Female infertility is the absence of pregnancy for a year or more in a woman who has a regular sex life and does not use contraceptives. Infertility is also diagnosed to women with repeated miscarriages.

It is known that every sixth marriage is barren. In approximately 60% of cases, infertility is caused by various disorders on the part of the female body, and in 40%, by the male.

They distinguish absolute infertility, in which severe changes are present in the body that make conception impossible in principle, and relative, in which the causes of infertility are completely removable. Primary infertility is also distinguished, in which a woman who has sex has never had a pregnancy; and secondary, when conception does not occur, but were in the past pregnancy.

Among the main pathological conditions that have the consequences of infertility:

• inflammatory diseases of the genital area;
• insufficient development of the organs of the genital area;
• endometriosis of the uterus, tubes and ovaries;
• pathology of the organs of the endocrine system;
• genital dystopia;
• severe extragenital pathology;
• genital tumor;
• pathology of the immune system.

Diagnosis of infertility in women

It begins with an assessment of clinical and medical history data. They start examining women only after examining their husband to exclude infertility. In women, the presence of monthly ovulation is first established, making for this purpose a blood test and ultrasound of the ovaries. If it is present, but fertilization does not occur, conduct a further examination. During a gynecological examination, the acidity of the vaginal contents, the viscosity of the cervical secretion and the test for compatibility of cervical mucus and sperm are determined. It is mandatory to carry out perturbation, metrosalpingography, bi-contrast genikography, kimographic hydrotubation. There are certain contraindications to the use of these techniques that need to be considered. If endocrine pathology is assumed as the cause of infertility, then the ovarian function is determined by functional diagnostics tests, an endometrial biopsy is performed. If infertility is a consequence of the pathology of the fallopian tubes and uterus, laparoscopic examination is performed. These examinations are carried out in stationary conditions.

Female infertility treatment

The direction of treatment depends on the type and nature of the pathological process that caused sterility. With obstruction of the fallopian tubes due to chronic inflammation, the use of ultrasound methods is effective. Inductothermy, electrophoresis of iodine, therapeutic hydrotubation with antibiotic solutions, lidase and hydrocortisone are also used. With insufficient development of the organs of the genital area, electrostimulation of the cervix, inductothermy, mud therapy, gynecological massage are used. Hormone therapy also finds its application by the nature of the identified changes. With Stein-Leventhal syndrome, a wedge-shaped resection of the ovaries is performed. The presence of uterine fibroids in young women in combination with infertility requires surgical treatment. Treatment of endometriosis is carried out with combined estrogen-progestogen drugs, and in case of its inefficiency - promptly. Tubal infertility is also treated surgically if conservative therapy is unsuccessful.

Essential drugs

There are contraindications. Specialist consultation required.

• Sibutramine (a drug for the treatment of obesity). Dosage regimen: inside, in the morning, without chewing and washing down with a sufficient amount of liquid of 10-15 mg.
•   (hypoglycemic agent). Dosage regimen: inside, 500 mg 3 times a day.
• Dydrogesterone (progestogen). Dosage regimen: inside, at 10 mg / day. from the 14th to the 25th day of the cycle.
• (estrogen-progestogen). Dosage regimen: inside, every day at about the same time, with a small amount of water, one tablet continuously for 21 days. In cyclic mode, apply for 3-4 months.
• Clomiphene (ovulation inducer). Dosage regimen: inside, 50 mg once a day at bedtime, starting from the 5th day of the menstrual cycle, for 5 days (in the absence of a cycle, at any time). In the absence of effect (ovulation does not develop within 30 days) increase the dose to 150 mg / day. or extend the course to 10 days. The course dose should not exceed 1 g. The course of treatment is 3-4 months.

What to go if women are suspected of infertility

• Compatibility Analysis

  In order to check how two people are compatible with each other and conduct the very first compatibility analysis - the post-coital Shuvarsky-Gunner test. Its essence is to determine the number of live sperm in cervical mucus taken from the woman’s vagina during ovulation. If there is no sperm in the cervical mucus at all, or if there are single and immobile, then there is a problem of incompatibility of the spouses.

• Infertility tests

  Non-pregnancy indicates problems with the reproductive system of a man or woman. To find out the reasons, the doctor prescribes several studies and tests. Among them are a spermogram, pelvic ultrasound, basal temperature measurement, hemostasiogram, tests for TORCH infections, etc. Thus, examination may reveal that the woman does not ovulate (if the basal temperature does not rise above 37 ° C throughout the cycle) , there is obstruction of the fallopian tubes, or that sperm or cervical fluid (during ovulation) contains antisperm cells, etc.

The diagnosis of infertility is assumed if, with constant intimate contacts (sexual intercourse every other day) and the absence of protection, the couple does not conceive during the year. This condition occurs annually in a quarter of couples, only 15% begin to be treated for infertility. Unfortunately, every 20th couple remains sterile, despite the therapy.

