What does infertility mean 2. Infertility

Problems in the material and professional spheres are nothing compared to the inability to get pregnant and continue your family line.

A diagnosis such as “infertility” often sounds like something irreparable, and is usually the cause of many deep psychological traumas for a person.

Men and women suffer from infertility in equal percentages, but how exactly? What types of infertility exist? And is this terrible diagnosis treatable?

Degrees of infertility

Infertility is divided into:

primary, or 1st degree infertility- this is infertility, during which neither man nor woman, leading an active sex life, were ever able to conceive a child;
secondary, or 2nd degree infertility- this diagnosis is made when a woman has been pregnant at least once, and no matter what the outcome of the pregnancy was, and the same applies to a man who has impregnated a woman at least once, and is currently complaining to doctors about the lack of the desired pregnancy.

There is also:

absolute infertility– this is when a man or woman has pathologies such as the absence of reproductive organs;
relative infertility– these are either diseases of the human reproductive system, or infertility of a man or woman.

Diagnosis of 2nd degree infertility

The most common cause of 2nd degree infertility, both among the fair sex and among the stronger sex, is hormonal imbalance. The birth and maturation of germ cells is hampered, which leads to changes in the reproductive organs that are extremely inconvenient for fertilization. Also, dysfunction thyroid gland also lead to hormonal imbalance, thereby making a connection between infertility and the thyroid gland.

Often, 2nd degree infertility occurs in women as a result of abortions, and associated cleaning of the uterus, often not of very high quality and accuracy. After all, when a pregnancy is artificially terminated, inflammation of the uterus and appendages can occur, as well as a disease such as endometriosis, and all this is a direct path to infertility.

The most common type of infertility is secondary infertility.

Causes of 2nd degree infertility in women

miscarriages and ectopic pregnancy;
decreased reproductive function due to age;
obstruction of the fallopian tubes;
problematic childbirth;
SPIA;
wrong lifestyle.

Causes of 2nd degree infertility in men

chemical effect on the body;
all kinds of injuries, as well as diseases of the genital organs;
smoking, alcoholism and drug addiction;
taking certain medicines, such as antibiotics and hormones;
poor nutrition;
depression.

Treatment of 1st and 2nd degree infertility in women and men

In order to begin treatment, the most important thing is to determine the cause of the disease. Doctors recommend getting tested for both couples. And only after receiving the results, and based on the state of the hormones and reproductive system of both, the doctor can prescribe treatment, individually for each.

First of all, future parents are advised to reconsider nutrition, sleep and work hours, as well as avoid depression and all kinds of nervous breakdowns and stress.
If the cause is hormonal, the doctor will prescribe medication, which will help restore hormonal levels.

If the spermogram results are negative, the female body does not accept male sperm, or there is obstruction in the fallopian tubes, IVF or ICSI treatment is used.
Well, in particularly complicated cases of infertility, doctors can recommend donor programs or adoption.

Therefore, do not put off going to the doctor for too long, because the sooner you discover the cause of infertility, the sooner you can overcome it.

If there are children in the family, a woman gave birth or became pregnant, the gestation ended in a miscarriage, but during subsequent attempts she cannot get pregnant, then she has 2nd degree infertility. The diagnosis is made if the spouses have lived together for at least a year and regularly had intimacy without contraception. This form of infertility is called secondary.

If there has never been pregnancy, then the disease is of the first degree (primary). If problems with the fertility of partners are detected, then this is combined infertility, which is sometimes confused with combined. In the latter case, 2-3 risk factors are identified.

The causes of 2nd degree infertility can be:

age-related changes in which the ovarian reserve decreases. After 35 years, it becomes more and more difficult to conceive a child every year. This is due to the fact that women have a stable supply of eggs received from birth, which decreases over the years and is exhausted when menopause occurs. According to statistics, after the age of 35, every fourth woman is diagnosed with this disease;
diseases of the uterus: myomatous nodes, endometrioid lesions, hyperplasia, dysplasia (atypical areas), malformations (bicornuate, saddle uterus), chronic endometritis;
vaginitis, STD;
pathology of the appendages: polycystic ovaries, cysts, polyps, blockage of the fallopian tubes, adnexitis, salpingitis;
menstrual dysfunction;
hormonal imbalance. Diseases of the endocrine glands, especially the thyroid gland and pituitary gland. The normal synthesis of gonadosteroids by the ovaries depends on the activity of these organs;
injuries of the pelvic organs, adhesions;
obesity;
chromosomal mutations;
frequent abortions, curettage, childbirth– any surgical manipulations that cause mechanical damage to the endometrium. The embryo is attached to the uterine layer, and if it is depleted, implantation will either not occur, or the embryo will not be able to stay in the thin layer and everything will end in an early miscarriage.

