Primary and secondary infertility: causes, treatment

Causes of infertility

The inability to have children does not come out of nowhere. It is provoked by external and internal negative factors. The diagnosis is made if a married couple is unable to conceive a child within 1 year of regular unprotected sexual activity.

Causes of female infertility

The cause of female infertility is:

• abnormal development of the genital organs;
• congenital pathology of the reproductive system;
• endocrine or hormonal disorders;
• trauma to the genitourinary system, as well as a history of surgical intervention;
• venereal infection;
• abortion (infertility develops in a young girl after damage to the mucous layer of the uterus);
• benign or malignant tumor;
• radioactive exposure;
• stress, increased emotionality;
• early onset of menopause;
• lack of nutrition, adherence to strict diets (they lead to ovulation disorders).

If a woman cannot conceive a child, the reasons need to be clarified as quickly as possible. After 35 years of age, the chances of getting pregnant naturally decrease. Therefore, preventing infertility in women is important during the growing years.

Causes of male infertility

Childlessness is a problem not only for the fair half of humanity, but also for men. There are reasons for this:

• endocrine and hormonal problems;
• diseases of internal organs (both reproductive and other systems);
• genetic disorders;
• hereditary predisposition;
• dilation of the veins in the area of ​​the testicles and spermatic cord (male infertility, the degree of infertility depends on the functionality of these organs, and when they overheat, the quality of sperm deteriorates);
• injury to the genital organs;
• inflammatory diseases, as well as sexually transmitted infections;
• premature ejaculation or erectile dysfunction;
• undergoing chemotherapy;

Bad habits can provoke a deterioration in reproductive ability. However, the development of infertility can be avoided if early prevention is undertaken in men.

Primary and secondary female infertility: what is the difference?

Female infertility is divided into primary and secondary.
Primary female infertility is a disease of women who have not previously become pregnant if, with regular sexual intercourse with a healthy man without the use of contraceptives, pregnancy does not occur within one year. Infertility is considered secondary if a woman has already had at least one pregnancy, but after that the woman can no longer become pregnant for a long time. And it doesn’t matter whether she gave birth to a child or whether the pregnancy ended in abortion, miscarriage, or ectopic pregnancy.

The causes of these two types of infertility may even be the same, but abortion most often leads to the appearance of secondary infertility. When a healthy body, already tuned in to pregnancy and preparing for the birth of a child, is unexpectedly and forcibly rebuilt, it experiences stress.

Causes of primary female infertility: 1. underdevelopment of the woman’s genital organs (infantilism), deviations in their development and accompanying hormonal disorders; 2. incorrect position of the uterus, creating conditions unfavorable for conception; 3. functional insufficiency of the gonads, manifested in menstrual irregularities.

Causes of secondary female infertility: 1. hyperfunction of the thyroid gland. With increased production of thyroid hormones, the production of pituitary hormones decreases, and this directly affects the production of female reproductive hormones. Because of this, various diseases of the genital organs can occur: endometriosis, uterine fibroids, polycystic ovary syndrome. At the same time, hypofunction of the thyroid gland leads to increased production of pituitary hormones, and because of this, the production of ovarian hormones is suppressed and the processes of fertilization and gestation are disrupted; 2. inflammatory diseases of the female reproductive system: fallopian tubes and ovaries, cervix, vagina; 3. sexually transmitted infections: gonorrhea, trichomoniasis, chlamydia, mycoplasmosis, herpesvirus and cytomegalovirus infections and others; 4. complications after abortion or gynecological curettage. In this case, the follicles can mature and be fertilized, but the uterus can no longer attach them to itself. This may be the result of a violation of the rules and technique of the operation. In this case, the woman’s chances of becoming pregnant again are minimal; 5. traumatic injuries of the perineum, postoperative complications, as well as hidden scars, adhesions, polyps formed as a result of injuries or after operations; 6. diseases of the endocrine glands (endocrine diseases); 7. ionizing radiation, radiation; 8. debilitating diseases, chronic intoxication, as well as poor nutrition (especially in childhood or ill-conceived diets in pursuit of an ideal figure); 9. “biological incompatibility,” which, as a rule, hides the inability to explain or identify the causes of infertility. Either the couple was simply “lucky” for the first time, or infertility arose after the first birth. It is most difficult to treat such couples for infertility, since if the diagnosis is unclear, then the treatment methods are also unclear.

