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.

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