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It is possible to determine infertility in women using an integrated approach. Doctors say childlessness is defined as a situation where a couple cannot conceive a child while having regular, unprotected sex for more than 12 months. Pathology is classified into absolute and relative. The second option is treatable.
Diagnosing infertility in women is an important step in dealing with the problem. The very first clinical blood tests are prescribed, which allow to determine inflammatory diseases of internal organs, pathologies of the blood system.
It is necessary to undergo an examination of the hormonal background, which can affect conception. Its change is closely related to pathologies:
- gonads;
- thyroid;
- pituitary gland, hypothalamus;
- adrenal glands.
An important test is the infectious TORCH panel, as well as an instrumental examination of the patient - ultrasound of the uterus and its appendages, MRI, and others. An ovulation test is performed to determine the best dates for conception or to identify an anovulatory cycle.
History taking in female infertility
This method allows us to understand some of the causes of childlessness that has developed, as well as to identify conditions such as menstruation disorders and other diseases of internal organs. The gynecologist finds out the complaints, the course of the patient's life, the presence of previous pregnancies, infectious processes, evaluates the woman's sexual life and activity.
Physical examination
This diagnostic method includes a general examination, which allows to identify some pathologies of the genital organs. The main evaluation criteria for a physical examination of a girl are:
- measurement of temperature, pulse, pressure;
- physique, body weight;
- bimanual manual examination;
- gynecological examination of the genital organs;
- hair growth;
- development of secondary sexual characteristics;
- palpation of the mammary glands, is there any discharge from the nipples;
- study of regional lymph nodes.
Methods of laboratory diagnostics
The main purpose of laboratory tests is to determine the hormonal background. The main indicators are:
- luteinizing and follicle-stimulating hormones LH and FSH;
- free and bound testosterone;
- cortisol;
- prolactin;
- anti-Mullerian hormone;
- estradiol;
- progesterone.
Table 1. The norm of sex hormones in a woman.
Hormonal imbalance plays a big role in infertility. Doctors recommend that all women get checked periodically. Childlessness in this condition can be cured by prescribing adequate therapy.
The level of hormones in the blood is determined by taking biological material from a vein, after which it is delivered to the laboratory, where it is evaluated using special equipment.
Tests are performed on days 5-7 and 21-23 of the cycle. It is necessary to evaluate the functionality of the thyroid gland.
Infectious screening for infertility in women
To determine female infertility, the examination includes the search for infectious diseases. This procedure includes:
- the usual bacterioscopy of a smear from the vagina, indicating the presence of pathogenic microflora;
- scraping from the cervix is subjected to PCR tests, in which herpes, cytomegalovirus, ureaplasma, papillomavirus and other pathologies that lead to infertility can be detected;
- ELISA, where the material for tests is venous blood.
TORCH-complex
This complex is mandatory when planning a pregnancy. All diseases that are included in it provoke intrauterine infection and developmental pathologies of the fetus, or spontaneous miscarriage. This includes toxoplasmosis, rubella, cytomegalovirus and herpes and others.. The abbreviation is based on the Latin names of all diseases.
It is important to understand that testing for TORCH infection does not answer the question of how to test for infertility in a woman, but will help plan the birth of a healthy child. The test is recommended to be performed a few months before the moment when pregnancy is expected.
Instrumental methods for diagnosing infertility in women
Instrumental diagnostics includes ultrasound, CT, MRI, radiography, colposcopy, hysteroscopy and endoscopy. These methods are assigned to identify organic problems. Sometimes they need to be used after curettage of the uterine cavity to determine the condition of the endometrium.
Uterine infertility is diagnosed through an endoscopic examination of its cavity, when a special device is inserted inside. It allows the doctor to evaluate the appearance of the endometrium, the presence of nodes, bleeding and other problems.
Endoscopic diagnostics
Endoscopic methods involve diagnostic laparoscopy, when an endoscope is inserted into the abdominal cavity. This technique allows to reduce the period of examination of girls with infertility. Its advantages include:
- determination of the cause in a short time;
- identification of comorbid pathology, including endometriosis;
- the possibility of simultaneous treatment of the condition;
- reduced traumatization of internal organs, fallopian tube, uterus;
- reduction of time of surgical intervention;
- short recovery and rehabilitation period;
- barely noticeable cosmetic defects of the skin.
Therapeutic and diagnostic endoscopic laparoscopic surgery is rightfully considered one of the effective methods of infertility treatment. Already at the stage of laparoscopy, it is possible to determine the cause of a woman's infertility, eliminate it, or decide on further treatment without the use of methods such as IVF or artificial insemination.
Hysteroscopy
Hysteroscopy is used to evaluate the internal cavity of the main reproductive organ of a woman - the uterus. The cervical canal is examined, the place where the fallopian tubes merge with the uterus (mouth).
This method of minimally invasive examination of the uterine cavity allows you to identify polyps, adhesions, endometritis and other pathologies that contribute to childlessness in women. The procedure can be performed as an independent method of examination for infertility, or in conjunction with laparoscopy, which gives the doctor complete information about the state of the organs of the woman's reproductive system.
Diagnostics of the sexual partner
It happens that in an infertile couple, when examining a girl, doctors conclude that she does not have any pathological processes that negatively affect the reproductive function. Then there is male infertility. At the same time, most of the representatives of the stronger sex are sure that if they have a normal erection and ejaculation, then they have no health problems.
Diagnostic measures for men begin with carrying out. The ejaculate is taken for the test. It may lack spermatozoa, which indicates a violation of spermatogenesis. It is possible that they are normally produced, but for some reason do not enter the lumen of the vas deferens. Then the diagnosis of obstructive infertility is established. Doctors check the patency of the ducts using genitography.
The spermogram is also able to show increased gluing of spermatozoa due to the antibody. Then it is necessary to look for and treat autoimmune processes. In this case, male germ cells have reduced mobility, which prevents the normal fertilization of eggs.
Examination of a man in an infertile couple is of great importance for the treatment of childlessness, since a fairly large proportion of such couples suffer from health problems among the stronger sex.
When passing a spermogram analysis, men are advised to adhere to the following rules.
- Sexual abstinence for at least three days before the test.
- Ban on smoking and alcohol during this period.
- You should not use various drugs, unless they are prescribed for health reasons (insulin, inhalers for bronchial asthma).
Ovulation test 
Testing for infertility in women involves doing a so-called ovulation test. The advantage of the technique is that it can be carried out at home. It also allows you to identify problems with ovulation, determine the best time to conceive a baby.
