Gynecology

Degrees and classification of infertility in women

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What it is? Infertility in women is a gynecological problem, due to the impossibility of realizing the reproductive function of the female body, which manifests itself as an inconsistency in conception and childbirth.

In physiologically healthy women of childbearing age, without signs of anatomical pathologies, the sterility factor is diagnosed if, during regular sexual relations, without the use of protective contraceptives, the desired pregnancy does not occur within one and a half, two years.

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Causes and extent of female infertility

The list of the main causes of infertility in women is extensive and diverse, due to the influence of factors of different etiologies.

  • One of the main causes of female infertility at the head of the classification registry is inflammatory pathologies that cause the development of adhesive processes in the peritoneal cavity and fallopian tubes (tubal infertility).
  • Artificial termination of pregnancy (abortion), trauma, during surgery on the organs of the reproductive system, which can lead to violations, in the form of changes in the anatomical configuration of the fallopian tubes, the development of their obstruction and narrowing of the uterine cervix. Sometimes, during surgical manipulations, for therapeutic purposes, excision of a part of the organ involved in reproductive functions is carried out, which can strongly influence the conception process.
  • When there are failures in the endocrine system, they talk about hormonal infertility in women. It is the result of hormonal secretion disorders in any of the organs that perform this function - the glands of the endocrine system (thyroid gland, adrenal glands, hypothalamus, pituitary gland). As a result, the egg does not reach maturity, does not leave the ovaries, and ovulation does not occur.
  • A significant role in the violation of the function of conception is played by the incompatibility of partners. The so-called conflict of an immunological nature between the mucus of the fallopian tubes of a woman and the sperm of a man. It is expressed in the fact that tubal mucus produces special substances that can immobilize or reduce the activity of sperm.
  • In addition, a psychological factor can also affect reproductive function. In this case, conception does not occur because the woman either does not want to have children from this partner, or is afraid of childbirth and the upcoming responsibility for the baby, or wants to be longer attractive to the partner. In this case, the problem can be solved by a psychologist, working not only with a woman, but also with her man.
  • Sometimes women are diagnosed with a form of combined infertility, and not infrequently, it is not immediately possible to establish its cause until a man is examined. After all, the fact of sterility may be due not only to infertility in women, but also in men.

Depending on the reasons, various forms of female infertility are diagnosed in medicine, and its degree determines the consequences. The term “degree of infertility in women” is rarely used in medicine. Usually, they talk about primary or secondary infertility.

First degree - implies that a woman has no conception throughout the entire reproductive period. This means that a woman has never been pregnant, despite regular sex and the lack of any contraceptive use.

Second degree - this degree is set when it is impossible to conceive at the present time, although pregnancy was already in the life of a woman. Usually, the cause of secondary infertility in women are complications after any internal diseases of the body.

Signs of infertility in women, characteristic symptoms

The signs of infertility in women depend on the severity of the pathology, as a result of which irreversible changes have occurred in the organs of the reproductive system (uterus and its appendages). Here you can add all the changes in hormonal background caused by somatic and hormonal pathologies that led to systematic disorders.

Signs of infertility can manifest themselves by various symptoms, for example, of inflammatory nature:

  • constant aching pain in the lower abdomen,
  • secretions of mucous and purulent character, or whiter and mixed substrate,
  • tuberculous damage to the functional layer of the uterine endometrium, which provokes dystrophic processes in the genitals.

Menstrual disorders in the form of:

  • disruptions in the cycles of menstruation,
  • scanty menstrual flow (amenorrhea).

Signs of a functional and anatomical nature:

  • purulent substrate of discharge and increased pain in the lower abdomen,
  • uterine hemorrhages in the inter-menstrual period,
  • atrophic pathologies in the urogenital system,
  • changing the natural position of the appendages and uterus.

According to statistics, in most cases, the problem of female infertility is solved today. The first step is an accurate final diagnosis with the definition of the type of disease and a properly chosen treatment strategy.

Diagnostic examination methods

The basis for the diagnosis of infertility in women is a certain logical scheme of examinations.

1) Careful history analysis, clarifying:

  • patient's life history
  • facts of possible conceptions (their outcome in the past)
  • the duration of the absence of pregnancy
  • the possibility of using different contraception,
  • the presence of common pathologies
  • what medications were used and whether the patient underwent surgery,
  • information about possible inflammatory pathologies in the genitals and breasts,
  • the presence of harmful heredity and characteristics of menstruation.

