What is primary infertility, how is it diagnosed and is pregnancy possible? What is primary infertility

According to WHO statistics, approximately one in seven families is faced with the problem of infertility. Infertility refers to the inability of a sexually active couple of childbearing age to reproduce. Such a diagnosis is made if pregnancy does not occur after a year of sexual activity without the use of any contraceptives. About half of these cases are due to primary infertility, when a woman's pregnancy has never occurred. The secondary includes problems with reproduction, if the pregnancy has already been, even if it is ectopic, frozen, with an early miscarriage.

The main causes of infertility are associated with hormonal and anatomical pathologies of various origins. For example, due to a violation of the menstrual function, ovulation does not occur, or the underdevelopment of the uterus makes it impossible to implant the embryo. There are many reasons for this, and they can be combined with each other.

Modern research in gynecology has shown that types of infertility can be grouped according to different criteria. First of all, it is primary and secondary infertility. Each of them is divided into several types.

Depending on the sex of the partner who has problems with fertility, there are male, female, combined infertility.
Depending on the ability to correct the causes, infertility is divided into absolute and relative.
In connection with the type of violations of the reproductive system, infertility occurs:

endocrine;
pipe;
associated with endometriosis
immunological,
psychological;
unexplained etiology.

Primary infertility in women and men

Primary infertility in men is as common as in women. Such a diagnosis can be made if one or more partners with whom unprotected sex has never become pregnant. The causes of this condition can be different, congenital and acquired. For example, this can include:

anomalies of the genital organs (cryptorchidism, absence, underdevelopment of the testicles or seminal ducts, hypospadias);
genetic pathologies;
varicocele;
infectious diseases (STDs, epididymitis, parotitis);
endocrine disorders.

Treatment of primary infertility should be aimed at eliminating its cause. It is usually possible to achieve conception in a natural way if the infectious factor is eliminated, the hormonal background is corrected, and some anomalies are corrected by surgery.

Unfortunately, even with the current level of development of medicine, not all pathologies can be cured, especially when it comes to the congenital absence of an organ, chromosomal changes. In such cases, assisted reproductive technologies will come to the rescue.

The causes of primary infertility in women, as well as in men, are associated with congenital and acquired anatomical features, hormonal imbalance, STIs. The list will be somewhat wider, due to the more complex structure of the female reproductive system.

Rarely, but there are cases of such a type as combined infertility, when both partners at the same time have any problems with fertility. If it was possible to establish the causes, and the treatment of infertility was carried out in a timely manner in full, then the chances of a woman to become a mother increase dramatically.

Congenital pathology of the anatomical structure

Primary infertility in women can be absolute due to congenital malformations of the genital area associated with the absence of:

uterus;
ovaries;
fallopian tubes.

The pathology of the structure of the uterus (hypoplasia, intrauterine septum, bicornuate uterus, doubling of the organ) or the fallopian tubes (their doubling, fusion, underdevelopment) can also interfere with conception. Because of this, the meeting of the egg and sperm is not feasible, that is, the possibility of natural fertilization is completely excluded.

Diagnosis of primary infertility

The diagnosis of primary infertility is made to a patient who complains about the absence of pregnancies with regular sexual activity, after a series of diagnostic studies. The doctor conducts an anamnesis, an external examination, assessing the condition of the skin, hairline, subcutaneous fat layer, breasts, and genital organs. A number of laboratory and instrumental examinations are carried out, including minimally invasive diagnostic operations.

Secondary infertility in women

If a woman cannot conceive for more than a year, but she has previously had a pregnancy, regardless of its completion, then we are talking about secondary infertility. Its varieties in women are associated with factors such as:

tubal obstruction;
infectious and inflammatory processes;
hormonal disorders, in particular, polycystic ovary syndrome and early menopause;
biological incompatibility of partners;
endometriosis;
psychological problems.

Fallopian tube obstruction

After undergoing gynecological operations, including abortions, inflammation of the uterus and appendages, adhesions appear in the fallopian tubes. Their inner surface, as it were, sticks together, grows together. The light is blocked. Due to obstruction of the tubes, spermatozoa do not reach the egg, conception does not occur. The adhesive process can spread to the pelvic organs, this type of infertility is called tubal-peritoneal.

Inflammatory diseases of the pelvic organs

The onset and normal development of pregnancy is prevented by infections that cause inflammatory diseases of the uterus, cervix, tubes or ovaries. It can be STDs, including venereal, tuberculosis and others. The causative agents are:

The infection can get, for example, into the ovaries through sexual contact, when performing gynecological procedures, during childbirth, menstruation, with blood flow from another diseased organ. More often women with chronic stress, weakened immune systems, leading promiscuous sex life suffer from diseases of the genital area.

Infectious processes can act as a factor in infertility. So, inflammation of the cervix changes the properties of the mucus of the cervical canal, it becomes too thick, which prevents the transport of sperm into the woman's uterus. With inflammation of the ovaries, their functioning is disrupted, problems with ovulation appear, and the menstrual cycle gets lost. Inflammation of the uterus affects the normal functioning of the endometrium, to which the fertilized egg is attached.

The danger of genital infections is that in about half of the cases they are asymptomatic or with erased symptoms. Launched infections without proper antibiotic treatment turn into a chronic, sluggish form and lead to adhesions of the pelvic organs, causing infertility.

endocrine infertility

Hormonal disruptions in the body are another common cause of infertility. They are caused by dysfunction of the endocrine glands involved in the work of the reproductive system and the reproduction of offspring: the ovaries, hypothalamus, pituitary gland, thyroid gland and adrenal glands.

The main symptom indicating an endocrine imbalance will be a violation of the menstrual cycle up to the complete absence of menstruation (amenorrhea), as a result of which ovulation does not occur. Failures in the body of such a plan cause:

head injury;
brain tumors;
obesity;
dramatic weight loss in a short time;
hypo- and hyperfunction of the thyroid gland, adrenal glands;
neoplasms of the ovaries;
stress;
genetic abnormalities;
somatic diseases.

