How dangerous is the IVF program

Today we will talk about the most exciting aspects of the IVF program and, based on scientific research in recent years, we will answer possible questions.

What is the danger of ovulation stimulation? Modern features

In the past years of the revival and the beginning of the use of controlled superovulation in the implementation of IVF programs, reproductologists used high doses of gonadotropins during stimulation, sought to get as many oocytes as possible, since it was believed that this increases the chances of fertilization and obtaining embryos. As they tried to get more cells, they also tried to transfer “more” embryos.

Now the approaches have changed categorically. Currently, it has been proven that the use of high doses of gonadotropins during controlled supervovulation does not increase the chances of fertilization, leads to rapid depletion of the ovaries, has a greater number of side effects. The ovarian response to stimulation after puncture is evaluated as follows: 0 oocytes – no response, 1-2 oocytes-poor response, 3-6 oocytes-a satisfactory response, more than 7 oocytes – a good response.

It is proved that the level of ovarian response does not affect the quality of embryos in the presence of mature oocytes. However, with a satisfactory and good response, it is possible to cryopreservate a larger number of embryos without forcing a woman to undergo the ovulation stimulation procedure several times.

IVF program

With a poor answer, the scheme of “accumulation” of embryos is currently used: several ovulation stimulations are performed with minimal doses of gonadotropins and 1-2 embryos are obtained from each such program, after which the “best” embryos are cryopreserved and only then the endometrium is prepared for embryo transfer. This scheme is beneficial for its gentle effect on the ovaries of a woman, it also contributes to the production of the most mature eggs and is used mainly in women with extremely low ovarian reserve (AMH level<1 ng/ml).

Ovarian hyperstimulation syndrome, what is it and how to avoid it?

Most women suffering from infertility have heard about ovarian hyperstimulation syndrome, the fear of this complication of IVF often pushes women away from the program. Ovarian hyperstimulation syndrome (OHSS) is a condition based on the reaction of the ovaries in response to the introduction of hormonal drugs (ovulation inducers), the doses of which exceed physiological values. This condition was first described in 1930 when using the serum of foaled mares.

Ovarian hyperstimulation syndrome is characterized by a fairly wide range of clinical manifestations: from minor changes in laboratory parameters to quite serious conditions requiring hospitalization.

The main reasons for its occurrence are high doses of hormonal drugs that are used to stimulate ovulation, and with a high level of activity of the hormone estradiol, which is produced in growing follicles, high levels of the hormone hCG. The main risk group for the formation of this syndrome are girls with a diagnosis of “Polycystic ovary syndrome”, since this group has a high follicular reserve and a large number of follicles “begins to grow” during induction.

Ovarian hyperstimulation syndrome is currently a well-studied syndrome, for this reason, reproductologists around the world are trying to stimulate the ovaries using minimal hormonal load, pursuing the main goal: to get the maximum number of mature and high-quality oocytes, to avoid ovarian hyperstimulation syndrome. All patients who are preparing for the IVF program undergo a thorough examination (according to order 107n of the Russian Federation), a reproductive doctor assesses all possible risks, preventive measures are taken in the presence of risk factors for OHSS.

Women with a high risk of the syndrome are recommended to carry out an IVF protocol followed by embryo cryopreservation and embryo transfer in another cycle.

IVF program” freezing ” of embryos

The cryopreservation method allows you to save embryos for a long time, so if the IVF attempt is unsuccessful, the “saved” embryos can be used in the future. In cases where the IVF program has been successful and the pregnancy has occurred, the remaining frozen embryos can be used in the future, when the couple decides to give birth to another child. An additional advantage of the method is to reduce the number of repeated ovarian stimulation and follicle puncture, which significantly reduces the drug load on the female body.

Drug therapy of diffuse mastopathy and PMS

According to the WHO definition (Geneva, 1984), mastopathy (fibrocystic disease, dyshormonal dysplasia of the mammary glands) is a dyshormonal hyperplastic process characterized by a wide range of proliferative and regressive changes in breast tissue with an abnormal ratio of epithelial and connective tissue components. Fibrocystic disease is very heterogeneous in its clinical, radiological and morphological manifestations. The etiology of the disease is also diverse. The occurrence of mastopathy is often associated with violations of the reproductive sphere of a woman, social and household problems, hormonal imbalance, various types of hepatopathies that lead to hormonal and metabolic disorders.

