Infertility means such a violation in the human body of reproductive age, when it is unable to produce offspring.
It is important to emphasize that this applies only to people of reproductive age, because before the onset of puberty in childhood and after the cessation of menstruation in women and after reaching a certain age in men, the inability to reproduce is quite physiological, i.e.normal. We offer to consider the main causes of infertility in women, diagnosis and treatment options.
Table of contents:
- Infertility classification
- Female infertility
- Criteria for diagnosing "infertility"
- Causes of infertility in women
- Infertility treatment in women
There are infertility in women and men. They differ for reasons and mechanism of their development. In addition, within these divisions there are many more classifications due to, pathogenesis, clinical picture of various types of infertility.
There are primary and secondary female infertility. Female infertility is considered to be primary in the event that pregnancy has never occurred in a given woman. The concept of "secondary female infertility" means that there were already one or several pregnancies in a woman's life.
The fact that this pregnancy ended with childbirth, miscarriage or leaking extrauterine, does not matter. If at least once in a lifetime a woman was pregnant, then her infertility will be called secondary.
Criteria for diagnosing "infertility"
A terrible diagnosis of infertility is based on certain criteria. The main of them is considered to be the absence of pregnancy with a regular sexual life of the couple( intimate relations at least once a week) throughout the year without the use of contraception or other obstacles to conception of factors or means.
To date, alas, we can say that about 8% of married couples at one or another stage of their relationship face the problem of infertility.
Causes of infertility in women
Let us dwell on the reasons that can lead to the development of female infertility. First, we emphasize that there are a great many of them, many of them have not been fully studied. However, all of them require detailed and comprehensive diagnosis and treatment. Thus, the most common cause of female infertility is absence, infection( obstruction) or congenital malignancy of the fallopian tubes.
Fallopian, or uterine tubes, are a paired tubular organ located in a small pelvis of a woman. They represent a kind of channel, designed to transport the egg and sperm. Here they also meet, merge and form a zygote( fertilized egg), which immediately goes to the uterus in order to initially fix on its mucous membrane - endometrium, and then gradually penetrate into deeper layers of the uterine wall. This process is called "implantation" of the zygote - the future fetus. There he "settles down comfortably", adjusts his own, common with his mother's blood supply system, so that with the blood of his mother receive all the necessary nutrients and oxygen.
During ovulation, the mature egg is separated from the ovary and enters the abdominal cavity. In order for her to meet with the spermatozoon, she needs to get from the abdominal cavity into the fallopian tube.
For this purpose, on the abdominal end of the fallopian tube there is a special funnel with cilia. Cilia also lined the inner surface of the uterine tube. The movements of the cilia are directed toward the uterus.
Thus, a mature egg is captured from its "free swimming" in the abdominal cavity and is directed straight to the canal of the uterine tube, where this very "significant encounter" with the most dexterous spermatozoon can occur.
Obstruction of fallopian tubes can develop as a result of the adhesive process inside the pelvis caused by other diseases.
As a result of chronic inflammation, after the surgical interventions the connective tissue can grow, and the lumen of the uterine tube( one or both) can overlap, twist or completely overgrow.
Pathology of the fallopian tubes is not only one of the most common, but, alas, the most serious from the point of view of the prognosis, the reasons for the development of female infertility. Restoring the patency of fallopian tubes can be very difficult, and in some cases, unfortunately, impossible.
Sometimes one of the fallopian tubes must be removed in connection with developing in her ectopic pregnancy. In the event that the second pipe is impassable( for example, due to the postoperative adhesion process), the woman develops secondary infertility.
Female infertility associated with obstruction, underdevelopment or lack of fallopian tubes( after their removal by surgery or congenital) is called the tubal factor of infertility.
Peritoneal factor of infertility
Adhesive process can develop as a result of any inflammation in the small pelvis, including, endometritis.
If the adhesive process of this kind has caused infertility in women, this cause of infertility is called a peritoneal factor of infertility.
If infertility is the result of a combination of adhesive process in the small pelvis and the pathology of the fallopian tubes, talk about the tubal peritoneal factor of infertility.