2) Examination for the presence of sexually transmitted infections.

3) Determining the level of rectal temperature - to determine the time of ovulation, the measured temperature data for three months are compared.

4) X-ray analysis of the skull, to exclude or confirm possible tumor processes in the structure of the pituitary gland, which can also be an obstacle to pregnancy.

5) Detection of violations of the visual field and ophthalmoscopy of the fundus, to exclude tumors in the pituitary gland.

6) Hormonal examination to assess the level of hormonal levels.

7) Ultrasound examination - identification of gynecological pathologies and possible anatomical structural changes.

8) Hysterosalpingographic examination with a contrast agent, which makes it possible to assess the size and relief of the uterine mucous layer, the functional state and obstruction of the fallopian tubes.

9) Laparoscopic examination, which allows to identify abnormalities in the functions of the internal organs of the reproductive system and at the same time make the necessary correction to eliminate the causes that prevent conception.

Treatment of infertility in women, drugs

Only on the basis of a comprehensive diagnosis, taking into account all the identified causes of reproductive impairment, does an individualized protocol for the treatment of infertility in women be drawn up and drugs are prescribed. The genesis can be extensive, but first of all, the most serious reasons preventing pregnancy are eliminated.

  • In case of identified inflammatory pathologies, treatment begins with the use of absorbing drugs, anti-inflammatory, antibacterial and activates the immune functions of the funds.
  • Endometriotic foci are stopped by cauterization and hormonal therapy — prescribing Danazol, Orgametril, Norkolut, Gestrinone, Dekapeptila Depot, Zoladex and Suprefact. Hormonal treatment is long, but effective. In most cases, contributes to the successful conception.
  • Hormone treatment for a period of three months is also prescribed for the detection of polyps and myomatous nodes. However, with such a pathology, hormone therapy alone cannot be avoided, it should be tuned to the inevitable surgical intervention.
  • With endocrine form of the pathology - hormone therapy, is the main method of treatment. Drugs are selected according to the type of egg maturation disorders. Depending on the situations, these can be estrogen-progestogen drugs - such as Marvelon, Mikroginona or Bisekurina, or three-phase sex hormone drugs - Tri-regola, Triziston, Triquilar, Trinovum.
  • At the next stage, the drug-induced stimulation of egg cell maturation begins with the help of Klostilbegit, Clomiphene, Serofen, Clomida and Pergotime.
  • In the absence of a positive effect, under the control of an ultrasound, gonadotropic hormones are prescribed - “Humegon” or “Menogon”.
  • If a high level of peptide hormone is detected (female hormone - prolactin), or male hormones, medications based on ergot alkaloids - Norprolac, Parloderl, or adrenal hormones - Prednisolone, Dexamethasone or Cortisone are included in the treatment .
  • In situations of prolonged absence of ripened eggs, treatment is aimed at stimulating the ovaries with Dinazola or Gonadotropin. The course of treatment continues for six months.

If drug therapy proves to be untenable and ineffective, at the request of the patient, artificial insemination procedures or the IVF method can be suggested.

What will help a woman not to face a problem?

Unfortunately, it is not always possible to eliminate congenital pathologies and genetic diseases, but in many cases, you can cope with them. Regular visits to the gynecologist, the elimination of provocative factors and the timeliness of treatment is the only option for the correct solution, eliminating problems with conception.

To increase the chance of successful fertilization, conception is possible in the inter-menstrual period, starting from the 10th to the 17th day of the cycle.

Ejaculation in men should not occur more than 3 times a week, which will ensure the maximum concentration of sperm for the act of fertilization. With sexual intimacy, the partners should not use any lubricants.

After the act of copulation, women are not recommended to wash for half an hour. It is useful to lie down in the supine position with your legs raised and bent at the knees. A good option to achieve the goal is to change the usual posture during sexual intercourse. For example - the missionary position, but in its active form.

Diversity in sexual postures can coordinate the parameters and anatomical mismatches of partners. Changes in the usual position of the bodies during sex, can contribute to the achievement of orgasm women simultaneously with ejaculation partner, which will increase the chances of successful fertilization.

Primary form

Primary infertility is diagnosed if the patient cannot become pregnant and before that she did not get pregnant or give birth. Often women are diagnosed with first-degree infertility, what is it? Primary form occurs mainly as a result of adverse effects factors:

Secondary infertility is diagnosed in women who have previously become pregnant.

