Diagnosis and treatment of infertility. Primary diagnosis of infertility: examination for infertility in women, men and what tests need to be taken. Essential drugs

Diagnosis of infertility is a series of examinations carried out to determine dysfunction reproductive system person who is the cause of the disease. Such diagnostics make it possible not only to find out what caused infertility, but to determine the most effective treatment methods for recovery. reproductive function.

Procedure for conducting the examination:
Diagnosis of infertility is carried out for both men and women. Naturally, different methods are also used for representatives of different sexes.
Diagnosis of male infertility usually involves examining sperm (spermogram), which determines its various functional and morphological properties.
Female infertility often requires a more comprehensive approach to the problem. This is due to the fact that there are significantly more reasons for problems with reproductive function in women, and, accordingly, methods for determining them.

The main types of diagnostics for women are:

endoscopy and laparoscopy - allow you to determine the presence or absence of fibroids, polyps, adhesions, tumor formations or other uterine abnormalities;
Ultrasound examination to identify anatomical pathologies, such as, for example, tubal infertility, the cause of which is complete or partial obstruction fallopian tubes;
laboratory endocrine examination (hormone tests), etc.

Also, for both female and male representatives, the causes of infertility are determined using DNA diagnostics, which identifies possible genetic reasons sterility.

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Content

Diagnosis of infertility includes examination of sexual partners for diseases of the reproductive system and involves the use of instrumental, laboratory, hardware, invasive surgical tactics. Thanks to modern methods The study is able to timely identify severe pathologies of the reproductive system: endocrine, congenital, infectious, genetic abnormalities. Diagnostic measures are aimed at choosing the optimal and quickest option for treating infertility, following an individual approach.

When to see a doctor

Diagnosis of infertility according to WHO standards should be carried out within 3-4 months from the moment the couple applies for medical care.

Lack of pregnancy with active planning throughout the year when not used oral contraceptives And barrier methods protection becomes a reason to visit a doctor. The inability to conceive may not be accompanied by other symptoms, but most often women notice some clear or minor pathological signs.

It is necessary to undergo an examination for infertility if certain symptoms occur.

Irregular menstrual cycle, manifested by the onset of menstruation more often than once every 24-25 days or less than once every 35 days.
Scanty or excessively heavy painful menstruation.
Appearing in the middle menstrual cycle bloody discharge, and brown daub at the beginning of menstruation.
Availability excess growth body hair, oily, problem skin along with cycle disruption.
Appearance painful sensations during sexual intercourse (except for the ovulatory period).
Infectious and inflammatory processes of the genital tract, manifested pathological discharge With unpleasant smell, itching, worsening cystitis and urethritis. The discharge may be mucopurulent in nature and contain fresh or altered blood.
Release of milk from the breast.

Weakly positive tests and the subsequent onset of menstruation, a history of miscarriages, missed pregnancies are also considered reasons to consult a specialist.

In the process of diagnosing infertility, the following diseases can be identified:

bends of the uterus;
endometriosis;
ovarian cysts;
fibroids;
polycystic ovaries;
pathologies of the cervix (cervical stenosis, endocervicitis, dysplasia, polyps);
endometritis;
adnexitis;
hyperplastic processes in the endometrium;
adhesive process in the tubes and pelvis.

In the absence of detection of diseases of the reproductive tract in a man or woman, a diagnosis of “idiopathic infertility” or infertility of unknown origin is made.

A history of several cleansings, which could lead to damage to the basal layer of the endometrium, is also considered a reason to visit specialists and diagnose infertility.

Diagnosis of female infertility

Diagnosis of infertility in women includes a number of methods, the list of which is determined by the duration of the complaints, as well as the type of infertility. Highlight primary infertility, in which pregnancy never occurred, as well as secondary, when the facts of conception were present earlier.

In the primary form, studies are carried out as part of the diagnosis of infertility, aimed at identifying obvious pathology:

general examination and medical history;
examination of the cervix in the speculum, palpation of the uterus and appendages;
smears for genital infections, oncocytology;
colposcopy;
Pelvic ultrasound, including folliculometry and Doppler ultrasound;
blood tests for sex hormones.

If necessary, consultations with related specialists (endocrinologist, immunologist, therapist, surgeon) are prescribed. As part of the primary diagnosis of infertility, a man is prescribed a semen analysis and smears for genital infections.

