INFERTILITY

From Big Medical Encyclopedia

INFERTILITY — inability to reproduction of posterity. The vast majority of authors considers that marriage should be considered sterile if pregnancy did not occur within two years of normal sex life without use of the protecting means. B. in families, according to statistical data of a number of the countries, makes from 10 to 20%.

B. B. is the reason of every fourth case of divorce can be physiological (children's and senile age, during a lactation) and pathological (as a result of malformations, hron, inflammatory diseases and injuries of gonads and a genital tract of both spouses or one of them, as a result of endocrine disturbances, the serious exhausting illness, mental or neurologic disorders). In B.'s emergence gene, chromosomal and immune factors have a certain value. Immunization of a female body the antigens which are contained in spermatozoa, or existence of anti-apermatozoal antibodies in a male body (autoantibodies) leads to decrease in fertility. B. because of pathology at women, by data K. B. Akunts (1971), it is noted in 59,4% of sterile marriages, at men — in 5,7% and at both spouses — in 28,4%. Thus, female B. in marriage makes 87,8%, and men's — 34,1%. In 1951 the International association on studying of problems of fertility and B. of the person (J.F.А) is created.

Infertility at women

Infertility at women (sterilitas) — inability to conception in childbearing age. B., connected with abortions or pre-natal death of a fruit, i.e. inability to incubation, infertilitas — is called see. Nevynashivaniye pregnancies .

B. at women subdivide on primary and secondary, absolute and relative, inborn and acquired, temporary and constant. At primary B. in the anamnesis there are no pregnancies. At secondary B. the pregnancies which were available in the anamnesis ended with childbirth, abortions or an extrauterine pregnancy then pregnancy did not occur within two years and more.

It is considered B. at the woman absolute if an opportunity to become pregnant is completely excluded, napr, in the absence of a uterus. At relative B. the probability of pregnancy is not excluded, but considerably lowered. Depending on whether B.'s reasons are inborn or acquired, speak about the inborn and acquired B.; at temporarily operating or constant reasons the terms «temporary infertility» and «constant infertility» are used.

The etiology and a pathogeny

can be female B.'s Cause both diseases of the sexual sphere, and various extragenital diseases (hron, infections, hron, intoxication and professional harm). Disbolism in an organism of the woman (obesity, diabetes, etc.) » starvation, malnutrition and a vitamin deficiency, psychosomatic disturbances, strong emotions, intellectual overfatigue can also be B. Prichinami B. cause there can be an inborn underdevelopment or malformations of the sexual device — hereditary or owing to aberation chromosomes or impact on a fruit of various hormonal, toxic or infectious factors.

During an organogenesis of the sexual device of disturbance of process of merge of paramezonefralny (myullerovy) channels (ductus paramesonephricus), involution of a pubic pryamokishechny fold and mezonefralny (volfov) channel (ductus mesonephricus) lead to formation of the partitions (a two-horned, double uterus) complicating penetration of spermatozoa into a uterus. In this case it is observed inborn relative B.

Existence of a rudimentary uterus, an atresia of a vagina or neck of uterus brings to absolute primary B. Nedorazvitiye of female generative organs can be also result of latent infection and hyponutrient at early children's age and during puberty. At the same time there is an acquired primary relative B. of CB. often give inflammatory diseases. According to O. K. Nikonchik (1956), B., connected with abortion, makes 56% among all reasons of B. Priobretennoye relative B. it is observed at inflammatory diseases of a uterus and its appendages, defiant, according to E. P. Mayzel (1965), at 67 — 82% of patients impassability of uterine tubes. Adhesive process of a peritoneum and in pipes is especially expressed at gonorrhea, tuberculosis, septic abortions, after intrauterine cauterizations by iodine). At the same time as a result of inflammatory infiltration uterine tubes are condensed. It is broken or completely their peristaltics stops, they become impassable for an ovum and spermatozoa. Besides, inflammatory changes in appendages of a uterus quite often conduct to depression of function of ovaries that leads to decrease in level of gonadotropic hormones in an organism. Especially often leads a combination of inflammatory process of generative organs and their underdevelopment to B. The important place among female B.'s reasons, especially primary, is occupied by the functional disturbances which are shown dysfunction of ovaries, pathology of sokratitelny activity of a uterus and uterine tubes (see below Endocrine infertility). B. at a fibromyoma is, as a rule, a consequence of dystrophic changes in ovaries. Especially often B. arises at a combination of a fibromyoma to endometriosis of uterine tubes (according to E. P. Mayzel, in 15,7 — 16,8% of cases patients with a fibromyoma have also endometriosis). At the same time an essential role is played by disturbances of hormonal mechanisms which essence is not studied yet. Traumatic injuries of a crotch, vagina and neck of uterus can be the cause of not deduction of a seed in a vagina and a neck of uterus. At considerable omission of walls of a vagina the neck of uterus is extended and falls. Traumatic damages on a neck of uterus (ectropion, an erosion, an endocervicitis) worsen conditions for conception.