Infertility diagnostics and treatment is carried out in antenatal clinics, andrology rooms, and assisted reproductive technology clinics.

Infertility in 4 out of 10 cases is associated with the male factor, female infertility is still the same, and 20% of all cases are of mixed nature.

Male infertility

Diagnosis of endocrine infertility is carried out using hormonal screening. A week after the onset of menstruation, the levels of FSH, LH, prolactin, testosterone, dehydroepiandrosterone sulfate (DEA-C), 17-hydroxyprogesterone are determined in the blood. To determine the usefulness of ovulation on days 20-22, the level of progesterone is determined.

To confirm ovulation at home, you can use special diagnostic tests to determine it, for example, Cliaplan. They are sold in pharmacies.

An immunological study in women is not as important as in men. With incompatibility of sperm and cervical mucus, the immunological form of male infertility is diagnosed.

Diagnosis of female infertility includes instrumental research methods:

• ultrasound examination (ultrasound) of the pelvic organs with dopplerometry (assessment of blood flow);
• Ultrasound of the thyroid and mammary glands;
•   (less commonly used, since the information content of the method is lower than ultrasound in women under 40);
• x-ray examination of the skull and the region of the Turkish saddle, where the pituitary gland is located;
• with an increase in the concentration of prolactin in the blood and suspicion of a pituitary microadenoma, computed or magnetic resonance imaging of the skull and pituitary gland is prescribed;
• in the presence of signs of hyperandrogenism (excessive hair growth, obesity in the form of an "apple" and others), an ultrasound scan of the adrenal glands is performed.

They try to limit the use of hysterosalpingography, since this method creates an additional radiation load on the reproductive organs and the risk of an allergic reaction to the contrast medium.

The method of echo hysterosalpingoscopy is deprived of these shortcomings. This is an assessment of the patency of the tubes and the internal structure of the reproductive organs using ultrasound. Before examination, physiological saline in combination with furacilin, novocaine and distilled water is injected into the uterine cavity and tubes. This method also has a therapeutic effect, as it stimulates the movement of the cilia of the fallopian tubes and clears their lumen. In the first 2 months after such a study, pregnancy occurs in every 10th woman.

Second phase

This stage includes such types of diagnostics as and. Without endoscopy data, a diagnosis of infertility is considered unconfirmed.

All women with infertility undergo hysteroscopy with separate diagnostic curettage. It is carried out in the first half of the cycle, since at this time the thin endometrium does not hide the possible causes of uterine infertility:

• polyps;
• intrauterine fusion (synechia);
• malformations;
• submucous uterine fibroids;
• foreign bodies;
• chronic

Using hysteroscopy, surgery can also be performed by eliminating some of these conditions.

The final stage of diagnosis, while often being the first stage of treatment, is laparoscopy. This is an endoscopic procedure, it is performed under local anesthesia. During laparoscopy, the doctor can carefully examine the pelvic organs “outside” (from the side of the abdominal cavity) and perform quite a lot of medical procedures.

Laparoscopy is one of the types of infertility diagnostics.

Laparoscopy is performed in such cases:

• all women with a regular menstrual cycle, since in most of them the disease is associated with organic pathology of the pelvic organs;
• women under 35 years of age with tubal-peritoneal infertility and a disease duration of less than 5 years, for the purpose of treatment;
• patients with an unclear cause of the disease;
• with infertility caused by the syndrome and the ineffectiveness of drug treatment for six months, as this indicates the combined causes of the disease.

In conclusion, we say that the set of diagnostic tests in each case is individual. The examination is quite lengthy, often takes several months, as it is “tied” to the phases of the menstrual cycle. A careful determination of the causes of the disease will allow you to choose the optimal treatment tactics.

In no case can you demand the acceleration of the process or the exclusion of its important stages - so a couple can not only spend years figuring out the causes of infertility, but also lose partnership, trust with a doctor. It is necessary to form a survey plan together with the doctor and find out all the questions of interest.

Infertility is diagnosed after 12 months of unsuccessful attempts to get pregnant while having active sex life and the absence of contraception. According to statistics, 20% of couples face such a problem. But this diagnosis is not a sentence. In most cases, the situation is fixable. It is necessary to identify the cause of infertility as soon as possible and prescribe a treatment that will result in a long-awaited pregnancy and childbirth.

Infertility (lat. Sterilitas) - the inability of women and men to fertilize.

Infertility can be:

• absolute - the presence of a pathology that excludes the possibility of conception (in women - the absence of the uterus, ovaries; in men - the absence of sperm, testicles);
• relative - the presence of a cause that can be eliminated.

Also distinguish:

• primary infertility - the absence of conception in a couple leading an active sex life;
• secondary infertility - lack of conception after pregnancy.

