Female infertility: causes, diagnosis and treatment. A complete scheme for diagnosing female infertility
*one. Collection of somatic, gynecological and reproductive anamnesis.
2. General inspection.
3. Gynecological examination.
4. Spermogram of the husband.
5. General clinical examination (general blood test, biochemical, coagulogram, RW, HIV, HbsAg, blood glucose test, blood group and Rh factor, general urine test).
6. Examination for STIs.
7. Ultrasound of the pelvic organs.
8. Colposcopy.
9. Hysterosalpingography.
10. Functional diagnostics of ovarian activity:
♦ basal temperature 2-3 months;
♦ hormonal colpocytology every week;
♦ study of the phenomenon of mucus arborization daily;
♦ Ultrasound on the 12-14-16th day of the cycle (determine the diameter of the follicle);
♦ determination of the levels of estrogen, testosterone, prolactin, FSH, LH in blood plasma;
♦ the level of progesterone in the blood and pregnandiol in the urine on the 3rd-5th day of mensis, in the middle of the cycle and in the 2nd phase;
♦ Level of 17-COP in urine 2 times a month.
11. Hormonal tests.
12. Additional studies according to indications:
a) hormonal examination: cortisol, DHEA-S (dehydroepiandrosterone - sulfate), insulin, T3, T4, TSH, antibodies to thyroglobulin;
b) immunological tests (in a later source, the inappropriateness of these tests is described, see the classification of infertility Gynecology - national guidelines, edited by V.I. Kulakov, G.M. Savelyeva, I.B. Manukhin 2009):
postcoital Shuvarsky-Guner test (see section "Immunological infertility").
the determination of antisperm antibodies in women in the mucus of the cervical canal is carried out on preovulatory days - the levels of Ig G, A, M are determined;
Kurzrock-Miller test - penetration of spermatozoa into the cervical mucus of a woman during ovulation;
Friberg's test - determination of antibodies to spermatozoa using a microagglutination reaction;
Kremer's test - detection of local antibodies in a partner during contact of sperm with cervical mucus;
immobilization test Izojima.
13. Examination by a mammologist, mammography.
14. X-ray of the Turkish saddle and skull.
15. Examination of the fundus and visual fields.
16. Hysteroscopy
17. Laparoscopy.
DIAGNOSTICS OF INFERTILITY
At the first stage, the patient undergoes a preliminary examination in a polyclinic. Already at this stage, it is possible to carry out effective treatment of some forms of female infertility, mainly associated with ovulatory disorders or gynecological diseases that are not accompanied by occlusion of the fallopian tubes and can be corrected in outpatient settings.
The second stage involves the performance of specialized studies prescribed according to indications (endoscopic, non-invasive hardware and hormonal) and treatment using both conservative and surgical (laparotomic, laparoscopic, hysteroscopic) methods, as well as ART. The latter include artificial insemination and IVF, performed in various modifications. Assistance with the use of specialized diagnostic and therapeutic procedures is provided in the gynecological departments of multidisciplinary hospitals, at the clinical bases of departments and research institutes, as well as in public or private centers using both endosurgical methods and ART.
ANAMNESIS
At the first visit of a patient about infertility, a survey of women is carried out according to a certain scheme recommended by WHO:
- number and outcome of previous pregnancies and births, post-abortion and post-natal complications, number of live children;
- duration of infertility;
- methods of contraception, duration of their use;
- diseases (diabetes, tuberculosis, pathology of the thyroid gland, adrenal glands, etc.);
- drug therapy (the use of cytotoxic drugs, psychotropic and tranquilizing agents);
- operations accompanied by a risk of developing an adhesive process (surgery on the uterus, ovaries, fallopian tubes, urinary tract and kidneys, intestines, appendectomy);
- inflammatory processes in the pelvic organs and STIs; type of pathogen, duration and nature of therapy;
- diseases of the cervix and the nature of the treatment used (conservative, cryo or laser therapy, electrocoagulation, etc.);
- the presence of galactorrhea and its relationship with lactation;
- epidemic, production factors, bad habits (smoking, alcohol, drug addiction);
- hereditary diseases in relatives of the I and II degree of kinship;
- menstrual history (age of menarche, nature of the cycle, nature of cycle disorders, the presence of intermenstrual discharge, painful menstruation);
- sexual dysfunction (superficial or deep dyspareunia, contact spotting).
PHYSICAL EXAMINATION
- The type of physique, height and body weight are determined with the calculation of the body mass index (body weight, kg / height2, m2; normal 20–26). In the presence of obesity (body mass index> 30), the time of its onset, possible causes and rate of development are established.
- Assess the condition of the skin and skin (dry, wet, oily, the presence of acne, stretch marks), the nature of hair growth, the presence of hypertrichosis and its degree (according to the D. Ferriman, J. Galwey scale). In case of excessive hair growth, the time of its appearance is specified.
- They study the state of the mammary glands (degree of development, the presence of discharge from the nipples, volumetric formations).
- Bimanual gynecological examination, examination of the cervix in the mirrors and colposcopy are used.
The polyclinic examination also includes the conclusion of the therapist about the possibility of carrying pregnancy and childbirth. When identifying clinical signs of endocrine and mental diseases or other somatic diseases, as well as malformations, consultations of specialists of the appropriate profile are prescribed - endocrinologists, psychiatrists, geneticists, etc.
LABORATORY STUDIES FOR INFERTILITY
In infectious screening, perform:
- a study on the flora from the urethra, cervical canal and the degree of purity of the vagina;
- cytological examination of smears from the cervix;
- smear from the cervical canal for detection by PCR of chlamydia, HSV, CMV;
- a study on infection by the cultural method (sowing the contents of the vagina and cervical canal to determine the microflora, the presence of ureaplasma and mycoplasma);
- blood test for hepatitis B and C, syphilis, HIV infection, rubella.
If an infection caused by these pathogens is detected in a patient, an appropriate etiotropic therapy is carried out, followed by a follow-up examination. At the same time, patients can be referred for specialized treatment under the supervision of a dermatovenereologist (gonorrhea, syphilis), an immunologist (HIV infection).
Hormonal screening during a standard outpatient examination aims to confirm/exclude endocrine (anovulatory) infertility. In patients with menstrual and ovulatory disorders, hormones are examined, the deviation of the content of which can cause such disorders.
The use of specialized hormonal and instrumental diagnostic methods that identify the causes of the identified hormonal imbalance (for example, various hormonal tests, the use of CT of the sella turcica, ultrasound of the thyroid gland, etc.) is within the competence of gynecologists and endocrinologists, who also determine the need and nature of the treatment of such disorders.
