Female infertility treatment

Have you been dreaming about a baby for a long time, but pregnancy still does not occur? Is infertility a sentence? Fortunately, even women who do not have a uterus or ovaries can become mothers now. Many diseases that make conception impossible can be treated by conservative treatment, and some require surgery. In more serious cases, IVF can help to solve the problem. Medical center “Nova Clinic” in Moscow deals with this kind of problems.

Let's see what problems can prevent pregnancy and how to overcome female infertility in each of these cases.

Essential Factors for Pregnancy

The birth of a new life is a very complex process. It is not surprising that even for a young and completely healthy couple, the chance of pregnancy in one menstrual cycle does not exceed 25%.

In order for fertilization to occur, several conditions must be simultaneously observed. It is necessary that ovulation occurs within the menstrual cycle, that is, a mature egg needs to exit the follicle into the abdominal cavity, and from there it goes into the fallopian tube. Since the menstrual cycle is regulated at several levels of the hypothalamic-pituitary-ovarian system, it is unacceptable that even one of them has disorders.

After leaving the follicle, the oocyte remains viable for 12 hours. During this time, the egg needs to meet with the sperm, which will fertilize it. As for male genital gametes, they remain viable in the genital tract of women for about 5 days. The highest chances of pregnancy if sexual intercourse occurs within 1-2 days before or exactly on the day of ovulation.

It is important that the fallopian tubes are not blocked, otherwise the egg will not be able to move through them, meet with the sperm, and then reach the uterus.

An important role is played by the quality of male sex gametes. In order for fertilization to occur and the embryo to develop normally, they must have good mobility and morphology (structure). Thus, in case of difficulties with conception, spouses need to come to see fertility specialist together.

The main causes of female infertility

There are many reasons underlying difficulties with the onset of pregnancy. It can be infectious inflammatory diseases of the pelvic organs, the consequences of surgeries, endocrine diseases, features of cervical mucus. Even the psychological state of a woman can affect reproductive function. Let's take a closer look at the main factors that prevent successful conception.

Blockage and / or disfunction of the fallopian tubes

The fallopian tubes are a paired organ of the female reproductive system. In fact, these are two tunnels, each one is connected to the one side of uterus. The other end of the tube, which opens into the abdominal cavity, is a wide funnel with growths (they are called fimbriae). They capture the egg which is released from the ovary and direct it to the uterus. The inner surface of the tube is covered with a special epithelium. Microscopic cilia help the egg move faster in the right direction.

A decrease in reproductive function can appear if the patency of the fallopian tubes is impaired or the ciliated epithelium is damaged. In addition, adhesions that form between the tube and the ovary can interfere with conception.

Dysfunction of the fallopian tubes provoke surgical interventions into the pelvic area, infectious and inflammatory diseases (in particular, sexually transmitted diseases), foci of endometriosis, impact of harmful chemicals, abortion.

Tubal-peritoneal factor is the cause of female infertility in about 40% of cases.

Uterine factor

In this case, infertility is caused by the presence of congenital anatomical anomalies or organ deformation due to acquired pathologies. For example, difficulties with conception may arise if there is an intrauterine septum, submucous myomatous nodes or synechiae (adhesions) have formed.

Among the causes of infertility, the uterine factor is about 50%.

Endometriosis

Endometriosis is mentioned in a case, when the cells of the mucous membrane of the uterus is found outside its cavity. There they form foci that gradually grow, affecting more and more healthy tissues. According to statistics, a decrease in reproductive function is detected for about 30% of patients who has genital endometriosis.

If cells that are functionally and structurally similar to the endometrium grow into the muscular layer of the uterus, they are diagnosed with adenomyosis.

If the ovary is affected, during the examination, endometrioid cysts are detected, which are also called chocolate cysts because of their characteristic color. Their tear can provoke inflammation and formation of adhesions.

Immunological infertility

As for women, normally, body do not produce antibodies against sperm antigens, but in chronic inflammatory infectious or autoimmune diseases, the body's immune protection may be disrupted. According to recent scientific studies, the presence of antisperm antibodies in women is not always accompanied by infertility, more often by miscarriage. The most significant factor affecting conception is the detection of antisperm antibodies in men, since the binding of antibodies to sperm leads to a decrease in their mobility, ability to penetrate the mucus of the cervix and fertilize the egg.