Second degree infertility can occur due to incompatibility between a woman and her partner. Such a couple usually has children in other marriages.

One of the most serious and common factors of 2nd degree infertility is obstruction of the oviducts. It can develop from inflammation, scarring, and the formation of adhesions after surgery on the reproductive organs. This is extremely important, since it is in the tube that the female and male gametes “meet” and their fusion occurs there. Next, the zygote gradually moves to the uterus, where, entering its cavity, it is implanted into the endometrium. The latter must be completely ready to accept the embryo. Only under such conditions will pregnancy occur.

Often severe psychological state Women, experiencing constant stress can reduce fertility. Excessive emotional tension leads to the fact that the hormones necessary for bearing a child are not produced in sufficient quantities, causing hormonal infertility. But if in such situations it is necessary to work with the patient’s psyche, then when endocrine diseases A completely different therapy is carried out.

In 5-7% of cases, idiopathic infertility is detected when the pathogenesis is unclear. Sometimes doctors identify erroneous reasons for such infertility. As a result, any treatment turns out to be ineffective.

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Diagnostics

To establish grade 2 infertility, a comprehensive examination is carried out:

Mandatory
Additional
Gynecological examination on a bimanual chair, using a mirror
Colposcopy
Ultrasonography transvaginal or transabdominal
Hysteroscopy, hysterography
Smears for microflora, oncocytology
MRI of the pituitary gland
Blood and urine tests
Sonography of endocrine glands
Coagulogram
Laparoscopy
FLG, ECG
Consultations with an endocrinologist, reproductive specialist, geneticist, psychologist
Hormonal panel
The spouse must undergo diagnostics.
Signs

In addition to the fact that it is not possible to have a child, a woman can suspect this disease due to some symptoms:

menstruation disorders: cessation of discharge, scanty or heavy periods, too painful;
severe pain during sexual intercourse;
aversion to intimacy;
pronounced hair growth on the face, limbs, decreased hair growth on the pubis and scalp;
acne, oily skin occurs when there is an excess of hormones;
genital discharge is mucous or purulent, an unpleasant odor, or bleeding may indicate an STD or inflammation.

If a woman monitors her basal temperature, she can note the absence of ovulation according to the change schedule. In addition, the presence of concomitant diseases must be taken into account, especially in older patients.

Second degree infertility causes serious concern among doctors. Often it is not possible to determine the reasons that provoked the problem. According to statistics, up to 35 out of 100 couples have difficulty conceiving. About half of them suffer from second-degree infertility. To choose a correction technique, it is necessary to examine both partners, and also to know about the course and result of previous pregnancies.

What is it?

With second-degree infertility, partners have difficulty conceiving if they have previously had pregnancies. It doesn’t matter how they proceeded or how they ended. This diagnosis is more often given to women than to their partners. However, an examination is necessary for both spouses in order to reliably determine the causes of violations and choose the appropriate correction method.

The diagnosis is made after one year of unsuccessful attempts to conceive with regular sexual activity without the use of contraceptives. In women over 35 years of age, the problem is reported after 6–9 months of unsuccessful attempts.

A family that is unable to have a child may find themselves at a loss from doctors' diagnoses. In fact, the degrees of infertility that are indicated in the medical record do not reflect either the reasons or prognosis at all. They only indicate whether or not the woman was pregnant before.

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Description and classification of diagnosis

Infertility is diagnosed, assigning it a certain degree, after unsuccessful attempts to conceive for 12 months. Previously it was five years. But statistics have shown that most couples manage to “get pregnant” within six months, and 10% within a year.

It is necessary to take into account the correctness of attempts to conceive.

Sexual intercourse on days 11-18 of the female cycle, from the first day of bleeding.
Regularity no more than every other day, and at least twice a week.
The best position is “missionary”.
Do not use lubricants.
After the act, it is better for a woman to lie on her back for up to half an hour, tucking her knees to her stomach. Do not wash yourself, do not douche.

