Primary infertility is expressed in the inability of a woman to become pregnant for a long period of time after the onset of the reproductive period (the time of the onset of menstruation).

Characteristics of primary infertility

Primary infertility is diagnosed in girls who have never had a pregnancy.

Primary infertility is diagnosed in more than 1.5% of women in the world between the ages of 20 and 44.

The causes of the onset of the disease

Primary female infertility can occur for many reasons. This disease can be triggered by neuroendocrine disorders, as well as the abnormal structure of the girl's reproductive apparatus.

The disease can occur due to complications of previously transferred diseases of the reproductive organs. In 70% of women, this disease is caused by endocrine dysfunction.

This condition can cause frequent use of combined oral contraceptives, frequent stressful situations, physical fatigue, anorexia, or, conversely, obesity.

With endocrine dysfunction, the necessary hormones are not produced by the body, and this leads to a failure in the process of egg maturation.

The table lists the main causes of primary infertility in women.

Cause	Short description
	Small ovarian cysts
Hypothyroidism	Insufficient production of thyroxine and triiodothyronine
Adrenogenital syndrome	Congenital dysfunction of the adrenal cortex and excessive amounts of androgens
Genital infantilism	Retardation of growth and development of organs of the reproductive system
Hyperretroflexion of the uterus	Bending the organ back
	Benign tumor in the myometrium
Hyperflexion of the uterus	Forward bending of the organ
	The location of the inner layer of the uterine wall outside of its normal location.

In 65% of women, primary infertility is a consequence. Also, the cause can be the so-called (damage to sperm by antisperm antibodies).

Classification of the disease

Primary infertility has several varieties:

1. Congenital.
2. Acquired.
3. Temporary.
4. Permanent.
5. Absolute.
6. Relative.

Congenital primary infertility is the inability to conceive due to the existing pathologies of birth (abnormal structure of the tubes, malformation of the uterus, congenital disorders in the endocrine system).

Acquired primary infertility occurs as a result of past diseases. Usually, the impossibility of getting pregnant occurs due to the occurrence of obstruction of the fallopian tubes, which provokes previously transferred such diseases:

• Lymphogranuloma venereum.
• Gonorrhea.
• Diphtheria.
• Mycoplasmosis.
• Pelvioperitonitis.
• Salpingitis.
• Syphilis.
• Scarlet fever.
• Trichomoniasis.
• Chlamydia.
• Endometritis.

Temporary infertility is a transient condition such as puberty. When the puberty is over, the girl will be able to get pregnant, that is, temporary infertility goes away by itself, you just need to wait a certain amount of time.

Permanent primary female infertility is a situation that is caused by a number of factors or diseases that will not go away on their own.

Permanent infertility requires competent medical intervention and treatment.

Absolute primary infertility in women is the inability to get pregnant ever, that is, the girl does not have a uterus or irreversible occurs pathological changes reproductive apparatus. Relative infertility is defined when the cause can be eliminated.

The main symptoms of primary infertility

The main symptom of infertility is the inability to get pregnant for a year without using contraception.

Many women suffering from this disease notice manifestations of amenorrhea (absence of a menstrual cycle for more than 6 months).

Hypomenstrual syndrome often appears (a decrease in the volume of menstrual flow, a decrease in the duration of menstruation). All other symptoms depend directly on the cause of the onset of primary infertility.

With genital infantilism in women, when examined, there is a weak hair growth in the pubic area and in the armpits, underdevelopment of the labia, an elongated conical neck. With polycystic disease, ovulation is absent, excess weight appears.

Methods for diagnosing the disease

A gynecologist-reproductologist can diagnose primary infertility only after passing a series of examinations. The first stage of diagnosis is an examination by a gynecologist-reproductologist.

The doctor must determine the shape, position and size of the uterus and appendages. The gynecologist also pays attention to the patient's weight and height, BMI, the degree of hair growth and the condition of the mammary glands.

Then the doctor takes an anamnesis and directs the girl to undergo an ultrasound examination of the pelvic organs.

When making a diagnosis, it is mandatory to take tests for hormones:

1. AMH (anti-Müllerian hormone).
2. Estradiol.
3. Testosterone.
4. Hormones thyroid gland.

An analysis for sexually transmitted infections is mandatory.

