Infertility: signs, causes and treatment. Simple language about complex

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Infertility and demographic security.

Oleg Leonidovich Tishkevich, Deputy General DIRECTOR for Medical Activities of the Embryo Clinic, Chief Physician, Obstetrician-Gynecologist, Reproductologist, tells about this problem, diagnostics and solutions.

- The population of Belarus is steadily declining. According to the National Statistical Committee, as of January 1, 2022, it was 9 million 255 thousand people. Until recently we said that there were 9 and a half million of us, and in 1995 there were 10 million 210 thousand of us... A significant factor in this problem is infertility. According to statistics, infertility occurs in 15% of couples in the world. Now this problem is solved in many cases.

What is considered infertile?

- Infertility is considered a situation when a couple has a regular unprotected sex life for a year, and pregnancy does not occur.

Such a period is taken for analysis, because not every sexual intercourse, even in a couple, leads to conception without any problems. Natural fertility, or, in other words, the ability to conceive, is about 20% per month.

How is it evaluated?

If 10 young healthy couples have regular sexual intercourse for a month, as a rule, only two will become pregnant. This is 20%.

The regularity of sexual activity throughout the year is important. The egg matures once a month. To get pregnant, at this moment there must be sexual intercourse: during the maturation of the egg and even a week before. Spermatozoa can be in the genital tract of a woman and wait for an egg for a whole week.

When do couples need treatment?

- If the situation is higher about your couple, then an examination is required. Start with an initial examination. It should answer three questions:

1. Does the man have sperm, how many and what is the quality of the sperm?

2. Does the egg mature and does the woman ovulate?

3. What is the condition of the fallopian tubes and are they passable?

Spermogram.

- To assess the quality of sperm, a man needs to make a spermogram. The normal concentration of spermatozoa in 1 milliliter is more than 15 million. The total number is more than 39 million, progressive sperm motility is more than 32%. Normal in structure of spermatozoa should be 4% or more. If a man sees such a small percentage in the finished analysis, there is no need to worry - this is not a pathology, but the norm.

Causes of reduced sperm production:

- hormonal dysfunction at the level of the hypothalamus and pituitary gland;

- genetic pathologies;

- dysfunction or pathology in the testicles;

- sexually transmitted infections;

- dysfunction of the thyroid gland or adrenal glands;

- the influence of environmental factors - oxidative stress (preservatives in food, ALCOHOL abuse, smoking, drugs, overheating or hypothermia, sleep disturbance, etc.).

To solve the problem, the DOCTOR may prescribe medication based on the examination data. Rarely, surgery is needed.

Ovulation.

- There are different ways to check if a woman's egg is maturing:

- urinary ovulation tests;

- assessment by the level of progesterone - it usually rises in the second phase of the cycle, when the egg matures;

- tests of functional diagnostics of cervical mucus of the vagina;

- ultrasonography.

Ultrasound is the most affordable and easiest way. And it is important to follow the dynamics. The first ultrasound is prescribed immediately after menstruation, then closer to ovulation - on the 10-12th day of the cycle. During this period, the follicle should mature. The third study is carried out a few days after the second, to make sure that the follicle has burst. If this does not happen, pregnancy will not occur.

Ovulation may not occur if a woman:

- overweight or underweight;

- excessive or insufficient production of certain hormones (for example, elevated prolactin levels suppress ovulation);

- polycystic ovary syndrome (PCOS);

- dysfunction of the hypothalamus, pituitary gland or ovaries;

- stress.

Treatment is aimed at eliminating the causes of ovulation disorders.

Medications are more commonly prescribed.

Permeability of the fallopian tubes.

The fallopian tube is a living organ where the spermatozoa meet the egg and fertilize it. Later, it is the fallopian tube that will "push" the embryo into the uterus, where it must attach and develop.

If the patency or function of the tube is impaired, then pregnancy may not occur.