The bottom line is that the egg leaves the ovary about 10 days after the start of the cycle. This period is characterized by an increase in the concentration of luteinizing hormone in the blood. The definition of ovulation is based precisely on this moment.
After the release of the egg from the ovary, a corpus luteum is formed, which produces progesterone. Doctors call it the pregnancy hormone. With its growth, the concentration of luteinizing hormone begins to decrease.
The ovulation test consists of strips and a urine jar. The procedure is the same as with a conventional pregnancy test. With the appearance of two strips, the onset of ovulation is expected in the next three days. It is important to pay attention to the brightness of these stripes, they should be approximately the same. If the color changes, the test is considered invalid.
In order to properly organize work on the reproduction of livestock, on any farm, for all females for every day, three states should be distinguished: 1) pregnancy; 2) the postpartum period (3-4 weeks after birth) and 3) infertility. Infertile (without a fetus) include all females that are not inseminated or inseminated, but not fertilized within a month after birth, and heifers, pigs and other young females - a month after they reach physiological maturity.
Diagnosis of pregnancy and infertility is a paramount and mandatory event in every household. When examining animals, specialists must not only detect pregnancy and its timing, but first of all establish infertility in order to take timely measures to eliminate it as soon as possible. Therefore, the diagnosis of pregnancy and infertility is a single, inseparable event.
Existing methods for diagnosing pregnancy and infertility can be divided into two groups.
- Methods for clinical diagnosis of pregnancy and infertility:
outdoor study;
internal examination: a) rectal; b) vaginal.
- Methods for laboratory diagnosis of pregnancy:
From the anamnesis, the following probable signs of pregnancy can be identified: no signs of estrus, sexual arousal and hunting for 30 days or more after the next insemination;
improving the appetite and fatness of the animal;
sometimes perversion of appetite (licking of stones, increased desire to eat minerals); fatigue and sweating; more relaxed behavior in dairy animals - weakening or cessation of mammary gland functions;
the appearance of edema of the extremities and lower abdominal wall;
increased frequency of urination, defecation.
Valuable anamnestic data include journal entries. Anamnestic data can be trusted to the extent that they coincide with the results of a clinical study. The anamnesis is only important to clarify the gestational age.
Reflexological method for diagnosing pregnancy and infertility. The use of the probe is based on taking into account the reaction of the female to the male or the reaction of the male to the female. It is known that, as a rule, after insemination of polycyclic animals, the appearance in them of the phenomena of the stage of excitation of the sexual cycle indicates the absence of fertilization, i.e., infertility. Therefore, the detection of heat by a tester is considered a true sign of infertility and, conversely, the absence of heat at the time when it should have manifested itself is a likely sign of pregnancy. This method makes it possible to diagnose the initial stages of pregnancy in adult animals with an accuracy of 95-100%, and in replacement females - 100%.
So far, there is no more accurate method for diagnosing the initial stages of pregnancy and infertility than reflexology. Therefore, it deserves great attention and should be applied in the daily practice of animal reproduction. Its particular value lies in the fact that in the case of infertility, the possibility of skipping estrus is excluded and it is possible to carry out insemination at the optimal time in the presence of pronounced phenomena of the stage of excitation of the sexual cycle.
For a reflexological study of pregnancy and infertility, a special pen is usually allocated, into which females are released along with a probe (in an apron or specially operated). When keeping pigs on complexes, the probe is driven along the aisle between the machines, and then an individual test is carried out. For 100-150 queens, one probe is isolated. The multiplicity of samples during the day depends on the duration of the hunt (see "Sexual cycle") (Table 15).
15. Time and frequency of reflexological examination of females for pregnancy and infertility
Probes should be kept isolated from the uterine composition, fed on a par with producers. Communication of females with the probe should not exceed
- -1.5 hours. A longer stay of probes among the broodstock and especially joint grazing in the herd is not allowed, as this reduces the activity of probes. Females with signs of hunting, as they are detected by probes, should be immediately taken out of the corral.
External examination for pregnancy. It consists of three diagnostic techniques: examination, palpation and auscultation.
By examining the animal, it is possible to establish:
probable signs of pregnancy: a change in the contours of the abdomen, an increase in the mammary gland, swelling of the limbs, mammary gland and abdominal wall;
the true sign is fetal movement.
Palpation of the abdominal wall reveals only one true sign of pregnancy - the fetus.
Auscultation perceives the fetal heartbeat. Recently, ultrasonic devices have begun to be used to capture the activity of the fetal heart, which are very convenient for examining pigs and sheep.
Palpation and auscultation of the fetus should be carried out on the right along the line running from the knee joint forward to the hypochondrium, parallel to the spine. A positive diagnosis by this method in cows can be established not earlier than 5-6 months of fruiting. It is impossible to deny pregnancy on the basis of a study by an external method.
Ultrasound procedure. It can be carried out with portable or stationary devices. Lightweight portable devices work on the basis of the Doppler effect (the reflection of ultrasonic waves from the fetal blood moving through large vessels or the fetal heart) and allow you to determine the fetal pulse rate, which is much faster than that of the mother. The signals of the device are perceived by ear or viewed in the form of teeth on the screen. Stationary devices allow you to see the fetal bladder or fetus on the screen. This method is more suitable for examining pigs or small ruminants that have hairless skin on the abdominal wall for applying the probe of the device. To study animals of other species, hair must be removed at the site of application of the sensor. In pigs and sheep, 1-1.5 months after insemination, the diagnostic accuracy reaches 95%.
Vaginal method for diagnosing pregnancy. In cows, it allows you to identify the following signs of pregnancy:
dryness of the mucous membrane, its pallor and stickiness of mucus;
tight closure of the cervix and the presence of a mucous plug in its mouth;
palpation of the presenting parts of the fetus through the fornix of the vagina.
In general, the method has little practical value.
Rectal method of research on pregnancy. The most accurate method for diagnosing pregnancy and infertility in large animals is a rectal examination. All zootechnicians and veterinary specialists of the highest and secondary qualifications and technicians for artificial insemination of animals should own this method.
In large farm animals, this method makes it possible to flawlessly make a positive or negative pregnancy diagnosis and determine its timing quite accurately. It is based on identifying the condition of the ovaries, horns, body and cervix, uterine mesentery, as well as the uterine arteries passing through them and, finally, the fetus. In some cases, due to anatomical and topographic features, fetal palpation cannot be performed, and yet a complex of other true signs of pregnancy allows an unmistakable conclusion about the presence of pregnancy and even about its timing.