Clinically, fibrocystic disease is manifested primarily by mastalgia, varying in nature and degree of intensity. As a rule, pain in the mammary glands bothers the patient before menstruation or in the middle of the menstrual cycle. Often such complaints are accompanied by an increase in volume, swelling, swelling of the mammary glands. The tissues become heterogeneous, painful on palpation, seals form. When pressing on the nipples, discharge may appear.

Classifications of mastopathy

Despite the many proposed classifications of mastopathy, one of them does not fully reflect the full variety of morphological changes occurring in the mammary gland. In clinical practice, the classification proposed by N. I. Rozhkova (1993) is most often used, where the following forms of mastopathy are distinguished: diffuse mastopathy with a predominance of the glandular component (adenosis); diffuse fibrocystic mastopathy with a predominance of the fibrous component; diffuse fibrocystic mastopathy with a predominance of the cystic component; mixed diffuse fibrocystic mastopathy; sclerosing adenosis; nodular fibrocystic mastopathy.

According to the degree of severity of the detected changes, diffuse fibrocystic mastopathy (FCM) is divided into slightly, moderately and sharply expressed. According to the degree of proliferative activity of the epithelium, there are: mastopathy without proliferation (I degree); mastopathy with epithelial proliferation (II degree); mastopathy with atypical epithelial proliferation (III degree). Due to the presence of a wide range of clinical and histological manifestations, the treatment of diffuse mastopathy is very difficult and requires, first of all, the establishment of the main causes of the disease. Adequately selected therapy should be complex, long-term, taking into account the hormonal, metabolic characteristics of the patient’s body, concomitant diseases. According to modern concepts, the complex treatment program for diffuse mastopathy includes phytotherapy-collections of herbs of multidirectional action.

Treatment of mastopathy

One of the most effective means of treating mastopathy and premenstrual syndrome is the combined drug Mastodinone (manufacturer-the German company “Bionorica”). The main component of the drug is an extract of prutnyak fruit BN0 1095. In addition, it includes a basilisk-shaped stalk, an alpine violet, a bitter chestnut, a multicolored killer whale, a tiger lily. The use of ordinary prutnyak (synonym-Abraham’s tree; Lat. Vitex adpis castus) has a long history (the first description refers to the IV century BC). Vitex agnus castus is widely used in the treatment of gynecological diseases: menstrual cycle disorders, amenorrhea, luteal phase insufficiency, premenstrual syndrome. Since 1975, the extract of prutnyak fruits has been used in the form of the phytopreparation Mastodinon.

The main mechanism of action is a stimulating effect on the dopamine D2 receptors of the anterior pituitary lobe, which leads to a decrease in prolactin secretion. Hyperprolactinemia, which is not associated with pregnancy and lactation, has a direct stimulating effect on proliferative processes in peripheral target organs, which is realized by increasing the production of estrogens by the ovaries. The ability of prolactin to increase the content of estradiol receptors in the tissues of the mammary glands also plays a role. These mechanisms determine the development of the entire symptom complex characteristic of premenstrual syndrome and fibrocystic disease.


A decrease in the increased level of prolactin due to taking Mastodinone leads to a regression of pathological processes in the mammary glands and stops the cyclic pain syndrome in mastopathy or premenstrual syndrome. When the prolactin level is normalized, the rhythmic production and the ratio of gonadotropins are restored, the imbalance between estradiol and progesterone is eliminated, which contributes to the restoration of the menstrual cycle. The recommended regimen for taking Mastodinone is 30 drops (1 tablet) 2 times a day for 3 months without a break, regardless of the menstrual cycle. After that, you can take a break for 1-2 months, then resume taking the drug. Clinical improvement is noted after 4-6 weeks of use. Individual intolerance to the drug is extremely rare.

Unlike many dietary supplements advertised for the treatment of fibrocystic disease, the effectiveness of Mastodinone has been demonstrated in a number of scientific studies, the results of which have been published in domestic and foreign literature. The most satisfactory results were obtained in the group of patients with diffuse forms of mastopathy and premenstrual syndrome (n=1472). 1064 patients (72.3%) noted a significant improvement in well-being (a decrease in the density of breast tissue, a decrease or cessation of nipple discharge, normalization of the menstrual cycle, a decrease in headaches and abdominal pain), 397 women did not record changes in their condition and only 11 patients complained of increased symptoms.


