Statistics call horrendous figures: in Russia, every sixth married couple is infertile. And for most spouses, the absence of children is a real grief. Father Sergiy Filimonov, a priest and doctor, shares his experience and knowledge with the site's readers: what are the causes of infertility, how to overcome them, and how to treat infertility as a curse or an opportunity to realize oneself in another capacity?

arch. Sergiy Filimonov

Chapter 1. Medical causes of infertility in marriage

(gynecologist-endocrinologist Yu. Yu. Toropkova)

Infertility in marriage is one of the most important and complex medical and social problems. The proportion of infertile marriages in Russia ranges from 8 to 17.5% and currently does not tend to decrease. There are regions (mainly metropolitan areas) where this figure reaches 24-29%, while the level of 15% poses a serious threat to demographics.

In other words, every 6-7 pairs of Russians (that is, about 7 million) during their reproductive period (15-49 years) encounter the problem of infertility.

So, a marriage is considered infertile, in which, for one reason or another, occurring in the body of a woman or a man, or both spouses, pregnancy does not occur with regular sexual activity without the use of any contraceptives within 12 months. subject to the childbearing age of the spouses.

It is customary to distinguish: primary and secondary infertility, female and male. Primary infertility in women is called infertility, in which pregnancy has not occurred even once from the onset of sexual activity without protection; secondary - pregnancy occurred in the past, but after that there is no regular sexual life for 1 year without the use of contraceptives.

The frequency of female infertility ranges from 40 to 50%, while there are 3 main groups of causes:

Endocrine (35–40%). Endocrine forms of infertility are always associated with a violation of the ovulation process (maturation and release of the egg from the ovary) and are often accompanied by menstrual dysfunction;
Tube-perinatal (30-74%). The most frequent, most studied and most difficult form of infertility to correct. In this group of patients, there are anatomical and functional disorders of the fallopian tubes, when it is difficult (or impossible) to move the egg to the place of its attachment (implantation) into the uterine cavity. Such conditions are not uncommon after suffering inflammatory diseases of the pelvic organs, abortions, and other intrauterine interventions, operations, incl. and gynecological, after which the risk of adhesions in the pelvis increases.
Gynecological diseases (1.5–28%). Most often, the main cause in this group is genital endometriosis - a serious disease that requires long-term and persistent treatment.
There are also: absolute female infertility, when the possibility of pregnancy is completely excluded (absence of the uterus, ovaries, anomalies in the development of the genital organs), and the so-called unexplained infertility (4.8–7.6%), the cause of which cannot be established by currently used research methods. succeeds.

The term "relative infertility" is used when a woman and a man are able to have children separately outside of marriage, but with a long life together, their marriage is infertile. In recent years, more and more attention has been paid to the problem male infertility, the frequency of which in infertile marriages also reaches 40-50%, and in combination with infertility in the wife - 1520%.

Male infertility is the inability of the germ cells of a mature male body to fertilize. Distinguish between secretory (associated with a violation of the process of spermatogenesis) and excretory (occurring in violation of sperm excretion) infertility.

Due to the fact that the frequency of female and male factors of infertility is the same, and every fourth married couple has a combination of several factors, the examination almost always begins with a joint conversation with the couple to exclude psycho-sexual and iatrogenic causes and assess the state of somatic health of both spouses. Working with a married couple allows you to outline a general examination plan and a sequence of diagnostic procedures. In the future, the examination is carried out by a gynecologist and an andrologist in parallel.

In clinical practice, the examination of infertile couples always begins with men. If, according to the results of the study of sperm (spermogram), no pathology was detected, then other studies in men are not carried out; if problems are found, it is shown full examination and treatment with the participation, often, of many specialists: a urologist, an endocrinologist, a surgeon, an andrologist, and sometimes a sexologist. Infertility in men occurs as a result of various pathological processes in the body that have a negative impact on internal organs, endocrine glands, central nervous system. It is impossible not to take into account the increase in the prevalence of anomalies in the development of the genital organs and the frequency of infectious and inflammatory diseases, the influence of harmful factors environment, urbanization, widespread and uncontrolled use of drugs, allergization of the population.

Therefore, the most justified in the treatment of male infertility is an examination in large specialized centers with the participation of several specialists and the conduct of a comprehensive, staged, individually selected therapy, where each stage is sequential, clearly limited in time and aimed at performing a specific task.

For women, the most important and diagnostic meaningful methods examinations are the evaluation of ovulation and tubal patency. To do this, the doctor of the center can conduct a number of studies, for example:

assessment of blood for hormonal profile. Determine the level of 6-7 hormones in blood plasma taken on a specific day of the menstrual cycle; sometimes hormonal tests are performed;
ultrasound monitoring of ovulation. This method allows you to directly observe the growth of the follicle in the egg of the woman's ovary and the degree of readiness of the internal mucous membrane of the uterus to receive a fertilized egg;
checking the patency and characterization of the internal lumen of the fallopian tubes using an x-ray or ultrasound method.
In some cases, to identify the causes of infertility, ultrasound of the thyroid and mammary glands, X-ray or computer examination of the skull, consultations of doctors of related specialties, and even medical genetic counseling may be required.

At present, at the final stage of the survey with female infertility endoscopic diagnostic methods are carried out: laparoscopy and (or) hysteroscopy. Without the use of these methods, the cause of infertility in marriage is considered unidentified. In addition, laparoscopy is not only final stage diagnosis, but also the first stage of treatment of female infertility.

Endoscopic technologies make it possible to carry out low-traumatic microsurgical correction of the identified changes in the pelvic organs - separation of adhesions, restoration of patency of the fallopian tubes, coagulation of endometriosis foci, removal of ovarian neoplasms, surgical treatment of certain diseases of the uterus - without subsequent pronounced adhesions.

In conclusion, it should be noted that a consistent assessment of all parts of the complex reproductive system of a man and a woman is a necessary condition for making the correct diagnosis, while the set of diagnostic techniques depends on clinical picture a specific disease and is strictly individual for each couple. If it is impossible to timely and quickly conduct a complete clinical and laboratory examination, it is necessary to send the couple to a specialized medical institution in time for the final diagnosis, remembering that delaying the examination reduces the hopes for success in restoring reproductive function.

In our region, 5 large centers deal with infertility issues:

Russian-Finnish clinic "Ava-Peter" (Nevsky prospect, 22-24, t. 325-92-72, 312-30-65),
clinic of reproductive medicine at the Institute of Obstetrics and Gynecology. BEFORE. Ott;
clinic "Avicenna" in Pushkin;
center for the treatment of infertility at the Military Medical Academy;
center for the treatment of infertility at the Military Medical Academy in the Sestroretsk district of the mountains. St. Petersburg.
In addition, many antenatal clinics have offices of a gynecologist-endocrinologist.

Chapter 2. Infertility - Medical and Spiritual Causes

Father Sergiy, please tell us about the causes of infertility.

There are medical and spiritual causes of infertility. If speak about medical reasons ah, there are about 30 diseases in which infertility is possible. Various medical centers and institutions advise people about the problem of childlessness. Spouses pass the appropriate medical tests, the results of which determine which side of the couple is the reason that a child cannot be born in the family. When it is found out which side is weak in relation to the birth of children, then examine the comfort of the spouse with "low opportunities" for childbearing for various diseases, especially chronic diseases of the genital area, which may be an obstacle to normal childbearing. Specialists who treat infertility in men are andrologists, urologists, and in women - gynecologists.