The main task of anyone seeking to use the method of rectal diagnosis of pregnancy is to learn how to find a non-pregnant uterus, and if a specialist has mastered this part of the method, it will not be a big problem for him to identify not only a pregnant or non-pregnant uterus, but also many pathological processes in the genital area that cause infertility.
Before the examination, it is necessary to cut the nails short on the hand that is used to work, and level them with a file or a whetstone. Without leveling, even short nails with sharp edges damage the intestinal mucosa, which is accompanied by bleeding.
During rectal examination, it is necessary to strive to comply with two conditions: 1) to prevent the introduction of the pathogen into the body of the animal under study and 2) to prevent the possibility of infection of the specialist from the animal under study and maintain the integrity of the skin of the hands. Compliance with the latter condition is important to keep in mind in mass studies, especially in the cold season. For outpatient admission, for prevention purposes, it is necessary to wash hands thoroughly with soap and rinse them with disinfectant after each examination of the animal. If the study is carried out on a household that is free from infectious diseases, it may be limited to rinsing the hands with warm water. The use of cold water for this purpose often causes occupational musculo-articular rheumatism of the hands or inflammation of the brachial plexus. Wounds and other damage to the skin are smeared with iodine solution and filled with collodion. It is advisable to use obstetric gloves that cover the entire hand. In this case, the glove worn on the hand must be covered with a layer of lanolin or moistened. You can not use Vaseline, as it spoils the rubber very quickly.
It is advisable to keep the animal on a semi-daily starvation diet or examine it before feeding, so that intestinal overflow does not impede palpation. Grabbing the root of the tail with one hand and pulling it to the side, with the other hand, carefully, smoothly, with drilling movements of the fingers folded in the shape of a cone, slightly open the anus and then expand it so that slit-like spaces form between the fingers. As a rule, with such manipulation, air begins to be drawn into the rectum, which is felt by the fingers and perceived by the ear in the form of a hissing sound. Following the entry of air, the animal shows signs of straining and an act of defecation occurs. It can be accelerated by stroking and light pressure on the rectal mucosa with the fingers, or by lightly massaging between thumb and forefinger its fold, captured at a distance of a few centimeters in front of the anus. Sometimes, after such a reception, the rectum is completely freed from the contents and further research proceeds without difficulty. But more often, after defecation, feces still remain in the rectum, which should be removed by hand, as well as feces, which are again introduced into the lumen of the rectum during the study. Failure to remove complicates the work, irritation of the rectum occurs, its wall becomes tense, which interferes with the palpation of the genital organs. In some cases, with sluggish intestinal motility and dense dry feces, it is advisable to put a warm enema.
When examining mares, care must be taken not to draw the hair of the tail into the anus with the hand; they cause irritation of the mucous membrane of the rectum and damage the skin of the hand.
The hand inserted into the anus first enters the ampulla-shaped extension. It is located in the pelvic cavity and, being attached by a connective tissue layer to the pelvic bones and the vestibule of the vagina, forms the most immovable part of the rectum. Therefore, it makes no sense to start palpation of the organs through the wall of the rectum in the area of its ampulloidal expansion. The hand should be inserted deeper. Following the feeling of spaciousness of the ampoule-shaped expansion of the rectum, the hand encounters its narrowed part, which forms several circular folds and kinks. In most cases, for free palpation of the uterus, it is enough to advance only four fingers into the narrowed part of the intestine, leaving the thumb in the ampulla-shaped part. In this position, the hand with the narrowed part of the rectum "put on" it can move to the right and left, since this section of the intestine is suspended on a rather long mesentery. Sometimes, when the hand is inserted beyond the ampoule-shaped extension, the narrowed section of the intestine sharply contracts, strongly squeezing the hand, and even makes it difficult to move forward, or, conversely, the intestinal lumen takes the form of an empty barrel-shaped cavity. Contractions should not be overcome by force: from hand pressure, the intestinal wall begins to contract even more, and with rough manipulations, there may be tears of the mucous membrane or even complete ruptures of the intestinal wall.
Rectal ruptures most often occur when a dry or inadequately lubricated hand is inserted into the anus. A dry hand encounters very significant resistance in the area of the sphincter, the examiner loses tactile sensations and, unnoticed by the fingers of the torn hand, causes perforation of the intestine. It should be palpated not with the ends of the fingers (the mucous membrane is easily injured by the nails), but with the crumbs, which, due to the abundance of nerve endings, perceive the subtlest sensations.
Clinical experience allows the researcher to capture the most favorable moments for palpation, characterized by complete relaxation of the intestine, which takes on the consistency of a rag. Such phases of relaxation occur periodically, during the peristaltic movements of the intestine, and follow the phase of tension. At the moment of tension of the intestinal wall, palpation gives almost no results. The weakening of the contractions of the rectum is either waited for 0.5-1 min (without removing the hand), or artificially caused by stroking the mucous membrane with the fingers in the area of its ampulloidal expansion.
After the release of the rectum from feces, at the moment of weakening the tone of its muscles, palpation of the genital organs can begin. It should be noted that only a systematic study (especially necessary for beginners) allows you to find all parts of the female genital apparatus and create a clear idea of \u200b\u200bits condition. Unsystematic research in most cases lengthens the work and does not provide the necessary ideas to the researcher. In addition, he, of course, must have a clear understanding of the morphology and topography of the uterus.
In cows, it is more convenient to start the study by looking for the cervix. The hand inserted behind the ampoule-shaped expansion of the rectum with the narrowed part of the intestine “put on” on it should be advanced to the middle of the pelvic cavity. By shifting the hand in this place to the right, to the left, forward and backward, they palpate the bottom of the pelvis, on which the cervix is found in the form of a dense tourniquet, which usually runs along the pelvic cavity. Finding the cervix represents the most essential part of the method. In the stage of excitement, during pregnancy and with some pathological processes in the uterus or ovaries, the neck can be shifted into the abdominal cavity, to the side and up; Based on this, if the cervix is not found in the pelvic cavity, it is necessary to palpate the anterior part of the bottom of the pelvic cavity, its side walls, in particular, to systematically examine the lower edge of the entrance to the pelvis. When lowering the uterus into the abdominal cavity at the anterior end of the pubic fusion, it is possible to feel the uterus, cervix or vagina in the form of an elastic or dense tourniquet.
