Female infertility means that a woman, leading regular sex life without use of contraceptives, can’t get pregnant during 1,5 — 2 years. 10−15% of couples suffer from infertility. From them in 40% of cases the reason of infertility is in the man’s body (impotence, defective sperm, ejaculation disorders), in other 60% – it is female infertility.
So violations can be connected with the health of one of the spouses or even both of them, therefore medical inspection of both partners is necessary. Family mental and social troubles can also lead to infertility.
Infertility can be absolute and relative.
Absolute infertility deals with irreversible pathological states that exclude conception (for example, anomaly of development of a female genital, absence of uterus or ovaries. Relative infertility can be corrected or removed.
We can also distinguish primary (if earlier the woman had no pregnancies) and secondaryinfertility (if there was a pregnancy in the anamnesis). Female infertility is a severe psychological injury both for the woman and for her man.
To choose the correct tactics of infertility treatment it is necessary to define the reasons which it caused.
Female Infertility Reasons
Female factors of infertility are:
- increased Prolactinum secretion;
- tumoral formations in a hypophysis;
- various forms of menstrual cycle disruption, caused by violation of hormonal regulation;
- congenital defects of anatomy of genitals;
- bilateral uterine tube impassability;
- adhesive processes in a small pelvis;
- acquired malformations of genitals;
- genital tuberculosis;
- system autoimmune diseases;
- negative result of Postcoital Test;
- psychosexual violations;
- vaginal factors.
Depending on the reasons, problems with conception can be classified into the following forms of female infertility:
- endocrine (or hormonal) infertility form;
- tubal (ectopic)/peritoneal infertility form;
- uterine form of infertility;
- infertility caused by endometriosis;
- immune form of infertility;
- infertility of undefined origin.
Endocrine infertility is caused by disorder of hormonal regulation of the menstrual cycle, which provides ovulation. Anovulation, i.e. lack of ovulation is characteristic of endocrine infertility. It can be caused by injuries or diseases of the hypothalamic-pituitary region, excess secretion of Prolactin hormone, polycystic ovarian syndrome, deficiency of progesterone, neoplastic and inflammatory lesions of the ovaries, etc.
Tubal infertility occurs in cases when there are anatomical obstacles on the path of the egg from the fallopian tubes into the uterus, i.e., both fallopian tubes are either absent or impassable. For peritoneal infertility, it is characteristic that obstacle occurs not in the fallopian tubes but between the tubes and the ovaries. Tubal-peritoneal infertility is usually caused by adhesive processes or atrophy of the cilia inside the tube, which ensures the movement of the egg.
Uterine infertility is caused by anatomical (congenital or acquired) defects of the uterus. Uterus underdevelopment (hypoplasia), doubling, arcuate uterus or uterine septum are among the congenital anomalies of the uterus. Intrauterine synechia or cicatricial deformity, tumors are acquired defects of the uterus. Acquired defects of the uterus develop as a result of intrauterine interventions, which include surgical abortion.
Infertility, caused by endometriosis, is diagnosed in approximately 30% of women suffering from this disease. It’s still not completely clear how endometriosis determines infertility, however, it can be stated that the areas of endometriosis in tubes and ovaries prevent normal ovulation and movement of eggs.
Immune infertility is associated with women antisperm antibody, that is specific immunity, generated against sperm or embryo.
In more than half of the cases, infertility is caused not by a single factor but by a combination of 2−5 or more reasons.
In some cases the cause of infertility remains unidentified even after a full examination of the patient and her partner. Infertility of undefined origin occurs in 15% of surveyed couples.
Treatment of Female Infertility
The decision on infertility treatment is made after receiving and evaluating the results of examinations, and finding out the reasons that caused it. Typically, treatment begins with removing the primary cause of infertility.
Therapeutic techniques, used in female infertility, are aimed at:
- restoration of reproductive function of the patient with the help of conservative or surgical methods;
- use of assisted reproductive technology in cases, when natural conception is not possible.
Endocrine infertility needs correction of hormonal disorders and ovarian stimulation. Normalization of weight (if obesity) through diet and increased physical activity, physiotherapy are non-pharmacological forms of correction. The main type of medical treatment of endocrine infertility is hormonal therapy. The process of follicle maturation is controlled with ultrasonic monitoring and observing the dynamics of the hormones content in blood. 70−80% of patients with this form of infertility get pregnant if the treatment is correct.
As for tubal-peritoneal infertility, its treatment goal is to restore the patency of the fallopian tube by laparoscopy. The effectiveness of this method in treatment of tubal-peritoneal infertility is 30−40%. In cases of long lasting adhesive obstruction or ineffectiveness of previous transactions, artificial insemination is recommended.
In cases of uterine infertility — anatomic defects of its development — reconstructive plastic surgery is performed. The probability of pregnancy in these cases is 15−20%. If surgical correction of uterine infertility (no uterus, vices of its development) is impossible — self-bearing is impossible, either. In such cases women use the services of surrogate parenting.
Infertility, caused by endometriosis is, treated by laparoscopic anticoagulation, during which pathological lesions are removed. The result of laparoscopy is fixed by a course of drug therapy. The percentage of pregnancy after such a treatment is 30−40%.
Immunological infertility is treated by the use of artificial insemination by woman’s insemination with the husband’s sperm. This method allows you to bypass the immune barrier of the cervical canal and helps get pregnant in more than 40% of cases.
The treatment of unidentified forms of infertility is the most difficult problem. Often, in these cases auxiliary methods and assisted reproductive technologies are used.
Artificial insemination is used if/when/while:
- tubal obstruction or absence of the fallopian tubes;
- conservative therapy and therapeutic laparoscopy for endometriosis has no results;
- unsuccessful treatment of endocrine forms of infertility;
- absolute male sterility;
- depletion of ovarian function;
- some cases of uterine infertility;
- comorbidities, in which pregnancy is impossible.
The main methods of artificial insemination are:
- the method of intrauterine insemination with donor sperm or the sperm of the husband;
- method of in vitro fertilization;
- intracellular injection of a sperm into the egg.
Effectiveness of infertility treatment depends on the age of both spouses, especially the woman (the probability of pregnancy is sharply reduced after 37 years). Therefore, it’s better to start infertility treatment as soon as possible. One should never be discouraged and lose hope. Many forms of infertility can be treated, using traditional or alternative methods of treatment.