In some cases, the physician prescribes additional studies:

• Hysterosalpingography (examination of the state of the uterine cavity and patency of the fallopian tubes).
• Hysteroscopy (examination of the uterine cavity using a hysteroscope).
• Examination of cervical mucus.
• Colpocytology (examination of the vaginal discharge to assess hormonal background).
• Geneticist consultation.
• Endocrinologist consultation.
• Laparoscopy.
• USGSS (non-invasive ultrasound of the uterus).
• Ultrasound of the thyroid gland.
• Folliculometry (monitoring the growth and development of follicles in the ovaries).

Also, women will need to take a smear for flora and provide the doctor with a schedule. A graph is needed to assess the nature of the menstrual cycle.

In parallel with the woman, a permanent sexual partner is also examined. He will also need to be tested for STDs and to establish a man's fertility.

Treatment of the disease

How to recover from primary infertility? The method of treatment depends directly on the cause of the disease.

If a woman does not have a uterus or ovaries, then the treatment of primary infertility is impossible, because there are no main reproductive organs. For such women, the only way out is surrogacy.

If the problem lies in endocrine disorders, then the doctor conducts hormonal therapy. If the reason lies in genital infantilism, then the woman is prescribed cyclic hormonal therapy with estrogens and gestagens.

With polycystic disease, a laparoscopic operation is performed and the administration of drugs that stimulate the growth of follicles in the ovaries is prescribed. In case of obstruction of the fallopian tubes, surgical correction is performed in order to eliminate it.

Conclusion

The syndrome of primary infertility is the cause of the abnormal structure of the organs of the reproductive system, previous diseases (especially STDs), obstruction of the fallopian tubes, as well as erosion of the cervix.

Today, this disease in most cases is successfully treated, with the exception of situations with congenital malformations of the reproductive organs.

Video: Infertility 1 and Infertility 2 - primary and secondary

The real scourge of gynecology is infertility. The symptoms of this diagnosis are manifested in the inability of a woman to become pregnant within 1 year of active sex life with a healthy man without using contraception. Primary infertility is a woman's inability to become pregnant from the beginning of her reproductive age. That is, conception never happened. Unfortunately, this diagnosis is not uncommon for modern married couples. A woman with grade 1 infertility has not yet had any pregnancy experience or a single child. The suppressed feeling of the impossibility of becoming a mother only causes apathy to everything that happens around. But don't despair. Today, there are not many diseases left that forever deprive a woman of the opportunity to find parental happiness. This article lists the main causes and treatments for primary infertility.

The reasons for the occurrence of infertility of the 1st degree. Treatment

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

Infertility of the 1st degree can occur after the termination of the first pregnancy in a woman. As a result of abortion, female hormones produced in the process of conception and fetal formation were unnecessary and provoked hormonal disruption in the body.

Another reason for primary infertility in this case is the possible trauma to the internal genital organs due to abortion. Adhesions are possible, causing obstruction of the fallopian tubes. Because of this, the egg simply cannot pass into the uterine cavity and fertilize. Read more about all the causes of infertility below.

1. Ovulation does not occur. A hormonal imbalance in a woman's body prevents a healthy egg from being released. This is manifested by a failure of menstruation, an abnormal amount of bleeding. Treatment consists of therapy with medications that stimulate ovulation.
2. Poor quality egg. The older the woman, the worse the quality of the egg becomes. In women wishing to become pregnant after age 40, the egg release may be abnormal. A way out of the situation: a surrogate mother or an egg transfer from a donor.
3. Endometriosis The disease consists in the proliferation of endometrial tissue outside the uterus. Endometriosis manifests itself as quite painful sensations during menstruation. Is fraught with miscarriages. Treatment is only surgical. The overgrown tissue is removed and the patency of the fallopian tubes is restored.
4. ... Obstruction is said if the egg is unable to reach the uterus. In this way, the sperm will not reach the egg. Infertility of the 1st degree in women of this nature can be the cause of inflammatory processes in the genitals, as well as sexually transmitted infections.
5. Polycystic ovary disease. Multiple cysts in the ovaries cause hormonal disruption, delayed menstruation, and therefore ovulation. Polycystic disease is manifested by an unexpected increase in body weight, rapid growth of body hair, acne. Treatment consists of taking medications that stimulate ovulation.

Diagnostics performed by a specialist will help to find out the cause and begin to determine the path of treatment. Primary infertility is surmountable. Modern medicine is capable of performing miracles in the truest sense of the word. The extreme solution to the problem of infertility of the 1st degree may be IVF or surrogacy. Good mood, the belief that everything will work out and the fulfillment of all the requirements of the attending physician are the components of success on the path to motherhood.