After determining the condition of the cervix, the horns and ovaries are examined. To do this, without letting go of the found part of the uterus from under the fingers, the hand is moved back and forth. Posteriorly, the fingers easily detect the vaginal part of the cervix, which is distinguished by its density and a sharp, blunt ending. When moving the hand forward, the crumbs of the fingers pass to the body and horns of the uterus. Upon reaching the level of the inner mouth of the cervix, the fingers feel the body of the uterus 1-2 cm long, which differs from the cervix in a more doughy or elastic consistency. Further anteriorly, the fingers begin to distinguish the beginning of the interhorny sulcus in the form of a longitudinal depression located between two rollers - the horns of the uterus. The middle finger is inserted into the interhorn groove, and the surface of the uterine horns is palpated with the index and ring fingers, slightly spreading them apart. At the same time, the thumb and little finger should cover the entire uterus from the sides. Moving forward beyond the bifurcation of the horns, move the hand to the right horn. It is convenient to grab between the palm and the crumbs of the fingers. Following cranially and downwards, the fingers follow the curves of the horn and encounter the ovary. The latter can be easily grasped by hand; palpation manages to create a clear idea of its shape and consistency.
Without releasing the horn, one should move the hand back to the bifurcation and palpate the left horn and ovary in the same order. If during such a transition the uterine horn slips out, it is better to start the study again from the cervix and interhorny sulcus.
In some cases, palpation of the ovaries is difficult due to their pulling under the body of the uterus. Then, after palpation of the body and uterine horns, the hand is placed along the body of the uterus so that the palm is located on the neck, and the fingers are on the interhorny groove and horns. By shifting the hand from the uterus to the side to the bottom of the pelvis and moving it medianly under the body of the uterus, you can easily find the ovary, which stands out with an oval shape and elastic consistency.
If the cervix cannot be found, the beginner can use the other hand as well. For this purpose, the pre-treated left hand is inserted into the vagina and the vaginal part of the cervix is captured with it. With the right hand, the left hand is easily felt through the rectum and the vaginal part of the cervix is found along it (it is more convenient and expedient in a prophylactic sense that an assistant inserts his hand into the vagina). Sometimes it is useful to pull the uterus down into the abdominal cavity by the neck with a hand inserted into the vagina. Finally, a system of finding the uterus by ligaments can be applied (see "Rectal diagnostic method in mares"). Palpation of the uterus and ovaries should be carried out only at the time of relaxation of the intestine.
Laboratory methods for diagnosing pregnancy and infertility. Based on the identification of specific changes in the hormonal function of the ovaries or placenta, the metabolism of the mother and the metabolic products of the fetus entering her body. Of the numerous laboratory methods for diagnosing pregnancy, the most accurate are hormonal. To detect hormones, blood serum, urine or milk is examined. To detect gonadotropic hormones, the blood serum of the studied female is administered in various doses to several infantile mice or rats. The result is evaluated after 100 hours by examining the ovaries, in which ovulated follicles are found.
A faster answer can be obtained using the F. Friedman method. In animal husbandry, a modification of this reaction is used. An isolated female rabbit is injected into the ear vein with 10 ml of the blood serum of the studied female. 36-48 hours after the injection, a laparotomy is performed, and if gonadotropins were present in the blood serum, then hemorrhages are found in the ovaries at the site of ruptured follicles, as well as follicles with blood-filled cavities (Fig. 56). After the wound of the abdominal wall has healed, after 2-3 weeks, the rabbit can again be used for a bioassay. In a mare in the period 1.5-
- months of pregnancy, the accuracy of determination reaches 98%.
day of pregnancy, folliculin (estrogens) can be detected in the urine by a bioassay on ovariectomized mice according to the method of S. Aschheim and B. Tsondek or by the physicochemical method according to G. Ittrich. The number of correct diagnoses reaches 98%. In recent years, diagnostics of pregnancy by detecting progesterone in blood serum or milk by radioimmunological or other methods is more often used abroad. Material for research is taken after insemination: in mares after 18-23 days, in cows after
- 23, in sheep after 17-20, in goats after 22-26, in pigs after 20-24 days. The diagnostic accuracy ranges from 60-100% (D. Kust, F. Shetz).
- day after insemination (D. Kust, F. Shetz).
DIAGNOSTICS OF PREGNANCY AND INFERTILITY OF COWS AND HEIFERS
In a barren cow, rectal examination reveals the following characteristic symptoms. The cervix, body, horns of the uterus and ovaries are located in the pelvic cavity (in animals that have given birth a lot, old ones, the uterus can descend into the abdominal cavity even in the absence of pregnancy). On palpation of the uterus, the interhorny sulcus and symmetrically located, equal size, the same shape and consistency of the uterine horns are clearly palpable. If you stroke the surface of the uterus with your hand, the horns contract; their consistency becomes elastic and even
Rice. 56. Rabbit ovaries: on the left - with a positive reaction to pregnancy; on the right - with a negative (according to N. A. Flegmatov)
the most accurate hormonal diagnostic methods can be used in most cases at such terms of pregnancy when it can be diagnosed by clinical research methods. Most other methods of laboratory research often give wrong answers. Research to further improve existing and develop new methods of laboratory diagnosis of pregnancy and infertility continues.
almost solid. The uterus can be freely grasped with the palm and fingers. The contracted uterus is felt as a hemispherical smooth formation, divided into two symmetrical halves by an interhorny sulcus and a bifurcation. At the time of contraction, it is convenient to compare the size and shape of the uterine horns. In cows that have given birth a lot, the right horn is usually somewhat thicker than the left. The size and shape of the ovaries are not constant, which depends on the functional state of the female genital area. Usually one of the ovaries is larger due to the presence of a corpus luteum or large follicles in it (Fig. 57,-4 and B).
- month of pregnancy. The cervix in the pelvic cavity; the horns of the uterus are located at the end of the pubic fusion or descend somewhat into the abdominal cavity. The uterus does not respond to stroking or the contraction of the horns is weakly expressed. The fruiting horn is somewhat larger than the free horn, its texture is looser, flabby; sometimes by the end of the first month it is possible to establish a fluctuation in it. The ovary of the fetal horn is larger than the ovary of the free horn; in it, as a rule, the corpus luteum is well felt.
- month of pregnancy. The uterine horns and ovaries are lowered into the abdominal cavity. The cervix moves from the middle of the pelvic cavity to the entrance to the pelvis. The fruiting horn is twice as large as the free horn; when it is palpated, a tight fluctuation is felt, sometimes extending to the free horn. The tissues of both horns are flabby, soft, juicy. Horns slowly, sluggishly or almost do not contract when stroking them. The interhorny furrow is somewhat smoothed, but still quite well detected. The shape and position of the ovaries are the same as in the first month of pregnancy, except for the corpus luteum; follicles are often palpated (Fig. 57, B).
