Signs of infertility in girls at an early age, early diagnosis, methods of treatment and prevention - articles on health

Obstetrician-gynecologist, reproductive specialist, member of the Russian Association of Human Reproduction

Perevoznikova

Ekaterina Mikhailovna

11 years of experience

Obstetrician-gynecologist

Make an appointment Author of the article: Ekaterina Mikhailovna Perevoznikova, Obstetrician-gynecologist, reproductive specialist, member of the Russian Association of Human Reproduction

In medicine, infertility is the inability of an adult at reproductive age to reproduce. This factor negatively affects the social and psychological adaptation of people, affects health and quality of life.

Infertility – is it worth fighting?

If a married couple has not conceived after a year of regular sexual activity without the use of contraceptives, it is necessary to contact a specialist for examination. This fact in itself does not mean that one of the spouses is infertile; doctors in this case talk about a temporary inability to conceive a child. In most cases, this problem is successfully solved. For this purpose, modern fertility clinics have been created, which practice well-proven methods of treating infertility.

Doctors distinguish between relative and absolute infertility. The first type includes cases in which it is possible to identify and eliminate the causes of disorders in the patient’s body. Absolute infertility refers to irreversible physiological changes in the reproductive system (anomalies in the development of the pelvic organs, traumatic injuries, surgical removal of the gonads).

Infertility is also divided into primary and secondary. In case of primary infertility, there is no history of pregnancy at all, although regular sexual activity occurs without any means or methods of contraception. They speak of a secondary pregnancy if there has been at least one pregnancy (regardless of how it ended: childbirth, abortion, miscarriage, ectopic pregnancy).

Contrary to popular belief, infertility affects both women and men equally. That is, the quantitative ratio of infertile patients of each sex is approximately the same. The position when one partner places the blame on the other is absolutely wrong. Firstly, it creates strong psychological pressure, which only aggravates the situation. Secondly, a solution to the problem is possible only if the spouses have full mutual support. Thirdly, there are often precedents when treatment is necessary for both partners.

Stressful conditions

In the life of any person there are plenty of situations when the body suffers from overwork, lack of sleep, nervous exhaustion. The only way out of this state is rest, but only proper, high-quality rest. If you neglect this, you can not only get infertility, but also a number of other health problems.

Sometimes it is impossible to relieve stress simply by resting, then you need to consult a doctor. It is important to understand that a stressful situation drives you into a vicious circle. Stress - hormonal surge - deterioration of the condition - even more stress and nervous exhaustion.

Symptoms and causes of infertility

First, we need to make a reservation that, due to physiological differences, infertility is divided into male and female. Accordingly, the causes, diagnosis and treatment methods differ.

Female infertility is more multifaceted than male infertility. After all, a woman’s body must not only produce an egg, but also create conditions for conception and the normal course of pregnancy. Any, even minor, malfunction of the female reproductive organs can significantly complicate conception. Among the main causes and signs of infertility in women are:

• problems with ovulation;
• hormonal problems;
• ovarian dysfunction;
• damage to the fallopian tubes, adhesions;
• polycystic ovary syndrome;
• hormonal imbalance;
• scars on the lining of the ovaries;
• cervical erosion;
• early menopause;
• disorders in the cervical canal;
• defects in the development and structure of the uterus;
• psychological reasons;
• endometriosis;
• unruptured follicle syndrome.

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The most common causes include the following violations.

Obstruction or absence of fallopian tubes

It is in them that the meeting of the egg and sperm occurs, their fusion and the formation of an embryo, which then enters the uterus. Obstruction develops mainly due to the formation of adhesions (sticking together of the walls) of the pipes as a result of their inflammation. Rarely, adhesions can be caused by sterilization, in which the fallopian tubes are ligated or crossed. The absence of a tube may be due to its surgical removal, performed for vital indications (local purulent process, ectopic pregnancy).

Adhesions in the pelvic area

They occur after inflammatory processes, endometriosis, and surgical interventions. The adhesion can envelop the ovary or be localized between it and the tube, making it impossible for the egg to pass through.

Endometriosis

This is the name of a disease in which the mucous membrane of the uterus (endometrium) grows beyond its boundaries. Foci of growth are formed, and adhesions arise between them, interfering with the fertilization process.