If there is no pathology, the couple is sent for further planning, while vitamin therapy, diet, refusal to bad habits, measurement basal temperature to identify the most suitable days for the purpose of conception.

Consultation with a gynecologist and medical history collection

Diagnosis of diseases of the reproductive tract in women with suspected infertility includes taking an anamnesis:

the duration of impossibility of conception in a particular marriage;
information on the number of marriages, presence and number of pregnancies;
methods of protection used;
presence of bad habits;
features of the menstrual cycle, its debut and duration of establishment;
family history on the female side;
the presence of diseases of the genital organs and extragenital pathologies;
analysis of previous treatment and diagnosis.

After receiving information about a woman’s reproductive status, the gynecologist forms a general picture of the situation, which allows him to optimally prescribe a list of measures for diagnosing infertility.

Physical examination

The collection of anamnesis during diagnosis ends with an examination of the woman and an assessment of external pathognomonic signs that indicate gynecological diseases.

Height, weight and BMI are to be determined, which is normally 20-26. If the values are outside the acceptable intervals, find out the time of the beginning of the decrease or increase in body weight, the rate and possible reasons.
Assessment of the degree and nature of hair growth, the presence of stretch marks, acne.
Palpation of the mammary glands.
Examination of the cervical part of the uterus in speculums, diagnosis of pathologies using smears (microscopy and cytology) and colposcopy.
Ultrasound of the pelvic organs.

The initial appointment with a doctor ends with the appointment of more detailed studies for subsequent diagnosis of infertility.

Laboratory diagnostics

Laboratory methods for diagnosing infertility include studies on possible infections, affecting reproductive status, as well as determining the level of sex hormones.

Diagnosis of endocrine infertility in women includes tests for:

first phase hormones (follicle-stimulating, luteinizing, estradiol);
second phase hormone (progesterone);
male sex hormones and metabolites (DHEA sulfate, 17-OH-progesterone, free testosterone);
egg reserve indicator (anti-Mullerian hormone, inhibin B);
prolactin;
hormones thyroid gland.

During diagnosis, it is advisable to take a cortisol test if there is an existing irregularity in the menstrual cycle.

In addition to hormones, when diagnosing infertility and suspected polycystic ovary syndrome, the level of insulin, glycated hemoglobin, and a glucose tolerance test are determined.

If you suspect immunological infertility perform an analysis for antisperm antibodies.

Diagnosis of the endocrine form of infertility allows us to determine hypothyroidism, hyperestrogenism, hyperandrogenism of ovarian and adrenal origin, ovarian wasting syndrome, and suspect polycystic disease - the most common reasons infertility in women.

Diagnosis of infections involves:

detection of the level of antibodies to cytomegalovirus, toxoplasma, rubella virus and herpes simplex viruses;
examination of vaginal smears using microscopy for the diagnosis of thrush, gonorrhea, trichomoniasis, gardnerellosis, degree of purity;
sowing the discharge onto nutrient media to detect growth opportunistic flora(diagnosis of dysbacteriosis);
smears from the urethra and cervical canal for the presence of chlamydial, mycoplasma and ureaplasma infections, genital herpes, cytomegalovirus, papillomavirus (PCR method).

When diagnosing infertility, vaginal microbiocenosis can be assessed using the Femoflor analysis.

Chronic genital tract infections are becoming one of the leading causes of female and male infertility.

Hardware diagnostics

The most effective and simplest method for diagnosing diseases of the genital organs is ultrasonography. Ultrasound diagnostics allows you to detect fibroids various localizations, adenomyosis, ovarian cysts, large polyps, uterine anomalies(bicornuate, saddle-shaped uterus).

In order to diagnose endometrial hyperplasia, polyps, endometriosis, ultrasound diagnostics are carried out at the end of the menstrual cycle. It is advisable to diagnose other pathologies at the beginning of the cycle.

Diagnosis of cervical pathologies using extended colposcopy makes it possible to identify endocervicitis, pseudoerosion, dysplasia, leukoplakia, and erythroplakia. The surface of the neck is treated with solutions acetic acid and iodine.

Thanks to an iodine-based reagent, it is possible to determine the boundaries of the junction of two types of epithelium, the transformation zone. Iodine does not stain the columnar appearance of the epithelium in Brown color, so the doctor can easily visualize the boundaries and state of the tissue transformation zone.