It is necessary to carefully examine both spouses for the presence of inflammatory diseases of the genitourinary system, since they can be the cause of an increase in the level of antibodies to sperm antigens. In this regard, it is not recommended to conduct a postcoital test. This test is based on the interaction of cervical mucus and sperm in vitro (outside the body). There are no convincing data on the relationship of its results with the onset of pregnancy.

Cervical factor

This factor of infertility is caused by a deformation of the cervix, which disrupts the transport of sperm into the uterus.

Endocrine infertility

As we have already mentioned, hormonal regulation of the menstrual cycle is a very complex process. If disorder occurs at one of the levels, then either the maturation of the follicle in the ovary or the ovulation process (the release of the egg from the follicle to the abdominal cavity) may be disrupted.

The absence of ovulation in the cycle can be caused by congenital chromosomal abnormalities, inflammatory diseases, surgeries, polycystic ovary syndrome, thyroid dysfunction, and other factors.

Infertility of unknown origin

In some cases, it is not possible to find out why pregnancy does not occur. Then the doctors diagnose an "idiopathic infertility" or unspecified female infertility.

Symptoms of female infertility

The main symptom of infertility is the absence of pregnancy during a year of regular sexual life, on the condition that the partners have refused to use any kind of contraception. In this case, it is necessary to consult with a fertility specialist, who will help you to find the causes of decreased fertility. If you are over 35 years old, it is recommended to make an appointment with a specialist after six months of attempts to concieve. At this age, the amount of eggs in the ovaries starts to decrease sharply, so there is no time to waste.

Sometimes there are other signs that may indicate disorders of female reproductive function. These signs include:

• discharge from the genital tract that has an atypical color, smell, or consistency;
• spotting from the genital tract outside the period of menstruation;
• menstrual irregularity;
• pain in the lower abdomen;
• difficulties with conception among close relatives;
• too large weight or, on the contrary, low weight;
• body type, male pattern hair growth;
• acne (severe forms);
• thyroid dysfunction.

Infertility diagnosis methods

Comprehensive diagnostics of the causes of infertility involves the use of laboratory and instrumental methods to identify all pathologies that can affect reproductive function.

At the initial consultation, the fertility specialist talks with patients, collecting anamnesis, and examines the available medical documents. In addition, the doctor conducts a general and gynecological examination and ultrasound examination of the pelvic organs, which makes it possible to assess the state of the uterus, endometrium and ovaries. Based on the data obtained, the specialist determines the scope of further examination.

During the diagnosis, it is important to assess the ovarian reserve of the ovaries. For this, in particular, a blood test for AMG (anti-Müllerian hormone) is done and antral follicles are counted during an ultrasound scan.

To assess the patency of the fallopian tubes, your doctor may prescribe tests such as:

• hysterosalpingography – X-ray using a contrast agent;
• echosalpingoscopy – ultrasound examination.

In addition, diagnostics include:

• tests to determine the concentration of pituitary hormones (FSH, LH, prolactin), sex hormones (testosterone, estradiol and progesterone) and thyroid hormones (unbound T4, TSH);
• tests to eliminate various infections (including sexually transmitted infections);
• consultation of a geneticist (according to indications).

Surgical methods for the diagnosis of female infertility

Surgical diagnostic methods include hysteroscopy and laparoscopy.

Hysteroscopy

Hysteroscopy is a minimally invasive and at the same time highly informative procedure, which allows not only to study in detail the state of the uterine cavity, but also to remove the detected pathologies. The doctor uses a special device equipped with a powerful optical system that has a very wide viewing angle. The hysteroscope is inserted into the uterus through the cervical canal, so there is no need to make any incisions in the skin. A significantly enlarged image is transmitted to the monitor, and doctors carefully examine the uterine cavity and the state of its mucous membrane. Hysteroscopy allows to detect:

• chronic endometritis (chronic inflammation of the mucous coat of the uterus). In case of women with infertility, this pathology is detected in 60% of cases;
• endometrial hyperplasia, including polyps;
• adenomyosis (endometriosis of the uterus);
• uterine fibroids;
• intrauterine septum;
• synechiae (adhesions)

Laparoscopy

This modern endoscopic technique gives the doctor the ability to access the abdominal cavity and pelvic organs without making large incisions. An optical device, called a laparoscope, is inserted through small punctures (on average their diameter is only 6 mm). The greatly enlarged image is transferred to the monitor screen.