- month of pregnancy. The horn-fetal place is 3-4 times larger than the free horn, so the interhorn furrow is not palpable. The uterus appears as a fluctuating bubble with faintly perceptible contours the size of an adult head; it is easy to mistake for a full bladder. However, finding the cervix, establishing its close connection with the fluctuating formation, and, finally, identifying the bifurcation of the horns in the region of the cranial part of the uterus, make it possible to make sure that the palpable formation is the uterus, and not the bladder. Ovaries unchanged; they are located in front of the pubic fusion on the lower abdominal wall (Fig. 57, D).
- month of pregnancy. The uterus is in the abdominal cavity, the cervix is at the entrance to the pelvis or is somewhat lowered into the abdominal cavity. The uterus is felt as a weakly fluid-filled, fluctuating thin-walled sac, in which the fetus and, as a rule, the placenta, the size of a hazelnut or bean, are sometimes felt. Larger placentas (up to a pigeon's egg) are found along the greater curvature of the horn-fetus. To identify the placenta, two methods are used:
- they capture the wall of the uterus with the thumb and forefinger and, palpating its individual sections, identify the placenta and get an idea of their size;
- determine the size of the placenta by palpation of the uterus with the whole hand. To do this, having found the cervix, move the hand forward, put it on the fluctuating part of the uterus and press the uterus against the lower abdominal wall with uniform light pressure. Under the influence of light pressure, the fetal waters are displaced and the hand feels a bumpy surface formed by overgrown placentas. Sometimes fluctuation is not felt at all (when the uterine wall relaxes, amniotic fluid descends into the tops of the uterine horns) and the uterus with its placentas is palpated in the form of a tuberous tourniquet located on the lower abdominal wall in front of the pubic fusion. In a fed animal, the uterus protrudes into the pelvic cavity.
th?
Rice. 57. Determination of pregnancy and infertility of a cow by the rectal method (according to A.P. Studentsov):
L - palpation of the non-pregnant uterus of an old cow; B - contracted non-pregnant uterus; B - 2 months of pregnancy; G- 4 months of pregnancy; L - scheme of blood supply to the uterus at the 4th month of pregnancy; ?-7-8 months of pregnancy; / -bifurcation of the uterine horns; 2- right horn of the uterus,.? -ovary; 4- rectum; 5 - wide uterine ligament; 6 - the left horn of the uterus; 7- interhorny furrow; 8- bladder; 9 - ilium and 10 - sacrum; 11 - vagina; 12 - the body of the uterus; 13 - the bottom of the pelvis; 14 - cervix, / 5 - posterior uterine artery; 16- aorta; / 7 - middle and 18 - anterior uterine arteries; 19- ovarian branch of the anterior uterine artery; 20- branch leading to the horn; 21-
placenta
In the early stages of pregnancy, the vibration of the wall near the place where the artery leaves the aorta is not felt. To obtain a tactile sensation of vibration, it is necessary to go down a little along the vessel to the periphery. Moving the hand forward to the posterior mesenteric artery (a. mesenterica caudalis, s. posterior), one should return backward along the vertebral bodies, skip a large, almost perpendicularly running vessel - the pelvic artery (a. iliaca externa) and then palpate the middle uterine artery (Fig. 51, D).
- month of pregnancy. Basically the same symptoms as at 4 months. The placentas near the cervix reach a size of 2 x 4-2 x 5 cm. The vibration of the middle uterine artery is clearly felt from the side of the horn-fetus; the artery of the free horn is unchanged or vibrates weakly. The fetus is often palpable.
- month of pregnancy. uterus in the abdomen; sometimes (with a short scrotum of the rectum) its horns are not palpable. Neck in the abdomen. The fetus is usually not palpable, being displaced far forward and down. Placenta the size of a small chicken egg are freely detected. The wall of the uterus is slightly tense, so sometimes the fluctuation is almost not felt. The vibration of the middle uterine artery of the fetal horn is strongly pronounced, and the vibration of the middle uterine artery of the free horn is weak.
- month of pregnancy. The signs are the same as at 6 months.
To determine the state of the posterior uterine artery, it is necessary to attach the palm to the side, to the wide pelvic ligaments, and here to find the middle, hemorrhoidal artery, which runs parallel to the spine. Above the middle part of the small sciatic notch of the pelvis, a freely moving posterior uterine artery departs from it downwards.
- month of pregnancy. The cervix is located at the entrance to the pelvic cavity or in the pelvic cavity. On palpation, the presenting organs of the fetus are easily palpated. The size of the placenta varies between small and large chicken eggs. Both middle arteries and one posterior uterine artery vibrate very clearly.
- month of pregnancy. The cervix and presenting organs of the fetus in the pelvic cavity. The vibration of the middle and posterior uterine arteries on both sides is clearly expressed. The presence of harbingers of childbirth.
Individual fluctuations can, for example, be observed in the strength and timing of the appearance of vibrations of the walls of the uterine arteries. According to A.E. Volokhin, in 20% of cows, already at the 2nd month of pregnancy, a weak vibration of the uterine artery of the pregnant horn is noted, and in some cows the artery of the free horn of the same name does not vibrate even at the 8th month. The size of the placenta can also vary significantly. Regardless of in which part of the uterus the size of the placenta is determined, when judging the term of pregnancy on this basis alone, an error can be made within 1-2 months. An anomaly of the placenta is described in the literature, which consisted in the fact that the cow, along with typical placentas, had areas built according to the type of scattered placenta and completely free from villi. Apparently, due to such anomalies, sometimes it is not possible to probe the placenta at all, despite the presence of all other signs of pregnancy. In very well-fed cows, it is sometimes impossible to palpate through the rectum not only the vessels, but also the uterus due to the strong thickening of the rectal wall due to the abundant deposition of fat.
DIAGNOSIS OF PREGNANCY AND INFERTILITY IN BUFFALES
Marin Khubenov (Bulgaria), on the basis of his research, came to the conclusion that in buffaloes, the external method does not make it possible to diagnose pregnancy. The elongated chest, thick abdominal wall and the small size of the fetus do not allow you to successfully feel the fetus and listen to its heartbeat. The configuration of the abdomen also changes little.
