Infertility Female and Male: Diagnostic Methods and Medications
Infertility can be a consequence of health problems at both or one partners. According to statistics, the reason for the absence of pregnancy is male infertility – in 46-48% of couples. The effect of female infertility is slightly higher – in 52-54% of pairs.
Successful fertilization is impossible without the harmonious interaction of the male or female reproductive system. For this, the following factors are necessary:
- Presence of healthy eggs
- Presence of necessary quantity of viable spermatozoa
- Absence of causes and factors. Preventing the transport of spermatozoa to the ampullar part of the fallopian tubes
- The subsequent unimpeded transport of the embryo into the womb of the womb of the woman for consolidation there and further development
In medical practice, there are many cases of combined infertility, in which both spouses have problems preventing the occurrence of a desired pregnancy. Similar violations of reproductive functions among partners are recorded in 30% of all cases of inability to become pregnant.
Brian Softener, Head of female consultation, obstetrician-gynecologist of the highest category, experience of 38 years: “Modern medical technologies help to have a child for almost every woman. There are no hopeless cases. But it is better not to delay the solution of the problem to 35 years. A qualified doctor will be able to select the optimal method for obtaining the result. Therefore, do not despair and postpone the visit to a specialist in the absence of pregnancy during the year. The sooner you seek help from medical professionals, the sooner you will become happy parents of a healthy baby.”
WHEN SHOULD YOU APPLY TO SPECIALISTS
To begin with, you should determine the very concept of infertility. The couple is considered infertile if the couple can not have a child during a year of regular sexual activity, if both partners do not use any of the methods of contraception.
If this definition you can relate to yourself, then postpone visiting a specialist for a long time is not worth it.
What kind of doctor should you contact a man and a woman with a suspicion of infertility? Men need to first turn to a urologist or andrologist, and a woman to a gynecologist. It is these specialists who will be able to determine what tests should be submitted, and also to recommend appropriate studies. In the future, it may be necessary to consult doctors and other specializations, for example, an endocrinologist.
HOW TO PREPARE FOR VISITING A DOCTOR
Before going to the doctor, there is no need to take any tests. It is enough to take with you available medical documents and be ready for a frank conversation with a specialist ..
At the first reception, as a rule, the doctor interrogates the patient, trying to find out the causes of possible infertility, the characteristics of sexual life and the presence of hereditary predisposition.
The doctor then compiles a plan for the necessary studies, including analyzes, diagnostic procedures and consultations of narrow specialists. Most often the examination begins with a spermogram of a man. As for the woman, she is asked to give a whole range of tests. In each case, the doctor determines the need for an event.
DIAGNOSIS OF INFERTILITY OF PAIR
Determine the cause of infertility in most cases is impossible without involvement in the study of both spouses. Statistics show that one third of couples suffer from combined infertility, seeking help from specialists.
In the process of studying the problem, both partners are required to submit tests for the presence of sexually transmitted diseases (gonorrhea, chlamydia, mycoplasmosis, trichomoniasis, ureaplasmosis).
From the man in the first place it is required to make a spermogram. In case of a satisfactory result, the diagnostic process focuses more on the woman.
DIAGNOSTICS OF MEN’S INFERTILITY
Diagnosis of infertility in men is done in several stages. First and foremost, the male doctor first of all specifies the individual characteristics of sexual life, information about the transferred operations, diseases that can negatively affect the reproductive function. In the future, the doctor conducts a physical examination (examination of the testicles, veins, etc.)
To male infertility often results in a change in the quality of sperm and the properties of spermatozoa. For the procedure of such violations, a spermogram is made. Depending on the quantitative characteristics of sperm, the following pathologies are determined:
- Insufficient quantity or absence of ejaculate (aspermia);
- Low concentration in the ejaculate of spermatozoa (oligospermia);
- Absence of spermatozoa (azoospermia);
- Disturbance of the structure and shape of spermatozoa (teratospermia);
- The combination of abnormalities in sperm counts (oligoasthenoteratozoospermia);
- Increased number of dead spermatozoa (necrospermia);
- Weak mobility of spermatozoa (astenospremia).
With a normal volume of sperm (2-6 ml), one milliliter contains an average of 20 million spermatozoa, 60% of which must be healthy and well-mobile.
When a violation in the spermogram is found, the man is asked to undergo laboratory tests on the level of hormones (genital, thyroid, and others).
In addition, men are referred for trans rectal ultrasound of the prostate and other pelvic organs to identify abnormalities in the development of the reproductive system.
If there is a suspicion of infertility in connection with a dysfunction of the testicles, the men are sent to the ultrasound of the scrotum organs.
ADDITIONAL METHODS OF SURVEY
MAR-test – reveals immune infertility, when the body produces antibodies to its own sperm). The essence of the test lies in the study of appendages and testes with ultrasound in combination with Doppler. The results obtained make it possible to exclude physiological, surgical and inflammatory disorders.
TRUS – is carried out for a more detailed study of the state of the organs of the male reproductive system.
Significant violations of spermatozoa often serve as an excuse to conduct a genetic study. In addition, bilateral genitography is used to detect the obstruction of the vas deferens.
Hormones in men affect not only their libido, but also the normal course of spermatogenesis. Therefore, it is important to determine what level of testosterone, prolactin, FSH and LH the patient has. This type of diagnosis is usually prescribed for oligozoospermia, hypogonadism and azoospermia.
