For many married couples, the issue of having a baby sooner or later becomes relevant. According to general statistics for the countries of the former CIS, among couples who decide to have a child, in 30% of families pregnancy occurs in the first three months, in 60% - within 7-10 months, in the rest - within a year. In the medical field, the average normal period during which a woman in a healthy married couple becomes pregnant is considered to be exactly one year. If, in the absence of protection, a man and woman are unable to have a child, this is a reason to contact a fertility specialist.
Can childbirth be natural after IVF?
IVF does not affect the birth process in any way. The method of delivery depends on the woman’s age, her state of health, the course of pregnancy, and the characteristics of the baby’s intrauterine development. Indeed, patients after IVF often undergo a cesarean section, but this is explained by the fact that reproductive technologies are mainly used by women of mature age or those with health problems, which are an indication for a cesarean section.
Ignorance creates fears, stress, problems. Don’t be afraid to ask questions to your fertility doctor: only a specialist will be able to give a competent, competent answer and resolve any doubts that may arise!
All information is for informational purposes only. If you have any health problems, you need to consult a specialist.
Who is a reproductologist, gynecologist-reproductologist, endocrinologist-reproductologist
Reproductology is a subsection of gynecology, a medical science responsible for the health of the female reproductive system. A related field is obstetrics, the science of managing pregnancy and childbirth.
Content:
- Who is a reproductologist, gynecologist-reproductologist, endocrinologist-reproductologist
- What does a fertility doctor do?
- Organs treated by a reproductive gynecologist
- Diseases and pathologies that are the doctor’s specialty
- In what cases and for what symptoms should you consult a doctor?
- Methods of examination and treatment used by a gynecologist-reproductologist
- Recommendations from a reproductive specialist for conceiving a healthy baby
A doctor who has received a higher specialized education, completed residency training and practice in the relevant specialization, and has successfully passed the final exam in the specialty “obstetrics and gynecology”, receives a doctor’s certificate with the right to manage pregnancy and childbirth, as well as treat problems of women’s reproductive health. However, the entire field of gynecology and obstetrics is very voluminous, so doctors generally choose a narrower field for themselves and specialize in it. That is why there are such specialists as a gynecologist-endocrinologist, a gynecologist-reproductologist, and an obstetrician-reproductologist. In general, all reproductology combines the theory and practice of such branches of medicine as gynecology, endocrinology, and andrology. A reproductive gynecologist is a doctor who deals with cases of inability to conceive a child caused by health disorders in women, while disorders of male sexual health are the area of expertise of an andrologist, who can also specialize in reproductive medicine. A reproductive endocrinologist can deal with infertility problems caused specifically by disorders of the endocrine system.
Quite often, in medical institutions, an appointment is conducted simply by a reproductive specialist who helps both men and women cope with infertility.
In what cases and for what symptoms should you consult a doctor?
First of all, the reason for visiting a doctor is the inability to conceive a child. This is true if a woman does not become pregnant within a year without using contraception without obvious reasons, provided that she has no problems with the onset of ovulation, the cycle is constant, and sexual activity is regular with the same partner.
In addition, it is imperative to consult a doctor if previous pregnancies ended in miscarriage or fetal death. Symptoms that require you to visit a fertility specialist are:
- irregular or absent menstrual cycle;
- hormonal imbalances;
- abnormal development of the uterus;
- primary infertility syndrome;
- symptoms of sexually transmitted diseases (characteristic rashes, itching, inflammatory processes).
You should also consult a doctor if your partner experiences premature ejaculation or abnormalities in the spermogram (low concentration or poor sperm motility).
A gynecologist-reproductologist usually sees patients in hospitals, antenatal clinics, specialized medical institutions and clinics.
Diseases and pathologies that are the doctor’s specialty
A reproductive doctor is the very specialist who must help a man and woman achieve the desired result - conceiving a child.
