24.04.2019

Causes and symptoms of infertility in women. Infertile couple

Statistics show terrifying figures: in Russia, every sixth married couple is infertile. And for most spouses, the absence of children is a real grief. The priest and doctor Father Sergius Filimonov shares his experience and knowledge with the readers of the site: what are the causes of infertility, how to overcome them, and how to treat infertility as a curse or as an opportunity to realize oneself in a different capacity?

prot. Sergiy Filimonov

Chapter 1. Medical causes of infertility in marriage

(gynecologist-endocrinologist Yu. Yu. Toropkova)

Infertility in marriage is one of the most important and complex medical and social problems. The proportion of infertile marriages in Russia ranges from 8 to 17.5% and currently has no downward trend. There are regions (mainly megacities) in which this figure reaches 24–29%, while a level of 15% poses a serious threat to demographics.

In other words, every 6–7 pair of Russians (i.e. about 7 million) for their reproductive period(15–49 years old) are faced with the problem of infertility.

So, a marriage is considered infertile in which, for one reason or another, occurring in the body of a woman or a man, or both spouses, pregnancy does not occur with regular sexual activity without the use of any contraception within 12 months. given that childbearing age spouses.

It is customary to distinguish between primary and secondary infertility, female and male. Primary infertility in women is called infertility, in which pregnancy has not occurred even once since the onset of unprotected sexual activity; secondary - pregnancy occurred in the past, but after that there is no pregnancy for 1 year of regular sexual activity without the use of contraceptives.

The frequency of female infertility ranges from 40 to 50%, and there are 3 main groups of reasons:

Endocrine (35–40%). Endocrine forms of infertility are always associated with disruption of the ovulation process (maturation and release of the egg from the ovary) and are often accompanied by disturbances in menstrual function;
Tubal-perinatal (30–74%). C is the most common, most studied and most difficult form of infertility to correct. In this group of patients, there are anatomical and functional disorders of the fallopian tubes, when it is difficult (or impossible) for the advancement of the egg to the place of its attachment (implantation) in the uterine cavity. Such conditions are not uncommon after inflammatory diseases of the pelvic organs, abortions and other intrauterine interventions, operations, incl. and gynecological, after which the risk of adhesions in the pelvis increases.
Gynecological diseases (1.5–28%). Most often, the main cause in this group is genital endometriosis, a serious disease that requires long-term and persistent treatment.
Also distinguished: absolute female infertility when the possibility of pregnancy is completely excluded (absence of the uterus, ovaries, abnormal development of the genital organs), and so-called unexplained infertility (4.8–7.6%), the cause of which cannot be established by currently used research methods.

The term “relative infertility” is used when a woman and a man are capable of having children separately outside of marriage, but after living together for a long time, their marriage is infertile. IN last years more and more attention is being paid to the problem male infertility, the frequency of which in infertile marriages also reaches 40–50%, and in combination with infertility in the wife – 1520%.

Male infertility is the inability of reproductive cells to mature male body to fertilization. There are secretory (associated with a violation of the process of spermatogenesis) and excretory (arising from a violation of sperm secretion) infertility.

Due to the fact that the frequency of female and male factors infertility is the same, and every fourth married couple has a combination of several factors, the examination almost always begins with a joint conversation with the married couple to exclude psycho-sexual and iatrogenic causes and assess the state of physical health of both spouses. Working with a married couple allows you to outline a general examination plan and sequence diagnostic procedures. Subsequently, the examination is carried out by a gynecologist and an andrologist in parallel.

IN clinical practice The examination of infertile couples always begins with men. If the results of a semen examination (spermogram) do not reveal any pathology, then no other studies are performed in men; if problems are identified, then it is shown full examination and treatment with the participation, often, of many specialists: a urologist, endocrinologist, surgeon, andrologist, and sometimes a sex therapist. Infertility in men occurs as a result of various pathological processes in the body, which have a negative effect on internal organs, endocrine glands, central nervous system. It is impossible not to take into account the increase in the prevalence of anomalies in the development of the genital organs and the frequency of infectious and inflammatory diseases, the influence harmful factors environment, urbanization, widespread and uncontrolled use medicines, allergization of the population.

Therefore, the most justified in the treatment of male infertility is examination in large specialized centers with the participation of several specialists and carrying out complex, staged, individually selected therapy, where each stage is sequential, clearly limited in time and aimed at performing a specific task.

For women, the most important and diagnostic meaningful methods examinations are to assess ovulation and tubal patency. To do this, the center’s doctor may conduct a number of studies, for example:

blood assessment for hormonal profile. The level of 6–7 hormones in blood plasma taken on a certain day of the menstrual cycle is determined; sometimes hormonal tests are performed;
Ultrasound monitoring of ovulation. This method allows you to directly observe the growth of the follicle in the egg of a woman’s ovary and the degree of readiness of the inner mucous membrane of the uterus to receive a fertilized egg;
checking the patency and characterization of the internal lumen of the fallopian tubes using x-ray or ultrasound.
In some cases, identifying the causes of infertility may require an ultrasound of the thyroid and mammary glands, an X-ray or computer examination of the skull, consultations with doctors of related specialties, and even medical genetic counseling.

Currently, at the final stage of examination for female infertility, endoscopic diagnostic methods are used: laparoscopy and (or) hysteroscopy. Without the use of these methods, the cause of infertility in marriage is considered unknown. In addition, laparoscopy is not only the final stage diagnostics, but also the first stage of treatment of female infertility.

Endoscopic technologies allow for low-traumatic microsurgical correction of identified changes in the pelvic organs - separation of adhesions, restoration of patency of the fallopian tubes, coagulation of foci of endometriosis, removal of ovarian tumors, surgical treatment of certain diseases of the uterus - without subsequent pronounced adhesions.

In conclusion, it should be noted that a consistent assessment of all parts of the complex reproductive system of men and women is necessary condition for staging correct diagnosis, while the set of diagnostic techniques depends on the clinical picture of a particular disease and is strictly individual for each married couple. If it is impossible to promptly and quickly conduct a complete clinical and laboratory examination, it is necessary to promptly refer the married couple to a specialized medical institution for a final diagnosis, remembering that delaying the examination reduces hopes of success in restoring reproductive function.

In our region, 5 large centers deal with infertility issues:

Russian-Finnish clinic “Ava-Peter” (Nevsky pr., 22–24, t. 325–92–72, 312–30–65),
Clinic of Reproductive Medicine at the Institute of Obstetrics and Gynecology named after. BEFORE. Otta;
clinic "Avicenna" in Pushkin;
infertility treatment center at the Military Medical Academy;
infertility treatment center at the Military Medical Academy in the Sestroretsky district of the city. St. Petersburg.
In addition, many antenatal clinics have offices of a gynecologist-endocrinologist.

Chapter 2. Infertility - medical and spiritual reasons

Father Sergius, please tell us about the causes of infertility.

There are medical and spiritual reasons for infertility. If speak about medical reasons oh, there are about 30 diseases that can cause infertility. Various medical centers and institutions advise people about the problem of childlessness. The spouses undergo appropriate medical tests, the results of which determine which side of the couple is the reason why a child cannot be born in the family. When it is determined which side is weak in relation to the birth of children, then the spouse with “low potential” for childbearing is examined for various diseases, especially chronic diseases of the genital area, which may be an obstacle to normal childbearing. Specialists who treat infertility in men are andrologists, urologists, and in women – gynecologists.

After an appropriate examination, treatment is carried out - conservative or surgical, if necessary. For example, with adhesions in the area of the fallopian tubes or with poor patency, it is possible to improve the latter as conservative methods, and with the help surgical methods– removal of adhesions in the area of the fallopian tubes in certain time when childbearing is most possible. That is, the doctor’s painstaking work with each married couple is required.