The symptomatology of the diseases leading to female infertility depends on pathological changes in bodies and systems. At inflammatory processes in generative organs complaints often appear on bleach: mucopurulent (gonococcal and septic infections), liquid in the form of a lymphorrhea (a proflyuiruyushchy hydrosalpinx or a retroflexion of a uterus). Trace amount of a secret from generative organs is a consequence of atrophic or dystrophic processes in an endometria (a cicatricial and commissural stage of tuberculosis of an endometria). The complaint following on frequency — frustration of a menstrual cycle; at primary B. — an amenorrhea, painful, scanty, rare periods (a gipotalamo-pituitary syndrome, a nutritional dystrophy, a psychogenic factor, malformations of generative organs, an atrophy of an endometria as a result of the postponed genital tuberculosis or surgical interventions), a hyper polymenorrhea (a fibromyoma of a uterus, polyposes of an endometria, an adenomyosis of a uterus, endometrial cancer, etc.). Existence of pains at B. is a consequence of inflammatory processes in generative organs (acute, Subacute and hron, stages), giperantefleksiya and retroflexions of a uterus, tumors of internal generative organs (a fibromyoma, a cyst or a cystoma of ovaries).

Diagnosis of female infertility

Diagnosis of female infertility is simple. Clarification of the reasons of B. is complicated that is necessary at purpose of treatment. First of all it is necessary to consider age of the woman. The most favorable age for approach of pregnancy — from 18 to 35 years. Find out a profession of the woman and her spouse (influence of radioelements, toxic and other factors), material living conditions of the woman (an alimentary, psychogenic factor), the postponed diseases, since the earliest children's age (tuberculosis, gonorrhea, neuroinfections, cardiovascular diseases, sugar and not diabetes mellitus, etc.). Consider mental features of the woman, psycho-sexual living conditions (frequency of the sexual intercourses, a libido, use before contraceptives, etc.); features menstrual (when for the first time appeared monthly, etc.) and genital function (artificial medical abortions, criminal abortions, spontaneous abortions, childbirth and an extrauterine pregnancy).

Objective inspection includes: general survey (growth, constitution, constitutional type, secondary sexual characteristics, etc.); inspection on bodies (arterial pressure, a state cardiovascular and other systems); gynecologic research (signs of infantility, malformations of generative organs, signs of hormonal disturbances); survey by means of mirrors for identification of possible pathological processes of a vagina and a neck of uterus (a colpitis, a cervicitis, ectropion, erosion, polyps, etc.); vulval bryushnostenochnoye inspection (hypoplasia, infantility, malformations, inflammatory processes and tumors of genitalias). Objective inspection includes special methods of a research, e.g. a gisterometriya — measurement of length of the channel of a neck of uterus and a cavity of the uterus by introduction of the uterine probe. The coefficient equal to the size of the relation of a difference of depth of a cavity of the uterus (U) and length of the channel of a neck of uterus is of great importance for identification of degree of an underdevelopment of generative organs at primary B. (C) to length of the channel of a neck of uterus:

(U - C)/C.

Normal coefficient higher than 1,5, at a hypoplasia of a uterus — from 1,2 to 0,5, at infantility — lower than 0,5 [R. Palmer, 1953].

For the purpose of identification of latent infection at both spouses it is necessary to conduct bacteriological, serological and hematologic researches.

