Infertility in women - causes, symptoms and treatment methods

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Female infertility is the inability of a healthy, motile, adequate amount of sperm to fertilize an egg, which means that a woman cannot conceive even if she has had sex for a year and has reached adulthood. Infertility is also said to end a pregnancy with an abortion. Infertile marriages occur in 10-20% of cases.

Female infertility should be distinguished from termination of pregnancy, in which sperm can fertilize an egg cell but the female organism cannot hold the fetus and it dies during embryogenesis.

The problem of infertility is one of the most pressing issues today. Because genital diseases are increasing day by day. If we consider 100% of infertile families, 33,3% of them are caused by men, 33,3% by women, and the rest by both sexes.

Infertility can be caused by immaturity of the genitals, dysfunction, severe intoxication, chronic diseases of the general body and psycho-neurological deficiencies. Infertility is not an independent disease, it is always the result of some other disease, in women it is often caused by inflammatory diseases.

Menstrual cycle

One of the causes of infertility can also be a violation of the menstrual cycle. Normally, the menstrual cycle lasts 21-35 days and consists of 3 phases.

1. Follicular phase - egg cell maturation (7 to 22 days);

2. The ovulation phase is the period of egg cell maturation and division, ready for fertilization;

3. The luteal phase is the corpus luteum period (13 to 15 days).

Of these periods, a woman’s chances of becoming pregnant are highest during ovulation.

Classification of infertility

Primary - Pregnancy was not observed at all. Congenital gynecological anomalies, diseases of the female genital organs, the inability to conceive after menstruation.

Secondary - She was pregnant before, but can't get pregnant now. There are varieties that are generally untreatable or treatable.

Some literature also has the following classification of infertility based on the physiology and pathophysiology of the female reproductive system:

Physiological. It is the norm not to become pregnant after puberty and menopause.

Optional. Infertility is performed by a woman of her own free will, i.e. using contraceptives.

Temporary. Long-term stress, weakening of the female body as a result of any disease, lactational amenorrhea - the cessation of ovulation, prolongation of the menstrual cycle.

Permanent. When female genitals are removed through surgery.

Symptoms of infertility

The main symptom of infertility is the inability to conceive for a year while adhering to a normal sex life. In this case, the male spermogram is normal, regular sex, without the use of contraceptives, the woman is 20 to 45 years old, and the woman can not get pregnant.

Pathological signs of infertility are not observed, i.e. it has no obvious symptoms, the disease is detected by anamnesis, general examination, laboratory and instrumental examinations.

Anamnesis. Deficiencies related to the menstrual cycle are requested: information on duration, duration, pain, volume, presence of additional discharges, infectious, non-infectious diseases, surgical procedures are collected.

Physical examination reveals the following:

• MTana weight index should not be higher or lower than 20-26 to exclude tumors in the pituitary gland;

• Defects of the skin and endocrine glands;

• Development of mammary glands;

• Painful cases in the small pelvic area are examined by bimanual palpation;

• Examination using a colposcope, vaginal speculum reveals gynecological diseases;

• Laboratory and instrumental examination includes:

• Hormonal examination;

• Ultrasound examination of small pelvic organs, thyroid gland (UZI);

• Hysterosalpingography - an X-ray examination to rule out obstruction of the fallopian tube;

• Infectious examination of STIs; RT examination;

• Laproscopy is a visual examination of the abdomen;

• Giteroscopy is an X-ray examination of the uterine wall.

Causes of infertility in women

The causes of infertility are many, they sometimes come without symptoms and cause difficulties in diagnosis and treatment.

They are divided into the following major groups:

• Congenital anomalies of the genitals;

• Acquired genital diseases;

• Anatomical and morphological changes;

• Functional changes.

• Imbalance in metabolism.

• Reasons not related to gynecological diseases:

• Physiological age;

• Long-term use of contraceptives.