After an appropriate examination, treatment is carried out - conservative or surgical, if necessary. For example, with adhesive processes in the fallopian tubes or with poor patency, it is possible to improve the latter both by conservative methods and with the help of surgical methods- removal of adhesions in the fallopian tubes in certain time when childbearing is at its maximum. That is, the doctor's painstaking work with each married couple is required.

There is a lot of talk in the media about the methods artificial insemination. Is it possible to resort to them if the treatment is ineffective?

There are various methods of artificial insemination. According to our church canons, according to the materials of the Jubilee Bishops' Council of the Russian Orthodox Church in 2000, they are not permissible. The only acceptable technique is the so-called "method of natural insemination", in which the husband's seed, sex learned during marital relationships, is introduced by a doctor into the area of ​​\u200b\u200bthe mouth of the uterus. Thus, the fertilization of the egg occurs after the natural relationship between husband and wife, in addition, with this method, the integrity of the family union is not violated, since only the sex cells of both spouses are used. In the case when a third party interferes in the process of childbearing, for example, if a donor's seed is used for artificial insemination, an element of sinfulness is introduced ... Outwardly, it would seem that there is no fact of treason, however, an alien element is introduced into the family. This is tantamount to a woman entering into an illegal marital relationship with an outsider for the sake of having a child. Although there is no physical component of sinful relationships here, at the same time, the genetic material of a stranger is introduced into the egg of a woman, i.e., sexual intercourse is obtained with the help of medical technology. There are a number of techniques for this type of artificial insemination where a third party intervenes. Some of them use donor egg a strange woman who, after being fertilized by her husband's semen, is implanted in the uterus. Such techniques are also unacceptable, since in this case a foreign element invades the family. There is even such a psychological phenomenon when a woman who has been implanted with such an egg feels something alien in her body, unusual for her.

Please tell us about the method of in vitro fertilization. How should an Orthodox person treat him?

Methods of in vitro fertilization are not blessed by the church, since it also uses genetically alien material, that is, there is a violation of the integrity of the family and marital union. In addition, the donor semen used in these methods is obtained artificially, and not as a result of natural marital relations. It is also important that when using in vitro fertilization there is no physical connection men and women, so the secret of childbearing is taken out of human body. There is no act of giving spouses to each other, necessary for the birth of a new life. Life is born in a test tube. What happens at this moment with the embryo outside the mother's body, what physical diseases it will be subject to, how the fallen spirits affect it - this is a big question. One of the serious problems of in vitro fertilization is that in a number of centers, when implementing this technique, so-called extra fertilized cells are produced, which are already new life. These cells are reduced, that is, they are killed. This means that if four eggs were fertilized, and the woman wants only one child, she will be planted with only one egg inlet. What to do with the other three embryos? They can be frozen or reduced. Thus, a child is born through the simultaneous killing of two or three unborn brothers and sisters. The life of one at the expense of the death of another is considered unacceptable by the church. Therefore, all types of in vitro fertilization are not blessed by the Church. This is confirmed in the materials of the Jubilee Bishops' Council of the Russian Orthodox Church in 2000, in Chapter 12 "Problems of Bioethics". There, the issues of various kinds of overcoming infertility are considered in sufficient detail, it is told how spouses should act if they do not have children.

What causes of a spiritual nature can lead to infertility?

There can be many reasons. I will try to list the main ones. I will rely on the writings of Elder Paisios Svyatogorets, who in Volume 4, entitled “Family Life”, answers questions about the birth of children, the difficulties of childbearing and the problem of infertility. To the question why some women develop infertility, Elder Paisios answers as follows: “Some barren women did not marry when it was necessary to do so, and therefore now spiritual laws apply to them. Some fastidious girls start choosing suitors: “No, I don’t like this one, but I don’t like that one.” Having promised a guy to marry him, such a girl simultaneously looks at the other, then says “no” to the first, and he wants to commit suicide, instead of considering it a blessing that she deceived him even, at least before they got married, not after. Uh, well, what kind of family will such a girl create? And there are women who are barren because in their youth they lived a disorderly sinful life. There are also those whose reason for infertility is poor nutrition, because many products contain a whole bunch of chemicals and hormones.

Regarding girls who are promiscuous, it can be noted that in such cases there are two components that can lead to infertility - medical and spiritual. Women with such a lifestyle are very likely to develop various infections that can lead to various chronic diseases sexual sphere, which entails the inability to bear children. The spiritual component lies in the fact that the Lord can allow such a girl to be punished for her desire to “work up” (that is, to satisfy her lust as much as possible) and not give children for such a depraved life.

The next reason noted by Elder Paisius: “There are also married couples who want to have a child as soon as they get married. And if the birth of a child is delayed, then they begin to worry and worry. How can they give birth to a child if they themselves are full of anxiety and mental anxiety? They will give birth to a child when they cast out anxiety and mental anxiety and direct their lives on the right spiritual track.

Sometimes God deliberately delays and does not give any married couple children. Look: after all, He gave the Holy Fathers of God Joachim and Anna, and the Holy Prophet Zechariah and Elizabeth a child in old age in order to fulfill His eternal plan for the salvation of people.

Spouses should always be ready to accept the will of God into their lives. God does not leave a person who trusts himself to Him. We do nothing but how much God does for us! With what love and generosity He gives us everything! Is there anything that God will not be able to do? ...

The birth of children depends not only on the person. It also depends on God. Seeing that spouses who are experiencing difficulties in connection with the birth of children have humility, God can not only give them a child, but also make them have many children. However, seeing spouses as stubborn and selfish [God does not fulfill their desires, because] by fulfilling their petition for the birth of children, He will satisfy their stubbornness and selfishness. Married couples must give themselves wholly to God. They should say: "My God, You care about our good," Thy will be done () ". In this case, their request will be fulfilled. After all, the will of God is fulfilled when we say “Thy will be done” and with trust in God we entrust ourselves to Him. But we, although we say "Thy will be done," at the same time insist on our own will. So what can God do for us in this case?”

The next reason for infertility can also be the egoism of parents, but manifested in the opposite way, when a young family delays the birth of a child, arguing that children are a concern, and that you first need to finish your studies, get on your feet, earn money for an apartment, build a summer house, buy a car, and now then it will be possible to have a child (not “God will give a child”, but “we will have”, like a cat or a dog). When the Lord sees such an attitude towards the blessing of God for childbearing, neglect of the commandment “Be fruitful and multiply”, then after a certain period of time, when the family already has everything - an apartment, a car, and a job, He does not give children. And apart from cats and dogs, such a family cannot have anything. Although there are no medical barriers to this.

Elder Paisius identifies two more possible causes of infertility. “God does not give children to many people, so that, having loved the children of the whole world as their own, these people helped their spiritual rebirth.” Elder Paisius gives the following example: “One man did not have children, but when he left the house, children from neighboring houses ran to him and surrounded him with love. They didn't let him go to work. You see: God did not give this man his children, but He gave him a blessing so that all the neighbor's children would love him like a father, and he would help them spiritually. The judgments of God are the abyss."

