What does a reproductive specialist do? Problems of the female genital area are solved by a gynecologist-reproductologist. What organs does a Reproductologist deal with?

A reproductologist is a doctor who solves problems of conception: studies, diagnoses and treats violations of the reproductive function of married couples, solves issues of infertility or, on the contrary, prevention of unwanted pregnancies.

A reproductive specialist deals with menstrual anomalies and hormonal disruptions in the body, infertile marriage (when a married couple cannot conceive a child for a year), habitual miscarriages and lack of ovulation, premature ejaculation, problems with spermatozoa. The task of the reproductologist is, first of all, to identify the reasons for the impossibility of conception and to find ways to eliminate them. In addition, he carries out IVF and oversees the process of gestation, the birth of a baby. Participates in the work of the stem cell bank, solves the issues of surrogate motherhood.

Reproductologist treats:

• Violation of the patency of the fallopian tubes.
• Adhesions of the pelvic organs.
• Growth of the endometrium inside the uterus and beyond.
• Polyps and tumors of the uterus of a benign nature.
• Anomalies of the reproductive system, congenital or acquired.
• Consequences of criminal or unsuccessfully performed abortions.
• Uterine bleeding.
• Infections of the genitourinary system.
• Endocrine diseases associated with the reproductive ability of the body of a man and a woman.
• Multiple cysts in the ovaries.
• Essential infertility.
• Human papilloma virus.
• Age-related changes that exacerbate the problems of conception.
• Herpes-CMV.
• Vaginosis of bacterial origin.
• Varicocele.
• Cryptorchidism.

The reproductive specialist works in close contact with general practitioners, obstetrician-gynecologists, endocrinologists, urologists, andrologists, immunologists, geneticists, and embryologists. The profession of a reproductive specialist is one of the most sought after in the country, as the number of infertile couples is on the rise.

In the world, about 20% of married couples cannot conceive a child on their own.

The difference between a reproductive specialist and a gynecologist

Places of work

The reproductive specialist works in specialized clinics and hospitals, perinatal centers, maternity hospitals, family planning consultations, large antenatal clinics, IVF clinics, family health centers.

History of the profession

The history of reproduction is inextricably linked with artificial insemination. A. Levenguk, who invented the microscope and saw spermatozoa in it (1677), is considered its ancestor. However, the first practical description of ART (assisted reproductive technology) refers to puppies from artificial insemination of a dog, which was presented by N. Spalazani in 1783. For the first time, artificial seeding to a woman at her own peril and risk was carried out by Dr. D. Hunter (1790). And only at the beginning of the twentieth century, our compatriots, under the leadership of S. Ivanov, developed the scientific foundations of artificial insemination.

The end of the forties of the last century gave mankind the development of Ch. Polga, dedicated to the storage of germ cells by cryopreservation. The fifties became the beginning of developments on the cultivation of embryos in vitro, but only in 1954 G. Petrov described in detail all the stages of embryogenesis, and after 5 years, based on his works, M. Chang fertilized the rabbit embryo. This was scientific proof of the possibility of in vitro conception with subsequent implantation of the zygote in the uterus.

The first pregnancy as a result of artificial insemination was carried out in 1973, but lasted only a few days. The first test-tube baby was born in January 1979 in Glasgow. This is Alistair MacDonald. For his safe birth, hCG (human chorionic gonadotropin) was used to manage the patient's periods during IVF. In 1981, FSH stimulation was proposed, then releasing hormone was used. In parallel, cryopreservation developed. In 2010, R. Edwards was awarded the Nobel Prize for the development of ART. The first IVF in the Soviet Union was carried out in 1986.

Cryopreservation allows you to save embryos for a long time for subsequent replanting.

Responsibilities of a reproductive specialist

The main responsibilities of a reproductologist are as follows:

• Counseling patients on the planning of the birth of a child.
• Ultrasound, hysteroscopy.
• Stimulation of ovulation.
• Transvaginal puncture of follicles, their collection.
• ICSI, insemination.
• Transfer of the embryo into the uterus.
• Conducting IVF pregnancy until the birth of the baby.
• Working with surrogate mothers.
• Strict observance of medical secrecy.

Requirements for a reproductive specialist

Basic requirements for a reproductive specialist include:

• Higher medical education, valid accreditation sheet for reproduction.
• Experience in ultrasound, certification is a plus.
• Proficiency in ART (assisted reproductive technology).
• Knowledge of IVF legislation in Russia and abroad.
• Ability to conduct a reception on a barren marriage.
• PC ownership.

The task of the specialist is to identify the reasons for the impossibility of conception and find ways to eliminate them.