The main causes of infertility include:

• hormonal imbalance;
• infectious diseases;
• irregular structure of the genitals;
• genital injuries;
• immunological problems;
• psychological problems.

Infertility Diagnostic Methods

In infertility, it is usually customary to blame a woman. But this is a profound error. According to studies, 40% of cases of infertility are diagnosed in women, 40% in men. The remaining 20% \u200b\u200bincludes combined and unexplained causes. Therefore, it is important to diagnose infertility in both women and men. Moreover, it is worth starting the examination with a man, because there are fewer factors affecting male infertility and this diagnosis is easier.

Diagnosis of infertility in men

Examination of men for infertility takes place in several stages. The main studies are assigned first. If after them the doctor has any questions, then additional ones are prescribed.

The main methods for diagnosing male infertility includes the following steps.

1. Consultation of an andrologist or reproductologist.

Poll. The past diseases, pregnancy in other partners, the characteristics of sexual life and the degree of influence of negative factors (harmful production, smoking, alcohol) are specified.

Inspection The severity of secondary sexual characteristics is determined, the scrotum is palpated.

1. Laboratory diagnosis of infertility.

Spermogram - the study of ejaculate. Preparation for the analysis is very important and begins a week before the study. Compliance with the diet, the exclusion of alcohol, sauna and bath, stress, lack of sexual intercourse for two days. If a man has a cold, the study should be postponed until complete recovery. The research procedure takes place in three stages: masturbation (in a room or house specially allocated in a medical institution), sampling, analysis. The ejaculate should get into the laboratory within an hour and must be in the process of transportation at room temperature. According to the results of a spermogram, the volume of ejaculate, the number of spermatozoa, their motility, morphology and several other indicators are estimated. If deviations from the norm are detected, the analysis is repeated 2 more times to eliminate errors or the influence of other factors.

Analysis of hormone levels. These are mainly follicle-stimulating hormone (FSH), testosterone, luteinizing hormone (LH) and prolactin. In the event of a deviation from the norm of these hormones, we can talk about endocrine disorders.

1. Ultrasound examination (ultrasound).

Ultrasound and dopplerometry of the scrotum. It is used to assess the structure and pathology of the testicles and their appendages.

TRUS (transrectal ultrasound) is performed to assess the condition of the prostate gland and seminal vesicles.

Additional diagnosis of infertility in men includes the following studies:

• genetic tests are prescribed for violations of maturation and sperm production or their absence;
• analysis for sexually transmitted diseases (STDs) is carried out with inflammation, combined with an abnormal spermogram;
• prostate secretion excludes or confirms inflammation of the prostate;
• determination of tumor markers is prescribed in case of suspected malignancy;
• an immunological test (MAR test) should detect the presence or absence of antisperm antibodies;
• testicular biopsy is indicated in the absence of sperm or a serious decrease in their number;
• examination of post-orgasmic urine is carried out in the absence of ejaculation or its small volume to exclude or confirm the reflux of sperm into the bladder.

Each of the additional methods for diagnosing the causes of infertility has serious indications for research and should be carried out by experienced specialists.

Diagnosis of infertility in women

Female infertility requires more serious research than male infertility. After all, the female body must not only form a high-quality egg, but also create special conditions for fertilization, gestation and the birth of a child.

As in the case of examination of male infertility, the diagnosis of female infertility is carried out in stages.

1. Consultation with a gynecologist or reproductologist.

Poll. The list of past diseases, operations (especially on the pelvic organs), genetic abnormalities in the genus, the presence of pregnancies, the characteristics of the sexual life and menstrual cycle, and the influence of harmful factors are being clarified.

Inspection First, the ratio of height and weight, the development of secondary sexual characteristics is assessed. Then, a gynecological examination of the vagina and cervix and a two-handed examination of the uterus and ovaries are performed.

1. Laboratory diagnostics.

Smear. Analysis of discharge from the cervical canal will show the presence of an inflammatory process or STD.

A blood test for hormones (FSH, LH, estrogens, progesterone and androgen), infections and increased coagulability.

1. Ultrasound diagnosis of the condition of the uterus and ovaries. Ultrasound is the most informative and reliable way to determine ovulation. In addition, you can assess the condition of the uterus and ovaries, observe the growth of the endometrium and determine the causes of menstrual irregularities.
2. Measurement of rectal temperature. This additional research method is carried out for 3 months and assesses the presence (37 ° C) or absence (<37°С) овуляции. Наблюдение и измерение женщина проводит самостоятельно.
3. Hysterosalpingography (GHA). This is a radiological examination aimed at diagnosing tubal infertility and assessing the condition of the uterus. This research method is carried out on the 5-7th day of the cycle by introducing a contrast agent into the uterus and evaluating its movement through the fallopian tubes. This method is not always informative in assessing the patency of the fallopian tubes, because the patient experiences discomfort, which may affect the result. This method is more suitable for identifying uterine pathologies. And the most reliable way to assess the patency of the fallopian tubes is laparoscopy.
4. Laparoscopy. This type of study is carried out under general anesthesia with a special apparatus through small holes in the abdominal cavity. The undoubted advantage of this study is not only its high information content, but also the ability to correct the revealed violations (restoration of the function of the fallopian tubes, removal of myomas and ovarian formations).
5. Hysteroscopy. This method of endoscopic examination of the uterus not only assesses its condition, but also allows the treatment of almost any uterine pathology.
6. Tomography of the skull and the Turkish saddle are prescribed for suspected endocrine infertility.
7. Spiral computed tomography of the pelvic organs is prescribed to clarify the pathologies of the internal genital organs.

