Female infertility treatment. Is it possible to cure infertility? Diagnosis and treatment methods for the disease in women and men. Where to start testing for infertility

Infertility is the absence of pregnancy for any reason after 1 year of sexual activity without the use of contraceptive methods or after 6 months if the woman is over 35 years old. According to Rosstat, more than 3% of women in Russia who are of reproductive age (from 20 to 44 years old) suffer from infertility after their first birth, and almost 2% are unable to give birth at all.

There are many reasons that interfere with conception or pregnancy: from health problems to psychological factors. Infertility can also occur in men, but due to the complexity of the female reproductive system, most infertile marriages are associated with malfunctions in the woman’s body. In most cases, the cause of failure to become pregnant can be identified and treated with medication or surgery, but unidentified factors may also occur.

The normal process of reproduction requires the interaction of male and female reproductive cells. During the release of the egg from the ovaries, it then moves through the fallopian tubes to the uterus. The male reproductive organs produce sperm.

The sperm and egg usually meet in a woman's fallopian tube, where fertilization occurs. The embryo is implanted into the uterine cavity for further development. Female infertility is when, for some reason, this circuit fails.

The most common problems leading to infertility are disorders of the ovulation process (in 36% of cases), (30%), endometriosis (18%). The causes of infertility remain unknown in 10% of women.

Hormonal infertility

A delicate balance of female sex hormones (estrogen, progesterone, luteinizing hormone, follicle-stimulating hormone) is necessary for the timely maturation and release of the egg from the ovary.

The following hormonal disorders can cause infertility:

1. Polycystic ovary syndrome. Due to an excess of male hormones or hypersecretion of insulin by the pancreas, many follicles are formed in the ovaries, but none of them mature and release an egg, that is, ovulation does not occur. The ovaries increase in size up to 2–6 times, the monthly cycle lengthens, and some menstruation may be missed. 70% of women diagnosed with polycystic ovary syndrome are overweight.
2. Insulin resistance, which often accompanies polycystic disease. The hormone insulin, produced by the pancreas, is responsible for delivering sugar from the blood to the cells of the body. If cells stop taking it, more insulin is released in response to increased blood sugar. According to research, resistance is associated with an increased number of male genital organs - hyperandrogenism. The causes of cell resistance to insulin are poor diet, stress, and a sedentary lifestyle.
3. Increased amount of male hormones. Irregular or even absent menstruation may indicate hyperandrogenism. Excess male hormones suppress the functioning of the ovaries, up to the cessation of ovulation and lead to infertility. Hyperandrogenism also causes strong growth of body hair, acne, deepening of the voice and changes in the figure according to the male type.
4. Excess of the hormone prolactin produced by the pituitary gland (hyperprolactinemia). Problems with the functioning of the gland occur due to impaired blood supply, genetic causes, injuries, medication, or previous meningitis. Characteristic signs of the disease are the appearance of milk in the breast and irregularities in the menstrual cycle. Mastopathy, breast growth, bone fragility, and decreased sexual desire are also observed. Prolactin is a hormone of nursing mothers, and it is because of it that many of them lack ovulation and menstruation. An increase in this hormone in other women is usually associated with thyroid dysfunction (hypothyroidism).
5. Premature menopause. The average age of onset of menopause is 50 years, but due to autoimmune or genetic disorders, diseases of the reproductive system, unhealthy lifestyle, smoking and other reasons, 1% of women experience menopause before the age of 40. The production of female hormones decreases, ovarian function and fertility gradually fade away.
6. Insufficiency of the corpus luteum. The corpus luteum is a temporary gland that appears in place of the follicle that released the egg. The gland hormone, prolactin, stimulates the preparation of the uterus for the implantation of a fertilized egg in it. If it is not enough, consolidation does not occur and pregnancy does not occur, but if implantation occurs, then a miscarriage soon occurs. Conditions for corpus luteum deficiency are genetic disorders, ovarian pathologies (polycystic ovary syndrome, cancer), malfunction of the pituitary gland.

Physiological factors of infertility

1. Damage to the fallopian tubes or lack of patency. It is in the fallopian tubes that fertilization occurs after the egg leaves the ovary and connects with the sperm, so if they are obstructed, fertilization is impossible. The tubes can be damaged as a result of inflammation, viral or bacterial infections, sexually transmitted diseases, complications due to surgery, when adhesions or scars occur.
2. Endometriosis. Due to genetic factors, pathology of immune and hormonal processes, the uterine mucosa forms in inappropriate places inside and outside the reproductive tract. Endometriosis can block the fallopian tubes and prevent ovulation, causing infertility. Signs of this disease are pain, heavy and painful periods.
3. Uterine fibroids. It is believed that the cause of fibroids (benign growths on the uterus, consisting of muscle tissue) is an increase in estrogen levels. Risk factors are genetic predisposition, metabolic disorders, stress, abortion. Myoma makes itself felt through heavy menstruation, cycle disorders, and pain. The consequences of a tumor depend on its size and location, in some cases it causes infertility, miscarriages or pregnancy complications.
4. Adhesions and abnormalities of the shape of the uterus (one-horned and two-horned, the presence of a septum, uterine infantilism). The causes of adhesions and fusion of the walls of the uterus are inflammatory processes, trauma and endometriosis, and structural pathologies are caused by genetic reasons. The consequence of these problems is most often spontaneous abortion, since the fertilized egg cannot implant in the uterus.
5. Scarring of the cervix or abnormalities in its shape. Adhesions and scars on the cervix are a consequence of surgery or infection. Because of this, sperm do not pass into the fallopian tubes and infertility occurs. Deformation of the cervix or changes in the composition of the cervical mucus can also complicate the path of sperm.
6. Inflammation of the pelvic organs. The reason for this may be infections caused by several types of bacteria, in particular sexually transmitted diseases (STDs) - gonorrhea, chlamydia, ureaplasmosis, and many others. Factors that increase the risk of infection are sex without a condom and changing sexual partners. Pathogenic bacteria can enter the body during intrauterine manipulation, during menstruation, and in the postpartum period, since at this time the effectiveness of natural defense mechanisms decreases. Infections can cause inflammation of the tubes and ovaries (salpingoophoritis) in combination with inflammation of the uterus (endormetritis), as well as inflammation of the cervix (cervicitis). The diseases are characterized by abdominal pain, unusual discharge (including uncharacteristic periods), the appearance of ulcers, spots, itching and soreness of the genitals.

