CAUSES AND SYMPTOMS OF INFERTILITY IN WOMEN

What is infertility?

Infertility in women (female infertility) is the impossibility of conceiving during the year of regular penetrations, viable and active sperm, by natural or artificial means, into the genital organs of a woman of sexual age. Infertility is also diagnosed if the pregnancy always ends in miscarriages. Up to 20% of couples are barren.

Infertility in women should not be confused with not carrying a pregnancy when a mature oocyte is successfully fertilized by a spermatozoon, but the pregnancy ends, at the stage of embryogenesis, by miscarriage or abortion.

A woman is not considered infertile if her partner is found to be unviable, weak spermatozoa by laboratory methods, or they are completely absent.

The problem of infertility. The problem of infertility is now much more serious than it was before, a few centuries ago. The sexual revolution bears a serious responsibility, if only because it spreads infectious diseases. And young people increasingly do not want the birth of children, the postponement of pregnancy is growing more and more. If you take all infertile couples for 100%, then 33.3% have infertile men, another 33.3% infertile women, and the remaining couples have both partners.

Causes of infertility can be defects in the development of the reproductive system, dysfunction of the genitals, severe intoxication and common diseases of the body, as well as mental and neurological disorders. Infertility does not belong to the group of independent diseases, it always appears as a result of various diseases of the body. The main cause of female infertility is inflammatory diseases.

Physiology of monthly cycles

Infertility can occur with disturbed and normal monthly cycles. The natural monthly cycle of a woman, lasts 21-35 days, consists of three consecutive phases.

1. Follicular phase - egg maturation (not less than 7 and not more than 22 days)

2. The ovulatory phase of maturation and release of a mature oocyte, the onset of the fertile period.

3. Luteal - a phase of a yellow body, catabolism (from 13 to 15 days).

A few days before and after ovulation is called the fertile period (phase) - this is the time most likely to conceive. Up to this point and after pregnancy cannot occur! However, we must understand that in different women this phase occurs in different periods of menstruation. If the cycle is not resolved by pregnancy, the body, under the action of estrogen is preparing for the next cycle.

Infertility Classification

Infertility may be:

• primary - pregnancy never occurred (congenital gynecological anomalies) or (complications on the female genital organs) before or after menarche (first cycle);
• secondary, after the first successful pregnancy, the impossibility of re-fertilization, can be absolute (incurable) or relative (curable).

In some sources, devoted to studies of the physiology and pathophysiology of the female genital sphere, the concept is complemented by the following types of infertility.

• Physiological. The rate is infertility of early age (before puberty), and postmenopausal infertility (after menopause ).
• Voluntary. Otherwise called deliberately selected infertility - the use of (medication) drugs or physical (spiral, other) means.
• Temporary. It may be the result of prolonged stress, weakening of the body after or during the illness, some authors refer to temporary infertility as lactational amenorrhea - inhibition of ovulation in the early period of regular breastfeeding.
• Constant. The removal of the female genital organs, in whole or in part, is the result of surgery.

Signs and symptoms of infertility in women

An important sign indicating infertility in a woman is the inability to become pregnant for a year or more if there are favorable conditions for conception, namely:

• regular sex;
• sexual partner with good semen;
• complete, long-term abandonment of contraception;
• age of women from 20 to 45 years.

Infertility has no pathognomonic (leading) trait, often asymptomatic, or has indirect symptoms. Signs of infertility set in the collection history, examination, physical, laboratory, instrumental studies.

Anamnesis. Establish clear symptoms associated with the violation of regular cycles: long, short, painful, abundant, with extraneous secretions. It is possible to assume infertility on the basis of the establishment of indirect symptoms, characteristic of infectious, non-infectious and surgical diseases.

Physical examination

With physical examinations in the clinic, possible signs of infertility are:

• body mass index is less than or greater than 20-26;
• the condition of the skin and derivatives with signs of endocrine disorders;
• poor development of mammary glands;
• signs of pain, induration in the projection of the female pelvic organs, with bimanual gynecological palpation;
• signs of gynecological diseases detected when examining the cervix, using a vaginal speculum, colposcopy.