Partner Compatibility Diagnostics

There are cases when conception does not occur due to incompatibility of partners. There are several methods for diagnosing such cases of infertility.

• Karyotyping is a study of the genetic compatibility of partners. The material for analysis is blood from a vein.
• HLA typing - an assessment of immunological compatibility. The more antigens that react aggressively to foreign cells, the less chance of pregnancy.
• Kurzrock-Miller test. This diagnostic method explores the interaction of male and female germ cells. The specialist puts cervical fluid and sperm in one tube and monitors the behavior of the cells.
• Sample Shuvarsky. This method is similar to the previous one, but the combination of cervical fluid and sperm occurs in vivo. A woman submits this analysis no more than 6 hours after sexual intercourse.

There are many reasons why there are problems with conception. Conducting timely diagnosis and prescribing infertility treatment in most cases can eliminate them. The main thing is to conduct a comprehensive study of both men and women. As a result, even already desperate couples are highly likely to become happy parents of the long-awaited child.

After a woman visits the clinic, a number of necessary tests are required.

Lab tests

An infertility test in women is a set of laboratory tests and diagnostic procedures aimed at identifying the causes of infertility. At the first visit to the doctor, a medical history is collected and a thorough examination of the patient is performed. At this stage of the examination, the specialist assesses the condition of the woman's reproductive organs for erosion and inflammatory processes. Further activities are related to instrumental and laboratory methods.

• Blood analysis. The study of clinical and biochemical blood parameters is necessary to determine the general state of health. In the patient’s blood, the amount of total protein, bilirubin, ALT, AST, creatinine, urea and glucose is determined. Blood is also examined for infections and viruses: syphilis, hepatitis, HIV. To exclude the endocrine cause of infertility, hormone levels are tested: prolactin, AMH, FSH, LH, progesterone, TSH, 17-OPK, testosterone and others. A study on hormones must be carried out on the 2nd-5th day from the beginning of menstruation. Separately, blood is donated to determine the group and Rh factor.
• Urinalysis - is prescribed to determine the functional function of the kidneys.
•   . Very often it is not possible to get pregnant due to the presence of infections in the woman's body. The defeat of the mucous membrane of the cervix and uterine cavity of an infectious nature creates unfavorable conditions for the development of pregnancy. For their identification and subsequent treatment or elimination of this problem, several tests are prescribed. Most often, with such tests, diseases that are initially asymptomatic are detected: gonorrhea, herpes virus, chlamydia, trichomoniasis, ureaplasmosis. In addition to a blood test, smears from the vagina and cervical canal are taken.
• Postcoital analysis - determination of sperm count and motility in cervical mucus of the cervix. This important study shows the ability of the sperm to interact with the egg. For fertilization to occur, conditions are needed for sperm to penetrate the cervical mucus. It is best to conduct a test in the periovulatory period of the cycle, before the examination, the presence of genital infections should be excluded. We recommend.

After laboratory tests, a woman is prescribed instrumental studies.

Instrumental research

These tests are carried out using specialized equipment and can confirm the alleged diagnosis.

   one. . The method allows you to visually determine the cause of infertility, which can be neoplasms of the reproductive organs. Using ultrasound, you can find out:

• condition of the cervix;
• size and condition of the uterus;
• ovarian condition;
• structure and condition of the endometrium;
• condition of the fallopian tubes.

During the examination, it is possible to identify polyps, cysts that interfere with pregnancy. In addition to neoplasms, ultrasound helps to diagnose hydrosalpinx - the presence of fluid in the fallopian tubes. The elimination of these pathologies is a step towards the treatment of infertility. The study is best done in phase I of the cycle.

   2. - the method of ultrasonic testing of the endometrium and patency of the fallopian tubes with physiological saline. It is carried out on the 6-14th days of the cycle (can be carried out on any day, but in the second phase of the cycle, the presence of an already completed pregnancy cannot be ruled out).

   3. - a picture of the pelvis and using contrast, displaying the uterus from the inside, as well as capturing the fallopian tubes. Gives information about the condition of the endometrium, tubes and their patency. Often it makes it possible to judge the presence of an adhesion process in the small pelvis. It can be carried out on any day, except for the days of menstruation (pregnancy on this cycle is better not to plan).