"And in other cases, God does not give spouses children to build some orphan." Elder Paisius tells about one of his Christian acquaintances - a lawyer, a man of spiritual life. One day the elder stayed with him for a day and met his wife, who also leads a pious life, helping many poor children. She complained that the Lord did not give her children, to which Elder Paisios answered her reproachfully: “You, sister, have more than five hundred children. And are you still complaining? Christ saw your good will. And he will reward you for it. Now, helping the spiritual rebirth of so many children, you are a better mother than many others. You leave behind all mothers of large families! And the reward that you will receive will also be much greater, because, being spiritually reborn, children spiritually secure their future in eternal life.”

It happens that the Lord does not give children to a family, not as a punishment, but as a special providence, so that through these people some unfortunate child, abandoned by his parents, would teach the floor to help.

There are other causes of infertility. These include the so-called birth curses- when a mother or father curses their children. Sometimes, when children bother their parents, instead of their parental blessing, they send reproaches to the children, which can “work” like curses. For example, when a mother tells her daughters: “May it be empty for you” or sends them to evil spirits. Elder Paisius also gives a similar example. When such a mother then repented of her curses, the life of the daughters settled down and the Lord gave them children.

There are also "generic" sins against God and against one's neighbor, when the Lord punishes with barrenness for sins committed against Him. For example, if someone destroyed churches, removed crosses, cut icons, laughed at the Church, the Lord can send barrenness to the family in a generation until people realize and atone for this sin. I know of a case where a priest after the revolution renounced his rank and then died without repentance. In subsequent generations, this family never had boys, and if they were born, then they died before they reached adulthood. Cases are known when in the 1930s children were forced to renounce their parents in public, in a work collective, at an institute. Such sins against God, desecration of the Church, blasphemy, renunciation of parents often affect the next generation or a generation later - one of the grandchildren. Sometimes people commit sins against their neighbor - they dig up tombstones and build their own house from them or commit other blasphemous acts.

Is it possible that the absence of children is due to such a phenomenon, which some people call "damage" or "evil eye"?

Of course, “damage”, “evil eye” are not church concepts. But some people use this terminology. By this should be understood the envy that some people sometimes have. evil people. For example, this can happen if one woman is jealous of another - beautiful, financially prosperous, married and happy in marriage. Out of envy, it may turn out that this woman will have everything, but she will not give birth to children. There are cases when, out of pride, the Lord can deprive a woman of a child if she mocks another, more unhappy, deprived of the happiness of motherhood. The Lord can deprive a mocker of her child and close her womb so that she herself can no longer have children because of her pride and exaltation over her neighbor.

Barrenness can also be sent as a test of a person's faith. The materials of the Jubilee Council of Bishops and the patristic teaching indicate that barrenness can be regarded as a cross that the Lord places on a married couple. A cross in which a married couple must show patience, humility, and hope in the will of God. A striking example is Abraham and Sarah, who for about 90 years prayed for the birth of a child, Zechariah and Elizabeth, Godfather Joachim and Anna. Their children were blessed when they were born after so many prayers, patience, trust in God. The test of faith can be an important moment for such a married couple, when the couple shows their loyalty to God, when they do not grumble at God, thank God for the sorrow sent. This test of faith may at some point end for the spouses, and a woman childless for 20 years may give birth to many more children.

Infertility may also be due to the fact that the Lord delays the birth of children according to His special providence for this family, wanting to arrange the fate of some abandoned child. I know some families in which it happened that a woman conceived a child as soon as the spouses showed a desire to adopt an orphan from orphanage. There were such couples who brought this intention to the end and as soon as they brought an orphan into their house, they were soon expecting their own baby, and in this way two children appeared at once in this family - one adopted and the second whom the Lord sent, resolving the womb of the previously barren women. Moreover, when doctors examined such women, they did not find any pathologies in them that prevented childbearing. But the will of the Lord was such that in these families they brought up not only their child, but also the adopted one.

The consecration of church marriage is very important for solving the problem of infertility. In prayers for the consecration of church marriage, there are such words in which God's blessing is called upon the woman's womb so that she is fruitful. Unbelieving husbands sometimes neglect this important sacrament, and the Lord does not allow a woman to become a mother until the marital union is sanctified by the grace of church marriage. There are also cases when women who were diagnosed with infertility, who lived for many years with their husbands in officially registered, but unmarried marriages, conceived children a few days after the wedding.

There are several other causes of infertility that can be considered. When the Lord sees that a possible child in the family will be very sick or will be severely disabled, He allows this baby not to be born. From church patericons, cases are known when mothers, under the threat of losing a child, fervently and zealously prayed to God, the Lord revealed to them through certain saints that their prayer was objectionable, because this child would be born a villain, a murderer, a blasphemer. If the mothers did not back down, wishing to fulfill their will at all costs, to satisfy their maternal egoism, the Lord allowed the birth of such children, who then became detractors of the family.

The case of the Decembrist Pestel, whom his mother begged for when he was dying of diphtheria at the age of five, is well known. The Lord then showed her that her son would recover but would end his life on the gallows. And so it all happened afterwards. The mother then repented, but it was too late, the Lord had already answered her prayers. Therefore, the prayer “Lord, not as I want, but as You want” is very important.

The Lord may not give children because the husband and wife are not ready to raise a child, because of the irresponsibility or malice of one of the spouses, or because of the possibility of mutual betrayals. For example, if there are constant quarrels and scandals in the family, the husband and wife are selfish, not ready to sacrifice themselves for the sake of the child, not ready to take care of him, give him his love, the Lord, seeing this, delays the birth of a child for several years until the married couple matures. until everything is settled in the family, until the husband and wife come to an agreement. A child must be born in love. If, from the very beginning of his life, he experiences the anger of his parents towards each other and towards himself, then what will this child grow up to be, what will happen to his soul, what will he absorb from such parents?

There are also such married couples in which the wives could not give birth to children, went to many doctors, knocking on thresholds. At the same time, their husbands humiliated them, insulted them, reproaching them with the impossibility of childbearing. These women went to all kinds of medical procedures, but nothing helped. As a result, these husbands cheated on their wives, went to other families. And women who were barren married other men and gave birth to children safely. Their infertility turned out to be imaginary. The Lord, foreseeing that a husband and wife are not ready to preserve the marital union, that a family breakdown is possible, sometimes allows that a child is not born in this family, because he will remain an orphan from a young age.

Next time we will talk about the sequence of necessary spiritual actions that a believing married couple can resort to in order for a child to be born in their family.

Chapter 3. Infertility - ways to overcome

What is the sequence of spiritual actions for a believing married couple so that a child is born in the family?

We will not now touch upon the issues of infertility in an unbelieving family, far from the Church. Let's not talk about people who lead a sinful lifestyle. Let's talk about those spouses who entered into a legal marriage and go to the Church, but for several years they have not been able to give birth to a child.

The first question that spouses should ask themselves is whether their marriage is married or unmarried. In prayers for the consecration of church marriage, the grace of God is especially called upon to ensure that it is good-bearing: “Yes, reveal that your will is a legal matrimony, and others like it, childbearing. Remember, Lord our God, Thy servant and Thy servant, and bless them, give them the fruit of the womb, goodness, unanimity of soul and body. Therefore, believing spouses whose marriage is not married, first of all, require church consecration of the marriage.

If, after a certain amount of time, children are still not born in this family, it is necessary to resort to help as methods medical diagnostics, so to church sacraments.

Medical diagnostics is carried out by various medical centers called reproduction centers, women's reproductive health centers or family and marriage centers. In different cities they have different names, but you can find them in any directory.