Obstetrician-gynecologist Andreeva O.V. talks about the primary and.

Today the problem of primary infertility is very urgent. Do not worry if you cannot get pregnant within two to three months of active sex life without using contraceptives. Doctors diagnose "primary infertility" in women who have not had a single conception since the beginning of their reproductive life. Before finding out the causes of the disease and developing the correct and effective treatment for infertility, it is also necessary to undergo an examination of the partner, since one of the reasons that it is not possible to conceive a child may be low sperm motility or a decrease in sperm concentration in a man.

The main causes of the disease

There are many reasons for primary infertility. All problems associated with the onset of the disease should be considered. The main problems are: menstrual irregularities, genital pathology, hormonal disorders, trauma, cysts, etc. All these reasons and many other factors affect the inability to become pregnant.

To eliminate menstrual irregularities, you should pay attention to the general condition of the body. Chronic illnesses, stress, improperly formulated diet or difficult living conditions significantly affect the menstrual cycle, but if the state of health improves, menstruation is restored.

Due to chronic diseases or inflammatory processes in the genitals, fallopian tubes, ovaries, as well as surgical interventions, adhesions, scar changes occur in tissues that adversely affect the patency of the fallopian tubes. During the examination, doctors determine the degree of this pathology and prescribe treatment methods.

Hormonal disorders also significantly affect the onset of pregnancy. Long-term use of contraceptive drugs, which include a large number of hormones, leads to the inability to become pregnant for a long period.

One more important reason for primary infertility should be paid attention to: this. As a result of this pathology, ovulation is impaired. With polycystic disease, there is a hormonal disruption, a delay in menstruation.

Primary infertility treatment methods

For the treatment of primary infertility, surgical methods, conservative therapy, and medications are used. In case of hormonal disorders, medications are used that eliminate hormonal imbalances, bringing the level of hormones back to normal.

Modern surgery allows endoscopic operations, after which the body quickly recovers. Surgical intervention is the most effective treatment for this pathology.

Infectious diseases of the genital organs are treated medications, while both partners are undergoing treatment. The drug is prescribed by a doctor depending on the causative agent of the infection.

Treatment of inflammatory processes includes several auxiliary techniques. These are physiotherapy, massage, acupuncture, etc.

In the case when treatment with all kinds of methods is ineffective, doctors recommend alternative modern methods of artificial insemination.

The reproductive health of a woman depends on preventive measures. From the very beginning of the reproductive life period, women should remember the basic rules, the implementation of which prevents the onset of primary infertility. Special attention is required to observe sexual culture, basic rules of personal hygiene - this will minimize the risk of inflammation in the genitals, prevent unwanted pregnancy, thereby preventing abortions, and also guard against hypothermia.

Treating primary infertility requires patience and a thorough medical examination. It is very important to find out the cause of the disease as early as possible and to conduct effective therapy, the result of which is a long-awaited and desired pregnancy.

First degree infertility or primary infertility is a serious problem in modern world... The main symptom is the inability of a married couple to conceive a child for twelve months, provided that they had a regular sex life without protection. When they talk about primary infertility, this means that a woman, from the beginning of her reproductive development, has never been able to become pregnant. And unfortunately, this diagnosis is not so rare.

Many, hearing about primary infertility, fall into depression, apathy, but modern medicine has made such a step forward that the chance of getting pregnant or just having a child increases every day. And in this article we will look at what causes primary infertility and how it is treated.

What is primary infertility in women

There are congenital pathologies, as a result of which a woman is not able to become pregnant. For example, pathologies include erosion of the cervix, fibroids, cysts, etc. Problem ovaries are widespread, and if the work of ovarian follicles is disrupted, then the maturation of the egg becomes problematic, with deviations from the norm. These diseases can occur if the patient has been absent for a long time, or vice versa, with their excessive duration.

Primary infertility in women

Abortions are common in women. After all, those hormones that were developed during the conception of a child, as well as during the formation of the fetus, are no longer needed, and a failure occurs in the body.

Often it is curettage during abortion that leads to injuries to the genitals, as a result of which adhesions occur, which lead to obstruction of the fallopian tubes. Therefore, the egg simply cannot enter the uterus for implantation to occur.

