Pathology of the fallopian tubes
Pathology of the cervix
Mental health and infertility
According to the world Health Organization, currently there are 22 causes of female and 16 male infertility.
The main causes of infertility in women:
- disorders of ovulation;
- violation of the structure of the fallopian tubes;
- various gynecological diseases;
- immunological causes.
We must remember that more than 60-70% of all cases of infertility there are several reasons, and the so-called "unexplained" infertility is often caused by the inability of the modern doctor to explain the absence of pregnancy.
To identify the causes of infertility in women more complex than men's.
Disorders of ovulation
In women with regular menstrual cycles and normal premenstrual phenomena, usually normal ovulation. In case of irregular menstruation or absence it is necessary to establish the cause of the disorder, before you start treatment. Most often it comes to ovarian cysts and some other neuroendocrine (associated with the nervous and hormonal systems) disorders arising on a background of stress, infections.
To detect ovulation daily measure body temperature in the mouth, or rectum, or vagina. However, this graph cannot be considered a reliable indicator for determining ovulation. Much more reliable ultrasound of the pelvic organs, which determine the diameter of the follicle. Healthy, normal ovary on ultrasound, describe as: "Not enlarged, position: adjacent to the wall of the uterus. Contains inclusions (follicles) up to a maximum of 20 mm.
To find out whether there was ovulation in this cycle, apply several biochemical assays. In particular, the sign of ovulation - the increase in the concentration of progesterone in serum.
In disorders of ovarian function can occur the so-called anovulatory cycles, when the egg is not released from the ovary. Simultaneously disturbed and secretion of ovarian hormones, regulating contractions of the fallopian tubes and normal development of the mucous membrane of the uterus.
Treatment and prevention.
In order to get pregnant, it is very important sincere desire to achieve this. Often in the course of infertility treatment turns out that she in fact (perhaps on a subconscious level) is afraid to become a mother. And therefore it is not necessary to develop the conception of sex hormones. The probability of psychological obstacles to conception should always be considered, and then it is not excluded that infertile married couples will help treatment from a therapist.
In some cases, the conception does not occur as long as the woman does not reduce the intensity of their professional activities. In fact, the subordination throughout his career, robotmania, constant stress in some sense, program the body that now is not the right time for the birth of a child.
On fertility (fertility) harmful effects of Smoking. According to a study by English scientists were surveyed 17 032 women), number of cigarettes smoked per day is inversely proportional to the fertility test. The more a woman smokes, the less her chances of getting pregnant. Therefore, in deciding to become a mother, first of all you should quit Smoking.
Recently it was found that the regularity of ovulation depends on the weight of the woman. Moreover, unfavorable factor here is both excessive and insufficient weight. The second is even more undesirable.
An intense workout can also affect reproductive capacity. The risk of infertility increases in women who engage in daily physical exercise more than one hour. In this regard, the athletes who have problems with ovulation, it is recommended to reduce the load (no training no sense).
According to statistics, about 80% of skinny women with no ovulation, adding just a few pounds (up to their optimal weight corresponding to the Constitution), restore ovulation cycle. This is due to the fact that adipose tissue is able to develop and to postpone the hormone estrogen. Low or too high (for obesity) content of estrogen can disrupt the overall hormonal balance and make pregnancy impossible.
Sometimes lead to infertility seemingly harmless habits. Thus, fertility is negatively affected by the caffeine, and women who drink more than one Cup of coffee a day lower their chances of getting pregnant.
To stimulate ovulation (anovulation or irregular ovulation) there are a lot of drugs, such as clomiphene. Ovulation usually occurs in 80% of women taking clomiphene and pregnancy is 40%. Can be assigned and gonadotropins (hormones that stimulate the production of sex hormones). This is a very expensive drugs, giving serious side effects, so their use should be under the close supervision of a doctor with experience treating these drugs. If women hypothalamus does not produce the hormones necessary for ovulation, can be used their synthetic analogues.
In addition to the above possible causes ovulation disorders are fairly common and physiological disorders of the ovaries. Various inflammatory processes, cysts, tumors, and so on, their Causes medicine could not identify, but nevertheless there are many effective ways of their treatment.