Data modern medicine indicate that there are more than 30 medical causes of infertility. Therefore, sometimes it takes time to find the cause. First, they find out whose health - husband or wife - prevents the appearance of children. After a thorough diagnosis, one or another type of conservative (medical) or surgical (if required) treatment is performed. I repeat - the question of choosing a method of treatment is decided depending on the cause of infertility.

Spouses should have an unshakably firm position regarding which methods are ecclesiastical blessed, bound by bonds, and which are impermissible from the point of view of Christian Orthodox ethics. What methods are not blessed by the Church are described in detail in the materials of the Jubilee Bishops' Council of the Russian Orthodox Church in 20002. You can read about this in the Orthodox periodical press, talk to your confessor or with Orthodox biomedical ethicists. In many cities there are now Societies of Orthodox Doctors, where specialists can answer what new medical techniques overcoming infertility are permissible, and which are not.

If medical treatment turns out to be ineffective, or is of a rather complicated nature, spouses can and should resort to church sacraments, asking for God's help to overcome their illness.

What arsenal of means does the Russian Orthodox Church have to help spouses with their problem?

First of all, spouses should pay attention to whether their wrong church life interferes with the birth of children - how churched they are, whether they confess correctly, how often they partake of the Holy Mysteries of Christ, what the confessor tells them.

That is, the first thing to start with is a thorough study by the spouses themselves of the quality of their Christian life, their relationship with the confessor. The confessor, by the will of God, can reveal which way they should go, what prayers to read, what sacraments to resort to. If, as a result of a thorough study of his life and repentance, the Lord reveals some kind of ancestral sins (we talked about this in the previous conversation), they must be confessed to the confessor, and in a certain way prayed. You must understand that the mistakes of grandmothers, grandfathers, great-grandfathers are reflected in your life.

To make amends for their sin, you can ask your confessor for some kind of penance or church blessing (for example, performing a penitential canon or reading certain penitential prayers). Or to make such a spiritual fulfillment that can appease God.

Spiritual replenishment includes such situations when, for example, in order to make amends for the sin of a mother who had an abortion, her barren daughter takes on the feat, with the blessing of a priest, to take care of children in an orphanage, visit orphans, visit maternity hospitals (if there is a maternity hospital in the parish) , to baptize dying babies for fear of a mortal, to help women who do not want to give birth, who are persuaded to terminate their pregnancy so that they do not take this step. So you will commit the opposite of the ancestral sin.

Another example: if a great-grandfather drove an orphan out of the house, then his granddaughter or great-granddaughter, who became barren, should take care of the orphans: provide them with some kind of care or become a godmother to the orphan. I have already said that barren spouses often take children from an orphanage, and after a while the Lord allows them the fruit of the womb and gives them their own children. The same happens in cases when a barren couple or one of the spouses makes some kind of spiritual fulfillment of those sins that their forefathers committed.

In addition to the Sacraments of Repentance and Communion of the Holy Mysteries of Christ, there is also the Sacrament of Unction in the Church. Barren spouses can turn to the priest with a request that it be done over them. Unction is usually celebrated during Great Lent, in some dioceses - during Christmas Lent. Sometimes the Sacrament of Fortune is performed upon the arrival of the relics of the holy saints of God, who have a special gift to help the sick. So, for example, unctions in the St. Petersburg diocese were performed during the transfer of the holy relics of St. healer Panteleimon.

It is also possible, with the blessing of the confessor, to make pilgrimages to the relics of the holy saints of God and ask them for grace-filled help.

Some saints (for example, St. Sergius of Radonezh, St. Seraphim of Sarov) specifically intercede for the birth of children. So, for example, many barren women pray to St. David of Gareji or St. the prophet of God Elijah. There is an example in my memory when a Christian woman, who had been infertile for about ten years, on the advice of a priest, decided to make a pilgrimage to the Holy Land, to Mount Carmel, to the cave where the prophet of God Elijah labored, and where women from all over the world come to solve their problems. infertility. She made a promise that if she had a boy, she would name him after the prophet Elijah. She became pregnant immediately, while preparing for this trip (it must be said that she never got into the cave of St. Elijah), and went on a pilgrimage to holy places already with a conceived child, who after the allotted time became the boy Elijah. There are many such examples.

In Russia, the concept of "votive children" has long been known. When the family could not wait for a son for a long time, or there were no children at all, the spouses made a vow to God to raise a future son for Him - to send him to monks or to other service to God. And according to such a vow, the Lord sent them children.

There are special places, special miraculous icons that give grace-filled help to childless spouses. For example, the icon of the Mother of God Trooditissa, which is located in the Troodos mountains, in Cyprus.

Once, in front of this icon, future parents begged the Mother of God for a child. They promised that they would ordain him as a monk. They had a boy. When he began to grow up (he was already eight or ten years old), his father and mother hesitated in their intention. And soon it happened that a large stone fell off the mountain and flew a few centimeters from the child's head. It was a warning to parents, a sign from God. They repented and as a result kept their promise. The frescoes of this monastery depict the Mother of God, Her belt and a large stone next to it as a reminder that the vows that are given to God must be fulfilled.

The birth of votive children often happened before and quite often happens now. Anyone who is in the monastery of Trooditissa in Cyprus will see a huge photographic file of barren women of all nationalities, from all countries of the world, who, having been in this monastery, were resolved from infertility and gave birth to two, three children after a prayer that the monks performed, putting on barren special belt. This is a huge filing cabinet. I saw it myself when I visited this monastery and prayed before this icon.

I must say that one of my acquaintances, a priest who visited the island of Cyprus, literally a week after praying in front of this icon (even without putting on the miraculous belt on the mother) conceived a child who had only one or two percent probability of being born. Although the priest did not even ask for a child, but simply prayed in front of the icon, the Lord gave him a child.

Such special places, such holy saints, which are glorified by the grace-filled help to childless parents, exist both in the Holy Land and in every diocese. You can turn to them prayerfully, make pilgrimages, order special prayers, and then you can name him in the name of the saint who will help in the birth of the baby in glorification of God's miracle.

In addition, Orthodox spouses, of course, should resort to the help of shrines. During the pilgrimage, spouses can immerse themselves in holy springs, take water home, sprinkle it, and anoint themselves with holy oil from lamps, from miraculous icons from the place of pilgrimage. All this, done with prayer and faith, will contribute to the solution of the problem.

If, after repeated appeals to God, proper churching, resorting to all the sacraments, pilgrimages to holy places, etc., children are not born, then patience must be shown. We must rely on the will of God.

It is not uncommon for women and young couples to come to our temple with similar problems. We usually advise spouses, if they want to have children, to set some sort of milestone, a year or two, in order to improve their family life, learn not to be selfish and not live only for themselves. All this time (for a year or two) they will go to the temple for special prayers. In each diocese there are churches where priests perform water-blessing prayers, pray to saints who provide grace-filled help to childless spouses.

If after the appointed time there are still no children, the husband and wife must decide whether they are ready to carry their life's cross further, perhaps for many years, and patiently relying on the will of God, wait for the birth of their own child, or take a foster child. child. The Lord gives such an opportunity.

This period is also a time of searching for the will of God, of exactly what path the Lord determines for this family. After all, the will of God is not revealed to man immediately. Sometimes it takes a long time to understand what kind of life the Lord wants for the spouses, what destiny he is preparing for them. Now it is necessary to know the will of God in order to conform with it to your parental will.