Endocrine, also known as hormonal disorder

Endocrine disruption is observed in diseases of the ovaries, thyroid gland, pituitary gland, hypothalamus, adrenal glands, kidneys, and liver. It can be caused by metabolic disorders or severe mental stress or a shock situation.

Psychogenic infertility

Arises as a psychological reaction to not wanting pregnancy. A woman may consciously or unconsciously experience fear of childbirth or possible changes in appearance due to pregnancy. Sometimes the reason is the reluctance to conceive with this particular partner.

Immunological infertility

Occurs when there are antibodies to sperm in the female body, which interferes with the fertilization process. Under the influence of antibodies, sperm become inactive, making it difficult for them to pass through a woman’s body.

Age - after 35 years, the chances of conceiving decrease!

Nowadays, so-called “late births” have become popular, when the first child appears after 30 or even 35 years. However, at this age the possibility of getting pregnant is significantly reduced. The risk of having a baby with chromosomal abnormalities also increases. From a material point of view, it may not be bad that a woman gives birth when she is already mature. But nature has established the optimal age for the birth of the first child - 19-25 years. It is during this age period that strong, healthy children are most often born, and a woman quickly recovers after childbirth.

There are 3 reasons for age-related infertility:

• Decreased ovarian reserve
  . At birth, a woman is given a certain number of eggs; when the reserve is exhausted, she becomes infertile.
• High risk of recurrent miscarriages
  . With age, toxins accumulate in the body, the immune system weakens, metabolism is disrupted, all this leads to disturbances in the formation of germ cells. Nature has laid down a program in which most of the embryos with abnormalities die in the very first stages and are born as miscarriages. The patient may not even know that heavy periods mean an early miscarriage.
• Possibility of early menopause
  . Every 10th woman experiences menopause before the age of 40.

Causes and signs of infertility in men

In men, infertility is manifested by one single symptom - the inability to conceive. Unlike women, symptoms of male infertility practically do not appear. This fact gave rise to the myth that men suffer from infertility much less often than women. The key factors causing infertility in men are:

• sperm deficiency (impaired sperm motility and viability);
• a sharp decrease in their number;
• complicated movement of sperm along the vas deferens and their release out.
• The causes of male infertility can be:
• varicocele;
• congenital abnormalities of the reproductive system (hypospadias, absence or obstruction of the vas deferens);
• isolated disturbances in seminal fluid;
• infectious and inflammatory diseases of the genitourinary system;
• surgical intervention (grooval hernia, hydrocele, bladder surgery, etc.);
• systemic diseases (liver cirrhosis, tuberculosis, diabetes, infectious mumps with complications of orchitis, chronic renal failure);
• sexual and ejaculatory disorders;
• psychogenic factors;
• necrozoospermia;
• obstructive azoospermia;
• endocrine (hormonal) disorders.

Additional reasons include: alcohol and nicotine abuse, exposure to radiation, and scrotal injury. Working in difficult and harmful professional conditions, for example, at too high or low temperatures, or in a toxic environment, has a negative impact on reproductive function. Separately, there are factors that can provoke a decrease in sperm count: stress, poor nutrition (lack of proteins and vitamins in the diet), chronic lack of sleep.

Classification of sperm pathologies

Regardless of what exactly caused infertility in a man, its mechanism can always be determined using a spermogram. The following sperm pathologies are distinguished:

• Azoospermia – sperm (ejaculate) does not contain sperm. It is divided into secretory and obstructive forms. In the secretory form, the testicles do not produce sperm; in the obstructive form, ejaculation is impaired due to obstruction of the vas deferens.
• Oligozoospermia – low number of sperm in the ejaculate (normally no less than 15 million/ml).
• Oligospermia – small sperm volume (norm – at least 1.5 ml).
• Anejaculation is the complete absence of sperm.
• Asthenozoospermia – sperm are not motile enough.
• Necrospermia - the ejaculate does not contain living sperm.
• Teratozoospermia is a disorder of the structure of sperm.