Thus, the results of the conducted studies have shown the high effectiveness of Mastodinone and Cyclodynone in patients with benign diseases of the mammary glands and menstrual function disorders. It should be emphasized that the high effectiveness of the drugs in combination with a low frequency of adverse reactions makes them extremely attractive for wide use.

Female Bodybuilding and Steroids

Often, many women coming to the mirror are disappointed: sluggish, not knowing even the minimum load, muscles, accumulated fat, swollen thighs. And how do you want to look like a Greek goddess and catch admiring glances at yourself, and that men turn their necks when you pass by?! But how to do it? Female bodybuilding is the answer.

Female Bodybuilding

All is not lost! It’s time to do bodybuilding. Bodybuilding literally means building, the architecture of the body. There are few people left who would dispute the benefits of this sport. Medical science has proven that weight training is a magical panacea for the troubles that come with the years, from the destructive lifestyle that we lead. But the figures of many bodybuilders are embarrassing. It seems to people that such achievements are possible only as a result of hard, many hours of work, incompatible with the lifestyle they lead, or with taking some drugs (for example, clomid) that provide growth and relief of muscles. They are partly right. However, just one 40-minute workout a week can have a pronounced effect, even the usual morning 10-15-minute exercise brings tremendous benefits to the body and stagnant muscles. Well, if you want to look like a bodybuilder, you need to train like a bodybuilder. That is, according to a scientifically-based method of training with special sports nutrition, purposefully and stubbornly. You can make your body strong and beautiful by walking the beaten paths of champions, using the legendary techniques of famous bodybuilders.

A man who wants to be like the heroes of Hollywood action movies, who do not care about lifting a truck or dispelling clouds of enemies without straining, has to work hard for a long time in the gym. It is three times more difficult for a woman to become such an Amazon. For the fairer sex, a serious restructuring of the body is fraught with serious health problems.

According to the plan of nature, the number of cells that form muscles. It remains relatively constant throughout life. Muscle cells do not multiply, they can only increase in size. How many muscle cells a person is endowed with at birth will depend on how soon he will be able to turn a soft, loose tummy into a rubber-like press. The growth of muscle mass is impossible without the entry into the body of the main building material for the formation of contractile fibers-proteins.

The fat layer between the muscles and the skin does not give the muscles beauty, so a large amount of animal and vegetable fats, as well as carbohydrates contained in food, is not consumed by a real bodybuilder.

It is not difficult for men with a minimum amount of fat in the diet to live at all. The main thing is not to bring yourself to a complete ” degreasing”. It begins to dissolve its own fat, for example, which is located around the kidneys, supports them and is a good amortizer. The kidneys can move down, become ” wandering”, which is fraught with a lot of unpleasant sensations and, in addition, can lead a handsome man to the nephrology department. In women, adipose tissue also serves as a source for the construction of their own sex hormones – estrogens. We have two x-chromosomes and we are, of course, women, but, figuratively speaking, fat makes a woman actually a woman. The shape of the female breast, so adored by men,is due to adipose tissue.. That is why completely fat-free bodybuilders can not boast of beautiful, lush, soft breasts. However, now plastic surgery is on top with numerous mammoprostheses.

How to achieve the result?

Who among us has not dreamed of achieving the desired results as soon as possible? Still, there is no need to hurry. A well-chosen training program and a proper nutrition system allow a woman to get rid of excess fat from 2% monthly, until the goal of harmony and perfection of the body is achieved. After several months of working in the gym, a woman, going to the mirror, can find remarkable results that are already noticed by others: the stomach does not hang down, does not gather folds, the buttocks have tightened, become elastic, the treacherous breeches have significantly decreased in size, and the chest, which until recently was hanging sadly from the chest wall, suddenly begins to please the eye. At this stage, body building can be called a beautiful word fitness. Literally translated from English, this word means ” fitness”, and this term means the development of optimal physical abilities that allow “to withstand the hardships of modern life”. For some, fitness means a thin waist, for others-to squeeze out their own weight lying down, for others-just feeling good. And for a woman engaged in physical labor, the level of fitness will be different than the necessary level for a secretary-assistant, older people need a different program and level than young people.