In means mass media a lot is said about methods artificial insemination. Is it possible to resort to them if treatment is ineffective?

There are various methods of artificial insemination. According to our church canons, based on the materials of the Anniversary Council of Bishops of the Russian Orthodox Church 2000, they are not valid. The only acceptable method is the so-called “natural fertilization method,” in which the husband’s semen, obtained during marital relations, is introduced by a doctor into the area of the uterus. Thus, fertilization of the egg occurs after a natural relationship between husband and wife; in addition, with this method the integrity of the family union is not violated, since only the sex cells of both spouses are used. In the case when a third party intervenes in the process of childbirth, for example, if a donor’s seed is used for artificial insemination, an element of sinfulness is introduced... Outwardly, it would seem that there is no fact of treason, however, a foreign element is introduced into the family. This is tantamount to a woman entering into an illegal marital relationship with a stranger in order to give birth to a child. Although there is no physical component of a sinful relationship, at the same time, the genetic material of a stranger is introduced into a woman’s egg, i.e., prodigal intercourse is obtained using medical technology. Exists whole line methods of this type of artificial insemination claim, when a third party intervenes. In some of them, a donor egg from a foreign woman is used, which, after fertilization with the husband’s seed, is implanted in the uterus. Such methods are also unacceptable, since in this case a foreign element invades the family. There is even a psychological phenomenon when a woman who has been implanted with such an egg feels something foreign in her body, unusual for her.

Please tell us about the method of in vitro fertilization. How should an Orthodox person treat him?

Methods of in vitro fertilization are not blessed by the church, since this also uses genetically foreign material, that is, the integrity of the family and marital union is violated. In addition, the donor semen used in these techniques is obtained artificially, and not as a result of natural marital relations. It is also important that when using in vitro fertilization there is no physical connection men and women, therefore the secret of childbirth is taken beyond the boundaries of the human body. The act of giving the spouses to each other, which is necessary for the birth of a new life, does not occur. Life is born in a test tube. What happens at this moment to the embryo outside the mother’s body, what physical diseases will it be susceptible to, how will it be affected? fallen spirits- this is a big question. One of serious problems in vitro fertilization is that in a number of centers, when implementing this technique, so-called extra fertilized cells are produced, which are already new life. These cells are reduced, that is, killed. This means that if four eggs have been fertilized and the woman only wants one child, only one egg will be implanted in her. What to do with the remaining three embryos? They can be frozen or edited. Thus, a child is born through the simultaneous killing of two or three unborn siblings. The life of one at the expense of the death of another is considered unacceptable by the church. Therefore, all types of in vitro fertilization are not blessed by the Church. This was approved in the materials of the Anniversary Council of Bishops of the Russian Orthodox Church in 2000, in Chapter 12 “Problems of Bioethics.” It discusses in some detail the issues of various types of overcoming infertility, and tells what spouses should do if they do not have children.

What spiritual reasons can lead to infertility?

There can be many reasons. I will try to list the main ones. I will rely on the works of Elder Paisius the Svyatogorets, who in volume 4, called “Family Life,” answers questions about the birth of children, the difficulties of childbearing and the problem of infertility. When asked why certain women develop infertility, Elder Paisios answers as follows: “Some infertile women did not marry when they should have, and therefore now spiritual laws apply to them. Some picky girls start choosing grooms: “No, I don’t like this one, and I don’t like that one.” Having promised a guy to marry him, such a girl simultaneously looks at the other, then says “no” to the first, and he wants to commit suicide, instead of counting it as a blessing that she deceived him yet, at least, before they got married, not after. Eh, what kind of family will such a girl create? And there are women who are barren because in their youth they lived a chaotic, sinful life. There are also those whose infertility is caused by poor nutrition, because many foods contain a whole bunch of chemicals and hormones.”

About girls who are promiscuous sex life It can be noted that in such cases there are two components that can lead to infertility - medical and spiritual. Women with such a lifestyle are very likely to develop various infections, which can lead to various chronic diseases genital area, which entails the inability to bear children. The spiritual component is that the Lord can allow such a girl to be punished for her desire to “have fun” (that is, to satisfy her lust as much as possible) and not give children for such a depraved life.

The next reason that Elder Paisius notes: “There are also married couples who want to have a child as soon as they get married. And if the birth of the child is delayed, then they begin to worry and worry. How can they give birth to a child if they themselves are full of anxiety and mental anxiety? They will give birth to a child when they have driven out anxiety and mental anxiety from themselves and have directed their lives along the right spiritual track.

Sometimes God deliberately delays and does not give children to some married couple. Look: after all, He gave a child to the Holy Fathers Joachim and Anna, and the Holy Prophet Zechariah and Elizabeth in their old age, in order to fulfill His eternal plan for the salvation of people.

Spouses must always be ready to accept the will of God into their lives. God does not abandon a person who trusts himself to Him. We don’t do anything, but how much God does for us! With how much love and generosity He gives us everything! Is there anything that God cannot do?...

Having children depends not only on the individual. It also depends on God. Seeing that spouses who are experiencing difficulties in having children have humility, God can not only give them a child, but also make them have many children. However, seeing persistence and selfishness in the spouses [God does not fulfill their desires, because] by fulfilling their request to have children, He will satisfy their persistence and selfishness. Spouses must completely surrender themselves to God. They must say: “My God, You care about our good, “Thy will be done” ().” In this case, their request will be fulfilled. After all, God’s will is fulfilled when we say “Thy will be done” and with trust in God we entrust ourselves to Him. But although we say “Thy will be done,” we simultaneously insist on our own will. Well, what can God do for us in this case?”

The next reason for infertility may also be the selfishness of the parents, but manifested in the opposite way, when a young family delays the birth of a child, reasoning that children are a concern, and that first they need to finish their studies, get on their feet, earn money for an apartment, build a dacha, buy a car, and now then it will be possible to have a child (not “God will give a child,” but rather “let’s have a child,” like a cat or a dog). When the Lord sees such an attitude towards God’s blessing for childbearing, a disregard for the commandment “Be fruitful and multiply,” then after some time, when the family already has everything - an apartment, a car, and a job, He does not give children. And such a family can no longer have anything other than cats and dogs. Although from the medical side there are no obstacles to this.

Elder Paisios identifies two more possible causes of infertility. “God does not give many people children so that, by loving the children of the whole world as their own, these people will help their spiritual rebirth.” Elder Paisios gives the following example: “One man had no children, but when he left the house, children from neighboring houses ran to him and surrounded him with love. They didn't let him go to work. You see: God did not give this man his children, but He gave him the blessing so that all the children in the neighborhood would love him as a father, and he would help them spiritually. God’s judgments are an abyss.”

“And in other cases, God does not give spouses children in order to give birth to some orphan.” Elder Paisios talks about one of his Christian acquaintances - a lawyer, a man of spiritual life. One day the elder stopped to stay with him for a day and met his wife, who also led a pious life, helping many poor children. She complained that the Lord did not give her children, to which Elder Paisios answered her reproachfully: “You, sister, have more than five hundred children. And you're still complaining? Christ saw your good will. And he will reward you for it. Now, helping the spiritual rebirth of so many children, you are a better mother than many others. You are leaving behind all the mothers of many children! And the reward that you receive will also be much greater, because by being reborn spiritually, children spiritually secure their future in eternal life.”

It happens that the Lord does not give children to a family, not as a punishment, but as a special providence, so that through these people some unfortunate child abandoned by his parents would receive help.

There are other causes of infertility. These include the so-called generational curses - when a mother or father curses their children. Sometimes, when children bother their parents, instead of their parental blessing, they send reproaches to the children, which can “work” as curses. For example, when a mother tells her daughters: “May you be empty” or sends them to evil spirits. Elder Paisios also gives a similar example. When such a mother then repented of her curses, the life of her daughters settled down and the Lord gave them children.