For example, the pituitary gland produces the hormone prolactin. When its level in the blood of a woman rises, the onset and development of pregnancy is impossible. Fortunately, endocrine infertility is treated with replacement therapy. After adjusting the hormonal background, 7-8 women out of 10 manage to get pregnant.

Polycystic ovaries

A type of endocrine pathology is polycystic ovary syndrome (polycystic, PCOS). The disease is widespread. In about a quarter of women who have problems with conception, it acts as the main factor in infertility. With this diagnosis, the ovaries visually become similar to a bunch of grapes. Many small cystic formations appear in them. These are immature follicles. In patients, along with cycle failures, excessive hair growth, multiple acne, obesity, skin pigmentation, increased insulin levels, and metabolic disorders are noted.

Immunological infertility

If a woman cannot become pregnant for a year or more, all known variants of infertility are excluded during the examination, then it is recommended to conduct a postcoital analysis for the presence of antisperm antibodies in the couple's blood. A positive result may indicate that spermatozoa are destroyed in the body of a man (more often) or a woman, as a result of which fertilization does not occur.

There is also genetic incompatibility between men and women. In such cases, conception occurs, but the mother's body begins to reject the fetus, and it dies. With the first pregnancy, the risk of rejection is minimal, but increases with each subsequent.

Immunological incompatibility is one of the rarest and most difficult to treat types of infertility.

endometriosis

Pathological growth of the internal mucous membrane of the uterus is the cause of associated primary or secondary infertility. The endometrium has the ability to take root, falling on other organs and tissues. It can be carried throughout the body with blood and lymph flow. Problems with conception arise for two reasons.

Adhesions in the tubes and uterus, due to chronic inflammation in places of endometriotic lesions.
Problems with the maturation of the egg, its quality and ovulation in the presence of endometrial tissue on the ovaries.

early menopause

Early menopause, or emaciated ovary syndrome, is a rare cause of infertility. It is diagnosed if a woman under the age of 40 or older stops having periods and there are such characteristic symptoms as hot flashes, sudden skin fading, weakness, irritability, pressure surges, pain in the heart.

Among the factors in the development of pathology, gynecologists distinguish:

genetic predisposition;
intrauterine damage to ovarian tissue;
autoimmune disorders;
dysfunction of the hypothalamus;
infectious diseases;
stress.

Premature menopause is characterized by a decrease in the size of the ovaries and the complete absence of follicles in them. The lack of maturation of the egg makes conception impossible. As a method of treatment, assisted reproductive technologies (ART) are usually used.

Psychological infertility

If the couple has passed all types of examinations, doctors do not find any obstacles to conceiving a child, and the desired pregnancy does not occur, then you should think about psychological infertility. The trigger mechanism can be a chronic stressful situation. There were cases when the excessive focus of thoughts on the cherished desire did not allow the dream to come true, and as soon as the woman switched her attention to something else, the test showed two stripes.

The causes of psychological infertility may lie in the subconscious. For example, unwillingness to give birth from a particular man, fear of childbirth. For treatment, methods of psychotherapeutic influence are used.

Secondary male infertility and its features

A couple should think about secondary male infertility if a man has suffered a trauma to the genitals, any disease, conception does not occur, but at the same time, the partner had a pregnancy with any outcome. The diagnosis is confirmed after a complete examination, within which a semen analysis, blood tests, ultrasound and doppler of the scrotum are required.

Prerequisites for the occurrence of pathology:

STD;
a history of viral diseases (flu, herpes, etc.);
endocrine pathologies;
varicocele;
surgical operations on the genitals;
regular intake of alcohol, anabolics, narcotic substances;
smoking;
exposure to high temperatures on the testicles (work in a hot shop, visiting a bath, sauna, too hot water while taking a bath);
strict diets and stress.

All these factors affect the quantity, transport of produced sperm, and its quality. Spermatozoa do not enter the ejaculate or are not viable, which makes the fertilization process impossible.

Diagnosis of secondary infertility

Various types of infertility in women can be combined with each other, as well as with male infertility in different combinations. The most frequent pathologies of an inflammatory nature. Therefore, the primary diagnosis is aimed at finding infections and their pathogens.

Women need to start the examination with a visit to a gynecologist, a consultation with a urologist or andrologist - for men. A number of laboratory diagnostic measures include ultrasound, hardware, instrumental examination of the uterus and appendages, blood tests for hormone levels. The results obtained will help to find the causes of childlessness for the selection of the most effective therapy.

General principles of infertility treatment

Types of female infertility are numerous, each of them requires a specific treatment regimen. Therapy aimed at restoring reproductive health is selected individually, depending on the reasons that violated it.

Treatment can be broadly divided into two types.

Conservative - taking various medications, including hormonal, physiotherapy. So, in case of infections, the patient is prescribed antibiotics, and in case of endocrine imbalance, substitution therapy is selected.
Operative, including surgical, minimally invasive, laparoscopic, endoscopic intervention. For example, it makes no sense to treat the symptoms of tubal infertility without surgery.

It makes sense to turn to alternative methods, for example, and so on. Currently, the Internet is replete with many ads for various food supplements that help get rid of infertility. Reviews speak of the positive effect of these funds, but this does not yet indicate a proven clinical effect.

A combination of methods is possible. For example, after surgery, antibacterial and anti-inflammatory drugs are prescribed. Or, on the contrary, after drug treatment of the infection, an operation is performed to eliminate adhesions.

If traditional methods have not led to a positive result, then modern assisted reproductive technologies, such as IVF, ICSI and others, can help a childless couple.