For establishment of the ascending advance of spermatozoa in a genital path carry out Shuvarsky's test — Sims — Hunera: define existence of mobile spermatozoa in a back vault of the vagina and an upper third of the cervical channel in 1 — 2 hour after the intercourse. In the presence in the anamnesis the instruction on the postponed inflammatory processes of genitalias or a chrevosecheniye for an exception of impassability of uterine tubes (a commissural salpingitis), and also for definition of their state kimografichesky blowing off is shown (see. Pertubation ).

At disturbance of menstrual function or suspicion on a hypoplasia, infantility and malformations investigate function of ovaries using hormonal tests: measurement of rectal temperature, a symptom of «pupil», crystallization of cervical slime (see. Menstrual cycle ), a cytologic research of a vulval smear — kariopiknotichesky and basphilic indexes (see. Cytologic research , in obstetrics and gynecology), a biopsy of an endometria etc. At an amenorrhea, oligogipomenory determination of quantity of gonadotropic and sex hormones is shown. At suspicion on anatomic changes in generative organs (malformations of a uterus and uterine tubes, impassability of uterine tubes, an adenomyosis and a fibromyoma of a uterus) it is applied metrosalpingografiya (see). At suspicion on peritoneal B., a tumor of appendages of a uterus, a syndrome of Matte — Leventalya is shown bikontrastny pelvigrafiya (see) and a kuldoskopiya (see. Peritoneoskopiya , in gynecology).

In the absence of the visible reasons of B. in marriage it is necessary to inspect married couple on existence from - and autoimmune antibodies.

Forecast depends on the reason which caused infertility.

Treatment

Treatment shall be carried out according to the established reason B. At the instruction on inflammatory process in generative organs — to carry out antibacterial therapy, whenever possible taking into account sensitivity of the activator to drug. In hron, complex therapy is shown to a stage: antibacterial (antibiotics and streptocides); desensibilizing (Calcium chloratum, a gluconate of calcium, etc.); stimulating (an autohemotherapy, an aloe); protein therapy (Sh. A. Azatyan, 1930); resorptional — Ichthyolum, physiotherapeutic procedures (an iiduktodiatermiya, mud cure, radonic bathtubs, irrigation); treatment in resorts (Pyatigorsk, Lipetsk, Staraya Russa, Belokurikha, Matsesta, Saky, Tsqaltubo, etc.); gymnastics, general and local massage; psychotherapy.

Besides, at adhesive processes in pipes physiotherapeutic treatment should be combined with hydrotubation (see).

According to Sh. Shlidman (1958) and K. N. Syzganova (1971), at complex treatment of inflammatory processes treatment is observed in 10 — 41% of cases. In case of lack of effect of careful complex treatment of B. caused by commissural process of a uterus and pipes, and also anomalies of their development operational treatment is shown (see. Uterus , operations; Uterine tubes , operations).

At the established passability of uterine tubes and normal function of ovaries some authors recommend to resort to an artificial spermatoosemeneniye — inseminatio artificialis (H. H. Nikolov, B. Papazov, 1971).

Endocrine infertility

B. caused by dysfunction of ovaries is called endocrine.

Normal activity of system a hypothalamus — a hypophysis — ovaries provides the corresponding morphological and hormonal changes in ovaries which are coming to an end with an ovulation and formation of a yellow body. Functioning of this system differs in big stability, self-control is carried out by the principle of a feed-back. Each phase of a menstrual cycle is regulated by a certain ratio of follicle-stimulating (FSG) and luteinizing (LG) of hormones. Disturbance of generative function of ovaries is characterized by insufficiency follikulinovy and lyuteinovy or only a lyuteinovy phase of a cycle, and also lack of an ovulation with existence hypo - and giperestrogeniya. According to most of researchers, disturbances of generative function of ovaries are, as a rule, connected with gipotalamo-pituitary frustration. Some authors divide dysfunctions of ovaries of the central genesis on cortical and hypothalamic and pituitary and hypothalamic (K. N. Zhmakin, 1966). Frustration can be connected with infectious or traumatic (a physical, mental injury) defeats of various sites of these systems. The large role is played hron, by infections, rheumatism, etc. At a number of syndromes of B. is one of symptoms of gipotalamo-pituitary disturbances: Shikhen's syndrome (see. Shikhena syndrome ), Simmonds's syndrome (see. Pituitary cachexia ), Kiari's syndrome — Frommelya (see. Kiari-Frommelya syndrome ), a syndrome of Morganyi (see. Morganyi syndrome ).

