Infertility In Women - Causes And Symptoms Of Infertility In Women, Factors And Degrees Of Infertility

2024 Author: Josephine Shorter | [email protected]. Last modified: 2023-12-16 21:43

Causes and symptoms of infertility in women

Content:

• What is allergy?
• Infertility problem
• Signs and symptoms of infertility
• Infertility reasons
• Causes of secondary infertility

• Infertility factors:

  • Cervical factor infertility
  • Tubal factor infertility
  • Cervical factor
  • Tubal peritoneal
  • Immunological factor
  • Endocrine factor
  • Psychological factor
  • Genetic factors
• The degree of infertility
• Treatment methods
• Recommendations

What is infertility?

Infertility in women (female infertility) is the inability to conceive during the year of regular penetration, viable and active sperm, naturally or artificially, into the reproductive organs of a woman of sexual maturity. The diagnosis of infertility is also made if the pregnancy always ends in miscarriages. Up to 20% of couples are infertile.

Infertility in women should not be confused with not carrying a pregnancy, when a mature oocyte is successfully fertilized by a sperm cell, but the pregnancy ends, at the stage of embryogenesis, with a miscarriage or abortion.

A woman is not considered infertile if her partner uses laboratory methods to detect non-viable, weak spermatozoa or they are completely absent.

Infertility problem. The problem of infertility is now much more serious than it was before, several centuries ago. The sexual revolution bears a serious responsibility, if only because it spreads infectious diseases. And young people more and more do not want to have children, the delay of pregnancy is growing more and more. If we take all infertile couples as 100%, then 33.3% have a man infertile, another 33.3% have a woman infertile, and in the remaining couples, both partners are infertile.

The causes of infertility can be defects in the development of the reproductive system, dysfunction of the genital organs, severe intoxication and general diseases of the body, as well as mental and neurological disorders. Infertility does not belong to the group of independent diseases, it always appears as a result of various diseases of the body. The main cause of female infertility is inflammatory diseases.

Physiology of monthly cycles

Infertility can occur with disturbed and normal monthly cycles. A woman's natural monthly cycle, which lasts 21-35 days, consists of three successive phases.

1. Follicular phase - maturation of the egg (not less than 7 and not more than 22 days)

2. Ovulatory phase of maturation and release of a mature oocyte, the onset of the fertile period.

3. Luteal - the phase of the corpus luteum, catabolism (from 13 to 15 days).

A few days before and after ovulation is called the fertile period (phase) - this is the time of the highest probability of conception. Until this moment and after, pregnancy cannot come! However, one must understand that for different women this phase occurs at different periods of menstruation. If the cycle is not resolved by pregnancy, then the body, under the influence of estrogen, prepares for the next cycle.

Infertility classification

Infertility may be:

• primary - pregnancy has never occurred (congenital gynecological anomalies) or (complications on the female genital organs) before or after menarche (first cycle);
• secondary, after the first successful pregnancy, the impossibility of re-fertilization, can be absolute (incurable) or relative (curable).

In some sources devoted to studies of the physiology and pathophysiology of the female genital area, the concept is supplemented by the following types of infertility.

• Physiological. The norm is infertility at an early age (before puberty), and postmenopausal infertility (after menopause).
• Voluntary. In other words, deliberately chosen infertility is called - the use of (medication) drugs or physical (spiral, other) means.

• Temporary. It may be the result of prolonged stress, weakening of the body after or during the period of illness, some authors refer to temporary infertility as lactational amenorrhea - inhibition of ovulation in the early period of regular breastfeeding.
• Constant. Removal of the female genital organs, in whole or in part, is the result of surgery.

Signs and symptoms of infertility in women

An important sign indicating infertility in a woman is the inability to get pregnant, for a year or more, if there are favorable conditions for conception, namely:

• regular sex;
• a sexual partner with a good spermogram;
• complete, long-term rejection of contraceptives;
• the age of a woman is from 20 to 45 years.

Infertility does not have a pathognomonic (leading) sign, is often asymptomatic, or has indirect symptoms. Signs of infertility are established by taking anamnesis, examination, physical, laboratory, instrumental studies.