Infertility is the inability of a mature organism to produce offspring. Currently, doctors are raising the question of couple infertility, when pregnancy does not occur after 1 year of regular intercourse without contraception. If there are signs of infertility, do not delay the appeal to the doctor.

Infertility is called primary if there has not been a single pregnancy before, and secondary if the woman has previously been pregnant. By gender, female, male and mutual infertility are distinguished. According to the type and causes of infertility, infertility can be genetic, mechanical, immunological, endocrine, psychogenic, and also mixed.

However, for the most part, this is a consequence of the interaction of not one, but several causes. Primary infertility - the woman did not have any pregnancies. Secondary infertility - a woman has had at least one pregnancy, regardless of how it ended - childbirth, term or premature, stillbirth, spontaneous or induced abortion, or surgery for an ectopic pregnancy.

The frequency of infertility is approximately the same in different countries and is about 15-20% of the total population of childbearing age. It is believed that male and female infertility occurs with the same frequency. In about a third of cases, there is a combination of female and male infertility.

Causes of infertility in women

Problems with ovulation

If the menstrual cycle is less than 21 days or more than 35 days, then there is a risk that the egg does not mature or is not viable. At the same time, in almost half of the cases of the absence of ovulation, the ovaries do not produce mature follicles, from which eggs could then develop. Therefore, ovulation is impossible, mature eggs do not appear, there is nothing for spermatozoa to fertilize. This is the most common cause of female infertility.

Ovarian dysfunction

Ovarian dysfunction in 20% of cases is the result of violations of hormone production in the hypothalamus-pituitary gland. If the activity of this system is disturbed, the corresponding signals do not enter the ovaries, and therefore the rhythmic production of hormones is disturbed. LH and FSH are produced in too much or too little amounts, or their ratio is disturbed. Accordingly, the maturation of the follicle is disrupted, the egg either does not mature at all or is not viable. Dysfunction of the hypothalamic-pituitary system can occur as a result of a head injury, due to a tumor, with chemical disorders in the pituitary gland.

Hormonal problems

Often the cause of female infertility is hormonal disorders. This can lead to the absence of menstruation at all, or to the lack of maturation of the egg. In this case, violations can relate to both sex hormones and any others, for example, the thyroid gland, pancreas.

early menopause

Early menopause (or ovarian dysfunction) is rarely the cause of a lack of ovulation. The usual age of female menopause is 50-55 years, but in some women, egg reserves are exhausted earlier for unclear reasons, menstruation stops at 40-45 years.

The causes of ovarian failure syndrome have not been elucidated, although the main theory is hereditary, since early menopause is often passed down from generation to generation.

Genetic disorders lead to a complete lack of egg maturation, such as Turner syndrome, in which girls are born with underdeveloped ovaries, or with their complete absence (this is called ovarian agenesis). Fortunately, this rarely happens.

Polycystic ovaries

Polycystic ovaries leads to both disturbances in hormone metabolism and changes in the ovaries. Outwardly, it is manifested by increased hair growth, cycle disorders or even amenorrhea, lack of ovulation, and infertility.

With polycystic disease, the production of (FSH) is reduced, although the level of (LH), estrogen and testosterone is within the normal range or even elevated. It is believed that low FSH levels cause permanent underdevelopment of the follicles produced by the ovaries, and therefore the absence of mature eggs.

In this case, many follicular cysts up to 6-8 mm in size are formed, which can be easily seen using ultrasound (ultrasound). The affected ovary is usually enlarged by 2 times, its surface is covered with a smooth white capsule, through which even a mature egg cannot pass.

Cervical disorders

If the mucus of the cervix is too thick, then the spermatozoa cannot overcome it. If the mucus is poisonous to spermatozoa (by chemical composition or due to immune characteristics), then they will simply die, without even starting the path to becoming a person.

Cervical erosion

Erosion of the cervix, as well as cervical canal polyps, can be the only cause of infertility due to changes in mucus, and therefore require mandatory removal before infertility treatment.

Fallopian tube damage

Most often, the tubes are damaged as a result of inflammation transmitted sexually (or from the genital tract). At the same time, violations in the tubes can be very different - from damage to the cilia lining the tubes from the inside to the formation of hydrosalpinx (accumulation of fluid in the fallopian tube, sealed as a result of inflammation. On the x-ray, the hydrosalpinx is visible as a huge bag filled with contrast fluid that came from the uterus through a small segment normal pipe.

In addition, the fallopian tubes can be damaged during previous births, miscarriage or abortion (especially a criminal one made by a non-specialist in unsanitary conditions), diseases of internal organs (for example, chronic appendicitis or colitis).

Finally, there is such a congenital condition of the reproductive system, in which the development and structure of both the uterus and the tubes are disturbed. Scars on the lining of the ovaries can lead to the loss of the ability to produce follicles. Scars are formed as a result of extensive or repeated surgical interventions (for example, for ovarian cysts).

Infectious diseases can also lead to the formation of a large amount of scarring on the ovary, which prevents the normal development of follicles and leads to a lack of ovulation.

Unexploded follicle syndrome

In some women, normal follicles with an egg mature every month. But for some unknown reason, the follicle does not burst in time, the egg remains inside the ovary and cannot participate in fertilization. The reasons for this state are unknown, there is not even a more or less acceptable hypothesis about the causes of what is happening.

endometriosis

Normally, endometrial cells form the inner surface of the uterus, help the embryo to feed, and in the absence of pregnancy, they participate in menstruation. With endometriosis, endometrial cells grow, forming something like polyps or deep "pockets" in the thickness of the uterus, they can penetrate into the fallopian tubes, ovaries, and even into the abdominal cavity. Endometriosis interferes with the maturation of the egg, interferes with the fusion of the egg and sperm, and also disrupts the attachment of the fertilized egg to the uterine wall.

