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Causes and symptoms of infertility in women


What is infertility?

Infertility in women (female infertility) is the inability of conception within a year of regular invasions, viable, active sperm, naturally or artificially, in the genitals, women Mature age. The diagnosis of infertility is as if the pregnancy always ends in miscarriage. Barren marriage exists in 10-20% of cases.

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

A woman is considered infertile if her partner laboratory methods detect viable, weak sperm or absent.

The problem of infertility. The problem of infertility is now much bigger than before, a few centuries ago. The sexual revolution bears a heavy responsibility, not least because it spreads infectious diseases. And young people increasingly don't want to have children, delaying pregnancy is increasing. If you take all infertile couples for 100%, then 33.3% of the infertile male is still 33.3% of infertile is a woman, and the remaining couples are infertile both partners.

The causes of sterility may be defects in the development of the reproductive system, dysfunction of genital organs, strong intoxication, and General diseases of the body, as well as mental and neurological disorders. Infertility does not belong to the group of independent disease, it appears as a result of various diseases of the body. The main reason of female infertility is inflammatory diseases.

Physiology of menstruation cycles

Infertility can be disrupted and normal monthly cycles. The natural monthly cycle of a woman lasts 21-35 days, consists of three consecutive phases.

1. Follicular phase - maturationeggs (not less than 7 and not more than 22 days)

2. Ovulatory phase of maturation and release of Mature oocytes, the onset of the fertile period.

3. Luteal - phase yellow body, catabolism (13 to 15 days).

A few days before and after ovulation is called the fertile period (phase) is the time of most likely conception. Up to this point and after pregnancy can not occur! However, we must understand that different women this phase occurs in a monthly period. If the cycle persists pregnancy, the body under the action of estrogens is preparing for the next cycle.

Classification of infertility

Infertility can be:

  • primary – the pregnancy never occurred (congenital gynecological anomalies) or (complications on the female genitals) before or after menarche (first cycle);
  • secondary, after a first successful pregnancy, the inability to re-fertilization can be absolute (incurable) or relative (curable).

Some sources dedicated to studies of the physiology and pathophysiology of female sexual sphere, the concept is supplemented with the following types of infertility.

  • Physiological. The norm is to infertility early age (before puberty), infertility and post-menopausal (after menopause).

  • Voluntary. Otherwise referred to as a consciously chosen infertility as the use of (medical) drugs or physical (helix, or other) funds.
  • Temporary. May be the result of prolonged stress, the weakening of the body after or during the disease, some authors to temporary infertility include lactational amenorrhea - the inhibition of ovulation in the early period of the regular breastfeeding.

  • Constant. Removal of the female genitalia, total or partial, is the result of surgical intervention.

Signs and symptoms of infertility in women

An important indication of the infertility in women is the inability to get pregnant within a year or more, under favorable conditions for conception, namely:

  • regular intercourse;
  • sexual partner with good sperm count;
  • complete, long-term rejection of contraception;
  • women aged 20 to 45 years.

Infertility is not pathognomonic (master) trait is often asymptomatic, or has circumstantial symptoms. Signs of infertility set in the collection of anamnesis, examination, physical, laboratory and instrumental investigations.

History. Establish clear symptoms associated with the violation of regular cycles of long, short, painful, copious, with strange selections. To assume infertility can be determined, establishing the indirect symptoms, infectious, non-infectious and surgical diseases.

Physical examination

When physical examinations at the clinic possible signs of infertility are:

  • the body mass index of less than or greater than 20-26;
  • skin and derivatives, with signs of endocrine disruption.
  • the unsatisfactory degree of development of the mammary glands;
  • signs of pain, seals in the projection of the pelvic organs women with gynecological bimanual palpation;
  • signs of gynecological diseases detected during the inspection of the cervix using a vaginal mirrors, colposcopy.

Laboratory and instrumental methods

Signs that may indicate infertility, set in the process of laboratory and instrumental studies:

  • infectious screening for STIs;
  • hormonal screening for the exclusion of endocrine infertility;
  • Ultrasound of the female pelvis, thyroid –hormone infertility;
  • the hysterosalpingography (HSG) is a radiological exclusion of symptoms of obstruction of the fallopian tubes;
  • MRI in tumors of the brain (the Turkish saddle), inhibiting the production of hormones – regulators of the lunar cycle;

  • spiral computed tomography (CT) of the pelvic organs – anatomical causes of infertility;
  • laparoscopy (visual examination of the abdominal cavity) – tubal-peritoneal infertility, adhesions, uterine tumors, ovarian retention cysts;
  • hysteroscopy (inspection of the uterine cavity) – tumor of the uterus, inflammation, ulceration of the walls of the uterus.