Causes of primary infertility

• Lack of ovulation... The reason for this is hormonal failure, violation of menstruation, heavy bleeding, or vice versa, their absence for a long enough time leads to the fact that a healthy egg cannot come out. As a rule, it is treated with medication to resume the woman's normal ovulation cycle.
• Endometriosis disease occurs when the endometrial cells of the uterus grow beyond the border of the uterus. Women usually experience a painful appearance of the condition, especially during menstruation. It is during endometriosis that the number of miscarriages increases. This disease is treated only surgically, removing unnecessary tissue and restoring the patency of the fallopian tubes.
• With age, the quality of the egg is deteriorating, and it becomes more difficult for women after forty to become pregnant, and there is a risk of all sorts of pathologies. In this case, a surrogate mother or the introduction of an egg from a donor is recommended.
• Poor patency of the fallopian tubes- this is when the sperm cannot reach the egg. Doctors say that with infertility of the first degree, inflammation in the genitals and infections can be the cause of obstruction.
• Polycystic... During this disease, a large number of cysts appear on the walls of the ovaries, due to which hormonal disruption occurs, the menstrual cycle fails, and the absence of ovulation. Symptoms of polycystic disease are increased vegetation on the body, rashes, weight gain. Polycystic disease is treated with medication.

Nevertheless, only a specialist can correctly diagnose the disease, and determine the nature of its course, and prescribe high-quality and correct treatment. Today infertility of the first type is treatable, and there are a huge number of ways. And in the case of an extremely difficult course of infertility, there is an option with IVF or surrogacy. Therefore, do not lose faith in yourself and in medicine, go for it, and you will succeed!

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

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

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

Types and signs

There are several types and subspecies of infertility. Two main forms: primary and secondary (acquired, arising after trauma or inflammation).

There are 2 other varieties: absolute and relative. Absolute infertility is the complete impossibility of getting pregnant due to the absence of a woman's uterus and ovaries. With a relative chance of conceiving a child, there are also considerable ones, for this you only need to carry out some operations. Primary infertility can be divided into 5 types:

1. Normogonadotropic anovulatory infertility or endocrine - occurs due to diseases of the thyroid gland and gonads. Their job is to regulate the menstrual cycle, so any deviation can lead to complex hormonal disruptions. Anovulatory normgonadotropic infertility does not allow ovulation to occur or makes this process rare and defective. There are 3 reasons due to which anovulatory infertility occurs:

• Disorders in the hypothalamus and pituitary gland: weight loss, stress, bleeding are observed. If the cause is a prolactinoma (tumor), with proper treatment, fertility will recover.
• Polycystic Ovary Syndrome: There is an excess of estrogen. If the form of the disease is severe, then the likelihood of restoration of the reproductive system is low.
• Depletion of the ovaries is the most difficult stage, in which the chances of getting pregnant are reduced to almost zero.

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

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

This is the most difficult form because doctors cannot determine what to treat to restore the reproductive system.

Infertility reasons

It is possible to determine why pregnancy does not occur by some signs:

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

All these signs indicate some reason that prevents a woman from getting pregnant. The main factors of grade 1 infertility include:

1. Endometriosis
2. Obstruction in the fallopian tubes.
3. Increased secretion of prolactin.
4. Amenorrhea.
5. Adhesions.
6. Defects in the organs of the reproductive system.
7. Psychosexual disorders.
8. Inflammation in the pelvic organs.
9. Hormonal imbalance.

Separately, it should be said about the medicine, which often becomes a provocateur of infertility - Postinor.

Postinor

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

Postinor - a provocateur of infertility

The remedy must be taken immediately after unprotected intercourse, within 72 hours. One package contains 2 tablets that must be taken sequentially. The first pill - in the next hour or two, the second - 12 hours after the first. The sooner the medicine is taken, the lower the risk of getting pregnant. If used incorrectly, infertility can occur after postinor.

The medicine inflicts a severe blow on the body and depletes the functions of the ovaries. With regular use of the drug, the reproductive system completely dies off. Postinor and infertility are indeed linked, but if you use it strictly according to the instructions, the body will not be harmed.