Anamnesis. They establish obvious symptoms associated with a violation of regular cycles: long, short, painful, abundant, with extraneous secretions. It is possible to assume infertility on the basis of establishing indirect symptoms, characteristic, infectious, non-infectious and surgical diseases.

Physical examination

During physical examinations in the clinic, possible signs of infertility are:

• body mass index less than or more than 20-26;
• condition of the skin and derivatives with signs of endocrine disorders;
• unsatisfactory degree of development, mammary glands;
• signs of pain, seals in the projection of the pelvic organs of a woman, with bimanual gynecological palpation;
• signs of gynecological diseases detected when examining the cervix, using a vaginal speculum, colposcopy.

Laboratory and instrumental methods

Signs, possibly indicating infertility, are established in the process of laboratory and instrumental studies, with:

• infection screening for STIs;
• hormonal screening to exclude endocrine infertility;
• Ultrasound of the female pelvic organs, thyroid gland - hormonal infertility;
• hysterosalpingography (HSG) - X-ray exclusion of symptoms of obstruction of the fallopian tubes;
• MRI for brain tumors (Turkish saddle), which inhibit the production of hormones - regulators of monthly cycles;
• spiral computed tomography (SCT) of the pelvic organs - anatomical causes of infertility;
• laparoscopy (visual examination of the abdominal organs) - tuboperitoneal infertility, adhesions, uterine tumors, retention ovarian cysts;
• hysteroscopy (examination of the walls of the uterine cavity) - uterine tumors, inflammation, ulceration of the walls of the uterus.

Causes of infertility in women

Infertility of women is due to many private reasons (factors). The reasons are not always obvious. In some cases, they cannot be diagnosed or combined with each other, intensifying the negative effect on the female body.

If we summarize the known causes (factors) of infertility, there are several large groups - the causes of infertility:

• Congenital anomalies of the reproductive organs.
• Acquired, caused in the reproductive organs:
• anatomical and morphological changes;
• functional disorders;
• metabolic imbalance.

The above describes most of the private (specific) causes of female infertility. It has been noticed that women over 35, especially those who have not given birth before, have an increased risk of infertility.

There are two general reasons for decreased fertility that are not associated with previous gynecological diseases:

• age-related slowdown of physiological processes;
• long-term use of contraceptives.

Infertility from birth control

In the literature, there are opposite opinions about the use of hormonal contraceptives. Proponents argue for the benefits of contraceptives due to the rebound effect after hormonal contraceptives are withdrawn. That is, the abolition of factors that inhibit the fertilization process, stimulates a sharp release of estrogen, increases the likelihood of getting pregnant. In some cases, this is the case.

On the other hand, there are cases of temporary or permanent decrease in fertilization (fertilization) after prolonged use of contraceptives. Obviously, the truth is in the middle. The negative effects of hormonal drugs should be avoided, based on the advice of a gynecologist, when planning a personal (married) life. It is possible to combine different methods of contraception and then they will not be one of the causes of infertility.

Causes of secondary infertility in women

Women who have previously successfully given birth seek help in determining the causes of infertility. The inability to get pregnant again for a long time is called secondary female infertility. If you do not take into account the voluntary refusal of conception and the age factor, the most obvious causes of secondary infertility are previous diseases, including gynecological infectious or non-infectious etiopathogenesis.

Infertility factors

Infertility almost always has many causes (factors). As a result of research and clinical observations, it was found that infertility factors are structured (grouped) based on the combination of homogeneous signs, according to:

• anatomical localization of the pathogenesis of diseases that caused infertility;
• the nature of the pathophysiological processes in the body (endocrine disorders, the phenomenon of immunological rejection of germ cells);
• genetic abnormalities that prevent fertilization;
• peculiarities of the psychosomatic state of women of fertile age in different living conditions;
• the influence of the male factor of infertility.

Cervical factor infertility

For successful fertilization, at least 10 million active sperm must enter the woman's uterus. The vaginal environment of a healthy woman is a barrier to any agents foreign to the female body, including sperm. With vaginitis, the causes of the death of sperm in the vagina are associated with pathological processes. The normal environment is not an absolute barrier to sperm, active cells move to the mucus-covered cervix. The mucus on the walls of the cervix is produced by epithelial cells.

The ability of sperm to penetrate cervical mucus depends on:

• activity and motility of sperm;
• physicochemical characteristics of cervical mucus.