INSTRUMENTAL STUDIES FOR INFERTILITY
At the outpatient stage of diagnosing the causative factors of infertility, ultrasound of the pelvic organs is mandatory. It is also advisable to prescribe an ultrasound of the mammary glands to clarify their condition and exclude tumor formations.
HSG is still being prescribed to patients with suspected tubal or intrauterine infertility factors. The study is carried out on the 5-7th day of the cycle with a regular rhythm of menstruation and oligomenorrhea, with amenorrhea - on any day. It should be noted that when assessing the patency of the fallopian tubes, the total number of discrepancies between the results of HSG and laparoscopy, supplemented by intraoperative chromosalpingoscopy with methylene blue, can reach almost 50%, which very clearly demonstrates the unsatisfactory diagnostic potential of HSG when studying the condition of the fallopian tubes. From this it follows that an accurate diagnosis of TPB with an understanding of the nature and severity of tubal changes can only be made on the basis of laparoscopy data with chromosalpingoscopy. As for the diagnostic significance of HSG, in our opinion, this method is more suitable for detecting intrauterine pathology (see "Uterine forms of infertility"), but not TPB.
CT or MRI of the skull and sella turcica is prescribed for patients with endocrine (anovulatory) infertility associated with hyperprolactinemia or pituitary insufficiency (low FSH), which allows to detect micro and macroprolactinomas of the pituitary gland, as well as the "empty" sella sella syndrome.
Patients with suspected surgical pathology of the internal genital organs may be assigned a spiral CT scan of the pelvis. This method allows obtaining a large amount of information about the anatomy of the internal genital organs, which is of great value in planning the nature and extent of surgical intervention. For the same purpose, MRI of the pelvic area is also used. However, it must be taken into account that MRI, in comparison with helical CT, has less diagnostic potential and requires more time to acquire images.
Ultrasound of the thyroid gland is prescribed for patients with endocrine infertility against the background of clinical signs of hyper or hypothyroidism, abnormal values of the content of thyroid hormones and hyperprolactinemia. Ultrasound of the adrenal glands is performed in sick women with clinical signs of hyperandrogenism and a high content of adrenal androgens. For a more reliable diagnosis, CT of the adrenal glands is indicated for such patients. Laparoscopy is indicated for patients with suspected TPB (according to the anamnesis, gynecological examination and ultrasound of the pelvic organs). For women with a reliably established diagnosis of endocrine infertility, laparoscopy is recommended after a year of unsuccessful hormonal therapy, since the absence of pregnancy during these periods with adequately selected treatment (ensuring the restoration of ovulatory function) indicates the possible presence of TPB.
Laparoscopy is also indicated for infertile patients with a regular ovulatory cycle who do not have signs of TPB at baseline, but remain infertile after the use of ovulation inducers in 3-4 cycles.
Laparoscopy provides not only the most accurate diagnosis of tubal and / or peritoneal factors of infertility present in the patient, but also allows for low-traumatic correction of the identified violations (separation of adhesions, restoration of patency of the fallopian tubes, coagulation of endometrioid heterotopias, removal of subserous and intramural myomas and retention formations of the ovaries).
Hysteroscopy is prescribed:
- with dysfunctional uterine bleeding of varying intensity;
- with suspicion of intrauterine pathology (according to the survey, gynecological examination and ultrasound of the pelvic organs).
With the help of hysteroscopy, it is possible to diagnose HPE and endometrial polyps, submucosal myomatous nodes, adenomyosis, intrauterine synechia, chronic endometritis, foreign bodies and malformations of the uterus. During hysteroscopy, separate diagnostic curettage of the walls of the uterine cavity and cervical canal can be performed. Under the control of hysteroscopy, it is possible to perform surgical treatment of almost any intrauterine pathology.
At the initial examination, women simultaneously conduct an analysis of the sperm of their spouse (partner) to exclude the male factor of infertility. With changes in the spermogram, the patient undergoes an examination by an andrologist, based on the results of which they decide on the choice of either methods for restoring natural male fertility or IVF to overcome infertility in this couple. In addition to the spermogram, when screening for male infertility factor, it is also advisable to use the MAPtest, which makes it possible to detect male antisperm antibodies. Normal MARtest<30%. Увеличение показателей МАРтеста >30% indicates the presence of an immune form of infertility in the husband and serves as an indication for the use in the treatment of such couples or artificial insemination with pre-treated sperm, or IVF.
Patients with infertility on the background of suspected surgical gynecological pathology (tubal occlusion, peritoneal adhesions, intrauterine synechia or uterine malformations, ovarian cysts, pronounced myomatous or endometrioid process) after the initial outpatient examination are sent to specialized institutions, where the nature of the existing disorders is clarified and, if If necessary, traditional surgical or endoscopic (hystero and laparoscopy) methods of treatment can be used.
It should be noted that when deciding on the possibility of treating infertility in outpatient settings (including after operations aimed at eliminating a particular gynecological pathology and restoring natural fertility), any conservative therapy should not exceed 2 years. If infertility persists during this period, the patient should be referred to an ART center without delay. This position is also argued by the fact that the age factor, starting from the age of 35, has an increasing adverse effect on the results of treatment using any ART methods. In this contingent of patients, unlike younger patients, the polyclinic stage of infertility treatment, associated with the use of various means and methods aimed at achieving pregnancy in a natural way, should not be used at all.
It has been scientifically proven that a period of 12 months is enough to determine the fertility level of almost any couple, provided that this couple lives a regular sexual life. According to statistics, with systematic unprotected intercourse, pregnancy in the first 3 months occurs in 30% of couples, within six months - in 60% and in 10% - during the first year.
If pregnancy has not occurred after the allotted period, there is every reason to consult a doctor. A comprehensive examination for infertility is the most correct solution in this situation, as it will allow you to determine the presence or absence of a reason that prevents you from conceiving a child. Optimally, an appeal to a specialist should be carried out even at the stage of the child, which will help eliminate the possible risks of the birth of handicapped children (with congenital diseases and anomalies), complications in the process of gestation and childbirth.
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A woman who wants to get pregnant should also think about visiting a gynecologist if she has the following signs:
- hyperprolactinemia (elevated levels of prolactin in the blood, which causes irregular menstruation);
- a sharp decrease in body weight;
- the complete absence of a woman's menarche;
- the hairline in the genital area is located according to an abnormal type (vertically directed, excessive, insufficient);
- underdevelopment of the mammary glands;
- spontaneous miscarriages and miscarriage in history;
- absence .
The above symptoms of infertility are quite common, so it is important to pay attention to them as soon as possible.
Female infertility: examination stages
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The diagnostic process in case of suspected infertility in the family should begin with an examination of the future dad. today occurs with the same frequency as in women. If during the examination no causative factors were found on the part of the husband, then they begin to diagnose the woman. It includes many items, starting with a survey and ending, if necessary, with a laparoscopy.
