The main causes of female infertility. Types of female infertility and factors contributing to its occurrence Types of infertility in women

Inability to conceive and give birth healthy child often becomes big problem for the family. Infertility or female infertility is said to occur when a woman does not use contraceptives for a year, has regular sex life, but cannot become pregnant. The period is reduced to 6 months if the woman is over 35 years old. There are plenty of reasons that deprive a young family of the happiness of becoming parents. That is why confirmation of the diagnosis of infertility requires a thorough examination of both partners in order to determine the causative factor (or several factors), and most importantly, to correctly and adequately select treatment.

Please note: Today, every 5 or 6 marriages face the problem of infertility. As a result, more than 60% of such families break up, so this problem, in addition to being physiological, is also of a social nature.

Types and degrees of female infertility

Infertility in women can be:

• acquired, formed due to gynecological pathologies and negative influence endogenous factors;
• congenital, provoked by underdevelopment or other defects of the genital organs;
• physiological – this is infertility caused by puberty or postmenopausal age;
• voluntary, when infertility is consciously chosen by a couple or a woman in the form of using or taking contraceptives (pills, injections, patch, spiral);
• temporary, develops due to prolonged nervous shock, stress, decreased immunity (some sources also include lactational amenorrhea, which develops with regular breastfeeding after childbirth);
• permanent is infertility, which occurs in the case of an ectomy (removal) of the genital organs. It can be full or partial.

Important: Sometimes miscarriage is mistaken for infertility. In the latter case, we are talking about a miscarriage, which occurs after successful fertilization of the egg, but at the stage of embryogenesis it is not implanted or is rejected from the uterine cavity.

Infertility is also divided into three degrees: infertility I, II, III degrees.

I degree infertility

It is also called primary, and it means that the patient has not had any previous pregnancies, and she is seeking help because of the inability to conceive a child for the first time. After 12 months of unsuccessful attempts, a woman has every reason to make an appointment with a specialist to find out the cause.

In most cases, 1st degree infertility is the result of an acquired or congenital pathology of the female reproductive system. Modern medicine has in its arsenal many therapeutic techniques that allow you to get pregnant even in very severe cases of infertility. Therefore, you should not lose hope, and it is best to entrust your health to professionals.

II degree infertility

This is secondary infertility, occurring in women who have already had pregnancies and ended in childbirth. However, the patient’s repeated attempts to become pregnant were unsuccessful. It will be divided into relative, when a woman can be cured, and absolute, incurable.

III degree infertility

III degree is absolute infertility caused by the absence of part of the genital organs or the presence of congenital abnormalities of the reproductive system. In this case, a woman may have absence of ovaries, hypoplasia of the uterus, and ugly changes in the genital organs.

Infertility in women: main causes

There are many factors that cause infertility. In one patient it can be caused either by one or nearby various reasons that prevent you from conceiving a child. Let's look at some of them.

Infertility of a woman due to disturbances in the ovulatory cycle

This reason occurs in 4 out of 10 women who cannot get pregnant. The absence makes conception impossible, since the follicle does not mature. This menstrual cycle is called anovulatory; menstruation may be present, but it is often irregular.

Female infertility due to obstruction of the fallopian tubes

This pathology is caused by either damage or blockage of the fallopian tubes, where human reproductive cells should normally meet: sperm and egg. Most often, tubal obstruction occurs after operations on the abdominal organs (gastric resection, hernia removal, appendectomy) because surgical intervention adhesions are formed.

In the development of such infertility, inflammation of the tissues of the genital organs – salpingitis and endometritis – also plays a significant role. Abortion and ectopic pregnancy history of sexually transmitted pathologies (trichomoniasis, syphilis,) – frequent occurrences in women with tubal obstruction, they also cause an inflammatory and adhesive process.

Please note: Obstruction fallopian tubes does not allow the release of the egg into the uterus, but at the same time significantly increases the risk of ectopic, that is. That is why, if the diagnosis of tubal obstruction is confirmed, you should definitely undergo treatment, refraining from trying to get pregnant during the period of therapy.

Female infertility due to endometriosis

is the proliferation of endometrial cells, which normally lines the inner layer of the uterus, in atypical places in the body, from the intestines to the nasal mucosa. Its result can be adhesions in the abdominal cavity, obstruction of the tubes, inability to mature the follicle, and bleeding. The likelihood of developing endometriosis is always individual for each woman, as it is determined by genetic and immunological factors.