- To check the patency of the fallopian tubes, use different methods:

- X-ray. It used to be a classic way of diagnosing. But recently it has been abandoned due to the negative effect of X-ray radiation on the ovarian region;

- Ultrasound examination with special contrasting. Now they are switching to this method of research;

- laparoscopy. This method is used if a woman had a previous inflammatory process, miscarriage, ectopic pregnancy, infections, operations in the abdominal cavity. The advantage of the method is that if there are adhesions on the fallopian tube, they can be dissected during laparoscopy.

Causes of obstruction of the fallopian tubes:

- previous infections;

- endometriosis;

- surgical interventions on the abdominal organs, which led to adhesions;

- abnormal structure of the fallopian tube. In this case, anti-inflammatory treatment, physiotherapy may be prescribed. But the main method of treatment is surgical - laparoscopy.

What else to check to identify all possible problems?

- To detect all the problems that may be the causes of infertility, carry out:

- study of the hormonal profile (hormones of the ovaries, adrenal glands, thyroid gland, pituitary gland);

- screening for sexually transmitted infections;

- examination for the pathology of the reproductive organs (uterine fibroids, polyps, endometriosis, adhesions in the uterine cavity - synechia);

- Ultrasound of the mammary glands, thyroid gland, abdominal cavity and kidneys.

Close attention is paid to the cervix. For example, erosion of this organ can prevent sperm from entering the uterine cavity.

When these problems are eliminated, as a rule, the problem of infertility is also eliminated.

What should a couple do if fertility treatment fails?

- In the treatment of infertility, there are two approaches that complement each other:

- restoration of natural fertility;

- assisted reproductive technologies (ART).

Restoration of natural fertility.

During the year, an examination is carried out, another year to two is needed for treatment. Doctors help to solve problems both conservatively and surgically - pregnancy occurs naturally.

The use of assisted reproductive technologies (ART).

These are in vitro fertilization (IVF) and intrauterine insemination (IUI). They are prescribed if natural fertility has not been restored, or when the doctor understands that such treatment will give the couple a better chance.

Intrauterine insemination is a procedure in which the most mobile processed (washed) and concentrated spermatozoa are injected into the uterine cavity through a special catheter.

The chance of getting pregnant in this case is the same as with natural conception - no more than 20%. The procedure is close to the natural process of fertilization. She is safe and harmless. Insemination can be done several times.

- IVF is resorted to as a last resort, when no other methods have helped a woman become pregnant.

For example, when there is an unrecoverable obstruction of the fallopian tubes, when the tubes are removed, when a man has a small number of spermatozoa and in no way can this figure be increased. The patient's ovaries are stimulated to obtain several healthy eggs. They are removed from the body of a woman under anesthesia, then combined with sperm in the laboratory. In special incubators, conditions have been created for the fertilization of the egg and the early development of embryos. On days 3-5, the embryo is painlessly transferred from the incubator to the uterus with a special catheter. After the procedure, the woman must take medication to maintain the pregnancy. After 2 weeks, you can do a blood test to find out if pregnancy has occurred, after another two - an ultrasound. If the ultrasound showed that the embryo in the uterus is alive, then the pregnancy has really come.

The frequency of pregnancy with IVF in young women under 35 years old is 40-45%. On average, in 3-4 attempts, 60-70% of women under the age of 38 manage to get pregnant.

Age matters in IVF.

A set of eggs in women is laid down from birth and with age they age, their quality deteriorates. The chance of getting pregnant is reduced. At the age of 38, the probability of pregnancy as a result of IVF is 35%, at 40 years old - 20%, at 43 years old - 5% or less.

Some more statistics.

More than 8 million children have been born worldwide with the help of IVF. In Belarus, the first child conceived with the help of IVF was born in 1995. For all the time in the country, about 20 thousand children were born thanks to this method.

Every year about 3.5 thousand IVF procedures are performed in Belarus, due to which 800-1000 boys and girls are born. This is 1% of all newborns. And this is a lot.

This is our contribution to the country's demographic security.