Taking an anamnesis is the first step in diagnosing infertility
A consultation with a gynecologist is very important at the beginning of the examination for infertility. It allows the doctor to assess the picture of the problem as a whole and identify for himself the possible causes of infertility.
Assessing the gynecological health of the patient, the doctor asks her about the following points:
- Symptoms that bother (general well-being, duration of absence of pregnancy, pain “before” and “during”, sudden weight loss or weight gain, discharge from the chest and vagina).
- Family history (the presence of gynecological pathologies in the mother, relatives, age, Rh factor and husband's health, bad habits).
- Medical history (surgical interventions, infections that the woman had earlier, injuries, gynecological and other diseases).
- Menstrual function (age of the first menarche, regularity, duration, pain of menstruation, amount of discharge).
- Sexual function (beginning of sexual activity, methods of contraception used, regularity of sexual intercourse, number of marriages and partners, level of libido, presence of orgasm, discomfort during sex).
- Childbearing function (the number of pregnancies and live children, spontaneous and induced abortions, the course of previous pregnancies, complications in childbirth).
- The results of examinations and treatments that were carried out earlier.
Objectively, the gynecologist assesses the general condition of the patient:
- body type;
- condition of mucous membranes and skin;
- the nature of hair growth;
- development and condition of the mammary glands.
He also palpation examines the thyroid gland, the abdominal region, takes into account the numbers of blood pressure and body temperature of a woman.
Special gynecological examination for suspected infertility
It is carried out with the help of gynecological mirrors on the chair. During the procedure, the doctor evaluates the condition and degree of development of the genital organs (internal and external), the type of pubic hair, the appearance of secretions and their nature. The presence of deviations in the structure of the genital organs can be a symptom of infantilism and other congenital anomalies of the reproductive system.
Excessive hair growth in the male pattern indicates hormonal problems. Discharge is a sign of an inflammatory or other pathological process in the vagina, which requires the appointment of additional tests to identify the pathogen.
Functional Tests
An examination for infertility also necessarily includes functional tests that provide information about the nature of ovulation, the level of female hormones, and the presence of antisperm bodies.
It uses:
- cervical index. This study reflects the quality of cervical mucus, expressed in a point system. It evaluates the level of estrogen saturation of the female body.
- Basal temperature. Based on the daily measurement of the temperature in the anus, a curve is built. Its analysis gives a picture of the monthly cycle, confirms the presence or absence of ovulation, ovarian activity.
- Postcoital test. It is performed for a more detailed study of the activity of spermatozoa in the mucus on the cervix.
Necessary tests for infertility
The most valuable studies in terms of information are tests for hormone levels, for which urine and blood are taken from a woman.
For the diagnosis of infertility are shown:
Important: in All these tests should be done some time after a gynecological examination and sexual intercourse, given that the level of certain hormones may vary.
Instrumental and hardware diagnostics of infertility in women
These survey methods include:
They are resorted to if there is a uterine form of infertility. Surgical diagnostic technologies are very highly informative and less traumatic.
Most often this is used:
- Hysteroscopy- this is a procedure for examining the uterine cavity using an optical device that is inserted into the uterus through the external pharynx - the cervix. It is performed under general anesthesia in a hospital. The doctor can not only examine the condition of the uterus from the inside, but also identify and immediately remove pathological formations (cyst, polyp).
Diagnosis of infertility includes:
Primary collection of anamnesis of the infertile couple
. general physical examination
.
. hormonal examination
. reproductive system
. examination for
. patency of the fallopian tubes
. husband's spermogram
. Shuvarsky test (compatibility of spouses)
. survey
Diagnosis of female infertility- taking into account the possibilities and equipment of the New Life clinic, in 2-3 months it is possible to identify the cause, develop a plan for effective treatment of a married couple, and prepare for pregnancy.
Patients who have already undergone examinations in other clinics bring the conclusions of previous examinations and treatment.
The main criteria for assessing the fertility of a married couple:
regular menstrual cycle,
- the presence of ovulation (ovulatory menstrual cycle),
- fertile sperm from the husband/partner (more than 20 million spermatozoa per 1 ml. Mobility more than 50%, no more than 85% of deformed spermatozoa)
- passable fallopian tubes, the normal shape of the uterus, the absence of pathology of the endometrium.
That's probably all you need in order to get pregnant on your own.
However, if you have been trying to get pregnant for a whole year, calculating ovulatory days, doing tests, and pregnancy does not occur, then it is better for you to contact our clinic.
Primary appointment with an obstetrician-gynecologist (for reproduction) for the diagnosis of infertility:
Collecting an anamnesis of the examined couple (questionnaire about previous diseases, operations, development in childhood, heredity, etc.)
. Physical examination (height, weight, examination and palpation of the mammary glands, percussion, palpation, etc.),
. Gynecological examination - examination in the mirrors on the chair, bimanual examination of the pelvic organs,
. Hormonal examination (to identify or exclude endocrine factors),
. Immunological examination (according to the indications of an immunogram, HLA typing of the 2nd class of histocompatibility, etc.),
. pelvic ultrasound,
. Examination of smears at the purity level, latent infections, sowing, cytological scraping from the cervix and central canal,
. Study of the patency of the fallopian tubes (, hysterosalpingography, echography),
. husband / partner
. Blood test for antibodies to viruses (both spouses)
These studies will help assess the condition and work of the reproductive organs.
Diagnostics- the most complex and lengthy than that, this is due to the fact that some studies are carried out on certain days of the menstrual cycle.
For example, in the same menstrual cycle, we cannot perform and test the patency of the fallopian tubes.
We cannot see the egg visually as it is very small, while semen analysis can immediately determine a man's fertility.
Diagnosis of male infertility- if any deviations in sperm parameters are detected, the man should be examined by.
In order to properly organize work on the reproduction of livestock, on any farm, for all females for every day, three states should be distinguished: 1) pregnancy; 2) the postpartum period (3-4 weeks after birth) and 3) infertility. Infertile (without a fetus) include all females that are not inseminated or inseminated, but not fertilized within a month after birth, and heifers, pigs and other young females - a month after they reach physiological maturity.
Diagnosis of pregnancy and infertility is a paramount and mandatory event in every household. In the study of animals, specialists must not only detect pregnancy and its timing, but first of all establish infertility in order to take timely measures to eliminate it as soon as possible. Therefore, the diagnosis of pregnancy and infertility is a single, inseparable event.
Existing methods for diagnosing pregnancy and infertility can be divided into two groups.
- Methods for clinical diagnosis of pregnancy and infertility:
outdoor study;
internal examination: a) rectal; b) vaginal.