Psychological infertility

It is diagnosed in 3 out of 10 infertile couples and indicates the presence of disturbances in the functioning of nervous system. Whether a woman is ready to conceive is most often determined by her brain. If a negative attitude is formed regarding conception, then the woman at the subconscious level perceives pregnancy not as a physiological process, but as a potential danger or threat to her body.

This attitude is created in most cases due to psychotrauma or phobia (getting fat, losing good job, etc.). This condition requires mandatory consultation with a psychologist, who will certainly help you look at the situation from the outside and cope with your fears.

Cervical factor in the formation of infertility in women

It consists of a violation of the composition and properties of cervical mucus, the task of which is to ensure the passage of sperm to the egg through the fallopian tube. This does not happen if there is insufficient mucus, it is very viscous, its physiological composition and acidity have changed. Mucus effectively protects sperm from negative impact the internal environment of the vagina, and provides them with additional energy so that they can reach the fallopian tubes. Despite this, in some cases it is the cervical mucus that causes the death of sperm. This reason occurs against the background of infections, , with problems in the functioning of mucus-producing glands, polyps.

Infertility due to uterine pathologies

This reason has quite a variety of uterine defects and malformations.

Infertility can be caused by:

• fibroma;
• “baby” uterus;
• myoma;
• septum in the uterine cavity;
• polyps;
• intrauterine adhesions;
• inflammation;
• bicornuate uterus;
• scars in the uterus;
• cysts;
• fibroids.

All these defects are eliminated today with the help of intrauterine surgery, which gives excellent results.

Please note: Very often, in women with infertility, a diagnosis such as “baby uterus” or uterine infantilism occurs. Its causes are chronic diseases suffered during puberty, endocrine pathologies, and poor nutrition. For such girls, menstruation is painful, the discharge is either heavy or very scanty.

as a cause of infertility

It causes disruption in the metabolism of hormones in the body and in the ovaries themselves. Patients with this diagnosis suffer from a disorder menstrual cycle, excessive hair growth, lack of ovulation, which manifests itself as infertility.

In this disease, follicle-stimulating hormone is found in the blood in insufficient quantities, so the follicles in the ovaries do not fully develop and the eggs do not mature. As a result, many follicular cysts are formed, which are clearly visible during ultrasound diagnostics, since the ovary becomes 2 times larger than its own normal sizes. Externally, it is covered with a white smooth film, which does not allow a mature egg to leave it.

Infertility due to endocrine disorders

The cause of infertility in the form of absence or problems with ovulation may lie in pathologies that affect such organs as:

• thyroid gland;
• hypothalamic-pituitary-ovarian system;
• adrenal glands

An infertile woman suffers from painful periods with scanty discharge or uterine bleeding, male pattern hair growth.

Immunological female infertility

This is a fairly rare cause of infertility, manifested in the form of an allergic reaction of a woman to male sperm (of a specific man or any man).

A number of processes may lie at the root of this problem:

• A woman’s immune system independently produces antibodies to sperm;
• antibodies to phospholipids are selectively produced (they are part of the incoming body tissues);
• The ovaries themselves produce antibodies to their own eggs.

In some cases, a woman manages to become pregnant, but it all ends in spontaneous abortion, fetal death, or severe toxicosis. The diagnosis is confirmed by testing for the detection of antisperm and antiovarian antibodies.

“False” infertility

It is possible if a woman wants to get pregnant so badly that she takes actions to prevent this from happening. In particular, there are cases where after each sexual intercourse douching with antiseptics was done to prevent the development of infection in the vagina. In turn, this procedure almost completely washed out all sperm from the vagina and made conception very problematic.

Important:Even if you suspect infertility, you should first visit a qualified specialist. He will conduct a diagnosis and correctly identify the problems that prevent a woman from becoming pregnant, and will also help eliminate them by prescribing treatment.

female infertility - problems of infertile marriage are associated only with health problems female body. The structure of infertility is approximately 50%.

male infertility - a couple’s infertility problems are associated with abnormalities in the man’s health - about 50%

combined - poor health of both women and men becomes the cause of their problems with conception and occurs statistically in more than half of all married couples.

