Causes of female infertility
- Obstruction,or absence of fallopian or fallopian tubes into which
the egg enters after ovulation and in whichmeets with spermatozoa. In the distal parts of the fallopian tubes, the sperm meets and merges with the egg, that is, fertilization occurs, resulting in the formation of an embryo. The embryo moves through the tube into the uterine cavity due to contractions of the muscular wall of the tube (peristalsis) and cilia (epithelium lining the tube from the inside), which “drive” the embryo into the uterus. Obstruction of the fallopian tubes, as a rule, is the result of an adhesive (sticky) process, which leads to inflammation of the tubes (salpingitis). Sometimes this is the result of a woman's sterilization (tubal ligation or division). The absence of fallopian tubes is observed after surgical removal of the tube, for example, due to an ectopic (tubal) pregnancy or a purulent process in it (pyosalpinx).
- Adhesion process in the small pelvis (peritoneal factor of infertility) isa consequence of operations, inflammation, endometriosis. Adhesions may envelop the ovary or be located between the tube and the ovary, preventing the egg from entering the tube. When tubal and peritoneal factors are combined, they speak of tubal-peritoneal infertility.
- Endocrine (hormonal) disorders may be a consequence of ovarian pathology(their depletion, polycystic ovary syndrome, etc.) and other endocrine (hypothalamus, pituitary gland, adrenal glands, thyroid gland) and non-endocrine organs (liver, kidneys, etc.). Endocrine infertility can be caused by metabolic disorders, mental stress, and so on. 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 which the disease occursembryo implantation and gestation. Pathology of the uterus can be congenital (intrauterine septum, bicornuate uterus, uterine duplication, etc.) and acquired (removal or scars on the uterus after surgery, 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 is associated with the presence of antibodies to sperm in a woman (antisperm antibodies).
- Chromosomal pathologycan lead to sterility of a woman.
- Psychological infertilityis seen as the result of conscious ora woman's unconscious desire to have a child. Sometimes it is fear of pregnancy and childbirth, sometimes it is reluctance to have a child from a given man, sometimes resistance to changes in appearance that pregnancy can lead to, and so on.
Infertility treatment
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 needs to be dealt with. First of all, undergo an examination 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 a comprehensive examination of both partners does not reveal any reasons for infertility.
Both prison 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 using modern medicine.
For example, it is impossible to establish biochemicalviolations of the receptors of the egg membrane (preventing the penetration of sperm) by means of medical examination. Such disorders 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.
- Incompatibility
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 sexual intercourse. A mucus sample is taken from the cervical canal and the number and motility of sperm in it is assessed. With the Kurzrock-Miller test, the interaction of cervical mucus of sperm occurs on glass, and it is possible to evaluate the interaction of 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.If a hormonal imbalance occurs in the body, it can be eliminated with medications, and tubal obstruction and cervical erosion can be removed through surgery.
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 blocked tubes due to infection or endometriosis. There are also factors affecting the peritoneum (the mucous membrane of the pelvis and abdomen).
25% of infertility in women is associated with ovulation. Another quarter of all women who have problems conceiving 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 women who are obese. Obesity can also cause an increased risk of miscarriage and reduce the success of fertility treatments.
Less than 3% of infertility patients requireadvanced 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 has increased from 5% to more than 45%.
Psychological infertility
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 sexual activity. Frequent changes of sexual partners can lead to infection with various infections.
Oleg Apolikhin, chief specialist of the Russian Ministry of Health for reproductive health
In turn, STDs such as gonorrhea andchlamydia may affect your ability to conceive. Chlamydia is especially insidious because it is often asymptomatic: 70% of women with chlamydia have no 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 divided into safe andunsafe. A safe abortion is one that 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 abortions result in approximately 70 thousand deaths.female deaths and about 5 million disabilities per year worldwide. With a safe abortion, the risk of complications is significantly lower. Safe abortion methods 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 doctors strictly followed the protocol, and duringThere were no complications from the operation, and the chances of subsequent conception are not reduced. It is worth considering that 45% of all abortions in the world are carried out in an unsafe manner, 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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