- Methods for laboratory diagnosis of pregnancy:
From the anamnesis, the following probable signs of pregnancy can be identified: no signs of estrus, sexual arousal and hunting for 30 days or more after the next insemination;
improving the appetite and fatness of the animal;
sometimes perversion of appetite (licking of stones, increased desire to eat minerals); fatigue and sweating; more relaxed behavior in dairy animals - weakening or cessation of mammary gland functions;
the appearance of edema of the extremities and lower abdominal wall;
increased frequency of urination, defecation.
Valuable anamnestic data include journal entries. Anamnestic data can be trusted to the extent that they coincide with the results of a clinical study. The anamnesis is only important to clarify the gestational age.
Reflexological method for diagnosing pregnancy and infertility. The use of the probe is based on taking into account the reaction of the female to the male or the reaction of the male to the female. It is known that, as a rule, after insemination of polycyclic animals, the appearance in them of the phenomena of the stage of excitation of the sexual cycle indicates the absence of fertilization, i.e., infertility. Therefore, the detection of heat by a tester is considered a true sign of infertility and, conversely, the absence of heat at the time when it should have manifested itself is a likely sign of pregnancy. This method makes it possible to diagnose the initial stages of pregnancy in adult animals with an accuracy of 95-100%, and in replacement females - 100%.
So far, there is no more accurate method for diagnosing the initial stages of pregnancy and infertility than reflexology. Therefore, it deserves great attention and should be applied in the daily practice of animal reproduction. Its particular value lies in the fact that in case of infertility the possibility of missing estrus is excluded and it is possible to carry out insemination at the optimal time in the presence of pronounced phenomena of the stage of excitation of the sexual cycle.
For a reflexological study of pregnancy and infertility, a special pen is usually allocated, into which females are released along with a probe (in an apron or specially operated). When keeping pigs on complexes, the probe is driven along the aisle between the machines, and then an individual test is carried out. For 100-150 queens, one probe is isolated. The multiplicity of samples during the day depends on the duration of the hunt (see "Sexual cycle") (Table 15).
15. Time and frequency of reflexological examination of females for pregnancy and infertility
Probes should be kept isolated from the uterine composition, fed on a par with producers. Communication of females with the probe should not exceed
- -1.5 hours. A longer stay of probes among the broodstock and especially joint grazing in the herd is not allowed, as this reduces the activity of probes. Females with signs of hunting, as they are detected by probes, should be immediately taken out of the corral.
External examination for pregnancy. It consists of three diagnostic techniques: examination, palpation and auscultation.
By examining the animal, it is possible to establish:
probable signs of pregnancy: a change in the contours of the abdomen, an increase in the mammary gland, swelling of the limbs, mammary gland and abdominal wall;
the true sign is fetal movement.
Palpation of the abdominal wall reveals only one true sign of pregnancy - the fetus.
Auscultation perceives the fetal heartbeat. Recently, ultrasonic devices have begun to be used to capture the activity of the fetal heart, which are very convenient for examining pigs and sheep.
Palpation and auscultation of the fetus should be carried out on the right along the line running from the knee joint forward to the hypochondrium, parallel to the spine. A positive diagnosis by this method in cows can be established not earlier than 5-6 months of fruiting. It is impossible to deny pregnancy on the basis of a study by an external method.
Ultrasound procedure. It can be carried out with portable or stationary devices. Lightweight portable devices work on the basis of the Doppler effect (the reflection of ultrasonic waves from the fetal blood moving through large vessels or the fetal heart) and allow you to determine the fetal pulse rate, which is much faster than that of the mother. The signals of the device are perceived by ear or viewed in the form of teeth on the screen. Stationary devices allow you to see the fetal bladder or fetus on the screen. This method is more suitable for examining pigs or small ruminants that have hairless skin on the abdominal wall for applying the probe of the device. To study animals of other species, hair must be removed at the site of application of the sensor. In pigs and sheep, 1-1.5 months after insemination, the diagnostic accuracy reaches 95%.
Vaginal method for diagnosing pregnancy. In cows, it allows you to identify the following signs of pregnancy:
dryness of the mucous membrane, its pallor and stickiness of mucus;
tight closure of the cervix and the presence of a mucous plug in its mouth;
palpation of the presenting parts of the fetus through the fornix of the vagina.
In general, the method has little practical value.
Rectal method of research on pregnancy. The most accurate method for diagnosing pregnancy and infertility in large animals is a rectal examination. All zootechnicians and veterinary specialists of the highest and secondary qualifications and technicians for artificial insemination of animals should own this method.
In large farm animals, this method makes it possible to flawlessly make a positive or negative pregnancy diagnosis and determine its timing quite accurately. It is based on identifying the condition of the ovaries, horns, body and cervix, uterine mesentery, as well as the uterine arteries passing through them and, finally, the fetus. In some cases, due to anatomical and topographic features, fetal palpation cannot be performed, and yet a complex of other true signs of pregnancy allows an unmistakable conclusion about the presence of pregnancy and even about its timing.
The main task of everyone seeking to use the method of rectal diagnosis of pregnancy is to learn how to find a non-pregnant uterus, and if a specialist has mastered this part of the method, it will not be a big problem for him to identify not only a pregnant or non-pregnant uterus, but also many pathological processes in the genital area that cause infertility.
Before the examination, it is necessary to cut the nails short on the hand that is used to work, and level them with a file or a whetstone. Without leveling, even short nails with sharp edges damage the intestinal mucosa, which is accompanied by bleeding.
In a rectal examination, it is necessary to strive to comply with two conditions: 1) to prevent the introduction of a pathogen into the body of the animal under study and 2) to prevent the possibility of infection of a specialist from the animal under study and maintain the integrity of the skin of the hands. Compliance with the latter condition is important to keep in mind in mass studies, especially in the cold season. For outpatient admission, for prevention purposes, it is necessary after each examination of the animal to thoroughly wash hands with soap and rinse them with a disinfectant liquid. If the study is carried out on an infectious disease-free farm, rinsing hands with warm water can be limited. The use of cold water for this purpose often causes occupational musculo-articular rheumatism of the hands or inflammation of the brachial plexus. Wounds and other damage to the skin are smeared with iodine solution and filled with collodion. It is advisable to use obstetric gloves that cover the entire hand. In this case, the glove worn on the hand must be covered with a layer of lanolin or moistened. You can not use Vaseline, as it spoils the rubber very quickly.
