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.

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.

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.

Pathospermia is a general name for changes in the spermogram: a decrease in the concentration of sperm, their motility or the proportion of normal forms. Having received a conclusion with incomprehensible terms, a man usually gets scared and starts looking for answers on the Internet. Meanwhile, the first thing you need to know: one bad analysis does not prove anything. Sperm counts fluctuate, and decisions are made on at least two tests at intervals of several weeks.