There are many reasons why conception without minimal medical intervention becomes difficult or impossible. Basically, these are pathologies and diseases, as well as the consequences of past illnesses or injuries. Among them:
- anovulatory cycle, other menstrual irregularities;
- adhesions in the fallopian tubes;
- oncogenic factors of human papillomavirus; pathological processes in the uterus (infectious, inflammatory, oncogenic and others);
- sexually transmitted diseases that cause infertility;
- consequences of abortion, curettage;
- congenital anomalies of the development of the genital organs, affecting the possibility of conception;
- genital and extragenital endometriosis;
- deformation of the fallopian tubes;
- cytomegaly, polycystic ovary syndrome, bacterial vaginosis.
If the cause of fertility disorders is hidden, for example, in the functioning of the endocrine system, the gynecologist-reproductologist sends the patient to an endocrinologist if he himself cannot examine and treat them.
Bottom line
Until recently, infertile couples were deprived of the chance to have their own child: they were offered adoption. Modern medicine has made great progress in matters of reproduction and artificial insemination. Now every married couple can become happy parents, thanks to reproductive technologies. Infertility is treatable, and in extreme cases, a woman will be offered IVF.
What hormonal medications did you take to stimulate ovulation?
- Gonal 34%, 5080 votes
5080 votes 34%5080 votes - 34% of all votes
- Clostilbegit 25%, 3685 votes
3685 votes 25%
3685 votes - 25% of all votes
- Menopur 17%, 2532 votes
2532 votes 17%
2532 votes - 17% of all votes
- Puregon 14%, 2090 votes
2090 votes 14%
2090 votes - 14% of all votes
- Decayed 8%, 1144 votes
1144 votes 8%
1144 votes - 8% of all votes
- Menogon 3%, 438 votes
438 votes 3%
438 votes - 3% of all votes
Total votes: 14969
Voted: 11041
January 17, 2018
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Long-awaited recognition
– You recently became the first reproductive doctor with an academic title. What does this mean to you?
– This means that our profession, our young specialty, has received recognition at the highest academic level... I hope I managed to live up to the hopes of my wonderful teachers.
– How long have you been in this profession?
– 27 years and 7 months. During this time, my patients gave birth to hundreds of children. I also have other children - my students, who have become very good reproductive doctors and of whom I am very proud. What could be more beautiful?
"I wish you happiness!"
Finally! We are going down to where we dreamed of going most. To the embryology laboratory. We will witness the process of how a little life is born in a woman.
Everything is very serious here. Before we even crossed the threshold of the laboratory, we were immediately put on shoe covers and surgical gowns. We are passing the red line, which means that there is a zone of complete sterility ahead. On top of one robe they put another one on us and another shoe covers on our feet, as well as a cap, a mask, and we definitely need to wash our hands with a disinfectant solution. But even after all these precautions, we are allowed to observe the embryo transfer procedure through a monitor without meeting the patient. Medical ethics, you can’t argue with it. Patient comfort is valued above all else here.
Photo: Tatyana Begaikina
The implantation procedure itself takes only a few seconds. But they are so exciting. We watch on the monitor how first one dot appears, then another. It's twins! The patient herself decided to transfer two embryos at once. She has no contraindications for carrying twins, so the doctors did not interfere with her desire.
Photo: Tatyana Begaikina
We only caught a glimpse of the patient in the hallway. Sholpan Kenesovna hugged her and said:
– I wish you great happiness! Go calmly and don’t even think about coming back!
The doctor returned to the laboratory, sat down on a chair, closed her eyes and sat in absolutely silence for several minutes. But we did not dare to disturb her. We just waited. Maybe she's just tired. Such a frantic pace of work can knock anyone off their feet. But it still seemed to me that at that moment she was talking to God. Maybe she asked the Almighty that everything would turn out well for her patient, who in a few hours would board the train and leave for her distant city. Who knows…
Sholpan Kenesovna opened her eyes and smiled:
- Well, now you can take pictures. Just make it quick, okay? We don't have much time.
