INTRODUCTION
Infertility in marriage is an important medical and social problem. Currently, every tenth married couple is infertile. A marriage is considered sterile if the spouses are sexually active without contraceptives for 2 years. Until recently, all cultures of the past were characterized by the belief that a woman was to blame for infertility in marriage. It has now been established that the fertility (fertility) of the family depends equally on the clomid-info.com of both women and men. In practice, most often a married couple is guilty of childlessness due to inflammatory diseases of the genital organs suffered by the spouses. It has been established that 75% of infertility in marriage is due to chronic inflammatory processes in the genitals caused by protozoa (trichomoniasis), bacterial microflora (streptococci, staphylococci, E. coli), chlamydia, gardnerella, as well as poorly treated sexually transmitted diseases (gonorrhea and other specific infections). Previously it was believed that infertility, depending on immunological reasons, accounts for 5% of all cases of childlessness in the family. As a rule, this was associated with the presence of antisperm immunity, a local conflict caused by antibodies to sperm. At the same time, practically no attention was paid to antibodies to the egg, in particular to its transparent zone. Most recently, it has been proven that in the presence of a chronic inflammatory process in spouses, in addition to dysfunctions of the endocrine system, which often accompany chronic inflammation of the genitals, a significant role in the pathogenesis of infertility belongs to systemic and local immune responses. Their violation is caused by the breakdown of endocrine-immune regulation, which as a result leads to the development of secondary immunodeficiency (SID), which aggravates infertility. A vicious circle arises: inflammation, disruption of endocrine-immune regulation, secondary immunodeficiency.
CHAPTER 1. CAUSES OF INFERTILITY
Infertility, inability of a mature organism to reproduce offspring. The causes of infertility are manifold. They can be congenital (hereditary) or acquired during pregnancy when the fetus is exposed to adverse factors (past infectious diseases, the threat of termination of pregnancy, the use of teratogenic drugs, industrial and domestic intoxication, etc.) and arising after childbirth. As a rule, these are infectious diseases of any organs, including diseases of the genital organs, various neuroendocrine disorders, chronic occupational and domestic intoxication and other adverse effects. All this can cause pathological changes in the gonads or in the reproductive tract and ultimately lead to infertility. Dysfunctions of the gonads are expressed in the fact that the testes do not produce spermatozoa or defective sperm are formed in them, and malformed eggs do not develop or develop in the ovaries. With some disorders in the genital tract, sexual intercourse (coitus) is possible, but it is difficult to meet germ cells capable of fertilization (for example, with inflammation of the oviducts or vas deferens). In cases of underdevelopment of the genital tract, vagina or penis with damage or lack of erection, not only fertilization, but also the sexual act itself is impossible. Infertility can be physiological (childhood and old age, lactation period) and pathological (with congenital diseases of the genital organs, endocrine disorders, chronic inflammatory diseases, severe non-inflammatory diseases, mental or neurological disorders, trauma to the genital organs), it can be female and male.
CHAPTER 2. FEMALE INFERTILITY
Female infertility is characterized by an inability to conceive during childbearing years. It can be primary, when there were no pregnancies at all, and secondary, if there is a history of one or more pregnancies that ended in childbirth or abortion, an ectopic pregnancy, after which the pregnancy did not occur for two or more years. Infertility can be absolute if the possibility of pregnancy is completely excluded, for example, in the absence of a uterus, or relative, when the probability of pregnancy is not excluded, but significantly reduced.
The cause of female infertility can be congenital underdevelopment or malformations of the genital organs of a hereditary or acquired nature, diseases of the genital area, other organs and systems. Disorders of metabolic processes in a woman’s body (obesity, diabetes, etc.), starvation, malnutrition and vitamin deficiency often lead to infertility. Infertility adversely affects the general condition and neuropsychic status of a woman; in some cases, a woman does not outwardly betray her condition, in others, more or less pronounced changes in character and behavior occur. The desire to have a child dominates all other interests. Conflicts appear. A woman is seized by a feeling of inferiority, a background is created for the development of psychoneurotic diseases. Treatment for infertility in a woman depends on the underlying cause. First of all, the anatomical changes of the fallopian tubes, cervix and uterine body are eliminated, then with the help of hormonal preparations, ovulation disorders are corrected.
CHAPTER 3. MALE INFERTILITY
Male infertility is characterized by the inability of a mature male body to fertilize. Distinguish between absolute infertility (impossibility of fertilization: occurs with testicular aplasia, azoospermia, akinospermia, aspermia, necrospermia) and relative (conception is possible after elimination of the underlying cause of the disease). Male sterility is caused by the pathology of the genitals of various origins and impaired patency of the vas deferens. Male infertility can be the result of underdevelopment of the testicles, as well as their absence in the scrotum when they are in the abdominal cavity or inguinal canal (cryptorchidism), which always leads to atrophic processes in the testicles and to impaired spermatogenesis. The underdevelopment of one testicle does not functionally manifest itself; with bilateral underdevelopment or absence (anorchism), a change characteristic of eunuchoidism is observed.