It is advisable to keep the animal on a semi-daily starvation diet or examine before feeding, so that intestinal overflow does not impede palpation. Grabbing the root of the tail with one hand and pulling it to the side, with the other hand, carefully, smoothly, with drilling movements of the fingers folded in the shape of a cone, slightly open the anus and then expand it so that slit-like spaces form between the fingers. As a rule, with such manipulation, air begins to be drawn into the rectum, which is felt by the fingers and perceived by the ear in the form of a hissing sound. Following the entry of air, the animal shows signs of straining and an act of defecation occurs. It can be accelerated by stroking and light pressure on the rectal mucosa with the fingers, or by lightly massaging between thumb and forefinger its fold, captured at a distance of a few centimeters in front of the anus. Sometimes, after such a reception, the rectum is completely freed from the contents and further research proceeds without difficulty. But more often, after defecation, feces still remain in the rectum, which should be removed by hand, as well as feces, which are again introduced into the lumen of the rectum during the study. Failure to remove complicates the work, irritation of the rectum occurs, its wall becomes tense, which interferes with the palpation of the genital organs. In some cases, with sluggish intestinal motility and dense dry feces, it is advisable to put a warm enema.
When examining mares, care must be taken not to draw the hair of the tail into the anus with the hand; they cause irritation of the mucous membrane of the rectum and damage the skin of the hand.
The hand inserted into the anus first enters the ampulla-shaped extension. It is located in the pelvic cavity and, being attached by a connective tissue layer to the pelvic bones and the vestibule of the vagina, forms the most immovable part of the rectum. Therefore, it makes no sense to start palpation of the organs through the wall of the rectum in the area of its ampulloidal expansion. The hand should be inserted deeper. Following the feeling of spaciousness of the ampoule-shaped expansion of the rectum, the hand encounters its narrowed part, which forms several circular folds and kinks. In most cases, for free palpation of the uterus, it is enough to advance only four fingers into the narrowed part of the intestine, leaving the thumb in the ampulla-shaped part. In this position, the hand with the narrowed part of the rectum "put on" it can move to the right and left, since this section of the intestine is suspended on a rather long mesentery. Sometimes, when the hand is inserted beyond the ampoule-shaped extension, the narrowed section of the intestine is sharply reduced, strongly squeezing the hand, and even making it difficult to move forward, or, conversely, the intestinal lumen takes the form of an empty barrel-shaped cavity. Contractions should not be overcome by force: from hand pressure, the intestinal wall begins to contract even more, and with rough manipulations, there may be tears of the mucous membrane or even complete ruptures of the intestinal wall.
Rectal ruptures most often occur when a dry or inadequately lubricated hand is inserted into the anus. A dry hand encounters very significant resistance in the area of the sphincter, the examiner loses tactile sensations and, unnoticed by the fingers of the torn hand, causes perforation of the intestine. It should be palpated not with the ends of the fingers (the mucous membrane is easily injured by the nails), but with the crumbs, which, due to the abundance of nerve endings, perceive the subtlest sensations.
Clinical experience allows the researcher to capture the most favorable moments for palpation, characterized by complete relaxation of the intestine, which takes on the consistency of a rag. Such phases of relaxation occur periodically, during the peristaltic movements of the intestine, and follow the phase of tension. At the moment of tension of the intestinal wall, palpation gives almost no results. The weakening of the contractions of the rectum is either waited for 0.5-1 min (without removing the hand), or artificially caused by stroking the mucous membrane with the fingers in the area of its ampulloidal expansion.
After the release of the rectum from feces, at the moment of weakening the tone of its muscles, palpation of the genital organs can begin. It should be noted that only a systematic study (especially necessary for beginners) allows you to find all parts of the female genital apparatus and create a clear idea of its condition. Unsystematic research in most cases lengthens the work and does not provide the necessary ideas to the researcher. In addition, he, of course, must have a clear understanding of the morphology and topography of the uterus.
In cows, it is more convenient to start the study by looking for the cervix. The hand inserted behind the ampoule-shaped expansion of the rectum with the narrowed part of the intestine “put on” on it should be advanced to the middle of the pelvic cavity. By shifting the hand in this place to the right, to the left, forward and backward, they palpate the bottom of the pelvis, on which the cervix is found in the form of a dense tourniquet, usually running along the pelvic cavity. Finding the cervix represents the most essential part of the method. In the stage of excitement, during pregnancy and with some pathological processes in the uterus or ovaries, the neck can be shifted into the abdominal cavity, to the side and up; Based on this, if the cervix is not found in the pelvic cavity, it is necessary to palpate the anterior part of the pelvic floor, its side walls, in particular, systematically examine the lower edge of the entrance to the pelvis. When lowering the uterus into the abdominal cavity at the anterior end of the pubic fusion, it is possible to feel the uterus, cervix or vagina in the form of an elastic or dense tourniquet.
After determining the condition of the cervix, the horns and ovaries are examined. To do this, without letting go of the found part of the uterus from under the fingers, the hand is moved back and forth. Posteriorly, the fingers easily detect the vaginal part of the cervix, which is distinguished by its density and a sharp, blunt ending. When moving the hand forward, the crumbs of the fingers pass to the body and horns of the uterus. Upon reaching the level of the inner mouth of the cervix, the fingers feel the body of the uterus 1-2 cm long, which differs from the cervix in a more doughy or elastic consistency. Further anteriorly, the fingers begin to distinguish the beginning of the interhorny groove in the form of a longitudinal depression located between two rollers - the horns of the uterus. The middle finger is inserted into the interhorn groove, and the surface of the uterine horns is palpated with the index and ring fingers, slightly spreading them apart. At the same time, the thumb and little finger should cover the entire uterus from the sides. Moving forward beyond the bifurcation of the horns, move the hand to the right horn. It is convenient to grab between the palm and the crumbs of the fingers. Following cranially and downwards, the fingers follow the curves of the horn and encounter the ovary. The latter can be easily grasped by hand; palpation manages to create a clear idea of its shape and consistency.
Without releasing the horn, one should move the hand back to the bifurcation and palpate the left horn and ovary in the same order. If during such a transition the uterine horn slips out, it is better to start the study again from the cervix and interhorny sulcus.
In some cases, palpation of the ovaries is difficult due to their pulling under the body of the uterus. Then, after palpation of the body and horns of the uterus, the hand is placed along the body of the uterus so that the palm is located on the neck, and the fingers are on the interhorny groove and horns. By shifting the hand from the uterus to the side to the bottom of the pelvis and moving it medianly under the body of the uterus, you can easily find the ovary, which stands out with an oval shape and elastic consistency.
If the cervix cannot be found, the beginner can use the other hand as well. For this purpose, the pre-treated left hand is inserted into the vagina and the vaginal part of the cervix is captured with it. The left hand is easily felt through the rectum with the right hand and the vaginal part of the cervix is found along it (it is more convenient and expedient in a preventive sense for an assistant to insert his hand into the vagina). Sometimes it is useful to pull the uterus down into the abdominal cavity by the neck with a hand inserted into the vagina. Finally, a system of finding the uterus by ligaments can be applied (see "Rectal diagnostic method in mares"). Palpation of the uterus and ovaries should be carried out only at the time of relaxation of the intestine.