There are also “generational” sins against God and against one’s neighbor, when the Lord punishes with infertility for sins committed against Him. For example, if someone destroyed churches, removed crosses, cut icons, laughed at the Church, the Lord can send infertility to the family through a generation until people realize and atone for this sin. I know of a case where a priest renounced his priesthood after the revolution and then died without repentance. In subsequent generations, there were never boys in this family, and if they were born, they then died before reaching adulthood. There are known cases when in the 30s children were forced to renounce their parents publicly, in the work collective, at the institute. Such sins against God, desecration of the Church, blasphemy, renunciation of parents often affect the next generation or, after a generation, one of the grandchildren. Sometimes people commit sins against their neighbor - they dig up gravestones and build their own house out of them, or commit other blasphemous acts.

Is it possible that the absence of children is due to a phenomenon that some people call “damage” or the “evil eye”?

Of course, “damage” and “evil eye” are not church concepts. But some people use this terminology. By this we should understand the envy that some people sometimes have evil people. For example, this can happen if one woman is jealous of another - beautiful, financially prosperous, married and happy in her marriage. Out of envy, it may turn out that this woman will have everything, but she will not give birth to children. There are cases when, out of pride, the Lord can deprive a woman of a child if she mocks another, more unfortunate woman, deprived of the happiness of motherhood. The Lord can deprive a mocker of her child and close her womb so that she herself will no longer be able to have children due to her pride and exaltation over her neighbor.

Infertility can also be sent as a test of a person's faith. The materials of the Jubilee Council of Bishops and the patristic teaching indicate that infertility can be considered as a cross that the Lord places on a married couple. The cross, in which the married couple must show patience, humility, and trust in the will of God. Vivid example are Abraham and Sarah, who prayed for about 90 years for the birth of a child, Zechariah and Elizabeth, Godfather Joachim and Anna. Their children were blessed when they were born after so much prayer, patience, and trust in God. The test of faith can be an important moment for such a married couple, when the couple shows their loyalty to God, when they do not complain about God, and thank God for the sorrow they send. This test of faith may at some point end for the couple, and a woman childless for 20 years may give birth to many more children.

Infertility may also be due to the fact that the Lord delays the birth of children according to His special providence for this family, wanting to arrange the fate of any abandoned child. I know some families in which it happened that the woman conceived a child as soon as the spouses showed a desire to adopt an orphan from orphanage. There were couples who carried this intention to completion and as soon as they brought an orphan into their home, they were soon expecting their own baby, and thus two children appeared in this family at once - one adopted and the second, whom the Lord sent, having allowed the womb of a previously barren woman to be born. women. Moreover, when doctors examined such women, they did not find pathologies in them that prevented childbearing. But the will of the Lord was such that these families would raise not only their own child, but also an adopted one.

Very important for solving the problem of infertility is the sanctification of church marriage. In prayers for the consecration of a church marriage there are words that call upon God’s blessing on a woman’s womb so that she is fruitful. Unbelieving husbands sometimes neglect this important sacrament, and the Lord does not give a woman the opportunity to become a mother until the marital union is sanctified by the grace of church marriage. There are also cases where women who were diagnosed with infertility, who lived for many years with their husbands in officially registered but unmarried marriages, conceived children within a few days after the wedding.

There are several other causes of infertility that can be considered. When the Lord sees that a possible child in a family will be very sick or profoundly disabled, He allows this baby not to be born. From church patericons, there are cases when mothers, under the threat of losing a child, fervently and earnestly prayed to God, the Lord revealed to them through certain saints that their prayer was objectionable, because this child would be born a villain, a murderer, a blasphemer. If the mothers did not retreat, wanting to fulfill their will at all costs, to satisfy their maternal egoism, the Lord allowed the birth of such children who later became scoffers of the family.

The case of the Decembrist Pestel, whom his mother begged for when he was dying of diphtheria at the age of five, is well known. The Lord then showed her that her son would recover, but would end his life on the gallows. That's how it all happened later. The mother later repented, but it was too late, the Lord had already answered her prayers. Therefore, the prayer “Lord, not as I want, but as You want” is very important.

The Lord may not give children because the husband and wife are unprepared to raise a child, because one of the spouses is irresponsible or malicious, or because of the possibility of mutual infidelity. For example, if there are constant quarrels and scandals in the family, the husband and wife are selfish, are not ready to sacrifice themselves for the sake of the child, are not ready to take care of him, give him their love, the Lord, foreseeing this, delays the birth of the child for several years until the married couple matures until everything is settled in the family, until the husband and wife come to an agreement. A child must be born in love. If from the very beginning of his life he experiences the anger of his parents towards each other and towards himself, then what will this child grow up to be, what will happen to his soul, what will he absorb from such parents?

There are also known married couples, in which the wives could not give birth to children, went to many doctors, knocking on doorsteps. At the same time, their husbands humiliated and insulted them, reproaching them with the impossibility of childbearing. These women went to all kinds medical procedures, but nothing helped. Subsequently, these husbands cheated on their wives and left for other families. And women who were infertile married other men and successfully gave birth to children. Their infertility turned out to be imaginary. The Lord, foreseeing that the husband and wife are not ready to preserve the marital union, that the collapse of the family is possible, sometimes allows that a child will not be born into this family, because he will remain an orphan from a young age.

Next time we will talk about the sequence of necessary spiritual actions that a believing married couple can resort to in order for a child to be born into their family.

Chapter 3. Infertility - ways to overcome it

What is the sequence of spiritual actions for a believing couple to have a child in the family?

We will not now touch on the issues of infertility in an unbelieving family, far from the Church. Let's not talk about people who lead a sinful lifestyle. Let's talk about those spouses who have entered into a legal marriage and go to Church, but have not been able to give birth to a child for several years.

The first question that spouses should ask themselves is whether their marriage is married or unmarried. In prayers for the consecration of a church marriage, the grace of God is especially invoked so that it is good-born: “Yes, show that your will is a legal marriage, and from it the creation of children. Lord our God, remember Thy servant and Thy handmaid, and bless them, give them the fruit of the womb, good children, like-mindedness of soul and body." Therefore, believing spouses whose marriage is not celebrated, first of all, require church consecration of the marriage.

If after a certain amount of time children are still not born in this family, it is necessary to resort to the help of both methods medical diagnostics, and to church sacraments.

Medical diagnostics are carried out by various medical centers, called reproduction centers, centers reproductive health women or centers of family and marriage. In different cities they have different names, but you can find them in any directory.

Data from modern medicine indicate that there are more than 30 medical causes of infertility. Therefore, sometimes it takes time to discover the cause. First, they find out whose health – the husband’s or the wife’s – prevents the birth of children. After a thorough diagnosis, one or another type of conservative (medicinal) or surgical (if required) treatment is carried out. I repeat - the question of choosing a treatment method is decided depending on the cause of infertility.

Spouses should have an unshakably firm position regarding which methods are church-blessed, bound, and which are impermissible from the point of view of Christian Orthodox ethics. What methods are not blessed by the Church are described in detail in the materials of the Anniversary Council of Bishops of the Russian Orthodox Church in 20002. You can read about this in Orthodox periodicals, talk with your confessor or with Orthodox biomedical ethicists. In many cities there are now Societies of Orthodox Doctors, where specialists can answer which new medical methods of overcoming infertility are permissible and which are not.

If medical treatment turns out to be ineffective, or is of a rather complex nature, the spouses can and should resort to church sacraments, asking for God’s help to overcome their illness.

What arsenal of means does the Russian Orthodox Church have at its disposal to help spouses with their problem?

First of all, spouses should pay attention to whether their incorrect church life is interfering with the birth of children - how churchgoers they are, whether they confess correctly, how often they partake of the Holy Mysteries of Christ, what their confessor tells them.