Other reasons

1. Age. By the time of puberty, a woman’s ovaries contain about 300 thousand eggs. Over time, they age - the DNA is damaged, since the system for its restoration works less well with age. Accordingly, their quality decreases—suitability for fertilization and embryo development. This process becomes noticeable after 30 years, and when a woman turns 35-40, aging accelerates.
2. Overweight or underweight. Excessive amount of adipose tissue in the body threatens hormonal imbalances - an increase in the amount of estrogen and testosterone, which threatens gynecological diseases, including infertility. Under the influence of medications, obese women can become pregnant, but problems often arise with the bearing and development of the child. Lack of weight (BMI less than 18.5) also leads to dysfunction of the endocrine system, but less hormones are produced than necessary for the normal functioning of the reproductive system, and eggs stop maturing.
3. Stress, nervous exhaustion, chronic fatigue. Stress is the cause of hyperprolactinemia and a decrease in estrogen levels in the blood, which affects the ability of the egg to mature and attach to the uterine wall. Another consequence of emotional overload is spasms and muscle contractions, which leads to hypertonicity of the uterus and fallopian tubes, which prevents conception.
4. Congenital disorders. Stein-Leventhal syndrome (provokes polycystic ovary syndrome), adrenogenital syndrome (impaired functioning of the adrenal glands and increased levels of androgens), Shereshevsky-Turner syndrome (absence of menstruation), blood clotting disorders and some other disorders are of a genetic nature and interfere with conception or cause early miscarriages.
5. Immunological factors. The presence of antibodies to sperm in cervical mucus can lead to infertility. In other cases, the mother's immune system prevents the embryo from attaching to the wall of the uterus and thus causes a miscarriage.
6. Psychological reasons. In some cases, a woman subconsciously perceives pregnancy as a danger. This may be caused by moral trauma, fear of changes in life or appearance, or fear of childbirth. The brain controls all processes in the body, so a negative psychological attitude leads to infertility.

Forms of infertility

There are several types of infertility, differing in conditions and mechanism of occurrence.

Depending on the possibility of eliminating the causes that caused problems with conception and the chances of a subsequent pregnancy, the following are distinguished:

• relative infertility, when after taking medications, normalizing hormonal levels or metabolism, surgery to restore reproductive function or other treatment, conception can occur;
• absolute, in this case, due to congenital factors, incurable diseases or disorders, pregnancy occurring naturally is impossible.

In some cases, after the first pregnancy (successful or unsuccessful), a woman cannot conceive again for various reasons, but often the first pregnancy does not occur. Depending on this they distinguish:

• primary infertility (lack of pregnancy);
• secondary infertility (there are cases of pregnancy in the anamnesis).

According to the mechanism of occurrence:

• acquired infertility occurs as a result of injuries, infections, diseases of the reproductive and endocrine systems that are not associated with a genetic factor;
• congenital – hereditary diseases, developmental anomalies.

For the reasons that caused it, infertility is divided into the following types:

• tubal (associated with obstruction of the fallopian tubes);
• endocrine (caused by disruption of the endocrine glands);
• infertility due to uterine pathologies;
• peritoneal, when adhesions in the pelvic organs prevent conception, but the fallopian tubes are passable;
• immunological infertility is caused by the formation of antibodies to sperm in the female body;
• infertility due to endometriosis;
• idiopathic (of unknown origin).

Diagnostics

The causes of female infertility are varied, and often it is necessary to undergo a large number of examinations to find out.

To diagnose the presence and causes of female infertility, a consultation with a gynecologist or reproductive specialist is necessary. He must find out from the patient whether she has complaints of pain, discharge, duration of unsuccessful attempts to get pregnant, the presence of genetic or infectious diseases, previous operations, complications, the nature of menstruation and sexual life. The doctor also performs an external examination - to assess the physique, the presence of excess body hair, skin condition - and a gynecological examination, which includes checking the condition of the internal genital organs.

There are a number of functional tests offered to determine the causes of infertility:

• cervical index, which involves assessing cervical mucus to determine estrogen levels;
• constructing a basal temperature curve, which allows you to assess the fact and time of ovulation;
• postcoital test, when the activity of sperm in the cervix is ​​studied and the presence of antibodies to sperm is determined.