Endocrine Infertility Factor
Another factor that plays a huge role in the development of infertility is, naturally, the hormonal factor. The hormonal background of a woman, the normal ratio and concentration of hormones in the blood plays a key role in conception, normal pregnancy and during childbirth.
In the formation of the normal hormonal background of women involved hormone of the pituitary, hypothalamus, adrenal and thyroid gland. They form and manage the fragile balance of the combination of various biological active substances in the blood of a woman who allow her to become a mother.
In addition, very few people know that in addition to these basic organs of the endocrine system, women are also involved in the formation and maintenance of a normal hormonal background of the liver, kidneys. Two organs, at first glance, are quite far from both the endocrine function and the reproductive system. But this is only the first. On closer inspection, they are more than important.
Very often, a chain of violations in a finely organized system of hormonal regulation triggers a stressful situation, or rather, distress, i.e.decompensated stress, excessive for a woman.
In this case, polycystic ovary syndrome, anovulatory cycle, amenorrhea and dysmenorrhea can develop. Now for each violation in order.
Polycystic ovary syndrome
Diagnosis is the most common cause of infertility among young and apparently perfectly healthy women. Often it is the cause of primary infertility. The syndrome of polycystic ovaries( PCOS) is a polyethiologic disease, i.e.for its development, a combination of several unfavorable factors is necessary, among which: hereditary predisposition, acute or chronic stress, eating disorders, chronic inflammatory processes in the organs of the reproductive system).
The essence of this disease is a violation of the function of the ovaries, in which they refuse to respond normally to hormonal stimulation. In this regard, the dominant follicle does not form, ovulation does not occur. Instead, several unripe and non-separated follicles form on the surface of the ovaries.
Gradually, these unripened follicles are replaced with connective tissue, resulting in a tight capsule around the ovary. This capsule further complicates the process of full ripening and separation of the dominant follicle, and then - the ripe egg.
So, the pathological chain closes, and pregnancy becomes less likely.
The development of the syndrome of polycystic ovaries is often associated with a violation of the sensitivity of the receptors located on them. This explains the lack of an adequate response from the ovaries in response to hormonal stimulation and the absence of a dominant follicle.
In addition, a huge role in the pathogenesis of PCOS is played by hyperadrogenemia, i.e.increased content of androgens in the blood of a woman.
There are many symptoms of PCOS, which are not necessarily all manifest in the patient, but can occur in various combinations.
The primary symptom: oligo- or dysmenorrhea - that is, the absence or violation of the cycle of menstruation.
In this case, the woman does not have a characteristic cyclic change in the vaginal temperature characteristic of the ovulatory cycle.
Menstrual discharge may appear, cyclic and acyclic. Sometimes they are too scanty, sometimes on the contrary too abundant.
If such abundant spotting lasts longer than 14 days, menstrual bleeding is reported and often a woman or girl is then hospitalized to stop bleeding.
Intravenous drip is prescribed blood-restoring drugs( dicynon, vikasol), intramuscularly - vitamin preparations.
The use of iron preparations for the prevention of iron deficiency anemia is also indicated.
Another important symptom of PCOS is a laboratory-diagnosed increase in the concentration in the blood of the androgen patient( male sex hormones and their precursors).
The high concentration of androgens in the blood of a woman in itself inhibits ovulation and worsens the condition of the reproductive system of a woman even more.
Often the concentration of androgens in a woman's blood reaches such figures that the patient begins to develop signs of masculinization.
This means the deposition of fat by the male type( mainly on the stomach).In combination with other metabolic disorders( provoked by hormonal disorders), a woman develops abdominal obesity - obesity in the central( male) type.
In addition, the signs of masculinization is hirsutism - the appearance of hair on the body of a woman in the habitually "masculine places"( ie on the chin, chest, back).
It should be noted that it is widely believed that the slight appearance of hair over the upper lip is also a sign of masculinization. This is not true.
The appearance or absence of hair over the upper lip in women is determined solely by their genotype.
