Complications of infertility are the pathologies that can occur in unborn women. Absence of childbirth and breastfeeding contributes to the appearance of breast tumors. A study involving 50,302 women from 30 countries confirmed this conclusion.
Patients treated for infertility are more likely to have mental disorders than women with children. This was confirmed by a study that included 7,148 women who were treated for infertility.
Diagnosis of female infertility
To clarify the cause of infertility, a survey algorithm has been developed, which is suitable for referral to IVF (In Vitro Fertilization) and use of ART (assisted reproductive technology):
- Microscopic examination of the cervical canal and vaginal smear by PCR to detect the following bacteria in the scrap from the cervical canal:
- Neisseria gonorrhoeae;
- Chlamydia trachomatis;
- Ureaplasma spp. (types of ureaplasma);
- Mycoplasma hominis (mycoplasma hominis);
- Mycoplasma genitalium (mycoplasma genitalium);
- Trichomonas vaginalis (vaginal trichomonade).
2. Ovulatory function can be determined by one of the following methods:
- Progesterone levels in the blood (7 days before menstruation);
- urine test for ovulation;
- Ultrasonic monitoring of ovulation (ultrasound), which allows to evaluate the maturation of follicles, the ovulation that occurred and the formation of the yellow body;
- endometrial biopsy with a histological examination of the biopsy (material obtained by biopsy) is shown if there is suspicion of endometrial pathological processes, such as chronic endometritis, polyps and hyperplasia.
Evaluation of the ovarian reserve at ultrasound is a calculation of the number of follicles in the ovaries. Low ovarian reserve is less than three anterior follicles (follicles at the last stage of maturation).
The determination of hormones in the blood is carried out on day 2-5 of the menstrual cycle. In the absence of menstruation (amenorrhea) tests can be taken on any day. The concentration of the following hormones is determined:
- FSH (follicle-stimulant);
- AMG (antimueller);
- PRL (prolactin);
- LH (luteinizing);
- E2 (estradiol);
- T (testosterone);
- TTG (thyroid).
- antibodies to thyroperoxidase.
- Instrumental diagnostics:
Small pelvic ultrasound is recommended for all women with infertility to assess the size of the uterus and ovaries and detect uterine and appendage growth. The ultrasound will show anomalies of the internal genital development, endometrial pathology (polyps, hyperplasia, chronic endometritis) and will help to determine the thickness of the endometrium and the number of anterior follicles. Ultrasound is recommended in case of suspected SPKY – ovaries are enlarged and there are more than 12 follicles.
Evaluation of uterine tubes permeability is performed by hysterosalpingography (HSG, X-ray examination with introduction of contrast substances) and/or sonohysterosalpingography (ultrasound with contrast substances), according to indications – laparoscopy (operation through small incisions). GSG and sonohysterosalpingography also determine the size and shape of the uterus, its congenital and acquired anomalies. Acquired abnormalities include submucosal myoma, polyps, intrauterine synechias.
Magnetic resonance imaging (MRI) detects abnormalities of the internal genitalia, neoplasms, foci of endometriosis, pituitary tumor.
Hysteroscopy allows to estimate the state of the cervical canal, the uterine cavity, and the mouth of the fallopian tubes.
Laparoscopy is performed if there is suspicion of tubal infertility: adhesions in the small pelvis, endometriosis, malformations of the internal genitalia.
- Examination of a man. The main method of male fertility estimation is spermogram (estimation of ejaculate indices). With a decrease in the number of sperm cells, their weak mobility and structural disorders, it is recommended to consult a geneticist and urologist.
- Consultations with other specialists:
- the therapist – in case of somatic diseases;
- endocrinologist – in diseases of the endocrine system;
- neurosurgeon consultation – in case of suspicion of pituitary adenoma;
- consultation with an oncologist – if there is a suspicion of a breast tumor;
- consultation of other specialists in case of detection of the corresponding pathology.