Female infertility: causes, examination and treatment in Tashkent

Other names: Инфертильность, бесплодие у женщин, первичное и вторичное бесплодие

Infertility is said to occur when pregnancy does not occur within a year of regular sexual activity without contraception, and after 35 years - within six months. This is not a verdict or a diagnosis of one person: in approximately a third of cases the cause is female, in a third male, and in the remaining cases it is combined or unclear. Therefore, the examination of a couple always proceeds in parallel, and it begins, contrary to common practice, with a spermogram of the partner as the simplest step.

🧾 МКБ-10: N97 🏥 Where it is treated: 2 A year of attempts, after 35 - six monthsBoth partners are examinedAge is a key factor

👨‍⚕️ Which doctor

Gynecologist, reproductive specialist

🔬 Diagnostics

Ovulation, tubal patency, hormones, partner’s spermogram

💊 Treatment

Treatment of the cause, stimulation, ART

📈 Prognosis

Depends on cause and age

⚠️ At risk

Age, inflammation, endometriosis, PCOS

⏱ When to see a doctor

Don't put it off after 35

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Возраст старше 35 лет и отсутствие беременности более полугода
Отсутствие менструаций или очень нерегулярный цикл
Перенесённые воспалительные заболевания органов малого таза
Внематочная беременность или операции на трубах в анамнезе
Два и более выкидыша
Выраженная болезненность менструаций
Низкий АМГ и сниженный овариальный резерв

When to start the examination

Up to 35 years of age - after a year of regular sexual activity without contraception
After 35 years - after six months
After 40 years - without delay, immediately when making a decision about pregnancy
Immediately in the absence or severe irregularity of menstruation
Immediately in case of pelvic inflammation, tubal surgery, ectopic pregnancy
With two or more miscarriages - examination for miscarriage
For known endometriosis or PCOS
If changes are detected in the partner’s spermogram

О возрасте стоит сказать прямо, потому что об этом часто умалчивают: запас яйцеклеток не восстанавливается, и после 35 лет он снижается заметно быстрее. Год, потраченный на ожидание или на лечение без плана, в этом возрасте имеет вполне конкретную цену. Это не повод для паники, но повод не откладывать.

Main reasons

Ovulation disorders - PCOS, hypothalamic disorders, hyperprolactinemia, thyroid diseases, premature ovarian failure
Tubal-peritoneal factor - tubal obstruction, adhesions, hydrosalpinx after inflammation
Endometriosis
Uterine factor - fibroids, deforming cavity, polyps, synechiae, chronic endometritis, uterine malformations
Cervical factor - changes in cervical mucus, consequences of cervical surgery
Immunological factors
Age-related decline in ovarian reserve
Genetic causes
Infertility of unknown origin - when all examinations are normal; occurs quite often
Male factor - present in approximately half of cases, alone or in combination

Examination: reasonable sequence

Спермограмма партнёра — первым шагом; выполняется быстро, стоит недорого и может сразу изменить всю тактику
Оценка овуляции: дневник цикла, УЗИ-мониторинг фолликулов, прогестерон во вторую фазу
Гормональное обследование: ФСГ, ЛГ, эстрадиол, пролактин, ТТГ, АМГ, тестостерон
УЗИ органов малого таза с подсчётом антральных фолликулов
Оценка проходимости маточных труб: гистеросальпингография, гидросонография или лапароскопия
Гистероскопия при подозрении на патологию полости матки
Пайпель-биопсия эндометрия при неудачах имплантации и подозрении на хронический эндометрит
Обследование на инфекции, передающиеся половым путём
Посткоитальный тест при показаниях
Генетическое обследование пары при невынашивании и тяжёлых нарушениях

The logic of this sequence is simple: first simple and non-invasive, then more complex. It is irrational to start with laparoscopy without knowing the spermogram and without assessing ovulation.

What is ovarian reserve and why is it assessed?

The supply of eggs is laid in utero and only decreases with age - new ones are not formed
AMH (anti-Mullerian hormone) reflects the amount of this reserve
Counting antral follicles during ultrasound on days 2–5 of the cycle is the second key indicator
FSH on days 2–5 of the cycle is an indirect marker
A low reserve does not mean the impossibility of pregnancy, but it reduces the time for thinking and affects the choice of tactics
The reserve is reduced by ovarian surgery, especially with endometrioid cysts, chemotherapy, and smoking.
Reserve assessment is mandatory before ovarian surgery in women planning pregnancy