Because long-term use of contraceptives reduces the production of the hormone estrogen, the ability to conceive after these treatments decreases. To avoid such problems, it is necessary to choose a method of contraception on the advice of a gynecologist.

Causes of secondary infertility in women

Even women who have been pregnant before and have children cannot have children by planning a pregnancy. The main reason for this is infectious and non-infectious diseases of the genitals.

Factors leading to infertility

• Anatomical location of the disease causing infertility;

• By pathophysiological nature (endocrine disorders, autoimmune reactions against germ cells);

• Genetic anomalies;

• Psycho-neurological conditions resulting from a negative lifestyle;

Infertility caused by men

Normally, an egg cell must contain at least 10 million sperm in order to be fertilized. The environment of the female vagina is a physiological barrier that protects against any foreign substances. As a result of inflammatory diseases in the vagina, the sperm that fall here die. Normally, the fallen sperm pass through the cervix, surrounded by a special fluid produced by the uterine mucosa.

The following play an important role in the passage of sperm through the uterus:

• Sperm activity and motility;

• Chemical and physical properties of the produced mucus.

Even active and motile sperm cannot pass through the uterus when the composition and properties of the mucus are disrupted. Such a factor is called a factor associated with the cervical mucosa.
Reasons for changes in mucus composition and properties may include:

• Deficiencies in the production of sex hormones;

• Inflammatory diseases of the cervix;

• Disorders of the cervical microflora.

Uterine tube factors

The mature egg cell passes through the fallopian tube into the uterine cavity, where the fallopian tube is made up of ciliated cells. The following play an important role in egg cell movement:

• Due to the peristalsis of the uterine tube;

• Due to the unilateral movement of the ciliated epithelium.

Due to the disruption of the movement of these lashes, the egg cell can remain in the fallopian tube and lead to ectopic pregnancy. It is also observed that due to the closure of the fallopian tube, the egg is unable to pass into the uterine cavity - this is called the fallopian tube factor.

Obstruction of the fallopian tube can be as follows

• In the ventral part - obstructions in the distal part of the fallopian tube;

• Blockages in the proximal part of the fallopian tube;

• The general closure of the nay.

Obstruction of the fallopian tube is caused by spasm or obstruction of the fallopian tube (formation of spikes after inflammation, tumor, cyst). In some diseases of the uterine cervix, there is also a buildup of transudate (fluid), which is called hydrosalpinx.

Causes of hydrosalpinks

• Salpingitis is an inflammation of the fallopian tubes;

• Salpingoophoritis - inflammation of the fallopian tubes and ovaries;

• Adnexitis is an inflammation of the fallopian tubes, ovaries and its ligaments.

The blockage of the egg cell pathway causes pain in the abdomen. X-ray examination (hysterosalpingography) and laproscopy are performed in the diagnosis of hydrosalpinx.

Cervical factor of infertility

The cervix is ​​the "channel" that connects the vagina and the uterus, and its function is as follows:

• Protection of the uterus from foreign substances;

• Transfer of sperm to the uterus;

• The mucous function it produces is:

• Storage of sperm in this place for a certain period of time;

• Impotence of weak sperm;

• Enhancing sperm motility.

The function of the uterine mucosa is due to the fluid mucus it produces, which changes its physicochemical properties at different stages of the menstrual cycle. During ovulation for egg cell fertilization, the environment at this location changes from a pH acid to a neutral and weakly alkaline environment so that the sperm do not die. If the cause of the mucosal pathology produced by the cervix changes, sperm cannot enter the uterus and this is called a cervical factor.

The outer part of the cervix - the vaginal window - is inspected visually, while the inner part is not visible using simple inspection methods.

A colposcopy examination of the cervical factor leading to infertility reveals a “pupillary symptom”. At the entrance to the cervix is ​​detected transparent premenstrual mucus.