How to become a reproductive specialist

To become a reproductive specialist, you must:

• Graduate from a university or medical school with a degree in General Medicine or Pediatrics.
• Get an accreditation sheet. To do this, you need to pass the exam and successfully pass an interview with an expert commission.
• After that, you can work with patients on an outpatient basis (for example, a general practitioner or pediatrician).
• To obtain a narrow specialization, you can enter the residency (2 years of study) in the specialty "Reproductology". Paid easier, because the competition is small and for admission you need to have only 50 attestation points. Is free You can get into residency in two ways: by competition on a general basis or by the target referral of the head physician of a medical organization in which the specialist is already working.

Each year, doctors are required to score 50 certification points. To do this, you can take advanced training courses (36 points), attend scientific and practical conferences (the number of points depends on the event, but usually about 10 points), publish scientific papers, write books, defend dissertations. If enough points are scored, then you can work further. If points are not scored, then you will either have to stop medical practice, or solve this problem in “non-standard” ways.

The experience, skill and quality of the doctor's work is usually assessed qualification categories which can be obtained by defending a research paper. During the defense, the commission evaluates the doctor's skills in the field of diagnosis, treatment, prevention, as well as the relevance of his knowledge.

What are the qualification categories?

• the second - over 3 years of experience;
• the first - more than 7 years of experience;
• higher - more than 10 years of experience.

The qualification category allows you to hold high positions in medical institutions, entitles you to a salary increase, gives you status in a professional environment and high confidence on the part of patients. Even more respect can be achieved by speaking at conferences, symposiums and creating scientific articles and papers.

The doctor has the right not to qualify, but this will hinder his career and professional growth.

Reproductologist salary

The general income range is as follows: reproductologists earn from 80,000 to 500,000 rubles per month. The most demanded profession in the Moscow region. The minimum wage was found in St. Petersburg - 80,000 rubles per month; maximum - in the IVF center in Moscow - 500,000 rubles per month.

The average salary of a reproductive specialist is in the region of 102,000 rubles per month.

Reproductology is a science that studies the normal reproductive function of a person, as well as its pathologies, as an object of study. The discipline deals with the prevention of violations of the human reproductive system in each age period.

There are normal, judicial and clinical reproductology. Each of the branches interacts with many medical sections, such as: genetics, obstetrics and gynecology, urology, neurology, endocrinology, surgery, etc.

Who is a reproductive specialist?

A reproductive specialist is a medical professional who deals with infertility issues. He specializes in matters of conception, gestation. The competence of a reproductive specialist includes helping people suffering from infertility through the use of assisted reproductive technologies. In particular, we are talking about the use of IUI, ICSI, in vitro fertilization.

The main goal of the work of a reproductologist is to help in the onset of pregnancy and in the birth of healthy offspring in couples who have problems with the function of reproduction.

The profession of a reproductive specialist is extremely in demand, according to statistics, the impossibility of self-conception is a problem for about 20% of all married couples in the world. The doctor helps to overcome the problem of infertility, miscarriages, missed pregnancies. To do this, he selects adequate therapeutic methods, after a comprehensive examination of the couple who applied for help.

A doctor who has a higher medical education can work as a reproductive specialist. He conducts complex diagnostic studies and selects methods of treatment for identified problems that are not within the competence of general practice gynecologists.

What does a reproductive specialist do?

The doctor is engaged in the diagnosis and treatment of infertility of various etiologies. He selects and develops methods and technologies for eliminating problems of reproductive function.

The reproductive specialist treats not only women, but also men. Problems with conception in different sexes have certain differences and arise under the influence of many factors, including as a result of diseases, due to hormonal disruptions, under the influence of external causes, etc. It is these factors that a reproductologist should be able to identify and correctly eliminate them .

The doctor should be well versed in human anatomy and physiology, in the features of male and female reproductive functions, in the mechanisms of conception, etc.

What diseases does a reproductive specialist treat?

All diseases leading to problems with conception are within the competence of a reproductive specialist. He must be able to identify them and prescribe therapy. The doctor can work with the patient both independently and in cooperation with other specialists.

Reproductologist helps to cope with the following pathologies:

Menstrual disorders.

Cystic formations that form on the genitals.

Sperm defects, sperm production disorders.

Adhesive formations.

Age-related changes affecting the function of reproduction.

Endometriosis.

Hyperthyroidism, hypothyroidism.

Anomalies in the development of reproductive organs of a congenital nature.

Infections of the reproductive system.

Viral diseases.

Disorders of hormonal regulation.

Ovulation disorders.

Polycystic ovary syndrome.

Bacterial vaginosis.

Cytomegaly.

Infertility of unknown etiology, etc.

If a couple is not able to conceive a child on their own, they need to seek the help of a reproductive specialist to try to solve this problem on a professional level. The specialist will help to more thoroughly understand this issue, perform a comprehensive diagnosis of both men and women. According to the results of the studies, the couple will be recommended appropriate treatment.

