Diagnosis of infertility in women and men

Diagnosis of infertility include a survey of sexual partners on the subject of reproductive disease system and involves the use of instrumentation, laboratory hardware, invasive surgical tactician. Thanks to modern methods of investigation fails to timely detect serious diseases of the reproductive system: endocrine, congenital, infectious, genetic abnormalities. Diagnostic measures are aimed at selecting the best and fast option for infertility treatment, respecting the individual approach.

When should you see a doctor

Diagnosis of infertility according to WHO standards should be carried out for 3-4 months from the date of circulation couples seek medical help.

The absence of pregnancy in active planning for a year, when it is not used oral contraceptives and barrier methods, it becomes a reason for visiting the doctor. Inability to conceive may not be accompanied by other symptoms, but more often than women suffer from some bright or minor pathological signs.

Be tested for sterility necessary for specific symptoms.

1. Irregular menstrual cycle, manifesting the onset of menses more than once every 24-25 days or at least once every 35 days.
2. Meager or overly abundant painful menstruation.
3. The appearance in the middle of the menstrual bleeding, as well as the brown spotting at the beginning of menstruation.
4. The presence of excessive growth of body hair, oily skin problem along with cycle disorders.
5. The appearance of pain during sexual intercourse (with the exception of the ovulatory period).
6. Infectious-inflammatory processes genital tract, manifested pathological secretions with an unpleasant odor, itching, sharpening cystitis and urethritis. Allocation may be muco-purulent, contain fresh or altered blood.
7. The milk from the breast.

Weakly positive tests and the subsequent onset of menstruation, the presence of a history of miscarriage, missed abortion is also considered a reason for referral to a specialist.

The following diseases can be identified in the course of diagnosis of infertility:

• bending of the uterus;
• endometriosis;
• ovarian cysts;
• fibroids;
• polycystic ovaries;
• cervical disease (cervical stenosis, endocervite, dysplasia, polyps);
• endometritis;
• adnexitis;
• endometrial hyperplastic processes;
• adhesions in the tubes and the pelvis.

In the absence of detection of reproductive tract diseases in men and women put the diagnosis of "idiopathic infertility" or infertility of unknown origin.

The reason for visits to specialists and diagnosis of infertility is also considered the presence of several cleansing in history, which could result in damage to the basal layer of the endometrium.

Diagnosis of female infertility

infertility diagnosis in women includes a number of methods, the list of which is determined by the prescription of complaints, as well as views of infertility. Distinguish primary sterility in which no pregnancy ever, as well as secondary when conception facts were present earlier.

When the primary form of studies conducted in the framework of infertility diagnosis, aimed at identifying obvious pathology:

• general examination and medical history;
• inspection of the cervix in the mirror, palpation of the uterus and appendages;
• swabs genital infections onkotsitologiyu;
• colposcopy;
• Pelvic ultrasound, including Doppler and follikulometriyu;
• blood tests for hormones.

If necessary, designate consultations related specialists (endocrinologist, immunologist, internist, surgeon). Men in the primary diagnosis of infertility, semen analysis and appoint swabs genital infections.

If there is no abnormality, a pair is sent to the further planning, the prescribed or recommended vitamin therapy, diet, avoiding harmful habits, the measurement of basal body temperature to identify the most suitable days for the purpose of conception.

Consultation of gynecologist and medical history

Diagnosis of diseases of the reproductive tract in women with suspected infertility includes medical history:

• the duration of the inability of conception in a particular status;
• information on the number of marriages, the presence and number of pregnancies;
• Prevention methods used;
• bad habits;
• characteristics of the menstrual cycle, and the duration of his debut establishment;
• family history through the female line;
• presence of diseases and genital pathologies extragenital;
• Analysis of previous treatment and diagnosis.

After receiving information about the reproductive status of women, a gynecologist formed the overall picture of the situation, to optimally assign a list of infertility diagnostics activities.

physical examination

Anamnesis during the diagnostics completed inspection and evaluation of the external female pathognomonic signs, testifying in favor of gynecological diseases.

1. Determination subject height, weight and BMI, which normally is 20-26. If the values ​​are outside the permissible interval, start time ascertain reduce or increase body mass, momentum and possible causes.
2. Assessment of the extent and nature of hair distribution, presence of stretch marks, acne.
3. Palpation of the breast.
4. Examination of the cervical portion of the uterus in the mirrors, diagnosis of pathologies using smear (microscopy and cytology) and colposcopy.
5. Pelvic ultrasound.

Initial appointments appointment ends more detailed studies for the subsequent diagnosis of infertility.

laboratory diagnosis

Laboratory diagnosis of infertility methods include investigation of possible infection affecting the reproductive status, as well as determining the level of sex hormones.