Primary and secondary infertility

primary - the spouses were never able to conceive and give birth to a child

secondary - the couple already has children or has become pregnant

Primary female infertility is often associated with some congenital pathology, for example, the absence or insufficient development of the uterus. Secondary female infertility can be caused by various factors: infectious processes, changes hormonal levels, the development of endometriosis and many other reasons. At the same time, absolute female infertility implies pathological changes, which cannot be corrected, and relative female infertility is reversible.

In men, primary infertility is also often based on genetic pathologies, and the secondary form can be associated with previous STIs, varicocele, and testicular injuries.

Causes of infertility

The causes of female and male infertility can be different.

Main causes of female infertility

tubo-peritoneal - observed exclusively in women and manifests itself in partial or complete obstruction of the fallopian tubes. Such pathologies can be regarded as the most common reasons female infertility. The adhesive process in the pelvis and changes in the structure of the epithelium of the fallopian tubes associated with previous inflammatory diseases of the pelvic organs (salpingo-oophoritis or adnexitis) are a consequence of sexually transmitted infections (especially gonococcal and chlamydial), abortions and their complications, as well as abdominal operations in the pelvic and abdominal areas. Occurs in 40% of cases of female infertility.

uterine - associated with structural disorders of the uterus due to birth defects its development, acquired changes in its structure after injuries and surgical interventions on the uterus, the formation of adhesions - intrauterine synechiae - in the uterine cavity.

associated with genital endometriosis - is the reason for the absence of pregnancy in women in 30% of cases.

These types of female infertility often become the reason that spouses do not have children. But it should be understood that the likelihood of problems with the male reproductive system is just as high.

Main causes of male infertility

obstructive - an analogue of the tubo-peritoneal factor, but from the male side. It manifests itself in a condition in which the movement of sperm along the vas deferens on one or both sides becomes impossible due to diseases and malformations of the urethra and accessory sex glands, congenital or acquired blockage of the vas deferens. Causes of male infertility in in this case– these are genital infections, injuries to the male genital organs.

secretory - associated either with insufficient sperm production or with their defects. This pathology often acts as a cause of male infertility and is a reason to contact a urologist-andrologist.

immune - can manifest itself in the form of an autoimmune process in a man’s body - the formation of immunity to one’s own sperm (for example, after a testicular injury), as well as in the form of the formation of antibodies to the husband’s sperm in a woman’s body. This also includes the compatibility of a married couple according to histocompatibility antigens of the first and second classes (HLA typing).

genetic factor - the genetic causes of female infertility, as well as male infertility, must be identified in full, for which a special medical genetic examination is carried out

idiopathic - in other words, unexplained, when the cause cannot be identified, occurs in 10% of cases.

To make a correct diagnosis, identify the cause of infertility and select treatment, you need to consult a specialist. Timely identification of the causes of female infertility or factors that negatively affect male fertility, in the vast majority of cases, allows you to successfully overcome the problem and achieve the birth of a healthy child.

Female infertility: causes, diagnosis and treatment

The doctor decides how to treat female infertility most effectively based on the results of the examination, which may include hormonal studies, hysteroscopy, ultrasound of the pelvic organs, and tests for infections. If endocrine disorders are detected, conservative therapy may be indicated; for endometriosis - surgical treatment, with tubo-peritoneal factor - IVF. If the patient does not have a uterus, infertility can be overcome by joining the program surrogacy. The information about female infertility, causes, treatment and diagnosis of this pathology presented on this page is of a general nature. If you are faced with the problem of infertility, be sure to consult a gynecologist-reproductologist.

Male infertility: causes, diagnosis and treatment

The choice of the optimal treatment regimen directly depends on the reasons underlying the decrease in the fertilizing ability of sperm. The main diagnostic method is a spermogram. In addition, you will need to undergo an ultrasound examination of the scrotum and prostate gland, and take tests for infections and hormones. The doctor will be able to tell you how to treat male infertility in each specific case only after conducting an examination. As a rule, surgical intervention is effective for the obstructive form. For the secretory form, drug or surgical treatment may be prescribed, as well as the use of ART methods. We briefly talked about male infertility, the causes and treatment of this pathology, however, more detailed information about the problem can only be obtained during a face-to-face consultation with a specialist.

The doctor definitely recommends an examination of both spouses, since only in this way can all existing pathologies be detected and an optimal treatment regimen be developed to achieve pregnancy. Nova Clinic has all the capabilities to tight deadlines find out the cause of infertility in a particular couple and suggest effective ways to overcome it.

