Reproductology: diseases — симптомы, диагностика и лечение

Infertility in a couple is said to occur when pregnancy does not occur within a year of regular sexual activity without contraception. In approximately half of such cases, a male factor is detected, either as the sole cause or in combination with a female factor. At the same time, examining a man is simpler, faster and cheaper than a woman’s, so it makes sense to start with him - with a spermogram.

Leukocytospermia is an increased number of leukocytes in semen, which is detected during a spermogram. All men have a small number of leukocytes in the ejaculate, but exceeding the accepted threshold indicates inflammation in the male reproductive system: most often in the prostate gland, seminal vesicles, epididymis or urethra. This in itself is not a diagnosis, but a signal to look for the cause. Leukocytes release reactive oxygen species that damage the membrane and DNA of sperm, so the condition is important for couples planning pregnancy and requires examination by a urologist or andrologist.

Luteal phase deficiency is a condition in which the second half of the menstrual cycle is too short or the corpus luteum produces little progesterone. It is progesterone that prepares the uterine lining for implantation of the embryo and supports early pregnancy, so difficulties with conception and early pregnancy losses are associated with this condition. Women notice a shortening of their cycle, spotting a few days before menstruation, sometimes breast tenderness and mood swings. It is important to understand: there is no single recognized way to make such a diagnosis, and the deficiency itself is almost always secondary - behind it there is another, quite detectable reason.

Ovarian hyperstimulation syndrome is a complication of infertility treatment that occurs after stimulation of ovulation, most often in in vitro fertilization programs. The ovaries respond excessively to drugs, enlarge, and the vessels become permeable: the liquid part of the blood leaves the vessels into the abdominal cavity. Bloating, heaviness and pain in the lower abdomen, rapid weight gain, nausea, and, in severe cases, shortness of breath and a decrease in the amount of urine appear. Mild forms are common and go away on their own; severe forms require hospitalization due to the risk of blood thickening and thrombosis. Knowing the warning signs is important for every woman undergoing stimulation.

Thin endometrium is a condition in which the uterine mucosa does not reach sufficient thickness at the time of possible implantation. The endometrium grows under the influence of estrogens in the first half of the cycle, and it is its quality that largely determines whether the embryo can attach. Most often, the conclusion about a thin endometrium appears in women preparing for embryo transfer, or in the absence of pregnancy for a long time. The reasons are different: the consequences of curettage and inflammation, adhesions in the uterine cavity, impaired blood flow, hormonal characteristics. It is important that thickness is not the only criterion, and the doctor also evaluates the structure of the mucosa and blood flow.

Polycystic ovary syndrome is a hormonal disorder in which ovulation is disrupted, the level of male sex hormones increases and many small follicles accumulate in the ovaries. This is one of the most common causes of irregular cycles and infertility in women. It is important to understand: PCOS is not a “cyst that needs to be removed,” but a systemic metabolic condition, and the main treatment here is not surgical.

Azoospermia is the complete absence of sperm in the ejaculate. For a man, this sounds like a death sentence, but in reality, the diagnosis only means the beginning of the examination, and not its end. The key question is why there are no sperm: because they are not produced or because they are formed but cannot be released. Both treatment and the chances of becoming a biological father, which in modern conditions a significant proportion of such men have, depend on the answer.

Chronic endometritis is a long-term, sluggish inflammation of the uterine mucosa. It gives almost no symptoms, but it is often the reason why pregnancy does not occur or is terminated at an early stage, and IVF attempts end in implantation failure. The diagnosis is made only by endometrial biopsy, so without a targeted search it is almost always missed.

Fallopian tube obstruction is one of the main causes of female infertility. The tube not only serves as a canal: it is where the egg and sperm meet, and its cilia propel the fertilized egg into the uterus. Therefore, not only formal patency is important, but also the preservation of the internal lining - and this is a key point when choosing between surgery and IVF.

Hydrosalpinx is an accumulation of fluid in the fallopian tube, resulting from the fact that its final section has stuck together and ceased to communicate with the abdominal cavity. The pipe stretches and turns into a closed bag. The peculiarity of this condition is that it is harmful not only in itself: fluid from such a pipe flows into the uterine cavity and sharply reduces the likelihood of embryo implantation - including during IVF.