  • disorders of the endocrine system,
  • anomalies of development or structure of female reproductive organs,
  • various congenital abnormalities can also cause second-degree infertility.

Secondary form

Secondary infertility is diagnosed in patients who have become pregnant at least once before. The outcome of previous pregnancies in this case does not matter (miscarriage, abortion, missed abortion, childbirth, ectopic pregnancy). Why does second degree infertility occur? Pathological factors may be the same as in the primary form.

This classification is very conditional, the main criterion in this case is the presence of pregnancies in the patient in the past. Reasons secondary infertility development most often become:

  • abortion
  • hormonal disorders,
  • pelvic trauma,
  • damage to the reproductive organs as a result of surgery,
  • inflammatory processes and other diseases of the genital organs,
  • obstruction of the fallopian tubes,
  • depletion of ovarian reserve, early menopause.

The secondary form most often develops after the termination of the first pregnancy. Such an operative intervention is a stress for the woman’s body, abortion often leads to the development of endometriosis, obstruction of the fallopian tubes and other complications that can later become an obstacle on the path to an already desired pregnancy.

Infertility Classification

Pathology is classified according to many factors:

  1. According to the mechanism of development:
  • congenital
  • acquired.
  1. The possibility of pregnancy:
  • Absolutein which a woman is unable to become pregnant naturally due to congenital or acquired malformations of the reproductive organs (uterus or ovaries are removed, the fallopian tubes are missing).
  • Relative - A pathological condition of the body that is to be treated. After eliminating the disease, fertility can be successfully restored.

It is important that the classification of infertility into absolute and relative can be called conditional, since the modern possibilities of medicine in some cases allow a woman to become pregnant even with the most complex pathologies. For example, if a woman has no fallopian tubes, she can become pregnant using the IVF technique.

  1. By duration:
  • temporary (due to the impact of some negative factors, stress, disease),
  • permanent (if the cause of infertility cannot be eliminated: the uterus and / or ovaries are removed),
  • physiological (due to physiological factors: lactation, menopause, for example).
  1. For reasons of:
  • endocrine - due to hormonal disorders, ovulation is absent, as a result of which fertilization becomes impossible. The causes of endocrine infertility can be pathological processes in the ovaries, as well as diseases of the organs of the endocrine system,
  • tubal - a common form, the reason for the inability to get pregnant is obstruction of the fallopian tubes.
  • uterine - a woman cannot become pregnant due to various pathological processes in the uterus,
  • cervical - as a result of pathological processes, the properties of cervical mucus change, which becomes an obstacle to the advancement of spermatozoa to a mature egg,
  • immunological - when the reason for the decrease in fertility is a violation of the immune system in the woman’s body,
  • psychogenic,
  • unclear genesis.

Also, infertility is voluntary (if a woman uses contraceptives voluntarily) and forced (when preventing pregnancy is necessary because the woman has pathologies in which carrying a child can only aggravate the situation).

Signs of Female Infertility

No pregnancy for a year in the presence of regular sexual life, is considered the main sign of infertility. That is, if sex is regular, it happens on fertile days and during these 12 months the partners are not protected. To clarify that it is about female infertility that is when the male (or mixed) factor is excluded.

The first to see a doctor is usually a woman. However, at the second admission, the gynecologist or reproductologist asks to bring a spermogram of the partner and the conclusion of the andrologist. As a rule, men are offended by the thought of their own inconsistency, and the prospect of being tested is just scary. Try to find the right words and intonation for a delicate conversation.

What other symptoms? may indicate probable female infertility?

  • Lack of menstruation (amenorrhea),
  • irregular cycle
  • pain in the lower abdomen,
  • too short (1-2 days) or too long periods (longer than a week).

All of the above may serve as an additional reason to consult a doctor. However, on their basis it is impossible to make a diagnosis. Often, infertility has no symptoms, and its symptoms are established only after consulting a gynecologist, who will take a history, conduct an examination and prescribe laboratory tests.

6 causes of infertility in women

The causes of female infertility are mass, and often they go hand in hand, reinforcing each other. True causes often remain subtle, asymptomatic. Clinical observations and studies indicate that the factors of infertility can be grouped depending on the "localization" of the problem in the female body:

1 Pipe factor. In 25% of cases, female infertility is observed for this reason. Obstruction of the fallopian tubes prevents the mature egg from moving into the uterine cavity. Pathology arises due to inflammatory adhesions, tumor proliferation, and so on. For diagnostics, laparascopy, x-ray or ultrasound are performed.