When a woman has no problems with the menstrual cycle, menstruation is stable, ovulation is timely, she lives a regular sex life with a regular sexual partner and practices unprotected intercourse, but pregnancy does not occur for a year - this is a reason to contact a reproductive specialist. If a woman is over 35 years old, then she needs to consult a specialist after six months of unsuccessful attempts at conception.

It is important that both sexual partners visit the doctor. The doctor will collect information about their health, lifestyle, sexual behavior.

In addition, consultation is required in the following cases:

Previous pregnancy ended in spontaneous miscarriage;

The woman was diagnosed with a frozen pregnancy;

Age-related changes in one or both sexual partners interfere with normal sexual activity and the possibility of conception;

With pathologies of the reproductive system of a congenital nature;

With detected hormonal disorders;

With inflammation and infections of the genital organs;

With venereal diseases.

What tests should be taken when contacting a reproductive specialist?

If the couple has the results of the studies that they underwent before contacting the reproductive specialist, then they must be taken with them to the appointment.

It could be:

spermogram;

The results of the ultrasound examination;

Blood tests for thyroid and pituitary hormones;

Study of hormones of the adrenal cortex;

Blood test for ovarian hormones;

Results of hysteroscopy or laparoscopy;

Identification of antispermal bodies;

Results of postcoital testing;

Immunogram results;

Results of hysterosalpinography;

Analysis of blood clotting and follicular reserve.

If studies have not been conducted, then the reproductologist himself can prescribe them. The choice of certain diagnostic methods is selected for each pair on an individual basis.

Diagnostic methods used by a reproductologist

The reproductologist most often uses the following diagnostic methods in his practice:

Ultrasound of the pelvic organs, which makes it possible to assess the condition of the uterus, ovaries, tubes, to identify their functionality and disorders. This method can be implemented both with the help of an abdominal sensor and with the help of a vaginal device.

Laparoscopy allows you to examine the organs of the abdominal cavity through small punctures in the wall of the peritoneum. This procedure is prescribed when other diagnostic methods (non-invasive) are uninformative. In addition, during laparoscopy, the doctor can perform some surgical procedures and prevent the need for surgery in the future.

Hysterosalpinography - this method makes it possible to assess the patency of the tubes, abnormalities in the formation of the uterus, infantilism.

A biopsy of the cervix makes it possible to perform a subsequent hysterological analysis to identify oncological processes and other pathologies.

The diagnostic methods that the reproductologist will prescribe will depend on the specific medical history and complaints of patients.

Eating foods rich in vitamins D and E has a positive effect on sperm quality. In addition, the diet of every man should include zinc, vitamin C and selenium.

Sex life in couples seeking to become pregnant should be regular (preferably every other day).

The quality of sperm in the direction of its deterioration will be affected by visiting baths and saunas, taking hot baths.

An obstacle to conception of the fetus is alcohol, smoking, overweight and underweight.

Reproductology is a science that studies the normal reproductive function of a person and its pathologies. That is, this discipline explores the male and female reproductive system and treats diseases that prevent normal conception. In addition, reproductology is engaged in the prevention of violations of the reproductive system of patients of different ages.

Many couples who cannot get pregnant for a long time turn to a reproductologist who studies the causes of infertility and determines the tactics of treatment. Patients are interested in the question of who a reproductologist is, what he does and how his consultation goes.

Reproductologist - who is it?

A reproductive specialist is a specialist with a higher education who deals with the problem of infertility. This health worker is a specialist in the conception and bearing of a child. That is, he provides assistance to patients who suffer from infertility with the help of modern reproductive technologies. During treatment, intrauterine insemination, intracytoplasmic injection, in vitro fertilization are used.

The main task of the specialist is to increase the degree of female and male fertility (the ability to conceive) of the genital organs affected by diseases that prevent pregnancy.

A reproductive specialist is a sought-after specialist, because according to statistics, about 20% of couples need his help. They turn to him for infertility, miscarriages, missed pregnancy. Then the doctor conducts a comprehensive examination of women and men, selects the most appropriate methods of therapy.

In addition to the fact that a reproductologist is engaged in the study and treatment of infertility of various origins, he also develops methods and technologies for eliminating problems of the reproductive organs.

This specialist must have an excellent knowledge of human anatomy, physiology, understand the specifics of the functioning of the reproductive system, the mechanisms of conception, etc.

Physician competence

This specialist deals with all pathologies that provoke problems with conception. He must be able to identify them and prescribe treatment. During the diagnosis of the disease, the reproductologist attracts specialists of a narrower profile.

The doctor will help cure the following diseases:

Disorders of the menstrual cycle.

Benign formations (cysts) on the genitals.

Defects in spermatozoa, violation of their production.

Adhesions in the pelvis.

Age features that provoke the extinction of reproductive function.

Growth of endometrial cells (inner layer of the uterus).

Increase or decrease in thyroid hormone.

Diseases of viral origin.

Hormonal disbalance.