Treatment

Stimulation of ovulation during anovulation is a basic method for PCOS and similar conditions
Correction of hormonal disorders: thyroid gland, prolactin, insulin resistance
Losing body weight in obesity - in some women, restores ovulation without drugs
Laparoscopy for tubal factor, endometriosis, adhesions
Hysteroscopic removal of polyps, nodes, synechiae, uterine septum
Treatment of chronic endometritis
Laparoscopic ovarian drilling for PCOS resistant to stimulation
Intrauterine insemination - with cervical factor and moderate changes in spermogram
IVF and ICSI - for tubal factor, pronounced male factor, endometriosis, ineffectiveness of other methods, as well as for infertility of unknown origin
Donor programs and surrogacy in certain situations

Существенный момент: лечение не должно быть бесконечным. Если избранный метод не даёт результата в разумные сроки, тактику меняют. Годы, потраченные на повторяющиеся курсы одного и того же лечения, — самая частая и самая обидная потеря при бесплодии.

What can a couple do?

Regular sex life: optimally every other day or two, especially during the fertile period
Smoking cessation for both partners - it reduces both ovarian reserve and sperm quality
Limiting alcohol
Normalization of body weight: both excess and severe deficiency disrupt ovulation
Moderate physical activity without strenuous exercise
Taking folic acid when planning pregnancy
Normalization of sleep and reduction of stress levels
Avoiding lubricants that reduce sperm motility
Examination of both partners at the same time, and not in turn
Psychological support - infertility is difficult for a couple, and this is normal

Where to get examined in Tashkent

We need an ultrasound with assessment of follicles, a hormonal laboratory, methods for assessing tubal patency, hysteroscopy and laparoscopy.

In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic; IVF programs are implemented jointly with reproductive specialists.

Practical advice: sign your partner up for a spermogram on the same day that you go to the gynecologist. This is the fastest way to narrow down your search without spending months examining just one of you. Clinic contacts are below.

Services and prices for this diagnosis

Based on official price lists of Tashkent clinics. The exact cost is determined after examination.

🔬 Diagnostics

Первичный приём гинекологаfrom 200 000 Гидропертубацияfrom 260 000 Диагностическая лапароскопияfrom 6 500 000 Гистероскопия диагностическая (амбулаторно)from 1 475 000 Пайпель-биопсия эндометрияfrom 525 000 Проба Шуварского (посткоитальный тест)from 470 000

💊 Treatment

Внутриматочная инсеминацияfrom 3 920 000 Лапароскопическая каутеризация яичников (дриллинг при СПКЯ)from 8 500 000

Frequently asked questions: Female infertility

After how many attempts is it time to get examined?+

Before 35 years of age - after a year of regular sexual activity without contraception, after 35 years - after six months, and after 40 years of age, it is better to start the examination immediately. It is worth not waiting and contacting earlier in the absence of menstruation, previous inflammation, tubal surgery, ectopic pregnancy and repeated miscarriages.

Where to start the examination?+

From the partner's spermogram. This is the fastest, simplest and most inexpensive analysis, which immediately shows whether there is a male factor, and it is present in about half of the cases. It is irrational to start with examining only women: you can spend months, but the reason will turn out to be something else.

Why is age so important?+

The supply of eggs is laid before birth and only decreases with age - new ones are not formed. After 35 years, the decline accelerates, and the quality of the eggs also deteriorates. This does not mean that pregnancy is impossible, but it does mean that you should not delay examination and treatment: time is against you here.

What to do if all tests are normal?+

This situation is called infertility of unknown origin and occurs quite often. This does not mean that there is no reason - just that the available methods do not reveal it. In such cases, they usually offer stimulation of ovulation with intrauterine insemination, and if there is no result within a reasonable period, a transition to IVF.

Is it necessary to do laparoscopy?+

Not always. It is performed if endometriosis, adhesions or tubal factor is suspected, when the result of the study changes the tactics. It is irrational to start an examination with laparoscopy without assessing the spermogram, ovulation and hormones: this is an operation, and the indications for it must be justified.

Do vitamins and dietary supplements help?+

Folic acid is really needed and recommended when planning pregnancy. Other supplements do not address specific causes - tubal obstruction, anovulation, endometriosis or male factor. The main danger is wasted time, especially after 35 years.

Does stress affect conception?+

Chronic stress can interfere with the regularity of ovulation, so its effects are real. But it is important not to shift all the responsibility onto him: the advice to “just relax” does not replace an examination and often hurts the couple. A reasonable approach is to simultaneously get examined and take care of your psychological state.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated female infertility в Ташкенте

Обследование при бесплодии должно быть последовательным и не растянутым на годы: возраст женщины — фактор, который нельзя вернуть. В Ташкенте комплексное обследование, включая оценку проходимости труб, гистероскопию и лапароскопию, проводят в медицинском центре UROLOGIC COMPLEX и в clinicsе Tashkent Medical Park.