Rus Articles Journal

Without the visible reasons. Infertility of not clear genesis

Is known that fruitless marriage for the majority of families is the tragedy. After unsuccessful attempts to conceive the child of steam usually asks for medical care. But happens so that even careful inspections cannot explain the reason of failures …

What such infertility?

Infertility is defined usually as lack of pregnancy in a family during 1 year after the beginning of regular sex life without protection.

Term - 1 year - is defined statistically: it is proved that at 30% of healthy married couples pregnancy comes in the first three months of joint life, at 60% - during the subsequent seven, at the remained 10% - in 11 - 12 months after the beginning of sex life. Thus, year - sufficient term to estimate ability of couple to conception and in the absence of pregnancy to speak about infertility.

Infertility belongs not to one person, and to couple of spouses, and it is more correct to call this state fruitless marriage. Approximately in a third of cases genital function (fertility) is reduced both at the husband, and at the wife. And, on the contrary, in 20 cases from 100 both spouses can have ideal indicators of reproductive function, and pregnancy nevertheless does not come.

Telling

about infertility, it is necessary to designate “primary“ and “secondary“ infertility. Primary - if the woman never had pregnancies. Secondary - if the woman had at least one pregnancy.

If these or those violations in the woman`s organism are the reason of fruitless marriage, speak about female infertility. The man`s factor is considered the reason of fruitless marriage in case the woman is healthy, and at the man sharp decrease in the impregnating ability of sperm is observed. At a combination of female and man`s infertility the combined infertility form takes place. In a case when normal indicators of reproductive function are found in both spouses, however special tests indicate their incompatibility, the last is considered as the special form of fruitless marriage demanding special approach at treatment tactics definition. At last, infertility can occur also among absolutely healthy and well compatible married couples. In such cases even full and profound inspection does not allow to define its reason. Then the diagnosis of infertility of not clear origin, or idiopathic infertility is made.

the conception Mechanism

“Stock“ of ova is already determined by

at the girl`s birth, it makes about 400 thousand. During one menstrual cycle (from the first day of one periods to first day of following) in one of ovaries one ovum, as a rule, ripens. After an ovum exit the yellow body is formed of an ovary (ovulation) which occurs approximately on 14 - y day of a menstrual cycle in an ovary. It emits hormones (gestagen) preparing a uterus for reception of a germ, and in case of successful conception - keeping pregnancy. The role of gestagen in the first trimester of pregnancy is especially big.

From an ovary the ovum gets to an abdominal cavity. Near each ovary settles down yaytsevod - a fallopiyeva (uterine) pipe to which funnel the ovum thanks to the movements of eyelashes of a uterine tube which “take“ an ovum has to get (it does not possess ability to the movement). In 6 - 7 days the ovum thanks to reductions of a uterine tube has to overcome distance from a funnel to a uterus in 30 - 35 cm. In ideal conditions fertilization happens while the ovum is in the top third of a yaytsevod. After an ovulation the ovum keeps viability about 24 hours.

Necessary researches at infertility Traditionally this diagnosis is made to

by

only after carrying out all methods of inspection and in the absence of any pathology. Inspections have to include a number of methods.

the Assessment of quality of an ovulation (an ovum exit from an ovary). Are necessary for this research:

  • of hormonal inspection - in certain days of a menstrual cycle the woman takes a blood test on various groups of hormones of reproductive system, the doctor estimates levels of these hormones and their ratio among themselves (in group);

  • carry out by
  • in certain days of a cycle ultrasonography of bodies of a small pelvis, BONDS - monitoring of follicles (bubbles in which ova ripen) and an endometriya (an inside layer of a uterus) - tracking of growth of follicles and their gap (ovulation) by means of the ultrasonic device. This research allows to establish whether there is an ovulation and when it occurs (it is necessary for approach of pregnancy that it was in the middle of a menstrual cycle).

readiness Research an endometriya to acceptance of the impregnated ovum. This combination of ultrasonic researches of a condition of a mucous membrane of a uterus in the second (sekretorny) phase of a cycle with histologic (under a special microscope) research of the cages an endometriya received with the help paypel - biopsies (the small piece of an inside layer of a uterus in out-patient conditions, without anesthesia undertakes). Normal to the middle of a cycle in an endometriya there have to be certain changes in order that there fetal egg could take root.

Assessment of passability of uterine tubes. Enter research:

  • of a sonogisterografiya - ultrasonic research with preliminary introduction to a uterus cavity on a catheter of physiological solution. Besides passability of uterine tubes this research allows to see various pathology of a uterus (anomaly of a structure, a tumor etc.) ;

  • a gisterosalpingografiya - by means of a special catheter is entered by
  • into a uterus cavity X-ray contrast substance - urografin, verografin, urotrast etc. Then a series of x-ray pictures is carried out. In case of passability of uterine tubes X-ray contrast substance gets to an abdominal cavity, it is visible in pictures. Gisterosalpingografiya treats low-painful interventions therefore anesthesia is not carried out.

I can occur among absolutely healthy and well compatible married couples infertility.