Pathological, irregular or absent ovulation.

Polycystic ovaries.

Gardnerellosis.

Cytomegalovirus infection.

Human papilloma virus.

Infertility of unknown origin, etc.

If a couple has problems conceiving, then they need to visit a reproductive specialist. The doctor will conduct a thorough diagnosis and find out the cause of the pathology.

The gynecologist-reproductologist deals with the problems of the female genital area. In most cases, a woman cannot bear a child due to diseases of the endocrine system due to the fact that the egg is defective or absent altogether. Infertility occurs due to pathologies in the fallopian tubes, which manifest themselves as a result of infectious diseases (causative agents - gonococcus, chlamydia), inflammatory processes, congenital diseases, abortions, and surgical intervention. A woman cannot bear a fetus due to inflammation in the uterus or oncological formations.

Male infertility occurs as a result of low sperm activity or deficiency. Andrologist-reproductologist is engaged in the treatment of such diseases. Most often, a man is not able to conceive due to metabolic disorders, infections, operations on the groin and small pelvis, injuries to the genital organs. In addition, fertility in the stronger sex occurs as a result of excessive drinking, hormonal imbalance.

According to statistics, 5% of couples are diagnosed with infertility due to the incompatibility of spermatozoa with the woman's body. In this case, rejection and death of male germ cells occurs.

The reproductologist reveals the true cause of infertility and determines the treatment plan.

When do you need a consultation with a reproductive specialist?

If a woman has a normal menstrual cycle, stable periods, ovulation occurs on time, she regularly enters into an intimate relationship with a regular partner, but pregnancy does not occur within 1 year - this is a good reason to consult a doctor. If a woman is over 35 years old, then she needs to visit a doctor after 6 months of unsuccessful attempts.

The reproductive specialist should examine both partners. First, the specialist asks the couple about how long they have been trying to conceive a child, how often sexual contact occurs. The doctor collects an anamnesis to find out what diseases they had in the past, whether the woman interrupted the pregnancy, whether she had miscarriages or mechanical trauma to the genital organs.

It is necessary to visit a reproductive specialist in such cases:

Spontaneous abortion during a previous pregnancy.

Frozen pregnancy.

Age features of the genitals, which do not allow to bear the child.

Congenital pathologies of the reproductive system.

Hormonal disorders.

Infectious diseases of the genital organs.

Venereal diseases.

It is in the couple's interest to provide the doctor with only reliable information so that he can provide real help.

A good specialist can be found in specialized medical centers or clinics where diseases are diagnosed and treated. The first consultation with a doctor is usually free.

Diagnostic methods

The reproductologist may prescribe the following laboratory or instrumental studies:

Analysis of the seminal fluid of a man.

Ultrasound procedure.

Blood test for TSH hormones (thyroid-stimulating hormone).

Study of adrenal hormones.

Analysis of female sex hormones.

Hysteroscopy (examination of the endometrium of the uterus).

Laparoscopy.

Examination for the presence of antisperm bodies.

Postcoital test (detection of the number and motility of spermatozoa in the cervical mucus).

Immunogram (study of the main indicators of immunity).

Hysterosalpinography (examination of the uterus and fallopian tubes).

Blood coagulation test and follicular reserve.

With the help of ultrasound, it is possible to identify the condition of the reproductive organs, their functionality and diseases. The study is carried out using an abdominal sensor or vaginal apparatus.

Laparoscopy is a minimally invasive diagnostic method during which small punctures are made in the abdominal wall. During the procedure, the doctor performs surgical manipulations to prevent future surgery.

Hysterosalpinography allows you to assess the patency of the fallopian tubes, pathology of the uterus, infantilism. With the help of a biopsy (collection of tissue cells), it is possible to identify oncological formations and other diseases.

The methods of therapy depend on the causes of the pathology and its origin. For example, with infertility, an extreme measure is IVF.

To bear and give birth to a healthy child, partners must follow the following rules:

Include in the diet foods rich in cholecalciferol, tocopherol, which improve sperm. In addition, a man should consume sources of zinc, ascorbic acid, and selenium.

During attempts at conception, you should not visit baths, saunas, or take hot baths.

Patients should take multivitamin complexes, avoid stress, walk more often in the fresh air.

Now you know who a reproductologist is and what he does. If you have been trying to get pregnant for more than a year, but without success, then urgently contact a competent specialist. Only with timely diagnosis and proper treatment do you have a chance to conceive, endure and give birth to a healthy child.

Reproductologist. What does a fertility specialist treat? Gynecologist-reproductologist. IVF at a reproductive specialist. Consultation with a reproductive specialist. Reproductologist at the family planning center

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Book a Reproductionist

Who is a reproductive specialist?

The first stage is a medical university, after which the future specialist becomes a general practitioner.