If some requirements are not met, infertility may well not exist. It’s just that the couple didn’t give the sperm and egg a chance to “meet.” But it is better to be examined for the presence of any pathology.

Approximately every tenth couple cannot have children. Both partners need to be examined. In a third of cases, the cause is found in a woman, in another third or even half - in a man. And the third part consists of couples where both have problems.

Can't get pregnant

First degree infertility in women and men (or primary) is diagnosed if pregnancy has never occurred. This means that the woman has never been pregnant, or the man has never been able to impregnate any partner. If conception occurred earlier, then second-degree, or secondary, infertility is diagnosed. Moreover, regardless of how the pregnancy ended - childbirth or miscarriage.

Infertility, or infertility, is divided into types:

physiological – childhood, postmenopausal period in women;
congenital – defects, underdevelopment of the genital organs;
acquired – diseases of the genital organs, their consequences;
voluntary – use of means of contraception against unwanted pregnancy;
temporary – a consequence of stress, depression, problems with immunity, also lactation;
permanent – occurring after partial or complete removal of the genital organs.

About third degree infertility, we can say that this is a type of absolute second, but doctors usually do not use such a diagnosis. It is implied that a person forever loses the ability to procreate.

Reasons leading to infertility

The reasons leading to infertility in women are the same for its different degrees. Their frequency distribution is as follows:

violation of the ovulation mechanism – 35-40%;
obstruction of the fallopian tubes – about 35%;
endometriosis – approximately 20%;
other reasons – about 10%.

Women are often diagnosed with 1st degree infertility precisely because of disruption of the ovulation process. It is caused by various pathologies:

polycystic ovary syndrome;
diseases of the endocrine system (adrenal glands, thyroid gland);
hormonal disorders, for example, impaired interaction of the ovaries, pituitary gland and hypothalamus.

Stage 2 infertility is often caused by operations and illnesses in women, which result in tubal obstruction. This:

abortions, especially early ones;
surgical interventions in the abdominal cavity;
inflammation of the uterus and appendages;
sexually transmitted infections (chlamydia, syphilis and others).

The result is adhesions or narrowing of the lumen of the fallopian tube. Against this background, an ectopic pregnancy may develop.

First or second degree infertility can occur due to the consequences of endometriosis. The disease is caused by immune and genetic disorders. It leads to:

adhesions inside the abdominal cavity;
tubal obstruction;
ovulation disorders;
bleeding.

Pathologies of the uterus directly contribute to the development of infertility, both 1st and 2nd degree, which means the inability to grow and develop for the fetus. Intrauterine surgery can successfully eliminate many of the problems:

uterine infantilism;
fibroma, myoma, fibromyoma;
polyps;
intrauterine septum;
adhesions;
inflammation;
bicornuity;
scarring;
cysts.

Cervical pathologies can also lead to first or second degree infertility. Erosions, infections, polyps and other ailments can change the composition of cervical mucus.

When it is impossible to get pregnant

Women may suffer from psychological infertility - this means that they subconsciously lack the readiness to become a mother. Pregnancy feels like a dangerous condition for the body. Usually this fact is not realized, but there is a fear of becoming fat, losing a job, or suffering during childbirth.

It happens that grade 1 is caused by the immune system - this is a factor that is very rare. Even less commonly, it leads to secondary infertility. One of the following situations occurs:

antibodies are produced that destroy any “incoming” tissue or specifically sperm;
The ovaries produce antibodies to eggs.

Even if pregnancy occurs, it freezes and ends spontaneously. At best, it is very difficult, with severe toxicosis and other complications.

In men, grade 1 or 2 infertility can be caused by many reasons. But it comes down to three factors that make fertilization difficult:

obstruction of the ducts for removing semen;
disorders of sperm production, causing a low number of sperm, insufficient sperm motility, reduced sperm production;
improper functioning of the immune system, leading to the formation of antibodies to sperm.

Second degree infertility in men, like primary infertility, can be caused by:

hormonal dysfunction;
pathologies of the genitals;
varicocele;
previous genital injuries;
genetic disorders;
decreased immunity;
taking various medications, radiation, chemotherapy;
inflammatory diseases – urethritis, prostatitis;
systemic diseases – tuberculosis, diabetes, cirrhosis;
endocrine disorders;
surgical interventions in the groin.