Infertility of unknown origin

Occurs in patients of both sexes. This is the name for a situation when, after a thorough diagnosis of the spouses, no causes of infertility are found. According to doctors, the couple is absolutely healthy, but conception does not occur. This diagnosis is explained by the fact that modern diagnostics are still not able to identify absolutely all the causes of pathology of the human reproductive system. Often, instead of an unclear genesis, another cause is mistakenly determined, and accordingly, measures to eliminate it do not bring the desired result.

Sometimes the cause of infertility of unknown origin is determined by the incompatibility of partners at the biological or immunological level. This is confirmed by situations where spouses were unable to conceive for many years, and after a divorce, each of them soon had children in new families.

Metabolic disorders

The problem of excess weight and its deficiency negatively affects the fertility of women. Moreover, deviations from the physiological norm of BMI 18-24 indicate existing problems with metabolism in the body. It cannot be said that all overweight girls are infertile. But obesity is one of the factors that causes hormonal imbalances, which result in diseases such as diabetes mellitus, polycystic ovary syndrome, and endometrial hyperplasia. It can cause disruption of menstrual cycles; the risk of disruption of the endocrine system increases and may even subsequently contribute to the development of cancer.

Lack of weight is also considered as a factor that can potentially cause infertility. A woman's adipose tissue plays an important role in the metabolism of a number of hormones and produces more than twenty bioactive substances involved in metabolic processes. Like severe obesity, lack of body weight often becomes one of the causes of anovulation (lack of release of an egg), which makes pregnancy impossible.

Metabolism is closely related to the endocrine system. To restore normal body weight and stabilize metabolic processes, sometimes it is not enough to adjust nutrition and physical activity. It is necessary to establish the cause of the imbalance and undergo a course of treatment.

Infertility diagnostics, examinations and tests

As with any other disorder, high-quality diagnosis of male and female infertility is the key to successful treatment. It is extremely important that the procedure for diagnosing infertility is carried out on both partners. First, you need to do blood tests for hormones, tests to detect infections, and an ultrasound of the pelvic organs.

Examinations for infertility in women

The following methods are used to diagnose infertility in women:

• A gynecological examination under ultrasound control is the first stage of examining a woman, allowing her to assess the size and establish the structural features of the uterus and ovaries, identify ovarian cysts, fibroids and other pathologies of the pelvic organs.
• Hysteroscopy is an examination used to more accurately examine the uterine cavity, making it possible to detect abnormalities that were not diagnosed during a routine examination and ultrasound.
• Hysterosalpingography is a method designed to determine the patency of the fallopian tubes; it is based on the introduction of a contrast agent into the uterus, after which a series of images is taken.
• A blood test for hormones is carried out to determine the function of the ovaries and endocrine system.
• Laparoscopy is both a diagnostic and therapeutic procedure. During laparoscopy, the doctor has the opportunity to see an enlarged, clear image of the pelvic organs on the screen. If the causes of infertility are discovered, the specialist can eliminate them directly during the procedure: remove ovarian cysts, adhesions, and foci of endometriosis.
• Basal temperature chart - compiled by the patient independently over 2-3 menstrual cycles, used to assess ovulation.
• Ultrasound monitoring of the process of follicle maturation and ovulation is prescribed at the discretion of the doctor as an additional examination.

Diagnosis of infertility in men

Just like a woman, a man must undergo general clinical tests, do a blood test for hormones, and undergo examinations aimed at detecting infection. An ultrasound of the scrotum and prostate gland is prescribed, during which they are examined visually.

In the process of diagnosing male infertility, the main point is to determine the fertility of sperm, that is, the ability to fertilize. The key analysis at this stage will be a spermogram. This is a complete detailed analysis of sperm, which examines its physical parameters, chemical and cellular composition. The examination allows you to find out the following characteristics:

• sperm concentration (must be more than 15 million per 1 ml);
• their mobility (over 40%);
• the number of normal forms of sperm (at least 4%);
• viability (more than 58%);
• ejaculate volume (1.5 ml or more);
• total number of sperm (39 million or more).

In addition to these indicators, be sure to pay attention to the color of the sperm, color, smell, acidity, and white blood cell content. The spermogram also determines the presence or absence of antisperm antibodies produced during the immunological form of infertility - MAR test.

