Infertility

Infertility - the absence of over 2 years and more pregnant women who regularly sexually active and do not use contraceptives. There are absolute infertility, when a woman's body are irreversible pathological changes interfering conception (absence of the uterus, fallopian tubes, ovaries), and the relative, where the causes of infertility can be eliminated. In addition, distinguish primary sterility where the woman lives sexual life, has never been pregnant, and secondary when conception does not occur, although the last pregnancy were. The frequency of infertile marriages is 10-15%. In 60% of cases of infertility are disorders in women, 40% in the male (sperm deficiency, ejaculation disorder, impotence). The most common cause of infertility women are anatomical and functional changes in the genitals: infantilism; inflammatory diseases of the fallopian tubes, ovaries, uterus, cervix, vagina; disorders of the ovaries and pituitary gland (see Anovupyatorny cycle.), adrenal gland (see congenital adrenal hyperplasia.), the thyroid gland; tumors of the uterus (fibroids); zndometrioz; ovarian tumors; traumatic lesions of the cervix during childbirth and abortion and others. An important reason for secondary infertility -aborty.

A survey of women suffering from infertility, should be carried out only after an appropriate examination of the husband, which prevents the possible causes of male infertility. Gynecology pay attention to the condition of the internal reproductive organs (uterus, appendages, neck). It is important to determine the acidity of the vaginal contents, the viscosity of the cervical secretion (increased acidity detrimental effect on sperm, and the increased viscosity of the cervical mucus prevents their promotion). It is necessary to carry out a test on compatibility of cervical mucus and semen (Shuvarskogo sample - Sims - Huneric). To this 30-45 minutes after intercourse in mucus drop taken from the cervical canal, determine the amount and condition of spermatozoa. Normally, in each field of view should be 10-15 spermatozoa per field of view intersecting with 8-10. Or absence of sperm motility in cervical mucus indicates a negative test.

To identify adhesions after inflammation in the uterus, cervix, fallopian tubes and is used around pertubatsiyu, metrosalpingography, bikontrastnuyu genikografiyu, kimograficheskuyu gidrotubatsiyu. These methods are used, taking into account contraindications (suspicion on pregnancy, acute inflammation of the genital organs, acute and subacute extragenital diseases). In women with endocrine forms of infertility ovarian function is determined by means of tests of functional diagnostics, produce endometrial biopsy. For the diagnosis of infertility due to disorders of the fallopian tubes and uterus, laparoscopy is used.

Treatment is determined by the location and the nature of the pathological process. When obstruction of the fallopian tubes on the basis of chronic inflammation (exclude tuberculosis of genitals!) Is most effective ultrasound in continuous or pulsed mode. Instead, ultrasound can be used inductothermy, electrophoresis iodine treatment gidrotubatsii with solutions of antibiotics, Lydasum and hydrocortisone. If underdevelopment of genitals displayed cervical electrostimulation, inductothermy, mud baths, pelvic massage. Hormone therapy is used depending on the nature of hormonal disorders. The syndrome Stein - Leventhal produce a wedge resection of the ovaries. Uterine fibroids in conjunction with infertility in young women require surgery. Endometriosis is subject to conservative (combined estrogen-progestin drugs) or surgical treatment. Surgical treatment of tubal infertility (salpingolizis, salpingostomy, salpingoplastika) is indicated for failure of conservative therapy.