It is necessary to refer insufficiency of the fermental systems participating in biosynthesis of estrogen in ovaries to primary ovarian defeats (sclerocystic ovaries — see. Shteyna-Leventalya syndrome ). Primary dysfunctions of ovaries can be caused by genetic factors (chromosomal and gene disturbances) causing dysgeneses) or a hypoplasia of gonads. However it is impossible to exclude also damage of ovaries during various periods of an embryogenesis (influence of late toxicoses, etc.). Sclerocystic ovaries can be observed at diencephalic disturbances, and also at disturbances of a steroidogenesis in bark of adrenal glands when the formed androgens exert impact on enzymatic systems of ovaries. Thus, the pathogeny of B. connected with sclerocystic ovaries is various.

At a number of endocrine and infectious diseases dysfunction of ovaries can be connected as with direct influence of a disturbing factor on function of ovaries, and with the mediated influence on its activity through gipotalamo-pituitary system (tuberculosis, a diabetes mellitus, etc.). At last, primary dysfunctions of ovaries can be connected with existence of a gormonalnoaktivny tumor (an arrhenoblastoma, a dysgermoinoma, etc.).

The clinical picture

Menstrual function at most of women with B. of endocrine genesis is broken (periods after 16 — 17 years, a hypomenstrual molimina, uterine bleedings, an amenorrhea). Primary B., sometimes in the anamnesis spontaneous abortions, artificial abortions, pathological childbirth is more often observed. At a research of function of ovaries insufficiency of the 1st and 2nd phases of a cycle comes to light: short-term (less than 8 days) and unsharply expressed increase in basal temperature in the 2nd phase of a cycle. The Kariopiknotichesky index (KPI) is lowered and fluctuates in the 1st phase of a cycle within 10 — 20%, during the ovulatory period — 30 — 40%, the symptom of «pupil» in the period of an ovulation does not exceed + or ++. At an anovulatory cycle basal temperature monophase. KPI at a hyper oestrogenic form reaches 70 — 80%, at a gipoestrogeniya — does not exceed 10 — 15%. Excretion of pregnandiol does not exceed 1 — 1,5 mg.

At dysfunction of ovaries of the central genesis decrease in excretion of gonadotrophins is noted. At primary insufficiency of ovaries excretion of gonadotrophins is raised, the underdevelopment of secondary sexual characteristics, sometimes the separate somatic anomalies characteristic of Shereshevsky's syndrome — Turner is often observed (low growth, valgus deviation of elbow joints, a short neck, a barrel-shaped thorax, etc.). At such patients the percent of a sex chromatin is often lowered and chromosomal anomalies are observed (more often mosaicism of type 46XX/45X).

In the presence of sclerocystic ovaries the clinical picture of a disease of a polimorfn also depends on the nature of enzymatic disturbance. Usually patients have normal growth, somatic anomalies are absent, secondary sexual characteristics are usually rather well-marked, there is obesity, a hypertrichosis, however increase in a clitoris is observed seldom.

At dysfunction of bark of adrenal glands virilescence is usually more expressed. The constitution is intersexual, it is frequent on men's type (big shoulders, a narrow basin), women are lower than average height, secondary sexual characteristics are underdeveloped, a hypertrichosis, increase in a clitoris. The amenorrhea, an oligomenorrhea is often observed.

Vegetovascular, exchange, multiglandular frustration are found in patients with the anovulation caused by diencephalic disturbances.

Diagnosis

endocrinological, endoscopic and radiological methods of a research are of great importance For clarification of the reason of B.: the roentgenogram of a skull, the Turkish saddle (for an exception of a tumor, identification of a hyperostosis, etc.), a research of internal generative organs in the conditions of a pneumoperitoneum (the sizes of ovaries, a uterus come to light), a gisterosalpingografiya. With the help kuldo-or laparoscopies the diagnosis at suspicion on sclerocystic ovaries is specified. At a giperandrogeniya of adrenal genesis increase in excretion of 17 ketosteroids (17-KC), pregnandiol, a pregnantriol is observed. Excretion of 17 oxycorticosteroids (17-OKC) usually is in limits of norm.