To take a spermogram, the patient must adhere to several medical requirements. For two weeks before the test, you should not drink alcohol, take antibiotics, or visit a sauna or bathhouse. You need to abstain from sexual intercourse for 4-7 days.

Often, simultaneously with a spermogram, an analysis of sperm maturity (SVA test) is performed. The test determines the binding of sperm to hyaluronic acid, an important component of the environment surrounding the egg. This parameter is extremely important for fertilization. A mature sperm usually connects with hyaluronic acid with special receptors, while an immature one is not able to connect. Normally, sperm maturity should be 60% or higher, otherwise conception through natural means is impossible.

As an additional examination, the doctor may prescribe a testicular biopsy, which allows you to find out the presence of sperm and the condition of the tissues. This procedure can also be used for therapeutic purposes.

Disorders of the ovarian-menstrual cycle

The regularity of menstruation is an important indicator of women's health. Any delays, changes in the duration of menstruation, or increased pain indicate a problem. Girls are recommended to keep a calendar of menstruation, which will mark the dates of their beginning and end. If the regularity and cyclicity of menstruation is disrupted, you should immediately contact a gynecologist for consultation.

The physiological norm for the duration of the menstrual cycle is 28 days. The onset of menstruation is the first day of a new cycle. The next menstruation should begin in 28 days. This schedule is observed in approximately 60% of women of reproductive age.

Due to the individual characteristics of the female body, the duration of the ovarian-menstrual cycle may differ from the generally accepted norm. But it should not be shorter than 21 days and longer than 42 days. These are the extreme points of the range of a non-pathological cycle, provided that it is constant. You must inform your gynecologist about any deviations from the physiological norm.

Which doctors treat infertility?

The field of medicine that deals with the diagnosis and treatment of infertility is called reproductive medicine. Treatment of men is carried out by andrologists, women – by gynecologists. Also involved in the treatment process are:

• embryologists – determine the fertilization method
• endocrinologists – study hormonal levels;
• hematologists – study blood counts;
• immunologists - I find out immune factors;
• ultrasound diagnostic doctors;
• geneticists - perform early diagnosis of chromosomal disorders.

One of the key factors for successful treatment will always be the qualifications of the attending physician. A true professional does not stop his education throughout his entire work experience, follows new techniques, and strives to use new technologies. Pregnancy and the birth of a child is a responsible step, so you should not skimp on the services of competent doctors. The specialists of JSC “Medicine” have dedicated themselves to the fight against infertility and have already helped many families find family happiness.

Recommendations

To quickly cope with infertility of any degree, before a woman is past fertile age, it is recommended:

• go for medical examinations, take tests to check your health status;
• exclude alcoholic drinks, cigarettes;
• do not take medications on your own, especially if it is oral contraception;
• Do not stay in the sun for a long time, in baths, solariums. For some categories of patients, thermal procedures are generally prohibited;
• be physically loaded for normal blood circulation in the pelvis, but do not overload;
• learn to cope with stress. Stress reactions disrupt hormonal levels and contribute to menstrual dysfunction;
• eat rationally;
• protect against infections and treat them in a timely manner;
• Do not delay visiting a doctor if unpleasant symptoms appear.

Treatment methods for male and female infertility

Infertility treatment tactics are determined by a fertility specialist based on the patient’s medical history and the results of a comprehensive diagnosis. Treatment methods are divided into traditional (medicinal, surgical) and assisted reproductive technologies (ART). It should be understood that in the process of treating even one of the partners, the second partner also takes a direct part. Therefore, the methods of treating female and male infertility described below are relevant for both spouses.

Treatment of female infertility

The treatment method is determined by the cause of the pathology. Drug treatment is used:

• for endocrine infertility, it is based on taking medications containing hormones (urinary or recombinant gonadotropins, Clomid);
• infertility caused by infectious diseases (antibiotic therapy: metrogil, metronidazole, ofloxacin, ciprofloxacin and other drugs);
• immunological infertility (antihistamines and corticosteroids are prescribed).

