have an infertility problem?
It is very important for the childless couple to be as informed as possible about their own problem, to have the trust of a doctor and to plan, examine and patiently in a reproductive clinic.
There is virtually no unsolved problem today, using modern methods of treatment, including assisted reproductive technologies, all the resources are available for a family to have a child.