   4. - This is the most accurate and fastest method for studying the condition of the pelvic organs and the causes of infertility. Allows you to visually inspect the pelvic organs, check the patency of the pipes, dissect adhesions. It is carried out under general anesthesia and does not require a long hospital stay. Before giving consent to the operation, we recommend that you consult a reproductologist, especially in cases when childbirth is planned in the future. It is carried out in the first phase of the menstrual cycle.

5.: visual inspection of the uterine cavity and taking a sample of the uterine mucosa (endometrium) for histological examination in order to identify pathology. It allows you to most reliably detect changes in the uterine cavity and cervical canal and conduct targeted histological diagnosis. Before the procedure, it is required to abandon sexual contacts and vaginal preparations. It is carried out in the first phase of the menstrual cycle, after the end of menstruation and up to the 10th day.

A complete list of tests for IVF is available.

Analyzes for infertility in women in our clinic are carried out as soon as possible and are accompanied by the necessary expert advice. After identifying the cause, on the basis of the test results obtained, a diagnosis is made and treatment is prescribed.

Name of service	Cost
Initial consultation of a gynecologist-reproductologist	3 000 rubles
Initial consultation of a gynecologist-reproductologist with ultrasound	3 900 rubles
Repeated consultation of a gynecologist-reproductologist	1 300 rubles
Repeated consultation of a gynecologist-reproductologist with ultrasound	2,200 rubles
Initial consultation of an obstetrician-gynecologist	2,400 rubles
Repeated consultation of the obstetrician-gynecologist	1 900 rubles
Pelvic ultrasound	1,500 rubles
Ultrasound of the abdomen	2 100 rubles
Ultrasound of the prostate and bladder	1,600 rubles
Ultrasound of the kidneys and bladder	1 800 rubles
Ultrasound of the kidneys, prostate and bladder	2 000 rubles
Thyroid ultrasound	1,600 rubles
Breast ultrasound	1 800 rubles
Ultrasound of the lymph nodes	1 250 rubles
Colposcopy	1 400 rubles
Office hysteroscopy	17 500 rubles
Diagnostic hysteroscopy (without the cost of histological examination)	19 500 rubles
Surgical hysteroscopy (without the cost of anesthesia and histological examination)	24 500 rubles

Infertility is diagnosed to a woman with her inability to become pregnant after a year of unprotected sexual intercourse.

According to statistics, more than 10% of couples in the whole world suffer from infertility, while both men and women are affected by this disease. According to official information from the Centers for Disease Control and Prevention, 1/3 of diagnoses are associated with female infertility, 1/3 with male infertility, and the remaining cases of infertility are due to joint factors from both partners. The exact figure is difficult to determine, but in percentage terms it is approximately 20% of pairs.

The effect of age onability to conceive

All women are born with a certain number of eggs. Thus, as a result of the reproductive process, the number and quality of eggs will decrease. Consequently, the probability of having a baby is reduced by 3% to 5% per year after the age of 30. It should be understood that a special decrease in fertility is observed to a much greater extent after the age of 40 years.

Symptoms of infertility in women

The main symptom of infertility is the couple’s inability to become pregnant. There are a number of factors, two of which are the most important:

1. The menstrual cycle: either too long (35 days or more), or too short (less than 21 days).

2. Irregular or absent menstruation as one of the signs of a lack of ovulation.

When to see a doctor about infertility

When to seek help depends, in particular, on your age. If you are under the age of 30, most doctors recommend trying to get pregnant for a year before testing or treatment begins. If your age is between 35 and 40 years old, you should discuss your problems with your doctor after six months of trying. If you are older than 40 years, then treatment should be started immediately.

Causes of Female Infertility

Female infertility can be caused by several factors:

Damage to the uterine (fallopian) tubes through which the oocytes pass from the ovaries to the uterus can prevent contact between the ovum and the sperm. Pelvic infections, endometriosis, and pelvic surgery can lead to scarring and damage to the fallopian tubes. Hormonal reasons due to which some women have problems with ovulation. Synchronous hormonal changes leading to the exit of the egg from the ovary, as well as a thickening of the endometrium (uterine mucosa) - lead to the fact that fertilization of the egg does not occur. These problems can be detected using basal body temperature charts, a blood test to detect hormone levels. A small group of women may have a cervical structure in which sperm cannot pass through its channel.

This problem is usually solved with a preliminary examination and a small surgical procedure. In about 20% of couples, the cause of infertility cannot be determined even using modern research methods.

Diagnostic tests are also common: hysterosalpingography and laparoscopy, which may be useful in detecting scar tissue and uterine obstruction.

The main factors causing female infertility

- Disorders of ovulation.   Ovulation disorders, in which ovulation occurs extremely rarely or does not occur at all, account for 25% of infertile couples. This may be due to deficiencies in the regulation of the sex hormones of the hypothalamus or pituitary gland or problems in the ovaries themselves.