This feature is inherited. And it is only characteristic, characteristic of this woman's trait, such as the shape of the ears or nose, and has nothing to do with the content of certain hormones in her blood.
Androgenic alopecia( alopecia) is also a characteristic and extremely unpleasant symptom of hyperproduction of androgens and PCOS.
Every woman with PCOS is very worried because of this manifestation of the disease, because it is difficult to combat androgenetic alopecia, as it is determined by hormonal imbalance, but the aesthetic defect is significant and can often cause additional stress for the woman, aggravating the course of the underlying disease -PCOS.
The appearance of acne and seborrhea also constitute an extremely unpleasant aesthetic defect. Treating hormone-mediated acne is quite difficult. This process requires a lot of time and patience, both on the part of the patient and on the part of the doctor.
Other significant signs of PCOS are diagnosed by ultrasound examination of the ovaries. This: a thickened capsule around the ovaries, an increase in ovaries in size, a change in their echogenicity and structure, multiple small follicles along the periphery of the ovary, a lack of dominant. The two main criteria for diagnosing PCOS are:
- Ovulation disorder( anovulatory cycle)
- Syndrome of increased production of androgen
- Symptoms of polycystic ovaries with ultrasound examination
It is on the basis of these criteria that a diagnosis of "polycystic ovary syndrome" is established and appropriate treatment is prescribed.
Pathology of the uterus
Another important cause of infertility may be the pathology of the uterus or its absence.
Changes in the uterus can be congenital. This applies to cases of the two-horned uterus, septum inside the uterus, bifurcation of the uterus. Also, the pathology of the uterus can be a phenomenon acquired.
Acquired pathology of the uterus is scars after caesarean section or other surgical interventions, benign neoplasm of muscle tissue - uterine myoma, endometritis, polyposis, endometrial hyperplasia.
Endometritis is an infectious inflammation of the internal mucosa of the uterus, which can be caused by various pathogenic microorganisms: hemolytic B-streptococcus, E. coli, klebsiels and other bacteria.
Uterine polyps are benign growths of its tissues, which, as a rule, originate from the basal layer, are never malignant, but nevertheless interfere with the normal fixation and implantation of the zygote( a fertilized egg), necessary for the further development of pregnancy.
Polyps are single and multiple. They can also occur in the cervical region, delivering a lot of inconvenience there.
There are polyps:
This classification is based on the structure of polyps.
Endometriosis is another important cause of infertility. It is also possible immunological infertility, gene pathology, which makes it impossible for a woman to become pregnant.
Treatment of infertility in women
Treatment of female infertility and its effectiveness or ineffectiveness are determined mainly by the reason that led to its development. If the cause is established and it is possible to eliminate it due to, for example, hormonal stimulation of ovulation( in the anovulatory cycle), with the passing of the fallopian tubes, the onset of pregnancy can easily be achieved.
In some cases( after removal of the uterus, both fallopian tubes, complete obstruction of the fallopian tubes, chromosomal pathology, etc.) treatment is impossible. Then the woman should think about the adoption of the baby.
In some situations, in vitro fertilization( IVF) can help. ECO has long been the "gold" standard of infertility treatment in Western countries and the United States. The woman has to select eggs, they are raised in a special incubator, then their artificial insemination( using the sperm of the father or in case of their biological incompatibility) - the donor spermatozoon) is carried out. The newly formed zygote is again placed in the incubator and after a certain period, when the embryo is ready for implantation - is transplanted into the mother's uterus. The effectiveness of IVF is 30-35% of everything, according to statistical data. But nevertheless this is the last chance to get pregnant normally and take out your child for many women.
If this method proves to be ineffective( and the number of possible repeated IVF attempts is limited and regulated by law), a family couple is advised to resort to surrogate motherhood. The method of fertilization is similar to that of IVF, only the ripe embryo is inserted into the uterus of the surrogate matter, which carries it and gives birth.
Of course, this process involves a lot of legal aspects and complexities. This is an expensive procedure. But no money is worth more than the joy of motherhood, so for a married couple all the options that allow them to solve their problems are good.
- Cervical myoma
- Treatment of ovarian inflammation