Acetic acid affects the vessels of the cervix, leading to their short-term spasm. Normally, capillary spasm gives the surface of the cervix temporary pallor. But with dysplasia, leukoplakia, cancer, acetowhite epithelium is noted - a prolonged spasm of the capillaries, as well as mosaic and punctation ( pathological changes vascular pattern), atypical tortuous and corkscrew-shaped vessels.

Diagnosis of cervical diseases makes it possible to identify the cervical form of infertility.

Hardware diagnostic methods also include MRI of the sella turcica to detect pituitary microadenoma, a sign of which is considered to be an increase in prolactin.

Surgical examination

At the second stage of diagnosing infertility, when attempts to get pregnant were unsuccessful and the couple turned for a re-examination, a gynecologist at mandatory prescribes invasive instrumental methods to the woman.

Examination for infertility in women at the second stage includes diagnostic hysteroscopy and laparoscopy.

Surgical diagnostic methods allow us to examine in detail intrauterine formations And pathological processes in the small pelvis.

The hysteroscope is equipped with a video camera and during its insertion into the uterine cavity it is possible to detect conditions not visible on ultrasound, in particular, adhesions and polyps.

In addition, invasive diagnostics of intrauterine pathologies makes it possible to determine:

the state of the entrance to the lumen of the pipes, their patency;
the presence of adenomyosis;
endometrial hyperplasia of a diffuse and focal nature;
submucous fibroids;
Uterine anomalies: saddle-shaped, bicornuate uterus.

In the process of hysteroscopy of the diagnostic plan, removal of pathological formations that initiated infertility.

After a successful hysteroscopy, pregnancy occurs within six months.

In addition to hysteroscopy, if tubal obstruction is suspected, two more studies are performed:

hysterosalpingography;
echohysterosalpingoscopy.

The first diagnostic method tubal infertility in women it involves the use of x-rays and a radiopaque substance that is injected into the tubes. Considering the radiation exposure, specialists are increasingly resorting to a diagnostic method such as echohysterosalpingoscopy, which means introducing an echo contrast agent (Furacilin, distilled water, saline solution) into the tubes, then performing an ultrasound.

Diagnostic laparoscopy is a method of examining the pelvic cavity using endoscopic equipment. Diagnostics female infertility Using laparoscopy, you can detect:

tubo-peritoneal infertility;
obstruction of the fallopian tubes;
endometriosis of the peritoneum, ovaries;
intramural and subserous fibroids.

During the operation, formations are removed and adhesions are dissected. A few months after diagnosis and treatment by laparoscopy, many women experience natural pregnancy.

Using Functional Tests

Tests functional diagnostics in case of infertility, they are used to assess hormonal regulation in a woman’s body. Tests are used for self-administration and outpatient testing. Women can assess whether they are ovulating by measuring their rectal temperature for at least three consecutive cycles.

Measuring basal temperature is considered a simple and effective test for home use, allowing us to determine the right time for conception.

Doctors use several tests to diagnose the cause of hormonal imbalance.

Progesterone test. If after its administration a woman begins uterine bleeding, confirm the insufficiency of the second phase as the cause of infertility.
Test with estrogen and progesterone. A woman is administered sequentially both drugs; when a menstrual-like reaction appears, the test is considered positive, which means ovarian failure and excludes uterine pathology, such as possible reason infertility.
Dexamethasone test to diagnose the source higher level male sex hormones. If after administration of the drug there is a decrease in the level of 17-ketosteroids, hyperandrogenism is adrenal in nature, if 17-KS increases - ovarian.
Ovulation stimulation test using clostilbegit. If there is no result during the diagnostic process, anovulation is of a hypothalamic-pituitary nature.

After determining the nature of hormonal disorders, appropriate infertility treatment is prescribed.

Diagnosis of male infertility

Tactics diagnostic measures when determining the cause of infertility in men, it comes down to a survey, laboratory tests and instrumental studies, the main role in this case belongs to the spermogram.

List of studies for diagnosing male infertility:

STI tests;
Ultrasound of the prostate;
determination of the level of sex hormones;
detailed spermogram;
MAP test of sperm (for immunological infertility);
Kruger sperm analysis;
tests for chromosomal abnormalities of sperm (FISH analysis, Y-chromosome integrity);
analysis of prostatic juice.

When diagnosing male infertility using the Kruger analysis method, they rely on a standard of more than 4%.

The norm for the MAP test is considered to be less than or equal to 30%; other results serve as a reason for establishing a diagnosis of “immunological infertility.”