- Polycystic Ovary Syndrome (PCOS).   In PCOS, complex changes occur in the hypothalamus, pituitary, and ovaries, which leads to hormonal imbalances that affect ovulation. PCOS is associated with insulin resistance, obesity, abnormal hair growth on the face and body. Today it is the most common cause of female infertility in the world.

- Dysfunction of the hypothalamus.   Two hormones responsible for stimulating ovulation every month - follicle-stimulating hormone (FSH) and luteinizing hormone (LH) - are produced by the pituitary gland in a certain pattern during the menstrual cycle. An increase in physical or emotional stress, a significant increase or loss in body weight, can disrupt the balance in the production of hormones and affect ovulation. The main symptom of this problem is irregular or absent menstruation.

- Premature ovarian failure.   This disorder is usually caused by an autoimmune reaction when your body mistakenly attacks the ovarian tissue or if the eggs are prematurely lost due to genetic problems or environmental influences such as chemotherapy. This leads to a loss of the ability to produce eggs in the ovary, as well as to a decrease in the production of estrogen under the age of 40 years.

- Excess prolactin.   Rarely, there are cases when the pituitary gland can cause excessive prolactin production (hyperprolactinemia), which reduces estrogen production and can cause infertility. Most often, this is due to problems in the pituitary gland, but it can also be associated with medications that you took in connection with any disease.

- Damage to the fallopian tubes (tubal infertility).   If the fallopian tubes are damaged or blocked, sperm cannot penetrate the egg and contribute to its fertilization. Causes of blockage or damage to the fallopian tubes may include:

Inflammatory diseases of the pelvic organs, infections of the uterus or fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections.
   - Previous surgery in the abdominal or pelvic area, including surgery related to an ectopic pregnancy.
- Pelvic tuberculosis, the leading cause of tubal infertility worldwide.

- Endometriosis.   Endometriosis occurs when tissue, which usually develops in the uterus, begins to grow elsewhere. This additional tissue growth and its subsequent surgical removal can lead to scarring, which can disrupt the elasticity of the fallopian tube, thereby making fertilization difficult. It can also affect the mucous membrane of the uterus, disrupting the development of a fertilized egg.

- Cervical fibroids.   Uterine fibroids are a benign tumor of the muscle layer of the uterus. The development of fibroids, as a rule, occurs rather slowly: for one reason that has not yet been studied, one muscle cell begins to divide, creating tumor muscle cells that form the node - myoma, which increases the likelihood of miscarriage.

- Changes and abnormalities of the cervix.Benign polyps or tumors common in the uterus can also affect fertilization by blocking the fallopian tubes or disrupting the process of sperm penetration. However, many women with fibroids or polyps can become pregnant.

- Inexplicable infertility.   In some cases, the causes of infertility are simply impossible to establish. There is a possibility that this is due to a combination of several minor factors of both partners. But at the same time, it is possible that this problem can eventually be solved by itself.

Female Infertility Risk Factors

Consider some of the factors contributing to a high risk of infertility:

- Age.   With increasing age, the quality and quantity of female eggs begins to decline. Approximately 35 years of age, the rate of loss of follicles is accelerated, as a result of which the quality of the egg cells is reduced and worsened, and conception is more difficult with an increased risk of miscarriage.

- smoking.   In addition to damage to the cervix and fallopian tubes, smoking increases the risk of miscarriage and ectopic pregnancy. As a result, the ovaries prematurely deplete, losing their eggs, thereby reducing your ability to become pregnant. That is why it is very important to quit smoking before starting infertility treatment.

- The weight.   If you are overweight or, conversely, underweight, this can also interfere with normal ovulation. It is necessary to achieve a healthy body mass index (BMI) to increase the frequency of ovulation and increase the likelihood of pregnancy.

- Sex story. Sexually transmitted infections such as chlamydia and gonorrhea can certainly cause damage to the fallopian tubes and fallopian tube. Having unprotected intercourse with multiple partners increases your chances of contracting sexually transmitted diseases, which can later lead to fertility problems.

- Alcohol.   Excessive alcohol consumption is directly associated with an increased risk of ovulation disorders and endometriosis.

Planning a visit to the doctor

In order to identify and assess the degree of infertility, it is necessary to undergo a comprehensive examination by a doctor - an endocrinologist specializing in reproductive diseases that prevent couples from conceiving. Your doctor will likely want you and your partner to determine in advance the possible causes of infertility. Here are the most common examples of questions for which you need to prepare answers in advance:

Schedule menstrual cycles and their symptoms for several months. On the calendar, mark when your period begins and ends, and also write down the days when you and your partner had sex.

Make a list of medicines, vitamins, herbs, or other supplements you are taking. Include doses and frequency of administration.