Psychological reasons

Psychological reasons are rarely the reason for infertility. But, at the same time, such conditions as wartime amenorrhea, stress amenorrhea, even examination amenorrhea, are known, when the natural functions of the female body are disturbed due to stress. In addition, the causes of idiopathic infertility (infertility of unknown origin) are referred to as psychological.

A woman (less often a man) subconsciously develops a negative attitude towards a possible pregnancy, and therefore the body itself, automatically, does not allow the processes leading to conception to take place.

Violations of the structure of the uterus

Any formations that deform the uterine cavity act as an intrauterine device, preventing the egg from attaching to the endometrium. Such diseases include polyps of the uterine mucosa, uterine myoma, endometrioid formations, as well as congenital conditions - a saddle-shaped, bicornuate uterus, a uterus with an incomplete septum, a double uterus, etc. These structural features are not inherited, they are easily detected by ultrasound, but treatment is most often presents significant difficulties.

Absence or persistent obstruction of the fallopian tubes

Finally, absolute female infertility - the absence or persistent obstruction of the fallopian tubes is an indication for in vitro fertilization with subsequent transfer of embryos into the mother's uterus (IVF).

Primary and secondary infertility

In addition to the alleged cause of infertility, doctors are also interested in whether it is primary or secondary.

If a woman has never had a pregnancy, then they talk about primary infertility.

If there was at least one pregnancy, then subsequent infertility is considered secondary, regardless of how the pregnancy ended - childbirth, miscarriage, abortion.

Unfortunately, one of the main causes of secondary infertility is the first abortion, that is, abortion before childbirth. The unprepared reproductive system of a young woman reacts to this intervention more acutely than after childbirth, and therefore inflammation of the appendages or uterus, obstruction of the fallopian tubes, changes in the endometrium easily occur.

Treatment of infertility in women

The latest achievements in the field of drug treatment, microsurgery and assisted reproductive technologies make it possible to choose the method of infertility treatment. There are a large number of non-invasive procedures that can eliminate tubal obstruction, remove tumors or hyperplasia.

Medical treatment for infertility

Many conditions that lead to infertility can be treated by a doctor with medications. For example, in women, medications can increase the chance of an egg being released and get rid of endometriosis.

Modern methods of infertility treatment

Fertilization can occur both inside the female body (artificial insemination) and outside it with the sperm of a partner or donor. Among these technologies are IVF (with a woman's egg and partner or donor sperm, donor eggs or donor embryos), transplantation of gametes or zygotes into the fallopian tubes, micromanipulation of eggs and embryos.

At your first address with the problem of infertility at the place of residence (antenatal clinic or gynecological department of the polyclinic), in most cases, treatment as such may not follow. The maximum that they can advise you is to pass a standard set of tests and recommend a clinic specializing in the treatment of infertility.

Treatment of infertility with folk remedies

In case of infertility, it is useful to drink a decoction of Adonis grass as tea. Brew 1 cup boiling water 1 tbsp. herbs, insist, wrapped, 2 hours and strain. Drink 3 times a day.
Drink a decoction of the herb of Adam's root. Brew 1 cup boiling water 2 tsp. herbs, insist, wrapped, 2 hours and strain. Drink 1 tbsp. 3-4 times a day.
Brew 1 cup boiling water 1 tsp. sage herbs and leave for 30 minutes. Drink 1/3 cup 3 times a day 30 minutes before meals. Another way: drink 1 des.l. 2 times a day on an empty stomach and in the evening the juice of a fresh sage plant. The drug should be taken within 12 days immediately after the cessation of menstruation.
Brew 1 cup boiling water 1 tbsp. plantain seeds, boil over low heat for 5 minutes. and insist 1 hour. Drink 1-2 tbsp. 3-4 times a day 30 minutes before meals. The same recipe is used for male infertility. Course 1-2 months.
Brew 0.5 l of boiling water 3-4 tbsp. knotweed, insist, wrapped, 4 hours and strain. Drink 1-2 cups 4 times a day 20 minutes before meals.
Brew 0.5 l of boiling water 3 tbsp. herbs ramishia lopsided and insist in a thermos overnight. Drink 150 ml 3-4 times a day 1 hour after meals. The same plant helps with many female diseases.
Traditional healers say: in order to cure infertility, you need to eat young.
As a fumigation, inhale the smoke from the burned St. John's wort, it is useful for infertility.
Inhale the smoke from the burned kirkazon seeds.

Questions and answers on the topic "Infertility in women

Question:Hello. I have a tubal factor, (tubectomy of two tubes). I want to get a quota for IVF. The antenatal clinic said that there are no quotas yet. Tell me where to turn for information, and what type of quotas in my case can be obtained (regional or federal).

Answer: Hello, the LCD cannot give answers of this kind, since the absence of quotas is not a basis for refusing to issue a voucher for high-grade medical care if there are medical indications. The patient simply registers on the "waiting list" and waits for his turn. In fact, you can independently apply to the Ministry of Health with all the necessary documents, and it is up to the LCD to help collect them (extracts from the medical card, etc.).

Question:Hello. My monthly cycle is 43 days. Could this be the cause of infertility?

Answer: If your periods are regular, this may mean that you are ovulating. Absolutely healthy women can have a menstrual cycle of up to 40 days. Accordingly, the number of menstrual cycles per year is less - fewer days favorable for conception. You need to more closely monitor the moment of ovulation, because. with a 43 day cycle, it occurs later than with a 28 day cycle.

Question:Hello. I have a "curved" uterus. Could this be the cause of infertility, since the sperm cannot enter the uterus?

Answer: About 20% of women have a "curved" uterus. If the uterus is mobile, this is absolutely normal and cannot be the cause of infertility.

Question:My gynecologist says that everything is absolutely fine with me. My husband and I have sex regularly and we are both healthy. I have regular periods. However, I still haven't been able to get pregnant. Advise what to do?