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

Cervical factor infertility

Cervical factor infertility is an abnormality in the cervix that prevents fertilization. There are 2 forms of deviations:

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

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

Treatment and prevention

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

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

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

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

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

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

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

1. Depending on the gender of the partner with fertility problems, there are male, female, combined infertility.
2. Depending on the ability to correct the causes, infertility is divided into absolute and relative.
3. Due to the type of reproductive system disorders, infertility is:

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

Primary infertility in women and men

Primary infertility in men is as common as in women. Such a diagnosis can be made if one or more partners with whom they have had unprotected sexual intercourse have never had a pregnancy. The reasons for this condition can be different, congenital and acquired. For example, these include:

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

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

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

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

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

Congenital pathology of the anatomical structure

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

• uterus;
• ovaries;
• fallopian tubes.

Pathologies of the structure of the uterus (hypoplasia, intrauterine septum, two-horned uterus, organ doubling) or fallopian tubes (doubling, fusion, underdevelopment) can also interfere with conception. Because of this, the meeting of the egg and sperm is impracticable, that is, the possibility of natural fertilization is completely excluded.

Diagnosis of primary infertility

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

Secondary infertility in women

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

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

Obstruction of the fallopian tubes

After undergoing gynecological operations, including abortions, inflammation of the uterus and appendages, adhesions appear in the fallopian tubes. Their inner surface seems to stick together, grow together. The lumen is blocked. Due to the obstruction of the tubes, sperm do not get to the egg, conception does not occur. The adhesion process can spread to the pelvic organs, this type of infertility is called tubo-peritoneal.

Pelvic inflammatory disease

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

The infection can get, for example, into the ovaries through sexual contact, when performing gynecological manipulations, during childbirth, menstruation, with blood flow from another diseased organ. Women with chronic stress, weakened immunity, and leading a promiscuous sex life are more likely to suffer from diseases of the genital area.

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

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

Endocrine infertility

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

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

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

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

Polycystic ovary

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

Immunological infertility

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

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

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

Endometriosis

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

1. Adhesion process in the tubes and uterus, due to chronic inflammation in the places of endometriotic foci.
2. Problems with the maturation of the egg, its quality and ovulation in the case of the presence of endometrial tissue on the ovaries.

Early menopause

Early menopause, or wasted ovarian syndrome, is a rare cause of infertility. It is diagnosed if a woman before or after 40 years of age ceases to have periods and there are characteristic symptoms such as hot flashes, a sharp wilting of the skin, weakness, irritability, pressure surges, pain in the heart.

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

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

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

Psychological infertility

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

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

Secondary male infertility and its features

A couple should think about secondary male infertility, if a man has suffered a genital trauma, any disease, conception does not occur, but the partner has previously had a pregnancy with any outcome. The diagnosis is confirmed after a full examination, in which semen analysis, blood tests, ultrasound and Doppler of the scrotum are required.

Prerequisites for the onset of pathology:

• STIs;
• viral diseases history (flu, herpes, etc.);
• endocrine pathologies;
• varicocele;
• surgical operations on the genitals;
• regular intake of alcohol, anabolic steroids, drugs;
• smoking;
• exposure to high temperatures on the testicles (working in a hot workshop, visiting a bath, sauna, too hot water while taking a bath);
• strict diets and stress.

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

Diagnosis of secondary infertility

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

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

General principles of infertility treatment

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

The treatment carried out can be broadly divided into two types.

1. Conservative - taking various medications, including hormonal ones, physiotherapy. So, with infections, the patient is prescribed antibiotics, and with endocrine imbalance, substitution therapy is selected.
2. Operative, including surgical, minimally invasive, laparoscopic, endoscopic interventions. For example, there is no point in treating the symptoms of tubal infertility without surgery.

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

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

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

Alena Strazdina
obstetrician-gynecologist, fertility specialist of the medical center "Lode"

Infertility has long been viewed not as a diagnosis, but as a condition. So this is precisely the condition in which, despite a regular sex life without using any methods of contraception, pregnancy does not occur within 12 months. Of course, the doctor can come to this conclusion much earlier. For example, in the presence of such problems as polycystic ovary syndrome, genetic diseases, indications of serious surgical interventions on the pelvic organs, and so on.

Distinguish primary infertility(when a woman has never become pregnant during her life) and secondary infertility(when at least once there was a pregnancy).

Sometimes the real reason is a mystery to the doctors themselves.

The factors leading to the problem under discussion can be very different. For example, if we talk about endocrine infertility, then this is the impossibility of pregnancy due to the lack of ovulation, violation of the luteal phase of the cycle, caused by changes in the normal secretion of hormones in the blood, or a violation of sensitivity to the effects of hormones in target organs - the ovaries and uterus.