Rectal examination. This method can establish both pregnancy and infertility. From the 1st month, the diagnosis is made on the basis of taking into account the position of the uterus, asymmetry of the horns, fluctuations, thinning of the wall of the uterine horn and the presence of a well-defined corpus luteum of pregnancy. The signs of infertility in buffaloes are the same as in cows. Placenta and vibration of the vessels of the horn-fetus are detected after the 4th month of pregnancy. At 6 months, the uterus descends into the abdominal cavity, at the 9th month, the organs of the fetus are probed in the pelvis.
Diagnosis of infertility performed on both men and women. There are several types of infertility diagnostics, for reliability it is desirable to resort to several methods.
Infertility affects every fourth couple - its causes are different, sometimes very difficult to determine. Experts say that the most common in women are hormonal disorders, while for men it is more often abnormal sperm parameters. You can talk about infertility when a couple tries to get pregnant within a year. Then both partners are advised to contact a specialist. The first step to solving a problem is to try to determine its cause - this is carried out infertility diagnostics, which consists of a number of studies.
Diagnosis of female infertility
The doctor should clarify: the date of the last menstrual cycle, the regularity of the cycle, medical history, as well as hospital records (operations, treatment, births, abortions), ask about lifestyle (working schedule, rest). Then conduct a gynecological examination (to assess the structure and condition of the genital organs, will conduct a bacteriological examination to detect any violations) and an ultrasound examination (thus, it is possible to more clearly assess the condition of the reproductive organs, the shape and size of the uterus, the thickness of the endometrium, to detect abnormalities). Only after that, the doctor will send for the appropriate examination.
Types of diagnosis of female infertility
As a rule, the first will be a blood test (test and thyroid gland). Then he moves on to more complex diagnostics to determine the sequence and methods of optimal treatment. Your doctor may order tests such as:
Ovulation monitoring
is a vaginal ultrasound examination, which is performed every 2-3 days, from the 10th day of the cycle. Thanks to it, it is possible to evaluate the growth of follicles, cracking and growth of the endometrium after ovulation stimulation (drugs are taken before the test to increase the bladder).
Stimulation of ovulation
. The purpose of this test is, or the growth and destruction of vesicles of follicles in the ovaries. On examination, the doctor can assess the growth and destruction of follicles in the ovaries (growth is caused pharmacologically - the patient takes drugs that stimulate ovulation before the study) and the endometrium in the uterine cavity.
Hysterosalpingography (HSG)
, the study of patency of the fallopian tubes is the process of applying a label through the cervical canal into the uterus and fallopian tubes, after which x-rays are taken. As a result, the doctor can determine the shape and size of the uterus, assess the patency of the fallopian tubes, and remove any irregularities. The test takes a few minutes, it is safe. 
Laparoscopy
- performed under general anesthesia. Through a small incision in the abdominal wall, small surgical instruments are inserted into the abdominal cavity so that the doctor can better diagnose the permeability and mobility of the fallopian tubes, identify endometriosis and eliminate if necessary. 
Hysteroscopy
- shooting with an endoscope (an optical eye is inserted through the vagina into the uterus - histeroskopu). This allows the doctor to see and evaluate the endometrium, the size of the uterus, the fallopian tubes of the mouth, see the damage, and then remove the bumps. 
Hydro laparoscopy
(hydro - laparoscopy)
is an endoscopic examination that is performed through the vagina. With its help, the doctor can assess the size of the pelvis, the fallopian tubes, the patency of the fallopian tubes, the presence of adhesions and endometriosis in the abdominal cavity and in the uterine cavity.
Transvaginal endoscopy
is a procedure performed under general anesthesia. It consists in the introduction of micro-instruments with a fiber-optic cable and a camera (through the vagina) into the pelvis. Marker fluid is then injected and the doctor observes whether it flows through the fallopian tubes, so he can evaluate the patency of the fallopian tubes, as well as the condition of the pelvic peritoneum and fallopian tubes.
Biopsy of the endometrium
(uterine mucosa) - this is done under short-term local or general anesthesia. With the help of micro-instruments, a piece of the endometrium is taken, which is subjected to tests: histopathological, assessment of the endometrium and the regularity of the menstrual cycle.
Examination of cervical mucus
- consists in the study (under a microscope) of the number and motility of spermatozoa collected within 24 hours after intercourse. As a result, the doctor can evaluate the so-called "cervical mucus hostility", i.e., the extent to which spermatozoa are able to pass through the mucus barrier.
Diagnosis of male infertility
.
The man, by masturbation into a sterile container, receives semen. Thanks to this study, it is possible to assess its fertility, as well as determine the parameters of sperm: the volume, structure and motility of spermatozoa. A study of bacteriological and enzyme immunoassay of semen (antisperm antibodies and detection of bacteria) is also carried out. 
Andrological study
- this is a study of the organs of the reproductive system (through the anus and during ultrasound). As a result, the doctor can evaluate the structure of the testicles and penis, detect pathologies (hernias, cryptorchidism, varicose veins, phimosis).
Hormonal tests
- blood test. Most often it is: testosterone, prolactin, androstenedione, FSH, LH, estradiol.
Testicular biopsy
- involves the collection, under general or local anesthesia, of a small piece of nuclear tissue. This allows you to get information about the presence or absence of germ cells and spermatozoa in the testes. 
Vasography
- This is an X-ray examination of the vas deferens after intravenous administration of a marker. With its help, the doctor can assess the patency of the ducts, as well as detect obstacles in the wires that remove the seed. This study is rarely performed, most often after a preliminary constriction of the vas deferens.
It has been scientifically proven that a period of 12 months is sufficient to determine the fertility level of almost any couple, provided that this couple lives a regular sexual life. According to statistics, with systematic unprotected intercourse, pregnancy in the first 3 months occurs in 30% of couples, within six months - in 60% and in 10% - during the first year.
If pregnancy has not occurred after the allotted period, there is every reason to consult a doctor. A comprehensive examination for infertility is the most correct solution in this situation, as it will allow you to determine the presence or absence of a reason that prevents you from conceiving a child. Optimally, an appeal to a specialist should be carried out even at the stage of the child, which will help eliminate the possible risks of the birth of handicapped children (with congenital diseases and anomalies), complications in the process of gestation and childbirth.
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A woman who wants to get pregnant should also think about visiting a gynecologist if she has the following signs:
- hyperprolactinemia (elevated levels of prolactin in the blood, which causes irregular menstruation);
- a sharp decrease in body weight;
- the complete absence of a woman's menarche;
- the hairline in the genital area is located according to an abnormal type (vertically directed, excessive, insufficient);
- underdevelopment of the mammary glands;
- spontaneous miscarriages and miscarriage in history;
- absence .