Answer: Good afternoon. A routine examination by a gynecologist in a district clinic cannot establish many possible causes of infertility. To do this, you need to go through all the necessary studies to find out if your husband’s sperm is normal, if your fallopian tubes and uterus are normal, and if your eggs are maturing. Only then will the doctor be able to determine why you cannot get pregnant.

Question:Good afternoon! I have secondary infertility (my husband and I have already done all kinds of tests) - the cause of polycystic ovaries and elevated prolactin, for 2 months. took bromkreptin - now he is normal, the doctor said not to do anything yet, and now during these 2 months. and 1 month after taking the drug, I try to get pregnant, but it doesn’t work, although sexual intercourse occurs on the 13th, 14th, 16th day of the cycle (each month is different). Why doesn't fertilization occur? How long will prolactin stay normal on its own?

Answer: Polycystic ovary syndrome is a complex disease and prolactin levels exacerbate it. Infertility with this combination is most often still due to ovarian disease, and when choosing therapy, this is what they pay attention to. Try to contact another institution. You need a competent consultation of a gynecologist-endocrinologist.

Question:Hello! I'm 32 years. Intrauterine fibroids 2.5 cm. Is IVF possible?

Answer: Hello. "Intrauterine" is a submucosal node in the uterine cavity. Eco is not done with this, since the node can interfere with implantation, such a fibroid must be removed. If the node is interstitial, or subserous, not deforming the cavity, IVF can be done.

Question:Good afternoon. I am 30. In February, the intrauterine device was removed. Pregnancy has not occurred for 3 months. Analyzes and ultrasound are normal. I already have a 10 year old child. The first child had a caesarean section. There have never been any abortions. What could be the reason and how long should it take for conception after the removal of the spiral? And how can it be accelerated?

Answer: Pregnancy normally occurs within 2 years with open sexual activity in healthy couples. No one has yet learned how to get pregnant "of their own accord", it is impossible to speed up the process.

We can talk about infertility if a woman does not become pregnant during a year with regular sexual intercourse without using contraceptives. In 40% of cases, it is associated with diseases in men, in 45% in women. In the remaining 15 out of 100 cases of infertility, both partners have its cause.

This is a condition where a woman has never become pregnant in her life, subject to regular sexual contact and in the absence of contraception. With secondary infertility, a woman previously had a pregnancy, but subsequently, as a result of any diseases, the ability to bear a child disappeared. Among all infertile women, the primary form is observed in 60%, the secondary - in 40%.

Primary female infertility can be relative and absolute. In the first case, pregnancy is possible; in the second, conception and gestation do not occur in natural conditions. A typical example of relative primary infertility in a woman is the absence of children in a marriage with an infertile man.

What causes infertility in women?

The main causes of primary infertility are associated with anatomical disorders in the structure of the genital organs:

infantilism (underdevelopment);
congenital developmental anomalies;
incorrect position of the uterus;
sexually transmitted infections.

In addition, this form of pregnancy pathology may be associated with disruption of the ovaries, changes in ovulation and the menstrual cycle.

Inflammatory processes in the genital tract, tumors, intoxication, endocrine and other serious diseases most often cause secondary infertility.

Primary infertility is a pathology that can occur as a result of psycho-emotional changes. , in which the egg is not capable of fertilization, appear due to prolonged stress, conflicts in the family, dissatisfaction with intimate life. They can be provoked by fear of pregnancy or, on the contrary, by a passionate desire to have a child.

In addition to suppressing ovulation, these factors contribute to the release of stress hormones and change the activity of the autonomic nervous system. As a result, the contractile activity of the fallopian tubes is disrupted and functional tubal obstruction is formed. This combination of ovulation disorders and the functioning of the uterus is difficult to diagnose.

The unfulfilled desire to become a mother leads to chronic nervous tension and further reduces the likelihood of fertilization. Thus, a vicious circle of fruitless marriage is formed.

Factors that can provoke primary infertility in women:

diseases of the endocrine glands;
damage to the fallopian tubes or peritoneum;
gynecological diseases;
immune incompatibility.

Endocrine disorders can cause primary infertility if they appear at a young age before the first pregnancy. They are associated with a violation of the ovulatory cycle, which occurs for one of the following reasons:

insufficiency of the luteal phase during the menstrual cycle;
luteinization of the follicle without ovulation.

Anovulation is the absence of egg maturation, which can be caused by pathology of the pituitary gland, hypothalamus, ovaries, adrenal glands. The absence of ovulation leads to an increase in the content of male sex hormones in the blood - androgens, prolactin; lack of female sex hormones - estrogens; overweight or wasting. Anovulatory infertility can be caused by Itsenko-Cushing's syndrome or disease, as well as thyroid diseases with impaired production of thyroid hormones (hypo- or hyperthyroidism).

Hormonal disorders are often associated with traumatic brain injury, encephalitis, and prolonged stress. In addition to anovulation, they can provoke insufficiency of the luteal phase of the menstrual cycle. At the same time, the ovaries do not provide the production of hormones responsible for preparing the endometrium of the uterus for pregnancy. The mucous membrane of the uterus does not thicken, as a result, the embryo formed during conception cannot attach to it. Spontaneous abortion occurs even before the expected delay in menstruation.

Sometimes the follicle in which the egg matures prematurely turns into a corpus luteum, and ovulation does not occur. The reasons for this condition are unknown.

Damage to the fallopian tubes or peritoneum is more characteristic of secondary infertility. It can cause an initial inability to become pregnant if the disease develops in a girl or teenager.

Violation of the function of the fallopian tubes, not accompanied by structural changes in these organs, can occur against the background of stress, an increase in the concentration of androgens in the blood, as well as in chronic inflammatory processes in the body, in which the content of prostacyclins increases.

The main cause of primary tubal infertility is tuberculosis of the reproductive system.

Peritoneal infertility may appear as a result of a pronounced adhesive process in the abdominal cavity. Such adhesions are formed after extensive operations on the abdominal organs.