That is, the first place to start is with a thorough examination by the spouses themselves of the quality of their Christian life, their relationship with their confessor. The confessor, by the will of God, can reveal which path they should follow, what prayers to read, what sacraments to resort to. If, as a result of a thorough examination of his life and repentance, the Lord reveals some kind of generational sins (we talked about this in the previous conversation), they must be confessed to the confessor and prayed for in a certain way. You need to understand that the mistakes of your grandmothers, grandfathers, and great-grandfathers affect your life.

To atone for their sin, you can ask your confessor for some kind of penance or church blessing (for example, performing a canon of repentance or reading certain prayers of repentance). Or to make such spiritual replenishment that can appease God.

Spiritual replenishment includes such situations when, for example, in order to atone for the sin of a mother who committed an abortion, her barren daughter takes on the feat, with the blessing of the priest, to care for children in an orphanage, visit orphans, and visit maternity hospitals (if there is a maternity hospital in the parish) , baptize dying babies out of fear for the sake of a mortal, help women who do not want to give birth, who are persuaded to terminate their pregnancy, so that they do not take this step. So you will commit the opposite of your ancestral sin.

Another example: if a great-grandfather kicked an orphan out of the house, then his granddaughter or great-granddaughter, who has become infertile, must take care of the orphans: provide them with some kind of care or become the orphan’s godmother. I have already said that often infertile spouses take children from an orphanage, and after a while the Lord allows them the fruit of their womb and gives them their own children. The same thing happens in cases where an infertile couple or one of the spouses makes some kind of spiritual replenishment of the sins that their ancestors committed.

In addition to the Sacraments of Repentance and Communion of the Holy Mysteries of Christ, there is also the Sacrament of Unction in the Church. Infertile spouses can turn to the priest with a request that it be performed on them. Usually Unction is performed during Lent, in some dioceses - during the Nativity Fast. Sometimes the Sacrament of Revelation is performed upon the arrival of the relics of the holy saints of God, who have a special gift to help the sick. So, for example, unction in the St. Petersburg diocese was performed during the transfer of the holy relics of St. healer Panteleimon.

You can also, with the blessing of your confessor, make pilgrimages to the relics of the holy saints of God and ask for their gracious help.

Some saints (for example, St. Sergius of Radonezh, St. Seraphim of Sarov) specifically petition for the birth of children. For example, many infertile women pray to St. David of Gareja or St. the prophet of God Elijah. In my memory, there is an example when one Christian woman, who had been infertile for about ten years, on the advice of a priest, decided to make a pilgrimage to the Holy Land, to Mount Carmel, to the cave where the prophet Elijah labored, and where women from all over the world come to resolve their infertility. She made a promise that if she had a boy, she would name him after the prophet Elijah. She became pregnant immediately, even while preparing for this trip (it must be said that she never got to the cave of St. Elijah), and went on a pilgrimage to holy places with a conceived child, who after the allotted time became the boy Elijah. Many such examples can be given.

The concept of “vowed children” has long been known in Rus'. When a family could not wait for a son for a long time or had no children at all, the couple made a vow to God to raise a future son for Him - to give him to become a monk or to serve God in some other way. And according to this vow, the Lord sent them children.

There are special places, special miraculous icons that provide gracious help to childless spouses. For example, the icon of the Mother of God Trooditissa, which is located in the Troodos mountains, Cyprus.

Once, in front of this icon, future parents begged the Mother of God for a child. They promised that they would ordain him as a monk. They had a boy. When he began to grow up (he was already eight or ten years old), his father and mother hesitated in their intention. And soon it happened that a large stone fell from the mountain and flew a few centimeters from the child’s head. This was a warning to parents, a sign from God. They repented and as a result fulfilled their promise. The frescoes of this monastery depict the Mother of God, Her belt and a large stone nearby as a reminder that vows made to God must be fulfilled.

The birth of vowed children often happened in the past and happens quite often now. Anyone who will be in the Trooditissa monastery in Cyprus will see a huge photographic file of barren women of all nationalities, from all countries of the world, who, having visited this monastery, were relieved of childlessness and gave birth to two or three children after the prayer that the monks performed, putting on barren special belt. This is a huge file cabinet. I saw it myself when I visited this monastery and prayed in front of this icon.

I must say that one of my friend priests who visited the island of Cyprus, literally a week after praying in front of this icon (even without putting a miraculous belt on the mother), conceived a child who had only one or two percent probability of being born. Although the priest did not even ask for a child, but simply prayed in front of the icon, the Lord gave him a child.

Such special places, such holy saints, who are glorified by their gracious help to childless parents, exist both in the Holy Land and in every diocese. You can pray to them, make pilgrimages, order special prayer services, and then you can name him by the name of the saint who will help in the birth of the baby to glorify God’s miracle.

In addition, Orthodox spouses, of course, must resort to the help of shrines. During the pilgrimage, spouses can immerse themselves in holy springs, take water home, sprinkle it, and also be anointed with holy oil from lamps, from miraculous icons from the place of pilgrimage. All of this, done in prayer and faith, will help resolve the problem.

If, after repeated appeals to God, proper churching, resort to all the sacraments, pilgrimages to holy places, etc., children are not born, then you need to be patient. One must rely on the will of God.

Women and young married couples with similar problems often come to our temple. We usually advise spouses, if they want to have children, to set some kind of control period, a year or two, to establish their family life, learn not to be selfish and not live only for yourself. All this time (for a year or two) they will go to the temple for special prayers. In every diocese there are churches where priests perform prayer services for water and pray to the saints who provide grace-filled assistance to childless spouses.

If, after the appointed time, there are still no children, the husband and wife must decide whether they are ready to carry their life’s cross further, perhaps for many years, and patiently relying on the will of God, wait for the birth of their own child, or take an adopted one child. The Lord gives such an opportunity.

This period is also a time of seeking the will of God, exactly what path the Lord determines for this family. After all, the will of God is not immediately revealed to a person. Sometimes required for a long time, so that it becomes clear what kind of life the Lord wants for the spouses, what destiny he has in store for them. Now it is necessary to know the will of God in order to conform one’s parental will to it.

And finally, the logical end of the entire series of spiritual actions that young parents perform is, in the event of the impossibility of getting pregnant, raising a foster child, adopted or in any form accepted into their family. And then, as the Lord wills.

Let us clarify once again where should we start – with a trip to the doctor or with a spiritual understanding of the illness?

I believe that we must begin our journey with the Church, by understanding what is happening together with our spiritual mentor, confessor or spiritual father. Because even on medical examination and treatment of churchly educated young spouses should take a blessing from their confessor. Having received God's blessing and the advice of their spiritual mentor, they can undergo certain medical events and at the same time ask for God’s help and resort to the grace-filled means of the Church.

Breviary. Following the rite of the Wedding of the Moscow courtyard of the Holy Dormition Pskov-Pechersky Monastery. Publishing house "Rule of Faith". 1995. pp. 117–118.

Anniversary Council of Bishops of the Russian Orthodox Church. Materials. Publishing Council of the Moscow Patriarchate a. Charitable Foundation "Christmas 2000". 2001

It's no secret that infertility is one of the most difficult challenges for a family. For a long time, a woman’s inability to have children was perceived as a misfortune and often became the reason for the destruction of a marriage. And today in the West they are already openly talking about an “infertility epidemic.”

For example, in the USA, 15-20% of married couples of reproductive age various reasons cannot become parents. And the number of families who have consulted a doctor about this issue has tripled over the past 20 years. Currently, almost every fifth married couple suffers from the lack of children. There are many reasons for the spread of this problem. For example, in developed countries this is due to the fact that spouses are in no hurry to have a baby, often preferring to give birth to their first child after 30 or even 40 years of age. But nature itself has determined that a woman’s fertility (that is, the ability to conceive) is highest before the age of 27. Then a decline begins, which means it becomes more and more difficult to conceive and bear a child. Of course, poor ecology also plays a role, especially in big cities, and sedentary lifestyle life, and smoking, and of any partner, and lack of normal rest.