Laboratory methods for diagnosing pregnancy and infertility. Based on the identification of specific changes in the hormonal function of the ovaries or placenta, the metabolism of the mother and the metabolic products of the fetus entering her body. Of the numerous laboratory methods for diagnosing pregnancy, the most accurate are hormonal. To detect hormones, blood serum, urine or milk is examined. In order to detect gonadotropic hormones, the blood serum of the studied female is administered in different doses to several infantile mice or rats. The result is evaluated after 100 hours by examining the ovaries, in which ovulated follicles are found.
A faster answer can be obtained using the F. Friedman method. In animal husbandry, a modification of this reaction is used. An isolated female rabbit is injected into the ear vein with 10 ml of the blood serum of the studied female. 36-48 hours after the injection, a laparotomy is performed, and if gonadotropins were present in the blood serum, then hemorrhages are found in the ovaries at the site of ruptured follicles, as well as follicles with blood-filled cavities (Fig. 56). After the wound of the abdominal wall has healed, after 2-3 weeks, the rabbit can again be used for a bioassay. In a mare in the period 1.5-
- months of pregnancy, the accuracy of determination reaches 98%.
day of pregnancy, folliculin (estrogens) can be detected in the urine by a bioassay on ovariectomized mice according to the method of S. Aschheim and B. Tsondek or by the physicochemical method according to G. Ittrich. The number of correct diagnoses reaches 98%. In recent years, pregnancy diagnostics by detecting progesterone in blood serum or milk by radioimmunological or other methods is more often used abroad. Material for research is taken after insemination: in mares after 18-23 days, in cows after
- 23, in sheep after 17-20, in goats after 22-26, in pigs after 20-24 days. The diagnostic accuracy ranges from 60-100% (D. Kust, F. Shetz).
- day after insemination (D. Kust, F. Shetz).
DIAGNOSTICS OF PREGNANCY AND INFERTILITY OF COWS AND HEIFERS
In a barren cow, rectal examination reveals the following characteristic symptoms. The cervix, body, uterine horns and ovaries are located in the pelvic cavity (in animals that have given birth a lot, old ones, the uterus can descend into the abdominal cavity even in the absence of pregnancy). On palpation of the uterus, the interhorny sulcus and symmetrically located, equal size, the same shape and consistency of the uterine horns are clearly palpable. If you stroke the surface of the uterus with your hand, the horns contract; their consistency becomes elastic and even
Rice. 56. Rabbit ovaries: on the left - with a positive reaction to pregnancy; on the right - with a negative (according to N. A. Flegmatov)
the most accurate hormonal diagnostic methods can be used in most cases at such terms of pregnancy when it can be diagnosed by clinical research methods. Most other methods of laboratory research often give wrong answers. Research to further improve existing and develop new methods of laboratory diagnosis of pregnancy and infertility continues.
almost solid. The uterus can be freely grasped with the palm and fingers. The contracted uterus is felt as a hemispherical smooth formation, divided into two symmetrical halves by an interhorny sulcus and a bifurcation. At the time of contraction, it is convenient to compare the size and shape of the uterine horns. In cows that have given birth a lot, the right horn is usually somewhat thicker than the left. The size and shape of the ovaries are not constant, which depends on the functional state of the female genital area. Usually one of the ovaries is larger due to the presence of a corpus luteum or large follicles in it (Fig. 57,-4 and B).
- month of pregnancy. The cervix in the pelvic cavity; the horns of the uterus are located at the end of the pubic fusion or descend somewhat into the abdominal cavity. The uterus does not respond to stroking or the contraction of the horns is weakly expressed. The fruiting horn is somewhat larger than the free horn, its texture is looser, flabby; sometimes by the end of the first month it is possible to establish a fluctuation in it. The ovary of the fetal horn is larger than the ovary of the free horn; in it, as a rule, the corpus luteum is well felt.
- month of pregnancy. The uterine horns and ovaries are lowered into the abdominal cavity. The cervix moves from the middle of the pelvic cavity to the entrance to the pelvis. The fruiting horn is twice as large as the free horn; when it is palpated, a tight fluctuation is felt, sometimes extending to the free horn. The tissues of both horns are flabby, soft, juicy. Horns slowly, sluggishly or almost do not contract when stroking them. The interhorny furrow is somewhat smoothed, but still quite well detected. The shape and position of the ovaries are the same as in the first month of pregnancy, except for the corpus luteum; follicles are often palpated (Fig. 57, B).
- month of pregnancy. The horn-fetal place is 3-4 times larger than the free horn, so the interhorn furrow is not palpable. The uterus appears as a fluctuating bubble with faintly perceptible contours the size of an adult head; it is easy to mistake for a full bladder. However, finding the cervix, establishing its close connection with the fluctuating formation, and, finally, identifying the bifurcation of the horns in the region of the cranial part of the uterus, make it possible to make sure that the palpable formation is the uterus, and not the bladder. Ovaries unchanged; they are located in front of the pubic fusion on the lower abdominal wall (Fig. 57, D).
- month of pregnancy. The uterus is in the abdominal cavity, the cervix is at the entrance to the pelvis or is somewhat lowered into the abdominal cavity. The uterus is felt as a weakly fluid-filled, fluctuating thin-walled sac, in which the fetus and, as a rule, the placenta the size of a hazelnut or bean are sometimes felt. Larger placentas (up to a pigeon's egg) are found along the greater curvature of the horn-fetus. To identify the placenta, two methods are used:
- they capture the wall of the uterus with the thumb and forefinger and, palpating its individual sections, identify the placenta and get an idea of their size;
- determine the size of the placenta by palpation of the uterus with the whole hand. To do this, having found the cervix, move the hand forward, put it on the fluctuating part of the uterus and press the uterus against the lower abdominal wall with uniform light pressure. Under the influence of light pressure, the fetal waters are displaced and the hand feels a bumpy surface formed by overgrown placentas. Sometimes fluctuation is not felt at all (when the uterine wall relaxes, amniotic fluid descends into the tops of the uterine horns) and the uterus with its placentas is palpated in the form of a tuberous tourniquet located on the lower abdominal wall in front of the pubic fusion. In a fed animal, the uterus protrudes into the pelvic cavity.
th?