One way or another, fortunately, the causes of infertility in women are in most cases treatable. What does not apply to absolute female infertility is the absence or persistent obstruction of the fallopian tubes. But even in such a severe case, a woman can have a child.

This is done through in vitro fertilization (IVF), then the embryo is transferred and “settled” into the mother’s uterus. Infertility can also be primary or secondary. Primary infertility is diagnosed if a woman has never been pregnant. If a woman has had at least one pregnancy, this is secondary infertility, regardless of the further fate of the pregnancy: childbirth, miscarriage, abortion.

Unfortunately, the main cause of secondary infertility, according to experts, is the first abortion, meaning an abortion performed before childbirth. The unprepared reproductive system of a young woman who has not yet given birth reacts to such an intervention more acutely, compared to an abortion after childbirth. For this reason, inflammation of the uterus or appendages, obstruction of the fallopian tubes, and endometrial disorders easily occur.

Infertility is a symptom of one or more medical conditions.

It is customary to distinguish the following main forms of infertility in women:

• 1) tubal infertility caused by pathology of the fallopian tubes;
• 2) endocrine infertility associated with disorders in the activity of the endocrine glands;
• 3) infertility caused primarily by anatomical disorders in the reproductive system;
• 4) immunological infertility.
• 1. Tubal infertility. This form of infertility is usually secondary and develops as a result of the inflammatory process, which leads to the closure of the lumen of the tubes due to infiltration of the walls, obliteration of the tube cavity, and kinks caused by periturbar adhesions. As pathogens that cause inflammation in the fallopian tubes, pathogenic and opportunistic microorganisms are the most common: gonococcus, pathogenic staphylococcus, which often causes inflammation along with Escherichia coli, Proteus. Tuberculous etiology of salpingitis (inflammation of the fallopian tubes) is less common. A major role in the origin of tubal infertility belongs to functional disorders of the kinetics of the fallopian tubes, which can be caused by endocrine factors, inflammatory infiltration of the walls of the tubes, and atrophy of the ciliated epithelium lining the inner surface of the fallopian tubes.
• 2. Endocrine infertility.

All the numerous variants of endocrine disorders leading to infertility can be conditionally combined into separate clinical groups, which are characterized by the corresponding symptom complex:

Group I hypothalamic-pituitary insufficiency. This includes pathological conditions defined as sexual infantilism and characterized by amenorrhea, hypomenstrual and, less commonly, hypermenstrual syndrome. In such patients, the content of FSH and LH (follicle-stimulating and luteinizing gonadotropins) in the blood is sharply reduced, the level of prolactin is not increased, and the amount of estrogen is sharply reduced. The uterus in such patients is reduced, the tubes are elongated, thin, tortuous, the cervix is ​​conical in shape, and the vagina is narrow. Such anatomical changes in the genital organs play a certain role in the origin of infertility, but the main significance is the absence of ovulation.

Group II hypothalamic-pituitary dysfunction. This group includes patients with menstrual cycle disorders (luteal phase deficiency, anovulatory cycles or amenorrhea), increased secretion of estrogen and low levels of prolactin and gonadotropin. This group also includes women with sclerocystic ovaries (the ovaries produce a lot of androgens, ovulation is suppressed, hypertrichosis and obesity develop).

Group III ovarian failure. It is manifested by amenorrhea, decreased estrogen production, increased amount FSH and is often the result of various chromosomal abnormalities (Shereshevsky-Turner syndrome, gopad dyspenesia, testicular feminization).

Group IV - congenital and acquired disorders of the reproductive system. Patients in this group are characterized by amenorrhea. It is persistent; this group includes patients with obliteration of the uterine cavity and the formation of synechiae after abortion.

Group V hyperprolactinemia in the presence of a tumor in the hypothalamic-pituitary region. Patients have persistent anovulation or insufficiency of corpus luteum function.

Group VI hyperprolactinemia without lesions in the hypothalamic-pituitary region. Pathology develops in connection with functional disorders in the hypothalamic region. The production of prolactin by the pituitary gland is increased, and ovulation is suppressed. Clinically this is expressed by amenorrhea.