Gynecological diseases most often lead to secondary infertility, the primary form of pathology is caused by anomalies in the development of the uterus.

In rare cases, the cause of infertility is the production of antibodies in the female body that destroy the sperm of the sexual partner (). However, it has been found that such immunoglobulins can also be found in a compatible couple. Therefore, the determination of antisperm antibodies in clinical practice is not used.

One cause of the pathology is detected only in 48% of women, in other cases, primary infertility of combined genesis is recorded. This must be taken into account when planning pregnancy. The later a woman decides to become pregnant, the more likely she is to "accumulate" several risk factors for infertility.

Diagnostics

In order to make a diagnosis of "primary infertility", the doctor must ask and examine the patient.

The following questions are clarified:

At what age did menstruation begin?
how long the cycle lasts, whether menstruation begins regularly;
Is there any spotting between periods?
painful menstruation;
whether the woman had a pregnancy in the past;
used contraception and duration of its use;
duration of infertility;
regularity of sexual activity.

The doctor looks for signs of diseases of other organs: diabetes, tuberculosis, diseases of the adrenal glands and the thyroid gland. The patient is asked about possible psychogenic factors.

During an external examination, attention is paid to excess body weight, skin condition, the presence of acne, facial hair.

Performed and gynecological organs. Within 3 months, a woman should measure her basal body temperature. A study of smears from the vagina, from the surface of the cervix. If necessary, prescribe seeding for microflora, polymerase chain reaction to identify possible infectious factors.

If endocrine infertility is suspected, it is necessary to find the affected link in the "hypothalamus - pituitary gland - ovaries" system. For this purpose, x-rays are prescribed, computer or magnetic resonance imaging of the skull and sella turcica, the fundus is examined, ultrasound of the thyroid gland, ovaries and adrenal glands is performed.

Analyze the hormonal background in detail:

follicle stimulating hormone;
luteinizing hormone;
prolactin;
thyroid-stimulating hormone;
adrenocorticotropic hormone;
estradiol;
progesterone;
thyroxine and triiodothyronine;
cortisol;
testosterone;
DHEA-S.

With concomitant obesity, a glucose tolerance test is prescribed to detect diabetes mellitus.

Insufficiency of the luteal phase is diagnosed according to the measurement of basal temperature. With this pathology, the second phase of the cycle is shortened to 10 days, and the temperature difference before and after ovulation does not exceed 0.6 ° C. The diagnosis is confirmed by detecting a reduced level of progesterone one week after ovulation (day 21 of the cycle).

Luteinization of a non-ovulated follicle is recognized by repeated ultrasounds. According to this study, the follicle first increases in size, then its growth stops. Ovulation does not occur, the follicle shrinks.

Tubal-peritoneal and gynecological infertility is most often secondary. For its diagnosis use:

hysterosonography;

Using these methods, it is possible to find structural changes that prevent the development of pregnancy. The same studies are often prescribed for primary infertility.

One of the best research methods to detect a violation of the structure of the genital organs is a spiral computed tomography of the pelvic organs. Magnetic resonance imaging of this area is also used, but its diagnostic value is somewhat lower.

For the diagnosis of immunological infertility, a postcoital test is performed. To do this, determine the number and nature of the movements of spermatozoa in the cervical mucus on the 12-14th day of the cycle. If the spermatozoa are immobile or not detected, this may be a sign of the immune incompatibility of the sexual partners.

In rare cases, the content of antisperm antibodies is determined in the blood or cervical mucus; however, this test is nonspecific and should not be used.

Simultaneously with the examination, women take a semen analysis from her partner to rule out male infertility.

Treatment

Therapy begins with attempts to normalize the emotional state of the patient. Consultation of a medical psychologist, psychotherapist is appointed. In some cases, seeing a psychiatrist and prescribing sedatives or tranquilizers is helpful. Sometimes these measures help to solve the problem of infertility without stimulating ovulation.

It is important to normalize body weight. In some cases, weight loss contributes to the onset of pregnancy, as this normalizes the production of gonadotropic hormones from the pituitary gland.

If sexually transmitted infections are detected, the woman is prescribed appropriate antibiotics.

If the cause of infertility is a pituitary tumor, the woman is referred to a neurosurgeon. Functional hormonal disorders require the appointment of appropriate drugs.

If the cause of infertility is infantilism, the patient is prescribed physiotherapy and gynecological massage. In the first phase of the cycle, B vitamins should be taken, folic acid in primary infertility is necessary to prevent congenital pathology in the fetus. In the second phase, vitamins A and E are shown. In addition, a course of oral contraceptives is prescribed. If these measures do not help, ovulation is stimulated, and if it is ineffective, assisted reproductive technologies are used.

With endocrine infertility, ovulation stimulation is often used. Such treatment of primary infertility is carried out using the following drugs:

monophasic combined oral contraceptives for 3 cycles;
Clomiphene from 5 to 9 days of the cycle;
preparations of gonadotropins (follicle-stimulating, luteinizing hormones, followed by the introduction of chorionic gonadotropin).

Ovulation stimulation is a complex procedure, its plan is formed individually for each patient. What helps one woman can only hurt another. Therefore, for all questions related to this method of treatment, you need to personally consult with a qualified gynecologist.

If pregnancy has not occurred within a year of treatment, the patient is referred for laparoscopy.

Treat with laparoscopic intervention, for example, dissect adhesions in the abdominal cavity. In case of severe obstruction of the tubes, it is carried out, and IVF is used for pregnancy.

If immunological infertility is diagnosed, the couple is advised to use contraception with condoms for six months. Within 3 days before ovulation, the patient is prescribed estrogenic drugs. After the termination of barrier contraception, a desired pregnancy often occurs.