Rice. 57. Determination of pregnancy and infertility of a cow by the rectal method (according to A.P. Studentsov):
L - palpation of the non-pregnant uterus of an old cow; B - contracted non-pregnant uterus; B - 2 months of pregnancy; G- 4 months of pregnancy; L - scheme of blood supply to the uterus at the 4th month of pregnancy; ?-7-8 months of pregnancy; / -bifurcation of the uterine horns; 2- right horn of the uterus,.? -ovary; 4- rectum; 5 - wide uterine ligament; 6 - the left horn of the uterus; 7- interhorny furrow; 8- bladder; 9 - ilium and 10 - sacrum; 11 - vagina; 12 - the body of the uterus; 13 - the bottom of the pelvis; 14 - cervix, / 5 - posterior uterine artery; 16- aorta; / 7 - middle and 18 - anterior uterine arteries; 19- ovarian branch of the anterior uterine artery; 20- branch leading to the horn; 21-
placenta
In the early stages of pregnancy, the vibration of the wall near the place where the artery leaves the aorta is not felt. To obtain a tactile sensation of vibration, it is necessary to go down a little along the vessel to the periphery. Having moved the hand forward to the posterior mesenteric artery (a. mesenterica caudalis, s. posterior), one should return backward along the vertebral bodies, skip a large, almost perpendicularly running vessel - the pelvic artery (a. iliaca externa) and then palpate the middle uterine artery (Fig. 51, D).
- month of pregnancy. Basically the same symptoms as at 4 months. The placentas near the cervix reach a size of 2 x 4-2 x 5 cm. The vibration of the middle uterine artery is clearly felt from the side of the horn-fetus; the artery of the free horn is unchanged or vibrates weakly. The fetus is often palpable.
- month of pregnancy. uterus in the abdomen; sometimes (with a short scrotum of the rectum) its horns are not palpable. Neck in the abdomen. The fetus is usually not palpable, being displaced far forward and down. Placenta the size of a small chicken egg are freely detected. The wall of the uterus is slightly tense, so sometimes the fluctuation is almost not felt. The vibration of the middle uterine artery of the fetal horn is strongly pronounced, and the vibration of the middle uterine artery of the free horn is weak.
- month of pregnancy. The signs are the same as at 6 months.
To determine the state of the posterior uterine artery, you need to put your palm on the side, to the wide pelvic ligaments, and here find the middle, hemorrhoidal artery, which runs parallel to the spine. Above the middle part of the lesser sciatic notch of the pelvis, a freely moving posterior uterine artery descends from it.
- month of pregnancy. The cervix is located at the entrance to the pelvic cavity or in the pelvic cavity. On palpation, the presenting organs of the fetus are easily palpated. The size of the placenta varies between small and large chicken eggs. Both middle arteries and one posterior uterine artery vibrate very clearly.
- month of pregnancy. The cervix and presenting organs of the fetus in the pelvic cavity. The vibration of the middle and posterior uterine arteries on both sides is clearly expressed. The presence of harbingers of childbirth.
Individual fluctuations can, for example, be observed in the strength and timing of the appearance of vibrations of the walls of the uterine arteries. According to A.E. Volokhin, in 20% of cows, already at the 2nd month of pregnancy, a weak vibration of the uterine artery of the pregnant horn is noted, and in some cows the artery of the free horn of the same name does not vibrate even at the 8th month. The size of the placenta can also vary significantly. Regardless of in which part of the uterus the size of the placentas is determined, when judging the term of pregnancy on this basis alone, an error can be made within 1-2 months. An anomaly of the placenta is described in the literature, which consisted in the fact that the cow, along with typical placentas, had areas built according to the type of scattered placenta and completely free from villi. Apparently, due to such anomalies, sometimes it is not possible to probe the placenta at all, despite the presence of all other signs of pregnancy. In very well-fed cows, it is sometimes impossible to palpate through the rectum not only the vessels, but also the uterus due to the strong thickening of the rectal wall due to the abundant deposition of fat.
DIAGNOSIS OF PREGNANCY AND INFERTILITY IN BUFFALES
Marin Khubenov (Bulgaria), on the basis of his research, came to the conclusion that in buffaloes, the external method does not make it possible to diagnose pregnancy. The elongated chest, thick abdominal wall and the small size of the fetus do not allow you to successfully feel the fetus and listen to its heartbeat. The configuration of the abdomen also changes little.
Rectal examination. This method can establish both pregnancy and infertility. From the 1st month, the diagnosis is made on the basis of taking into account the position of the uterus, asymmetry of the horns, fluctuations, thinning of the wall of the uterine horn and the presence of a well-defined corpus luteum of pregnancy. The signs of infertility in buffaloes are the same as in cows. Placenta and vibration of the vessels of the horn-fetus are detected after the 4th month of pregnancy. At 6 months, the uterus descends into the abdominal cavity, at the 9th month, the organs of the fetus are probed in the pelvis.
Primary diagnosis of infertility: examination for infertility in women, men and what tests to take
For a perfectly healthy woman under the age of 25, the probability of becoming pregnant in 1 menstrual cycle (MC) is 22-25%. In a married couple with a regular sexual life (with a frequency of 2-3 times a week), pregnancy occurs within 1 year in 75% of cases.
Therefore, primary infertility is considered to be the absence of pregnancy in a woman of reproductive age within 12 months of regular sexual activity without the use of contraception. We will analyze where to start the examination for infertility, what diagnostic methods exist and where to go.
It should be noted that the period of diagnosing infertility, from the initial visit to a specialist to determining the cause, should not be more than 2 months. The period of examination and treatment of infertility should not exceed 2 years in women under 35 and 1 year in patients over 35. With age, the effectiveness of treatment only decreases. After these two periods, treatment with the method is recommended.
- What is infertility and how does it happen
- When to start testing
- First consultation: what you need to know
- How to start diagnosing
- Examination for female infertility
- What will the doctor ask
- Clinical examination
- Ultrasound diagnostics
- Assessment of the hormonal background
- Tests for infections
- genetic research
- Treatment
What is infertility? Types and classification
One of the partners should not be blamed for infertility, it can be both female and male, but the combined form is more common. So if you or your doctor suspect that the reason for the lack of pregnancy lies precisely in it, then the diagnosis of infertility should be carried out for both a man and a woman. It is necessary to undergo a series of examinations and pass tests.
There are 3 types of infertility:
- - the inability of the male germ cells of a mature male body to conceive (there can be many reasons, but male infertility is reversible in most cases). The incidence of true male factor infertility is 30%.
- Female infertility is the absence of pregnancy, which is associated with problems in women's reproductive health. The frequency is 40%.
- Combined infertility is 30%.
Therefore, the infertility examination algorithm provides for the diagnostics of reproductive health in both partners.
Infertility is further subdivided into:
- primary, when there was no pregnancy at all;
- secondary, when the fact of pregnancy was in the past and no matter how it ended - childbirth, miscarriage, ectopic pregnancy, abortion in youth.