Pathology of the fallopian tubes
Dysfunction of the fallopian tubes is responsible for approximately 45% of cases of infertility. Possible congenital anomalies in the structure of the fallopian tubes, but often these deviations occur after infectious diseases of the uterus and appendages. As a result of inflammatory process develops obstruction of the fallopian tubes (and therefore no sperm can meet the egg) or narrowing of the lumen, which hinders the promotion of a fertilized egg in the uterus. Diagnosis. To determine the patency of the fallopian tubes using a special x-ray examination (with contrast) - hysterosalpingography. Also studies by hysteroscopy - optical system, which is introduced through the cervix into the uterus. Upon detection of foci of infection is prescribed medication (antibiotics), usually in combination with excision of adhesions and suppression of foci of infection using a laser beam through an incision in the abdominal wall or incision.
If the fallopian tube obstruction was caused by trauma, ectopic pregnancy or infectious inflammation, is sometimes surgery. However, such interference is very traumatic and can cause subsequent ectopic pregnancy, therefore, is not often.
Safer and more accurate is the study by using a laparoscope, modern optical apparatus in the form of a tube which is inserted through the puncture in the abdominal wall in 1-4 see
Inflammatory diseases of female genital organs are the most common gynecologic pathology. This infectious processes in the urethra, vulva (the external genital organs of the female), vagina, uterus, fallopian tubes and ovaries, caused by different microorganisms. In addition, inflammatory diseases of female genital organs is one of the most frequent causes of infertility, but not directly, as, for example, endometriosis, and provocative.
The infection affects the fallopian tubes, they are growing connective tissue that leads to narrowing and, respectively, a partial or complete obstruction. If the pipes are impassable, the sperm cannot reach the egg and fertilize it. When frequently repeated inflammation of the pelvic organs, the likelihood of infertility increases (after once migrated woman inflammatory diseases of the pelvic organs, the risk of infertility, according to statistics, equal to ~ 15%; after two cases ~ 35%; after three or more cases of ~ 55%). In addition, in women undergoing inflammatory diseases of the pelvic organs, are much more likely to develop an ectopic pregnancy. Exacerbation of the inflammatory process is fraught with the threat of miscarriage.
Diagnosis. Diseases of the female genital organs can occur without complaint, but in most cases, the woman complains of pain in the lower abdomen, vaginal discharge, fever, and General malaise, discomfort during urination, irregular menstrual periods, pain with intercourse. In addition, in the blood increased level of leukocytes gives reason to suspect the inflammatory process. On examination, the gynecologist may reveal tenderness of the cervix and ovaries. The doctor also takes vaginal swabs for the detection of the pathogen.
In difficult cases, resorted to laparoscopy.
Mainly for the treatment of inflammatory diseases of the pelvic organs using different antibiotics. After treatment, the women take control swab of the vagina to assess the effectiveness of therapy. During treatment it is not recommended to have sex. When the continuation of sexual intercourse, the man should use a condom. While undergoing treatment sexual partner woman, otherwise a high risk of re-infection.
Unfortunately, 20-25% of women of reproductive age are the recurrence of these diseases, so the woman undergoing them, should minimize the risk of recurrent disease and, therefore, fertility. For this it needs to be examined for the detection of infections of the reproductive system (a smear from a vagina, and, if necessary, a blood test for antibodies to the different pathogens). And be sure to cure existing disease to the end and to boost immunity.
Of gynecological diseases in the clinic of female infertility are often also dealing with fibroids and endometriosis, although the role of the latter is not entirely clear, because at the time of laparoscopy in patients with endometriosis often with passable pipes show signs of ovulation, and pregnancy does not occur.
Uterine fibroids - benign tumorous formation that develops in the muscle layer of the uterus. Statistics show that more than 24% of all women suffer from this disease, but not all of it leads to a pronounced infertility. However, if a woman seeks to become pregnant, it is necessary to remove the fibroids, so as pregnancy provokes tumor growth and leads to complications during pregnancy and during the birth (miscarriage, bleeding and so on)
In ~ 30% of women with fibroids fibroid education is not accompanied by a very pronounced manifestations, and the tumor can be detected only when a regular gynecological examination or to be incidental finding during surgery. The main complaint is bleeding, heavy periods, menstrual disorders, pain, compression of adjacent organs, visible tumor growth. In ~ 20 % of women with uterine fibroids do not cause absolutely no complaints and is incidental finding during an ultrasound.
Surgery is the only radical solution to the problem. Depending on the size of the fibroids and the desire to have children spend the removal of only the tumor sites, while preserving the uterus, the whole body of the uterus, keeping the cervix or do a complete destruction of the body and cervix. And conservative treatment of this disease, as a rule, is inefficient. Some hormones allow time to stop tumor growth or slightly decrease its size. However, this tactic is only considered as a preoperative preparation.