The above symptoms of infertility are quite common, so it is important to pay attention to them as soon as possible.
Female infertility: examination stages
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The diagnostic process in case of suspected infertility in the family should begin with an examination of the future dad. today occurs with the same frequency as in women. If during the examination no causative factors were found on the part of the husband, then they begin to diagnose the woman. It includes many items, starting with a survey and ending, if necessary, with a laparoscopy.
Taking an anamnesis is the first step in diagnosing infertility
A consultation with a gynecologist is very important at the beginning of the examination for infertility. It allows the doctor to assess the picture of the problem as a whole and identify for himself the possible causes of infertility.
Assessing the gynecological health of the patient, the doctor asks her about the following points:
- Symptoms that bother (general well-being, duration of absence of pregnancy, pain “before” and “during”, sudden weight loss or weight gain, discharge from the chest and vagina).
- Family history (the presence of gynecological pathologies in the mother, relatives, age, Rh factor and husband's health, bad habits).
- Medical history (surgical interventions, infections that the woman had earlier, injuries, gynecological and other diseases).
- Menstrual function (age of the first menarche, regularity, duration, pain of menstruation, amount of discharge).
- Sexual function (beginning of sexual activity, methods of contraception used, regularity of sexual intercourse, number of marriages and partners, level of libido, presence of orgasm, discomfort during sex).
- Childbearing function (the number of pregnancies and live children, spontaneous and induced abortions, the course of previous pregnancies, complications in childbirth).
- The results of examinations and treatments that were carried out earlier.
Objectively, the gynecologist assesses the general condition of the patient:
- body type;
- condition of mucous membranes and skin;
- the nature of hair growth;
- development and condition of the mammary glands.
He also palpation examines the thyroid gland, the abdominal region, takes into account the numbers of blood pressure and body temperature of a woman.
Special gynecological examination for suspected infertility
It is carried out with the help of gynecological mirrors on the chair. During the procedure, the doctor evaluates the condition and degree of development of the genital organs (internal and external), the type of pubic hair, the appearance of secretions and their nature. The presence of deviations in the structure of the genital organs can be a symptom of infantilism and other congenital anomalies of the reproductive system.
Excessive hair growth in the male pattern indicates hormonal problems. Discharge is a sign of an inflammatory or other pathological process in the vagina, which requires the appointment of additional tests to identify the pathogen.
Functional Tests
An examination for infertility also necessarily includes functional tests that provide information about the nature of ovulation, the level of female hormones, and the presence of antisperm bodies.
It uses:
- cervical index. This study reflects the quality of cervical mucus, expressed in a point system. It evaluates the level of estrogen saturation of the female body.
- Basal temperature. Based on the daily measurement of the temperature in the anus, a curve is built. Its analysis gives a picture of the monthly cycle, confirms the presence or absence of ovulation, ovarian activity.
- Postcoital test. It is performed for a more detailed study of the activity of spermatozoa in the mucus on the cervix.
Necessary tests for infertility
The most valuable studies in terms of information are tests for hormone levels, for which urine and blood are taken from a woman.
For the diagnosis of infertility are shown:
Important: in All of these tests should be done some time after a gynecological examination and sexual intercourse, given that the level of certain hormones may vary.
Instrumental and hardware diagnostics of infertility in women
These survey methods include:
They are resorted to if there is a uterine form of infertility. Surgical diagnostic technologies are very highly informative and less traumatic.
Most often this is used:
- Hysteroscopy- this is a procedure for examining the uterine cavity using an optical device that is inserted into the uterus through the external pharynx - the cervix. It is performed under general anesthesia in a hospital. The doctor can not only examine the condition of the uterus from the inside, but also identify and immediately remove pathological formations (cyst, polyp).
The birth of a baby is the most important event in a family. But not everyone manages to have children due to diseases of the reproductive system. Modern medicine has learned to overcome these problems, now doctors have a whole arsenal of tools, from drug therapy to "heavy weapons" in the form of assisted reproductive technologies. IVF procedures are not only a serious test for the female body, but also a very expensive service. In pursuit of profit, many "fertility clinics" do not even try other methods of treatment, going straight to the most expensive service - IVF. The doctors of the Moscow clinic Vitalis specialize in restoring reproductive function without in vitro fertilization. We try to use sparing methods of treating infertility and recommend that couples use ART only in cases where this is really the only way to achieve pregnancy. Our doctors help couples cope with the diagnosis of infertility and become parents.
How common is the problem?
According to the criteria of the WHO (World Health Organization), a 15 percent level of infertile couples of reproductive age is considered a threat to the country's national security. In Russia, this figure is 17-20% and has a negative trend. This dry statistics means that every fifth family of our friends and acquaintances is faced with the problem of infertility.
When is infertility diagnosed?
The WHO official definition states: "Infertility is the inability of a sexually active, non-contraceptive couple to achieve pregnancy within one year." Of course, there is a chance of getting pregnant later, but the highest chances of pregnancy are in the first year (provided that the couple is not protected), then the chances decrease every year. If you did not manage to get pregnant in the first year - do not waste precious time and seek help from a doctor.
Although the wording of the diagnosis speaks of the inability of the couple to achieve pregnancy, it is a common misconception that the cause is more often in the woman. This is not surprising, since even 10 years ago, even doctors did not consider the “male factor”. Medical centers often and now under the treatment of infertility mean the treatment of a woman, and men draw a direct connection between their "male power" and the ability to reproduce (note, completely unfounded). According to the European Association of Urology, in 50% of cases, the absence of pregnancy is associated precisely with problems in a man. Therefore, it is better for a married couple to immediately come to the clinic together for the first consultation. This will significantly reduce the time to find out the cause of infertility in your particular case. It is also worth considering that treatment in men is a longer process than in women, which is associated with different cycles of maturation of spermatozoa and eggs (the process of spermatogenesis takes almost three months, unlike the usual 1 month for women).
Factors affecting reproduction in men
Fertility problems can result from smoking or alcohol abuse, taking antidepressants, or having a sexually transmitted disease. Ecology has also contributed: over the past half century, as a result of environmental degradation and an unhealthy lifestyle, the concentration of sperm in the sperm of men has decreased by 2 times.
Violations of spermatogenesis can develop as a result of nervous stress, a state of chronic fatigue and lack of physical activity.
Spermatogenesis proceeds normally at a temperature a few degrees below body temperature, excessive heat causes damage to young germ cells. A short-term increase in body temperature above 39 ° C can seriously inhibit spermatogenesis, normal sperm activity is restored only after 2.5 months. For this reason, overheating of the genitals caused by frequent visits to the sauna, the use of seat heating in a car, wearing thermal underwear, etc. is harmful for men.