Diagnosis of endocrine infertility in women include tests for:

• Phase hormones (FSH, luteinizing, estradiol);
• second phase hormone (progesterone);
• male sex hormones and metabolites (DHEA-sulfate, 17-OH-progesterone, free testosterone);
• component stock of oocytes (Anti-Müllerian hormone, inhibin B);
• prolactin;
• thyroid hormones.

Analysis of cortisol in the diagnosis it is advisable to take with existing violations menstrual cycle.

In addition to the hormones, the diagnosis of infertility and polycystic ovary suspected determine insulin levels, glycosylated hemoglobin and glucose tolerance test.

For suspected immunological infertility perform the analysis on antisperm antibodies.

Diagnosis of endocrine forms of infertility to determine hypothyroidism giperestrogeniey, ovarian hyperandrogenism and adrenal origin, ovarian failure syndrome, polycystic suspect - the most common causes of infertility in women.

Diagnosis of infection includes:

• identifying the level of antibodies to cytomegalovirus, toxoplasma, rubella virus herpes simplex viruses;
• vaginal smear microscopy method for the diagnosis of thrush, gonorrhea, trichomoniasis, Gardnerella, purity;
• seeding separated on nutrient media in order to identify the growth pathogenic flora (dysbiosis diagnostics);
• swabs from urethra and cervical channel for the presence of chlamydial, mycoplasma and ureaplasma infection, genital herpes, cytomegalovirus, human papillomavirus (PCR).

Microbiocenosis vagina for the diagnosis of infertility can be estimated by analyzing Femoflor.

Chronic genital tract infections are one of the leading causes of infertility.

hardware diagnostics

The most effective and simple method of diagnosing diseases of genitals - is ultrasound. Ultrasound diagnostics can detect fibroids of different locations, adenomyosis, ovarian cysts, large polyps, uterine anomalies (two-horned, saddle-shaped uterus).

In order to diagnose endometrial hyperplasia, polyps, endometriosis ultrasonic diagnosis is performed at the end of the menstrual cycle. Another pathology advisable to diagnose early in the cycle.

Diagnosis of cervical abnormalities using colposcopy Advanced View allows you to define endocervite, pseudo, dysplasia, leukoplakia, erythroplakia. cervical surface treated with a solution of acetic acid and iodine.

Due to the reagent on the basis of iodine can not determine the boundaries where two types of epithelial transformation zone. Iodine does not color the cylindrical form of the epithelium in the brown, so the doctor can easily visualize the borders of the state and the transformation of tissue area.

Acetic acid acts on the neck vessels leading to their momentary spasms. Normally capillaries spasm gives temporary neck pallor surface. But dysplasia, leukoplakia, celebrate cancer atsetobely epithelium - a long spasm of the capillaries, as well as and mosaic punktatsiyu (pathological changes vascular pattern), and atypical crimped corkscrew vessels.

Diagnosis of diseases of the cervix allows the identification of cervical form of infertility.

Hardware diagnostic methods also include sella MRI to detect microadenomas pituitary, which is considered a sign of increasing prolactin.

surgical exploration

In the second stage of diagnosis of infertility when trying to conceive have not been successful and the couple turned to re-examination, a gynecologist without fail appoint a woman invasive tool methods.

Examination of infertility in women in the second stage includes a diagnostic hysteroscopy and laparoscopy.

Surgical diagnostic methods allow to consider in detail the intrauterine formation and pathological processes in the pelvis.

Hysteroscope is equipped with a video camera and during its introduction into the uterine cavity can be detected conditions, not visible in ultrasound, in particular, adhesions, polyps.

Furthermore, invasive diagnosis of intrauterine abnormalities detected are:

• The status of input into the lumen tubes, their permeability;
• the presence of adenomyosis;
• endometrial hyperplasia, diffuse and focal character;
• submucous myoma;
• Uterine abnormalities: saddle, two-horned uterus.

During the diagnostic hysteroscopy plan parallel wires and removal of pathological formations initiated infertility.

After the successful hysteroscopy, pregnancy occurs within six months.

In addition to hysteroscopy for suspected obstruction of the fallopian tubes carry out two studies:

• hysterosalpingography;
• ehogisterosalpingoskopiyu.

The first method of diagnosis of tubal infertility in women and involves the use of X-ray-opaque material which is introduced into the tube. Given the radiation exposure, experts are increasingly resorting to this method of diagnosis as ehogisterosalpingoskopiya, which means administering to a pipe echo contrast agent (Furatsilinom, distilled water, saline), then, operate US.

Diagnostic laparoscopy is pelvic examination method using endoscopic equipment. Diagnosis of female infertility by laparoscopy can detect:

• tubo-peritoneal infertility;
• fallopian tube;
• peritoneal endometriosis, ovarian;
• intramural fibroids and subserous.

The removal process operation is carried out formations colliotomy. A few months after the diagnosis and treatment of laparoscopy by many women there comes a natural pregnancy.