And, finally, the logical end of the whole series of spiritual deeds that young parents perform is, in case of impossibility to get pregnant, the upbringing of an adopted child, adopted or in any form accepted into their family. And then, as the Lord will give.

Once again, let's clarify, where should one start - with a trip to the doctor or with a spiritual understanding of the disease?

I believe that one should start one's path with the Church, with understanding what is happening together with one's spiritual mentor, confessor or spiritual father. Because even for a medical examination and treatment, churchly educated young spouses must take a blessing from their confessor. Having received God's blessing and the advice of their spiritual mentor, they can undergo certain medical measures and at the same time ask for God's help and resort to the grace-filled means of the Church.

Trebnik. Following the rite of the Wedding The Moscow Compound of the Holy Dormition Pskov-Caves Monastery. Publishing House "Rule of Faith". 1995, pp. 117–118.

Jubilee Bishops' Council of the Russian Orthodox Church. Materials. Publishing Council of the Moscow Patriarchy a. Charitable Foundation "Christmas-2000". 2001

Consultation as the first step to overcoming infertility

Knowledge is power! This postulate is applicable not only in science or technology. It is no less suitable for medicine. Especially in such a delicate issue as the problem of infertility. Unfortunately, many do not even suspect that infertility can be treated at all. Or, at best, they rely on all sorts of "folk" healers, neglecting the achievements of modern medicine. But, even those couples that still know something about this are more likely to perceive modern methods of treatment negatively. The so-called "word of mouth" is actively spreading various rumors and prejudices in society that modern reproductive technologies are dangerous, unnatural and very expensive, and therefore inaccessible. Women with inert thinking perceive the advice of “experienced” friends more than the opinion of practitioners. We are talking, first of all, about the method of in vitro fertilization (IVF).

The truth is that IVF is affordable and effective method conception of a child. More than 75 specialized clinics are already actively operating in Russia, successfully using this method of treatment in solving infertility problems in patients with infertility. The price for one completed cycle in Moscow is 100-150 thousand rubles. Agree, this is not at all a huge amount for the opportunity to love and raise your own baby! The essence of the method is to help people who are faced with the diagnosis of "infertility" to get the desired child. Pre-selected male and female germ cells are joined together in the laboratory, as a result of fertilization, embryos are formed. Then one or more embryos are returned to the body of the expectant mother. This is where the intervention process ends - pregnancy can be checked as early as two weeks after embryo transfer. The effectiveness of one cycle is 30-35%. If the first time did not work out, then experts recommend trying again at least 1-2 more times. Statistics say that in this case, more than 70% of women manage to get pregnant. This is a very worthy indicator, giving hope to become parents to the vast majority of couples!

According to statistics, 15% of all families in our country face the problem of infertility - a terrible figure! In this regard, various educational programs and public research conducted in this area acquire a special role. After all, they contribute to greater education, which means that more couples will be able to make the right decision. One of such programs is "Happiness of motherhood - to every woman!", conducted with the support and direct participation of specialists from the Russian Association of Human Reproduction (RAHR). She does available information about assisted reproductive technologies (ART), which are actively used in the treatment of infertility. By the way, IVF is a widespread and popular procedure in the West. And this is not surprising - the first child born through in vitro fertilization was born more than 30 years ago! During this period of time, assisted reproductive technologies have improved and help to cope with almost all forms of infertility.

an important step in the implementation of the above program is the recent creation of " virtual tour ECO". This 9-step series of educational animations will guide you through all the steps of the procedure, giving you the opportunity to look at the process from the outside. This tour is an excellent choice for those who are not yet mentally ready to go to the clinic, have internal prejudices or fears. Compiled under the editorship of the best reproductologists in the country, the course is very informative and rich - it covers all aspects of IVF.

Another equally important initiative within the framework of the global action is the creation and support of a specialized free online consultation. With its help, you can quickly ask a competent specialist a question, while spending a minimum of time. This practice brings you much closer to your cherished goal, making the consultation something simple and natural, such as talking with a friend. You don't even have to leave the house. It's really very convenient!

The main thing is to believe in the dream! Take advantage of modern opportunities for obtaining information today, and tomorrow you will become happy parents!

Until recently, IVF seemed like a fantastic procedure. Today, cloning seems to be the same fantasy. Do not think that cloning is about to enter our lives and solve all its problems. What is done in the most advanced laboratories is very far from being applied to humans.

The development of ways to combat infertility, like everything else in the world, goes from simple to complex, and then to even more complex. At first they treated with poultices and leeches, then with physiotherapy and massage. The time of pills and injections has come, and then operations and hormonal drugs. The new stage is working with weak sperm, using donor sperm, and, finally, IVF. Yes, plus ICSI - in general, the latest word in science and technology.

In fact, the creation of IVF became possible only at the intersection of the achievements of various sciences. Embryology understood the subtle processes of conception and early development germ. Endocrinology has found out what hormonal changes occur in preparation for conception and in the early stages of pregnancy. Medical technology has developed the finest instruments, without which it is impossible to monitor the development of the follicle and the fertilization of the egg: ultrasound, microsurgical instruments, etc. And only when the knowledge and skills of these sections of medicine were combined, IVF became a reality.

With each new step forward, an interesting and natural pattern is observed. First, the indications for the procedure are expanding, all new married couples are involved in the fight against infertility, for whom only yesterday the only answer from the doctors was condolences: unfortunately, we are not treating this yet ... And then the IVF efficiency indicators are sharply reduced: just yesterday was 70%, and now 25%.

This is quite understandable - after all, a new group of patients has its own characteristics, which doctors are far from immediately able to cope with. But for the patients themselves, the situation is offensive: “Others are doing well, but I am again unlucky. Unlucky or doctors don't know how? Or don't they want to? This is the reason for resentment and conflict. Although, I repeat once again, any technique after invention, after theoretical substantiation, after experiments on animals, is still finally perfected on the first patients.

Therefore, these very first patients are in interesting position: either take risks now, realizing that the chances are small, or wait until the procedures are worked out, but at the same time waste time (which is sometimes for all gold). By the way, I will say that such a situation is also unpleasant for doctors - after all, it is human nature to do good and rejoice in it. And if it doesn’t work out, then grief is equally strong both in the first year of work and after 10 years of work.

So, intrauterine insemination was replaced by IVF, which over time was reinforced by ICSI. As long as it's the limit modern science and practice, although voices are increasingly heard heralding the advent of cloning as a method of treating infertility of any degree of complexity. Is it so?

The question is not so simple. Of course, creating a clone on the basis of any organism is a direct path to the acquisition of offspring by any person, and in complete solitude and without contact with the opposite sex. Any woman can become a mother, whether single or married. Moreover, as soon as they learn how to grow the embryo to a certain stage of development, they will very soon create a purely technical device - something like an artificial uterus to intercept the baton. And then any man can become a father without entering into any contact with a woman.

A brilliant prospect for science fiction writers is the complete separation of the animal past from the human essence. Sex is only for pleasure, and reproduction will be entrusted to smart machines. It will probably be so, but, as the great and wise Nekrasov used to say: “It’s a pity, neither I nor you will have to live at this time of pleasure.”

Despite the rapid development of science and technology, the rapid change in moral and ethical principles in society and medicine, the path to the serial implementation of cloning is very far away. What is being done in the most advanced laboratories is as far from being applied to a person as Tsiolkovsky's ideas are from flight. space station"Peace". According to the most conservative estimates, overcoming the PRINCIPAL obstacles that appeared at the very first stages of cloning will take at least 30-50 years. And what is there, behind these problems - how many more stones will lie in the way of not researchers, but practitioners?