DIAGNOSTICS OF INFECTIOUS DISEASES
STIs – sexually transmitted infections – also often provoke the development of infertility. Therefore, a study is being conducted to determine all genital infections by a swab from the urethra. In the case of an inflammatory process, the detection of leukocytes and bacteria in the semen, an analysis of secretion and sperm sowing is carried out. Very often this way, prostatitis is detected.
An increased level of free radicals is fraught with damage to the membrane of spermatozoa, as well as their chromosome DNA. Therefore, this type of diagnosis is carried out to find out the main cause of the disease, chemical abnormalities on the head of the sperm, making it difficult to penetrate into the egg reveals an acrosomal reaction.
For completeness of the picture, in case other methods have not revealed a problem, at the doctor’s discretion,
- Microscopic examination of spermatozoa under an electron microscope
- An expanded spermogram according to Kruger
- Biochemistry of ejaculate, testicular biopsy
- The Kurzrok-Miller test
- Definition of oncomarkers
MEDICINES FOR TREATING MEN’S INHERITANCE
The scheme of the use of drugs for the treatment of male infertility is selected by the doctor individually for each man. Only under such conditions it is possible to achieve an early restoration of all disturbed functions.
Drugs that can be prescribed for male infertility:
- Hormonal preparations (after preliminary assessment of the basic hormonal profile). Some of them are used to stimulate spermatogenesis, others are derivatives for the formation of sex hormones.
- Antibacterial preparations. This group of drugs is prescribed for inflammatory diseases of the reproductive organs. In this case, the doctor takes into account the sensitivity of the patient’s microflora to the drug.
- Preparations containing L-carnitine – a substance that participates in the process of spermatogenesis.
- Vitamins, vitamin-mineral complexes and phytopreparations containing vitamin E and zinc, which positively influence spermatogenesis.
- Actovegin and Trental – improve microcirculation.
DIAGNOSTICS OF WOMEN’S INFERTILITY
Women for infertility diagnosis undergo the following examinations:
- Diagnostic laparoscopy – is performed to determine the patency of the fallopian tubes.
- Determination of the hormonal background – to determine violations in the ovaries and other endocrine organs responsible for the synthesis and the supply of hormones into the blood.
- Folliculometry and ultrasound of the pelvic organs – to monitor the development of the endometrium and the dominant follicle on certain days of the cycle.
- EFORT-test – to determine the functions of the ovaries and their ovarian reserve.
- Extended haemostasiogram – to exclude conditions for the formation of blood clots due to excessive blood density or bleeding due to too much dilution. Such deviations can cause death of the embryo, DIC-syndrome, pregnancy fading.
- Analysis for homocysteine - to determine the cause of miscarriage.
- Surveys of polymorphisms of genes of the hemostasis system – helps to identify genetic factors of placental insufficiency, fetal growth retardation and its miscarriage.
- Examination of autoantibodies – helps to identify the presence of autoimmune disorders.
This is the basic examination that every woman needs to undergo to diagnose infertility. The doctor in each individual case determines what tests should be given to more accurately determine the cause of the disease and prescribe the most appropriate treatment that can help her successfully become pregnant.
MEDICINES FOR TREATMENT OF WOMEN’S INFERTILITY
Drugs are mainly prescribed for women who have problems with ovulation and are the primary treatment for infertility. These medicines. Taken orally or in injections, stimulate the production of hormones, which in turn provoke or regulate ovulation.
Most often doctors prescribe:
1. Hormones in tablets
Clomid (Clomifene). Approximately in 60% – 80% of women taking clomiphene, ovulation is regulated and half of them are pregnant. Most often appoint three cycles of admission.
2. Hormones in injections
If there is no result after treatment with Clomid, the doctor can prescribe injections of hormones that stimulate ovulation. Namely:
- Human chorionic gonadotropin (hCG), Ovidrel, Profi, Pregnil, and Novarel are used in conjunction with other drugs that stimulate ovarian function and the yield of a mature egg
- Follicle-stimulating hormone (FSH), Fertinex, Follistim, Gonal-F and Bravell
- Human menopausal gonadotropin (hMG), Metrodine, Regronex and Pergonal – are used in conjunction with luteinizing and follicle-stimulating hormones
- Lutrepuls, Zoladex, Faktrel and Gnadoliberin (Gn-RH) – to stimulate pituitary production of luteinizing and follicle-stimulating hormones
- Gnadoliberin agonist (GnRH agonist), Sinarel, Nafarelin, Zoladex and Lupron
- Gnadoliberin antagonist (GnRH antagonist), Cetrotid and Antagon – to cure many problems with fertility and thus stimulate ovulation in women
3. Other medicines
- Aspirin (after consulting a doctor) – in some cases is used to reduce the risk of miscarriage
- Heparin – used for women who had repeated miscarriages, to reduce the risk of miscarriage
- Antagon (genirelix acetate) – is used to suppress premature ovulation in women
- Dostinex and Parlodel (cabergoline and bromocriptine) – to reduce the size of the pituitary tumor, which can reduce ovulation and reduce the level of the hormone prolactin
In conclusion, I want to note that you should never give up. Joint efforts of you and medical specialists will help to get the desired result!