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Identification of causes and development of an effective treatment regimen for infertility.
Infertility is defined as the absence of pregnancy after one year of regular sexual intercourse with one partner without the use of contraceptives. Despite major advances in assisted reproductive technologies, the prevalence of infertility is 25%. That is, one in four modern couples has certain difficulties with conception. This is related to the fact that women wish to become pregnant at a more mature age, by which time numerous health problems may have accumulated. However, medicine does not stand still, and even if, for certain reasons, both fallopian tubes have been removed, there is a high probability of carrying and giving birth to a healthy baby.
Types of infertility
Infertility may be male, female, or combined (when both partners have reduced reproductive function).
Female infertility may be primary (no prior pregnancies) or secondary (pregnancy occurred previously).
In cases of infertility, both spouses must be evaluated. A man must consult a urologist to exclude male factors of subfertility.
There are 5 types of female infertility:
Endocrine (ovarian). Any disturbance in the endocrine system can lead to anovulation (disruption of oocyte maturation and release). Various hormonal systems may influence this—thyroid gland, adrenal glands, liver. Dysfunction of these organs results in the absence of hormone-secretory transformation of the endometrium.
Tubal–peritoneal. This involves impaired patency of the fallopian tubes and is one of the most common causes of infertility. The fallopian tube is a unique structure of the female body, a kind of “tunnel” about 12 cm long with a diameter up to 5 mm in its narrowest segment. The fimbriae at the distal end open into the pelvis like “tentacles.” At ovulation they grasp the ovary and guide the oocyte into the fallopian tube, where it meets the spermatozoon. Unfortunately, this system can be severely affected by inflammation, ectopic pregnancy, chemical agents (e.g., nicotine), and surgical interventions. Any incision during surgery may affect a vessel or a nerve, without which the tube cannot flex and propel the oocyte. The cilia of the tube are damaged and do not regenerate, and its walls adhere.
Peritoneal infertility refers to the presence of adhesions in the pelvis. Its frequency is about 40% and it arises as a result of inflammatory diseases of the internal genital organs.
Uterine. A condition in which the uterine cavity is unable to accept an embryo. Contributing factors include intrauterine polyps, hyperplasia, and the presence of fibroid nodules.
Cervical. Structural and functional changes of the cervix significantly hinder sperm passage, creating a block at the level of the cervical canal. This form of infertility has a favorable prognosis because it responds well to treatment.
Other types. For example, those associated with endometriosis or immunological disorders. Let us dwell in more detail on endometriosis. The endometrium is the inner lining of the uterus. For various reasons (surgical interventions, childbirth), cells of this mucosa “disperse” to other locations—the thickness and muscle of the uterus, the adnexa, the intestinal region—inducing inflammatory processes there.
Main causes of female infertility:
induced abortions,
intrauterine interventions (curettage, intrauterine devices),
ovulatory dysfunction (failure of oocyte release or inadequate ovarian function),
tubal occlusion,
inflammatory diseases of the uterus,
uterine fibroid, polyps, uterine septum,
pelvic adhesive disease,
prior infections (gonorrhea, chlamydia),
endometriosis of the pelvic organs,
presence of chronic diseases (diabetes mellitus, obesity).
Factors provoking infertility:
pelvic inflammatory disease,
smoking,
alcohol,
drugs,
exhausting athletic activity.
Diagnosis of infertility
The evaluation begins with a meticulous history and data collection. Next come a physical examination (height, weight) and assessment of the breasts. Gynecologic evaluation, in addition to speculum and bimanual examination, includes a vaginal smear for flora, PCR testing for STIs, and a cervical smear for atypical cells.
Of course, the set of necessary tests and studies is prescribed individually.
However, the basic panel for assessing women’s reproductive health is as follows:
Complete blood count.
Blood test for sex hormones.
Serum progesterone measured on day 22 of the cycle.
To determine a woman’s fertility reserve, anti-Müllerian hormone (AMH) is measured; it reflects the current ovarian reserve.