Yes, the sensations that shake the world press from time to time sound very tempting, but their fate is somehow modestly lost in the darkness of forgetfulness of both readers and reporters themselves. Well, they shouted to the whole world that the fetus was grown up to 10 days of age - and for some reason they fell silent. And why? But because, either it turned out that it was a duck, or it was never possible to repeat an outstanding achievement. And in science the only criterion of truth is the repeatability of experience.

So, although it’s usually not harmful to dream, in this case, it’s not worth betting on the appearance of a magical method tomorrow. Time will pass, but the way will not appear. And when it appears, then, according to the pattern mentioned above, the first generation of patients will have five times less chance than those who follow in their footsteps.

As the ancients said, "The law is harsh, but it is the law" - and this also applies to the laws of medicine.

Yuri PROKOPENKO

Take the first step - make an appointment!

When you can’t get pregnant for a long time, it seems that you are surrounded only by pregnant women and mothers with babies in strollers. And as soon as you go once again from the gynecologist with a new pack of referrals for tests, only your pregnancy tests again mercilessly showed one strip. But it's not. Many mothers who are now happy once also could not get pregnant, they were worried, despaired. After all, in Russia infertility diagnosed in 15% of couples.

Where does infertility treatment begin?

When the period that the couple set for themselves to achieve the goal comes to an end, but it still didn’t work out to get pregnant, the spouses begin to worry and go to the doctor. Usually it is women who go to the gynecologist with complaints that pregnancy does not occur. Infertility treatment is a standard protocol for tests and examinations that are prescribed to a woman (be sure to check her partner for fertility) in order to find the cause of failures. Examination and treatment require a long time, and cases of curing infertility by gynecologists from antenatal clinics are quite rare.

Despite the fact that the doctor is not yet shrugging her shoulders and offering to try something else, the patient, having passed a lot of tests, having gone through several cycles of ovulation stimulation, checking the patency of the tubes, and much more, begins to think - what should I do next?

In recent decades, the protocol for the treatment of infertility has been replenished with the item "in vitro fertilization" - IVF. Assisted Reproductive Technologies every year make happy parents a huge number of couples who do not get pregnant. In vitro fertilization has been recognized as an effective treatment for infertility and is often the only chance for many couples to become pregnant when the cause that prevents conception cannot be identified or removed.

It is a pity that sometimes IVF is perceived by women as a last resort:

“Here I’ll try myself for a month, six months, a year, I’ll change my doctor, go through a new treatment, and if it doesn’t work out, then I’ll go to a reproductive clinic.”

There is no need to wait until years of unsuccessful attempts to conceive a baby can lead to a deterioration in relations between spouses and even to the breakup of a family, lower self-esteem, and awaken a sense of guilt. Anxiety and stress, fueled by incorrect questions from the outside - “When will you have children?” – can not but affect the psychological state of the couple.

If a year after the infertility diagnosis was made, the treatment did not bring results, and your doctor recommends IVF, and not treat something else, then this indicates his high qualification and desire to save your time, money and effort.

Do not delay the decision, because the chances of a successful in vitro fertilization the more the younger the woman. And from a long ineffective treatment, the gynecological history is only aggravated. Some women go from doctor to doctor for years, afraid of the word "IVF" ... But in the end, they still come to IVF clinics and in most cases become mothers.

decision to make ECO for many women it is not easy, information is collected, all the pros and cons are weighed.

There are many fears and most of them are fueled by the stories of people who are generally far from medicine. For them, in vitro fertilization is something from the category of magic, and therefore they often operate with such concepts as " artificial pregnancy"," Fake children. But are these words true?

Debunking the Myths

• Unnatural or artificial pregnancy?

How can a long-awaited pregnancy be unnatural? After all modern technologies they simply help to bring about the meeting of your own germ cells with your husband, children carry your genetic information. An IVF pregnancy is no different than a spontaneous pregnancy, and your OB/GYN doctor won't know about it unless you tell him.

• Artificial children?

The health of children conceived through IVF is no different from the health of traditionally conceived children. Take a look around – who can tell which baby is conceived in bed and which is conceived with ART? No one! Children are no different from their peers, do not need special supervision. These are just prejudices that have no basis.

• More harm than good?

Well, how? After all, the greatest benefit of ART is the birth of a long-awaited child. Yes, they are used in IVF medications, anesthesia, etc. But in the same way, years of infertility treatment by a gynecologist are accompanied by prescriptions for various drugs and examinations. There are no drugs that do not have side effects, but the risk of complications in the in vitro fertilization program can be minimized.

• Does IVF hurt?

Do not be afraid of pain during IVF. Reproductive clinics have a sufficient arsenal of tools to make your stay there as comfortable as possible.

• IVF is expensive?

Yes, the cost of the protocol is considerable. But IVF is included in the state program, and if there are financial restrictions, you can do IVF under compulsory health insurance for free.

• Maybe there is no result?

The effectiveness of IVF is quite high - 35% of women become pregnant after the first attempt, and it is highly likely that you will be in these happy percentages. We must not give up, believe the doctor, believe in success.

Many reproductive clinics have their own "portfolios" - collections of photographs of children who were conceived thanks to the knowledge and skills of doctors. Go and see such collections on the website or on the wall in the clinic, admire what beautiful and natural babies were born thanks to IVF.

How to overcome infertility

The topic of infertility and in vitro fertilization raises many questions, and there are also stereotypes that often interfere with correctly assessing the situation and solving the problem of conceiving a child. The impossibility of getting pregnant is not written in statuses on social networks and is rarely discussed even with close friends and relatives. Many perceive this as a sentence, and someone is wasting time, hoping that with the right way life the problem will be solved by itself. Contrary to misconceptions, men are no less likely than women to experience such difficulties. In the end, behind the closed doors of the bedrooms, there are two who want to have children, but for some reason they cannot.

Irina Bezpechnaya - gynecologist-reproductologist, head of the department of the IVF clinic

What is infertility from a medical point of view, is it a diagnosis that cancels life plans or is it certain state and a combination of physical and psychological factors, which it is possible to overcome the majority of couples? Together with the CRC "Clinic of Professor Feskov A.M." understand the reason for so many personal dramas.

In the first part of our joint project, we talked about infertility with Irina Bezpechnaya, a gynecologist-reproductologist, head of the IVF clinic department.

Infertility: what to do and who is to blame

- What is infertility? Can it be called a disease or is there another definition?

Infertility is a collective concept. But such a diagnosis can be made if the couple lived a year without contraception, and pregnancy did not occur. Of course, if sex life irregular, then you should not rush to the diagnosis.

We are talking about infertility if, within a year of regular sexual activity, pregnancy does not occur.

There are different forms infertility: primary and secondary, when a woman has already had pregnancies, and then for some reason they do not occur. If a woman knows that she has problems with the fallopian tubes, then you should not even wait a year. If a woman is planning a second pregnancy and knows that she already had difficulties associated with any factor before, she should also immediately contact the clinic. The earlier a married couple comes for treatment, meaning, the younger the age, the greater the chances of a long-awaited pregnancy.

- You mentioned primary and secondary infertility. What is their difference?