On laboratory examination

• Biochemical and rheological examination of mucus composition;

• Examination of the interaction of sperm and mucus after sexual intercourse, usually their interaction takes place within 9-24 hours;

• Kurtsrok-Miller test.

Peritoneal factor of infertility

The organs located in the abdominal cavity are surrounded by the peritoneum (peritoneum) and the organs are separated from each other. The peritoneum consists of two layers:

1. The parietal layer is the membrane that covers the outside;

2. The visceral layer is the inner membrane that attaches to the organs.

The uterus and fallopian tubes hang from the peritoneum. Under the influence of some pathogenic factor, a spike (scar) is formed between the peritoneum and the fallopian tube. As a result, the fallopian tube: motility, insufficient blood supply, its complete innervation is disrupted. The fallopian tube function is impaired and this is called the peritoneal factor of infertility.

The reasons for this are:

• Transmission of chronic pelvic inflammatory disease, often in JYBYK;

• After small pelvic organ surgeries and abortions;

Ultrasound (ultrasound), laproscopy, exography are performed for diagnosis.

Immunological factor of infertility

Normally, when a foreign protein, ie sperm, enters a woman's body, the immune system does not react to them. The reason why sperm stimulate the immune system has not been well studied. The production of specific antibodies against sperm by the immune system is based on type 2 of the allergic reaction. In such cases, treatment is carried out by immunodepressive methods.

Another type of immunological factor that leads to infertility is that the female body’s immune system produces antibodies against its own egg cells. The treatment of this is carried out as in all autoimmune diseases.

Endocrine factor of infertility

Hormonal imbalance is caused by the disruption or absence of the menstrual cycle at all. Endocrine system deficiencies are caused by:

• Tumors of the hypothalamic-pituitary area, brain injuries;

• The “dominance” of androgen hormones over estrogenic hormones occurs in ovarian or adrenal gland lesions, polycystic ovaries;

• Decreased thyroid function (hypothyroidism) - affects the menstrual cycle;

• Estrogen hormone deficiency affects the menstrual cycle and the mucous membranes of the genitals;

• Impairment of fat metabolism, impairment of ovarian function as a result of their more or less accumulation;

• Hormonal changes due to early onset menopause;

• Congenital endocrine abnormalities lead to incomplete formation of the genitals.

Psychological factor of infertility

Stress is a general reaction of the organism to an external environmental factor. The causes of stress are individual and can include:

• Plenty of negative information;

• Regular emotional tensions;

• Physiological or pathophysiological reactions of the organism.

As a result of chronic stress, the body's protective flexibility decreases. Bioregulatory function (autonomic nervous system, adrenal glands, pituitary hormones) is disrupted, and the body's adaptive mechanism is disrupted. As a result, hormonal metabolism is disrupted and women suffer from infertility.

To get rid of the psychological factor

A different approach to stress factors. Correction of hormonal imbalances through physical education, hobbies, recreation, positive emotions and mental training;

Getting advice from a qualified psychologist can also help relieve stress.

Genetic factor of infertility

• Factors leading to infertility in women are poorly understood, including:

• Hyperandrogen syndrome (hyperthyroidism in women);

• Endometriosis (thickening of the lining of the uterus);

• Early climacteric age;

• Primary amenorrhea syndrome (Shershevsky-Turner syndrome).

It is much more difficult to eliminate such factors.

Treatment of infertility

Experts say the best time for an egg to be fertilized is between 11 and 18 days of the menstrual cycle. These days, if a man's sperm falls on a woman's genitals at least twice, the maximum pregnancy rate is high. After sexual intercourse, a woman should not take a shower immediately, lie down in her place for 10-15 minutes and bend her knees.

If they cannot achieve pregnancy by such methods, the man and the woman should take special treatment measures. Even then, if pregnancy is not observed, ECO (extrauterine fertilization) can be performed.

Every woman hopes to have a child, if a woman is unable to conceive, she should not be depressed and should be treated and trusted with good intentions!