Endometriosis is a disease that is characterized by the appearance of cells of the endometrium (the lining of the uterus) in unusual places: the fallopian tubes, the ovaries, the uterine wall, the peritoneum, in the urine CMV bladder, rectum and other organs. These clumps of cells called "foci of endometriosis", and these cells begin to function in cycles, like a normal mucous membrane of the uterus, i.e., "menstruate". The incidence of endometriosis is on the third place after inflammatory diseases of the pelvic and uterine fibroids.
Symptoms of endometriosis diverse. In some cases, endometriosis can not occur, but the most common symptom of endometriosis is pain that gets worse during menstruation, often the pain occurs when sexual intimacy that makes it impossible. Another characteristic symptom of endometriosis of the uterus are spotting after menstruation. Next, perform an ultrasound to detect increased ovarian cysts and so on, do an x-ray of the uterus and fallopian tubes and, finally, laparoscopy is the only reliable method in the diagnosis of endometriosis.
The most efficient two-stage treatment. Initially held a laparoscopy to assess the degree distribution of foci of endometriosis, the size of ovarian cysts, etc. Then assigned to hormone therapy - synthetic substitutes hormones (drugs Zoladex, depo-decapeptyl, diferelin and others).
Pathology of the cervix
The cervix secretes mucus, which represents a biological filter. It prevents the penetration into the uterus of the microflora of the vagina, in the period of ovulation increases the viability of sperm. Texture, composition and viscosity of cervical mucus change under the influence of estrogen in accordance with phases of the menstrual cycle. Excessive density and viscosity of mucus can prevent the penetration of sperm into the uterus. In addition, there is a notion of immunological infertility, which is caused by the formation of the woman's special aggressive-protective proteins (antibodies) to the sperm in the cervical canal.
Special tests allow us to estimate the composition of the mucus and the survival of spermatozoa and their ability to penetrate the mucus in the upper divisions sexual tract. The test is carried out in the middle of the menstrual cycle, when the concentration of estradiol (a hormone from the group of estrogens) is the highest. A sample of vaginal mucus take in the period from 2 to 8 hours after intercourse.
If the test showed that the density and viscosity of mucus in the norm, doctors recommend performing additional test for antisperm Unitel (antibodies to membrane antigens of sperm).
The simplest and most informative test for the detection of antisperm antibodies on motile sperm is mixed antiglobulin test (MAR-test).
Individually tailored and may include intrauterine insemination (fertilization through the introduction of semen directly into the uterine cavity) or the use of drugs to reduce the viscosity of mucus. If the tests reveal the presence of antisperm immunity, doctors recommend in a few months be sure to use condoms during sexual acts (to avoid getting semen in the woman's body) and is prescribed immunosuppressive therapy drugs.
This leads to lower levels of antibodies and enables the woman to become pregnant. The ineffectiveness of this treatment you can spend intrauterine insemination - mechanical introduction husband's sperm directly into the woman's uterus.
Mental health and infertility
Psychologists advise to all infertile couples before infertility treatment to engage in the psychological support group, group psychotherapy, or to see a psychologist (not psychiatrist, of course). One or two months spent on improving mental wellbeing, can pay off significantly increase the effectiveness of standard treatment for infertility.
Scientific studies in recent years demonstrate the importance of the emotional state of the woman on the effectiveness of infertility treatment. Women who could not cope with his depression, anger and guilt, total depression, pregnancy rate was twice lower than those who were able to overcome their difficult emotional state.
To overcome this condition psychotherapists recommend that women most sincerely "emotionally open" in relation to other people, to share your feelings with your husband, your family, or with other infertile couples.
In scientific practice described numerous cases of infertility due to hormonal disorders on the grounds of mental anxiety and psychological and family problems. Not all couples are able to complete a full course of examination and treatment for infertility simply because of the lack of a stable marital relationship without any sexual disorders. Significantly less anxiety develops when the couple previously thoroughly discusses and coordinates all stages of examination and treatment with your doctor.
In addition, there are also the so-called syndrome of expectation of pregnancy, when a perfectly healthy woman is not pregnant, constantly thinking about it and afraid of not getting pregnant. It is in the infinite temperature measurement, graphing, listening to your body, sex on the clock and with tears during menstruation.
Increased because of this excessive desire level of anxiety disrupts the normal functioning of sex hormones, including those produced in the brain, and violates fertilization in General. And therefore, relaxation techniques, and changing attitudes toward the goal for the session of psychotherapy also reinforce the use of midwives and other experts in the conception (of reproduction).