The most likely age for women to give birth to a child is the period from 15 to 30 years. At the age of 30, a slight decline in the ability to have children begins, and after 35 years, fertility declines sharply in most women, and almost 25% of women generally become infertile.

It is known that about 25% of couples being treated for infertility are already parents. Some had problems with their first conception, but most encountered this problem when trying to conceive a second child. Thus, a successful first conception does not guarantee a successful pregnancy in the future.

People experiencing secondary infertility are less likely to seek medical help than those who initially cannot conceive. In some cases, they simply refuse to believe that such a problem exists. In this case, there is no point in delaying treatment, as this only aggravates the problem, turning it into incurable.

The definition of “primary” and “secondary” infertility does not only apply to women. If we talk about a man, then primary infertility means that none of his partners became pregnant from this man. And we can talk about secondary pregnancy when this man had at least one pregnancy, in at least one of his partners.

We can also talk about primary or secondary infertility of a married couple as a whole.

If you have been unable to get pregnant for a long time, make an appointment with an experienced fertility specialist by calling the numbers listed on the website.

Prevention of female infertility

Prevention of infertility in women should be carried out from childhood. Such measures should be followed.

1. Do not have sex with different partners, as they may be infected with sexually transmitted infections or even HIV.
2. Maintain daily personal hygiene (the same applies to sexual intercourse).
3. Do not have sex during menstruation (discharge in this case is thrown back into the uterus, provoking the development of endometriosis).
4. Stop smoking and do not abuse alcohol.
5. Use medications only after being prescribed by a doctor in the indicated dosage.
6. Eat properly and balanced.
7. Avoid stressful situations, strong emotional outbursts or nervous tension.
8. Promptly treat any infectious and inflammatory diseases of the reproductive system - they can cause uterine infertility.
9. Avoid too intense physical activity, as it destabilizes the menstrual cycle.
10. Do not douche with chemicals.
11. Take contraceptives prescribed by your doctor to prevent unwanted pregnancy and reduce the risk of abortion.
12. Regularly undergo examination by a gynecologist (twice a year).

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You should not allow excessive gain or loss of body weight. This provokes hormonal imbalance and infertility. As a preventative measure, you can also limit your coffee consumption throughout the day.

Diagnosis of primary infertility

Patients who complain about the absence of pregnancies are examined according to an expanded scheme. At the first visit to the gynecologist, clinical and anamnestic data are clarified and an examination is performed. The general and gynecological anamnesis, the nature of menstrual function, and how long unsuccessful attempts to conceive have been noted are determined. An objective examination includes determining height, weight, BMI; assessment of hair growth and condition of the mammary glands; performing a rectal or bimanual examination. Already at this stage, sexual infantilism and anomalies in the structure of the genitals can be suspected or identified.

The second stage of examination of women with primary infertility is carried out using laboratory and instrumental techniques. Functional diagnostic tests (colpocytology, examination of cervical mucus, analysis of the basal temperature chart) help assess the nature of the menstrual cycle. In addition, to study the functional state of the reproductive system, it is advisable to examine the hormonal status, the most important indicators of which are the levels of prolactin, gonadotropins (FSH and LH), estradiol, testosterone, cortisol, thyroid hormones (TSH, T3, T4), etc. It is advisable for all patients to study smear for flora, according to indications, conduct a bacteriological examination of discharge from the genital tract, PCR and ELISA.

The information value of ultrasound of the pelvic organs can hardly be overestimated in the diagnosis of structural defects, post-inflammatory changes, and space-occupying formations of the uterus and ovaries. Folliculometry is used to track folliculogenesis and ovulation. In the diagnosis of primary uterine and tubal infertility, the role of ultrasound examination and hysterosalpingography is invaluable. Endovideosurgical examination (laparoscopy) is usually performed at the final stage of diagnosis.

To establish the causes of infertility, it may be necessary to perform an ultrasound of the thyroid gland, Rg of the sella turcica, examination of the fundus, determination of visual fields, consultation with an endocrinologist, ophthalmologist, and genetics. In order to exclude the male factor of primary infertility, simultaneous examination of the sexual partner (spermogram, ultrasound of the scrotum, assessment of androgen status) is recommended. A postcoital test suggests the immunological nature of primary infertility.

Prevention of infertility in girls

Here, the prevention of infertility and diseases of the female genital organs consists of preventing pathologies such as measles, scarlet fever, rubella, influenza, and diphtheria. All of them negatively affect the formation of follicles, and the formation of the reproductive apparatus is disrupted from childhood. For this purpose, children are vaccinated. You should also strengthen your immune system by taking vitamins and microelements.

