Infertility in women

Infertility in women may be due to the inability to conceive - sterility (sterilitas) - or inability to the birth of healthy child as a result of repeated miscarriages or premature delivery - miscarriage (infertilitas).
Distinguish between primary and secondary infertility. Primary call such infertility, when the woman, in spite of regular sexual life without the use of contraceptives, never did get pregnant, secondary - when a woman became sterile after one or more pregnancies, even ended childbirth. Infertility can be absolute, when, due to various reasons, pregnancy absolutely impossible (the absence of the uterus or extreme degree of hypoplasia, lack of ovarian cancer, deformity of the genital organs and others), and a relative term when used in connection with certain disorders of pregnancy are currently impossible, but after their removal, it can occur.
Causes of female infertility can be infantilism, common and genital (see Infantilism), a severe form of tuberculosis, anemia, and rapid fatigue, both mental and physical. Ovaries, especially yellow body, normally the most rich in ascorbic acid, sharply sensitive to lack of vitamins. Low power and lack of vitamins in the diet can cause a lack of ovarian function, and in some cases lack of ovulation and fertility.
A significant role in infertility in women play inflammatory diseases of genital organs; the most common cause of infertility, particularly secondary, is obstruction of the fallopian tubes. When cervicitis, vaginitis, endometritis pathological allocation can lead to infertility, as they be toxic to sperm. Genital TB is the cause of infertility because of the defeat of the endometrium, fallopian tubes and ovaries. In the opinion of the majority of authors significant role in causing infertility plays women gonorrhea. Breaks vagina and perineum during childbirth can continue to serve the cause of infertility because the ejaculate is not kept in the vagina and poured out; the same can be observed with the omission of the vagina, and especially when it appears.
A very common cause of infertility in women are functional disorders of sexual apparatus. Infertility is often observed in women with disorders of the menstrual cycle: menstruations, changes of rhythm, absence of ovulation. In addition, despite ovulation, the egg is in some cases not fertilized, in others after fertilization the fetus in early or even late stage of development dies (miscarriage, premature birth or birth dead fetus). For the normal process of conception, the egg must go to the fallopian tube, where usually you meet her with sperm. However important the appropriate pace of the egg before getting her in the fallopian tube: if the pace slowed down, the egg may die before fertilization, which results in infertility. For the development of uterine pregnancy are required pace of the fertilized egg from the fallopian tube into the uterus (otherwise can be formed tubal pregnancies), mainly due to normal peristalsis pipes; the latter depends on hormonal impulses. Implantation of a fertilized egg is only possible if the so-called pregradni prepare the lining of the uterus (secretory phase), which is under the influence of hormone yellow body after preliminary steps estrogen. Thus, in the implementation of conception and pregnancy significant role played by many endocrine factors.
In women, suffering from polimenorea, very often there is a single-phase cycle involving early atresia of the follicle, followed by uterine bleeding in the stage endometrial proliferation; in such cases, pregnancy does not occur. When polimenorea even in the presence of two phase cycle education yellow body pregnancy usually comes despite ovulation and possibly conceive. This is because when a shortened menstrual cycle due to the early degradation of yellow body and weak intensity secretory phase endometrium fertilized egg does not get sufficient conditions for implantation and very early dies. Known role in the etiology of infertility play anovulatory cycles.
Often the causes of infertility are hypoplasia of the uterus and infantilism on the grounds of low ovarian function. In primary ovarian failure and weak development of genitals cervix short, conic, outer hole the size of a pinhead; uterus in the position of sharp anaflaxia is very small; the fallopian tube is long and winding, their peristalsis is poorly expressed. When infantilism weakened motility of the fallopian tubes, which also depends on the violation of hormonal balance. In the fallopian tubes happen cyclical changes according to changes in the mucous membrane of the uterus during the menstrual cycle. The shortage in the body estrogen anxiety fallopian tubes reduced, the response to irritation not present, so that there is no mechanism of perception eggs". Case of insufficient production of progesterone may occur long spasm, leading to delayed eggs in the fallopian tube. However, the slow movement of the egg in the fallopian tube may be at increased against the norms of the amount of the hormone yellow body, as progesterone contribute to the weakening of muscle contractility of the fallopian tube. Neuro-psychic experiences that change the motility of the uterus, can cause changes in motor skills of the fallopian tube. When hitting a nerve reflex mechanism of perception eggs" is formed.