On cycle day 2–3, pelvic and breast ultrasound is performed.
Folliculometry (ultrasound to determine the day of ovulation).
Hysteroscopy (endoscopic inspection of the uterine cavity with a small camera).
Postcoital test (assessment of sperm motility in the cervical mucus).
Laparoscopy. This is a minor surgery in which the organs of the abdominal and pelvic cavities are inspected with a camera. If necessary, therapeutic procedures are performed; thus, laparoscopy may be both diagnostic and therapeutic. It is performed when the cause of infertility cannot be established by previous methods. Laparoscopy allows visualization not only of the fallopian tube but also of adhesions within it.
Consultation with a geneticist, which may be recommended if the woman is older than 35 and the partner older than 40.
In the treatment of infertility, not only the woman but also the man must undergo testing and evaluation. For example, semen analysis (spermogram) is a very important step.
If medication and surgical treatment are ineffective, assisted reproductive technologies may be offered:
Intrauterine insemination (IUI). Introduction of processed and prepared sperm into the uterine cavity during the ovulatory period. This is a simpler reproductive technology compared with IVF. Necessary conditions: patent fallopian tubes (one or both), presence of ovulation, absence of infectious diseases, satisfactory semen quality of the partner.
IVF (in vitro fertilization). Indicated for serious reproductive problems. Stepwise, IVF includes:
• Ovarian stimulation (to obtain oocytes within a single menstrual cycle).
• Oocyte retrieval via ovarian puncture.
• Fertilization of oocytes in vitro.
• Embryo culture to specific stages.
• Embryo transfer into the uterus.
• Support of early pregnancy with hormonal medications.
• Pregnancy test (detection of hCG) two weeks after embryo transfer.
• Ultrasound confirmation of pregnancy.
At present, IVF is a real salvation for couples wishing to have children. It is especially effective in tubal–peritoneal infertility.
for consultation
Prevention of female infertility
To identify conception problems as early as possible, it is essential to visit a gynecologist every year or every six months. This will protect you from undesirable difficulties in pregnancy planning.
Prevention of female infertility includes:
Annual laboratory testing.
Gynecologist consultation once a year or every six months.
Control of sexually transmitted infections.
Monitoring of total cholesterol and its fractions (HDL, LDL, triglycerides) every 2 years.
Screening for cervical cancer (Pap test) and breast cancer once a year.
Mammography for women after age 35.
Female infertility treatment at Expert Clinics
The physicians at Expert Clinics approach the restoration of women’s health with great sensitivity and tact. They have enormous experience not only in obstetrics and gynecology but also in anti-aging medicine. This allows our doctors to give a woman a chance at the joy of motherhood even when many well-known methods have already been tried.
The anti-age approach involves restoring essential biochemical processes in the body as well as hormonal balance. Evidence-based ovarian rejuvenation techniques are also actively used at the clinic. This is often sufficient to restore reproductive function even in the “velvet” age.
Mastery of the most modern technologies, the clinic’s high level of equipment, and the physicians’ vast knowledge help dozens of couples realize their dream. Our doctors foster a positive mindset and prescribe competent, safe, and effective treatment to help the family welcome a long-awaited baby.
“A married couple that comes to an ordinary doctor, and not to a preventive medicine doctor, is given the diagnosis of ‘Infertility,’ and that already hits them hard, and it is difficult to remove this diagnosis from their minds. Meanwhile, the ovaries are already under strain—our social conditions put shackles on them. Therefore, we do not diagnose ‘Infertility’ at all—only in the case of a tubal factor (fallopian tube obstruction). In other cases, we write that the woman has come for pregnancy planning. And we look for the reason why the ovary is not producing an oocyte, what it lacks. What are the enemies of the ovaries? The first factor is obesity, because adipose tissue is a kind of garbage dump that constantly produces toxins and destroys good healthy hormones while accumulating their ‘bad’ metabolites. The second enemy of our ovaries is stress, in which we live chronically. Third, thyroid dysfunction hinders us. We work with these and other factors so that the ovaries recover and the woman attains the long-awaited pregnancy.”
