What is infertility?
Infertility in women (female infertility) is the inability to conceive within a year of regular intercourse with viable and active sperm, either through natural or artificial means, in the reproductive organs of a sexually mature woman. The diagnosis of infertility is also made if pregnancy always ends in miscarriage. Up to 20% of couples are infertile.
Infertility in women should not be confused with failure to carry a pregnancy to term, where a mature egg is successfully fertilized by a sperm but pregnancy ends in miscarriage or abortion during the embryonic stage.
A woman is not considered infertile if her partner’s laboratory methods reveal non-viable or weak sperm, or if they are absent altogether.
The problem of infertility. The problem of infertility is much more serious now than it was a few centuries ago. The sexual revolution bears serious responsibility, at least in part because it spreads infectious diseases. And young people are increasingly unwilling to have children, with the delay of pregnancy increasing. If we take all infertile couples as 100%, then 33.3% of men are infertile, 33.3% of women are infertile, and both partners are infertile in the remaining couples.
The causes of infertility can be abnormalities in the development of the reproductive system, impairment of the functions of the reproductive organs, strong intoxications and general diseases of the body, as well as psychological and neurological disorders. Infertility is not a standalone disease, it always arises as a result of various diseases of the body. The main cause of female infertility is inflammatory diseases.
Physiology of Menstrual Cycles
Infertility can occur in both irregular and normal menstrual cycles. A natural menstrual cycle in women lasts for 21-35 days and consists of three consecutive phases.
- Follicular phase – maturation of the egg cell (not less than 7 and not more than 22 days).
- Ovulatory phase of maturation and release of the mature egg, onset of the fertile period.
- Luteal phase – yellow body phase, catabolism (from 13 to 15 days).
Several days before and after ovulation is called the fertile period (phase) – it is the time of the greatest likelihood of conception. Before and after this time, pregnancy cannot occur! However, it is important to understand that this phase occurs at different times during the menstrual cycle for different women. If the cycle does not result in pregnancy, then under the influence of estrogens, the body prepares for the next cycle.
Classification of Infertility Infertility can be:
- Primary – pregnancy has never occurred (congenital gynecological anomalies) or (complications in female reproductive organs) before or after menarche (first cycle).
- Secondary – after the first successful pregnancy, the inability to conceive again, may be absolute (incurable) or relative (curable).
In some sources devoted to the study of the physiology and pathophysiology of the female reproductive system, the concept is complemented by the following types of infertility.
- Physiological. Early age infertility (before sexual maturity) and postmenopausal infertility (after menopause) are considered normal.
- Voluntary. Otherwise known as consciously chosen infertility – the use of (medicinal) preparations or physical (spiral, other) means.
- Temporary. It can be the result of prolonged stress, weakening of the body after or during illness. Some authors consider lactational amenorrhea – inhibition of ovulation in the early period of regular breastfeeding – to be temporary infertility.
- Permanent. Removal of female reproductive organs, complete or partial, is the result of surgical intervention.
Signs and Symptoms of Infertility in Women An important sign indicating infertility in women is the inability to conceive for a year or more under favorable conditions for conception, namely:
- regular sexual contact
- a sexual partner with good spermogram results
- full and prolonged abandonment of contraception
- women aged 20 to 45 years
Infertility does not have a pathognomonic (leading) sign, often proceeds without symptoms, or has indirect symptoms. Signs of infertility are established during the collection of medical history, examination, physical, laboratory, and instrumental studies.
Medical history. Obvious symptoms associated with the disruption of regular cycles are established: long, short, painful, heavy, with extraneous discharge. Infertility can be suspected based on the establishment of indirect symptoms characteristic of infectious, non-infectious, and surgical diseases.
Physical Examination During physical examinations at the clinic, possible signs of infertility include:
- body mass index less than or greater than 20-26
- skin condition and its derivatives with signs of endocrine disorders
- unsatisfactory development of the mammary glands
- signs of tenderness or density in the projection of the female pelvic organs, during bimanual gynecological palpation
- signs of gynecological diseases detected during examination of the cervix using a vaginal speculum or colposcopy.