Tubal-peritoneal factor infertility is characterized by impaired patency or peristalsis (contractile movements) of the woman's fallopian tubes, as well as the presence of an adhesive process in the small pelvis.

As a separate factor, infertility caused by endometriosis... It leads to a decrease in the quality of oocytes and ovarian reserve, disruption of the fertilization process and peristalsis of the fallopian tubes, and so on.

About immunological factor infertility is said in the event that a man has a large number of spermatozoa loaded with antisperm antibodies. To identify such a situation, a man needs to pass an MAP test.

Violation of spermogram indicators indicates the presence of a male factor of infertility

In 10-15% of cases, the cause of infertility remains unknown. The methods that exist in clinical practice today do not always give an unambiguous answer. Man is a complex creature. It also happens that no obvious diseases have been identified, both the man and the woman are healthy, but for some reason pregnancy does not occur.

Even if there are no ovaries or fallopian tubes, pregnancy is possible

In most cases, infertility treatment begins with conservative (drug) therapy. But there are a number of indications in which it is possible to fulfill a dream only with the help of IVF. These are conditions in which pregnancy cannot occur without the use of assisted reproductive technologies (absolute indications) or when their use will give the most favorable result (relative indications).

An absolute indication is, for example, the absence of fallopian tubes (due to surgery). That is, these are, as a rule, very serious reasons that the couple cannot fix.

However, most of the indications for IVF are still relative. Even if a woman has practically no ovaries or they have ceased to function due to diseases, but there is a uterus, the opportunity for pregnancy remains. In this case, you can carry out a program using donor oocytes (obtaining eggs from a female donor, subsequent fertilization in the laboratory and transplantation into the body of a female recipient). In case of severe sperm pathology in men, programs are carried out using donor sperm.

In our country, it is allowed to conduct surrogacy programs for women who do not have a uterus or when, for a number of other reasons, carrying a pregnancy is impossible.

The list of contraindications for pregnancy is quite large

There are situations where pregnancy poses a high health risk. The Resolution of the Ministry of Health No. 54 lists all contraindications for IVF programs. As a rule, these are those diseases for which carrying a pregnancy is contraindicated. This includes: serious illnesses connective tissue, tuberculosis, syphilis, thrombosis, severe forms diabetes mellitus, diseases of the central nervous system - the list is quite long.

- If there is a problem with conception, perhaps a woman without a partner turns to specialists first?

Yes, after all, women usually look for the problem in themselves. But from my own experience I can say that in recent times more and more often they come to the reception in pairs. And, of course, this is correct.

Male infertility accounts for about 40% of the total statistics.

- Still, who has infertility more often: men or women?

Currently, the combined factor of infertility is becoming the most common when both partners have health problems that prevent conception. If you still choose between the sexes, women are diagnosed more often. But somewhere 40% of the total statistics is male infertility, and this is a high figure.

- What are the most common causes of male infertility?

Violation of hormonal regulation of spermatogenesis, thyroid function, diseases of the scrotum, problems with blood vessels, which led to malnutrition of the testicles, severe general diseases.

Therapy in the treatment of malignant diseases can also adversely affect spermatogenesis. Even harmful working conditions sometimes contribute to the problem. For example, frequent interaction with toxic substances, work in conditions high temperature etc.

- And what role do bad habits play in the overall unfavorable picture?

Great. By the way, it has been scientifically proven that non-smoking men have much less problems with conceiving than smokers. For women, smoking threatens miscarriage. But, like alcohol, nicotine is only an additional aggravating factor, not the main factor in infertility.

Sometimes some unexplained forces take over.

- Have there been any amazing cases in your practice?

I think every fertility doctor has such stories. I can cite as an example a case when a woman was operated on three times due to endometriosis, an IVF program was carried out, only one embryo was obtained and the patient became pregnant on the first attempt. Today the couple are raising a wonderful boy.

You should never despair. No matter how competent we, doctors, may be, today far from all the mechanisms of reproduction in the human body have been studied. Probably, there really are forces that contribute to the final success or failure. After all, it happens that even if all the procedures of the same IVF were successful and, it would seem, the result is simply obliged to please, at the last moment something breaks down.

By the way, sometimes the problem lies not at all in weakened health. Psychological barriers is also a serious obstacle. It is known that the regulation of the menstrual cycle in women is closely related to the central nervous system... Stressful situations negatively affect any processes in the body.