But still, one of the important reasons for infertility in modern couples, of course, is inflammatory diseases- as a rule, due to sexually transmitted infections, the outcome of which can be pathologies of the cervix, endometrium, as well as adhesive process in the small pelvis. Inflammatory changes can make it difficult for sperm to penetrate into the uterus, and most importantly into the tubes, where fertilization occurs. All this can cause a number of complications that make it difficult to conceive and bear a child. In addition, even if the pregnancy went well, during childbirth the baby can become infected from the mother, which is by no means safe for his health. Therefore, any inflammatory infections must be treated, even during pregnancy.

What else could be the cause of infertility?

First, let's remember that there are male and female infertility. Currently, it is believed that this occurs in approximately 30% of cases, also in 30% the culprit of childlessness is the man, and in 30%, reproductive system disorders are detected in both spouses. Infertility of unknown origin is 10%.

In a woman, the inability to conceive a child can be caused by both anatomical pathology (for example, cervical erosion, fibroids and endometriosis, various ovarian cysts) and hormonal disorders leading to insufficient ovarian activity.

The absence of normal ovulation (anovulation) may be a consequence of pituitary and hypothalamic diseases. In this case, the proper production of pituitary hormones does not occur, and this, in turn, disrupts the functioning of the ovaries.

It should be noted that the pathology of any organ endocrine system, ultimately changes the function of the ovaries in women, leading to impaired sperm fertility in men.

Most often, pathology of the thyroid gland leads to infertility and the inability to carry a child to term. Anovulation can also be caused by polycystic ovary syndrome and premature exhaustion ovaries. In both cases there is genetic predisposition. But a disease such as premature ovarian failure is increasingly caused by autoimmune processes in the body.

And finally, one of the important causes of infertility is abortion. This is not just a surgical intervention, but also a huge hormonal disruption, which not every body is able to cope with. Therefore, I would like to remind you once again that you should not be afraid to use contraception, including hormonal ones, but you should be afraid of abortion if you really care about your own health and the health of your future children.

Do hormonal disorders manifest themselves in the form of disruptions in the menstrual cycle?

Yes, various diseases endocrine system disrupt menstrual cycle. Menstruation can be rare, with long delays (opso-oligomenorrhea), or absent for more than 6 months - amenorrhea. Besides, endocrine disorders lead to changes in appearance - hair growth increases, for example on the face, legs, chest, etc., various papular rashes may appear on the skin, weight increase, etc. But hormonal disorders are not always accompanied by changes in the menstrual cycle. It would seem that menstruation occurs on time, everything seems to be in order, but in fact, normal ovulation does not occur, which means that conception is out of the question.

What problems are the most common causes of infertility in men?

Here, as well as in women, the main cause is inflammatory diseases. Sooner or later they lead to prostatitis and changes in sperm. This is often a consequence of varicocele - enlarged veins spermatic cord. In this case, as a rule, the problem is solved by surgical correction.

Infertility can be caused by complications from mumps suffered in childhood, testicular trauma, etc. Of course, pathology of the endocrine system in men also disrupts the production of hormones and reduces fertility. And finally, a very common reason is a simple lack of rest, which makes a man’s sperm unviable. Sometimes, in order to conceive a healthy child, a couple of months spent by the spouses in a good sanatorium is enough.

Which couple is considered infertile from a medical point of view?

U healthy couple the possibility of conception within one cycle is about 20-25%, and the overall probability within 12 months is 85-90%. And if, with regular sexual activity without the use of contraceptive methods, conception does not occur within 1 year in women under 35 years old, and over 35 years old - within 6 months, we can talk about infertility of this couple. Today, doctors strongly advise such families not to delay their visit to the doctor. In addition, it is currently believed that after diagnosis of infertility for couples under 35 years of age, the maximum period of conservative and surgical treatment should not exceed two years, and after 35 - 1 year. If during this period it is not possible to achieve visible result, the most realistic solution is to use methods of in vitro (artificial) fertilization (of course, if all the possibilities of medication and surgical treatment Was used).

What are the main diagnostic methods used to determine infertility?

First of all, this is, of course, tests of both spouses for sexually transmitted infections (bacteria and viruses).

For a woman in number mandatory procedures includes ultrasound examination (ultrasound). Moreover, this procedure is carried out several times during the menstrual cycle in order not only to detect possible pathology uterus and ovaries, but also to detect ovulation and confirm the presence corpus luteum formed after ovulation. It is the production of the corpus luteum normal level progesterone in women ensures implantation of the embryo in the uterus and helps maintain pregnancy until the placenta forms (approximately 13-14 weeks of pregnancy). It is mandatory to study the level of hormones in the blood, which is carried out twice during the menstrual cycle, in phases I and II.

A post-coital test is performed, the blood is examined for the presence of antisperm antibodies.

It is very important to assess the condition and patency of the fallopian tubes. After all, the process of conception occurs exactly there, and the fertilized egg enters the uterus only after 4 days. If movement through the tubes is difficult, an ectopic pregnancy may occur.

In order to determine the patency of the fallopian tubes non-operatively, hysterosalpingography was previously performed (an X-ray examination with the introduction of a radiopaque liquid, currently - hydrosonography, a more gentle procedure using aqueous solution and ultrasound. However, only the use of endoscopic methods (laparoscopy and hysteroscopy) allows one to reliably assess the condition of the organs of the reproductive system, followed by surgical correction, for example, cauterization of endometriosis foci, separation of adhesions in the pelvis, tubal plastic surgery, etc.

In addition to being examined by a urologist and taking smears for infections and prostate secretions, my husband must undergo a semen examination, as well as an ultrasound. If necessary, a man donates blood for hormones to rule out pathology from the endocrine system.

Only after collecting all necessary information the doctor can draw conclusions and prescribe treatment. Depending on the cause of infertility, this may be surgical intervention (in the case of endometriosis, often uterine fibroids, ovarian cysts.). If the cause is endocrine diseases, hormonal treatment is required, which is aimed at correcting the functioning of the endocrine system organs, followed by stimulation of ovulation and further hormonal support of the function of the corpus luteum. Another method of solving the problem of infertility can be intrauterine insemination, when active sperm are placed directly into the uterus.

If the above methods do not bring results, it is better not to delay treatment, but to think about in vitro fertilization (IVF). However, modern methods diagnostics and treatment give a quite optimistic prognosis: 50% of married couples with an established cause of infertility will become pregnant in the future after treatment.

What should couples do if the cause of infertility has not been identified?

Indeed, there is a so-called idiopathic infertility, that is, infertility, for which modern diagnostic methods have not revealed obvious reasons. Fortunately, statistics show that approximately 60% of couples with unexplained infertility who do not receive treatment have favorable conditions (healthy image life, proper rest, nutrition, etc.), pregnancy occurs within 3-5 years. In the absence of the desired pregnancy after ovulation induction and artificial insemination, such couples are also referred for IVF.

And finally, I really want to give a little encouragement to spouses who have a similar problem. Yes, it is known that most couples perceive infertility as a serious crisis, in front of which they feel helpless. In fact, there is a way out - do not delay the visit to the doctor. If there is a specific reason that is preventing you from having a child, it can be identified and, if possible, eliminated. And the more years the family has left, the more more likely give birth to a desired and healthy baby.

Unfortunately, gynecologists around the world are faced with cases of infertility every day. Against the background of an increase in the number of abortions and cases of infection with sexually transmitted diseases, the problems of infertility are becoming more acute and relevant for modern people.