If MAP analysis values are more than 30%, it is advisable to carry out IVF with the mandatory use of ICSI. Thanks to this procedure, the optimal sperm is selected and artificially introduced into the egg.

Examination of a couple for infertility

Infertility by female factor are registered in 45% of cases, in male cases - in 40%, the rest of the causes of infertility are due to both male and female pathologies.

If an infertile couple comes to see a reproductologist, a specific diagnostic algorithm is prescribed:

the man is prescribed a sperm analysis and, in the absence of pathology, no other measures are taken at this stage;
postcoital test (diagnosis of the immune form of infertility);
two-stage examination of a woman.

At the first stage, methods are used to eliminate three common female diseases: ovulation disorder, tubo-peritoneal factor, infectious and inflammatory processes of the reproductive tract. This diagnostic stage consists of standard set minimally invasive techniques.

Primary diagnosis of infertility in women, the stages of which are divided into blocks, includes:

Study of anamnesis and clinical data.
Infectious screening: vaginal smears for purity, bacterial culture, PCR examination of a cervix smear for chlamydia, urea and mycoplasma, herpes simplex, CMV, HPV, as well as blood for antibodies to toxoplasma.
Hormonal screening: on day 2 with short cycles, on days 2-5 (at 28-32 daily cycle), on days 6-9 (with a cycle length of 35 days), donate blood for sex hormones, including FSH, LH, estradiol, free testosterone, prolactin, DEA-sulfate, 17-OH-progesterone. To determine the level of progesterone, the blood is tested for 7 days after ultrasound-proven ovulation.
Ultrasound diagnosis of diseases of the mammary glands, pelvic organs, thyroid gland, adrenal glands.

In the absence of menstruation, blood is donated for hormones any day.

Primary diagnosis and treatment of infertility identified by the results of a study in women implies normalization hormonal balance, removal of pathological formations, vitamin therapy.

Diagnosis at the second stage is always individual. The set of methods usually includes studies based on identified pathologies during the first stage of infertility diagnosis, and also includes:

tests that detect genetic abnormalities (karyotypes, determination of HLA compatibility of partners);
blood tests for hemostasis mutations, thrombophilia, antiphospholipid syndrome;
instrumental diagnostic methods (MRI of the sella turcica, laparoscopy, hysteroscopy, hysterosalpingography).

48% of infertile women are diagnosed with 1 infertility factor, and 52% have more than two.

When identifying diseases that cannot be fully cured during the diagnosis of infertility, for example, ovarian wasting syndrome, severe endometriosis, asthenozoospermia, false aspermia, azoospermia, bilateral adhesive process in pipes, couples are offered IVF or artificial insemination.

Conclusion

Diagnosis must be consistent and time-limited. Each of its stages must be directed towards completing a specific task in order to assign optimal treatment. If there are no results of diagnosis and treatment of infertility in men and women within a year, it is necessary to seek a second consultation. It is considered advisable to change the clinic or specialists.

To find out the reasons for decreased fertility, tests are taken. The cost of the examination depends on the number and type of diagnostic measures prescribed to you. The price for testing for infertility in women varies depending on the type of test. There is no universal cost for all tests.

Analysis for infertility in women

Since it is not possible to determine infertility in women based on symptoms or medical history, it is necessary to laboratory research. They include: blood and urine tests, determination of blood group and its Rh factor, analysis for syphilis and hepatitis, as well as some types of viral infections.

Screening for sexually transmitted infections

The examination is carried out to identify pathogens of sexually transmitted infections, such as gardnerella, ureaplasma, chlamydia and mycoplasma. It is very important to detect and treat them in time, since they are often the cause of infertility or fetal death.

Immune tests

To identify antisperm bodies that interfere with conception, the MAP test and PCT (postcoital) test are used. The essence of the latter is to determine the effect of mucus inside the cervix on sperm activity a couple of hours after intercourse.

Basal temperature measurement

This test should be carried out for at least 3-4 cycles. It is the most inexpensive and has sufficient accuracy. With its help, you can determine whether a woman is ovulating or not.

A preliminary examination allows our specialists to identify the causes of infertility and develop an optimal plan that will achieve best results treatment and give birth to a healthy baby.

A test for infertility in women makes it possible to understand where the source of the problem lies. Perhaps the partner is to blame for the lack of conception; According to statistics, about 40% of married couples do not have children as a result of infertility in the man. Therefore, both partners must be examined.