When should you start screening for infertility?
You need to start an examination for infertility with your own or local gynecologist. You can also contact the reproductive medicine clinic. Women under the age of 35 should seek medical help after 1 year of regular sexual activity (remember that without the use of methods and means of contraception), after 35 years - after 6 months.
The reduction in time is due to the fact that the older the patient, the lower the pregnancy rate in both natural cycles and when applied. Delaying an examination for infertility after 35 reduces the chances of pregnancy in principle and reduces the chances of having healthy offspring.
First consultation with a specialist in infertility
During the initial treatment, the doctor will find out whether or not there are contraindications for pregnancy. Since there are such diseases (genital and extragenital, not related to the reproductive system), the course of pregnancy in which carries a potential risk to a woman's life. Therefore, the doctor will collect an anamnesis - ask about the following:
- whether there are problems with the heart (defects);
- anomalies in the development of the genital organs (two-horned,);
- from a woman and close relatives, etc.
The second stage is the correction of identified and confirmed diseases (fat metabolism disorders, obesity, diabetes mellitus, etc.)
Contraindications for pregnancy can be: mental illness, oncological formations.
How to start an examination for infertility?
Any examination of a married couple regarding infertility is complex, but begins with a man. First, it's easier and faster. Secondly, the exclusion of the male factor is already the first (albeit intermediate) result. Thirdly, it is possible to restore fertility to a man in 70% of cases after medical correction, lifestyle correction or elimination of harmful factors. For the diagnosis of infertility, a man needs to pass a semen analysis. It's called a spermogram.
Diagnosis of male infertility
An assessment of the reproductive ability of a husband or partner begins with an anamnesis - questioning. The doctor will find out:
- age;
- the presence or absence of injury;
- the number of marriages and the presence of children (and their age);
- past illnesses;
- what were the operations;
- professional hazards;
- desire to have children.
Then, according to the plan, you will need to pass an analysis - a spermogram. This study is mandatory, it allows you to evaluate the concentration of spermatozoa, their mobility, the correctness of the structure.
- infectious screening;
- (antilobulin mixing reaction).
If deviations from the norm are found in the spermogram, an andrologist's consultation is prescribed. When the husband passed, then it makes sense to deal only with the health of the woman.
Diagnosis of infertility in women
Basic examination of patients with infertility includes the following steps:
- collection of information (anamnesis) about a woman;
- clinical examination (general blood and urine tests, hormonal panel, blood glucose, etc.);
- ultrasound diagnostics of the pelvic organs;
- blood tests for hormones;
- research (there are several methods for diagnosis).
What is important in collecting information about a woman with infertility?
Age is important for making a diagnosis. If a woman aged 25 is compared with a woman aged 43-45, then the pregnancy rate is higher in a young woman. A closer diagnosis awaits women of older reproductive age.
The second equally important factor for treatment is the duration of infertility. If a couple has not been able to get pregnant for 10 years and has a history of, for example, several, then the tactics of preparation and the method of treatment and diagnosis will be different.
When collecting an anamnesis, it is necessary to take into account the presence of chronic general diseases, operations in the abdominal cavity and the pelvic cavity with the use of drainage. These surgical interventions can lead to the development of adhesive disease, and this is one of the factors that can.
Standard in gynecology for the diagnosis of infertility is assessed:
- menstrual function: when the first menstruation began, the date of the beginning of the last cycle, ;
- time of onset and intensity of sexual activity;
- childbearing function:, (natural or artificial), abortions, miscarriages, intrauterine fetal death, inflammatory complications after them;
- the use of contraception (physiological, medical, condoms): it is especially important for the diagnosis of infertility - long-term wearing of an intrauterine device, which can cause;
- sexually transmitted infections, their treatment regimens;
- surgical operations on the pelvic organs for,.
Operations on the ovaries are fundamentally important. They may be the cause.
Clinical examination for infertility
Diagnosis of female infertility consists of a general examination, during which attention is paid to:
- On the body type, the distribution of subcutaneous fat. If problems with weight are identified, correction is required. With a small weight, it is recommended to get better, with an excess - to lose weight. In some cases, this allows you to solve the problem of normalizing the menstrual cycle and, and, therefore, if there are no other violations.
- On the degree of hairiness. With an excess of hair on the female body, hyperandrogenism (an excess of male sex hormones) or can be suspected.
- development of the mammary glands.
Then a gynecological examination is carried out, smears are taken for.
During the examination, the psycho-emotional state is assessed. A woman may, on a subconscious level, not want a child, despite the fact that her closest relatives are pushing her to this, but emotionally she is not ready for his appearance. It plays an important role in pregnancy.
Ultrasound examination of a woman with infertility
Ultrasound is prescribed in the first phase of the menstrual cycle - 2-5 days. During ultrasound diagnosis, the presence or absence of uterine pathology (, intrauterine synechia) is assessed.
Without fail, the ovaries are examined - the size of the ovaries and the number of antral follicles.
Assessment of hormonal status in infertility
Assessment of the hormonal background consists of the following steps:
- Laboratory blood tests for hormones. Screening is carried out on days 2-4 of the MC (LH, FSH, E2 - estradiol, testosterone, DHA-sulfate, TSH, T4, which is a marker of ovarian reserve).
- Evaluation of ovulation: measurement of basal temperature, urinary tests for ovulation, folliculometry - ultrasound monitoring of the development of follicles.
Tests for infections
An infectious agent can also be the cause of female infertility. For diagnosis, a swab is taken from the vagina during a gynecological examination.
Specific analyses:
- Cervical mucus (cervical smear) is analyzed for the presence of chlamydia, myco-, ureaplasma, herpes and cytomegalovirus by PCR.
- Blood test for TORCH-complex: determined to the pathogens of toxoplasmosis, rubella virus, cytomegalovirus and herpes.
Genetic testing for infertility
Sometimes a doctor may prescribe a genetic examination - a study of the karyotype. A genotype is a set of human chromosomes. Women have 46 XX, men have 46 XY. This is the genetic "passport" of a person. Often there are deviations in the form of mutations, translocations (the location of the shoulder or section changes), the absence of a chromosome or the presence of additional ones.
Indications for the study of karyotype in infertility:
- primary amenorrhea - absence of menstruation;
- secondary amenorrhea - premature menopause;
- delayed sexual development;
- (examine both spouses).
- prolonged primary infertility of unknown origin.
Genetic analysis for both spouses is also prescribed in case of several ineffective IVF cycles.
Infertility treatment
Restoration of reproductive function can be achieved with:
- methods (therapeutic and surgical - laparoscopy);
- assisted reproduction method - IVF.
