INFERTILITY

A B B D E F G And K L M N O U R C T Y P X C H W E I

INFERTILITY - the inability of persons of childbearing age to reproduce offspring within 1 year of regular sexual activity (sexual intercourse at least once a week) without contraception. Approximately 30% of infertile marriages due to disturbances in the reproductive system of both spouses. To determine the causes of infertile marriages at the same time, careful examination of both spouses. The diagnosis of infertility in women can only be made after the exclusion of infertility in men and at a positive sample, confirming the compatibility of semen and cervical mucus.

Infertility in men is related, usually with impaired spermatogenesis (sperm maturation process convoluted seminiferous tubules of the testes) or sperm excretion due malformations, trauma, inflammatory diseases of the genital organs, neuroendocrine disorders, intoxication (alcohol, lead, phosphorus, etc.), the impact of unfavorable factors (ionizing radiation, stress, starvation, etc..). Sometimes infertility can be the result of autoimmunity -. Education in the male antispermatozoidnyh antibodies cause agglutination and violation of sperm motility, disruption of spermatogenesis seen a decrease in the number or absence of sperm in the ejaculate, a change in their morphological and functional properties. The most common infertility in men reveal oligozoospermia - insufficient number of sperm in the ejaculate (less than 20 million in 1 ml), which often occurs in inflammatory diseases of the testis and epididymis (especially often when gonoreynyh orchitis and epididymitis), expansion and extension veins of the spermatic cord ( varicocele). Oligozoospermia can also be observed after infectious disease of viral etiology, intoxications (eg, alcohol), exposure to ionizing radiation, mental trauma. Infertility can be caused by azoospermia - the absence of sperm in the ejaculate. Distinguish true and false azoospermia. If true azoospermia sperm in the testicles are not formed; it is observed in the absence or underdevelopment of the testes, bilateral cryptorchidism, endocrine disorders. In the case of false azoospermia sperm produced in the testes, but they do not fall into the ejaculate due to congenital or acquired (for example, as a result of injury) obstruction of deferent ways. Infertility can be caused astenospermii (reduced sperm motility), nekrospermiey (viable sperm), teratospermia (broken structure of sperm). sperm fertilizing capacity decreases when changing the content of the sperm proteins, amino acids, lipids, carbohydrates, trace elements, enzymes. Often, the cause of infertility in men is aspermia - absence of ejaculation during intercourse.

If you suspect that infertility man should be sent to the urologist. Diagnosis of infertility in men is based on anamnesis, examination of the external genital organs, microscopic, biochemical and immunological study of the ejaculate (sperm). Before examining ejaculate recommend abstinence from sexual intercourse for 3-10 days. The ejaculate obtained by masturbation, is collected in a clean, dry glass jar with a wide neck. The ejaculate must be delivered to the laboratory no later than 1 hour after its receipt; during transport can not allow cooling the ejaculate. After 20 - 40 minutes after ejaculation, the sperm clotted first diluted, which gives the opportunity to explore the mobility of sperm. If abnormal changes in the sperm are not found, examine the compatibility of semen and cervical mucus. For this purpose, the most commonly used post-coital sample, based on microscopic examination of cervical mucus after 1 - 2 hours after intercourse. When semen incompatibility and cervical mucus sperm in it are missing or still. If you suspect a violation of patency of the vas paths used radiological methods.

Infertility in men is aimed at restoration of spermatogenesis, seminiferous tract patency, correction of violations of sexual intercourse. Apply restorative therapy, anti-inflammatory indications and hormonal agents. When obstruction of deferent ways and varicocele is performed surgery.

The prognosis depends on the cause of infertility. In case of failure or inability of treatment (for example, when the true azoospermia due to the absence of testicles) and if you want to have a couple of children in the marriage, according to their mutual agreement, the artificial insemination of a woman with donor sperm can be carried out.

Prevention is the early detection and treatment of malformations of the reproductive system, the prevention of sexually transmitted diseases, the elimination of the harmful effects on the body. Of great importance is the exclusion of alcohol.

Infertility in women. If women who are sexually active, never advancing pregnancy , infertility is considered primary, while in the past had at least one pregnancy - secondary.