To determine the causes of infertility, the following tests are offered:

1. For laboratory diagnosis of infertility, hormonal levels are first checked. In particular, this is an assessment of the level of testosterone, prolactin, cortisol on days 5–7 of the cycle, progesterone on days 20–22, hormonal tests, when indicators are assessed after stimulation or inhibition of various hormonal processes based on their response.
2. Testing for STDs is mandatory.
3. The study of the content of antibodies to sperm in the blood and cervical mucus is an immunogram, analysis of vaginal secretions and compatibility tests.
4. Genetic analysis of chromosomal abnormalities leading to infertility.

The woman will be asked to undergo the following examinations:

1. Ultrasound. Allows you to see disorders of the pelvic organs, uterine fibroids, evaluate the structure of the uterus, ovaries, fallopian tubes and their patency. You can also evaluate the processes of ovulation and follicle maturation.
2. Hysterosalpingography (HSG)– checking the internal genital organs using x-rays. The contrast agent administered by the gynecologist gives an informative picture of the condition of the uterus, fallopian tubes, and ovaries.
3. X-ray of the skull, since the cause of infertility may be a malfunction of the pituitary gland or its tumor.
4. Colposcopy, including examination of the vagina and cervix by introducing a colposcope - a special device consisting of a binocular and a lighting device. This study allows us to identify signs of erosion and cervicitis - signs of an inflammatory process.
5. Hysteroscopy. It is performed under general anesthesia using an optical hysteroscope inserted through the vagina. Makes it possible to visually evaluate the cervical canal, uterine cavity, fallopian tubes, and also take the uterine mucosa for analysis.
6. Laparoscopy– this is an examination of the pelvic organs with optical equipment through a micro-incision in the abdomen. Like hysteroscopy, this is a low-traumatic operation; after 1–3 days the patient can leave the hospital.

Treatment

The decision on the methods and need for treatment is made after all examinations have been carried out and the causes of infertility have been established. If it is relative, therapeutic or surgical methods of treatment are used, absolute (incurable) infertility requires alternative solutions to the problem - assisted reproductive technologies.

Drug treatment

Fertility drugs are mainly prescribed to correct ovulation disorders in patients due to problems with hormones. This method is used as the first treatment option for many patients, often used after surgery or in combination with IVF and ICSI.

There is a wide range of drugs. The most common ones are:

• Clomid and Serophene. These drugs are taken in tablet form and stimulate the ovulation process by causing the hypothalamus (gonadotropin hormones) and pituitary gland (follicle-stimulating and luteinizing hormones) to produce hormones necessary for egg maturation.
• Hormone injections: human chorionic gonadotropin (hCG), follicle-stimulating hormone (FSH), human menopausal gonadotropin (hMG), gonadotropin-releasing hormone (Gn-RH), gonadoliberin agonist (GnRH agonist). Hormones are given by injection at regular intervals. These drugs are more effective and expensive than Clomid and Serophene. They are typically used to stimulate ovulation and subsequent IVF.
• Utrozhestan– a drug containing progesterone and stimulating the preparation of the uterus for egg implantation.
• Duphaston Due to the content of dydrogesterone, it helps the fertilized egg to attach to the uterus.
• Bromocriptine inhibits the production of prolactin.
• Wobenzym It is prescribed for inflammation and infections, as it increases the body's resistance.
• Tribestan normalizes the level of estrogen and follicle-stimulating hormone.

Surgery

Surgery can solve a number of issues, but it is only used in the initial stages of infertility treatment for several reasons.

These can be the following types of operations:

1. Removal of polyps, fibroids, cysts- Removing excess or abnormal tissue in the uterus or ovaries can improve ovulation and clear the way for sperm and egg to reunite. The excised tissue is always sent for a biopsy to check for malignant cancerous tumors.
2. Surgical treatment of endometriosis. The operation is prescribed when conservative methods of treating infertility do not help, and the disease leads to severe pain and disruption of the urinary system.
3. Restoration of ligated fallopian tubes. Women's fallopian tubes may be cut or sealed for sterilization purposes. The reverse process - restoring their patency - is a serious surgical operation, the successful outcome of which depends on the method and duration of the blockage of the pipes and their condition.
4. Salpingolysis– removal of adhesions on the fallopian tubes.
5. Salpingostomy– to restore the patency of the fallopian tube, the area with impaired patency is removed, and the remains of the tube are connected.

These operations are performed using hysteroscopy or laparoscopy, but when removing large cysts, fibroids, or extensive endometriosis, laparotomy is used, when a large incision is made in the abdomen.

Assisted reproductive technologies (ART)

In ART, the egg is fertilized by a sperm outside the body. The ART procedure involves surgically removing an egg from the ovaries, combining it with sperm in the laboratory and returning it to the patient's body or transplanting it to another woman. In vitro fertilization (IVF) is mainly used.

The success of the surgery varies depending on many conditions, including the cause of infertility and the woman's age. According to statistics, after the first IVF protocol, pregnancy occurs in 40% of women under the age of 35 and gradually decreases to 2% in those over 44 years of age.

ART can be expensive (the compulsory medical insurance policy only provides for free IVF) and time-consuming, but it allows many couples to have children.