Olga Polyanina, obstetrician-gynecologist, gynecologist-endocrinologist, ultrasound diagnostician, specialist in aesthetic gynecology.
Types of infertility
Infertility may be male, female, or combined (when both partners have reduced reproductive function).
Female infertility may be primary (no prior pregnancies) or secondary (pregnancy occurred previously).
In cases of infertility, both spouses must be evaluated. A man must consult a urologist to exclude male factors of subfertility.
There are 5 types of female infertility:
Endocrine (ovarian). Any disturbance in the endocrine system can lead to anovulation (disruption of oocyte maturation and release). Various hormonal systems may influence this—thyroid gland, adrenal glands, liver. Dysfunction of these organs results in the absence of hormone-secretory transformation of the endometrium.
Tubal–peritoneal. This involves impaired patency of the fallopian tubes and is one of the most common causes of infertility. The fallopian tube is a unique structure of the female body, a kind of “tunnel” about 12 cm long with a diameter up to 5 mm in its narrowest segment. The fimbriae at the distal end open into the pelvis like “tentacles.” At ovulation they grasp the ovary and guide the oocyte into the fallopian tube, where it meets the spermatozoon. Unfortunately, this system can be severely affected by inflammation, ectopic pregnancy, chemical agents (e.g., nicotine), and surgical interventions. Any incision during surgery may affect a vessel or a nerve, without which the tube cannot flex and propel the oocyte. The cilia of the tube are damaged and do not regenerate, and its walls adhere.
Peritoneal infertility refers to the presence of adhesions in the pelvis. Its frequency is about 40% and it arises as a result of inflammatory diseases of the internal genital organs.
Uterine. A condition in which the uterine cavity is unable to accept an embryo. Contributing factors include intrauterine polyps, hyperplasia, and the presence of fibroid nodules.
Cervical. Structural and functional changes of the cervix significantly hinder sperm passage, creating a block at the level of the cervical canal. This form of infertility has a favorable prognosis because it responds well to treatment.
Other types. For example, those associated with endometriosis or immunological disorders. Let us dwell in more detail on endometriosis. The endometrium is the inner lining of the uterus. For various reasons (surgical interventions, childbirth), cells of this mucosa “disperse” to other locations—the thickness and muscle of the uterus, the adnexa, the intestinal region—inducing inflammatory processes there.
Main causes of female infertility:
induced abortions,
intrauterine interventions (curettage, intrauterine devices),
ovulatory dysfunction (failure of oocyte release or inadequate ovarian function),
tubal occlusion,
inflammatory diseases of the uterus,
uterine fibroid, polyps, uterine septum,
pelvic adhesive disease,
prior infections (gonorrhea, chlamydia),
endometriosis of the pelvic organs,
presence of chronic diseases (diabetes mellitus, obesity).
Factors provoking infertility:
pelvic inflammatory disease,
smoking,
alcohol,
drugs,
exhausting athletic activity.
Diagnosis of infertility
The evaluation begins with a meticulous history and data collection. Next come a physical examination (height, weight) and assessment of the breasts. Gynecologic evaluation, in addition to speculum and bimanual examination, includes a vaginal smear for flora, PCR testing for STIs, and a cervical smear for atypical cells.
Of course, the set of necessary tests and studies is prescribed individually.
However, the basic panel for assessing women’s reproductive health is as follows:
Complete blood count.
Blood test for sex hormones.
Serum progesterone measured on day 22 of the cycle.
To determine a woman’s fertility reserve, anti-Müllerian hormone (AMH) is measured; it reflects the current ovarian reserve.
On cycle day 2–3, pelvic and breast ultrasound is performed.
Folliculometry (ultrasound to determine the day of ovulation).
Hysteroscopy (endoscopic inspection of the uterine cavity with a small camera).
Postcoital test (assessment of sperm motility in the cervical mucus).
