1ST CITY CLINICAL HOSPITAL

03/28/2024

Today, pregnancy issues affect a large number of married couples.

Infertility is an alarming word, which is the main fear of any couple who wants to have a child. There are many myths surrounding this diagnosis, and today I would like to highlight this topic from a modern scientific point of view.

Infertility is diagnosed when a woman complains of the inability to become pregnant within 1 year of regular sexual activity (at least 2 times a week) without using any contraceptive methods. It is worth pointing out that in women over 35 years of age, diagnosis of the causes and treatment of infertility can begin with a complaint of non-occurrence of pregnancy within 6 months of regular sexual activity without contraception. Why is that? Because the ability to conceive decreases significantly after 35 years.

It is important to understand that infertility is not only a women's problem. Both spouses undergo the examination, because Infertility can be caused by changes in the health of both women and men.

There is primary infertility - when a woman has not had a single pregnancy, despite regular sexual activity for a year without the use of contraceptives. Secondary infertility is a condition when pregnancy has already occurred, but within a year of regular unprotected sexual activity, conception no longer occurs.

Absolute infertility is also distinguished - when independent pregnancy is impossible for a couple, only treatment using assisted reproductive technologies will help: absence of the uterus, ovaries, both fallopian tubes, absence of sperm in men.

Classification by causes of infertility:

1. Infertility caused by male factors (causes: various forms of pathospermia: decreased concentration, motility and normality of sperm). Morphologically normal sperm has the greatest fertilizing potential. The fewer sperm, the less motile they are, the more sperm have structural anomalies, the lower the chances of pregnancy. Such sperm are infertile. In addition, chronic prostatitis, varicocele - dilation of the veins of the pampiniform plexus of the spermatic cord, hydrocele - accumulation of fluid between the membranes of the testicle, previous inflammation of the testicle due to viral infections (the most famous is mumps = “mumps” in the people) can lead to a decrease in sperm fertility.
2. Infertility associated with lack of ovulation. What is ovulation? Every month, a vesicle - a follicle - matures in the ovary; upon reaching its maximum size, under the influence of hormones of the hypothalamic-pituitary system, it bursts and an egg is released into the abdominal cavity.

In some conditions and diseases, ovulation does not occur. Among the causes of infertility due to lack of ovulation, it is worth highlighting:

- starvation or stress, which leads to functional hypothalamic amenorrhea. The body has no time for pregnancy. He would have to survive on his own;

- polycystic ovary syndrome - independent ovulation occurs, but is extremely rare;

- premature ovarian failure syndrome - when for some reason in women under the age of 40 there is a decrease in the number of follicles, as a result of which the woman stops ovulating;

- resistant ovarian syndrome - there is no ovulation due to the fact that the ovaries are insensitive to the action of hormones of the hypothalamic-pituitary system;

- hyperprolactinemia - increased levels of the pituitary hormone prolactin. Prolactin suppresses the production of luteinizing hormone, which is responsible for egg maturation in the ovaries and ovulation. As a result, the egg does not mature and does not leave the follicle, ovulation does not occur, and therefore conception is impossible.

     3. Female infertility of tubal origin : problems associated with impaired patency and functionality of the fallopian tubes:

- absence of fallopian tubes due to their surgical removal due to inflammatory processes, ectopic pregnancy;

- obstruction of the tubes due to adhesions in the pelvic organs, in the tubes themselves, damage to the fimbriae that capture the egg, damage to the villi inside the fallopian tube.

     4. Uterine factors of infertility . Such reasons include:

- synechiae (adhesions) in the uterine cavity;

- fibroids, deforming the uterine cavity;

- endometrial polyp;

- malformations of the uterus, for example a septum in the uterine cavity.

Sometimes doctors are forced to make a diagnosis of “unexplained infertility” when the cause of infertility has not been established.

In addition to all of the above, there is such a thing as “combined infertility” - when the reasons for the failure of pregnancy are found in both women and men.