Types of ART:

1. ECO- the most effective and widespread form of ART. With the help of drugs, a woman is induced to superovulate (the maturation of several eggs), which are then combined with the man’s sperm under special conditions, and after fertilization are returned to the patient’s uterus. The seed material may belong to the husband, or it may be donor - cryopreserved.
2. ICSI(Intra Cytoplasmic Sperm Injection - intracytoplasmic sperm injection) is often used for couples with male factor infertility. One healthy sperm is placed into the egg, unlike IVF, where they are placed in a Petri dish together and fertilization occurs on its own.
3. Embryo transfer (gametes) into the fallopian tubes– GIFT and ZIFT. The embryo is transferred to the fallopian tubes instead of the uterus.
4. Insemination with husband's sperm (ISM) or insemination with donor's sperm (ISD) used in case of impossibility of vaginal ejaculation, “bad” sperm, and the use of cryopreserved seed material. Sperm are transferred into the vagina or directly into the uterine cavity.
5. Surrogacy offered to women who do not have a uterus. The patient's egg is fertilized with her husband's sperm and transferred to the uterus of a surrogate mother - the woman who will bear the child.

Complications when using ART may include allergies to drugs that stimulate superovulation, ovarian hyperstimulation syndrome, inflammation and bleeding.

If, as a result of long treatment and numerous attempts to have a child, including the use of assisted reproductive methods, pregnancy does not occur, do not despair. Those couples who are confident in their desire to have a child may consider adoption.

The adoption process requires the collection of a large number of documents and often a long selection of candidates. There are also risks of ignorance about the child's genetic makeup or lack of mutual understanding if an older child is adopted, so this decision requires a balanced approach.

In order to conceive and bear a child, a woman needs healthy ovaries, fallopian tubes, uterus, and endocrine system. Disruption of any of these organs can contribute to infertility. It is wise to seek medical help if there are risk factors - irregular menstrual cycles, endometriosis, ectopic pregnancy, PCOS, pelvic inflammatory disease and others.

To establish the causes of infertility, many tests and examinations are required, including studies for hormonal and genetic disorders, search for pathologies of the genital organs and infectious diseases. In most cases, infertility is treatable with medications (mostly hormonal drugs), surgery, or assisted reproductive technologies. The latter give a chance to those couples who, due to health problems, are not able to have children naturally.

Olga Rogozhkina

midwife

If a woman does not become pregnant within 12 months with regular unprotected sexual intercourse, she is diagnosed with infertility. Why is this particular time allotted for possible conception? The period of 12 months is specified by statistics: it has been proven that 30% of women were able to get pregnant in the first 3 months of open sexual activity, 60% over the next 7 months, 10% after 11-12 months from the start of pregnancy planning. It turns out that one year is enough to confirm a woman’s fertility. Modern medicine is able to solve the issue of female infertility in most situations. A reproductive specialist helps identify the type of infertility and select options for solving this problem.

Useful video about solving the problem of female infertility

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Approximately 15% of married couples in Russia are diagnosed with infertility. According to the World Health Organization, a marriage is considered infertile in which pregnancy does not occur within a year of regular sexual activity without the use of contraception.

Unfortunately, for many couples the path to the birth of a long-awaited child can be very long. Expert of the educational program “Happiness of Motherhood for Every Woman!” Antonina Kozlova, Ph.D., reproductive specialist at the MirA Medical Center:

“One of the most common causes of female infertility is damage or obstruction of the fallopian tubes, preventing the egg from meeting the sperm and the subsequent transport of the already fertilized egg to the uterus. In addition, dysfunction of the fallopian tubes due to previous inflammatory diseases or impaired production can also lead to this sex hormones.

Another serious reason is disturbances in the menstrual cycle and egg maturation. If a woman has irregular or absent menstruation, there is a reason for examination. Ovulation disorders are often associated with hormonal imbalances. Fortunately, it is not difficult to diagnose, and treatment is simple and quite effective.

The next factor is various lesions of the uterus, as a result of which the physiological process of implantation, or engraftment, of the embryo is disrupted. Such lesions of the uterus include: uterine fibroids, endometrial polyps, adhesions in the uterine cavity, congenital deformities, and sometimes the complete absence of the reproductive organ.

In addition, changes in the composition of cervical mucus (produced in the cervix) may also affect your ability to conceive.

Separately, it is necessary to note the importance of the woman’s age. This is especially true now, when there has been a change in women’s reproductive behavior. Modern ladies are trying to first make a career, secure a stable social position, and then give birth to a child. But we must not forget that after 35 years of age, female fertility (the ability to conceive) begins to decline sharply, the chances of getting pregnant are 2 times lower than at 20 years old, and by the age of 40 the probability of spontaneous pregnancy is only 10% compared to 20 years old. summer age.

A factor that should also not be forgotten, especially for young people who are keen on various diets, is weight. Significant deviations from normal body weight, whether overweight or underweight as a result of sudden weight loss, can lead to decreased fertility and sometimes infertility in both women and men. According to one study, 12% of primary infertility is associated with weight problems.

Thus, a woman's fertility can be affected by various factors such as: sexually transmitted diseases, stress, sexual disorders and some common diseases.

Infertility is not just a female factor

It so happened that infertility was previously considered an exclusively female problem. However, today in 30% of married couples infertility is associated with disorders in the woman’s body, and in the other 30% - in the man’s body. In another 30% of couples, the cause of infertility is a combination of disorders in both partners. In 10% of cases, the cause of infertility cannot be identified. may be caused by various diseases that ultimately lead to deterioration in sperm quality, up to the complete absence of sperm, and ejaculation disorders.

Infertility is curable!

But even if you have heard the diagnosis of infertility, do not despair! Modern medicine now offers many methods to conceive a child. The main thing is not to waste time and contact specialists on time.