Laboratory and instrumental methods

The signs, possibly indicating infertility, are established in the process of laboratory and instrumental studies, with:

• infectious screening for STIs;
• hormonal screening for the elimination of endocrine sterility;
• Ultrasound of the female small pelvis, thyroid – hormonal sterility;
• hysterosalpingography (HSG) - X-ray exclusion of symptoms of obstruction of the fallopian tubes;
• MRI of tumors of the brain (sella), inhibiting the production of hormones - monthly cycle regulators;
• spiral computed tomography (CT) of the pelvic organs - the anatomical causes of infertility;
• laparoscopy (visual examination of the abdominal cavity organs) - tuboperitoneal infertility, adhesions, uterine tumors, retention ovarian cysts;
• hysteroscopy (examination of the walls of the uterus) - uterine tumors, inflammation, ulceration of the uterus.

Causes of Infertility in Women

Infertility of women - due to many private causes (factors). The reasons are not always obvious. In some cases, they are not amenable to diagnosis or are combined with each other, they increase the negative effect on the female body.

If you summarize the known causes (factors) of infertility, there are several large groups - the causes of infertility:

• Congenital malformations of childbearing organs.
• Acquired, caused in the reproductive organs:
• anatomical and morphological changes;
• functional impairment;
• metabolic imbalance.

The above describes most of the particular (specific) causes of female infertility. It is noticed that in women after 35 years, especially those who have not given birth earlier, the risk of infertility increases.

There are two general causes of fertility decline that are not related to gynecological diseases previously transferred:

• age delay of physiological processes;
• long-term use of contraceptives.

Infertility from contraceptive

In the literature, there are opposing views about the use of hormonal contraceptives. Supporters argue that contraceptive is beneficial in connection with the “rebound effect” after the abolition of hormonal contraceptives. That is, the abolition of factors inhibiting the process of fertilization, stimulates a sharp release of estrogen, increases the likelihood of becoming pregnant. In some cases, this is what happens.

On the other hand, there are cases of a temporary or permanent decrease in fertilization (fertilization) after prolonged use of contraceptives. Obviously, the truth is in the middle. The negative impact of hormonal drugs should be avoided, based on the advice of a gynecologist, when planning a personal (married) life. Perhaps a combination of different methods of contraception, and then they will not be one of the causes of infertility.

Causes of secondary infertility in women

For help determining the causes of infertility are women who have previously successfully given birth. The impossibility of re-becoming pregnant for a long time is called secondary female infertility. If you do not take into account the voluntary abandonment of conception and the age factor, the most obvious causes of secondary infertility are previous diseases, including gynecological infectious or non-infectious etiopathogenesis.  

Infertility factors

Infertility almost always has many causes (factors). As a result of research and clinical observations, it was established that the factors of infertility are structured (grouped) on the basis of a combination of homogeneous features, according to:

• the anatomical localization of the pathogenesis of infertility diseases;
• the nature of the pathophysiological processes in the body (endocrine disorders, the phenomenon of immunological rejection of germ cells);
• genetic abnormalities that prevent fertilization;
• features of the psychosomatic state of women of fertile age in different conditions of life;
• the influence of male factor infertility.

Cervical infertility factor

For successful fertilization, at least 10 million active spermatozoa must enter the uterus of the woman. The environment of the vagina of a healthy woman is a barrier for any foreign agents to the female body, including sperm. When vaginitis causes the death of sperm in the vagina associated with pathological processes. The normal environment is not an absolute barrier to sperm, the active cells move into the cervix covered with mucus. The mucus on the walls of the cervix is produced by epithelial cells.

The ability of spermatozoa to penetrate cervical mucus depends on:

• sperm activity and motility;
• physicochemical characteristics of cervical mucus.

In pathologies, mucus properties change, becoming an insurmountable barrier, even for active spermatozoa. The impossibility of male germ cells to overcome the cervix is called the cervical factor of infertility. 

The cervical factor of infertility (changes in the viscosity of mucus, other properties) can be the result of:

• hormonal disruption of the production of female sex hormones;
• inflammatory processes in the cervix;
• impaired microflora on the mucus of the cervix.