Primary is when a woman has never had a pregnancy. And the secondary - when the pregnancy was, and it does not matter how it ended. It could be childbirth, it could be an abortion, a miscarriage, or ectopic pregnancy. In this case, we are talking about secondary infertility.

- Can infertility occur as a result of physical trauma? Or psychological?

Maybe if there were, for example, injuries of the pelvis, abdomen, which led to surgical interventions, which in turn can lead to adhesions in abdominal cavity. And this means that the patency of the fallopian tubes may be impaired. This leads to infertility. Therefore, it is necessary to pay attention to such factors. Or an operation transferred during life, for example, appendicitis, complicated by purulent peritonitis, which also leads to the formation of adhesions.

How widespread is the problem of infertility in Ukraine now? Are there more such couples? How do you assess the situation based on your experience?

The number of cases of infertility is now increasing in percentage terms, and almost every fifth couple is faced with this problem. The picture has changed a little: earlier they talked more about female infertility, and recent years seven are more likely to encounter male.

- With what it can be connected?

It is difficult to answer this question unequivocally, but most likely - ecology, nutrition, lifestyle and other similar social factors.

What causes infertility in men? What are the most common factors?

These are infections urinary tract, inflammatory processes, varicocele - dilation of the veins of the epididymis. Also injuries, oncological diseases of the scrotum. There is also such a thing asparotitis . If men suffer from this disease in childhood or adolescence, this can also lead to disruption of the maturation of spermatozoa.

When to sound the alarm if you can't get pregnant

- At what point should a couple seek medical advice?

If a couple has not become pregnant within a year, they should contact a fertility clinic. We begin the examination of the man with the analysis of the spermogram, and the woman is given an ultrasound of the pelvic organs and an examination in accordance with the order of the Ministry of Health of Ukraine No. 787. Then, based on the results objective methods examinations, the couple is diagnosed with "infertility" and determine what to do next. Often there is a combination of male and female infertility factors.

- Which specialist should I go to first of all?

To the reproducer. After conducting an initial consultation on infertility based on the history and examinations, it is already possible to determine the next steps. If infertility is associated with a male factor, the man is sent for examination and treatment to a urologist-andrologist. The reproductive specialist continues to deal with the woman.

- How many tests will you have to take?

First of all, the tests necessary to determine the cause of infertility are given. Depending on the method by which we will achieve pregnancy, for each procedure there is a list of examinations, without which it is impossible to conduct it. This is regulated by orders of the Ministry of Health of Ukraine. Some of the analyzes are mandatory, and some are to identify a specific issue.

Is infertility curable? After identifying the causes, can both a man and a woman be cured so that they can conceive a child? Or are there times when there is no hope?

We can overcome infertility. Solution methods can be different, ranging, for example, from an auxiliary insemination technique to more complex genetic tests on embryos, up to surrogate motherhood. Therefore, it is possible to overcome infertility, I think, in almost any case. Everyone has their own way to achieve results. It depends on the causes of infertility, on the infertility factor and on the age of the couple.

- Does age matter?

In a married couple under 35, the probability of pregnancy can reach 45-47%. In the older age group, this indicator is reduced by 7-10%, and we have less effectiveness. After the age of 40, the probability of pregnancy is from 1 to 5%. We are talking about the effectiveness of treatment with the use of their germ cells. If we use the processes of donation, surrogate motherhood, there are completely different performance data. The chance of pregnancy is 50 to 75%.

IVF to help

You can go into more detail about assistive techniques so that our readers understand exactly what options exist to overcome infertility. What awaits a couple if you suddenly have to face this problem.

Of the auxiliary methods, there is a method artificial insemination husband's or donor's sperm. Insemination is a technique that allows you to create the most favorable conditions for pregnancy. It is carried out at normal sperm and with preserved patency of the fallopian tubes in a woman. The essence of the method is that during the period of ovulation, a woman is injected with a special catheter into the uterine cavity with the sperm of her husband or a donor.

As for reproductive technologies, they include in vitro fertilization - IVF. Various methods are already being added to the IVF program, which can improve performance depending on the spermogram data, the woman's health indicators and the infertility factor itself. If the woman's age is up to 35 years and the partner's sperm indicators are fertile, then the standard IVF procedure can be performed. The IVF technique imitates the natural menstrual cycle. But there are differences. The first is that during this method, the growth of not one follicle is stimulated, but from 8 to 10 follicles in one menstrual cycle. On the day of the puncture, when we receive the eggs, the husband donates sperm. It is processed, the actively mobile fraction of spermatozoa is selected, and then the spermatozoa independently fertilize the egg in a special cup (this is in vitro fertilization, i.e. "in vitro"). After fertilization, within 3-5 days, the embryos develop in incubators. On the fifth day, one or two embryos are transferred into the uterine cavity. This is considered normal IVF.

If the percentage of actively motile spermatozoa in the semen is reduced and, for example, the woman's age is over 35 years, or there are endocrine factors of infertility, in this case, the ICSI technique is performed - the introduction of one selected spermatozoon into the egg. With pathospermia, when there is pathological forms spermatozoa using IMSI technology. In this case, a morphologically normal spermatozoon is selected, after which ICSI is performed. These are the most common methods that are most often used to overcome infertility.

The IVF procedure is already the final stage, and before that there are still preparatory processes? What could it be? How do they happen?

There may be inflammation of the vagina, infections genitourinary system, for which we will definitely examine in advance. Men can be trained by an andrologist to increase their percentage of higher quality sperm. There are endocrine conditions in women that require hormonal correction before ovulation stimulation. There are a lot of states. Therefore, it is not necessary that a couple who decided on IVF came and immediately entered the program. To get the most best result with IVF, the necessary preparation is always carried out, including the choice of a cycle to stimulate ovulation.

- How long can this all take?

From a month to three. The minimum is a month. There are such changes in the spermogram that require stimulation of spermatogenesis. This can last from 1 month to a year. Everything, as always, individually.

- During treatment, are they offered to visit other doctors who are not directly related to reproductive function?

Necessarily. Before the IVF program, there will be a consultation with a therapist, an ultrasound examination of target organs, such as the mammary glands, liver and thyroid gland. If everything is normal, the patient is admitted to the IVF program. If any formations, dysfunctions of these organs are detected, patients are consulted by related specialists, and only with permission to conduct an IVF program does the procedure itself begin.

Is it possible to use different methods before IVF? For example, try something one, it will not work - try another? Or does the doctor initially choose the procedure that is most suitable for a particular couple?

The approach is individual, exactly the set of techniques that are needed in a given state of a married couple is selected. You can't say that let's do IVF, and then ICSI. If there are indications for ICSI, an in vitro fertilization program plus an ICSI procedure is initially performed.

If one of the methods does not work, then you can choose another? And then the next one? Is it dangerous for a woman's health?

If pregnancy did not occur at the first attempt, they are analyzed weak spots. Looking for areas to improve. Was there a problem with obtaining eggs, or was it due to the quality of the sperm, or was there a problem with the quality of the embryo itself? Based on the analysis of the situation, the next IVF attempt takes into account the factors that could lead to a negative result. At 70%, the probability of pregnancy depends on the quality of the embryo, on its genetic and chromosomal composition, and 30% is the state of the endometrium, i.e. that can be regulated by the prescription of medications. Correct Dosage and strict adherence to the doctor's recommendations is a guarantee that the woman's body will cope with this process. Modern medical preparations safe for health.