When a couple goes to a clinic specializing in sterility, an examination begins to identify the causes of infertility. The initial examination must provide answers to 3 main questions:

• Does a woman ovulate and how regularly?
• Is a man's sperm capable of fertilization?
• Are a woman's fallopian tubes patent? Are there other anatomical obstacles to the passage of sperm to the egg and fertilization?

The examination of spouses is carried out simultaneously. Only after excluding pathology in a man is a diagnosis of infertility in a woman made.

If the initial examination does not reveal the cause of infertility, additional tests and diagnostic procedures may be needed. Sometimes the traditional battery of diagnostic tests fails to make a diagnosis for both partners. Then they resort to additional examinations, such as transvaginal ultrasound, hysteroscopy, laparoscopy, endometrial biopsy, and immunological test.

Taking into account the medical history and examination of both spouses, consultation and treatment can be prescribed not only from gynecologists, andrologists, reproductive specialists, but also from other specialists (endocrinologist, neurologist, therapist, psychotherapist).

Based on the results of the examination, a treatment method is selected for this couple:

• drug correction of hormonal and immunological disorders;
• surgery;
• a combination of surgical and medical methods;
• the use of assisted reproductive technologies (intrauterine husband or donor, in vitro fertilization with subsequent transfer of embryos into the uterine cavity).

Hormonal drugs, endoscopic methods, and IVF are modern, highly effective methods of treating infertility, which are links in one chain, the ultimate goal of which is the restoration of reproductive ability.

The IVF procedure includes several stages:

1. Ovarian stimulation. During 1 menstrual cycle, a woman matures one egg. Retrieving multiple eggs increases the chances of IVF success.
2. Receiving an egg by puncturing the follicles. The puncture is performed through the vagina under ultrasound control.
3. Fertilization of eggs with sperm in a special nutrient medium.
4. Cultivation of the obtained embryos in a special medium.
5. Transfer of embryos into the uterine cavity.

To increase the chances of IVF success, 2-3 embryos are transferred into the uterine cavity.

The success of IVF depends on many factors: the response of the ovaries to stimulation, the receipt of “high-quality” eggs capable of fertilization, the ability of sperm to penetrate the egg, the development of the resulting embryo, the readiness of the uterine mucosa to accept the embryo, attachment (implantation) to the uterine wall and further development embryo.

To date, the overall effectiveness of infertility treatment is more than 50%.

The use of modern techniques makes it possible to establish the cause in 99.6% of married couples within 2-3 months of examination and to restore fertility in 70% of couples within 12-15 months.

But, despite the available medical capabilities, the main thing is not to miss your chance to become parents and see a doctor on time! By working together you will achieve the desired result!

To achieve their goal of becoming parents, spouses require patience, mutual understanding, strict adherence to all recommendations and complete trust in the doctor. Only together with a specialist will you be able to go from the first visit to the clinic to that desired moment when your baby is born. Tatyana Yanochkina, head of the IVF department of the Health Clinic: “The main thing is not to lose heart, not to panic, if a woman stops fighting, the possibilities of medicine are limited. And no doctor will cure if the person does not want it. In addition, between the doctor and the patient There must be complete trust and mutual understanding, only then can a positive result be expected.”

Antonina Kozlova,
Ph.D., doctor-reproductologist of the Medical
center "MirA", educational program expert
"The happiness of motherhood is for every woman!"

Comment on the article "Infertility can be treated!"

A friend of mine had IVF done 5 times and nothing.... she ended up adopting and is very happy. They live happily! Although of course it’s possible to get treatment! We believe in good things

My husband and I decided to do IVF. His sperm is not normal, I have PCOS. We are from Vologda, my husband says to go to the capital, to a good, paid clinic, where everything will be done to the highest standard. My question is: does it matter in which clinic IVF is done? We are recommended IVF with ICSI. In Vologda there are also clinics where IVF is performed.

For such a responsible procedure as IVF, I came fully prepared! I studied the reviews, consulted with a gynecologist and chose Mom. Because they were one of the first in Moscow to begin to engage in in vitro fertilization. I made an initial appointment by phone, came and, to my surprise, found no queues! I strictly went to the office at the appointed time, the consultation with the fertility specialist lasted about an hour and a half! I received answers to my questions, heard a lot of new things, did an ultrasound, and heard sensible recommendations from the doctor on existing tests. The most important thing is that there is no compulsion to take tests only there and to do IVF for everyone! Now I’m preparing for the removal of fibroids, and then we’ll start preparing for pregnancy with Fazel Irina Yuryevna)

Total 15 messages .

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The factor of female infertility in 35-40% of cases is the cause of childless marriage.

The problem of infertility is a tragedy for any woman faced with it. However, successful treatment of female infertility became possible thanks to research that made it possible to learn the basic mechanisms of regulation of the reproductive system in various disorders. Treatment of female infertility has become possible, including thanks to the successes of endoscopic surgery, which makes it possible to accurately diagnose the condition of the pelvic organs and eliminate pathological changes.

Is there a cure for infertility in women?

It depends on the form of infertility and the reason that caused it. If the cause can be eliminated using conservative or surgical methods, then treatment of infertility in women will be effective and pregnancy will occur naturally.

If, despite the treatment methods taken, pregnancy does not occur, then procedures are carried out to achieve pregnancy using artificial insemination and assisted reproductive technologies. In this case, pregnancy occurs artificially. In clinical practice, in the treatment of female infertility, these methods are often used in combination. Below we will touch upon the question of how infertility is treated in women with different factors of infertility.