Examination and treatment of women suffering from infertility, holds a gynecologist. Infertility can be caused by anatomical and functional changes in the Fallopian tubes (obstruction, motility disorders), adhesive process in the pelvis - the so-called tubal-peritoneal infertility, cervical or less mucous membrane of the uterus body pathological changes. These changes make it difficult to move the sperm from the vagina into the uterus and fallopian tubes, transport and implantation of a fertilized egg. In most cases, the anatomical and functional changes in the uterus, fallopian tubes, ovaries, leading to infertility are due to abortion and transferred inflammatory diseases of uterus and appendages. Also, infertility can occur when malformations, tumors of the uterus and ovaries, neuroendocrine disorders, and immunological disorders (antispermatozoidnyh occurrence of antibodies in the woman's body). Endocrine causes of infertility are a violation of egg maturation and release of the egg from a mature ovarian follicle into the abdominal cavity (ovulation) as a result of diseases or disorders of ovarian function, adrenal and / or hypothalamic-pituitary system. At the same time reveal the lack of ovulation (anovulatory cycles cm.), Slightly less defective ovulation - not mature egg leaves the follicle and subjected to reverse development, the site of unexploded follicle appears defective corpus luteum.

Identifying the causes of infertility in women begin with a thorough history (find out the age of the parents at her birth, during pregnancy the mother, particularly fertility and menstrual function in close relatives on the mother and father of the disease experienced in childhood, puberty and after the start sexuality). The nature of the menstrual cycle assessed by menstrual calendar, schedule basal (rectal) temperature, and others. When the menstrual cycle, manifesting the lack of menstruation (see. Amenorrhea), lengthening the intervals between periods (oligomenorrhea), dysfunctional uterine bleeding et al., Conducted a study Organs reproductive system to ascertain the level of destruction. Of great importance is the definition of the content in the body and sexual gonadotropins.

In normal terms of rhythm and character of menses should investigate the condition of the fallopian tubes and the pelvic peritoneum to avoid the so-called tube-peritoneal infertility factor. For this purpose, use hysterosalpingography. Keep in mind that the results of this method are not absolute, and only hromosalpingoskopiya - examination of the fallopian tubes during a laparoscopy with simultaneous introduction to them through the cervical canal solutions of dyes allows a high degree of accuracy to determine the status of the fallopian tubes and the pelvic peritoneum and ovaries and uterus . With chronic salpingitis, peritubal adhesions, small forms of external endometriosis, small ovarian cysts and uterine fibroids can be detected using this method. Application of hysteroscopy enables to estimate characteristics of the endometrium of the body shell to reveal polyps, fibroids or internal endometriosis of the uterus.

Treatment of infertility in women depends on its cause. For example, in women with regular menstrual cycles should be eliminated tuboperitoneal causes of infertility and diseases of the body and cervix. When infertility, caused transferred inflammation in the fallopian tubes, previously widely used gidrotubatsiyu, mud therapy, physiotherapy. Currently, in the absence of effect of conservative therapy used plastic surgery on the fallopian tubes. Sparing methods of surgical treatment of uterine anatomical changes, fallopian tubes, ovaries and pelvic peritoneum are the methods of endoscopic surgery. For the treatment of female infertility artificial insemination using the husband's sperm (or donor) - the introduction of sperm into the cervical canal.

Indications from the husband: impotence , lack of ejaculation, oligospermia with the presence of motile spermatozoa morphologically altered. Sperm donors are used for the following indications: azoospermia husband, immunological fetal conflict Rh factor, is not amenable to treatment, genetic disease husband, is inherited. Donor passes a thorough medical examination.

The procedure of artificial insemination performed after exclusion of tubo-peritoneal causes of infertility in women.

Contraindications: acute and chronic diseases of the vagina and cervix, somatic diseases of women that may impede the flow of pregnancy or worsen her health during pregnancy and childbirth.

Conditions for artificial insemination: sperm injected into the cervical canal catheter special mid-menstrual cycle, under the control of symptoms "pupil" (+++), cervical mucus tensioning length (at least 8 cm), the follicle value (minimum diameter of 18 mm) and endometrial thickness' is not less than 6 - 8 mm by ultrasound.

All the more common in the treatment of infertility receives a method of in vitro fertilization (IVF) - fertilization outside the body and transplanting cleaving embryos into the uterine cavity - transport of embryos (TE). In recent years there has been a trend towards the expansion of indications and an increase in age limits for women for IVF and TE.

Indications for IVF and TE are: tubal infertility - the tube removed, impassable, treatment tuboperitoneal infertility is not effective for more than 5 years in women under the age of 35 years and more than 2 years in women under the age of 40 years; gynecological diseases causing infertility (endometriosis). My husband azoo-, oligo, asthenospermia.

Conditions for IVF and TE: the absence of contraindications for pregnancy (somatic, psychic, hereditary diseases), lack of inflammatory diseases and tumors of the uterus and ovaries.

Pregnancy rates in special centers reaches 46- 50%, multiple - 12%, the incidence of spontaneous abortion up to 25%.

Prevention of infertility in women is mainly aimed at the prevention of abortion, inflammatory diseases of the genital organs and infections, sexually transmitted diseases. In addition, important have a healthy lifestyle, proper diet and hygiene of sexual life.