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If conception does not occur within a year, both partners should be screened.

An examination of a woman includes:

  • necessary assessment of her ovaries, uterus and fallopian tubes
  • various hormonal investigations
  • tests for urogenital infections and sexually transmitted diseases

In the detection of male infertility the main role is played by spermogram (semen investigation). Experts estimate the number, structure and mobility of male germ cells. If their quantity or quality are insufficient, additional studies are called to find out the causes that negatively affect the spermatogenesis of the man.

When examining a childless couple, there is a clear goal - to find out the cause of infertility, to determine treatment tactics, to leave nothing out of sight and to do nothing unnecessary.

The desire to have a baby is a natural desire. Every sixth couple has an unwanted conception delay. Half of them can rely on spontaneous (natural) conception after simple doctor's advice or after a complicated treatment. The rest are infertile and require more complex treatment, such as in vitro fertilization or other assisted reproductive techniques. Much of these couples have primary infertility. Married couples who have problems conceiving do not always have absolute infertility (that is, when there is no chance of conception). In most of them relative subfertility is found, when the chance of conception due to one or more factors in the body of one or both partners is reduced. Subfertile couples have only a 4% chance of getting a spontaneous pregnancy without any treatment..

The chance of spontaneous conception 

The probability of conception in the first month of sexual life is 30%. The chance of conception is gradually reduced to 5% by the end of the first year of marriage. The cumulative level of normal spontaneous conception is about 75% over the first six months, 90% after one year, and about 95% over two years of married life.

Subfertility is the failure to conceive after one year of regular sexual life without the use of contraceptives. Usually, the investigation begins after a year of conception failure, but some couples may have to start it earlier.

The likelihood of a spontaneous concept depends on:

  • age of the couple
  • the history of pregnancy
  • duration of infertility
  • duration of sexual relations of spouses in natural cycles
  • body weight
  • the presence of somatic pathology

It has been proved that there is a strong correlation between women's age and infertility:

  • Fertility reductions are most pronounced in women after 35 and in the early 40s
  • For women aged 35-39 years, the chance of conception in the natural cycle is half lower than for women aged 19-26
  • The natural cumulative conception rate for women aged 35-39 is in the range of 60% over one year and about 85% over two years

It is noted that age associated with a decline in natural conception is also of similar importance in treatment outcomes using assisted reproductive technologies. It has recently been proven that the male factor of infertile marriage also depends on the patient's age. Genetic defects in sperm and oocytes reduce the ability of reproductive cells to fertilize and form embryos of high quality and increase with age. There is an age connected decrease in female fertility due to a dynamic fall of the cells number in the ovaries - a decrease in reproductive potential.

The longer a couple spends in anticipation of spontaneous conception, the less is the chance of success. If the duration of infertility is less than three years, a couple is 1.7 times more likely to become pregnant than couples who have a significantly longer infertility. In case of infertility of unexplained genesis lasting more than 3 years the chances of spontaneous conception are expected within 1 - 3% for each cycle.

Determination of infertility

Infertility is called a failure to conceive after one year of regular sexual life without the use of contraceptives. Infertility can be primary or secondary:

  • Primary infertility - if the couple has not had any pregnancy before
  • Secondary infertility - if the couple has at least one pregnancy, regardless of how it ended (childbirth, abortion, ectopic pregnancy)

Social change means that most couples postpone creating a family until women reach the age of 35 or older, significantly reducing the likelihood of conception in such women. When the cause of infertility fails to be ascertained, it is more likely a secondary than primary infertility. Abortion (especially the first) of pregnancy often leads to infertility.

The main causes of infertility

The main goal in the examination of a couple is to find out the cause of infertility, to determine the tactics of treatment - to miss nothing and do nothing unnecessary.

There are several main causes of infertility:

  • ovulatory dysfunction, endocrine factor;
  • tubal factor;
  • endometriosis and fibroids;
  • male factor (impaired spermatogenesis and obstruction);
  • infertility of unknown origin.

The frequency of these factors and their combination varies across publications and across populations. For example, the tubal factor is more prevalent in patients with secondary infertility and those who have had sexually transmitted infections. The WHO Guide for Standardized Examination and Diagnosis of Infertile Couples (1997) identifies the following causes of infertility:

Causes of infertility in men:

  1. Sexual and ejaculatory disorders
  2. Immunological factor
  3. No apparent cause of infertility
  4. Isolated pathology of seminal plasma
  5. Iatrogenic factor
  6. Systemic diseases
  7. Congenital anomalies
  8. Acquired testicular damage
  9. Varicocele
  10. Infection of genital glands
  11. Endocrine factor
  12. Idiopathic oligozoospermia
  13. Idiopathic asthenozoospermia
  14. Idiopathic teratozoospermia
  15. Obstructive azoospermia
  16. Idiopathic azoospermia

Causes of infertility in women (diagnostic categories):

  1. Sexual disturbances 
  2. Hyperprolactinemia
  3. Organic lesions of the hypothalamic-pituitary region
  4. Amenorrhea with high levels of FSH
  5. Amenorrhea with sufficient concentration of endogenous estrogens
  6. Amenorrhea with low concentration of endogenous estrogens
  7. Oligomenorrhea
  8. Irregular menstrual cycle and ovulation
  9. Anovulation with regular menstrual bleeding
  10. Congenital anomalies
  11. Bilateral occlusion of the fallopian tubes
  12. The connective process in the pelvis
  13. Endometriosis
  14. Acquired pathology of the uterus or cervical canal
  15. Acquired pathology of uterine tubes 
  16. Acquired ovarian pathology 
  17. Genital tuberculosis
  18. Iatrogenic factor
  19. Systemic diseases

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