Diagnosis of infertility in women includes various procedures, from the simplest standard tests to complex invasive procedures. In some cases, during the intervention, it is possible not only to detect the cause of the disorders that have arisen, but also to eliminate it, for example, with hysteroscopy or laparoscopy.

In most cases, the problem of infertility that occurs in a couple is associated with 4 main objects that play a decisive role in conceiving a child: sperm, ovaries, uterus and fallopian tubes. The probability of detecting disturbances in the functioning of these organs in men and women is approximately the same - 40%. In 10% of cases, both partners have problems. The remaining 10% are cases where no obvious abnormalities in the functioning of the organs were detected and the cause was not clear. Such situations are called idiopathic or infertility of unknown origin.

Every year the number of couples experiencing difficulties conceiving is increasing. For some, it is enough to change their established lifestyle, while others require treatment. In any case, only a doctor can determine the cause of difficulties with conception.

Manipulations with the reproductive system should be carried out in childhood.

Screening for infections

Very important stage diagnosing infertility is testing for infections. Be sure to get tested for:

chlamydia;
trichomoniasis;
gonorrhea.

There are many more dangerous infections; the lion's share are not capable of causing infertility, but they increase the risk. You should definitely be examined for candidiasis, syphilis, hepatitis, HIV, gonococcus, and mycoplasma. These infections can be transmitted to the unborn child.

Hormonal disorders

If a man is found to lack the hormone testosterone, the cause of infertility is hormonal disorders. To determine the cause of the failure, you should visit an andrologist. To diagnose the condition, take hormone tests. It is also worth identifying sexually transmitted infections; perhaps they contributed to the development of the disease, leading to infertility.

Hormonal imbalances in men occur due to a number of reasons, including: head injuries, testicular disease, etc. Stress and emotional stress have a negative impact on the hormonal background. Reason hormonal disorder are diseases.

Ultrasound

To find out the factor of male infertility, an ultrasound scan of the pelvic organs, scrotum, and thyroid gland is performed. The examination technique allows us to determine pathologies in reproductive organs.

If the doctor does not rule out hypertrophy or inflammation of the prostate gland, he prescribes TRUS (ultrasound of the prostate).

Testicular biopsy

If you suspect the presence malignant tumor in the reproductive organs, the specialist prescribes a testicular biopsy. The procedure is carried out qualified specialist. He makes a puncture in the testicle or an incision in the scrotum and collects sperm.

Other diagnostic options

One of the popular and effective methods diagnosing male infertility is a postcoital test. With its help, a specialist evaluates the interaction between sperm and cervical mucus, observes the survival rate and behavior of sperm. The test must be carried out in the coming hours following sexual intercourse, which should occur on the day of ovulation.

Before this, the couple should abstain from sex for five days. Be sure to avoid drinking alcohol and smoking, reduce the amount you consume fatty foods, eat more vitamins and get enough sleep. After sexual intercourse, a smear is taken from the woman's cervix for diagnosis.

Cost of diagnostics for male and female infertility in centers

Today throughout Russia there are specialized medical clinics and centers capable of identifying the exact cause of female and male infertility. They employ qualified doctors who are ready to prescribe effective treatment and help the couple become parents. There are more than a hundred similar centers in Moscow: “VitroClinic”, “Medsi”, “Aimed”, “Mother and Child” clinic.

The latter successfully applies the possibilities of infertility treatment. Diagnosis of male infertility begins with a spermogram. In this center, the procedure costs from 2300 rubles.

Consultation with a urologist is required, clinical trials. Depending on what tests are required to determine the cause of infertility, the cost of diagnosis will depend. On average, a male examination costs about 30-35 thousand rubles.

A female examination begins with hormone tests, a doctor’s examination, and an ultrasound scan. Diagnosis of a woman takes much longer. To go through the initial stage of diagnosis, a woman will need an average of 30 thousand rubles. As a rule, prices in St. Petersburg (in the most popular clinics, such as LabStory or the North-Western Perinatal Genetic Center) for such procedures and studies vary within the same limits as in the capital.

Effectiveness of the data obtained

It is extremely important to diagnose infertility and determine main reason as soon as possible. The effectiveness of the treatment depends on the correctly chosen methods of therapy. A woman or man can only be helped with this by a doctor who knows his job well.

This is not a sentence and you should never give up. The disease can be treated, the main thing is to correctly diagnose the cause. There are many factors that cause infertility; only a reproductive health worker, having correctly assessed the state of the body and health, will collect anamnesis and prescribe medication or surgical treatment.