Primary infertility in men requires, first of all, stopping smoking, drinking alcohol, normalizing the regimen and physical activity. The patient is examined by an andrologist, after which appropriate therapy is prescribed. In case of pathology of the vas deferens, it is proposed to take sperm directly from the epididymis or the testicle itself, followed by artificial insemination (introduction into the woman's uterus).

If therapy is ineffective for 2 years, assisted reproductive technologies are used - artificial insemination or. If at the time of the diagnosis of "primary infertility" the woman is already 35 years old, conservative methods of treatment should not be used at all. In these cases, it is necessary to use assisted reproductive technologies as soon as possible.

The success of treatment depends on many factors and cannot be predicted in advance. It must be remembered that the psychological state of a woman is very important in her fertility. On average, as a result of treatment with ovulation stimulation, pregnancy occurs within a year in about half of patients with primary infertility. The prognosis is worse for diseases such as those accompanied by a lack of egg maturation and menstruation. In this case, modern medical technologies help.

male infertility

If the couple does not have children, both partners should be examined.

Primary male infertility can be caused by such reasons:

varicocele;
orchitis transferred in childhood, for example, with mumps (mumps);
anomalies in the development of the reproductive system;
endocrine diseases in a child or adolescent.

The main method for diagnosing such a condition is. This biological fluid is examined according to the protocol approved by the World Health Organization. An andrologist or urologist should interpret the results.

If the spermogram is within the normal range, the man is considered healthy. If abnormalities are detected, the patient is prescribed a urological examination. Sometimes it is necessary to consult an endocrinologist or geneticist.

The real scourge of gynecology is infertility. Symptoms of this diagnosis are manifested in the inability of a woman to become pregnant within 1 year of active sexual activity with a healthy man without the use of contraception. Primary infertility is the inability of a woman to become pregnant from the beginning of her reproductive years. That is, conception never occurred. Unfortunately, this diagnosis is not rare for modern couples. A woman with 1st degree infertility has neither the experience of pregnancy nor a single child yet. The suppressed feeling of the impossibility of becoming a mother causes only apathy for everything that happens around. But do not despair. Today, there are not many diseases left that forever deprive a woman of the opportunity to find parental happiness. This article presents the main causes and methods of treatment for primary infertility.

Causes of infertility of the 1st degree. Treatment

A woman is not able to conceive a child subsequently due to congenital or acquired pathology, as well as due to experienced infectious diseases of the internal genital organs. For example, among the pathologies that develop in women are uterine fibroids, cervical erosion, cysts and other gynecological diseases. Ovarian pathologies are also very common. When the ovarian follicles do not work properly, there can be problems with the maturation of the egg. Such diseases are manifested by a prolonged absence of menstruation and prolonged bleeding when they appear.

Infertility of the 1st degree can occur after the termination of the first pregnancy in a woman. As a result of abortion, the female hormones produced during the process of conception and the formation of the fetus turned out to be unnecessary and provoked a hormonal failure in the body.

Another cause of primary infertility in this case is the possible traumatization of the internal genital organs due to abortion. Adhesions that cause obstruction of the fallopian tubes are possible. Because of this, the egg simply cannot pass into the uterine cavity and be fertilized. Read more about all the causes of infertility below.

Ovulation does not occur. The hormonal failure that occurs in the body of a woman prevents the release of a healthy egg. This is manifested by a failure of menstruation, an abnormal amount of bleeding. Treatment consists in therapy with medications that stimulate ovulation.
Poor quality egg. The older the woman, the worse the quality of the egg becomes. In women who want to become pregnant after age 40, the egg that is released may be abnormal. The way out of the situation: a surrogate mother or implantation of an egg from a donor.
Endometriosis. The disease consists in the growth of endometrial tissue outside the uterus. Endometriosis is manifested by rather painful sensations during menstruation. Is fraught with miscarriages. Treatment is surgical only. The overgrown tissue is removed and the patency of the fallopian tubes is restored.
. Obstruction is said to be when the egg is unable to reach the uterus. In this way, the sperm will not reach the egg. Infertility of the 1st degree in women of this nature can be the cause of inflammatory processes in the genital organs, as well as sexually transmitted infections.
Polycystic ovaries. Multiple cysts in the ovaries cause a hormonal imbalance, a delay in menstruation, and, consequently, ovulation. Polycystic disease is manifested by an unexpected increase in body weight, rapid growth of body hair, and acne. Treatment consists of taking drugs that stimulate ovulation.

Diagnosis performed by a specialist will help to find out the cause and begin to determine the path of treatment. Primary infertility can be overcome. Modern medicine is able to work miracles in the truest sense of the word. An extreme solution to the problem of infertility of the 1st degree may be IVF or surrogacy. A good mood, the belief that everything will work out and the fulfillment of all the requirements of the attending physician - these are the components of success on the path to motherhood.

Obstetrician-gynecologist Andreeva O.V. speaks of primary and .

The diagnosis of "infertility" is made if within 1 year, with regular attempts to conceive a child, pregnancy has not occurred. There are 2 forms of infertility: 1 and 2 degrees.

Primary infertility is the inability to conceive a child at the beginning of the reproductive age (from 20 to 27 years). The problem is complicated by the deterioration of the mental state of the woman, and when trying to get pregnant, any disorders only worsen the situation.

Primary infertility in women is a fairly common factor. With the correct diagnosis of the disease that caused infertility, competent treatment and restoration of the reproductive system is possible.

Types and signs

There are several types and subspecies of infertility. Two main forms: primary and secondary (acquired, resulting from injuries or inflammatory processes).