Treatment of tubal infertility in women

How to cure infertility in women caused by tubal obstruction?

When treating tubal infertility in women, conservative and surgical (microsurgical) treatment methods are used. Treatment of inflammatory diseases of the tubes is carried out with antibiotics, anti-inflammatory, immunomodulatory drugs. Physiotherapeutic and sanatorium-resort treatment is indicated. If there is no effect of conservative therapy for 1.5-2 years, the question of surgical treatment is raised.

The operation is indicated for complete or partial obstruction of the tubes, for saccular swellings and pathological torsions, as well as for the formation of adhesions that limit the mobility of the tubes. As a result of microsurgical operations, the pregnancy rate increases to 30-60%.

Infertility caused by endometriosis is treated with laparoscopic endocoagulation. In this case, pathological foci are removed, and the result of laparoscopy is consolidated with drug therapy. The onset of pregnancy is observed in 30-40%.

If infertility is caused by functional disorders of the fallopian tubes, then treatment is aimed at eliminating the factors that cause this disorder. In this case, psychotherapy, sedatives, tranquilizers and antispasmodics are used.

How can infertility in women be treated using PCI?

For some forms of infertility, the paracervical injection method is recommended. The effectiveness of this method is more than 90%. Injections are performed locally into the cervix, which can effectively eliminate many gynecological diseases. The PCI method is successfully used in the treatment of endometriosis, uterine fibroids, amenorrhea, pelvic inflammatory diseases, polycystic disease, and ovarian cysts. As a result of treatment with this method, the functioning of the ovaries is restored and the adhesive process regresses.

Is endocrine infertility treated in women?

Treatment of women with this form of infertility depends on the nature of the menstrual cycle and hormonal changes. Replacement or stimulating therapy normalizes the maturation of follicles, promotes the production of healthy eggs and prepares the woman’s body for pregnancy.

How to treat infertility in women with polycystic ovary syndrome? Conservative treatment in this case is aimed at stimulating ovulation, which is carried out after inhibition of ovarian function by antiestrogens. The duration of hormonal therapy is 3-5 cycles. If the ovulatory menstrual cycle has not been restored, surgical treatment is indicated: bilateral ovarian biopsy, electrocautery of the ovaries or wedge resection. Such operations are performed laparoscopically.

Is there a cure for female infertility with resistant ovarian syndrome? Hormone replacement therapy and subsequent stimulation of ovulation leads to pregnancy in some cases.

How to treat immunological infertility in women?

The immunosuppressive method of treatment (glucocorticoids) has not become widespread, although its effectiveness, according to literature data, reaches 20%. The most commonly used method for this form of infertility is artificial insemination.

Treatment of undiagnosed forms of infertility is the most difficult problem. In these cases, they resort to assisted reproductive technologies. These include:

• intrauterine insemination with sperm from a donor or husband;
• in vitro fertilization;
• intracellular injection of sperm into the egg.

How infertility in women is treated with intrauterine insemination

First, hormonal stimulation of the ovaries is performed. The maturation of the follicles is monitored (using ultrasound) and the day before ovulation, the husband’s sperm is injected into the uterine cavity using a special catheter. Insemination allows you to overcome the vaginal barrier and the cervical factor, in which during normal sexual intercourse some of the sperm die. The probability of pregnancy after insemination reaches 30%.

Despite the intensive development and successes in various medical fields, including genetics and endocrinology, obstetrics and gynecology, and assisted reproductive technologies, questions about whether female infertility can be treated, what are the most effective means of treating and preventing it are not only have not lost their relevance, but are becoming increasingly important.

In the world, the number of infertile couples averages 15-20%. Every seventh couple under the age of 35 and every third after 35 years face this problem. The steady increase in the number of infertile families in many developed countries has turned from a purely medical problem into a medical, social and demographic one. According to the World Health Organization, this problem ranks third in importance after cardiovascular diseases and cancer.

Types of female infertility

Existing classifications are based on different criteria. So, infertility is distinguished:

• primary is the absence of pregnancies in the past, despite sexual activity without the use of contraceptives;
• secondary - infertility in a woman who has had pregnancies before.

Depending on the causes, infertility is divided into the following types:

1. Absolute, when pregnancy naturally is impossible in principle due to the absence of the uterus, fallopian tubes or ovaries. This condition may be associated with previous operations or the presence of significant defects in the development of the genital organs of a congenital nature.
2. Tubal-peritoneal, or female infertility of tubal origin associated with a disorder. It is the cause in 40% of cases.
3. Endocrine, in which the cause lies in the maturation of the egg. This type also accounts for 40% of all causes.
4. Uterine, associated with reasons that prevent the penetration of sperm into the fallopian tube or the implantation of a fertilized egg into the endometrium.
5. Immunological - biological incompatibility of partners, caused by the presence of antisperm antibodies in the woman’s body.
6. Psychogenic.

Main causes of pathology

Inflammatory diseases of the pelvic organs

They are the most common cause of infertility. Inflammation is usually caused by sexually transmitted infectious agents - gonococcus, syphilitic spirochete, ureaplasma, genital herpetic virus, cytomegalovirus, gardnerella.