Causes of infertility in women

Infertility women –due to many private reasons (factors). Not always cause obvious. In some cases, they are not amenable to diagnosis or combined with each other, intensify the negative effect on the female body.

To sum up known causes (factors) infertility, there are several large groups of causes of infertility:

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

The above describes the majority of private (specific) reasons women infertility. It is noted that women after 35 years of age, particularly parous earlier, increases the risk of infertility.

There are two General reasons for the decline in fertility that are not associated with previously transferred gynecological diseases:

  • age-related slowing of physiological processes;
  • prolonged use of contraceptives.

Infertility from birth control

In the literature there are opposing views about the use of hormonal contraceptives. Supporters argue the use of the contraceptive in connection with "rebound effect" after the cancellation of hormonal contraceptives. That is, the cancellation of the factors hindering the process of fertilization, stimulates the sudden release of estrogen, increases the likelihood of getting pregnant. In some cases it happens.

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

Causes of secondary infertility in women

For help determining the causes of infertility treatment for women previously successfully given birth. The inability for a long time again to get pregnant women is called secondary infertility. If you do not take into account the voluntary waiver of conception and the age factor, the most obvious causes of secondary infertility – previous conditions, including gynaecological infectious or non-infectious etiopathogenesis.

Infertility factors

Infertility is almost always a lot of reasons (factors). Inthe result of research and clinical observations it is established that factors of infertility are structured (grouped) on the basis of combining homogeneous of signs:

  • anatomical localization of the pathogenesis of diseases caused by infertility;
  • the nature of the pathophysiological processes in the body (endocrine disruption, the phenomenon of immunologic rejection of germ cells);
  • genetic abnormalities that prevent fertilization;
  • the features of the psychosomatic condition of women of fertile age in different conditions of life;
  • the influence of male factor infertility.

Cervical factor of infertility

For successful fertilization in the uterus of a woman should get at least 10 million active sperm. Vaginal environment of healthy women is a barrier to any alien female body agents, including sperm. When vaginitis causes for the loss of sperm cells in the vagina are associated with pathological processes. The normal environment is not an absolute barrier to sperm, the active cells moves to the neck of the uterus, covered with mucus. The slime on the walls of the cervix produced by the skin cells.

The ability of sperm to penetrate cervical mucus depends on:

  • activity and sperm motility;
  • physico-chemical characteristics of the cervical mucus.

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

Cervical factor infertility (changing the viscosity of the mucus and other properties) can be the result of:

  • hormonal failures produce the female sex hormones;
  • inflammatory processes in the cervix;
  • disturbed microflora in the mucus of the cervix.

Tubal factor infertility

Tubal ligation is transported to the Mature oocyte from the ovary to the uterus. Mucosa of fallopian tubes is lined with ciliated epithelium.

The movement of the ovule is due to:

  • peristaltic movements of the walls of the pipes;
  • the flickering of the cilia, creating a pipe for fluid

Damage to cilia, produces a pathological fixation of the ovum in the tube, creates a risk of ectopic pregnancy. The greatest negative impact is due to complete or partial obstruction of pipes for Mature ovum is tubal factor infertility.

Obstruction (obstruction) of the fallopian tubes canto be:

  • in the region of the funnel – distal (distant) part of the fallopian tubes;
  • in the field of uterine part of the tube (proximal or middle) part of the fallopian tubes;
  • all over (obstruction of the funnel, ampoules, otmechennogo departments and fallopian) tubes.

Diagnostic importance is the identification of the obstruction:

  • partial;
  • full.

Obstruction of pipes – factor infertility can be caused by a spasm or overlap of the lumen of the tube in consequence of the inflammatory adhesions, growths, tumors, and other causes. Disease of the fallopian tubes, accompanied by obstruction of pipes and accumulation in their lumen transudate (fluid) is called a hydrosalpinx.