We rejoice quietly...
Sholpan Kenesovna's working day begins at eight, but it ends... as it turns out. The administrative duties of the director take up time, but she can no longer live without her patients. From the threshold of the clinic we are warned that all photographs of patients can only be taken with their consent. Not all patients agree, but we understand this. It is not customary to talk about a diagnosis such as infertility out loud. Therefore, we have changed the names of all patients in the article.
The doctor tries to arrive at the clinic early in order to have time to drink a cup of coffee and discuss important issues with colleagues and management. But if there are already patients sitting in the corridor, the coffee will remain unfinished on her table...
Just like this time. It's a quarter to eight. First patient today. We are allowed to attend the reception.
- Hi dear! How are you? – Sholpan Kenesovna gets up from the table and hugs the girl who entered the office. From the outside it seems that this is her close relative, friend or good acquaintance. But no, this is her patient. - Show me. – The doctor picks up the papers and hugs her again. Even stronger. - Everything worked out. We succeeded. Only we rejoice quietly, okay? Happiness, it loves silence. Come on, I'll take a look at you.
Photo: Tatyana Begaikina
Natalya had a difficult case of infertility. She is 38 years old, of which the last three years have been spent in unsuccessful attempts at in vitro fertilization. One of which, by the way, was in a foreign clinic. Tears, depression, another attempt - and a miracle happened... Now we can talk about this with peace of mind, because three months have passed since that appointment and Natalya’s pregnancy is proceeding without complications. The dangerous period is over.
– Sholpan Kenesovna, thank you! – Natalya’s voice is trembling.
- Silly girl, why are you crying? You need to be happy. Just be quiet, remember, right? – Sholpan Kenesovna accompanies the girl to the door and hugs her goodbye again.
Photo: Tatyana Begaikina
Organs treated by a reproductive gynecologist
The scope of this doctor’s competence includes the woman’s organ system, which is responsible for the reproduction of offspring, namely:
- uterus and fallopian tubes;
- vagina;
- Cervix;
- ovaries.
If a thorough examination of a male partner is necessary, the doctor refers him, for example, to a urologist or andrologist, who study the state of his reproductive system:
- penis;
- testicles;
- spermatic cords and seminal vesicles.
Where to get training
In addition to higher education, there are a number of short-term training on the market, usually lasting from a week to a year.
The Medical University of Innovation and Development invites you to take distance courses for retraining or advanced training in the field of “Obstetrics and Gynecology” to obtain a diploma or state certificate. Training lasts from 16 to 2700 hours, depending on the program and your level of training.
The Institute of Professional Education "IPO" invites you to take distance courses in the field of "Midwifery" (there are options 256, 512 and 1024 academic hours) to receive a diploma or state-issued certificate. We have trained more than 8,000 graduates from almost 200 cities. You can undergo external training and receive interest-free installments.
How is diagnostics performed for women?
During the interview, the doctor asks about age, date of first menstruation, cycle length, symptoms accompanying ovulation and menstruation, family diseases, history of inflammation, diseases and operations. Subsequent diagnosis depends on the medical history:
- In women with irregular menstruation, the cause of the irregularity is determined by evaluating images of the ovaries using ultrasound. Additional tests for progesterone concentration are also carried out 7 days before the expected menstruation.
- In women with amenorrhea, the levels of prolactin, LH and FSH are checked; in case of hyperprolactinemia, magnetic resonance imaging is performed.
- In women who have regular menstruation but are late in their reproductive years, after ovarian surgery or advanced endometriosis, FSH levels are checked on day 3 of the cycle to assess ovarian reserve.
To assess the anatomical state of the reproductive organs, ultrasound, laparoscopy, and hysteroscopy are used. Studies help determine the presence of blockage of the fallopian tubes or adhesions, inform about the shape of the uterine cavity and changes in it (septum, fibroids), etc.