2 Endocrine factor. According to various estimates, this is the cause of infertility in 10–40% of cases. Под эндокринными нарушениями подразумевают как разной модификации «разрывы связей» в системе яичники — гипофиз — гипоталамус, так и дисфункцию коры надпочечников и щитовидной железы.All this leads to violations of the menstrual cycle and anovulation. Diagnose disorders through ultrasound and hormonal studies.

3 Cervical factor. "Responsible" for 5−15% of cases of infertility. Cervical mucus changes its properties throughout the cycle: on fertile days it becomes viscous, suitable for sperm migration. The properties of mucus can be impaired due to inflammatory processes, hormonal disorders, the presence of antibodies to spermatozoa, etc. For diagnostics, colposcopy, postcoital test, Kurzrock-Miller test are carried out.

4 Immunological factor. From 10 to 20% of cases accounted for this reason. More often, immune problems occur in men. For women, these types of immune responses are characteristic: sperm rejection with special antibodies (ASAT), as well as the “attack” of their own eggs by antibodies (AOA). It is diagnosed by means of a test and other methods.

5 Genetic factor. A very rare cause of female infertility is 8–10% of cases. On the one hand, it includes such genetic abnormalities as the absence of the uterus, ovaries or tubes. On the other hand, these may be hereditary diseases affecting reproductive health. Karyotyping, HLA-typing and other methods are used for diagnosis.

6 Psychosomatic factor. Fears and internal conflicts, parental influence and negative experience create a conflict that can be formulated as follows: consciously you want to get pregnant, but on an unconscious level, parenthood is “prohibited”. Often, psychosomatic causes go along with a real-life diagnosis.

Treatment of infertility in women: 6 ways

Often, infertility has a whole complex of causes, and treatment is prescribed depending on the nature of the disease. Modern medicine uses surgical and medical methods.

1 Endocrine problems adjusted correctly selected complex of hormonal drugs. Clomiphen-based drugs stimulate ovulation in the absence of it. Gonadotropins contribute to improving the quality and quantity of eggs. Progestin drugs support the luteal phase (period from 15 to 25 days of the cycle) with its failure.

2 Inflammatory diseases most often treated with antibiotics. Along with pills, physiotherapy, massage, various measures to improve immunity, improve blood circulation, and course treatment at balneological resorts are prescribed.

3 When immunological problems may prescribe antihistamines or corticosteroids, in some cases, plasmapheresis (blood purification) may be effective. Also, the doctor refers to artificial insemination or IVF.

4 One of the surgical methods is laparoscopy - a low-traumatic operation, during which micro-incisions are made in the abdominal wall and laparascope is injected. The purpose of the intervention is to restore the anatomy and function of the fallopian tubes and ovaries (dissect adhesions, remove tumors, etc.).

5 Hysteroscopy - the introduction of a hysteroscope through the vagina into the uterine cavity for the purpose of biopsy (taking a piece of endometrial tissue for histological examination) and eliminating uterine pathologies (removing endometrial polyps, adhesions in the uterus, etc.).

6 In the presence of psychological causes of infertility resort to psychotherapy, relaxation techniques, changes in interests and lifestyle.

The main factors of infertility

Female infertility can be caused by a number of the following reasons:

  • psychogenic infertility factors, consisting in conflict situations at work, in the family, dissatisfaction with sex life, the persistent desire to conceive a child or, on the contrary, fear of getting pregnant, can cause ovulation disorders similar to endocrine sterility. Vegetative disorders, which are similarly induced by stress, are often the cause of tube obstruction due to the discoordination of contractions of the smooth muscles of the fallopian tubes,
  • endocrine sterility (disruption of the ovulation process), manifested in the absence of ovulation (anovulation), luteal insufficiency of the menstrual cycle, luteinization syndrome of a neovulatory follicle. The reasons that cause anovulation are lesions of the reproductive system, manifested in hyperandrogenism, hyperprolactinemia, hypoestrogenism, metabolic disorders, Cushing's syndrome, as well as hyper- and hypothyroidism. Luteal deficiency is associated with insufficient secretory transformation of the endometrium, which results in a decrease in the function of the corpus luteum of the ovary. Infertility is a consequence of a violation of the implantation of an embryo or spontaneous miscarriage, abortion before the delay of menstruation,
  • tubo-peritoneal factor associated with organic lesion of the fallopian tubes, leading to obstruction or with a violation of their functional activity. It is caused by inflammatory diseases of the female reproductive system, surgery, endometriosis of the fallopian tubes, as well as stress, hyperandrogenism and impaired prostaglandin production. Peritoneal infertility is a consequence of the formation of adhesions in the uterus. May be the result of inflammatory diseases of the female reproductive system, as well as after surgical interventions on adjacent organs,
  • gynecological pathologies (intrauterine septum, synechia, endometriosis, submucous uterine myoma, endometrial polyps), which lead to a violation of the implantation of the embryo in the uterus,
  • immunological factors of infertility (immune infertility) - in cases when the fallopian tubes, cervix or endometrium produce antisperm bodies, which lead to the absorption of spermatozoa.

Degrees of infertility

There are two main degrees of infertility: 1st degree infertility (primary infertility), and 2nd degree infertility (secondary infertility). Infertility 1 degree means the complete absence of pregnancy throughout the life of a woman. In this case, the woman has never experienced a developed pregnancy, or spontaneous miscarriages or abortions. The complete impossibility of pregnancy is due to diseases of the reproductive system (congenital or acquired). Grade 2 infertility is diagnosed if a woman has at least one pregnancy: successful if the child was born, or unsuccessful if the pregnancy is interrupted. Grade 1 infertility, like grade 2 infertility, is usually not a final sentence for women, as treatment, after which a woman can safely become pregnant and bear the child. The reasons for both primary and secondary infertility are hormonal imbalance in women, changes in the endocrine system, and also ill gynecological field. Secondary infertility can also be caused by unsuccessful first births, surgical interventions associated with them, and artificial abortions of pregnancy.

Infertility: Symptoms

The main sign indicating female infertility is non-occurrence of conception for one year or more, with regular sexual intercourse with a partner who has a good spermogram, with full, prolonged abandonment of contraceptives, if the woman is 20-45 years old. For infertility is not typical the presence of a pathognomonic symptom, often the course of the disease is asymptomatic or with the presence of indirect signs. In order to make a diagnosis of infertility, anamnesis is collected, a gynecological examination, physical, instrumental and laboratory tests. Clear signs are established that are associated with a violation of the menstrual cycle: the duration of menstruation, its volume, the presence of extraneous secretions. Infertility can be assumed if indirect symptoms are identified that are characteristic of infectious, non-infectious or surgical diseases.

Infertility Treatment - Reproductive Studies

To date, to combat female infertility, conservative therapy, surgical treatment, and also the achievements of reproduction are used. These methods help to restore the reproductive function of women. Conservative therapy is to stimulate ovulation and determine the days of the cycle, which are most favorable for conception. This method is applicable in the absence of tubular obstruction, as well as with normal indicators of male sperm. Surgical treatment is prescribed for impaired patency of the fallopian tubes, as well as if there are problems with the mucous membrane of the cervix. If it is not possible to become pregnant by natural means for any objective reasons, reproduction science comes to the rescue. With the advent of in vitro fertilization (IVF), infertility has ceased to be an insurmountable disease. With this method of treatment, the couple had a chance to become parents of a genetically dear child. If you are suspected of infertility, it is important to contact a qualified center with expertise in reproductive medicine to undergo examination and treatment. This center is the clinic "Center IVF" in Volgograd, equipped with modern medical equipment. Here, patients can be helped to eliminate all possible causes of infertility, as well as restore their reproductive health. In situations where the physiological features or the consequences of surgical interventions are barriers to the onset of conception naturally, the IVF Center will help both the couple and single women to become parents during IVF, ICSI, surrogate motherhood, sperm and oocyte donation. The effectiveness of in vitro fertilization in the center is almost 50%. In order to become a patient of the IVF Center clinic, you must first register for a consultation with a specialist you are interested in. At the reception is recommended to take the results of all previous studies. If they are not available, all studies will be conducted on modern diagnostic equipment in our clinic.Do not waste precious time, in this case it is not an assistant, because with age, the effectiveness of IVF, unfortunately, decreases. Weigh all the pros and cons and feel free to contact the Volgograd "Center of IVF"!

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