What is important in fitness is not strength, endurance or fat content, but their combination. A prerequisite for fitness is the lack of bodybuilding massiveness. For a bodybuilder, muscle mass is everything! A fitness player with her beautiful, harmoniously developed body can not be disliked even by people who are far from sports. The main slogan of fitness is for beauty and femininity! Such results are achieved by special types of training aimed at women. At the same time, muscle strength increases, but the relief of the muscles remains smooth and soft. In addition, with the help of strength exercises, such vital qualities as endurance, speed, flexibility, dexterity are developed. Fitness has a positive effect on the cardiovascular system, normalizes the physical and mental state, which allows a person to live fully and successfully endure all the hardships of life presented in our turbulent time. Most are quite satisfied with the transformed body, which has not lost a single drop of femininity. They stop and maintain the achieved state with short, but regular workouts.

Many women think that training with weights will immediately lead to the growth of huge muscles and loss of femininity. But this is a misconception!

Imagine that all women who train with loads have large muscles. Then why do we not see such girls in athletic halls? It’s very simple. In order to develop such muscles, a woman needs: genetic data, intensive long-term training, it is desirable to have an increased level of testosterone (male hormone). Most of the pumped-up women are elite professional female bodybuilding, athletes engaged in light and weightlifting, who have been training for years to achieve such a result. Of course, there are also those who additionally take androgens for an unnatural increase in muscle volume. It is very difficult for an ordinary woman to develop really big muscles. But many people do not understand this and avoid bodybuilding. And big muscles in the mass consciousness make a woman less of a woman. All over the world, the strength, musculature and masculinization of a woman seems at best a strange phenomenon, and at worst it causes dislike and disgust. And it is quite obvious that if professional bodybuilders become more and more like guys with implanted breasts, female bodybuilding will die.

Female bodybuilding harm from testosterone

But some women do not stop at the achieved harmony and go further than female bodybuilding-fitness. What makes women increase the load and bring the body to a state of total masculinization, sacrificing their own health? Scientists have conducted research and noted that a mental illness called “muscle dysmorphia”is common among bodybuilders. This disease is inherent in both women and men. In this condition, a person is constantly worried: have his muscles disappeared somewhere? And did the torso look worse than 2-3 hours ago? Such thoughts make him / her not leave the gym at all or turn his / her entire home into a gym. The constant self-admiration of the reflection in the mirror does not suit the worried bodybuilder at all.

female bodybuilding

Strength exercises more than five times a week are a serious danger for women. Ardent bodybuilding fans often suffer from eating disorders, a distorted perception of their own body and complications caused by the excessive use of steroid hormones. Today, the truth of female bodybuilding is that female bodybuilders are sitting on the needle just like men. This is an easier way to build muscle. After all, without this, nothing shines at tournaments. But hormones in the bodies and souls of women cause more severe and irreversible symptoms of rejuvenation. Muscles by themselves do not take away a woman’s femininity. Femininity is taken away by steroids!

As steroids penetrated into female bodybuilding, public interest in it fell. Today, creatures whose gender is difficult to determine, if at all possible, are coming to the podium. Except for Linda Murray and Sue Price, who somehow managed to survive in this battle for masculinity, the ranks of participants were terrifying. The participants do not discuss the topic of “chemistry”, and go into a deaf refusal with such questions. Since this topic is quite painful for them, and no one will ever understand what happens to a woman’s brain when she gradually turns into a man.

Testosterone causes significant harm to a woman’s health. Normally, they produce this sex hormone in a small amount. In minidoses, getting into the blood, the hormone stimulates muscle growth, improves regenerative processes in tissues, reduces the phenomena of osteoporosis, accelerates metabolism, and does not have a bad effect on the body. But everything is good in moderation, however, for female athletes, the abuse of steroid hormones is typical. Horse doses of synthetic analogues of testosterone cause suppression of the production of female sex hormones, moreover, they have effects that do not improve the appearance of a woman at all. Among the numerous side effects:

  • skin defects, a huge number of red pimples appear on the face, scientifically called acne, the skin becomes drier, pimply, with laces of veins on swinging muscles;
  • hirsutism or increased hair growth on the body and on the face is an irreversible effect of steroids. Hair breaks out on the chin, on the upper lip, arms, legs, and even on the chest. And in the perineum, they grow just crazy! Depilation will have to be done, almost every day, for the rest of your life. Hair loss and deterioration of the structure of the hair on the head;
  • stretching of the abdominal wall: steroids irritate the intestines, as a result, constipation, accumulation of gas, liquids begin. The stomach sticks out forward, and to hide it, you need to constantly strain the press. Pathological weakening of the internal corset, stretching of the abdominal wall, training with a load lead to rectal prolapse and hemorrhoids;
  • a sharp increase in the smell of sweat: testosterone affects the sweat glands, the composition changes and the secretion of sweat increases, the smell becomes unpleasant, striking, like a man after a long active workout. Aggressiveness and psychological instability: testosterone makes a bodybuilder simply unmanageable. She will yell, make a row, wave her hands about and without;
  • sexual aggression and increased sexual activity: a bodybuilder wants complete animal satisfaction immediately, right where physical desire has rolled over her, and this is several or more times a day. And it will be quite burdensome for a partner to perform male duties several times a day. And it is very unusual and many people become uncomfortable if the partner expresses her emotions in a male baritone (and if the neighbors are listening ?!);
  • the coarsening of the voice, the growth of cartilage (an overgrown nose) is an irreversible process;
  • clitoral enlargement (irreversible process): to an unnatural size, and in a state of arousal, the clitoris increases even more, almost like a small penis during an erection. To see a woman like this is not a sight for faint-hearted men! Bodybuilders say that thanks to such an acquisition, they experience a deeper orgasm, and sometimes the sensitivity increases so much that climbing the stairs in tight jeans becomes a problem due to unbearable excitement. And this is forever;
  • increased vaginal secretion: vaginal discharge, which becomes abundant only at the moment of the highest sexual arousal, in “steroid patients’ The changes of bodybuilders occur continuously, creating a lot of problems. This is not a disease or an infection, but simply a physiological disorder that stops with the cessation of taking steroidoad;
  • absence of menstruation;
  • ovarian sclerocystic disease: with subsequent infertility. The ovaries, as if hiding from male hormones, are covered with a dense capsule;
  • liver damage, increased blood pressure and other disorders of the cardiovascular system.


We found out why masculinization occurs, why large muscles grow in a short time and saw the problem of taking steroids by a woman even deeper. If you accept it, then stop before it’s too late!

Female bodybuilding is a wonderful and very useful sport, the purpose of which is to make your body worthy of your spirit. This is one of the ways to keep yourself in good physical shape. And you can choose how strong, beautiful, fit you want to become. Come up with your own ideal and strive for it, and “healthy” bodybuilding is a great ally for you in this!

Hormone therapy during menopause

Hormone therapy: During the menopausal transition, the restructuring of hormonal homeostasis causes a number of changes in the female body, which negatively affect the quality of life and can lead to the formation of chronic diseases.

Hormonal therapy (contraception) and prevention of unwanted pregnancy

Hormonal contraception (combined and purely gestational) is widely used in gynecological practice, and the need for its appointment for the purpose of preventing pregnancy persists until the onset of menopause. Hormonal contraceptives are based on progestins-derivatives of nortestosterone, 17-hydroxyprogesterone or spironolactone. They are used as monopreparations or in combination with estrogens (ethinyl estradiol, estradiol, etc.), the main purpose of which is to level the side effects of progestogens.

Hormonal contraceptives have many positive non-contraceptive properties. Reducing the risk of ovarian cancer directly depends on the duration of combined oral contraception, and this effect persists up to 20 years after discontinuation of the method. The same is true for reducing the risk of endometrial cancer, which correlates with the duration of use of combined oral contraceptives and is observed for more than 20 years after their withdrawal. Combined oral contraceptives also reduce the risk of colorectal cancer and, without significantly affecting the risks of other malignancies, generally reduce the cancer risk. In addition, there is evidence of proven therapeutic or preventive effects of combined hormonal contraception (CGC) in relation to a number of gynecological and extragenital diseases and conditions.

But even if there are additional indications in the instructions for the use of the contraceptive drug, hormonal contraception remains primarily a method of preventing pregnancy. Ignoring this circumstance, recommending a contraceptive to a patient who does not live a sexual life, or is absolutely unable to conceive, or who wants to become pregnant, is possible only in cases where there is no alternative way to resolve a clinically significant problem. However, it is during the menopausal transition against the background of a decrease in sexual activity and the ability to conceive that complaints of menstrual cycle disorders often appear, requiring the appointment of therapy, not contraception.

