The modern approaches to diagnostics and treatment of infertility is based on knowledge of the female reproductive system. It presumes a decline in reproductive potential and ability to conceive with the age. Consequently the treatment of infertility must be realized by modern methods which proves its efficiency.
In accordance with recommendations of leading professional associations and international organizations (WHO, ESHRE, ASRM), infertility may be suspected in the cases below. It is highly recommended to start an examination at this time:
– in lack of pregnancy during 12 months of active sexual life for patients to 35 years and during 6 months for patients after 35 years without application of contraception;
The diagnostics of a couple with the problem of infertility begins with a complete anamnesis, in which particular attention is paid to the past diseases of an infectious nature (chlamydia, gonorrhea, mycoplasmosis, etc.), lifestyle, systemic diseases and surgical operations, which could cause difficulties in conception.
To find out the causes of infertility, it is necessary to involve both men and women in the examination.
The factors that reduce fertility :
– Violation of the menstrual cycle;
– tubal (ectopic) pregnancies in anamnesis;
– resection of ovaries;
– other operations on the organs of small pelvis or abdominal cavity;
– amenorrhea (absence of menstruation more than 6 months);
– cases, when ovarian reserve is in the state near to exhaustion (in the age after 40, after radiation therapy or chemotherapy for young women and other).
The examination of women is carried out according to the following plan:
♦ Gathering of anamnesis regarding past diseases, regularity of the menstrual cycle, etc .;
♦ A physical examination to find out signs of malformations and symptoms that can lead to infertility;
♦ Diagnostics of the woman’s hormonal background;
♦ Diagnostics of cervical infertility;
♦ Diagnostics of fallopian tubes;
♦ Diagnostics of infertility of uterine factors.
Echosalpinography is a highly informative and atraumatic method used to evaluate the patency of fallopian tubes. The essence of this method is that in the cavity of the uterus with the help of a special catheter, a contrast medium is introduced and under the ultrasound control the motion of the fluid through the fallopian tubes is observed. The procedure is carried out ambulatory and does not require hospitalization. If the fluid does not pass through the fallopian tubes and does not enter the ectopic space, the doctor diagnose the obstruction of the fallopian tubes.
Hysteroscopy is an endoscopic method that allows you to visually evaluate the uterus cavity. This method enables, with a high degree of accuracy, to study the condition of the uterus, to detect abnormalities in the uterine cavity: submucosal fibroids, endometrial polyps, mucosal tumors, chorionic or fetal fragments after induced or spontaneous abortion, placenta tissue, evaluate relief and diagnose the developmental defects, submucosal endometriosis. During hysteroscopy, a biopsy is performed – a piece of tissue of the inner membrane of the uterus is taken for examination under a microscope (histological examination).
When examining men first of all it is necessary to make a spermogram. The analysis of sperm allows doctors to diagnose the cell composition of sperm, their mobility, morphology and quantity. In this case, the following violations are established:
♦ Small volume of ejaculate (oligospermia);
♦ Small number of sperm in ejaculate (oligozoospermia);
♦ Complete absence of spermatozoa (azoospermia);
♦ Low sperm motility (asthenozoospermia);
♦ High content of spermatozoa with a broken morphological structure (teratozoospermia).
In teratozoospermia, as an additional diagnostic method, determine the degree of DNA fragmentation of spermatozoa – the detection of sperm with damaged genetic material. The greater the rate of DNA fragmentation is the lower the integrity of the genetic material in the sperm and less chance of pregnancy.
With violations in the spermogram of a man, also perform laboratory tests – determine the level of sex hormones, hormones of the thyroid gland, etc.
To exclude the incompatibility of partners, a special analysis (postcoital test) and antisperm antibodies are prescribed.
The couples, who faced the problem of infertility, should not be disappointed. It is worth turning to highly skilled professionals who will help to achieve the desired.
In our clinic patients can get advices from the experts of reproductive medicine, a comprehensive examination to find out the causes of infertility and the selection of optimal treatment methods.
In the Clinic of Professor Stefan Khmil successfully used the IVF method for infertility.