The use of functional tests

functional diagnostic tests for infertility are used to assess the hormonal regulation in women. Use tests for independent and ambulatory of. Women can assess the presence of ovulation by measuring the temperature in the rectum for at least three consecutive cycles.

Measurement of basal body temperature is considered to be a simple and effective test for home use, allowing to determine the appropriate time for conception.

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

1. Test with progesterone. If, after its introduction, the woman begins uterine bleeding, lack of support of the second phase, as the cause of infertility.
2. Test with estrogen and progesterone. Women both drugs are administered sequentially, testing is considered when a reaction menstrualnopodobnoe positive, which means ovarian failure and exclude uterine abnormalities, as a possible cause infertility.
3. Test with dexamethasone for diagnosing the source of elevated levels of male sex hormones. If after treatment there is a decrease the level of 17-ketosteroids, adrenal hyperandrogenism is the character, if the 17-COP increase - ovarian.
4. Test of ovulation stimulation using Clomid. If the result is not in the process of diagnosis, anovulation is the hypothalamic-pituitary character.

After clarifying the nature of hormonal disorders following treatment of infertility.

Diagnosis of male infertility

Tactics diagnostic measures in elucidating the causes of infertility in men is reduced to the survey, implementation of laboratory and instrumental studies, the main role belongs to spermogramme.

List of tests for the diagnosis of male infertility:

• tests for sexually transmitted infections;
• Prostate ultrasound;
• determining the level of sex hormones;
• deployed semen;
• Sperm MAP test (for immunologic infertility);
• Sperm analysis by Kruger;
• Tests on spermatozoa chromosomal abnormalities (FISH-analysis, the integrity of the Y-chromosome);
• analysis of prostatic juice.

In the diagnosis of male infertility by Krueger analysis based on a standard 4%.

The norm for the MAP test is considered to be a value less than or equal to 30%, other results are the cause for the diagnosis "immunological infertility."

For values ​​of the MAP analysis more than 30% is advantageously carried out using the ECO with binding ICSI. Thanks to this procedure is the selection of the optimal artificial sperm and its introduction into the egg.

Screening for pairs of infertility

Infertility in women's factor recorded in 45% of cases, male - 40%, the remaining percentage of the causes of infertility is caused by male and female disorders.

If an appointment with a reproductive turns barren couple is assigned a diagnostic algorithm:

• male semen analysis prescribed in the absence of pathology at this point other actions are not carried out;
• postcoital test (diagnosis of immune forms of infertility);
• women two-stage examination.

In the first stage using techniques that allow to exclude three common female diseases: ovulation disorder, tubal peritoneal factor, an infectious-inflammatory processes reproductive tract. This diagnostic step consists of a standard set of minimally invasive techniques.

Primary infertility diagnosis in women whose stages are divided into blocks, includes:

1. The study of the history and clinical data.
2. Infectious Screening: vaginal swabs for purity, bakposev PCR smear of cervix for chlamydia, urea and mycoplasmas, herpes simplex, CMV, HPV, as well as the blood for antibodies to Toxoplasma.
3. Hormonal Screening: on day 2 at short cycles, at 2-5 day (at 28-32 day cycle) for 6-9 days (when the length of the cycle from 35 days) donate blood for hormones including FSH, LH, estradiol, free testosterone, prolactin, DHEA-sulfate, 17-OH-progesterone. To determine the level of progesterone blood tested for 7 days after ovulation proven by ultrasound.
4. Ultrasound diagnosis of breast disease, pelvic, thyroid, adrenal glands.

In the absence of menstrual blood on hormones pass any day.

Primary diagnosis and treatment of infertility, revealed the results of studies in women involves normalization of hormonal balance, removal of pathological entities, vitamin therapy.

Diagnosis of the second stage is always individual. methods set usually includes a study based on findings of pathology in the first stage of diagnosis of infertility, and also includes:

• assays that detect genetic abnormalities (karyotypes, identification of partners HLA-compatible);
• Blood studies hemostasis mutations, thrombophilia, antiphospholipid syndrome;
• instrumental diagnostic methods (MRT of the sella turcica, laparoscopy, hysteroscopy, hysterosalpingography).

In 48% of infertile women diagnosed with infertility factor 1, 52% - more than two.

In identifying the diagnostic process in infertility disorders that can not be full cure, e.g., ovarian wasting syndrome, heavy endometriosis, asthenozoospermia, false aspermia, azoospermia, double-sided adhesive process in pipes pair offer IVF or artificial insemination.

conclusion

Diagnostics infertility It should be consistent and time-limited. Her every step should be directed to perform a specific task to appoint the optimal treatment. In the absence of infertility diagnosis and treatment results in both men and women during the year must apply for re-consultation. Considered expedient change clinic or specialist.