Bring previous medical notes. Your doctor will want to know what tests you had and what treatment methods you have already tried.

Think about the most important questions you want to ask.

   Here are some basic questions you can ask your doctor:

When and how often should we have sexual intercourse if we want to conceive?
   - What changes in lifestyle can we make to improve the chances of getting pregnant?
   - What medicines can be purchased to improve the ability to conceive?
   - What side effects can the prescribed drugs cause?
   - What treatment do you recommend in our situation?
   - What is your level of success in helping couples achieve pregnancy?
   - Do you have brochures or other printed materials that you can provide to us?
   - What sites do you recommend visiting?

Feel free to ask your doctor to repeat the information or ask additional questions.

Some potential questions your doctor may ask are:

How long have you been trying to get pregnant?
   - How often do you have sex?
   “Have you never been pregnant before?” If so, what was the result of this pregnancy?
   - Have you had pelvic or abdominal surgery?
- Have you been treated for any gynecological diseases?
   - At what age did menstruation first begin?
   - On average, how many days pass between the beginning of one menstrual cycle before the next?
   - Have you encountered premenstrual symptoms such as chest pain, bloating or cramps?

Diagnosis of female infertility

The standard birth rate includes physical, medical, and sexual histories of both partners. Men take a sperm test that measures the number and movement of sperm. Look at the percentage of active sperm and their level of movement. Often, it is not possible to determine the specific cause of the disorder. But there is a theory that a very low sperm count may be related to genetics - anomalies in the Y chromosome.

The first thing that a doctor checks for women is whether ovulation occurs. This can be determined using a blood test that detects and shows the level of female hormones, ovarian ultrasound, or an ovulation test kit that is used at home. You should also pay attention to the menstrual cycle, since an irregular cycle can become the main cause of non-occurrence of ovulation.

- Ovulation test.An ovulation test that detects a burst of luteinizing hormone (LH) that occurs before ovulation can be done at home without any problems. If you have not received positive results, you must pass a blood test for progesterone - a hormone produced after ovulation, and document the onset of ovulation. Other hormone levels, such as prolactin, can also be confirmed by a blood test.

- testing ovarian reserve.   This test helps determine the quality and number of eggs available for ovulation. As a rule, this study is conducted by women with a risk of egg loss, including women older than 35 years.

- Research on the level of hormones.   Other hormone tests will determine the levels of ovulatory hormones, as well as thyroid hormones and pituitary hormones that control reproductive processes.

- Visual tests.   An ultrasound of the pelvic organs examines the cervix in detail or shows a fallopian tube disease. It is often used to see details inside the uterus that are not displayed on regular ultrasound.

- Laparoscopy. This minimally invasive surgery is a small incision under the navel into which a thin catheter is inserted with a device to examine your fallopian tubes, ovaries and uterus. Laparoscopy can determine endometriosis, scarring, obstruction of the fallopian tubes, as well as problems with the ovaries and uterus. During this procedure, a laparoscope (a thin tube equipped with a fiber optic camera) is inserted into the abdominal cavity through a small incision near the navel. A laparoscope allows the doctor to examine outside the uterus, ovaries and fallopian tubes to detect neoplasms, as with endometriosis. Your doctor may also check if the fallopian tubes are open.

- Genetic testing.   Genetic testing helps determine if there is a genetic defect in the chromosomes that has led to infertility.

- Hysterosalpingography.   This procedure involves an ultrasound or X-ray of the reproductive organs, in which a dye or saline solution is injected into the cervix through the fallopian tubes. This allows you to identify whether the fallopian tubes are open or not.

Female infertility treatment

Female infertility can be treated in several ways, including:

- Laparoscopy.   Women who have been diagnosed with tubal or pelvic diseases or ill defects can undergo surgery to restore their reproductive organs or try to conceive through in vitro fertilization (IVF). Using a laparoscope inserted through an incision in the navel will allow you to remove scar tissue, ovarian cysts, and also restore patency of the fallopian tubes.

The hysteroscope is placed in the uterus through the cervix and is used to remove polyps, fibrotic tumors, scar tissue, and also helps to open blocked fallopian tubes.

- Drug therapy.   Women suffering from ovulation problems may be prescribed medications such as Clompiphene (Clomid, Serophene) or gonadotropins (e.g. Gondal F, Follistim, Humegon and Pregnyl), which can lead to ovulation.
   Metformin (Glucophage) is another type of medication that helps restore or normalize ovulation in women who have insulin resistance and / or polycystic ovary syndrome.

Intrauterine insemination refers to a procedure during which sperm is taken from a partner during maturation, washed with a special solution to isolate healthy, non-defective spermatozoa, and then placed in the uterus during ovulation. Sperm is inserted through the cervix using a thin plastic catheter. This procedure can be carried out in combination with the previously listed drugs that stimulate ovulation.