It is important to treat inflammatory processes in the cerebral cortex and avoid traumatic brain injuries. Parents of girls need to pay attention to the formation of early sexual characteristics and a delay in the menstrual cycle. If a girl started bleeding for the first time at 10 or 16 years old, she needs to be seen by a doctor. This situation may indicate problems with the development of the reproductive system, which will lead to infertility in later life.

You need to be wary if the discharge is too strong or scanty, menstruation is irregular, accompanied by severe pain. In adolescence, girls make strict demands on their appearance and go on different diets, which is absolutely not allowed. This leads not only to the loss of fatty tissue, but also to a narrowing of the uterus and shrinkage of the ovaries. In this case, there is no talk of pregnancy. In this case, parents bear full responsibility for the prevention of infertility.

Girls should not be allowed to have sexual intercourse before the age of 18, since their reproductive system is not fully formed until that time. The explanatory work of parents is important here.

General information

Primary infertility is the impossibility of pregnancy associated with congenital pathology of the female body or acquired before the onset of sexual activity. The concepts of “infertility” and “childlessness” should be differentiated: in the first case we are talking about complete infertility (the absence of pregnancies in any form - uterine and ectopic), in the second - about the inability of a woman to carry a pregnancy to term and complete it with the birth of a viable fetus (this category includes cases of ectopic pregnancy, spontaneous miscarriages, stillbirths, etc.). According to researchers in 2010, in the world 1.5% of women aged 20 to 44 years suffer from primary infertility, and in Russia – 1.9% of women in the same age range. It is believed that primary disorders of reproductive function in women occur 1.5-2 times more often than secondary ones.

How to avoid infertility in adulthood

Prevention of female infertility is important not only at a young age. The possibility of conceiving may be lost, even if the couple already has children. Early menopause is harmful to health. It can be caused by insufficient treatment of diseases of the ovaries and fallopian tubes, the presence of polyps in the uterus, which often develop after the age of 40 years.

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To maintain the possibility of conceiving, you need to follow these preventive measures:

• avoid negative emotions, avoid stress;
• maintain daily intimate hygiene;
• after 35 years, it is desirable to maintain regular sex life, but frequent changes of partners are contraindicated;
• periodically undergo examination by a gynecologist, even if nothing hurts;
• monitor the ovulation process and if it subsides, consult a doctor.

It is necessary to dress warmly in cold weather and not stay in a draft for a long time.

Prevention of male infertility

Problems with conceiving a child often occur in men. This is facilitated by a lack of sperm, which are characterized by good mobility and carry intact genetic material. To find out exactly the cause of this situation, you need the results of examinations and tests, thereby preventing infertility in men.

Male infertility can be prevented if you follow these recommendations:

• avoid promiscuity;
• monitor your diet, exclude beer and other alcoholic drinks (they have a bad effect on sperm quality);
• expose the body to daily physical activity (it should be moderate);
• give up cigarettes;
• do not take hot baths too often;
• avoid stressful situations, excessive nervous tension;
• do not cross your legs while sitting;
• From early childhood, prevent mumps through vaccination;
• take tests on time during a preventive examination, as well as in the event of symptoms of an infectious pathology;
• rest and sleep should be complete;
• have regular sex life with a stable partner (every 3-5 days).

Both women and men need to monitor their body weight. Wearing tight underwear contributes to reproductive dysfunction, so it is better to avoid it.

Classification of primary infertility

In gynecology, primary infertility is divided into congenital and acquired, temporary and permanent, absolute and relative. Congenital infertility is caused by pathology that a woman has from the moment of birth (endocrine disorders, genital malformations), acquired infertility is associated with diseases suffered after birth, but before the onset of sexual activity (attempts to get pregnant). Temporary infertility is a transient condition (for example, early puberty in girls, lactational amenorrhea or anovulation) and does not require special medical intervention, permanent infertility is due to reasons that cannot be resolved on their own.

Absolute infertility is understood as the complete exclusion of the possibility of conception due to irreversible pathological changes in the reproductive system; under relative – the impossibility of pregnancy for reasons that can be eliminated. However, the criteria for absolute and relative primary infertility may change as reproductive science develops. Thus, the advent of IVF has made pregnancy potentially possible in women with the absence of fallopian tubes, and experimental uterine transplant operations have made it possible for women to have children without this organ - that is, in those patients who just a few years ago were considered absolutely infertile.