Infectious pathogens can contribute to the development of acute purulent inflammation in the fallopian tubes (pyosalpinx) and in the pelvis (pelvioperitonitis), requiring surgical treatment, including removal of the tubes. But more often they cause chronic inflammatory processes in the cervix (endocervicitis), in the uterine cavity (), in the fallopian tubes (salpingitis) or in the appendages (), which can often be asymptomatic from the very beginning or with mild symptoms and are difficult to treat.

Inflammation leads to the formation in the uterine cavity, in the pelvis, in the lumen of the tubes, which causes deformation and disruption of the correct anatomical location of the latter, creating obstacles for the entry of the egg into their lumen and its advancement to the uterine cavity, as well as implantation after fertilization.

Similar inflammatory processes leading to tubal obstruction can also be caused by tuberculous lesions of the pelvic organs, especially the tubes (tuberculous salpingitis). Despite the fact that there are various surgical ways to solve the problem associated with impaired tubal patency, in most cases they are ineffective.

Dysfunction of the endocrine glands

It can occur at any level of the hypothalamus-pituitary-ovary system (disorders of the regulatory function of the central nervous system after injury, encephalitis, arachnoiditis and tumors). This system, according to the feedback law, is also influenced by dysfunction of the thyroid gland (hypothyroidism and hyperthyroidism) and the adrenal cortex. Obesity or rapid significant loss of body weight are also of considerable importance - adipose tissue is an endocrine organ that takes part in the regulation of the metabolism of sex hormones.

Any endocrine disorders can lead to disruption of the maturation of eggs and follicles and to. Hormonal changes, but of a physiological nature, causing female infertility associated with the lack of ovulation, also include age-related processes in the female body. After 37 years, the number of ovulatory cycles decreases sharply. That is, a healthy woman after 37 years of age is capable of becoming pregnant, but this possibility for her is significantly reduced, since ovulation (the release of an egg from the follicle) after 37 years of age no longer occurs monthly, but once every 3-5 months.

Surgery

Surgical operations and manipulations - in the abdominal cavity (on the intestines for appendicitis, diverticulum perforation, peritonitis, tumors, etc.), on the bladder and on other pelvic organs, diagnostic laparoscopy, repeated artificial termination of pregnancy, especially surgical, repeated diagnostic curettage and other medical procedures.

Erosion and dysplasia of the cervix, the presence of an intrauterine device

All this contributes to the development of inflammatory processes and adhesions in the tubes, around them and in the pelvis, the formation of adhesions in the cervix and uterine cavity (synechia).

Congenital pathology of the anatomical structure of the uterus

Diseases of the uterine cavity:

• (especially in the corners), compressing the mouth of the fallopian tube in the area of ​​its intrauterine section;
• changes in the composition of the mucus of the cervical canal (during inflammatory processes, dysplasia, endocrine diseases), which prevents the penetration of sperm;
• endometrial polyps;
• and its appendages.

Prolonged stress and severe psychological stress

They can lead to disruption of the menstrual cycle and nervous regulation of the function of the fallopian tubes - peristalsis, mucus formation, a certain direction of vibration of the villi of the ciliated epithelium of the mucous membrane, etc.

Is female infertility curable?

First of all, anti-inflammatory treatment is carried out. It includes drugs that suppress the growth and development of infectious pathogens (after their identification), drugs that increase immune defense due to a decrease in general and local immunity during chronic inflammatory processes. Of auxiliary importance are biostimulants, local antiseptics and antibiotics, physiotherapeutic procedures - medicinal electrophoresis with enzyme and absorbable drugs, vitamin “E”, biostimulants and microelements (iodine, calcium, magnesium), electrical stimulation of the uterus with appendages, etc.

The main treatment of female infertility depends on the identified causes. It includes:

• various methods of surgical restoration of the anatomical position and patency of the lumen of the fallopian tubes; their meaning is to cut adhesions, free the fallopian tubes and fimbriae from them; such operations include salpingolysis, resection of the fallopian tube or salpingoplasty, fimbryolysis;
• treatment and/or correction of hormonal disorders;
• stimulation of ovulation according to certain schemes with drugs such as clomiphene citrate or Clostilbegit, Pregnyl or human chorionic gonadotropin, Menogon or Puregon, etc., with the further addition of Utrozhestan, Duphaston or Crinone (progesterone drugs);
• treatment of cervical dysplasia, myomatosis, polyposis;
• prescription of psychotherapeutic drugs, etc.

• hormonal stimulation of ovarian function;
• collection of eggs matured to the required degree;
• special preparation of sperm taken on the day of egg retrieval or pre-frozen;
• the stage of laboratory cultivation of eggs, which consists of their isolation from the follicular fluid, quality assessment and preparation for fusion with sperm;
• the process of direct fertilization, which is carried out either by adding a portion of sperm to the egg, or by introducing sperm into it using a microsyringe; the result is assessed the next day;
• culturing the fertilized egg in an incubator for two or more days;
• transfer of embryos using a catheter into the fundus of the uterus.

In vitro fertilization is considered the most complex and costly, but the main and most effective (30-35%) for many types of female infertility. Even if a positive result cannot be achieved from the first procedure, it can be repeated several times.

Since ancient times, it has been believed that one of the most important and main missions of a woman on the planet is to give new life. Genetically, the fair sex has a maternal instinct from birth, which develops with age, takes root and waits for the time when the girl, in soul, body and mind, is ready to carry a baby under her heart and soon become a mother. And now this time has come, when you have established yourself as a person, have a loved one, financial stability, tests are done one after another, but you can’t get pregnant.