Laparoscopy. This is a minor surgery in which the organs of the abdominal and pelvic cavities are inspected with a camera. If necessary, therapeutic procedures are performed; thus, laparoscopy may be both diagnostic and therapeutic. It is performed when the cause of infertility cannot be established by previous methods. Laparoscopy allows visualization not only of the fallopian tube but also of adhesions within it.
Consultation with a geneticist, which may be recommended if the woman is older than 35 and the partner older than 40.
In the treatment of infertility, not only the woman but also the man must undergo testing and evaluation. For example, semen analysis (spermogram) is a very important step.
If medication and surgical treatment are ineffective, assisted reproductive technologies may be offered:
Intrauterine insemination (IUI). Introduction of processed and prepared sperm into the uterine cavity during the ovulatory period. This is a simpler reproductive technology compared with IVF. Necessary conditions: patent fallopian tubes (one or both), presence of ovulation, absence of infectious diseases, satisfactory semen quality of the partner.
IVF (in vitro fertilization). Indicated for serious reproductive problems. Stepwise, IVF includes:
• Ovarian stimulation (to obtain oocytes within a single menstrual cycle).
• Oocyte retrieval via ovarian puncture.
• Fertilization of oocytes in vitro.
• Embryo culture to specific stages.
• Embryo transfer into the uterus.
• Support of early pregnancy with hormonal medications.
• Pregnancy test (detection of hCG) two weeks after embryo transfer.
• Ultrasound confirmation of pregnancy.
At present, IVF is a real salvation for couples wishing to have children. It is especially effective in tubal–peritoneal infertility.
for consultation
Prevention of female infertility
To identify conception problems as early as possible, it is essential to visit a gynecologist every year or every six months. This will protect you from undesirable difficulties in pregnancy planning.
Prevention of female infertility includes:
Annual laboratory testing.
Gynecologist consultation once a year or every six months.
Control of sexually transmitted infections.
Monitoring of total cholesterol and its fractions (HDL, LDL, triglycerides) every 2 years.
Screening for cervical cancer (Pap test) and breast cancer once a year.
Mammography for women after age 35.
Female infertility treatment at Expert Clinics
The physicians at Expert Clinics approach the restoration of women’s health with great sensitivity and tact. They have enormous experience not only in obstetrics and gynecology but also in anti-aging medicine. This allows our doctors to give a woman a chance at the joy of motherhood even when many well-known methods have already been tried.
The anti-age approach involves restoring essential biochemical processes in the body as well as hormonal balance. Evidence-based ovarian rejuvenation techniques are also actively used at the clinic. This is often sufficient to restore reproductive function even in the “velvet” age.
Mastery of the most modern technologies, the clinic’s high level of equipment, and the physicians’ vast knowledge help dozens of couples realize their dream. Our doctors foster a positive mindset and prescribe competent, safe, and effective treatment to help the family welcome a long-awaited baby.
“A married couple that comes to an ordinary doctor, and not to a preventive medicine doctor, is given the diagnosis of ‘Infertility,’ and that already hits them hard, and it is difficult to remove this diagnosis from their minds. Meanwhile, the ovaries are already under strain—our social conditions put shackles on them. Therefore, we do not diagnose ‘Infertility’ at all—only in the case of a tubal factor (fallopian tube obstruction). In other cases, we write that the woman has come for pregnancy planning. And we look for the reason why the ovary is not producing an oocyte, what it lacks. What are the enemies of the ovaries? The first factor is obesity, because adipose tissue is a kind of garbage dump that constantly produces toxins and destroys good healthy hormones while accumulating their ‘bad’ metabolites. The second enemy of our ovaries is stress, in which we live chronically. Third, thyroid dysfunction hinders us. We work with these and other factors so that the ovaries recover and the woman attains the long-awaited pregnancy.”
Olga Polyanina, obstetrician-gynecologist, gynecologist-endocrinologist, ultrasound diagnostician, specialist in aesthetic gynecology.
+7 (495) 154-21-44 
admin@expertclinics.ru 
Moscow, Starovolynskaya st., 12 bld. 1