Causes of female infertility
- Obstruction, or the absence of the fallopian or fallopian tubes, into which
- Adhesion process in the small pelvis (peritoneal factor infertility) isa consequence of operations, inflammation, endometriosis. Adhesions can wrap around the ovary or be located between the tube and the ovary, preventing the egg from entering the tube. With a combination of tubal and peritoneal factors, they speak of tubal-peritoneal infertility.
- Endocrine (hormonal) disorders may be a consequence of ovarian pathology (theirexhaustion, polycystic ovary syndrome, etc.) and other endocrine (hypothalamus, pituitary, adrenal, thyroid) and non-endocrine organs (liver, kidneys, etc.). Disorders of metabolic processes, mental stress and others can lead to endocrine infertility. Whatever the cause of endocrine infertility, its key point is always a breakdown of the ovulation mechanism (anovulation).
- Pathology or absence of the uterus - pathology of the organ in whichembryo implantation and fetal bearing. Pathology of the uterus can be congenital (intrauterine septum, bicornuate uterus, doubling of the uterus, etc.) and acquired (removal or scars on the uterus after operations, uterine fibroids, endometritis, adenomyosis, polyposis, endometrial hyperplasia, etc.).
- Endometriosis, which is expressed in the proliferation of the mucous membrane of the uterus (endometrium) outside of it. Adhesions occur between the foci of endometriosis, which are the cause of tubal-peritoneal infertility.
- Immunological infertility associated with the presence in a woman of antibodies to sperm (antisperm antibodies).
- Chromosomal pathology can lead to sterility of a woman.
- Psychological infertility seen as the result of a conscious orunconscious unwillingness of a woman to have a child. Sometimes it is fear of pregnancy and childbirth, sometimes reluctance to have a child from this man, sometimes resistance to changes in appearance that pregnancy can lead to, and so on.
From a medical point of view, infertility isa diagnosis that has certain criteria. It is given not to one person, but to a couple, if the partners cannot conceive a child during the year with regular sexual activity (that is, when having sex 2-3 times a week) without protection. If the partners are over 35 years old, then half a year is enough.
In practice, the first diagnosis rather means that there is a problem, and it needs to be dealt with. First of all, get tested to identify the cause. And this applies to both partners.
Men's health becomes the cause of infertility as often as women's health - in 35% of cases. And in 20% of cases, problems are detected in both at once.
Infertility of unknown origin
The diagnosis of "infertility of unknown origin" (idiopathic infertility) is established when no reasons for infertility have been identified during a comprehensive examination of both partners.
Both incarceration partners are healthy, butpregnancy does not occur. This situation is quite common (about 5-7% of all infertile couples) and is associated with the inability to determine all possible causes of failure in the reproductive system of partners by means of modern medicine.
For example, it is impossible to establish biochemicalviolations of the receptors of the membrane of the egg (preventing the penetration of the sperm) by means of medical examination. Such violations are sometimes detected indirectly during the in vitro fertilization procedure.
Very often, instead of the cause of infertility of unknown origin, imaginary causes of infertility are established, the elimination of which turns out to be ineffective.
Often, the cause of "unclear" infertility lies inbiological or immunological incompatibility of the couple. The most reliable confirmation of this form of infertility is a situation in which a married couple cannot achieve pregnancy for a long time, but after a divorce, each of the former spouses quickly has children in new families.
There are different tests to identify the incompatibility of a couple. The most common are the "Postcoital test" and the Kurzrock-Miller test.
Postcoital test is performed after 9 hoursafter intercourse. A mucus sample is taken from the cervical canal and sperm count and motility are assessed. In the Kurzrock-Miller test, the interaction of the cervical mucus of the sperm occurs on the glass, and it is possible to evaluate the interaction of the cervical mucus with the sperm of both the husband and the donor.
To exclude an error, the tests must be carried outas close as possible to the day of ovulation in a woman. In this case, a woman should not take drugs that alter the properties of cervical mucus. The most common such drug is clomiphene, against which the test results are distorted.
The incompatibility of the pair can be overcome by intrauterine insemination after checking the patency of the fallopian tubes.
What are the chances of being cured with such a diagnosis?
Infertility can be cured in 90% of cases.In the event that a hormonal failure has occurred in the body, it can be eliminated with drugs, and the obstruction of the tubes and erosion of the cervix can be removed with the help of an operation.
There is also artificial insemination. Cells are taken from partners and fertilized in a test tube. An already obtained embryo is transferred into the uterus, grown to the state of a group of cells.
35% of cases of infertility in women are due todamage to the fallopian tubes. This includes blockage of the tubes due to infection or endometriosis. There are also factors affecting the peritoneum (the lining of the pelvis and abdomen).
25% of infertility in women is associated with ovulation. Another quarter of all women who have problems with conception can associate their infertility with problems with ovulation.
60% of women who have miscarriages have a chance of successfully becoming pregnant in the future.
Also, weight loss of 5% to 10% can significantlyimprove ovulation and pregnancy in obese women. Obesity can also cause an increased risk of miscarriage and reduce the success of fertility treatments.
Less than 3% of infertile patients needadvanced treatments such as IVF. Since IVF was first performed in the late 1970s, technological advances have dramatically increased the likelihood of a quality procedure. The success rate of the procedure increased from 5% to over 45%.
When the cause of infertility cannot be found (this happens in 10% of cases), doctors often talk about psychogenic factors - chronic stress, anxiety and depressive disorders.
For example, in women with symptoms of depression, the chances offor conception in one cycle are reduced by 38%. Another study found that women with increased levels of biochemical markers of stress in their saliva took 29% longer to conceive.
Chronic stressors (severefamily treatment, serious illness, poor living conditions) can lead to inhibition of ovarian function. Sperm quality in men can also deteriorate due to stress and overwork.
At the same time, as other studies show, onthe chances of conception are also influenced by the very diagnosis of "infertility". Partners are already worried about the fact that they cannot conceive for a long time, and this can further complicate the situation.
Does a large number of sexual partners affect infertility?
Directly one with the other is not connected. But often gynecologists consider the frequent change of partners as a risk factor.
The main risk lies not in the number of partners, but in the nature of their sex life. Frequent change of sexual partners can lead to infection with various infections.
Oleg Apolikhin, Chief Reproductive Health Specialist of the Russian Ministry of Health
In turn, STDs such as gonorrhea andchlamydia can affect fertility. Chlamydia is especially insidious because it is often asymptomatic: 70% of women with chlamydia do not have symptoms and do not seek treatment.
STDs can cause ectopic pregnancy, tubal scarring and additional reproductive problems, as well as infertility if left untreated.
Abortion and infertility
Abortions are classified as safe andunsafe. A safe abortion is when it is performed with the participation of a qualified professional (doctor, midwife, nurse) using approved and recommended methods and in a suitable medical facility.
Abortion is considered unsafe if it is performed by a person without medical education or training, in unsanitary conditions, or if it is performed by the woman herself.
Unsafe abortion leads to roughly 70,000female deaths and about 5 million disabilities a year worldwide. With a safe abortion, the risk of complications is much lower. The methods of safe abortion themselves also vary in the likelihood of complications.
In addition, the likelihood of complications depends onthe quality of the procedure and the duration of pregnancy. Legal abortions performed in developed countries are among the safest procedures in modern medical practice.
If the doctors strictly adhered to the protocol, and duringthe operation had no complications, the chances of subsequent conception are not reduced. It should be borne in mind that 45% of all abortions in the world are carried out in an unsafe way, and this affects the statistics.
During an abortion, the risk of infection or internal bleeding increases, and this, in turn, reduces the chances of getting pregnant again.
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