Sperm antibody tests, extended immunogram, genetic diagnosis, cervical/endometrial biopsy may be required. Laboratory tests also require blood and urine tests, PCR for sexually transmitted infections, flora smears and oncocytology.
Methods of examination and treatment used by a gynecologist-reproductologist
It is better to come to the doctor’s appointment together, together with your partner. If you have current advisory opinions from related specialists (endocrinologist, immunologist, urologist), as well as test results, you must take them with you.
You need to be prepared for the doctor to ask questions of an intimate nature, as well as those related to lifestyle and bad habits - maximum truthfulness when answering them is one of the guarantees of successful treatment.
In order to most accurately determine the cause of infertility, the doctor, in addition to the initial examination and interview, prescribes special measures for the patient to examine the health status:
- Ultrasound examination of the reproductive organs: during the examination, the doctor, using a special apparatus, examines the pathological condition of the pelvic and abdominal organs, the thyroid gland and adrenal glands, and can also assess the patency of the fallopian tubes.
- Blood tests for hormones of the pituitary gland, adrenal glands and thyroid gland: hormonal examination can detect malfunctions of the endocrine glands and ovaries, and helps assess the supply of eggs.
- Study of the adrenal cortex.
- Hysteroscopy or laparoscopy: invasive methods allow you to study the condition of the fallopian tubes and the inner layer of the uterine epithelium. In the first case, the probe is inserted into the uterine cavity after it has been treated with an expanding fluid. In the second, an incision is made in the abdominal cavity while the patient is under general anesthesia, after which the internal organs are examined using a laparoscope (a special tube with a camera).
- Immunogram.
- Analysis of blood clotting and follicular reserve indicators.
- Endometrial biopsy.
- Analysis of the presence of antisperm antibodies (ASAT).
- Hysterosalpenography (a method that can be used to evaluate abnormalities in the formation of the uterus and patency of the fallopian tubes).
Partners also need to undergo genetic testing: for this, a CFTR blood test is performed, as well as karyotyping.
Men need to take some blood tests like an immunogram and ASAT, as well as a test called a “spermogram”.
Treatment and overcoming of infertility can be carried out using various methods - through the prescription of anti-inflammatory or hormonal therapy, surgical intervention, and artificial methods of conception.
For example, hormonal drug treatment can stimulate ovulation. Intrauterine insemination is a medical technology in which pre-obtained sperm from a man is introduced into the cervical canal or uterus of a woman for fertilization. Injection of sperm into the cytoplasm of a cell is another auxiliary method of overcoming infertility, when the sperm is immobilized and injected directly into the egg. The IVF method or in vitro fertilization is a method in which a pre-selected egg and sperm meet and fuse outside the body of the expectant mother (in vitro), after which they are surgically inserted into the uterus of the woman - the patient herself, or a surrogate mother.
“My little flower, it doesn’t hurt”
Today we are lucky. We were able to get acquainted not only with patients planning a pregnancy, with a donor, but also with a surrogate mother - more precisely, with a girl planning to become one.
Madina already has a 5-year-old son, and having her own child is the main condition for participation in the surrogacy program. Slender, long-haired, stylishly dressed, with a well-spoken speech - she looks more like a manager at a bank than a candidate for surrogate mother. She radiates well-being with her entire appearance.
Previously, it seemed to me that people become surrogate mothers for two reasons: the first is for money, the second is for free, in order to help a relative or loved one, for example, a sister, if for some objective reason she cannot bear a child herself. In fact, this is true. But Madina’s case is a little different. She agreed to become a surrogate mother for a married couple whom she had known for a long time.
“We are afraid to go far from you”
A married couple is already waiting in Sholpan Kenesovna’s office. After two unsuccessful (and probably very expensive, compared to Kazakh prices) attempts at fertilization, they specially came to Kazakhstan from the UK to undergo an IVF procedure with Dr. Karibaeva. Everything went well - pregnancy occurred. And the couple just stopped by to say thank you to the doctor.