Group VII amenorrhea due to a tumor in the hypothalamic-pituitary region. In such patients, the production of releasing hormones and gonadotropins is reduced. The amount of estrogen is reduced, ovulation is reduced, amenorrhea develops with normal prolactin levels (a similar picture occurs with Simmonds' disease).

• 3. Infertility associated with anatomical disorders in the reproductive system (trauma, tumors, developmental abnormalities). Surgical removal of the uterus, fallopian tubes, and ovaries leads to the loss of a woman’s reproductive function. Infertility often occurs with genitourinary fistulas, with the formation of synechiae in the uterus as a result of trauma during curettage. With uterine fibroids, endometriosis, and ovarian tumors, pregnancy is possible, but the possibility of conception is usually reduced.
• 4. Immunological infertility. It is characterized by the fact that a woman or man develops a reaction of cellular and humoral immunity to sperm antigens.

It has been established that not only spermatozoa, but also seminal plasma have antigenic activity. The female egg also has antigenic properties. A woman’s body produces the following antisperm antibodies:

• 1) spermioalgglutinating;
• 2) sperm immobilizers;
• 3) spermiocytotoxic.

The mechanism of immunological infertility varies depending on the location of the development of immune reactions; immobilization of sperm is possible when they encounter antibodies present in the mucus of the cervical canal or upon contact with an egg during implantation of the zygote into the uterus. The corresponding immune antibodies that arise in a woman’s blood can have a harmful effect on sperm, the zygote and the fetus. It is now known that the immobilization of sperm in the cervical mucus due to communication with antibodies is of some importance, which leads to infertility.

• Relative infertility, if a woman’s likelihood of pregnancy is not excluded, but to a certain extent reduced.

• Acquired infertility, when a woman has a history of indications that its causes are inflammatory diseases, injuries to the genital organs, etc.

• Congenital infertility By congenital cause (vaginal aplasia, genital hypoplasia, etc.).

• When, within a certain time, the causes of infertility can be eliminated, such a condition is defined as temporary infertility, and if the reasons causing infertility act constantly - this permanent infertility.

• Endocrine infertility: the woman does not ovulate or has insufficiency of the corpus luteum.

• Uterine form of infertility- these are anatomical defects of the uterus; they can be congenital (absence or underdevelopment of the uterus, its duplication, saddle-shaped uterus, the presence of a septum in the uterine cavity) or acquired, most often the result of intrauterine interventions (cicatricial deformation of the uterus, intrauterine adhesions, etc.)

• Endometriosis- penetration of endometrial cells through the fallopian tubes into the pelvic cavity. These cells can take root in places completely unusual for them (on the peritoneum, the outer surface of the ovaries and tubes). These lesions behave as if they were in the uterus: they change according to the days of the cycle, and bleed during menstruation. This disease can be suspected by the following symptoms: pain in the lower abdomen, radiating to the lower back and sacrum and intensifying during menstruation, with physical stress, and sexual intercourse. The growth of the endometrium and the presence of blood in the pelvis disrupts the fertilization process, preventing conception.

• Mixed form of infertility There is a combination of several factors leading to infertility.

Types of male infertility:

• In the secretory form the testes do not produce enough sperm to reach and fertilize the egg, or the sperm have impaired motility, or the majority of the sperm have structural defects. Varicose veins of the testicle or varicocele, hydrocele, inguinal hernia, cryptorchidism (not descending of the testicles into the scrotum), mumps, syphilis, tuberculosis, typhus, hormonal disorders, long-term use of antitumor, antiepileptic drugs, some antibiotics, steroid hormones and antiandrogens - these diseases can lead to this type of infertility. A decrease in sperm count can also be caused by factors such as stress, lack of protein and vitamins in food, ecology, chronic lack of sleep, abuse of cigarettes, alcohol, and drugs.
• Obstructive form male infertility - the movement of sperm along the vas deferens on one or both sides becomes impossible. With unilateral obstruction of patency, a decrease in the number of spermatozoa is observed in the sperm. With a bilateral violation, sperm are completely absent. Epididymitis - inflammation of the epididymis, trauma to the testicles, compression of the vas deferens by a cyst or tumor of the epididymis can lead to an obstructive form of infertility.
• Immunological infertility. The reason is the formation of antisperm antibodies. In men, antibodies to sperm are formed in the seminal plasma, which leads to their agglutination - that is, the “gluing” of sperm to each other, preventing their forward movement.