ATTENTION!!!
A married couple is considered infertile if the expected pregnancy does not occur within 2 years of regular unprotected sexual activity.

Today, according to statistics, out of 100 married couples, 15 are infertile. Spouses who are able to have as many children as they want are unlikely to fully understand the misfortunes of those who are deprived of the opportunity to become parents. Every year, millions of women have abortions, but on the other side there are those who make every effort to give life to at least one child. I would like to remind you that, despite the achievements of science in the field of human reproduction, only 15-20% of all infertile couples have the fortunate opportunity to conceive and give birth to a child.

Causes of male infertility

Few people know that in 40% of cases of infertile marriages, the culprit is the man. That is why both spouses must undergo an infertility examination. Only in this case can we hope for a positive result.

There are many causes of male infertility. Firstly, malformations or underdevelopment of the testicles or vas deferens. It happens that during fetal development, both or one testicle does not descend into the scrotum. Spermatozoa are very sensitive to elevated temperature(and in the abdominal cavity it is higher than in the scrotum), so their development is suspended or completely stopped.

Secondly, infertility in men, as in women, can be caused by various inflammatory or infectious diseases and their consequences. Often, infertility occurs as a result of disruption of the endocrine glands, which directly affects the development of sperm. Alcoholism, excessive smoking and serious diseases accompanied by an increase in body temperature (malaria, typhus and others) directly affect the ability to fertilize.

The opinion that impotence provokes infertility is wrong. Sexual impotence and infertility are in no way related to each other. A man with a weakened erection can easily become a father, and vice versa, a sex giant may be unable to inseminate.

Causes of female infertility

The causes of infertility in women are not much different from those in men. Anomalies or underdevelopment of the genital organs (mainly the uterus and fallopian tubes) make conception impossible. The most common cause of female infertility is inflammatory diseases (often occurring in every second woman after an abortion). The fallopian tubes become difficult to pass or become completely stuck together, leaving the woman at risk of ectopic pregnancy or infertility.

Like inflammation, sexually transmitted diseases do not go away without leaving a trace. Advanced forms of syphilis, chlamydia, mycoplasmosis, ureaplasmosis, genital herpes and a number of other diseases lead to infertility. Ovarian dysfunction is also one of the most common causes of inability to conceive. The eggs either do not mature at all (no ovulation), or ovulation occurs incorrectly. Such a disorder can occur genetically during puberty, or much later: after childbirth or abortion.

Infertility treatment

Treatment of infertility involves eliminating the causes that interfere with conception. If these are sexually transmitted infections, then both partners undergo treatment. If a woman has hormonal disorders, then under the supervision of an experienced gynecologist-endocrinologist it is necessary to restore hormonal levels. Obstruction of the fallopian tubes and adhesions also need to be treated. If the main cause of infertility is associated with a violation of the quality of sperm in a man, then in this case he is prescribed special diet and drugs.

In the most difficult situations, when other treatments do not give positive results, modern doctors There are unique technologies for artificial insemination.

Infertile couples should not despair. Get examined, get treatment, go towards your dreams! Everyone who really wants it has a chance to become a parent.

I recommend reading my book How to overcome infertility and give birth to a healthy child, which was published in 2013 by Phoenix Publishing House. With the help of this book, you will be able to use all available opportunities to successfully conceive a child.

"A truly happy married couple does not need children at all, because each other is enough for the husband and wife. A man and a woman are like two uneven surfaces, each with bumps and dents. If the surfaces do not fit tightly together, then glue is needed, without it the structure will I mean, you can't save your family. Children are the very glue. If the surfaces match perfectly, the bump into the depression, there's no use for glue."
Boris Akunin "Leviathan"

Infertility is a condition that cannot be attributed to one person, it is a problem for a couple, and it would be correct to speak not about infertility, but about an infertile marriage. Previously, doctors did not examine a married couple until the “experience” of their childless marriage reached 4 years, then the period was reduced to 3, then to 2 years. Today, a marriage is considered infertile if pregnancy does not occur with regular (at least 4 times a month) sexual intercourse for a year without using contraception. According to statistics, in 30% of married couples pregnancy occurs in the first 3 months, in 60% - during the next 7, and in the remaining 10% - 11-12 months after the start of regular sexual activity. The frequency of infertile marriage, according to various sources, ranges from 10-15% to 18-20%, and, interestingly, in a third of cases, reproductive function is reduced in both the husband and wife.

There are primary and secondary infertility, as well as male, female, combined (a combination of female and male infertility or due to incompatibility of spouses) and idiopathic (of unclear nature). If a couple has never had children before marriage, they speak of primary infertility. And if a woman has had at least one pregnancy, then no matter how it ended - childbirth, abortion, miscarriage, ectopic pregnancy- subsequent infertility is considered “secondary”. And also, depending on whether the causes of infertility are congenital or acquired, they speak of congenital or acquired infertility. Temporary or permanent infertility is also distinguished (depending on the cause).

There is, however, so-called physiological infertility - before puberty (before puberty) and after menopause. But this infertility is not absolute, since it is known that pregnancy sometimes occurs both before the first menstruation and many years after menopause. Physiological infertility is also called infertility during pregnancy and lactation.

The main conditions for successful conception are: on the one hand, the cyclic release of the egg from the follicle (ovulation); entry of an egg capable of fertilization into a functioning fallopian tube, providing favorable conditions for the fusion of female and male germ cells inside the fallopian tube and for implantation of the zygote into the endometrium (attachment of the fertilized egg to the inner lining of the uterus); on the other hand, a sufficient number of motile sperm in the ejaculate, concentrated in the immediate vicinity of cervical canal(from the cervix); favorable conditions in the cervix and body of the uterus, ensuring the active movement of sperm towards the fallopian tubes.

When a couple suffering from infertility first approaches, the doctor initially examines the spouse. Male infertility accounts for about 40% of infertile marriages.

It is generally accepted that the fertility (ability to conceive) of men is ensured by the number of sperm (from 20 to 100 million/ml). At least 50% of the sperm should remain motile 2 hours after ejaculation, and after 24 hours more than half of the original number of motile sperm should still be alive.

Disorders leading to male infertility can be: Firstly, a small number or absence of sperm in the ejaculate. Which may be a consequence of obstruction or congenital absence of the spermatic ducts, damage to the testes, or varicocele - an abnormal dilation of the veins of the testis, impairing the outflow of blood from the testicle, which leads to an increase in temperature in the scrotum and impaired spermatogenesis. Also, the temperature may increase with ARVI; when wearing tight shorts and jeans; frequent visits saunas or steam rooms; during activities that require prolonged sitting. Sexual activity - daily or more frequent copulation (ejaculation) can lead to a decrease in sperm count. However, abstinence for 5–7 days is also undesirable, since an increase in the number of sperm is accompanied by a decrease in their motility as a result of an increase in the number of old cells.

Secondly, agglutination (gluing) of sperm. This may occur periodically in most men, but if such changes are detected repeatedly, this may indicate autoimmune reaction or infection.

Thirdly, the lack of dilution of seminal fluid. Secretory disorders of the seminal vesicles, prostate gland and other accessory glands in the male reproductive ducts are also important.

Fourthly, retrograde ejaculation. Sometimes there is a violation of ejaculation with the release of sperm into the bladder, this happens when diabetes mellitus, Hodgkin's disease, after removal of the prostate and for neurological disorders.

Fifthly, a violation of the structure of sperm. The reasons may be: trauma to the testicles, surgical interventions on them, or mumps (mumps) in the past; heavy allergic reactions; impact ionizing radiation; application of some medications(nitrofurantoin, sulfasalazine and others).

Finally, sperm motility. Smoking and alcohol can lead to decreased testosterone levels in the blood; decreased libido and potency.