Tube infertility factor

A mature egg is transported from the ovary to the uterus through the fallopian tubes. The mucous membrane of the fallopian tubes is lined with ciliated epithelium.

The movement of the egg occurs as a result of:

• peristaltic movements of pipe walls;
• a flicker of cilia epithelium, creating a flow of tubular fluid   

Damage to the cilia provokes the pathological fixation of the egg in the tube, creates a risk of ectopic pregnancy. The greatest negative impact is associated with complete or partial obstruction of the tubes for a mature egg - this is a tubal factor of infertility.

Obstruction (obstruction) of the fallopian tubes may be:

• in the area of the funnel - the distal (distant) section of the fallopian tubes;
• in the area of the fallopian tube (proximal or near) department of the fallopian tubes;
• throughout (obstruction of the funnel, ampoule, isthmic and uterine sections) pipes.

Diagnostic value is the establishment of types of obstruction:

• partial;
• complete.

Obstruction of the tubes - the factor of infertility can be caused by a spasm or overlap of the lumen of the tube as a result of inflammatory adhesions, tumor growth, and other reasons. Disease of the fallopian tubes, accompanied by obstruction of the tubes and accumulation of transudate (fluid) in their lumen is called hydrosalpinx.

Typical causes of hydrosalpinx are a complicated course of inflammation:

• fallopian tubes - salpingitis;
• fallopian tubes and ovaries - salpingoophoritis;
• fallopian tubes, ovaries, and ligaments - adnexitis (inflammation of the appendages).

An obstacle in the way of the egg can be accompanied by pain in the abdomen. For the diagnosis of hydrosalpinx use X-ray examination (hysterosalpingography) and/or laparoscopy (a special type of examination of the abdominal cavity).

Cervical infertility factor

A through hole - a pharynx in the center of the cervix, like the airlock, connects the uterine cavity and the vagina. The function of the gateway, the cervical canal pharynx, manifests as periodic:

• inaccessibility of the uterus, most of the time, for foreign agents, including sperm;
• accessibility of the uterus to active sperm seeking to fertilize a mature egg.

The function is provided by the mucus of the cervical canal, which, under the influence of estrogen, changes its physicochemical and rheological (viscosity) properties at different periods of the monthly cycle.

• During the period of the greatest probability of fertilization, mucus changes its properties, for example, pH from acidic to neutral for spermatozoa — neutral and weakly alkaline and less viscous.
• In the inactive phase of the cycle, the phlegm of the pharynx protects the woman's body against disease agents.

If the cervical mucus of the cervix of the cervix, under the influence of pathological factors, is not accessible to the penetration of sperm into the fertile phase, this is the cervical factor of infertility.

Cervical mucus in the body of a healthy woman performs the functions of:

• protection (protection) and temporary depot (storage) of sperm in the reproductive tract;
• delays of weak sperm that cannot overcome the physical barriers of viscous cervical mucus;
• transfer of sperm activation factor, enhancement of their motor activity;
• Capacitation (ability) and acrosomal reaction (penetration) of spermatozoa, i.e. The ability to penetrate the sperm into the oocyte.

External pharynx - visually examined vaginal speculum. Internal pharynx - not available with normal exam methods.

The cervical factor of infertility is detected by colposcopy, detecting a "pupil symptom" in the throat of the cervical canal. The positive symptom of the pupil is transparent watery periovular mucus.

The cervical factor is detected by laboratory methods:

• research of rheological and biochemical properties of mucus;
• postcoital test (PCT) on the interaction of sperm and mucus after some time after intercourse. Typically, the PCT determination time is 9-24 hours;
• the definition of perovulyatornoy test Kurzrok-Miller.

Laboratory tests are conducted by experienced medical technicians. Research results depend on the correct time of the study.

Tubular peritoneal infertility factor

The abdominal cavity and internal organs are protected by the mesentery from contact and merging with the abdominal wall and adjacent organs. The mesentery is a serous membrane lining the inside of the abdominal cavity, divided into:

• a parietal sheet of the mesentery - separates the internal organs from the abdominal wall from the inside.
• the visceral sheet of the mesentery hangs all the internal organs of a person.