The cause of male infertility can be primary congenital or acquired hypogonadism, which is often caused by various unfavorable external factors that negatively affect spermatogenesis: infectious and inflammatory diseases, chronic intoxication (alcohol, nicotine, medicinal substances), malnutrition, especially with complete or partial starvation , ionizing radiation, work at high temperatures, inflammation and trauma of the testicles, etc. The occurrence of secondary testicular damage (secondary hypogonadism) depends on disorders in the hypothalamic-pituitary system. Insufficient formation of gonadotropic hormones during puberty causes the phenomenon of eunuchoidism, and later leads to disruption of spermatogenesis. The most common cause of male infertility is inflammatory diseases of the prostate and testicles, which cause oligozoospermia, asthenozoospermia, teratozoospermia.
CHAPTER 4. DIAGNOSTICS OF INFERTILITY
Infertility diagnosis consists of several procedures and takes about a month (or one woman’s menstrual cycle). The examination begins with a complete gynecological examination, including an ultrasound (ultrasound) examination of the genitals. Ultrasound allows you to assess the size and structure of the uterus and ovaries, to identify fibroids, ovarian cysts, and other pathology of the pelvic organs. The study of the patency of the fallopian tubes is carried out using hysterosalpingography – a method of examining the fallopian tubes with the introduction of a radiopaque substance into the uterine cavity, which makes it possible to see the uterus and fallopian tubes in the images. To assess ovulation, a basal temperature graph is used. For this woman in 2-3 menstrual cycles, measures the temperature in the rectum for 5-7 minutes in the morning without getting up from the bed, preferably in one and the same time. Additionally, the doctor prescribes an ultrasound of the genitals on certain days of the cycle to track the process of follicle maturation and ovulation – ultrasound monitoring. To study the function of the ovaries and other endocrine organs (thyroid, pituitary, adrenal glands), hormones in the blood are examined . For a more accurate examination of the uterine cavity, a doctor may prescribe a hysteroscopy. During this examination, a thin optical instrument is inserted into the uterine cavity – a hysteroscope, equipped with a mini-video camera, through which the contents of the uterine cavity are projected onto a telemonitor screen. This procedure allows you to examine the entire uterine cavity, to identify diseases that are not always detected during routine examination and ultrasound. To determine the compatibility of the spouses , a postcoital test or other special studies, the determination of antisperm antibodies are prescribed.
If, after the above examination, the cause of infertility is not clear, then laparoscopy is performed – examination of internal organs through a puncture of the abdominal wall with an optical tube – a laparoscope equipped with an illuminator and a video camera. The doctor sees a clear, color, enlarged image of the pelvic organs on the TV screen and receives the most complete information about their condition. The procedure is performed under general anesthesia and is minimally traumatic. When the causes of infertility are identified, they are immediately eliminated – the foci of endometriosis are removed, adhesions are dissected, the patency of the fallopian tubes is restored, ovarian cysts, fibromatous nodes on the uterus are removed . If, after the examination of the spouses, including laparoscopy, it is not possible to identify the causes of infertility, then this condition is regarded as unexplained (or idiopathic) infertility. Unexplained infertility can be treated with artificial insemination or in vitro fertilization.
The examination of a man consists in conducting a spermogram (analysis of the ejaculate) in order to identify the degree of pathospermia. Examination of a married couple includes:
1. Bacteriological analysis of biological media. For a woman – a smear of secretions to detect Trichomonas; sowing of vaginal secretions and cervical mucus to identify common microflora, ureo- and mycoplasmas; scraping of the mucous membrane of the cervix and urethra – to identify chlamydia and gardnerella. For a man – a smear of urethral discharge, sperm culture and prostate juice; to identify chlamydia and gardnerella – scraping of the urethral mucosa.
2. Conducting an immunogram. Rule: For a woman of childbearing age, an immunogram is performed either in the middle of the first phase of the cycle, or at least 4-5 days before the start of the next menstruation.
3. Determination of blood group and Rh factor.
4. Typing for histocompatibility antigens of the HLA system.
CONCLUSION
Prevention of infertility consists in the timely identification and treatment of malformations of the reproductive system, as well as inflammatory diseases of the genital organs of venereal and non-venereal genesis, prevention of abortion in women, observance of sexual hygiene and genital hygiene, elimination of harmful effects on the body in everyday life and at work, in healthy lifestyle.
If infertility is suspected, a man should be examined by a urologist, a woman – by an obstetrician-gynecologist, in case of an infertile marriage, spouses should contact the antenatal clinic, “Marriage and Family” consultation.
Most couples seeking fertility treatment must seek comprehensive treatment. It can include traditional, conservative and surgical methods, ranging from diagnostic tests that can help spouses plan the optimal time to conceive, to surgical correction of deficiencies.
Infertility is a diagnosis, not a sentence. A married couple should know that almost nothing is impossible for modern specialists. But the main thing still depends on the future parents: the lost time and opportunities cannot be returned, which means that you need to take care of the offspring now. Then in the future there will be much more chances of becoming a happy mother.