With pathologies, the properties of mucus change, becoming an insurmountable barrier even for active spermatozoa. The inability of male germ cells to overcome the cervix is called the cervical factor of infertility.

Cervical factor infertility (change in the viscosity of mucus, other properties) can result from:

• hormonal disruptions in the production of female sex hormones;
• inflammatory processes in the cervix;
• disturbed microflora on the mucus of the cervix.

Tubal factor infertility

A mature egg is transported through the fallopian tubes from the ovary to the uterine cavity. The mucous membrane of the fallopian tubes is lined with ciliated epithelium.

Egg movement occurs as a result of:

• peristaltic movements of the tube walls;
• flickering of cilia of the epithelium, creating a flow of tubal fluid

Damage to the cilia, provokes pathological anchoring of the egg in the tube, creates the risk of ectopic pregnancy. The greatest negative effect is associated with complete or partial obstruction of the tubes for a mature egg - this is the tubal factor of infertility.

Obstruction (obstruction) of the fallopian tubes can be:

• in the funnel - the distal (distal) section of the fallopian tubes;
• in the area of the fallopian tubes (proximal or near) of the fallopian tubes;
• throughout (obstruction of the funnel, ampoule, isthmic and uterine sections) tubes.

Establishing the types of obstruction is of diagnostic value:

• partial;
• complete.

Obstruction of the tubes - the factor of infertility can be caused by spasm or blockage of the lumen of the tube as a result of inflammatory adhesions, tumor growth, and other reasons. Disease of the fallopian tubes, accompanied by obstruction of the tubes and the accumulation of transudate (fluid) in their lumen is called hydrosalpinx.

Typical causes of hydrosalpinx are a complicated course of inflammation:

• fallopian tubes - salpingitis;
• fallopian tubes and ovaries - salpingo-oophoritis;
• fallopian tubes, ovaries and ligaments - adnexitis (inflammation of the appendages).

An obstruction in the path of the egg can be accompanied by pain in the abdomen. To diagnose hydrosalpinx, X-ray examination (hysterosalpingography) and / or laparoscopy (a special type of examination of the abdominal cavity) are used.

Cervical factor infertility

Through hole - the throat in the center of the cervix, like a sluice, connects the uterine cavity and the vagina. The function of the gateway, the pharynx of the cervical canal, manifests itself in the form of periodic:

• inaccessibility of the uterus, most of the time, for foreign agents, including sperm;
• the availability of the uterus for active spermatozoa seeking to fertilize a mature egg.

The function is provided by the mucus of the cervical canal, which, under the influence of estrogens, changes its physicochemical and rheological (viscosity) properties at different periods of the monthly cycle.

• During the period of the highest probability of fertilization, mucus changes properties, for example, the pH from acidic to favorable for sperm - neutral and slightly alkaline and becomes less viscous.
• In the inactive phase of the cycle, throat mucus protects the woman's body from disease-causing agents.

If the cervical mucus of the cervical pharynx, under the influence of pathological factors, is inaccessible to the penetration of sperm into the fertile phase, this is the cervical factor of infertility.

Cervical mucus in a healthy woman's body performs the following functions:

• protection (protection) and temporary depot (storage) of spermatozoa in the reproductive tract;
• retention of weak sperm, unable to overcome the physical obstacles of viscous cervical mucus;
• transfer of the activation factor of spermatozoa, enhancement of their motor activity;
• sperm capacitation (ability) and acrosomal response (penetration) i.e. the ability to penetrate the sperm into the oocyte.

External pharynx - visually examined with a vaginal speculum. Internal pharynx - not available for conventional examination methods.

Cervical factor infertility is detected by colposcopy by detecting a '' pupil symptom '' in the cervical os. A positive symptom of the pupil is clear, watery periovular mucus.

Cervical factor is detected by laboratory methods:

• research of rheological and biochemical properties of mucus;
• postcoital test (PCT) for the interaction of sperm and mucus after some time after intercourse. Typically, the time to determine PCT is 9-24 hours;
• determination of the periovulatory Kurzrock-Miller test.

Laboratory tests are performed by experienced laboratory doctors. The research results depend on the correctly chosen research time.