Menopausal hormone therapy and correction of menopausal disorders

The late phase of the menopausal transition begins with the prolongation of menstrual delays up to 60 days and the appearance of episodes of amenorrhea, characterized by an increase in the frequency of anovulatory cycles. The duration of this stage of reproductive aging is usually one to three years before menopause. Do not forget about stimulating ovulation with clomid. There is an opinion that the secretion of estradiol at this time steadily decreases, and the level of follicle-stimulating hormone increases. However, monitoring of hormonal indicators demonstrates their significant variability and the possibility of periodic return to the premenopausal range. Given such significant fluctuations in the secretion of follicle-stimulating hormone, it is not recommended to use the determination of its concentration in the blood to clarify the status of the reproductive system. Like the early phase of the menopausal transition, the late phase is established clinically by the appearance of intermenstrual intervals, the duration of which exceeds 60 days.

Of course, the clinical criteria for entering the menopausal transition are valid only if the initial regular rhythm of menstruation and the non-use of hormonal drugs that simulate the menstrual rhythm. If it is impossible to establish the status of the reproductive system clinically, the average population characteristics should be used, according to which the majority of women enter perimenopause after 45 years. Starting from this age, complaints of hot flashes and other vasomotor and psychosomatic symptoms signal the onset of a late phase of the menopausal transition associated with estrogen deficiency, and require MGT. There may be a reasonable objection: according to the instructions for the use of MGT drugs, they are recommended to be prescribed to women during the menopausal transition with a duration of menstruation delay of more than six months. Why do the instructions and clinical recommendations of international and expert communities contradict each other?

Thus, vasomotor and psychosomatic symptoms caused by estrogen deficiency, which not only negatively affect the quality of life, but also reflect delayed health problems, become the main starting point in solving the issue of MHT. Waiting for six months of amenorrhea to initiate MGT is advisable when a woman’s complaints are insignificant, do not violate the quality of life and, accordingly, call into question the very need for treatment.

Principles of prescribing hormone therapy

After studying the characteristics of the three types of hormone therapy and the indications for their appointment, it becomes clear that the choice of one or another of them will depend on the status of the reproductive system, evaluated clinically or, if such an approach is impossible, established presumably by the age of the patient.

Contraception will be the first in the order of use of hormone therapy methods, which is built depending on the age. Recommendations on the specifics of the primary appointment of KGC come into force when consulting women over 35 years old, that is, long before the beginning of the menopausal transition.

hormone therapy

The main concern when using hormonal contraception is the risk of thrombosis due to the action of the estrogenic component. The generalized data indicate a low frequency of thrombotic complications of KGC: the frequency of acute conditions caused by thrombosis is 6-9. 9 cases per 10,000 women per year. These conditions are usually represented by venous thromboembolism. The risk of myocardial infarction increases exclusively in women who smoke, and a twofold increase in the risk of ischemic stroke does not look so threatening due to its rarity in the population of women of fertile age (1 case per 10,000 women per year) and dependence on other factors, especially migraines.

Nevertheless, the increased risk of thrombotic complications in the older age group imposes a number of restrictions on the use of KGK, including in women who smoke or patients with migraine. In the absence of contraindications to taking KGK, only those drugs that contain estradiol or a microdose of ethinyl estradiol are suitable for primary administration. Minimizing the effect of the estrogenic component allows not only to reduce thrombotic risks, but also to reduce the likelihood of estrogen-dependent weight gain associated with fluid retention, as well as to increase the level of triglycerides entering the fat depots. Overweight is an additional risk factor for thrombosis in adult women, which deserves attention in the process of individual selection of a contraceptive.

If there are appropriate indications and there are no contraindications, drugs of sex steroid hormones and their combinations can be used in the periods of late reproduction, menopausal transition and postmenopause, providing a high quality of life and prevention of diseases associated with aging. The skillful use of this resource is really able to provide women with active longevity.

Infertile marriage

Infertile marriage is the absence of pregnancy in the spouses of childbearing age during one year of regular sexual life without contraception. The frequency of infertile marriages is 8-17% and has no tendency to decrease. Every year,2-2.5 million new cases of male and female infertility are registered in the world.

Important parameters that affect the effectiveness of infertility treatment are the age of a woman and the duration of a barren marriage.

So, if in the population of women under 30 years of age during one year of regular sexual life without protection, spontaneous pregnancy occurs in 80% of cases, before 40 years-in 25%, then after 40 years-no more than 10%.