This is followed by post-university education, which is called internship or residency, and in European countries - residency.
The future reproductive specialist should be a specialist in obstetrics and gynecology or urology. He may also complete an additional education in a science such as endocrinology.

Finally, the third stage is another stage of additional education, which is called professional retraining. It consists in passing additional courses on the study of human reproductive health. During this period, the future specialist studies in more detail the causes of infertility and new methods for their elimination. After retraining, the doctor receives a certificate indicating his specific activity. Thus, a reproductologist is a doctor of a very narrow specialization, but with basic training in gynecology, obstetrics and urology. Like other specialists, a reproductologist must improve his qualifications and confirm his diploma every five years.

Reproductology is a science that studies human reproductive health. Reproductive health refers to the ability of an individual to reproduce, that is, to conceive a child. The subject of study is not an individual, but a couple - as a whole. It is important to understand that reproduction is an interdisciplinary science, standing on the border of such disciplines as gynecology, obstetrics, endocrinology. Therefore, a part-time reproductive doctor is also a gynecologist and obstetrician.

The subjects of study of reproduction are:

• diagnosis and treatment of male infertility;
• diagnosis and treatment of female infertility;
• prevention of infertility in couples;
• selection of contraceptive methods for the regulation of reproductive function;
• diagnosis and elimination of causes of miscarriage;
• prevention of unplanned pregnancies and, as a result, abortions;
• preparation of couples for in vitro fertilization ( ECO) ;
• choice of in vitro fertilization method.

What does a fertility specialist treat?

Female infertility is the inability of a woman to conceive during her childbearing years. There are primary and secondary female infertility. Primary infertility is called when, with the onset of sexual activity, pregnancy has never occurred. Secondary infertility is the absence of conception after previous pregnancies.

The most common causes of female infertility

So, the menstrual cycle of every healthy woman begins after the first menstruation ( menarche) and lasts until menopause ( last menstrual period). The cycle goes through two phases - follicular and luteal. During the first ( follicular) phase is the growth and maturation of follicles. Inside the follicles, eggs grow and develop simultaneously with them. Having reached its intended maximum and maturity in the ovary, the follicle bursts and an egg comes out of it. The process of releasing an egg is called ovulation. The ovum released from the ovary travels to the fallopian tube. If fertilization does not occur, the second luteal phase begins, which is associated with the formation of the corpus luteum and certain changes in the endometrium. Prepared and matured endometrium begins to be rejected ( desquamation process) and leaves the uterus together with its surface layer. The process of desquamation of the endometrium and its release is clinically manifested as menstruation.

Hormonal ( endocrine) infertility

The main forms of hormonal infertility include:

• gonadotropic insufficiency- characterized by damage to the reproductive function even at the level of the central link and is manifested by a decrease in the secretion of gonadotropic hormones ( follicle-stimulating, luteinizing);
• polycystic ovary syndrome- characterized by changes in the ovaries ( or rather, the formation of cysts in them), which leads to menstrual disorders, lack of ovulation and increased concentration of male hormones ( androgens) and infertility;
• ovarian failure- this is another form of endocrine infertility, which is characterized by a violation of the follicular function of the ovaries and the absence of their response to gonadotropic hormones;
• hyperprolactinemia- a condition characterized by an increased concentration of the hormone prolactin, which, in turn, may be the result of both a certain pathology and chronic stress.

Diagnosis of this form of infertility is based on determining the concentrations of specific hormones in the blood serum. So, anovulatory infertility can be the result of polycystic ovaries, increased concentrations of prolactin or reduced concentrations of pituitary hormones.

The main manifestation of endocrine infertility is the lack of conception. However, with some disorders, other symptoms are also characteristic, which may indirectly indicate the cause of infertility. Yes, hirsutism increased male pattern hair) and impaired fat metabolism are characteristic signs of polycystic ovaries, which, in turn, is a common cause of infertility.

Concomitant signs of endocrine infertility include:

• menstrual disorders, which can be expressed in oligomenorrhea, amenorrhea and uterine bleeding;
• lack of ovulation;
• hirsutism - excessive hair growth in the male pattern;
• violation of fat metabolism.

Risk factors for female infertility include:

• stress;
• chronic infection;

The causes of ovarian hypofunction are manifold. congenital hypoplasia ( underdevelopment) of the ovaries is associated with exposure to harmful factors during fetal development. Acute and chronic infections ( rubella measles, mumps, tuberculosis) that a woman suffered during pregnancy, as well as alimentary factors ( malnutrition) can lead to intrauterine underdevelopment and, as a result, to ovarian hypofunction. Ovarian damage can also occur due to radiation exposure. At the same time, the influence of negative factors leads to damage not only to the ovaries, but also to other structures of the reproductive system.

pathogenesis ( development) of the disease depends on the type of damaging factor, as well as on the duration of its impact. As a result, both morphological changes in the ovaries and the pathology of enzyme systems can be observed. In the first case, sclerotic processes are noted in the ovaries ( connective tissue replacement), cellular infiltration and scarring. In the second case, the process of hormone synthesis is disrupted, and the state of the receptor apparatus is also damaged ( ovaries become insensitive to the action of central hormones). Sometimes resistant ovary syndrome can develop.