Functional trials are applied to differential diagnosis between a giperandrogeniya of ovarian and adrenal genesis. At increase in excretion 17-KC test with Prednisolonum or dexamethasone is carried out. If after introduction of corticosteroids (on 20 mg of Prednisolonum within 5 days) excretion 17-KC decreases by 1,5 times and more, then the giperandrogeniya is caused by adrenal disturbances; if decrease does not happen or it is insignificant, then administration of the progestins (Infecundinum, etc.) which are slowing down release of gonadotroyny hormones is applied to confirmation of a giperandrogeniya of ovarian genesis as causes decrease in excretion 17-KC.

At the expressed hypomenstrual molimina and a considerable underdevelopment of secondary sexual characteristics test with horiogoniny which is entered on 1500 or 3000 PIECES within 3 days is applied. At an amenorrhea of the central genesis after test KPI considerably raises, at a dysgenesis of gonads of change of a kolpotsitogramma it is not observed.

Treatment

At B. which developed as a result of a hypo-ovaria in combination with infantility is applied a balneolecheniye (dirt, ozokerite) with the subsequent cyclic hormonal therapy: in the 1st phase of a menstrual cycle enter estrogen (ethinylestradiol on 0,05 mg of 6 — 8 days), into the 2nd — estrogen with progesterone: from the 18th day of a cycle — progesterone 0,5 or 1 of % on 1 ml of 7 days or once 0,5 ml of 12,5% pregnenoldione kapronat and estrogen (ethinylestradiol on 0,05 mg of 6 — 8 days). Treatment is carried out during 2 — 3 menstrual cycles. At insufficiency of a lyuteinovy phase of a cycle also treatment is applied by progestins (Infecundinum, Bisecurinum, etc.). Therapy is carried out during 3 cycles and is counted on strengthening of gonadotropic function after its temporary braking during administration of drugs (rebaund-phenomenon). Positive takes are noted also at use of a horiogonin on 1500 PIECES within 3 — 4 days from the 18th day of a cycle. S. N. Davydov (1963), V. M. Strugatsky and V. I. Tolcheeva (1970) reported about successful use at such forms B. of electrostimulation of a neck of uterus.

At an anovulatory cycle against the background of sufficient oestrogenic activity, including and at sclerocystic ovaries, positive takes at treatment by clomifene on 50 — 100 mg within 3 — 5 days, since 6 — the 9th day of a cycle, were received by I. A. Manuylova and T. Ya. Pshenichnikova (1972). At sclerocystic ovaries if they are not caused by gipotalamo-pituitary disturbances or dysfunction of bark of adrenal glands (a post-pubertal form of an adrenogenital syndrome), good results are received by M. L. Krymska, L. V. Petukhova and V. P. Smetnik (1972), N. I. Beskrovnoy (1970) at a wedge-shaped resection of ovaries: at 60% of patients it is recovered generative and at 90% — menstrual function. If excretion 17-KC after operation remains a little raised and pregnancy does not occur, then corticosteroid therapy is in addition applied (Prednisolonum on 5 — 10 mg within 2 — 3 months). At a giperandrogeniya of adrenal genesis (various manifestations of an adrenogenital syndrome) treatment by Prednisolonum on 10 — 15 mg before permanent decrease in excretion 17-KC and further within 4 — 6 months — on 5 mg is applied. At patients with an amenorrhea at the expressed gipogo-nadotropny gipoestrogeniya the positive effect can be gained only at administration of follicle-stimulating hormone. Pergonal-500 is applied, the dosage is selected individually. Treatment should be carried out in a hospital in view of danger of hyper stimulation of ovaries (3. L. Lemeneva, A. G. Homasuridze, 1972).