Factors that put patients at risk for possible infertility:

  • age over 35 years;
  • the duration of infertility in this and previous marriages is more than five years;
  • miscarriage in the anamnesis;
  • neuroendocrine disorders of the menstrual cycle;
  • sexually transmitted infections that were transmitted before and during marriage; genital endometriosis;
  • repeated surgical interventions on the female genital organs, especially performed by laparotomy (removal of ovarian cysts, tuboovarial inflammatory formations, plastic of the fallopian tubes, ectopic pregnancy, myomectomy).

Such patients need an in-depth examination, even if they do not raise the issue of infertility treatment (active identification of potentially infertile married couples) when applying to a medical institution.

Algorithm of examination of women with infertility

Anamnesis: information about the number of marriages, the nature of infertility (primary/secondary), the duration of infertility, the number of pregnancies in marriages, their outcomes and complications. Features of menstrual function, menstrual cycle disorders, probable causes and duration. Analysis of previous examination and treatment, the use of contraceptives and medications that affect fertility. Extragenital diseases and surgical interventions, including gynecological; inflammatory diseases of the pelvic organs (etiological factors, features of the clinical course, the number of episodes). Features of the influence of environmental factors, occupational hazards, bad habits (alcohol, drugs).

Clinical examination: determination of the body mass index; the presence of hirsutism; the degree of development of the mammary glands and discharge from them; the state of the thyroid gland, skin and mucous membranes; assessment of the general condition, gynecological status.

TORCH-complex: determination of antibodies (immunoglobulins – Ig) G and M to rubella, toxoplasmosis, herpes simplex virus types 1 and 2, cytomegalovirus. If there are no IgG antibodies to rubella, you should be vaccinated.

infertile marriage

Ultrasound examination of the pelvic organs. Ultrasound examination of the mammary glands for all women under 36 years of age and the thyroid gland (if indicated).

Endoscopic methods: laparoscopy and hysteroscopy followed by endometrial biopsy in the presence of endometrial pathology and subsequent histological examination of scrapings

If the examination program is not fully completed, the diagnosis of infertility in a woman cannot be considered reliable, and treatment will obviously be unsuccessful. Taking clomid here will not be effective.

Algorithms for diagnosing male infertility

Anamnesis: number of marriages; primary/secondary infertility; duration of infertility; previous examination and treatment for infertility; systemic diseases (diabetes mellitus, nervous and mental diseases, tuberculosis); medicinal and other therapies affecting fertility; surgical interventions on the organs of the urogenital tract; sexually transmitted infections; congenital and acquired pathology of the reproductive system; sexual and ejaculatory dysfunction; environmental factors, occupational hazards and bad habits (smoking, alcohol, drugs).

Clinical examination: measurement of height and body weight; determination of the presence of signs of hyperandrogenism, gynecomastia; andrological examination of the genitals, inguinal region and prostate.

Additional research methods: determination of prolactin levels, follicle-stimulating hormone, testosterone; thermography of the scrotum; craniogram (if pituitary adenoma is suspected); testicular biopsy.

As a rule, the frequency of female infertility is 70-75%, male-35-40%. The combination of female and male infertility occurs in 30-35% of married couples.

Stages of therapy depending on the causes of infertile marriage

Tubal-peritoneal factor. Rehabilitation and conservative treatment (antibiotic therapy, physiotherapy, balneotherapy) for 6-12 months are subject to patients after laparoscopic correction of the adhesive process of the first-second degree according to the Hulk classification and with passable fallopian tubes. In the absence of pregnancy, repeated surgical treatment is not indicated and the couple is sent to an IVF clinic. In the presence of hydrosalpinxes, the inability to restore the patency of the fallopian tubes, the third-fourth degree of the adhesive process, the IVF program is immediately shown.

After laparoscopic removal of foci of endometriosis, endometrioid ovarian cysts and salpingo-oovariolysis (with adhesive process in the small pelvis) for three to six cycles, depending on the stage of endometriosis, progestogen therapy is carried out in a continuous mode, gonadotropin – releasing hormone agonists, danazol, estrogen-progestogenic drugs.

Infertile marriage: The male factor of infertility. Depending on the parameters of the spermogram and the results of the clinical examination of the husband, it is possible to conduct intrauterine insemination with the sperm of the husband or donor for three to six cycles against the background of ovulation stimulation in the wife. If the therapy is ineffective, IVF is indicated, often with the procedure of intracytoplasmic injection of a sperm into an egg.

A infertile marriage couple should be warned about a possible additional examination after consultation with specialists of the clinic.