One way or another, due to varying degrees of damage to the ovaries, an insufficiency in the synthesis of sex steroid hormones develops. This causes sexual, and in severe degrees, somatic ( bodily) infantilism.

tubal infertility

According to etiology origin) distinguish two main forms - direct damage to the fallopian tubes and a violation of their function without organic damage. Each of these forms includes certain subtypes.

Types of tubal obstruction

One of the main causes of tubal obstruction is the formation of connective tissue adhesions ( adhesions) in the pelvis. These adhesions are located between the sheets of the peritoneum, between the fallopian tubes and the peritoneum, between the tubes and the ovaries. In the future, they lead to a change in the structural and functional state of the organ. So, located between the fallopian tube and the ovary, connective tissue strands lead to deformation of the tubes, tightening and narrowing them. In far advanced cases, they can close the opening of the fallopian tube, leading to their total obstruction.

In general, the adhesive process can lead not only to obstruction, but also be the cause of acquired pathologies of the uterus and ovaries, as well as endometriosis and chronic endocrine imbalance.

The main signs of tubal obstruction are:

• lack of pregnancy with regular sexual activity;
• periodic pain in the lower abdomen;
• bowel dysfunction;
• dyspareunia - painful intercourse.

Initially, the mucosa swells, as a result of which the fallopian tubes thicken and become dense and painful. Further, the process very quickly passes into the chronic stage. In the course of the fallopian tubes, extensive dense adhesions are formed, which lead to severe pain. Well, the main manifestation of this process is the formation of obstruction. The danger of tuberculosis of the fallopian tubes is that the process, as a rule, is bilateral. Thus, two fallopian tubes are affected simultaneously, which leaves little chance of conception.

Uterine infertility

The cause of uterine infertility may be abnormal positions of the uterus. Normally, given the bends and inclinations, there can be two options for the position of the uterus - inclination and bending anteriorly - anteflexio, inclination and bending backwards - retroflexio. Around the uterus are the organs of the genitourinary system - in front of it is the bladder and urethra, and behind it is the rectum. The position of the uterus may vary depending on the filling of these organs. However, in this case it is not regarded as a pathology.

Abnormal positions of the uterus do not change depending on the surrounding organs. So, they distinguish motionless ( fixed) uterus, turning and twisting of the uterus, as well as its prolapse and prolapse of the uterus. Such position pathologies can develop as a result of inflammatory processes, the formation of adhesions, as well as with sexual infantilism.

When lowered, the bottom of the uterus falls below the prescribed level, that is, the fourth sacral vertebra. But, nevertheless, during straining ( for example, constipation) the uterus does not come out of the genital slit. While during prolapse, the uterus shifts sharply downwards and, when straining, can completely exit the genital slit. Turning and twisting is usually caused by tumors of the uterus and its appendages.

autoimmune infertility

All forms of thyroiditis occur with a variety of menstrual dysfunction. In this case, amenorrhea, algomenorrhea, oligomenorrhea can be noted. In addition to this, girls have ideational and motor sluggishness, dry skin, stool disorders in the form of frequent constipation. If autoimmune thyroiditis developed in adolescence, then menarche ( first menstruation) can occur much later, namely 3-5 years after the established norm.

Ultrasonography shows enlarged ovaries, often with multiple cysts ( phenomenon of cystic degeneration). In blood tests, there is an increased content of not only thyroid-stimulating hormone, but also gonadotropic hormones, namely prolactin, luteinizing ( LG) and follicle-stimulating ( FSH) hormone. This indicates a disturbed sensitivity of the ovarian receptor apparatus, which causes violations of the reproductive system and the menstrual cycle.

male infertility

The components of the male reproductive system are:

• testicles;
• vas deferens;
• seminal vesicles;
• prostate;
• penis with urethra.

Main characteristics of sperm

Directly the process of maturation and accumulation of sperm is determined by the proper functioning of the testicles, seminal vesicles and prostate gland. An equally important role in this process is given to the Leydig cells, which secrete the hormone testosterone. In turn, its synthesis is regulated by luteinizing ( LG) and follicle-stimulating ( FSH) hormone. In addition to testosterone, the testicles also secrete another nonsteroidal hormone, inhibin.

Types of male infertility

Semen analysis is recommended after 3-day or 4-day abstinence. Semen analysis is carried out 2 times with an interval of 7-10 days. Sperm collection is obtained by masturbation, after which it is collected in a glass dish. Further research should be carried out within an hour. Quality analysis begins with the determination of volume, color, odor, viscosity, after which special studies are carried out. A semen volume of less than 2 or more than 7 milliliters indicates reproductive disorders. Immediately after receiving the ejaculate has a thick consistency, with a specific smell.