Then couples, as a rule, go to clinics, undergo a series of tests, check sexual compatibility with each other, undergo examinations, and then, out of the blue, one of the partners hears that he is infertile. Such news is always shocking, perplexing, and you want not to believe what you hear.

Today we will talk about female infertility, since it occurs half as often in women. This diagnosis is usually made if, after a year or more of regular sexual activity without protection, pregnancy does not occur, as well as in the case of physiological disorders in the structure of female internal organs.

According to scientists, approximately 17% of families around the world have encountered a similar diagnosis, which suggests that the question of the accuracy of medical reports has remained open for many decades. Therefore, do not rush to ruin your marriage, give up your dream of creating a full-fledged family and hear the long-awaited word - Mom.

Causes of female infertility

These factors are the most significant for the development of such a diagnosis as infertility. But in turn, the “disease” itself is divided into several types, which may entail additional causes and consequences.

Types of infertility in women

Under each type hides the magnitude and scale of pathologies, in comparison of which you can understand the true cause of the existing problem, as well as try to find ways to solve it.

First degree - primary

The woman has a permanent partner, intimacy is regular, not protected, but the conception of a child does not occur. Also, before this, she could have had one or more partners with whom she had penetration without a condom with ejaculation inside, without subsequent pregnancy.
In this case, if you consult a specialist, gynecologist or reproductive specialist, you can choose a technique that can help. These could be special medications that cause continuous ovulation, or recommendations from traditional medicine. In more than 80% of cases at this stage, the problem can be resolved and eliminated.

Second degree - secondary

With this type, the woman became pregnant and gave birth successfully, but subsequent attempts to become pregnant did not end in success. In this case, luck is 50/50; there may be a chance of conception or completely absent for a number of reasons.

Endocrine (hormonal) infertility

These are a variety of menstrual disorders:
- prolonged, heavy menstruation for more than 7 days;
- too short, spotting discharge during menstruation lasting one to two days;
- complete absence of menstruation, and therefore ovulation.

Uterine infertility

Infections, inflammations, tumors in the organ, cysts, fibroids, polyps, erosions are often factors preventing pregnancy. They can be diagnosed by your doctor or using ultrasonic diagnostics. In cases where the disease does not reach a critical state, it can be cured and the desired can be achieved.

Infertility of psychological type

Wild reluctance, fear of being a mother, strained relationships and frequent conflicts with a sexual partner (negative impulses in the brain can affect the functioning, maturation and development of eggs).

Infertility of unknown type

In the case when any of the previous types is excluded, and the cause of the problem cannot be found out. All indicators of tests and examinations are normal for both partners, as well as high compatibility, but pregnancy has never occurred. This type occurs in 3% of diagnoses.

Very often, when drug treatment does not produce results, couples come to alternative or folk medicine, where there can be a variety of types and ways to help find a way out, including special massages in the woman’s pelvic area. Previously, this type of treatment was carried out by old healers and healers; the technique was also relevant in the last century in the post-war period, but the question remains in demand today. Therefore, let's talk in more detail about traditional methods of treatment.

Treatment of infertility with folk remedies

Carrot juice

It has been scientifically proven that carrot juice can increase the level of female hormones, therefore, if the cause is a small amount of estrogen, it is enough to drink 50 ml of fresh juice daily for 1-1.5 months.

Sage

The Greek Gods called Sage a holy plant and classified it as one of the phytohormones, and their role and function are similar to female hormones. It is able to enhance libido, increase contractions of the uterine walls, this will help sperm quickly reach the meeting point with the egg. To do this, you need to take an infusion from the seeds of the plant (0.5 tsp per glass of boiling water) 40 minutes before meals - a month. You can also sprinkle the dry plant on food or add it to tea.

Not so long ago, doctors began to recommend that women with the problem we are talking about today drink the juice of a fresh sage plant. Namely, in this way: pour 250 ml of boiling water into one teaspoon of juice and take 10 milliliters twice a day, for 11 days, starting the first dose immediately after the end of menstruation, so that before ovulation, the body has time to saturate itself with the required amount of phytohormone.

The main thing in this technique is to strictly adhere to the dose; in case of an overdose, serious allergic manifestations, as well as intoxication, can occur.

Plantain

Pour a tablespoon of plantain seeds into a glass of boiling water and leave to simmer for 10 minutes, then cover and leave for an hour and a half, then strain. Divide the dose into 4 times a day, 30 ml each, starting from the first days of menstruation and without a break until the next menstruation; you can repeat the course after 2 months.

Nettle

Pour 90 grams of not completely dried plant seeds with 750 milliliters of fortified wine, preferably homemade, and boil over very low heat for 45-40 minutes, filter, pour into a dark container and into the refrigerator. Take 45 milliliters warm immediately before bed, from three months to six months without a break.

Geranium essential oil

You can buy it at the pharmacy. Add three to four drops of oil and 5 ml of liquid honey to warm, boiled water in a volume of 100 ml, drink three times a day for 21 days.

Also, geranium serves as an aphrodisiac, increases sexual desire and prevents the development of vaginitis and thrush.

No matter how funny it may seem, healers claim that consuming such a familiar product as honey every day helps eliminate infertility. The recommended dose is 100-250 ml per day, based on the woman’s body weight.

Uterus hogweed

Finely chop 50 grams of herb, pour half a liter of vodka, leave for 14 days in a warm place. After meals, 20 drops 4 times a day. Course 1-3 months.

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