Surgical treatment methods are effective for pathologies of the fallopian tubes and uterus. We are talking about minimally invasive operations that cause minimal harm to the patient. They are carried out in a hospital setting, but the rehabilitation period is short – 3-5 days. Surgical methods include laparoscopy and hysteroscopy.

Do not forget about such an important factor as the psychological state. According to statistics, about 30% of infertility problems are caused by psychological factors affecting the patient - stress, shock, etc. Psychologists and psychotherapists successfully combat this problem.

Assisted reproductive technologies in women

If traditional treatment methods are ineffective, then ART is resorted to. There are many reproductive technologies:

• planned sexual intercourse;
• artificial intrauterine insemination;
• in vitro fertilization (IVF);
• oocyte donation;
• sperm injection into the egg (ICSI);
• surrogacy.

Intrauterine insemination is based on the introduction of sperm into the uterus artificially, using a catheter. Then everything happens naturally: sperm move towards the egg through the fallopian tubes and fertilization occurs. A prerequisite is the integrity of the fallopian tubes. Insemination is possible with both the partner’s sperm and the donor’s sperm. The method is effective in case of reduced fertility of the spouse (low number or absence of sperm, their weak mobility), as well as if a single healthy woman desires pregnancy.

In vitro fertilization (IVF) involves fertilizing an egg in a laboratory, obtaining embryos and transferring them to the uterus - this is a standard technology. It is possible to carry out IVF using a donor egg or donor sperm. The IVF method consists of several stages, quite extended over time. This is a complex but effective technique, it is performed by experienced reproductologists.

Classification, reasons

First degree infertility is said to exist if a woman has never been pregnant. It is also known as “primary sterility”. In this case, infertility can be absolute, when it is impossible to conceive a child naturally, and relative, when, having eliminated the cause, pregnancy is possible.

The following can lead to the disease:

• congenital anomalies in the structure of the reproductive organs, making pregnancy impossible. This is an irregular shape, size, disproportion, unusual location, developmental delay. For example, bicornuate, double, saddle-shaped uterus, absence or fusion of the vagina (aplasia and atresia), stenosis, hypo- or hyperplasia;
• unclear genesis of infertility (idiopathic), when a woman and her partner are reproductively healthy, but it cannot be established why conception does not occur;
• ovarian dysfunction (30%), impaired production of gonadosteroids;
• anovulation;
• obstruction of the oviducts (fallopian tubes), their absence, sterilization (ligation);
• endometriosis, adhesions;
• menstrual dysfunction, amenorrhea;
• combined form of first degree infertility, when 2-3 pathological criteria are present.

The disease can be provoked by inflammatory processes of the genitourinary system, autoimmune diseases, obesity, stress, radiation, bad habits, injuries to the reproductive organs, cancer, and incompatibility of spouses.

Treatment of male infertility

When treating the secretory form of male infertility, if possible, they strive to eliminate the cause - varicocele, hydrocele, mumps, elimination of an unfavorable factor. After eliminating the cause, a course of therapy is carried out aimed at improving the spermatogenic function of the testicles - drug therapy comes into play. The course includes taking medications that stimulate blood supply to the scrotum, vitamin therapy, good nutrition and adherence to the regimen. Sometimes stimulating hormone therapy is required. Treatment of this form is a long and painstaking process, but not hopeless, so the patient should be patient.

Treatment of obstructive infertility in men is based on performing different types of biopsies - surgical extraction of mature sperm from the testicle and its appendages. For this purpose, special testicular biopsy techniques have been developed: using puncture (testicular tissue - TESA, appendage tissue - PESA) and small incisions (TESE and MESE, respectively). The rehabilitation period after a biopsy is 10-12 days, during which physical activity, sexual intercourse, and increased physical activity are contraindicated.

Cost of initial appointment and examinations

You need to understand that the total price of the initial appointment and examinations is formed as the diagnosis progresses. For some patients, a few tests are enough to determine the cause of the disease, while others may need additional examinations. Sometimes diagnosis takes a fairly long period, but the result - pregnancy - is worth the effort and money. You can get an approximate picture of the cost by reading the table of prices for services. But the best decision would be to make an appointment at JSC “Medicine” (academician Roitberg’s clinic), where, during a conversation with qualified doctors, the most accurate total cost will be determined.