There are 2 other varieties: absolute and relative. Absolute infertility is the complete inability to become pregnant due to the absence of a uterus and ovaries in a woman. With a relative chance of conceiving a child, there are considerable, for this you only need to perform some operations. Primary infertility can be divided into 5 types:

Normogonadotropic anovulatory or endocrine infertility occurs due to diseases of the thyroid gland and sex glands. Their work is the regulation of the menstrual cycle, so any deviation can lead to complex hormonal disruptions. Anovulatory normagonadotropic infertility does not allow ovulation to occur or makes this process rare and inferior. There are 3 reasons why anovulatory infertility occurs:

Disorders in the work of the hypothalamus and pituitary gland: weight loss, stress, bleeding are observed. If the cause is a prolactinoma (tumor), with proper treatment, fertility will be restored.
Polycystic ovary syndrome: there is an excess of estrogens. If the form of the disease is severe, then the probability of restoring the reproductive system is low.
Ovarian exhaustion is the most difficult stage in which the chances of getting pregnant are reduced to almost zero.

Tubal-peritoneal - caused by obstruction of the fallopian tubes. Adhesions form in the fallopian tubes and ovaries, so pregnancy does not occur until the channels are cleared. This procedure is usually done with a surgical method called laparoscopy. A microscopic instrument in the cavity of the pipes expands the channels and cleans them from adhesions. If the form of the disease is severe and the tubes are practically impassable, doctors recommend refraining from laparoscopy and trying to conceive a child using IVF, including surrogacy.
Genetic - caused by chromosomal abnormalities. Manifested by frequent miscarriages. Doctors recommend genetic testing if there have been 2 miscarriages in a row.
Immunological - observed with a special activity of antisperm antibodies that disrupt the ability of sperm to be fertile. Most often, immunological infertility of the 1st degree occurs due to the incompatibility of cervical mucus and seminal fluid. During ovulation, the ovaries produce special substances that coat the cervix with mucus. Because of it, sperm cannot approach the uterus and die, and the egg is never fertilized. To establish the immunological form, women conduct a postcoital test immediately after intercourse. The test helps to determine cervical mucus and determine the cause of difficult conception.
Infertility caused by artificial termination of pregnancy. Abortions negatively affect the state of hormonal processes and often provoke adhesions in the fallopian tubes. Even a mini-abortion can subsequently interfere with a planned pregnancy. If the endometrium is damaged, the egg will not be able to attach to the uterus. Pregnancy will not occur until the endometrium is fully restored.

Also known is the concept of idiopathic infertility. This term doctors call the inability of a woman to become pregnant for unknown reasons. Both partners undergo a full examination, but no abnormalities in the body are found.

This is the most difficult form, because doctors cannot determine what needs to be treated to restore the reproductive system.

Causes of infertility

You can determine why pregnancy does not occur by some signs:

unpleasant odor from the vagina;
grayish discharge;
frequent gripping pains in the lower abdomen;
itching in the genital area;
discomfort during intercourse, pain;
disturbed menstrual cycle;
menstruation lasting less than 3 or more than 7 days;
delay in menstruation (also does not always indicate pregnancy).

All these signs indicate some reason that prevents a woman from becoming pregnant. The main factors of infertility of the 1st degree include:

Endometriosis.
Obstruction in the fallopian tubes.
Increased secretion of prolactin.
Amenorrhea.
Spikes.
Defects in the organs of the reproductive system.
Psychosexual disorders.
Inflammation in the pelvic organs.
Hormonal imbalance.

Separately, it is worth mentioning a medicine that often becomes a provocateur of infertility - Postinor.

Postinor

This is a powerful remedy that should only be used in extreme cases: a torn condom during intercourse, rape, unsafe sex, etc. This medicine is used in really emergency situations, but many girls use it as a regular contraceptive. This approach leads to infertility.

Postinor - provocateur of infertility

The remedy must be taken immediately after unprotected intercourse, within 72 hours. One pack contains 2 tablets to be taken consecutively. The first tablet - in the next hour or two, the second - 12 hours after the first. The sooner the medicine is taken, the lower the risk of becoming pregnant. If used improperly, infertility can occur after postinor.

The medicine deals the strongest blow to the body and depletes the functions of the ovaries. With regular use of the drug, the reproductive system completely dies. Postinor and infertility are indeed connected, but if you use it strictly according to the instructions, the body will not be damaged.

Postinor after ovulation slows down the movement of the egg and sperm.

Cervical factor infertility

Cervical factor infertility is a violation in the cervix, due to which fertilization does not occur. There are 2 forms of deviations:

Poor quality of the composition of the cervical mucus.
Narrowed cervical canal.

Treatment of the cervical factor is related to the cause of its manifestation. The most common: hormonal failure, poor microflora of the cervix, inflammatory processes. After establishing the diagnosis, the doctor prescribes complex therapy, which includes taking restorative drugs and a special diet.

Treatment and prevention

Before prescribing treatment, the doctor conducts a complete examination of the patient for all forms of infertility. All methods are aimed at restoring the reproductive functions of the body. Both medicines and surgical instruments can be used here. Depending on the type of infertility, therapy is established:

With endocrine, hormonal correction is prescribed, stimulating the work of the ovaries. If there are physiological abnormalities, they are eliminated: normalization of weight, maintaining proper nutrition. Hormone therapy helps the follicles to mature properly, while the level of hormones in the blood is controlled.
If the problem is in the fallopian tubes, treatment is aimed at improving their patency (laparoscopy method).
Endometriosis is eliminated in the same way. The chance of pregnancy is 40%.
With immunological infertility, preference is given to the method of artificial insemination. In this case, the father's sperm is injected into the uterine cavity using a special tube. This option allows sperm to bypass the immune barrier and quickly enter the egg.
It is most difficult to formulate a treatment for an indeterminate cause of infertility. In this case, the patient is prescribed various procedures, examination for all known factors of infertility.

To maintain the reproductive system, every woman needs infertility prevention.

As a rule, it includes regular visits to the gynecologist (1-2 times a year), going to the doctor at the first symptoms of any disease, proper nutrition, personal hygiene, use of contraceptives only on the advice of a doctor.