– Doctor, my husband is afraid to fly home. He wants me to give birth to a child here in Kazakhstan. And I wanted to ask, can you help us choose a clinic and a doctor?
The husband, a respectable middle-aged British man, chimes in:
– It’s true, Sholpan Kenesovna, I’m afraid. You are the only one who could help us, so I don’t want to go far from you until the baby is born.
– You can be observed by me until 12 weeks of pregnancy, and feel free to go to England to give birth. But I can't insist. So if you decide to stay here, I will of course help you.
Honestly, hearing such words from people living in a country where the level of medicine is one of the highest in the world is incredibly pleasant. It was also nice to hear how fluently the doctor conducted the appointment in English.
A patient who was late for her appointment was already waiting outside the door. She refused the presence of strangers, so we went back to wait in the corridor.
Incompatibility of partners
One of the important roles in the successful conception of a baby is played by the compatibility of parents:
- genetic;
- psychological;
- immunological;
- by Rh factor.
In the absence of compatibility, various problems arise. Let's consider these types of incompatibility.
Immunological
Immunological incompatibility is called incompatibility caused by a negative reaction of the female body to the sperm of her husband. The clinical picture is characterized by the woman’s body producing antibodies to the man’s sperm due to a “threat” to the body. That is, the woman’s immune system characterizes them as dangerous viruses. Accordingly, conception cannot occur under such unfavorable conditions.
Immunological incompatibility can also appear due to the “fault” of the spouse himself, in whose body the immune system begins to destroy sperm. If some of the sperm manage to survive, they will not be able to ensure healthy conception and development of the embryo. Due to low-quality sperm, a woman cannot bear a fetus: it ends in spontaneous miscarriage or frozen pregnancy. Therefore, both spouses are sent for examination.
The spouse is prescribed a MAR test and a spermogram analysis. A spermogram will allow you to determine the nature and activity of sperm, the viscosity of seminal fluid and the time of sperm liquefaction. The MAR test shows the presence/absence of antibodies. The analysis requires compliance with certain conditions: a ban on smoking, alcohol, sexual intercourse, visiting a steam room, taking medications for 4-6 days.
Doctors cannot yet guarantee the successful treatment of immunological incompatibility, but some couples successfully overcome the immunological barrier.
Treatment methods:
- barrier (coitus using a condom);
- taking histamines (if you are allergic to sperm);
- a woman taking corticosteroids.
If the above methods do not help, artificial insemination is performed.
Genetic
Conflict at the chromosomal level characterizes the genetic incompatibility of partners. In this case, the mother's body views the fetus as mutated (oncological) cells and begins an attack. As a result, the pregnancy is terminated (spontaneous miscarriage) or freezes. Diagnosis of genetic incompatibility is carried out by a geneticist.
Genetic analysis is carried out using venous blood. Pure DNA is isolated from the blood of the spouses and subjected to detailed examination. The analysis takes a lot of time - up to two weeks. Complete incompatibility is rarely diagnosed: partial incompatibility is more typical for married couples. This pathology can be controlled by a geneticist. He monitors the pregnancy at all stages: from conception to birth. Sometimes the issue can be resolved with the help of IVF or ICSI.
Psychological
Dissonance in the relationship between spouses plays a key role in the success of conception. The emotional sphere regulates hormonal levels, and hormones regulate all processes in the body. Therefore, many health issues depend on the emotional background. The issue of psychological infertility is becoming more and more pressing, and this problem is getting worse every day. Spouses do not know how to hear each other and are extremely selfish towards each other. Under such conditions, pregnancy cannot occur. The couple needs help from a psychologist.
By Rh factor
Sometimes a healthy woman cannot bear a child due to incompatibility with her husband due to the Rh factor. The mother's body perceives a different blood type in the fetus as a threat to its well-being and tries to get rid of it. This problem affects women with a negative blood group. Therefore, when planning a pregnancy, it is necessary to visit a gynecologist and talk about the incompatibility of blood groups.