Laboratory and Instrumental Methods
Possible signs indicating infertility are established during laboratory and instrumental studies, such as:
- screening for STIs (sexually transmitted infections);
- hormonal screening to exclude endocrine infertility;
- ultrasound of the female pelvic organs and thyroid gland – for hormonal infertility;
- hysterosalpingography (HSG) – a radiological exclusion of symptoms of uterine tube blockage;
- MRI for brain tumors (pituitary gland) that suppress the production of hormones that regulate menstrual cycles;
- spiral computed tomography (CT) of the pelvic organs – for anatomical causes of infertility;
- laparoscopy (visual examination of the organs of the abdominal cavity) – tuboperitoneal infertility, adhesions, uterine tumors, and retention cysts of the ovaries;
- hysteroscopy (inspection of the uterine cavity walls) – uterine tumors, inflammations, and ulcerations of the uterine walls.
Causes of infertility in women
Infertility in women is caused by a multitude of specific factors, not all of which are always obvious or diagnosable. In some cases, these factors cannot be identified, or they may be compounded and exacerbate negative effects on the female body.
If we generalize the known causes of infertility, there are several major categories of causes:
Congenital anomalies of the reproductive organs.
Acquired conditions that affect the reproductive organs, including:
- anatomical and morphological changes
- functional disorders
- metabolic imbalances.
The above describes most of the specific causes of female infertility. It has been noted that women over the age of 35, especially those who have not previously given birth, are at increased risk of infertility.
There are two general causes of decreased fertility that are not related to previously acquired gynecological conditions:
- age-related slowing of physiological processes;
- prolonged use of contraceptives.
Stages of infertility
The term “stage” in medicine refers to the level or extent of a particular medical condition or disease. In the context of infertility, the use of the term is appropriate when referring to the progression or severity of the condition. Infertility is often categorized into two stages: Stage I and Stage II.
Stage I infertility in women, also known as first-stage infertility, refers to the absence of pregnancy in a woman who has never given birth. The duration of infertility is typically measured from the start of regular sexual activity without the use of contraception for one year. The causes of Stage I infertility are listed above in the text (see classification of infertility).
Stage II infertility in women, also known as second-stage infertility, refers to the condition where a woman is unable to conceive after having previously been pregnant or given birth. The duration of infertility is measured from the first attempts at repeat pregnancy, typically also for one year. The causes of Stage II infertility are listed above in the text (see classification of infertility).
The term “Stage III infertility” is not commonly used in available literature to categorize the severity of infertility.
Recommendations for suspected infertility
Experts claim that to achieve the maximum chance of conception, intercourse should take place between the 11th and 18th day of the menstrual cycle. It is important to remember that the first day of menstruation is considered the first day. Men should not ejaculate more than once every two days, as sperm concentration is at its highest during this time. Both partners should avoid using lubricants, and the woman should not douche after intercourse. In addition, specialists recommend that intercourse during ovulation should occur in the missionary position, and after intercourse, the woman should lie on her back for 15-20 minutes with her knees bent and raised.
If these methods do not yield the desired results, the couple will be recommended to undergo treatment. In cases where the causes of infertility cannot be eliminated, modern reproductive assistance methods such as IVF are recommended.
In vitro fertilization (IVF) is a relatively new method of treating infertility, which involves fertilizing egg cells with sperm in a laboratory dish and then transferring the resulting embryo to the uterus. This procedure provides a good chance of pregnancy, but it is important to choose a reputable clinic. The main factors influencing the choice of clinic are the level of professionalism and experience of the reproductive specialists, as well as the modern equipment they use.
Even if a woman dreaming of having a child is diagnosed with infertility, it is not a reason to despair! Modern medicine not only provides hope for family expansion but also proves its capabilities through numerous successful families.