For example, with grade 1 varicocele, the development of infertility is possible due to increased testicular temperature. This happens gradually, the function of sperm production is disrupted, and their activity decreases.

For hormonal imbalance

Treatment methods for women and prognosis

Sometimes no cause of infertility is found. Then planned sexual intercourse is recommended. The days of ovulation on which contact is recommended are calculated. It is best if these calculations are carried out by a doctor.

Treatment of 2nd degree infertility caused by identified pathologies in a woman comes down to eliminating these ailments. The same applies to primary infertility.

Infertility caused by hormonal imbalances is treated with appropriate medications. Insemination is also used - the introduction of sperm directly into the uterine cavity, then the process continues naturally.

If such treatment of primary infertility, as well as stage 2 infertility, is unsuccessful, in vitro fertilization is recommended. Female and male cells are extracted, and after fertilization, the selected embryos are implanted in the uterus. Donor cells can be used, then there will be no genetic relatedness with the baby. The effectiveness of the method is 30%.

Other methods are also used. For example, stem cells for hypoplasia. Or intracytoplasmic injections in women over 40 years old. A controversial method is surrogacy.

Infertility is not a disease in the traditional sense of what it is. It can be caused by one or several reasons. After identifying them, treatment tactics are developed. Prevention comes down to preventing diseases that lead to infertility.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist

We are all familiar with the situation when our desires do not coincide with our capabilities. This is easy to come to terms with when it comes to material wealth. But when it comes to procreation, problems with conception cause deep psychological trauma, and the diagnosis of “infertility” sounds like a death sentence. Most often, both men and women suffer from grade 2 infertility. What is behind these words? What is infertility like? Is second degree infertility treatable?

Classification of infertility

Doctors divide infertility into primary and secondary, absolute and relative. 1st degree infertility (primary) means that a man or woman has never been able to conceive a child in their life, having regular sexual intercourse with different partners. They speak of second degree infertility (secondary) when a woman has had a pregnancy at least once in her life (it doesn’t matter whether it ended in childbirth or not), and a man was able to conceive a child at least once. At this time, they are experiencing problems with conception. Contrary to popular belief, the concept of “grade 3 (4, etc.) infertility” does not exist in medicine.

The diagnosis of “absolute infertility” is made if the patient has congenital or acquired pathologies that are incompatible with conception, for example, the absence of genital organs. With relative infertility, the causes of problems with conception lie in diseases of the reproductive system, or in the infertility of the partner.

What causes infertility?

The most common cause of 2nd degree infertility, both in women and men, is hormonal imbalance. In this case, the process of maturation of germ cells is disrupted, and changes in the reproductive organs that are unfavorable for conception and pregnancy occur. Infertility and the thyroid gland, or rather, disturbances in its functioning, are also interconnected: both hyper- and hypofunction of the thyroid gland leads to hormonal imbalance.

In women, secondary infertility most often occurs after abortions and related curettages. Artificial termination of pregnancy in most cases leads to the development of inflammatory diseases of the uterus and its appendages, including and, ultimately, to infertility.

Other causes of 2nd degree female infertility may include:

decreased fertility due to age (after 30 years);
ectopic pregnancy and miscarriages;
obstruction of the fallopian tubes;
uterine fibroids;
polycystic ovary syndrome;
previous difficult birth;
early menopause, ovarian exhaustion;
autoimmune diseases;
stress and poor nutrition.

Second degree infertility in men occurs for the following reasons:

injuries and diseases (including infectious) of the genital organs;
chemical or radiation exposure;
taking certain medications (antibiotics, hormones);
bad habits (smoking, alcohol, drugs);
harmful working conditions, poor environmental conditions;
poor lifestyle, poor nutrition;
stress, depression.

Secondary infertility – how to treat?

Before starting treatment for secondary infertility, it is necessary to establish the cause of the disease. To do this, both spouses take tests and undergo examinations. Having received information about the state of the patient’s hormonal levels and reproductive system, the doctor prescribes individual treatment. Both spouses are recommended to normalize their diet, work and rest schedules, avoid psychological stress, and give up bad habits. In case of hormonal infertility, the doctor will prescribe special medications to normalize hormonal levels.

If the results of a spermogram are poor, a woman has obstruction of the fallopian tubes, they resort to insemination (injection of sperm directly into the uterus), IVF, or ICSI. And in case of severe hereditary diseases and depletion of the ovarian reserve, doctors suggest using donor programs.