The abdominal cavity is filled with serous fluid, also serves as the protection of organs from mutual merging and friction. Normally, all internal organs have some degree of spatial mobility.

On the mesentery suspended fallopian tubes and uterus. Under the action of pathogenic factors, adhesions form between the fallopian tubes and the mesentery or the adjacent organ.

As a result, the fallopian tubes connected to the mesentery lose:

• mobility;
• adequate blood supply
• full innervation;

As a result of adhesions in the abdominal cavity, the fallopian tubes cease to fully perform their functions. The termination of the functioning of the fallopian tubes under the influence of adhesions of the peritoneum is called the tubal peritoneal factor of infertility.

Causes of tubal peritoneal infertility factor:

• Inflammatory diseases of the pelvic organs that have passed into the chronic stage of fibrinous inflammation (often STIs)
• Complications after abortion, operations on the pelvic organs.

Pipe damage leads to disruption of menstrual cycles, chronic pain syndrome.

Infertility or reduced fertility of turbo-peritoneal genesis is manifested:

• fallopian tube impaired - a tubal factor of infertility
• adhesive process in the pelvis - the peritoneal factor of infertility
• a combination of tubal and peritoneal infertility

For the differential diagnosis of a tubal-peritoneal factor of infertility, ultrasound, laparoscopy, and echography are performed.

Immunological factor of infertility

Normally, the immune system of a woman, when foreign proteins penetrate - in the form of seminal fluid and spermatozoa (antigens), does not react with the production of specific antibodies (ASAT). The reasons that result in the immunological rejection of sperm, not fully understood.

The appearance of ASAT in women is probably the result of the development of rejection reactions according to the type 2 allergic reactions. The barrier properties of the mucous membranes may be impaired as a result of a decrease in the amount of mucus on the internal surfaces of the genital organs during degenerative inflammatory processes. Currently, this pathology is treated by immunocorrection methods, by reducing the number of circulating antibodies, by stimulating reparative (restorative) processes on the mucous membranes of the birth canal.

Another immunological pathology is the factor of infertility, the production of anti-ovarian antibodies (AOA) by the female body on its own eggs. The reasons for the emergence of immune complexes that destroy their own immune defenses are complex and are within the competence of immunologists. Like all autoimmune diseases, the early stages of pathogenesis are treatable. In advanced cases, the prognosis is cautious.

Endocrine factor infertility

Disorders of hormonal metabolism lead to irregular cycles or their absence. The main causes of this type of infertility are dysfunctions:

• The consequences of traumatic brain injury, tumors hypothalami-pituitary region of the brain;
• Androgen imbalance over estrogens (hyperandrogenism) in the female body occurs with damage to the ovaries or adrenal glands, accompanied by polycystic ovary syndrome;
• Decrease in the functional activity of the thyroid gland (hypothyroidism) - the cause of violations of cycles;
• An insufficient amount of estrogen, accompanied by a violation of the rhythm of menstrual cycles, leads to pathological damage to the mucus of the birth canal;
• Disruption of lipid metabolism, accompanied by an excess or loss of adipose tissue provokes a decrease in ovarian function;
• Disorders of hormonal metabolism, accompanied by premature menopause;
• Congenital anomalies of the hormonal system, accompanied by an underdevelopment of the birth canal.

Endocrine disorders are investigated for violations of menstrual cycles, against the background of external signs of endocrine disorders (obesity, exhaustion, others).

Psychological factor of infertility

Stress is a general adaptive response of the body to various stimuli, it has a complex regulatory mechanism involving, among other things, the body’s hormones. It makes no sense to search for private causes of stress, as psychological factors of infertility, they are individual for each woman. In summary, the sources of stress are:

• excess of negative information;
• regular emotional reactions;
• physiological or pathophysiological reactions of the body.