Common causes of hydrosalpinx is a complicated course of inflammation:

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

The obstacle of an egg may be accompanied by pain in the abdomen. For the diagnosis of hydrosalpinx using x-ray (hysterosalpingography) or laparoscopy (a special kind of examination of the abdominal cavity).

Cervical factor infertility

Through hole – mouth in the center of the cervix, like the gateway that connects the uterus and vagina. The gateway function, the throat of the cervical canal, manifests in the form of periodic:

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

A function is provided by the mucus of the cervical canal under the influence of estrogen changes its physico-chemical and rheological (viscosity) properties in different periods of the monthly cycle.

  • In the period of greatest likelihood of fertilization, the mucus changes properties such as pH sour favorable for sperm – neutral and slightly alkaline and becomes less viscous.
  • In the inactive phase of the cycle the mucus of the throat protects the female organism from pathogenic agents.

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

The cervical mucus is in the body of a healthy woman, performs the following functions:

  • the patronage (protection) and a temporary depot (storage) of sperm in the reproductive ways;
  • delay weakof sperm, not able to overcome the physical barriers of a viscous cervical mucus;
  • transfer factor activation of the sperm, increased their motor activity;
  • capacitated (capacity) and acrosomal reaction (penetration) i.e. sperm penetration of the sperm into the oocyte.

The outer jaws are visually examined vaginal mirror. The inner throat is inaccessible to the ordinary methods of examination.

Cervical factor infertility discover colposcopy revealing "symptom of the pupil" in the throat of the cervical canal. Positive symptom pupil – transparent periocularly watery mucus.

Cervical factor detect by laboratory methods:

  • study of rheological and biochemical properties of mucus;
  • postcoital test (PCT) on the interaction between sperm and mucus after a certain time after intercourse. Usually definitions of PKT is 9-24 hours;
  • definition of the peri-ovulatory samples Kurzrok-Miller.

Lab tests carried out by experienced doctors technicians. The research results are dependent on correctly chosen time of the study.

Tubal peritoneal factor infertility

The abdominal cavity and internal organs protected by a mesentery from contact, and splicing the abdominal wall and adjacent organs. The mesentery is a serous membrane that lines the inside cavity of the abdomen, divided into:

  • the parietal leaf of the mesentery – separates the internal organs from the abdominal wall from the inside.
  • visceral leaf of the mesentery hangs all the internal organs.

Abdominal cavity is filled with serous fluid also serves to protect the organs from mutual splicing and friction. Normal all the internal organs have some degree of spatial mobility.

Suspended in the mesentery of the fallopian tube and uterus. Under the influence of pathogenic factors is the formation of adhesions between the fallopian tubes and the mesentery or adjacent organs.

The result of fallopian tube, connected with the mesentery, lose:

  • mobility;
  • adequate blood flow
  • full innervation.

As a result of adhesions in the abdominal cavity, fallopian tubes no longer fully perform its functions. Cessation of the functioning of the fallopian tubes under the influence of adhesions of peritoneum called tubal peritoneal factor infertility.

Causes of tubal peritoneal factorinfertility:

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

Damage to the pipe results in menstrual cycles, chronic pain syndrome.

Infertility or reduced fertility of tubal peritoneal Genesis appears:

  • violation of patency of fallopian tubes – tubal factor infertility
  • adhesive process in the pelvis – peritoneal factor infertility
  • the combination of tubal and peritoneal infertility

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

Immunological factor of infertility

In normal immune system women, with the penetration of foreign proteins – in the form of seminal fluid and sperm (antigens), and does not respond with production of specific antibodies (ASAT). Reasons, resulting in immunological rejection of sperm is not fully understood.

The emergence of ASAT in women is probably a result of the development of rejection reactions by type of allergic reactions of type 2. The barrier properties of the mucous membranes can be affected reducing the amount of mucus on the inner surfaces of the genital organs degenerative inflammatory processes. Currently, this pathology is treated by the methods of immunomodulation, reduction in the number of circulating antibodies that stimulate reparative (replacement) processes in the mucous membranes of genital tract.

Other immunological disorders – factor infertility, the development of the female body antiovarian antibodies (AOA) on their own egg cells. Causes of immune complexes that destroys its own immune protection, challenging the competence of the doctors and immunologists. Like all autoimmune disease in the early stages of pathogenesis to treatment. In advanced cases, the prognosis is cautious.