It is important to remember that a man’s potency is not an indicator of his fertility, that is, his ability to bear children. Often a woman’s confidence in her husband’s good reproductive function is based only on a high assessment of his sexual potency. However, extremely low potency is often combined with excellent sperm fertility, and vice versa - the owner of sperm without sperm can have high potency.

If the cause of an infertile marriage is one or another disorder in a woman’s body, we speak of female infertility. So, what are the causative factors:

Firstly, ovulation factors. A disorder of the endocrine regulation of any phase of the menstrual cycle often leads to impaired ovulation. Absent or irregular ovulation may be due to hyperprolactinemia, polycystic ovary syndrome, hypothalamic amenorrhea, or luteal phase deficiency. Also common reasons lack of ovulation are changes in body weight ( metabolic syndrome, obesity, anorexia nervosa); taking medications (hormonal drugs, tranquilizers, etc.) or psychological disorders (family or work problems, travel, sports, etc.).

Secondly, tubo-peritoneal factors. Anatomical disorders are possible, accompanied by obstruction of the fallopian tubes, the causes of which may be: inflammatory diseases of the genital organs (sexually transmitted infections); previous surgical interventions on the internal genital organs (myomectomy, ovarian resection, etc.); postpartum complications(traumatic and infectious) or endometriosis. Also, sometimes the function of the fallopian tubes is disrupted, which is caused by: impaired prostaglandin synthesis, stress, or impaired adrenal function.

Thirdly, cervical factors. The mucus secreted by the cervix serves as a biological filter, preventing the penetration of bacteria from the vagina and increasing the viability of sperm. Typically, sperm pass through the cervical canal and end up in the fallopian tube within 5 minutes of entering the cervix. The causes of infertility at this stage may be: abnormalities in the position of the cervix; chronic endocervicitis (inflammation of the cervical canal); previous surgery on the cervix, leading to narrowing of the cervical canal or reduction of formation cervical mucus; the presence in the cervical mucus of antibodies to the husband’s sperm (causing the death of the latter) - this is called immunological incompatibility of the married couple.

In 30% of infertile marriages there is a combination of male and female infertility, that is, the diagnosis of male infertility in no case cancels the examination of the wife, and, if necessary, their parallel treatment.

In cases where pregnancy does not occur within 1–2 years and no pathology is detected in either partner, infertility is considered difficult to explain or idiopathic. Some experts associate idiopathic infertility with the presence of genetic disorders, while others, in turn, identify a psychogenic origin. There is an opinion that its cause simply cannot yet be identified by modern diagnostic methods.

Examination and treatment of men is carried out by an andrologist or urologist. They start with a sperm analysis (spermogram). The spermogram determines the volume of sperm (normally more than 1 ml), total spermatozoa (1 ml - more than 20 million), the number of actively motile and structurally normal spermatozoa (at least 50%), count the number of leukocytes (0–1 in the field of view).

In order for the spermogram to be informative, it is necessary to abstain from sexual activity for 3-5 days before submitting sperm for analysis (preferably no less, but no more). It is best to donate sperm for analysis in the same room where the laboratory is located. Cooling sperm leads to distortion of its parameters.

If a large number of pathological (abnormal) spermatozoa is detected, it is indicated additional research– morphological analysis of sperm, which will allow you to more accurately determine the nature of sperm pathology, the number of normal forms and serves as one of the criteria for choosing a method of treating infertility. If an increased number of leukocytes is detected in the sperm, the sperm is additionally cultured for infection.

The main methods used when examining women are:

measurement of rectal temperature - a way to assess ovarian function over a long period of time, provides indirect information about endocrine dysregulation;
ultrasound diagnostics(percentage of pathology detection 70-90%);
hystersalpingography - insertion into the uterus contrast agent and it's done X-ray, which shows the uterine cavity and the lumen of the tubes (the accuracy of determining pathology ranges from 40 to 55%);
hormonal examination - determining the presence or absence of ovulation, as well as identifying the causes and mechanisms of anovulation;
infectious disease examination - detection of obvious and latent sexually transmitted infections;
hysteroscopy - a thin optical instrument (hysteroscope) is inserted into the uterine cavity, which allows you to examine the entire uterine cavity and identify diseases that are not always detected during a routine examination and ultrasound;
laparoscopy is a method of diagnosis and surgical treatment, when radical interventions are performed without wide dissection of the integument, through pinpoint punctures of tissue (diagnostic accuracy is close to 99%);
postcoital test or others special studies- Shuvarsky test, Kurzprock-Miller test, determination of antisperm antibodies - all this to determine the immunological compatibility of spouses.

If necessary, a genetic examination is prescribed to determine the karyotypes of the spouses.

Among the methods of infertility treatment, we can roughly distinguish those that are aimed at restoring the natural fertility of a married couple and those that use the technique of artificial insemination.

To restore natural fertility, depending on the causes of infertility, the following is used:

conservative and surgical repair patency of the fallopian tubes;
correction of endocrine disorders;
restoration of impaired spermatogenesis.

Artificial insemination techniques can be:

intrauterine insemination with husband's sperm;
intrauterine insemination with donor sperm;
in vitro fertilization with subsequent transfer of embryos into the mother's uterus in its various variants.

There is also a “surrogate mothers” program, which gives a chance to have a child to women who, for various reasons, have had their uterus removed or have serious illnesses (heart, kidney, etc.) that are a contraindication for pregnancy. In these cases, the infertile couple's own eggs and sperm are used. The resulting embryos are transferred into the uterine cavity of a healthy woman - a “surrogate mother”, who will carry this donor pregnancy for all nine months.

Something interesting

"A man must be strong, healthy and abstain from junk food".
Hippocrates

At all times, nutrition and the ability to reproduce offspring have been closely interrelated. IN Ancient Greece To increase the birth rate in general and the birth of male babies in particular, dry food was recommended - lentils, grains and nuts. Even now some representatives alternative medicine They suggest that expectant mothers, before conceiving, adjust their diet to the desired sex of the child. However, none of these diets have been scientifically proven to work.

Some women who have been taking birth control pills for several years experience a decrease in their ability to conceive when they stop taking them. This may continue for several months. To better restore fertility, it is worth including in your diet foods rich in magnesium (oats, sprouted wheat, chestnuts, rye bread and peas), which enhances the effect of estrogens, and vitamin B6 (whole grains, green vegetables), also involved in the metabolism of hormones of this group.

It is wise for both men and women to limit their intake of highly refined foods, such as wheat flour and sugar, which lack essential nutrients.

Consuming large amounts of alcohol can make it difficult to absorb B vitamins and such minerals, like zinc and iron, and excessive tea consumption interferes with the absorption of iron.

To maintain the fertilizing ability of sperm, food containing essential fatty acids (present in fatty fish and polyunsaturated vegetable oils), vitamins A, B, C and E, zinc and selenium is necessary. All these components are involved in the production of healthy sperm.

Many studies confirm the relationship between sperm quality and zinc intake. High levels of zinc were found in male gonads and sperm. In addition, healthy testicles have a high concentration of vitamin C. It is claimed that with the help high doses Vitamin C can cure a common cause of male infertility - sperm agglutination (clumping of sperm). During experiments at the University of Texas Medical School, scientists gave a group of men 50 mg of vitamin C twice a day for a month. At the beginning of the experiments, all men received very little vitamin C from food. After three weeks, sperm agglutination decreased sharply - from 37 to 11%, which is the norm for a healthy man.

In many cases, however, the causes of infertility have nothing to do with nutrition. Whatever the reason, the results of studies in many European countries are alarming: over the past 50 years, the fertilizing ability of sperm has declined sharply, which is associated with excessive alcohol consumption, stress, increased use of chemicals in agriculture and environmental pollution. The UK Department of Agriculture, Fisheries and Food is studying the effects of estrogen-like pollutants - substances found in river water and food plastic packaging that have similar effects to female hormones.