In addition to female infertility, primary infertility also occurs in men: as a rule, it is caused by infertile sperm or abnormalities of the reproductive system that prevent normal ejaculation (for example, impaired patency of the seminal tract). In rare cases, infertility factors are determined in both spouses (sexual partners) - this form of pathology is regarded as combined infertility.

Treatment and its features

Depending on the cause of infertility, the patient is prescribed treatment. It can be medicinal or surgical. In some cases, it is enough to adjust your body weight and lifestyle to be able to conceive a baby (the functioning of the endocrine system improves).

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Success increases with timely treatment of infectious diseases in spouses before they cause complications. If the problem of natural pregnancy remains, the couple may be prescribed the following procedures:

• stimulation of ovulation with medications;
• insemination (probability of success - 17%) - direct transfer of sperm from a partner or donor into the uterine cavity;
• in vitro fertilization (40-60%) is the most effective method, when a ready-made embryo is implanted into a woman;
• use of a donor egg;
• use of surrogate mother services.

Such methods are used if the chances of natural fertilization are sharply reduced.

Treatment options

When the causes of secondary infertility have been identified, it is time to begin therapeutic measures. Treatment of secondary infertility in women is accompanied by the following procedures:

• When a pathology in the endocrine system in the female genital area is diagnosed, treatment is aimed at eliminating metabolic disorders. A woman should lead a healthy lifestyle and adjust her weight. The specialist prescribes medications whose action is aimed at restoring normal functioning of the thyroid gland and adrenal glands. With treatment, the menstrual cycle normalizes, after which the long-awaited conception occurs. Hormonal medications are prescribed at subsequent stages in the form of replacement therapy. If tumors are found on the endometrial layer of the uterus, surgical operations are performed to remove the tumors.
• If a woman has been diagnosed with infertility caused by endometriosis, specialists prescribe surgical operations, and then hormonal therapy.
• Infertility caused by psychological trauma and disorders is treated with sedatives.
• If a gynecologist-reproductologist finds tubal obstruction, he prescribes conservative and surgical therapy. Basically, the woman undergoes laparoscopy. Antispasmodics and sedatives are also prescribed if functional disorders are present in the female body.
• With reduced immunity, a woman takes antihistamines and hormonal drugs. If this is ineffective, insemination is performed, in which the man's sperm is released into the uterus.

Attention! There are many other ways to treat secondary infertility. Half of the methods involve drugs and surgery. To begin with, both partners must undergo diagnostics, after which the doctor will prescribe treatment therapy that corresponds to the examination.

Alternative Methods

If the problem of infertility is caused by menstrual irregularities or nervous shock, then unconventional methods of prevention and treatment will help to cope with it.

1. Homeopathic remedies. The patient is offered herbal extracts and minerals. Some of them are prescribed to stimulate the ovulation process, while others calm the nervous system.
2. Acupuncture.
3. Reflexology. Here a massage is performed on the active points located on the feet. The patient feels better and the functionality of the reproductive system is normalized.

You cannot rely solely on alternative therapies. They will be effective only in a comprehensive treatment regimen.

When and which doctor to go to

It is necessary to go to a specialist even when, within six months of marriage, the couple is unable to get pregnant naturally (provided that contraceptives were not used). You should consult a specialist if there are signs of an infectious or inflammatory process affecting the reproductive system.

You will have to be examined by different specialists: urologist, gynecologist, andrologist, endocrinologist, reproductologist. Consultations with other doctors are necessary: ​​therapist, venereologist, nutritionist. In most cases, only a comprehensive approach can overcome infertility. But timely prevention of infertility is a more rewarding endeavor.

Diagnostics and tests

If you cannot get pregnant for a long period of time, contact a gynecologist-reproductologist and endocrinologist. A qualified doctor will prescribe:

• Ovulation testing, in which a blood test is performed for hormones: LH (luteinizing hormone), progesterone, prolactin.

• Hysterosalpingography is a procedure that involves examining the genital organs using X-ray or ultrasound scanning. The resulting images may highlight abnormalities or blockages in the fallopian tubes.
• Laparoscopy. A thin optical tube is inserted into the organs through a small incision, which gives an idea of ​​what is inside. It can be used to detect adhesions, irregularities in the fallopian tubes or scars due to endometriosis.