Under chronic stress, the adaptive defense mechanisms of the body are depleted. Bioregulation structures (vegetative nervous system, adrenal hormones, pituitary, and others) stop working in the direction of adaptation, cause pathophysiological changes in the body. The psychological factors of infertility hide the pathophysiological alterations of the body (including hormonal disorders). To determine the causes of psychological infertility, you should stop looking for a source of stress, you must:

• Change the attitude to the stress factor. It is noted that families with low levels of education do not have problems with the birth of children, in contrast to families where women with a high level of intelligence and social status suffer from obvious and perceived stresses. Physical education, useful hobbies, recreation, positive emotions, and so on will restore hormonal and emotional balance.
• Turn to a qualified psychologist. Not always stress can be overcome by yourself. Find a specialist who will help stop thinking about imaginary problems, will help to understand the true causes of infertility.

Genetic factors of infertility

The literature describes in detail the genetic factors of male infertility. The genetic factors of infertility in women are little studied. Known private pathologies that cause female infertility, having genetic roots.

• Hyperandrogenism syndrome in women (an excess of male hormones).
• Endometriosis (proliferation of the walls of the uterus).
• Syndrome of premature menopause.
• Syndrome of primary amenorrhea (Sherevsky-Turner syndrome).

Other diseases accompanied by genetically determined infertility are also known. The causes and likelihood of future exclusion of genetic abnormalities are the subjects of genetic research. Laboratory methods for diagnosing genetic factors of infertility are currently being developed.

Degrees of infertility

The etymological meaning of the word "degree" in medicine means the magnitude of the comparison, of pathological processes of different intensity. The use of the term is appropriate when comparing particular (specific) pathological processes, in relation to a limited group of patients, with a similar diagnosis. More often, in the available literature, infertility is characterized as I and II type of infertility.

Infertility 1 degree in women . Or infertility I am the absence of pregnancy in a woman who has never given birth before. Usually, the period of infertility is counted after one year of the onset of regular sex life, without the use of contraceptives. Causes of infertility 1 are listed above in the text (see the classification of infertility).

Infertility 2 degrees in women . Or infertility II - is the impossibility of conception, refers to women who have previously had a pregnancy or gave birth. The term infertility is counted from the first attempts at pre-pregnancy. Usually also in a year. The causes of infertility II are listed above in the text (see the classification of infertility).

Infertility 3 degrees in women. The term characterizing the degree of impossibility of becoming pregnant is not used in the available literature.

Treatment methods

Recommendations for suspected infertility

Experts say that to achieve the maximum chance of fertilization, you need to be conceived from 11 to 18 days of the menstrual cycle. We remind you that the first day of menstruation is taken on the first day. Men should not ejaculate more than once every 2 days, as the concentration of sperm is maintained at the maximum, only in this case. Both partners should not use lubricants. And after sex, a woman should not be washed. In addition to all this, experts say that you need to have sex during fertilization in the pose of a “missionary”, and after intercourse, a woman should still lie on the back for about 15-20 minutes, with knees bent and raised.

If the presentation methods do not give the desired result, the couple will be assigned to undergo treatment. In the case when it is impossible to eliminate the causes of infertility, experts recommend modern reproductive assistive methods, such as IVF.

In vitro fertilization is a relatively young method of treating infertility, the essence of which lies in the fertilization of eggs with spermatozoa in a test tube and the subsequent transfer of a fertilized developing egg (embryo) into the uterus. This procedure gives a good chance of pregnancy, however, it is worthwhile to approach responsibly to the choice of the clinic. The main factors influencing the choice of the clinic are the level of professionalism and experience of reproductive physicians, as well as modern equipment.

Among the centers of Russia with the best reputation can be identified Moscow Reproduction Center "Life Line", which fully complies with the above requirements. The center has the latest innovative equipment, which allows for increasing the effectiveness of the procedure. And the staff is highly qualified specialists, considered to be one of the best in the field of IVF, including Potapov M. Ye. and member of the Russian Association of Human Reproduction Deck Yu.A

Even if a woman who dreams of a child is diagnosed with infertility, this is not a reason to despair! Modern medicine not only gives hope for replenishment in the family but also proves its capabilities by the result of numerous happy families.