They are used as plastic modifiers to make them more flexible and appear to have an increased ability to "bleed" into foods containing fat, such as crisps, chocolate and even milk. Sometimes they are included in paints and cosmetics, from which they gradually disappear. Scientists suggest that these components, which mimic estrogens and are part of a complex combination chemical substances present in the environment somehow affect unborn male infants, impairing their future ability to produce sufficient numbers of healthy sperm.

For example, in the United States, 15–20% of married couples of reproductive age cannot become parents for various reasons. And the number of families who have consulted a doctor about this issue has tripled over the past 20 years. Currently, almost every fifth married couple suffers from the lack of children. There are many reasons for the spread of this problem. For example, in developed countries this is due to the fact that spouses are in no hurry to have a baby, often preferring to give birth to their first child after 30 or even 40 years of age. But nature itself has determined that a woman’s fertility (that is, the ability to conceive) is highest before the age of 27. Then a decline begins, which means it becomes more and more difficult to conceive and bear a child. Of course, poor ecology also plays a role, especially in big cities, a sedentary lifestyle, smoking (by any partner), and lack of normal rest.

But still, one of the important causes of infertility in modern couples, of course, is inflammatory diseases - usually due to sexually transmitted infections, the outcome of which can be pathologies of the cervix, endometrium, as well as adhesions in the pelvis. Inflammatory changes can make it difficult for sperm to penetrate into the uterus, and most importantly into the tubes (where fertilization occurs). All this can cause a number of complications that make it difficult to conceive and bear a child. In addition, even if the pregnancy went well, during childbirth the baby can become infected from the mother, which is by no means safe for his health. Therefore, any inflammatory infections must be treated, even during pregnancy.

What else could be the cause of infertility?

First, let's remember that there are male and female infertility. Currently, it is believed that female infertility occurs in approximately 30% of cases, also in 30% the culprit of childlessness is the man, and in 30% disorders of the reproductive system are detected in both spouses. Infertility of unknown origin is 10%.

In a woman, the inability to conceive a child can be caused by both anatomical pathology (for example, cervical erosions, fibroids and endometriosis, various ovarian cysts) and hormonal disorders leading to insufficient ovarian activity.

It should be noted that pathology of any organ of the endocrine system ultimately changes the function of the ovaries in women and leads to impaired sperm fertility in men.

Most often, pathology of the thyroid gland leads to infertility and the inability to carry a child to term. Anovulation can also be caused by polycystic ovary syndrome and premature ovarian failure. In both cases, there is a genetic predisposition. But a disease such as premature ovarian failure is increasingly caused by autoimmune processes in the body.

And finally, one of the important causes of infertility is abortion. This is not just a surgical intervention, but also a huge hormonal disruption, which not every body is able to cope with. Therefore, I would like to remind you once again that you should not be afraid to use contraception, including hormonal ones, but you should be afraid of abortions if you really care about your own health and the health of your future children.

Do hormonal disorders manifest themselves in the form of disruptions in the menstrual cycle?

Yes, various diseases of the endocrine system disrupt the menstrual cycle. Menstruation can be rare, with long delays (opso-oligomenorrhea), or absent for more than 6 months - amenorrhea. In addition, endocrine disorders lead to changes in appearance - hair growth increases, for example on the face, legs, chest, etc., various papular rashes may appear on the skin, weight gain, etc. But hormonal disorders are not always accompanied by changes menstrual cycle. It would seem that menstruation occurs on time, everything seems to be in order, but in fact, normal ovulation does not occur, which means that conception is out of the question.

What problems are the most common causes of infertility in men?

Here, as well as in women, the main cause is inflammatory diseases. Sooner or later they lead to prostatitis and changes in sperm. Often this is a consequence of varicocele - dilation of the veins of the spermatic cord. In this case, as a rule, the problem is solved by surgical correction.

Which couple is considered infertile from a medical point of view?

For a healthy couple, the chance of conceiving within one cycle is about 20–25%, and the overall chance over 12 months is 85–90%. And if, with regular sexual activity without the use of contraceptive methods, conception does not occur within 1 year in women under 35 years old, and over 35 years old - within 6 months, we can talk about infertility of this couple. Today, doctors strongly advise such families not to delay their visit to the doctor. In addition, it is currently believed that after diagnosing infertility for couples under 35 years of age, the maximum period of conservative and surgical treatment should not exceed two years, and after 35 - 1 year. If during this period it is not possible to achieve a visible result, the most realistic solution is to use in vitro (artificial) fertilization methods (of course, if all the possibilities of medical and surgical treatment have been used).

What are the main diagnostic methods used to determine infertility?

First of all, this is, of course, tests of both spouses for sexually transmitted infections (bacteria and viruses).

For a woman, mandatory procedures include ultrasound examination (ultrasound). Moreover, this procedure is carried out several times during the menstrual cycle in order not only to detect possible pathology of the uterus and ovaries, but also to detect ovulation and confirm the presence of the corpus luteum formed after ovulation. It is the production of normal levels of progesterone by the corpus luteum in women that ensures implantation of the embryo in the uterus and helps maintain pregnancy until the placenta forms (approximately 13–14 weeks of pregnancy). It is mandatory to study the level of hormones in the blood, which is carried out twice during the menstrual cycle, in phases I and II.

A post-coital test is performed, the blood is examined for the presence of antisperm antibodies.

In order to determine the patency of the fallopian tubes in a non-surgical way, hysterosalpingography was previously performed (x-ray examination with the introduction of a radiopaque liquid, currently - hydrosonography, a more gentle procedure using an aqueous solution and ultrasound. However, only the use of endoscopic methods (laparoscopy and hysteroscopy) allows for a reliable assessment condition of the organs of the reproductive system, followed by surgical correction, for example, cauterization of foci of endometriosis, separation of adhesions in the pelvis, tubal plastic surgery, etc.

Only after collecting all the necessary information can the doctor draw conclusions and prescribe treatment. Depending on the cause of infertility, this may be surgical intervention (in the case of endometriosis, often uterine fibroids, ovarian cysts.). If the cause is endocrine diseases, hormonal treatment is required, which is aimed at correcting the functioning of the endocrine system organs, followed by stimulation of ovulation and further hormonal support of the function of the corpus luteum. Another method of solving the problem of infertility can be intrauterine insemination, when active sperm are placed directly into the uterus.

If the above methods do not bring results, it is better not to delay treatment, but to think about in vitro fertilization (IVF). However, modern diagnostic and treatment methods give a quite optimistic prognosis: 50% of married couples with an established cause of infertility will become pregnant in the future after treatment.

What should couples do if the cause of infertility has not been identified?

Indeed, there is so-called idiopathic infertility, that is, infertility for which modern diagnostic methods have not identified obvious causes. Fortunately, statistics show that approximately 60% of couples with infertility of unknown origin who do not receive treatment, when creating favorable conditions (healthy lifestyle, proper rest, nutrition, etc.), develop pregnancy. In the absence of the desired pregnancy after ovulation induction and artificial insemination, such couples are also referred to IVF.

And finally, I really want to give a little encouragement to spouses who have a similar problem. Yes, it is known that most couples perceive infertility as a serious crisis, in front of which they feel helpless. In fact, there is a way out - do not delay your visit to the doctor. If there is a specific reason that is preventing you from having a child, it can be identified and, if possible, eliminated. And the more years the family has left, the greater the likelihood of giving birth to a desired and healthy baby.

Keywords: And finally, I really want to give a little encouragement to spouses who have a similar problem. Yes, it is known that most couples perceive infertility as a serious crisis, in front of which they feel helpless. In fact, there is a way out - don’t delay

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