Methods of examination. During the collection of anamnesis need to figure out what diseases suffered a woman in childhood. Special attention is paid to the history of measles, scarlet fever, i.e., those infectious diseases that are often complicated by the defeat of the ovaries or the mucous membrane of the uterus and fallopian tubes; sexually transmitted diseases (gonorrhea, syphilis not only in adulthood, but in the childhood), acute inflammatory diseases of the pelvic organs, including the uterus, ovaries (tuberculosis, colibacillosis peritonitis, pelvioperitonit, and others), which is the possible reason of not only fallopian tubes, but the defeat of the ovaries. Find out the nature of the menstrual cycle - timing, duration, number of loose blood during menstruation and so on; the duration of sexual life, marriages (number and duration), with secondary infertility - number and nature of pregnancy, childbirth, abortion, and the testimony, which were made of artificial abortions.
It is necessary to examine and wife and husband. First of all it is necessary to examine husband, so as to establish the cause of infertility male easier and less stressful than the cause of female infertility. In case of positive assessment of the ejaculate (see below Infertility in men) produce research on Koneru - Severskom: 1-2 hours after intercourse determine the presence of motile sperm in the posterior fornix of the vagina and cervical canal. It is desirable definition gialuronidasy activity of sperm.
Bimanual pelvic examination to find out the presence or absence of congenital malformations of the reproductive organs, violations of the topography (wrong position) of the genital organs, inflammatory changes and tumors sexual apparatus. If in the past, the patient had inflammatory diseases of the uterine appendages, when indicated, and the absence of contraindications produce blowing off the fallopian tubes (see), hysterosalpingography (see). Then determine basal metabolism and excretion of sex hormones (every 2 to 3 days in order to identify the dynamics of excretion). B some cases produce endometrial histological examination, as based on the data of research of excretion of sex hormones can judge gonadal function, but it is not always possible to find out the reaction of the endometrium on hormonal impulses of the ovary. In addition, based on histologic endometrial possible to judge whether ovulation. If the results of histological studies indicate that ovulation was not (no secretory phase), this does not mean that subsequent cycles will be also anovulatory. It is therefore recommended that systematic measurement rectal temperature for several months. If the endometrium is found secretory phase, it means that you have ovulated and formed a yellow body. In such cases, the prognosis of pregnancy more favorable.
In addition to these studies, produce x-rays of the Turkish saddle, because changes in this area can explain the cause of the dysfunction of the pituitary gland; define sugar in the urine and blood for the exception of diabetes mellitus.


Treatment. In the appointment of therapy must take into account the General condition of an organism of the woman. Restorative events help to increase the reactivity of the organism, activation of redox processes; it plays a role in improving metabolic reactions and improvement of the functions of the endocrine glands, including the pituitary gland and the ovaries. Tuberculosis, heart disease, anemia need treatment of these diseases, because without this special fertility treatment appear to be ineffective. In the conversation with the patient need to explain to her during the normal menstrual cycle and indicate the best days for conception (9-17-th day of the cycle). When signs of vaginismus (see) need regular treatment. Chronic inflammatory processes, fallopian tubes - medication anti-inflammatory therapy, physiotherapy (diathermy, iontophoresis), mud (Saki, Evpatoria, Odessa estuary), hydrotubation.
The use of sex hormones are shown in the cases when infertility is combined with amenorrhea or with hypoplasia of the uterus. Treatment estrogenic hormones is only a part of complex therapy of infertility in women. Not appoint large doses estrogen without complying with the cyclical nature of their introduction in combination with progesterone. You need to create a body of physiological cycles ratios of these hormones, the change of the prevalence in different periods of one or another hormone (see Amenorrhea).
Infertility treatment gonadotropic hormones, especially certain ratios hormones FSH and LH, can be effective: stimulates the function of the ovary and ovulation resumes in cases where there are anovulatory cycles. The use of serum pregnant mares, extremely rich gonadotropic hormones, primarily follicle stimulating, also may cause ovulation in the presence of anovulatory cycles. Good effect is observed among women with secondary amenorrhea and reduced function of the pituitary gland. The horiogonin injected intramuscularly in a dose of 500-1000 units within 2-3 days prior to the expected ovulation (9-14-th day of the cycle). When the underdevelopment of the uterus effectively combined treatment with serum of pregnant mares and estrogens. With symptoms of hypothyroidism is prescribed small doses of the thyroid gland.
In most cases hormonal treatment is combined with the use of pharmacological agents in order concurrently to affect the function of the nervous system with consideration of the specific functions of the autonomic nervous system in the different phases of the menstrual cycle.
Surgical methods of infertility treatment - salpingostomy (see the Fallopian tube), tubal-ovarian anastomosis (especially implantation of the ovary to the uterus) - have the effect of not more than 5-10% of cases.