Tubal peritoneal factor infertility

The abdominal cavity and internal organs are protected by the mesentery from contact and fusion with the abdominal wall and adjacent organs. The mesentery is the serous membrane lining the inside of the abdominal cavity, it is divided into:

• parietal mesenteric leaf - separates the internal organs from the abdominal wall from the inside.
• the visceral mesenteric leaf hangs all the internal organs of a person.

The abdominal cavity is filled with serous fluid; it also protects organs from mutual fusion and friction. Normally, all internal organs have some degree of spatial mobility.

The fallopian tubes and uterus are suspended from the mesentery. Under the influence of pathogenic factors, adhesions form between the fallopian tubes and the mesentery or a neighboring organ.

As a result, the fallopian tubes, connected to the mesentery, lose:

• mobility;
• adequate blood supply
• full innervation;

As a result of adhesions in the abdominal cavity, the fallopian tubes cease to fully perform their functions. The termination of the functioning of the fallopian tubes under the influence of adhesions of the peritoneum is called tubal peritoneal factor of infertility.

Causes of tubal peritoneal factor of infertility:

• Inflammatory diseases of the pelvic organs that have turned into a chronic stage of fibrinous inflammation (often STIs)
• Complications after abortion, operations on the pelvic organs.

Damage to the tubes leads to disruption of monthly cycles, chronic pain syndrome.

Infertility or decreased fertility of tubal peritoneal genesis is manifested by:

• impaired patency of the fallopian tubes - tubal factor of infertility
• adhesions in the small pelvis - peritoneal factor of infertility
• a combination of tubal and peritoneal infertility

For the differential diagnosis of tubal peritoneal factor of infertility, ultrasound, laparoscopy, echography are performed.

Immunological factor of infertility

Normally, the woman's immune system, when foreign proteins penetrate in the form of semen and sperm (antigens), does not react by producing specific antibodies (ASAT). The reasons for the immunological rejection of sperm are not fully understood.

The appearance of ASAT in women is probably the result of the development of rejection reactions of the type 2 allergic reactions. The barrier properties of the mucous membranes can be impaired as a result of a decrease in the amount of mucus on the internal surfaces of the genital organs during degenerative inflammatory processes. Currently, this pathology is treated with methods of immunocorrection, a decrease in the amount of circulating antibodies, stimulation of reparative (restorative) processes on the mucous membranes of the birth canal.

Another immunological pathology is the factor of infertility, the production of antiovarian antibodies (AOA) by the female body on its own eggs. The reasons for the appearance of immune complexes that destroy their own immune defenses are complex and are in the competence of immunologists. Like all autoimmune diseases in the early stages of pathogenesis, they are treatable. In advanced cases, the prognosis is cautious.

Endocrine factor infertility

Hormonal disorders lead to irregular or no cycles. The main reasons for this kind of infertility are dysfunctions:

• Consequences of craniocerebral trauma, tumors of the hypothalamic-pituitary region of the brain;
• An imbalance of androgens over estrogens (hyperandrogenism) in the female body is observed with damage to the ovaries or adrenal glands, accompanied by polycystic ovary syndrome;
• A decrease in the functional activity of the thyroid gland (hypothyroidism) is the cause of cycle disorders;
• An insufficient amount of estrogens, accompanied by a violation of the rhythm of monthly cycles, leads to pathological damage to the mucous membrane of the birth canal;
• Lipid metabolism disorders, accompanied by excess or loss of adipose tissue, provoke a decrease in ovarian function;
• Disorders of hormonal metabolism, accompanied by premature menopause;
• Congenital anomalies of the hormonal system, accompanied by an underdevelopment of the birth canal.

Endocrine disorders are investigated for violations of monthly cycles, against the background of external signs of endocrine disorders (obesity, exhaustion, others).

The psychological factor of infertility

Stress is a general adaptive response of the body to various stimuli; it has a complex regulation mechanism with the participation of hormones in the body. It makes no sense to look for particular causes of stress, as psychological factors of infertility, they are individual for each woman. In summary, the sources of stress are:

• excess of negative information;
• regular emotional reactions;
• physiological or pathophysiological reactions of the body.