There are many methods and technologies, but first of all it all depends on the biology of the egg and sperm. This is what is transmitted with genetics to embryos, and subsequently to children. If the embryos are of high quality, the chance of pregnancy is higher. If low, they are not tolerated because they will not give pregnancy.

There is an opinion that if a couple is about 40 years old, then they should immediately go for IVF and not even try in a different way. Is it true? Is it worth it in this case to make attempts to get pregnant on your own or immediately go for artificial insemination?

The older age group is primarily shown the IVF program. The couple, of course, has the right to insist on their vision of the process, but we initially offer what is more optimal for achieving the result, and then we individually decide how to proceed.

After 35 years, the aging process of the eggs begins, and the reproductive capabilities of a woman are reduced. The probability of success for such couples is lower. In women of the same age, the laying of antral follicles in the ovaries may be different. (In the course of a woman's life, about 400-500 follicles mature, which are suitable for conception. The rest (and there are thousands of them) undergo the process of atresia (reverse development) - approx. The Devochki. ) Indeed, it is important not to waste time in which you can achieve success. Trying to get pregnant naturally in a woman after 35, we lose precious follicles. With IVF, they can be used to the maximum and achieve results faster than naturally. Over time, pregnancy with your eggs risks becoming impossible altogether. The real reserve is declining, the quality of eggs is deteriorating, and in order to achieve a result, we will be forced to offer donor eggs already.

Do couples often fear or distrust IVF because it is something unnatural, wrong? Have you come across such stereotypes?

Of course they did. First of all, everyone has the question of whether children will be normal after IVF. This is the most common fear. Pregnancy after IVF is no different from natural. Children are born absolutely normal. The malformations of the fetus do not depend on the IVF program, the mental abilities of the child do not depend. This is due to the genetics that a married couple will pass on with their germ cells to an unborn child. Only the conditions for the embryo to enter the uterus, the conditions for creating the embryo, change - during IVF this happens outside the body. Otherwise, we imitate everything that nature does.

- That is, the observation of pregnancy and everything connected with it are exactly the same as during normal conception?

Yes, just like natural conception. The only thing is that after the IVF program, the woman in the first trimester is observed more carefully, since she takes drugs to maintain pregnancy. Closer attention is needed. Although the course of an IVF pregnancy itself is no different from a normal pregnancy.

Probably one of the most common questions: is it true that the chance of twins or twins is much higher with IVF than with natural pregnancy?

When transferring two embryos into the uterine cavity, the probability of twins is approximately 20-30%. Of course, this is more than in natural life. And it is connected precisely with the fact that we introduce two embryos into the uterus. If, for medical reasons, a woman cannot transfer two embryos (there are conditions when twins are contraindicated), we tell her about it. With twins, there is always a risk of preterm birth, the risk of miscarriage is also higher. In this case, one embryo is transferred. This is always discussed during consultations.

Psychology of infertility

- When passing a large number procedures, a woman may need some kind of psychological help?

In our clinic, a consultation with a psychotherapist is always offered: if you need help or even just talk, express your doubts, fears. Few people know about it, but there is such a thing as "psychological infertility", which can really affect the results of treatment. But at present, very few women agree to consult a psychotherapist. For some reason, they are probably afraid of the very word “psychotherapist”.

How do men perceive infertility? As far as I know, men were less examined in the past. Is it more painful for them? Are there times when a man refuses to believe in his diagnosis?

Often men refuse to even undergo an examination, claiming that everything is in order with them. In general, this is a couple's problem, and not one of the partners, regardless of which factor prevails - female or male. All the same it is necessary to pass or take place inspection, treatment together. The moral aspect and support of each other are also important here. Men, indeed, endure the whole process much more painfully. Adequate man almost always agrees to the examination. Recently, a patient opposed to IVF says: "I am against it, but not categorically." That is, if there is no other option, he will come to IVF. Sometimes you need to hold not one, but two consultations. If a man refuses to be examined, then we ask him to visit the clinic once or twice, we conduct an informational conversation with him, a consultation, so that he understands that this is important and for the sake of the child it is worth deciding on an examination and treatment.

Is it possible that in preparation for IVF, a couple can become pregnant naturally? It happens?

There are couples who become pregnant even at the stage of examination. It happens that after one successful IVF program, the second pregnancy occurs on its own. There is such a thing as a psychological block, that is, a woman is so obsessed with pregnancy that she subconsciously interferes with herself. And when she achieves pregnancy, and a child is born, the woman relaxes, and a second, third natural pregnancy occurs.

That is, in this moment there is also a psychological stopper, which also needs to be investigated and it is desirable to work with a psychologist?

Yes, there is nothing wrong with that. On the contrary, it helps to cope with anxiety, with fears of the IVF procedure, before pregnancy, anesthesia, which is necessary before the puncture (Follicle puncture is the process of extracting mature eggs from the ovaries with a hollow needle for subsequent fertilization in vitro (test tube) - approx. The Girls ). Therefore, the reproductologist himself, to some extent, conducts psychotherapy and psychological support throughout the IVF program. There are women who would only benefit from a consultation with a psychotherapist, an increase in self-esteem, faith in success, in positive results. This is just a plus. It would be nice to attend such a consultation in parallel with the husband or together with him, so that the man also supports the woman, because often there is not enough support from the family, and this is very insulting for the woman.

There are couples who do not tell anyone that they have a pregnancy problem. Some decide on IVF, and only when they achieve a positive result, they tell their relatives about it. There are couples who hide from all their friends and relatives that they cannot get pregnant. They, probably, this topic would be as close as possible.

This is individual. It is believed that abortion reduces the chance of getting pregnant, but this depends on many factors. What was the background during the abortion, were there any complications in postoperative period, what was the interruption period, what method was carried out. All factors must be taken into account. Therefore, it is difficult to name a certain percentage.

If a girl constantly has an abortion after conception - a miscarriage? Can this be called infertility?

No, we are talking about miscarriage. There are a number of studies that determine the causes: either these are chromosomal abnormalities of the embryo, or concomitant factors. There is such a thing as "thrombophilia" - a violation of the blood coagulation system, miscarriage may be associated with it. It is necessary to understand in each case separately. Anomalies in the structure of the uterus can also lead to miscarriage. Therefore, the diagnosis can be made only after the examination.

- And what about infections, the same so-called thrush?

Thrush (candidiasis) is less affected. Thrush is just a condition that can be a trigger but not the root cause. Chlamydia, gonococcal infections can lead to impaired patency of the fallopian tubes. These are more serious infections that are transmitted exclusively through sexual contact.

In childhood, many girls were scared that if they sat on the cold floor, there would be no children. How true is this? Can hypothermia affect your ability to get pregnant?

To some extent it can, but primarily it is an infection. Some microorganism should get into the genital tract, perhaps even a conditionally pathogenic microflora that lives on our mucous membranes and on the skin. When creating unfavorable conditions from the vagina, urethra, inflammatory processes may occur. In the absence of timely treatment and treatment, there may be inflammatory changes. In women, this is primarily the fallopian tubes, in men - the prostate. Hypothermia acts here only as a concomitant factor.

If a girl regularly visits a gynecologist throughout her life and takes care of herself, then she should not have infertility at all? How important is regular visits to the doctor to avoid such a problem? Or are they unrelated things?

Any woman should visit a gynecologist once a year if nothing bothers her. If there are any complaints, you need to visit more often. But infertility can be encountered, even by regularly visiting a specialist.