Pathological spermogram options include:

• aspermia- lack of ejaculate;
• azoospermia- the absence of mature spermatozoa in the semen, but the presence of spermatogenesis cells in it;
• oligozoospermia- low sperm count, which may be of the first degree ( sperm count is less than 50 million), second degree ( sperm concentration between 40 and 20 million per milliliter) and third degree ( sperm count less than 20 million);
• asthenozoospermia- when less than 50 percent of spermatozoa are inactive ( i.e. no forward movement);
• necrozoospermia- motile spermatozoa are completely absent;
• teratozoospermia- less than half of the spermatozoa have a normal morphological structure;
• polyzoospermia- the number of spermatozoa exceeds 150 million in one milliliter of semen;
• oligoastenozoospermia- a small number of spermatozoa, and at the same time they are inactive;
• oligoteratozoospermia- a small number of spermatozoa, and at the same time they are of the wrong structure;
• oligoasthenoteratozoospermia- the sperm count is low, and at the same time they are inactive and irregular in shape.

Gynecologist-reproductologist

In order to understand what menstrual irregularities are, it is necessary to know the physiology of a healthy menstrual cycle. So, menstruation is called recurring with certain, normally identical, intervals of blood discharge from the genital tract. At the same time, the menstrual cycle is a two-phase period between two periods. This cyclicity is due to the circulation of hormones and the regulation of the nervous system. In the menstrual cycle itself, the luteal and follicular phases are distinguished. The first is characterized by rejection of the functional layer of the endometrium and bleeding from the genital tract. First day of menstruation bleeding) is the first day of the menstrual cycle. The second is characterized by the growth and development of follicles. A normal menstrual cycle lasts from 21 to 35 days, with more than half of women having an average duration of 28 days. The duration of the discharge ranges from 3 to 7 days, and the amount of blood loss in this case is an average of 50 milliliters.

Disorders of the menstrual cycle can manifest as amenorrhea, algomenorrhea, or hypomenstrual syndrome. Amenorrhea is the absence of menstruation for six months. Physiological amenorrhea is possible, which is observed during pregnancy and lactation. Pathological amenorrhea can develop in connection with general and gynecological diseases.

Algodysmenorrhea is called painful menstruation, which is most often observed in young unmarried women. In this case, the pain is most pronounced at the beginning of menstrual bleeding. The cause of pain most often lies in the underdevelopment of the genital organs ( infantilism), pathological position of the uterus and concomitant inflammatory diseases of the genital organs.

Hypomenstrual syndrome refers to the shortening or slowing of menstruation. In the first case, this is called oligomenorrhea, in the second - opsomenorrhea. Hypomenorrhea can also be observed, which is characterized by scanty and insignificant secretions. Various types of hypomenstrual syndrome develop with endocrine and inflammatory pathologies.

What does a reproductive specialist do?

The assessment of a woman's reproductive function begins with a survey regarding her sexual life - at what year of sexual life and at what age did the first pregnancy occur. If there were pregnancies, how many were there in total and how did they proceed. Much attention is paid to the presence of a history of ectopic pregnancy and miscarriage. Complications in the birth and postpartum period also negatively affect the subsequent reproductive function of a woman.

Artificial insemination at a reproductive specialist

Indications for artificial insemination are:

• oligozoospermia- low sperm count in semen;
• asthenozoospermia- a large percentage more than 50) inactive spermatozoa;
• oligoastenozoospermia- low concentration of spermatozoa in one milliliter and at the same time they are inactive.

The essence of the method is the introduction of the resulting sperm into the uterine cavity. In this case, insemination is performed repeatedly from 4 to 5 times during the period of ovulation. If the studies confirm an irreversible pathology of sperm ( genetic abnormalities) and there is no chance of restoring fertility, donor sperm is used. Donor sperm can be used fresh or frozen. The effectiveness of artificial insemination ranges from 20 to 30 percent.

Contraindications to artificial insemination are:

• inflammatory processes of the genital tract in one of the spouses;
• age over 50 for men and over 35 for women;
• general contraindications for pregnancy;
• the inability to conduct a thorough full examination of the spouses.

IVF at a reproductive specialist

fertilized egg ( or rather, the already obtained embryo) after a few days are implanted in the uterine mucosa. There, if the embryo takes root, it grows and develops for the next nine months.

To date, there are many programs and protocols for in vitro fertilization. However, they all go through roughly the same stages.

The stages of in vitro fertilization are:

• stimulation of the female body with hormonal drugs in order to simultaneously mature several eggs;
• ultrasonic tracking of follicle growth;
• on the day of maximum maturation, a puncture is performed with the extraction of eggs;
• fertilization of an egg with sperm of a spouse or donor in vitro ( or on glass);
• cultivation ( cultivation in the laboratory) received embryos;
• transfer of the largest embryos to the uterus;
• tracking the progress of the pregnancy.