Identification of the immunological conflict between the husband and the wife. The conflict comes to light at the level of a uterus neck: slime which is in the channel of a neck of a uterus is capable to detain advance of spermatozoa, Normal it is connected with change of characteristics of slime during the different periods of a menstrual cycle, in pathological situations - with development of antispermalny antibodies (antibodies against the spermatozoa reducing their mobility). In other words, it is necessary to check how spermatozoa interact with contents of a vagina and the cervical channel.

are for this purpose carried out by

:

  • of the postkoitalny test - definition of quantity and mobility of spermatozoa in tservikalny slime after a while after sexual intercourse (usually in 4 - 6 hours). The Postkoitalny test is one of the most “whimsical“ methods of inspection at infertility. Very frequent too early or too late carrying out research (on days of a cycle) becomes the reason of the negative postkoitalny test (bad result) - it needs to be seen off in the middle of a menstrual cycle. Local inflammatory processes, the increase of viscosity of tservikalny slime connected with the low level of female sex hormones of estrogen before an ovulation in a research cycle can be the cause of the negative test. Does not indicate a single negative test result authentically existence of a cervical factor of infertility since it can be connected with the wrong carrying out. In case of negative result repeated test in the following cycle, and also carrying out test of Kurtsrok - Miller is recommended;

  • Kurtsrok`s test - Miller
    - the slime taken from the cervical channel place
  • under a microscope together with the husband`s sperm (for this research the husband separately hands over sperm). Normal in 20 - 30 minutes spermatozoa get into a drop of slime and continue the movement. If penetration does not happen, the test is estimated as negative and begin to find out a cause of infringement: or this impact on spermatozoa of aggressive antispermalny antibodies from tservikalny slime, either initially bad indicators of mobility of spermatozoa, or the violated characteristics of tservikalny slime arising from - for insolvency of a hormonal background of the patient. The slime intake for the test is carried out strictly before an ovulation or in day of an ovulation (day of an ovulation is determined by ultrasonography);

  • definition of antispermalny antibodies in cervical slime - antispermalny antibodies - a special type of the antibodies which are developed in a female organism against the partner`s spermatozoa. Antibodies suppress the movement of spermatozoa via the cervical channel, prevent them to be attached and get into an ovum.

the Intake of tservikalny slime carry out

in the middle of a menstrual cycle of the woman, to the preovulyatorny period (when the channel of a neck of a uterus contains the maximum quantity of slime).

the Assessment of existence of adhesive process in a cavity of a small pelvis and endometriosis (a disease at which the inside layer of a uterus expands in places uncharacteristic for this purpose). The laparoscopy - operation during which through small cuts on a forward belly wall (stomach) enter the special tools equipped with light optics is for this purpose carried out. This operation allows to see internals of a small pelvis (a uterus, uterine tubes, ovaries, a bladder, intestinal loops, etc.) and to obtain large volume of information on their state, to reveal diseases which cannot be found noninvasive (not connected with penetration into an abdominal cavity) methods. Important advantage of a laparoscopy is the possibility of carrying out one-stage surgical treatment of a number of the found deviations (solderings, the centers of endometriosis, cysts, miomatozny knots, etc.). The laparoscopy is carried out in a hospital in the first phase of a menstrual cycle against anesthesia (epiduralny anesthesia or the general anesthesia).

Research of an eyakulyat. For research the following methods are used:

  • of a spermogram - definition of qualitative and quantitative characteristics of sperm (the maintenance of spermatozoa, their mobility, morphological parameters, etc.) ;

  • sperm biochemistry - research of maintenance of some important minerals in sperm, spermatozoa, necessary for normal activity;

  • the antispermalny antibodies which are developed in the man`s organism - one of the main reasons worsening education and functions of spermatozoa. At research define existence of such antibodies in sperm (method latex - agglutinations, ASAT), and also on spermatozoa (MAR - the test). For an exception of the factors breaking implantation of the impregnated ovum in a mucous membrane of a uterus, married couples need also to pass the special inspection directed to an exception of the immunological reasons of infertility (the reasons which lead to development of the conflict between mother and a fruit at different stages of approach and development of pregnancy).

So if to a married couple all described researches were conducted, and any pathology was not revealed, then speak about inexplicable infertility.

Methods of a solution of the problem of infertility

without having found any deviations in reproductive health of couple at full traditional inspection, offer it the scheme of attempts of achievement of fertilization. This scheme includes stimulation of an ovulation, an intrauterine insemination, extracorporal fertilization. These technologies can be applied in different combinations.

Stimulation of an ovulation. So call use of medicines for receiving several mature ova during one menstrual cycle at once that increases chances of fertilization. Stimulation of an ovulation can be repeated during 3 - 6 menstrual cycles. Intrauterine insemination (VMI). In a natural cycle or against hormonal stimulation of an ovulation in the period of an ovulation to the woman enter previously prepared husband`s sperm. The artificial insemination is carried out by 2 - 3 times during one menstrual cycle. Extracorporal fertilization (EKO). This method includes fertilization of the ovum received at the woman, the husband`s sperm in vitro, and replanting in the subsequent the impregnated ovum in a uterus.

in the conditions of obligatory medical insurance of inspection, the infertility reasons, necessary for examination, are free. However not all healthcare institutions have the equipment necessary for inspection, and then the woman goes to larger centers or there takes place inspection in the commercial medical centers, it is also possible to execute Stimulation of an ovulation and an intrauterine insemination within obligatory insurance. Procedure of extracorporal fertilization only in some regions of the country can be free for rather limited number of patients.