With chronic stress, the body's adaptive defense mechanisms are depleted. Bioregulation structures (autonomic nervous system, hormones of the adrenal glands, pituitary gland and others) stop working in the direction of adaptation and cause pathophysiological changes in the body. Behind the psychological factors of infertility are pathophysiological changes in the body (including hormonal disorders). To determine the causes of psychological infertility, you should stop looking for the source of stress, you must:

• Change the attitude towards the stress factor. It was noticed that families with a low level of education do not have problems with the birth of children, in contrast to families where women with a high level of intelligence and social status suffer from explicit and imaginary stress. Physical education, useful hobbies, relaxation, positive emotions and so on will restore hormonal and mental balance.
• Consult a qualified psychologist. It is not always possible to overcome stress on your own. Find a specialist who can help you stop thinking about imaginary problems, help you understand the true causes of infertility.

Genetic factors of infertility

The literature describes in detail the genetic factors of male infertility. The genetic factors of female infertility are poorly understood. There are known particular pathologies that cause female infertility and have genetic roots.

• Syndrome of hyperandrogenism of women (excess of male hormones).
• Endometriosis (proliferation of the walls of the uterus).
• Premature Menopause Syndrome.
• Primary amenorrhea syndrome (Sherevsky-Turner syndrome).

Other diseases are also known, accompanied by genetically determined infertility. The reasons and the likelihood of excluding genetic abnormalities in the future is the subject of research by geneticists. Laboratory methods for the diagnosis of genetic factors of infertility are currently being developed.

The degree of infertility

The etymological meaning of the word `` degree '' in medicine means the value of comparison, different in intensity of pathological processes. The use of the term is appropriate when comparing private (specific) pathological processes in relation to a limited group of patients with a similar diagnosis. More often, in the available literature, infertility is characterized as I and II types of infertility.

Infertility of 1 degree in women. Or infertility I is the absence of pregnancy in a woman who has never given birth before. Usually, the period of infertility is counted after a year of the onset of regular sexual activity, without the use of contraception. The reasons for infertility 1 are indicated above in the text (see the classification of infertility).

Infertility of the 2nd degree in women. Or infertility II is the impossibility of conception, refers to women who have previously had a pregnancy or have given birth. The period of infertility is counted from the first attempts at repeated pregnancy. Usually also after a year. The reasons for infertility II are indicated above in the text (see the classification of infertility).

Infertility of 3 degrees in women. The term characterizing the degree of inability to become pregnant is not used in the available literature.

Treatment methods

• Modern approaches to the treatment of infertility
• Fertility drugs
• Healing herbs for infertility
• Combined use of borax uterus, red brush and sage

Recommendations for suspected infertility

Experts say that to achieve the maximum chance of fertilization, you need to conceive from 11 to 18 days of the menstrual cycle. We remind you that the first day of your period is taken as the first day. Men should not ejaculate more often than once every 2 days, since sperm concentration is maintained at a maximum, only in this case. Both partners should not use lubricants. And after sex, a woman shouldn't wash. In addition to all this, experts say that you need to have sex during fertilization in the "missionary" position, and after intercourse, the woman should still lie on her back for 15-20 minutes, with knees bent and raised.

If the presentation of the methods does not give the desired result, then the couple will be assigned to undergo treatment. In the case when it is impossible to eliminate the causes of infertility, experts recommend modern reproductive assisted methods, such as IVF.

In Vitro Fertilization is a relatively young method of infertility treatment, the essence of which is the fertilization of eggs with sperm in a test tube and the subsequent transfer of the fertilized developing egg (embryo) to the uterus. This procedure gives a good chance of pregnancy, however, it is worth approaching responsibly in choosing a clinic. The main factors influencing the choice of the clinic are the level of professionalism and experience of reproductive specialists, as well as modern equipment.

Among the centers of Russia with the best reputation, one can single out the Moscow Center for Reproduction "Life Line", which fully meets the above requirements. The center has the latest innovative equipment that allows you to significantly increase the effectiveness of the procedure. And the staff consists of highly qualified specialists who are considered one of the best in the field of IVF, including M. E. Potapov, who is at the origins of domestic reproductive medicine. and member of the Council of the Russian Association for Human Reproduction Koloda Yu. A.

Even if a woman dreaming of a child is diagnosed with infertility, this is not a reason to despair! Modern medicine not only gives hope for replenishment in the family, but also proves its capabilities as a result of numerous happy families.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.