For pregnancy to occur, 4 conditions are necessary:

1st condition – the woman is ovulating (a vesicle, a follicle, matures in the ovary, it bursts and an egg is released into the pelvis);

2nd condition – passable fallopian tubes (“tunnel” in which the egg meets the sperm, and they merge into one cell - the zygote - from which the embryo is subsequently formed);

3rd condition – good sperm quality (defective, immobile sperm will not be able to travel a long way (vagina - cervix - uterine cavity - fallopian tubes) to meet the egg in the fallopian tube);

4th condition – absence of pathology in the uterine cavity (polyp, fibroids, etc.). The womb is the house in which the baby will grow for 9 months. The endometrium is the inner layer of the uterus - like a feather bed into which the fertilized egg is immersed. It is the endometrium that nourishes the embryo until the chorion and then the placenta are formed.

Knowing the conditions necessary for pregnancy to occur, the directions for examining a married couple on the path to overcoming infertility become clear.

What methods of treating infertility exist today? In each specific case the approach is individual. It is very important that the doctor and patient work in tandem, both are interested in pregnancy. It is unacceptable to walk around with a diagnosis of infertility for years. It takes a maximum of 6 months to clarify the cause of infertility. Next, you should start treatment.

Conservative methods of treatment : for example, for polycystic ovary syndrome, we start with conservative methods: recommendations on nutrition, physical activity, weight loss. If the above recommendations have no effect, we stimulate ovulation.

For thyroid diseases, we work together with an endocrinologist and prescribe medications to restore thyroid function.

Surgical methods of treatment : for varicocele, hydrocele in men. For polyps/fibroids in the uterine cavity, anomalies of the uterus - hysteroresectoscopy. In case of adhesions in the pelvic cavity: during laparoscopic surgical treatment, we will simultaneously check the patency of the fallopian tubes and separate the adhesions.

In the absence of the effect of treating infertility with conservative and surgical methods and/or the patient’s reproductive age is late, and/or the ovarian reserve is reduced, it is advisable to offer assisted reproductive technology programs as the most effective method of achieving pregnancy.

By the way, based on the decree of the President of the Republic of Belarus dated May 18, 2020. No. 171, married couples in which the woman’s age does not exceed 40 years, if there are medical indications, are given one attempt at in vitro fertilization (hereinafter referred to as IVF) free of charge. One IVF attempt is provided free of charge exclusively to married couples under the following conditions:

• presence of medical indications and absence of medical contraindications determined by the Ministry of Health;
• lack of medical indications for the use of donor germ cells;
• whether the spouses have citizenship of the Republic of Belarus;
• The wife's age is up to 40 years.

How to exercise your right to a free IVF attempt?

1. If they are unable to conceive, a married couple turns to the state outpatient health care organization at the place of registration (place of stay) or to a non-state health care organization (hereinafter, unless otherwise indicated, the health care organization).
2. Spouses are subject to medical examination and, if necessary, treatment in accordance with clinical diagnostic and treatment protocols.

After a medical examination and (or) treatment, the following is established for the spouse:

• presence (absence) of medical indications and absence (presence) of medical contraindications to the use of the IVF procedure;
• absence (presence) of medical indications for the use of donor germ cells.

3. To provide one IVF attempt free of charge, spouses personally apply with a corresponding application, drawn up in any form, to the regional commission for the selection of patients for a free IVF attempt, and in Minsk - to the Minsk City Commission for the selection of patients for a free IVF attempt (hereinafter – regional commission).

Along with the application the following must be submitted:

• passports of spouses;
• documents confirming marriage;
• extract from medical documents.

At the City Center for Reproductive Health on the basis of the health care institution “City Clinical Maternity Hospital No. 2”, a preliminary registration of married couples with specialist doctors has been organized to submit documents to the Minsk City Commission for the selection of patients for a free IVF attempt:

Make an appointment by calling 373-20-84, 374-08-14.

Documents are accepted (the list is listed on the website in the IVF section at the expense of budgetary funds) is carried out daily, except weekends and holidays.

        And most importantly, remember, infertility is not a death sentence!

Author: obstetrician-gynecologist of the first qualification category (head of consultation) of the 4th antenatal clinic Shkarupa A.S.