As a doctor, I am opposed to a healthy couple at the very start of pregnancy planning, when they have just begun an open intimate life, "fixated" on this issue: they constantly passed ovulation tests, calculated auspicious days or even hours for intercourse and fearfully awaited the days of menstruation. People are not machines. Everything has its time. Do not rush and worry once again.

In the end, you can go to a psychologist. There are things that are difficult to entrust to both loved ones and a doctor. But sometimes you just need to get rid of the accumulated internal problems, pour out your soul to someone. And then everything will definitely work out.

Photo: Olga Chertkova

Primary infertility in medicine is called infertility of the 1st degree. This concept characterizes the state when a mature person is unable to produce offspring due to congenital or acquired pathologies of the reproductive system.

There are many reasons for rejection. Abortion and other methods of termination of pregnancy lead to primary infertility. There are more chances to harm the body during the first pregnancy. Terminating a pregnancy means abruptly stopping the hormonal processes associated with it. The body is not able to quickly rebuild and failures occur.

Among the provoking gynecological diseases: uterine fibroids, cysts and erosion. More chances of infertility in chronic or protracted illnesses. With pathologies of the ovaries, the egg is not able to mature due to the malfunctioning of the follicle. Pathology is expressed in the absence of menstruation or its severe course. The adhesions of the fallopian tubes completely close the passage to the uterus. Women with genital trauma are also at risk.

Primary infertility is also common in men. The reason for this is dysfunction of the reproductive system or problems with sperm. Due to its insufficiency or absence, ejaculation is malfunctioning. It happens that primary infertility is diagnosed in both partners.

There are several types of types of primary infertility:

• congenital (pathology present at the time of birth) or acquired (as a result of an illness that arose after birth and before the onset of sexual activity);
• temporary (a transitional state for natural reasons that does not require treatment) or permanent (that has arisen for reasons that cannot go away on their own);
• absolute (irreversible pathology, impossibility of conception) or relative (pregnancy does not occur for reasons that can be eliminated).

The latter types are the most unstable. As science and medicine develop, there are ways to cure previously irreversible pathologies of the reproductive system. The breakthrough was the invention (in vitro fertilization). With its help, hope has appeared even in those women who do not have fallopian tubes. Experiments have led to the fact that today it is possible to transplant a uterus. Until recently, these reasons were considered absolute.

There is also combined infertility - the infantility of both partners.

Causes of primary infertility

The most common causes of primary infertility include endocrine pathologies, developmental abnormalities, complications of diseases, and excessive attempts to get pregnant. According to the source, the causes of infertility are divided into endocrine, uterine, tubal and immunological.

More than half of all women with primary infertility received their diagnosis due to disorders in the endocrine system. At risk of women with:

• ovulation disorders due to stress and overwork;
• hypothyroidism (insufficient amount of thyroid hormones);
• obesity;
• adrenogenital syndrome (disturbances in the synthesis of corticosteroids).

Primary infertility in women causes:

• There is no ovulation (the process of forming a new egg). It occurs against a background of hormone instability, manifests itself in abundant menstruation and cycle failures.
• Aging of the egg. After forty years, the eggs are practically unable to fertilize. Transplantation of a healthy egg helps.
• Endometriosis or proliferation of uterine tissue beyond its limits. It is manifested by severe pain during menstruation. Requires surgical intervention.
• Obstruction of the fallopian tubes.
• Complete overgrowth of the virgin pleura (hymen atresia).
• Polycystic or the presence of cysts in the ovaries. It manifests itself in delayed menstruation and ovulation, overweight, rapid hair growth, acne.
• Absence of uterus, ovaries and fallopian tubes.
• Bending of the uterus at right angles to the fallopian tubes (hyperantheflexia).
• towards the spine (hyperretroflexia).

Primary infertility in men causes:

• Varicocele or abnormal. As a result, the testicles overheat and harm the sperm. This is the most common cause of male infertility (40% is primary, and 80% is).
• Urinary tract infection. Various fungi and viruses promote sperm adhesion.
• Genetic abnormalities (do not allow the option of surrogate bearing, because diseases are inherited).
• Hormonal factors.
• Diseases of the gastrointestinal tract (especially pancreatic abnormalities).
• Diseases of the respiratory tract (most often bronchial asthma).