Prevention infertility shall begin in a progenesis: treatment of inflammatory diseases and endocrine disturbances at future parents, elimination of action of harmful factors on an organism of the woman; prevention, early identification and treatment of toxicoses of pregnancy, anemia, strict observance of hygiene by the pregnant woman. A hardening, especially careful control of development and health of the girl during the prepubertatny and pubertal periods (infections, overloads!) prevent possible disturbances of generative function of future woman.

See also Nevynashivaniye pregnancies .

Infertility at men

Infertility at men — inability to fertilization irrespective of a possibility of commission of sexual intercourse.

The etiology and a pathogeny

B. is caused by numerous internal and exogenous causes and is connected or with disturbance of process of a spermatogenesis (secretory B.), or with disturbance of removal of sperm (excretory B.).

Relative B.'s cases at clinically healthy faces are observed. Some authors explain relative B. with existence of antagonism between formative cells, a negative himiotaksis between the spermatozoon and an ovum making their connection impossible.

B. accompanies heavy malformations of the sexual device. At an aplasia of testicles, at the expressed hypoplasia of testicles and appendages, at bilateral belly and in most cases at an inguinal cryptorchism the spermatogenic epithelium is absent or process of a spermatogenesis stops at early stages.

At an inborn tubular sclerosis (see. Klaynfeltera syndrome ) and at a germinal aplasia at a research of an ejaculate reveal an aspermia, an azoospermism or a heavy oligozoospermia.

At simultaneous defeat of a spermatogenesis and dysfunction of closed glands the phenomena characteristic of an eunuchoidism develop.

In B.'s etiology the large role is played by the infectious and toxic component which is especially expressed at infectious parotitis, a paratyphoid, tuberculosis and syphilis.

Hron, intoxication nicotine and alcohol, industrial poisons, the alimentary factor, thermal influence and the ionizing radiation can be the cause of the expressed disturbance of a spermatogenesis.

Torsion of a seed cord, the general cooling of a body, bilateral to a varikotsela cause disturbance of blood circulation in testicles with the subsequent decrease in a spermatogenesis and B.

The inflammation directly of a small egg (an orchitis, an orchiepididymitis) and seminiferous ways (An epididymite, a deferentitis, prostatitis, a vesiculitis) is the most frequent reason of male B. Less often B. which came after an injury of bodies of a scrotum or wound of deferent ducts during operations for hernia and edema of covers of a small egg meets. Male B. can be also as a result the seed does not get into a vagina (e.g., at hypo - and epispadiya), at sharply expressed scrotal hernias and edemas of covers of the testicles interfering rather deep introduction of a penis to a vagina.

The main criterion of fertilizing capacity of the man is fertilizing capacity of sperm, to-ruyu define at a microscopic and biochemical examination (number and quality of spermatozoa). Change of volume of an ejaculate can also bring to B. Increase in volume of sperm up to 10 — 12 ml (polyspermia) often is followed by decrease in number of spermatozoa in 1 ml in relation to norm (40 — 60 million). The oligospermatism or hypospermia always sharply reduces fertilizing capacity of sperm to 1 — 1,5 ml.

The aspermatism when the ejaculation is not caused or pathological increase in the braking influence of a cerebral cortex on the spinal center of an ejaculation which normal excitability is kept (a cortical aspermatism), or as a result of the inborn or acquired not excitability of the eyakulyatsionny center (a spinal aspermatism) is the frequent reason of male B. At a neuroreceptor aspermatism the ejaculation does not come because of decrease or total loss of sensitivity of nerve terminations of a balanus at extensive hems after an injury or a burn. B. it is observed also in cases of a false aspermatism, at Krom the ejaculation occurs, but sperm is not thrown out of an urethra because of its narrowing or gets into a rectum in the presence of uretro-rectal fistula.

Exceptional cases of disturbance of correlation between internal and outside sphincters of an urethra are described that leads to a pelting of sperm in a cavity of a bladder.