- In vitro fertilization (IVF).   IVF refers to a method in which the resulting embryo is kept in an incubator, where it develops within 2-5 days, after which the embryo is then introduced into the uterus for further development.

After monitoring, confirming the maturation of the eggs, they are collected using a vaginal ultrasound probe. Sperm cells are also harvested, washed and added to the eggs in vitro (in vitro) conditions. A few days later, embryos, or fertilized eggs, return to the uterus using an intrauterine catheter.

Any additional eggs or embryos can be frozen for future use with the consent of the spouses.

ICSI. Intracytoplasmic sperm injection is also used for problems associated with a lack of fertilization. This is a method in which a pre-selected viable sperm under a microscope is introduced into the egg “manually” using special microsurgical instruments. With ICSI, only one sperm is required for each mature egg.

- Egg donation.   Egg donation can help women who do not have normally functioning ovaries, but who also have a healthy uterus to achieve pregnancy. Egg donation involves taking oocytes, also called oocytes, from the ovary of a donor who underwent ovarian stimulation using special hormonal drugs. The donor's eggs are placed with the partner's sperm for in vitro fertilization, after which the fertilized eggs are transferred to the uterus of the recipient.

Drug therapy and artificial insemination can increase the likelihood of a long-awaited pregnancy in women with a diagnosis of infertility of unknown origin.

The risks of using drugs to treat women with infertility

The use of drugs for the treatment of infertility may carry some risks, such as:

Multiple pregnancy. Oral drugs carry a relatively low risk for a singleton pregnancy (less than 10 percent), mainly an increase in the risk relates to bearing twins. Injection drugs carry the greatest risk for conceiving twins, triplets or more (multiple pregnancy of the highest order). Therefore, the more fruits you carry, the greater the risk of premature birth, low birth weight and problems associated with late development.

Ovarian hyperstimulation syndrome.   Using injectable drugs to enhance yovulation can lead to ovarian hyperstimulation syndrome, in which your ovaries can swell and cause pain. Signs and symptoms usually last a week and include: abdominal pain, bloating, nausea, vomiting, and diarrhea. If you manage to become pregnant, these symptoms can last up to several weeks.

Long-term risks of developing ovarian tumors.   Most studies have shown that women using drugs for pregnancy have long-term risks. However, some studies show that women taking hormonal drugs for 12 months or more without a successful pregnancy may have an increased risk of developing borderline ovarian tumors in later life. Like women who have never had a pregnancy, they are at increased risk for ovarian tumors, so this may be due to the underlying problem rather than treatment.

Surgicalfemale infertility treatment

Some surgical procedures can correct problems or significantly improve female fertility. Consider the main ones:

Laparoscopic or hysteroscopic surgery.   During the operation, you can remove or correct violations that reduce the chances of pregnancy. Using this method, you can correct the shape of the uterus, remove the effects of endometriosis and some types of fibroids. This will certainly improve your chances of achieving pregnancy. If a woman previously had a ligation of the fallopian tubes for permanent contraception, the operation will help restore her ability to conceive. Your doctor may determine if you are a good candidate for this, or if you need to resort to in vitro fertilization (IVF).

Emotional support

The process of treating female infertility can be physically and emotionally exhausting. To cope with the ups and downs of mood, multiple tests and the treatment process itself, doctors unanimously say to their patients: “Be prepared.”

Maximum information.   Ask your doctor to explain in detail the steps of the therapy you have chosen, so that you and your partner can be as prepared as possible for each of them. Understanding the process will help reduce your anxiety.

Support for loved ones.   Although infertility is a deeply personal matter, contact your partner, close family members, or friends for support. Today there are online support groups that will allow you to remain anonymous while you discuss issues related to infertility. Feel free to seek professional help if your emotional burden becomes too heavy for you or your partner.

   Moderate training and a healthy diet will help improve your appearance and keep you toned despite fertility problems.

Prevention of infertility in women

If you plan to become pregnant in the near future, in the future, you can improve your chances of normal fertility if you follow several important recommendations:

Maintain a normal weight.   Women, both overweight and underweight, are at an increased risk of ovulation disorders. If you need to lose weight, exercise it sparingly. Intense, intense exercise over seven hours a week, studies have shown, are associated with reduced ovulation.

Stop smoking.   Tobacco has a negative effect on fertility, not to mention your general health and the health of the unborn baby. If you smoke and plan a pregnancy, then it's time to give up this addiction right now.

Avoid drinking alcohol.   Alcohol abuse can lead to decreased fertility. Any use of alcohol can affect the health of the developing fetus. If you plan to become pregnant, avoid alcohol and do not drink alcohol during pregnancy.

Stress reduction.   Some studies have shown that couples experiencing psychological stress had worse results during infertility treatment. If you can, find a way to reduce stress in your life before trying to get pregnant.

Limit caffeine.   Some doctors suggest limiting caffeine intake to less than 200 to 300 milligrams per day.