Common reasons:

• Genital trauma.
• Traumatic brain injury.
• Improper use of combined oral contraceptives.
• Use of emergency pregnancy prevention products.
• Genital infantilism (underdevelopment of the genitals due to inflammation of the hypothalamus and pituitary gland).
• Dysgenesis of the gonads (underdevelopment of the ovaries or testicles due to chromosome abnormalities).
• "Children's" diseases (scarlet fever, diphtheria).
• Sexually transmitted diseases.
• Genital tuberculosis.
• Diabetes.
• Tuberculosis.
• Cirrhosis of the liver.
• Long-term bad habits (smoking, alcoholism, drug addiction).
• Strong exposure, exposure to radiation, chemical poisoning.
• Living or working in a hazardous environment.
• Stress.
• Chronic fatigue and constant overwork.
• Wrong way of life.
• Ovum and sperm antigenicity.

It happens that it is impossible to find out the cause of infertility. Such infertility is called unclear or unexplained.

Medical history and symptoms

The main alarming signal for infertility is the absence of pregnancy during the year with active attempts. Depending on the cause, there may be such manifestations:

• disruptions in the menstrual cycle;
• absence of menstruation for several months in a row (amenorrhea);
• a reduction in the days of menstruation and the amount of discharge (hypomenstrual syndrome);
• severe pain during menstruation, similar to labor pains (algomenorrhea).

However, most menstrual irregularities do not appear in any way. The only symptom is the absence of pregnancy.

With genital infantilism, the symptoms are as follows:

• absence or insignificant amount of pubic hair, armpits;
• underdevelopment of the mammary glands, external and internal genitals;
• the absence of the first menstruation after 15 years.

During a gynecological examination, the doctor notes the abnormal dimensions of the vagina, improper placement of the labia, the uterus in the form of a cylinder with a long conical neck. In the absence of a uterus, the external genital organs develop correctly, there is no menstruation. With underdevelopment of the vagina, pain during sexual intercourse or its absolute impossibility may become a symptom.

Underdevelopment of the uterus and vagina accompanies not only primary infertility, but also many diseases of the kidneys and urinary tract.

Psychologically speaking, primary infertility causes depression. The inability to conceive and bear a child makes a woman nervous, irritable and aggressive. She is susceptible to neuroses, has low self-esteem, and shields herself from society. Infertility is a common cause of divorce because couples cannot use their parenting potential.

Primary infertility: diagnosis

The treatment regimen is made up depending on the root cause of infertility and concomitant deviations. There are many studies and tests that can identify the primary deviation:

• collection of anamnesis;
• examination of the patient;
• analysis of the correspondence of height, weight, hair growth and size of the mammary glands to age;
• rectal and bimanual analyzes;
• laboratory and instrumental research;
• functional diagnostics;
• examination of hormonal status;
• smear analysis;
• Ultrasound of the pelvic organs and thyroid gland;
• UZGSS;
• fundus analysis;
• research of genetics;
• spermogram;
• Ultrasound of the scrotum;

Treatment of primary infertility in men and women

First of all, an infertile woman is referred to a psychotherapist to correct her emotional state... To normalize weight, special diets are prescribed. Cigarettes, alcohol and other bad habits are excluded. The daily routine should be adjusted.

Antibiotics are indicated for infections. If the cause is a pituitary tumor, the woman needs a neurosurgeon's consultation. With infantilism, physiotherapy and gynecological massage are used. Of the drugs, vitamin A, B, E and folic acid are prescribed to prevent deviations in the unborn child. If the above is ineffective, they resort to artificial stimulation of ovulation. It is also effective for endocrine infertility.

If all efforts were in vain, after a year of treatment, the woman is recommended to have surgery. Laparoscopy allows you to treat peritoneal and without serious damage to the skin.

A man's treatment begins with giving up bad habits. After consulting an andrologist, it is necessary to examine the semen for abnormalities.

• For polycystic: wedge resection, cauterization.
• Obesity: diet, exercise, medication.
• Genital infantilism: hormone therapy, vitamins, physiotherapy.
• Ovulation problems: drug stimulation.
• Tubal infertility: physiotherapy, drugs for inflammation, immunomodulators, hydrotubation with enzymes and corticosteroids. In case of failure, surgery will be required (plastic surgery of the fallopian tubes, laparoscopic adhesiolysis).

For all types of primary infertility, psychotherapy is mandatory. IVF is considered an alternative treatment.