Well, the "scourge" of modern men is becoming overweight. It has been proven that overweight in men, especially those with central obesity (pronounced "belly"), causes a decrease in the number and deterioration of the quality of spermatozoa and directly leads to a decrease in the likelihood of natural conception.
Factors affecting reproduction in women
There are several classifications of female infertility, but from a practical point of view, the most important is the one based on pathological and genetic factors that led to infertility. It is on the basis of it that the attending physician determines the method of treatment.
According to this classification, the following types are distinguished:
| View |
Explanation |
|
Uterine |
This type includes various gynecological diseases with a violation of the state of the endometrium, but with preserved patency of the fallopian tubes (internal and external endometriosis, uterine fibroids, endometrial polyps, endometrial hyperplasia, endometritis, etc.). |
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It implies obstruction of the fallopian tubes as a result of the adhesive process (as a result of inflammatory processes in the pelvic organs or operations). As a result, sperm cannot reach the egg, or the fertilized egg cannot descend into the uterine cavity. |
|
|
Endocrine |
It means an imbalance in the hormonal profile of a woman, when a deficiency or excess of various hormones makes it impossible for the normal process of egg formation. |
|
Immunological |
Associated with the production in the female body of antibodies to the sperm of a partner. The antibodies attack the spermatozoa and destroy them. There are no visible causes of infertility, because. the pregnancy is terminated so early that the woman does not have time to notice it. |
|
Psychological |
Caused by stress (including chronic sleep deprivation and dieting) or a state of chronic fatigue |
|
idiopathic |
That is, unexplained. Such a conclusion is made if, as a result of the examination, it was not possible to find the reason for the absence of pregnancy. |
Hormonal disorders are one of the most common causes of infertility. Below are the most common endocrine disorders.
| Hormone |
Impact on the reproductive system |
|
Testosterone |
It is one of the factors in the development of a dominant follicle. Elevated testosterone can lead to the formation of a functional cyst, since the follicle does not rupture during ovulation. |
|
Estradiol |
The hormone is responsible for the growth of the endometrium in the uterus and the attachment of the embryo directly to the functional layer. If the level of estradiol is below normal, the likelihood of becoming pregnant and bearing a child is negligible. |
|
LH (luteinizing hormone) |
Stimulates the production of estrogen by the ovaries, which contribute to the onset of ovulation. With LH deficiency, the dominant follicle capsule will not rupture and the egg will not be able to be released. |
|
Prolactin |
The level of prolactin during pregnancy rises, since the main task of this hormone is to prevent the onset of a second pregnancy if fertilization has already occurred. Therefore, an excess of prolactin outside of pregnancy leads to the suppression of ovulation, which makes pregnancy impossible. |
Normal values of hormones that affect the reproductive function of a woman
| Hormone |
Unit |
follicular phase |
ovulation |
luteal phase |
postmenopause |
|
LH (luteinizing hormone) |
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|
FSH (follicle stimulating hormone) |
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|
Prolactin |
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|
Estradiol |
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|
Progesterone |
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|
Testosterone |
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What examinations are needed?
To choose the right tactics for the upcoming treatment, it is extremely important to find out the exact cause of infertility, for which it is necessary to conduct a diagnosis. You can undergo an examination and pass all the necessary tests at our clinic. If you have previous test results, please bring them with you.
Diagnosis of infertility in men
- appointment with a urologist-andrologist
- Ultrasound of the reproductive system (prostate, scrotum organs)
- spermogram + MAR test
- STD diagnostics
- hormonal blood test
Additional examinations may be required at the discretion of the doctor:
- Genetic analyzes
- Sperm DNA fragmentation
- acrosomal reaction analysis
- biochemistry of seminal fluid.
Diagnosis of infertility in women
The basic examination includes:
- gynecologist's appointment
- Ultrasound of the pelvic organs (on the 10-16th day of the cycle)
- hormonal blood test (taken on the 2nd or 3rd day of menstruation)
- diagnosis of infectious diseases (PCR smear)
- ovulation assessment (ovulation test strip)
Additionally, the doctor may decide to conduct the following diagnostic procedures:
- colposcopy
- genetic research
- postcoital test
- hysterosalpingography (HSG)
- hysteroscopy
- laparoscopy
Diagnosis of infertility in women takes longer than in men, because many tests and studies need to be carried out only on certain days and phases of the cycle.
The ovulation test strip gives a result after contact with urine, namely, it shows the concentration of luteinizing hormone (LH), the level of which rises a few hours before ovulation. Do an ovulation test every day, this will not miss the moment when the LH level reaches its maximum. If you have a regular menstrual cycle, subtract 17 from your cycle length and you will get the day of the cycle on which you need to start doing ovulation tests. Cause of infertility
Method of treatment
Hormonal disorders
Drug therapy with drugs designed to restore (for example, with testosterone deficiency) or, conversely, to lower (as with an increased level of prolactin) the production of the corresponding hormone.
Infectious diseases (STDs)
Course of antibiotics
Parenchymal infertility (sperm density and motility below normal)
Medical therapy or surgery depending on the cause
Obstructive infertility (no sperm in the ejaculate)
Surgery, ICSI (in vitro conception)
Methods of treatment in women
| Type of infertility |
Method of treatment |
|
Royal |
The most effective is the surgical method. Before the operation, a hysteroscopy is performed - an examination of the uterus for changes and abnormalities. |
|
Fallopian tube obstruction is treated using a laparoscopic technique. In addition to laparoscopic surgery, an effective way to eliminate violations is the IVF procedure. It gives a positive result even in cases where there is severe tubal damage or microsurgery was insufficient. |
|
|
Endocrine (hormonal) |
At the first stage, the treatment will be aimed at normalizing the functioning of the endocrine system. After that, drug treatment is applied to stimulate ovulation. In 60% of patients who have undergone hormonal infertility treatment, pregnancy occurs within six months. With hyperprolactinemia, these figures reach values of 80-90%. |
|
Immunological |
With immunological infertility, the body produces antibodies to its own cells (embryo) or partner cells (spermatozoa). The most effective method for today is the method of correction with the help of IVF |
|
idiopathic |
Modern research methods have reduced the proportion of such cases to 8-10%. The greatest effectiveness in infertility of unknown origin is shown by drug stimulation of ovulation and ART methods. |
Vitalis clinic doctors specializing in infertility treatment