With the help of laparoscopy, it is possible to identify:

• subserous myoma;
• genital endometriosis;
• tumors and cysts of the ovaries;
• pathology of the fallopian tubes;
• adhesions in the small pelvis.

Fertility treatment methods for women

The choice of the optimal method to achieve pregnancy and the birth of a healthy baby is always based on the results of a thorough examination.

Conservative therapy

In some cases, reproductive function can be recovered using conservative methods. In particular, hormonal drugs are prescribed for thyroid dysfunction, hyperandrogenism and some other pathologies. Physical therapy, dietary adjustments and lifestyle changes can increase the chances of pregnancy.

Surgical treatments

Surgical intervention is performed if infertility is based on endometrial pathologies, fibroids, adhesions in the small pelvis, endometriosis, ovarian cysts.

Laparoscopy is effective if the patient has:

• endometriosis. Timely removal of pathological foci allows to prevent the spread of endometriosis to surrounding tissues and neighboring organs, to stop pain and recover the patient's fertility even in the later stages of the disease;
• a chronic inflammatory process that provokes the formation of adhesions in the small pelvis. They need to be removed. If during the examination it turns out that the fallopian tubes have irreversible damage, pregnancy can be achieved using IVF, but the organ must be removed first. Such a measure avoids the development of an ectopic pregnancy and increases the chances of success in IVF;
• uterine fibroids requiring surgical treatment. Surgical intervention can be recommended, for example, if several myomatous nodes are found at once or the formation is rapidly increasing in size. The surgery allows to remove fibroids up to 10 centimeters in diameter;
• ovarian cysts, as they are characterized by active growth during pregnancy. In addition, there is a possibility of their malignant transformation.

Hysteroscopy helps patients who have endometrial hyperplasia, submucous myoma, adhesions in the uterine cavity, and an intrauterine septum. As a rule, the surgery is carried out in the first half of the menstrual cycle (from 5 to 10 days), since it is during this period that the thickness of the uterine lining is optimal. However, the doctor always determines the optimal moment individually, based on the indications. So, it is better to remove synechiae on the 20-24th day of the cycle, and with endometrial hyperplasia, the operation can be performed at any time (except for the period of menstruation).

ART methods

In more complex cases, when conservative and surgical treatment does not give or initially cannot give a positive result, assisted reproductive technologies are used.

Intrauterine insemination is performed in cases of cervical factor, sexual dysfunction, unexplained or unspecified infertility, and in case of the absence of a sexual partner (insemination with using donor sperm). In this case, doctors place specially processed sperm directly into the uterine cavity, bypassing the cervical canal.

IVF involves the fertilization of an egg not in a woman's body, but in an embryological laboratory. Then, one or two of the obtained embryos are transferred into the patient's uterine cavity. Initially, this method was used to overcome the tubal factor, but now the indications for the use of IVF have expanded significantly. So, in vitro fertilization is effective in case of endometriosis, unspecified infertility, polycystic ovary syndrome. In addition, this method is recommended for women in advanced reproductive age and / or with a decrease in ovarian reserve.

If germ cells are absent or they are of very poor quality, it is possible to do IVF with donor oocytes.

For women who, for health reasons, cannot bear and give birth to a child, a surrogacy procedure is recommended. The point of this procedure is embryos, which are obtained as a result of fertilization of a patient's oocytes with the sperm of her husband (or donor), are then transferred into the uterine cavity of a surrogate mother. She bears a child, and after delivery, she hands the baby to biological parents.

Facts about female infertility treatment

• Contrary to popular belief, treatment of female infertility does not always involve the use of assisted reproductive technologies. Sometimes diet and lifestyle changes are enough to achieve pregnancy.
• A healthy lifestyle (giving up bad habits), proper nutrition, body mass index from 19 to 30 kg / m2 increase the possibility of conception. If your body mass index is more than 35 kg / m2, the time till conception doubles, and if it is less than 18 kg / m2 – it increases in 4 times.
• Proper sleep ensures a normal ovulation process. At least 7-8 hours of sleep in complete darkness restore normal hormonal levels. Stop working at night.
• The most favorable day for conception is the day of ovulation and 1-2 days before it. The day of ovulation can be determined by a urine test. It is necessary to start doing tests depending on your menstrual cycle. We subtract 17 days from the duration of the menstrual cycle and it turns out to be the day of the cycle, from which you need to start doing the tests.