The endocrine factor of infertility

Violation hormonal metabolism lead to irregular cycles or lack thereof. The main causes of this kind of infertility – disorders of:

  • The consequences of traumatic brain injury, tumors, hypothalamo-pituitary region of the brain;
  • The imbalance of estrogen over androgens (hyperandrogenism) in the female body occurs when damage to ovaries or adrenal glands, accompanied by polycystic ovary syndrome;
  • The decrease in the functional activity of the thyroid gland (hypothyroidism) is the cause of cycles;
  • Insufficient amounts of estrogen, accompanied by the rhythm of the lunar cycle, leads to pathological damage to the mucosa of the genital tract;
  • Disorders of lipid metabolism accompanied by excess or loss of fat tissue provokes a decrease in the function of the ovaries;
  • Violation hormonal metabolism, accompanied by premature menopause;
  • Congenital abnormalities of the hormonal system, accompanied by underdevelopment of the genital tract.

Endocrine disorders are investigated in disorders of the lunar cycle, on the background of the external signs of endocrine disorders (obesity, malnutrition, other).

The psychological factor of infertility

Stress is a General adaptive reaction of the organism to different stimuli, has a complex mechanism of regulation involving in particular the body's hormones. It is pointless to look for specific factors of stress, psychological factors of infertility, they are individual for each woman. Summarized the sources of stress is:

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

Chronic stress is the depletion of the adaptive protection mechanisms of the body. Structure of Bioregulation (of the autonomic nervous system, adrenal hormones, pituitary and others) stop working in the direction of adaptation, cause pathophysiological changes in the body. Psychological factors of infertility are hiding pathophysiological changes of the body (hormonal disorders including). To determine the psychological causes of infertility should seek to stop the source of stress, you need to:

  • To change the attitude towards the stress factor. Observed that families with low level of education have no problems with the birth of children, in contrast to the families where women with high level of intelligence and social status, suffer from obvious and imaginary stress. Physical education, a rewarding hobby, leisure, positive emotions, and so on will restore hormonal and emotional balance.
  • Turn to a qualified psychologist. Not always the stress can be overcome independently. Find a specialist who will help you to stop thinking about imaginary problems will help to understand the true causes of infertility.

Genetic factors of infertility

In the literature described in detail the genetic factors of male infertility. Genetic factors of infertility in women is poorly understood. Known particular pathology that causes the femaleinfertility have genetic roots.

  • Syndrome of hyperandrogenism (excess male hormones).
  • Endometriosis (overgrowth of uterine walls).
  • Syndrome premature menopause.
  • Syndrome primary amenorrhea (Cherskogo-Turner syndrome).

Also known and other diseases accompanied by genetically determined infertility. The causes and likelihood in the future of genetic abnormalities – the subject of genetics research. Currently being developed laboratory methods for diagnosis of genetic factors of infertility.

The extent of infertility

The etymological meaning of the word "degree" in medicine means the value comparison of different intensity of pathological processes. The use of the term is appropriate when comparing private (specific) pathological processes in respect of a limited group of patients with similar diagnosis. Often, in the available literature, infertility is described as I and II type of infertility.

Infertility 1 degree women. Or I infertility is lack of pregnancy in a woman has never given birth. Usually the term infertility is measured using the year of the beginning of regular sexual life without using of contraceptives. Causes of infertility 1 mentioned above in the text (see classification of infertility).

Infertility 2 degrees in women. Or II infertility is the inability of conception, refers to women who previously had a pregnancy or gave birth. The term infertility is counted from the first attempts of repeated pregnancy. Usually through the year. The causes of infertility II mentioned above in the text (see classification of infertility).

Infertility 3 degrees in women. A term used to describe the degree of inability to get pregnant, the available literature is not used.

Recommendations for suspected infertility

Experts say that for maximum chance of fertilization, to conceive from 11th to 18th day of the menstrual cycle. We remind you that the first day is the first day of menstruation. Men should not ejaculate more often than every 2 days, as sperm concentration is maintained at the maximum, only in this case. Both partners must not apply lubricants. And after sex, the woman should not wash. Besides all this, experts say that having sex during fertilization is necessary in the posture of "missionary", andafter intercourse, the woman should lie on her back for about 15-20 minutes, with bent and raised knees.