IVF Protocol

In turn, the process of obtaining sperm can occur in different ways. If the man is healthy, and it is not difficult to extract the sperm, then in this case the man donates sperm by masturbation. If the process of spermatogenesis is disturbed, then treatment is recommended beforehand, after which the sperm is taken. However, it also happens that sperm is produced, but it is not possible to obtain it naturally. In this case, a puncture of the seminal vesicles is performed.

Further, having both male and female reproductive cells, the reproductive specialist carries out their fusion. In laboratory conditions, using modern equipment, the eggs and spermatozoa are combined - that is, the process of fertilization is carried out. The resulting embryos are placed in a special incubator where they are grown for a few more days. Before the grown embryo is placed in the uterus, clinics often carry out the so-called pre-implantation diagnosis. It consists in the early detection of various malformations and genetic anomalies - Down syndrome, Patau syndrome, hemophilia.

After the screening of gross developmental anomalies has been carried out, the stage of transferring the grown embryo into the uterus follows. This happens with the help of a special elastic catheter, which is inserted into the uterine cavity. It should be noted that not one embryo is introduced into the uterus, but several at once - two or three. This is done on the basis that at least one will take root. After the transfer, women are advised to avoid physical activity. A pregnancy test is done 10 to 12 days after the procedure.

The efficiency of IVF from the first time ranges from 20 to 30 percent. This means that only 2 - 3 women out of 10 who have undergone in vitro fertilization become pregnant. The number of retries varies from case to case. Some couples get pregnant after 5 or 6 attempts. At the same time, not all pregnancies that occur after IVF end in childbirth. Statistics say that 8 out of 10 pregnancies end in childbirth. This means that a pregnancy that occurs after IVF does not at all guarantee a successful delivery. As a rule, maintenance hormone therapy is recommended during the first trimester. Further, periodic monitoring by the attending physician, regular ultrasound examination is recommended.

Childbirth during pregnancy, which occurred after in vitro fertilization, is no different from normal.

IVF at a reproductologist using ICSI

Indications for the ICSI method are:

• lack of vas deferens in men;
• previous vasectomy ( ligation of the seminal ducts);
• spermatozoa with low quality indicators - inactive, irregular in shape;
• previous failed IVF attempts.

The stages of fertilization by ICSI are:

• stimulation of ovulation;
• follicle growth tracking folliculometry);
• collection of mature follicles;
• preparation of sperm and obtaining ejaculate by masturbation or surgery;
• on the day of follicle puncture, a procedure is performed to remove the radiant crown surrounding the egg;
• a good quality spermatozoon is selected under a microscope, after which it is placed in a microneedle;
• introduction of a microneedle with a spermatozoon into the cytoplasm of the egg;
• growing a fertilized egg for several days;
• the introduction of the embryo into the uterus;
• pregnancy tracking.

reception ( consultation) at the reproductologist

The survey is an integral part of the consultation. A carefully collected history helps to make a preliminary diagnosis, which is further confirmed by research.

The stages of collecting an anamnesis from a reproductologist are:

• assessment of the age of both partners;
• features of the family history - what diseases were observed in the family of each partner;
• lifestyle, which includes dietary habits, bad habits, working and living conditions;
• previously transferred diseases - and diseases not only of the reproductive system, but of the body as a whole;
• features of menstrual and reproductive function - the age when menstruation began, when an active sexual life began;
• the presence and nature of contraception;
• the presence of previous pregnancies;
• having surgery on the genitals.

Sample questions at the reception at the reproductologist may be the following:

• When did the first menstruation appear?
• When did regular sex life start?
• How often did you change sexual partners?
• At what age did the first pregnancy occur, and how did it end?
• How many births / pregnancies and when?
• Were there any abortions and how many? Were these abortions for medical reasons?
• What treatment was carried out in the post-abortion period?

Next, the doctor proceeds to a special examination of the genital organs. The presence of puberty, the severity of secondary sexual characteristics is noted. For example, there may be various changes in the penis in the form of hypospadias or phimosis, or pathology in the size of the testicles. The assessment of the internal genital organs is carried out using ultrasound.

What tests can a reproductive specialist prescribe?

• ultrasound examinations - to assess the condition of the internal genital organs;
• blood tests for hormones - to assess the hormonal background of a man and a woman;
• tests for HIV infection, hepatitis, syphilis;
• spermogram;
• genetic analyzes - determination of the karyotype and sex chromatin, help determine genetic abnormalities ( Morris Klinefelter, Shereshevsky-Turner syndromes);
• immunological study - consists in the detection of sperm antibodies and is carried out when any causes of infertility have not been identified in the course of numerous studies.

Variants of tests for hormones in a woman