If you find a problem on initial stage, it will be easier to cope with the disease, which will increase the couple’s likelihood of conceiving a child. When diagnosing, it is necessary to examine both partners; according to statistics, in almost half of the couples facing problems in conceiving, the man is infertile.

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Primary diagnosis of infertility: examination for infertility in women, men and what tests need to be taken

For absolutely healthy woman at the age of 25 years, the probability of becoming pregnant in 1 menstrual cycle (MC) is 22-25%. U married couple with regular sexual activity (with a frequency of 2-3 times a week), pregnancy occurs within 1 year in 75% of cases.

Therefore, primary infertility is considered to be the absence of pregnancy in a woman. reproductive age within 12 months of regular sexual activity without using contraception. Let's look at where to start testing for infertility, what diagnostic methods exist and where to go.

It should be noted that the period for diagnosing infertility, from the initial visit to a specialist to determining the cause, should not be more than 2 months. The period of examination and treatment of infertility should not exceed 2 years in women under 35 years of age and 1 year in patients over 35. With age, the effectiveness of treatment only decreases. After these two periods, treatment with the method is recommended.

What is infertility and how does it happen?
When to start the examination
First consultation: what you need to know
Where to start diagnostics
Examination for female infertility
What will the doctor ask?
Clinical examination
Ultrasound diagnostics
Grade hormonal levels
Tests for infections
Genetic research
Treatment

What is infertility? Types and classification

There is no need to blame one of the partners for infertility; it can be either female or male, but the combined form is more common. So if you or your doctor suspect that the reason for the lack of pregnancy lies precisely in him, then both the man and the woman need to be diagnosed with infertility. It is necessary to undergo a series of examinations and tests.

There are 3 types of infertility:

– inability of male reproductive cells to mature male body to conception (there may be many reasons, but male infertility in most cases reversible). The incidence of true male factor infertility is 30%.
Female infertility is the absence of pregnancy, which is associated with problems in women's reproductive health. The frequency is 40%.
Combined infertility is 30%.

Therefore, the examination algorithm for infertility involves diagnostics reproductive health for both partners.

Infertility is also divided into:

primary, when there was no pregnancy at all;
secondary, when the fact of pregnancy was in the past and no matter how it ended - childbirth, miscarriage, ectopic pregnancy, abortion in youth.

When should you start testing for infertility?

You need to start testing for infertility with your or your local gynecologist. You can also contact the clinic reproductive medicine. Women under the age of 35 should seek medical help after 1 year of regular sexual activity (remember, without the use of contraceptive methods and means), after 35 years - after 6 months.

The reduction in time is due to the fact that the older the patient, the lower the pregnancy rate and in natural cycles and when using. Delaying examination for infertility after 35 reduces the chances of pregnancy in principle and reduces the chances of having healthy offspring.

First consultation with a specialist for infertility

At the initial visit, the doctor will find out whether there are contraindications for pregnancy or not. Since there are diseases (genital and extragenital, not related to the reproductive system), the course of pregnancy in which carries a potential risk to the woman’s life. Therefore, the doctor will collect anamnesis and ask about the following:

Do you have heart problems (defects);
developmental anomalies of the genital organs (bicornuate,);
from the woman and immediate relatives, etc.

The second stage is the correction of identified and confirmed diseases( , violations fat metabolism, obesity, diabetes, etc.)

Contraindications for pregnancy may be: mental illness, oncological formations.

Where to start testing for infertility?

Any examination of a married couple regarding infertility is comprehensive, but begins with the man. Firstly, it’s easier and faster. Secondly, the elimination of the male factor is already the first (albeit intermediate) result. Thirdly, a man’s fertility can be restored in 70% of cases after medicinal correction, correcting lifestyle or eliminating harmful factors. To diagnose infertility, a man needs to undergo a semen analysis. It's called a spermogram.

Diagnosis of male infertility

Assessing the reproductive capacity of a husband or partner begins with collecting an anamnesis - questioning. The doctor will find out:

age;
presence or absence of injuries;
number of marriages and presence of children (and their age);
past illnesses;
what operations were there;
occupational hazards;
desire to have children.

Then, according to the plan, you will need to take a test - a spermogram. This study is mandatory; it allows you to evaluate the concentration of sperm, their mobility, and the correctness of their structure.

infectious screening;
(antilobulin mixing reaction).

If abnormalities are detected in the spermogram, a consultation with an andrologist is scheduled. When the husband has passed, then it makes sense to deal only with the woman’s health.

Diagnosis of infertility in women

Basic examination of patients with infertility includes the following steps:

collecting information (history) about the woman;
clinical examination ( general analysis blood and urine, hormonal panel, blood glucose, etc.);
ultrasound diagnostics of the pelvic organs;
blood tests for hormones;
research (there are several methods for diagnosis).

What is important in collecting information about a woman with infertility?

Age is important for diagnosis. If we compare a woman aged 25 years with a woman 43-45 years old, the pregnancy rate is higher in a younger woman. More careful diagnosis awaits women of older reproductive age.

The second equally important factor for treatment is the duration of infertility. If a couple cannot become pregnant for 10 years and has a history of, for example, several, then the tactics of preparation and the method of treatment and diagnosis will be different.

When collecting anamnesis, be sure to take into account the presence of chronic common diseases, operations in abdominal cavity and pelvic cavity using drainage. These surgical interventions may lead to the development adhesive disease, and this is one of the factors that can.

Standard assessments in gynecology for diagnosing infertility include:

menstrual function: when the first menstruation began, the start date of the last cycle, ;
time of onset and intensity of sexual activity;
reproductive function: (natural or artificial), abortions, miscarriages, intrauterine fetal death, inflammatory complications after them;
use of contraception (physiological, medicinal, condoms): especially important for diagnosing infertility – long wearing intrauterine device, which may cause;
past sexually transmitted infections, their treatment regimens;
surgical operations on the pelvic organs for,.

Surgeries on the ovaries are of fundamental importance. They may be the cause.

Clinical examination for infertility

Diagnosis of female infertility consists of general examination, during which pay attention:

Based on body type, distribution of subcutaneous fat. If weight problems are identified, correction is required. If you are underweight, it is recommended to gain weight; if you are overweight, you are advised to lose weight. In some cases, this allows you to solve the problem of normalizing the menstrual cycle and, therefore, if there are no other disorders.
On the degree of hair growth. If there is excess hair female body you can suspect hyperandrogenism (excess of male sex hormones) or.
development of mammary glands.

Then a gynecological examination is performed and smears are taken.

During the examination, the psycho-emotional state is assessed. A woman may, on a subconscious level, not want a child, despite the fact that her closest relatives are pushing her to do so, but emotionally she is not ready for his appearance. This plays an important role in pregnancy.

Ultrasound examination of a woman with infertility

Ultrasound is prescribed in the first phase of the menstrual cycle - days 2-5. During ultrasound diagnostics presence or absence is assessed uterine pathology(, intrauterine synechiae).

It is mandatory to examine the ovaries - the size of the ovaries and the number of antral follicles.

Assessment of hormonal status in infertility

Assessment of hormonal levels consists of the following steps:

Laboratory blood tests for hormones. Screening is carried out on days 2-4 of MC (LH, FSH, E2 - estradiol, testosterone, DHA sulfate, TSH, T4, anti-Mullerian hormone, which is a marker of ovarian reserve).
Ovulation assessment: basal temperature measurement, urinary ovulation tests, folliculometry - ultrasound monitoring of follicle development.

Tests for infections

The infectious agent can also cause female infertility. For diagnosis, take during gynecological examination vaginal smear.

Specific tests:

Conducting analysis cervical mucus(smear from the cervix) for the presence of chlamydia, myco-, ureaplasma, herpes and cytomegalovirus using the PCR method.
Blood test for the TORCH complex: determined for the pathogens of toxoplasmosis, rubella virus, cytomegalovirus and herpes.

Genetic testing for infertility

Sometimes the doctor may prescribe genetic testing– karyotype study. A genotype is a person's set of chromosomes. For women it is 46 XX, for men it is 46 XY. This is a person’s genetic “passport”. Often there are deviations in the form of mutations, translocations (the location of an arm or section changes), the absence of a chromosome or the presence of additional ones.

Indications for karyotype examination in case of infertility:

primary amenorrhea – absence of menstruation;
secondary amenorrhea – premature menopause;
delayed sexual development;
(both spouses are examined).
long-term primary infertility of unknown origin.

Genetic analysis is also prescribed to both spouses in the case of several unsuccessful IVF cycles.

Infertility treatment

Restoration of reproductive function can be achieved with the help of:

methods (therapeutic and surgical - laparoscopy);
assisted reproduction method - IVF.