The most frequent sign of male B. is the aspermia, at a cut in an ejaculate there are no all cells of a spermatogenesis owing to dystrophic changes and an atrophy of a spermatogenic epithelium or the inborn and acquired impassability of seminiferous ways. Male B. is observed at an azoospermism, an oligozoospermia, an asthenospermia and a necrospermia. In the latter case it is about an immovability of spermatozoa, despite their sufficient quantity in an ejaculate. It is necessary to specify that the immovability of spermatozoa is not the proof of their death. Therefore while there are no proofs of frailty of motionless spermatozoa, it is more correct to speak about an akinospermiya. Akinospermiya meets very seldom; detection at a research of sperm in an ejaculate of motionless spermatozoa, as a rule, is result of technical errors during the receiving an ejaculate, but not toxic influence of a pathological secret of a prostate and seed bubbles at inflammatory processes in these bodies. Also defects of a structure of spermatozoa are male B.'s reason. Male B. often does not cause any subjective frustration. The only complaint, about a cut see a doctor — absence of children.

The diagnosis

the Diagnosis of male infertility in the presence of malformations of a penis is simple. The diagnosis of an aspermatism comes easy. Lack of an ejaculate in the condom used at sexual intercourse confirms reliability of the complaint of the patient to not approach of an ejaculation. In all other cases B.'s diagnosis is made on the basis of microscopic examination uncolored, received directly after sexual intercourse of an ejaculate.

The patient is recommended to have sexual intercourse, using a condom and to immediately bring him with contents for microscopic examination. However this method of receiving an ejaculate can be used for establishment of an azoospermism and as a last resort an oligozoospermia, but not for the diagnosis of a necrospermia. Observations show that spermatozoa in most cases quickly lose the mobility in a condom that is connected with cooling, with an adverse effect on them of the talc which is in a condom, and also contained in rubber of harmful substances. Also the method of establishment of male B. by a research of the ejaculate got by massage of seed bubbles on presence of spermatozoa at it is insufficiently reliable. For judgment of mobility of spermatozoa it is necessary to do at the same time massage of seed bubbles and a prostate in view of a promoting effect of a secret of a prostate on seed threads. At this method of a research only positive takes can be taken into account; not finding of spermatozoa and their immovability do not speak about their valid absence and an immovability in an ejaculate. The most right data manage to be obtained at a research of the ejaculate (not earlier than in 5 — 7 days after the last sexual intercourse) received as a result of masturbation several minutes prior to a research. At impossibility to get an ejaculate in such way it is necessary to try to receive it by the interrupted sexual intercourse. It is necessary to bring the received ejaculate immediately to laboratory in glasswares, without allowing its cooling. Define quantity of an ejaculate, a consistence, color, concentration of hydrogen ions, quantity of spermatozoa and activity of their movement, and also maintenance in an ejaculate of pathological forms of spermatozoa. At insignificant quantity of spermatozoa in an ejaculate it is reasonable to investigate tsentrifugat. More exact assessment of their number can be made by means of calculation in any cytometer (Predtechensky, Goryaev etc.) after cultivation of a seed following solution: hydrosodium carbonate — 5 g, formalin — 1 ml, a distilled water — 100 ml. The morphology of spermatozoa best of all is defined on stained preparations. Determination of quantitative content of fructose in an ejaculate, a research of ability of spermatozoa to dehydrogenation gains value. Time is defined, during to-rogo there occurs decolouration methylene blue, added in the corresponding quantity to an ejaculate which is parted in the solution consisting from gelatin, glucose, phosphates and a distilled water. The research is made in vacuum. The more the quantity of viable spermatozoa in an ejaculate, the are shorter time of decolouration.

The forecast

the Forecast depends on the reason which caused B. At the azoospermism caused by disturbance of a spermatogenesis, treatment is ineffective. At a mechanical aspermatism the forecast depends on character and localization of pathological changes in generative organs; it is favorable at an aspermatism as a result of an urethrostenosis.

Treatment

At disturbances of a spermatogenesis at a hypogenitalism, an eunuchoidism, a hypoplasia of testicles and a cryptorchism is recommended use of a chorionic gonadotrophin on 1000 PIECES every other day intramusculary, for stimulation of a spermatogenesis — to 30 000 — 50 000 PIECES on a course of treatment. At dysfunctions of gonads at men acetate (vitamin E acetate) on 100 — 300 mg a day in combination with hormonal therapy is effective tocopherol.

At an obturatsionny aspermia after epididymites create an anastomosis between a deferent duct and a body or a head of an appendage. Operations on an occasion to a varikotsela at an oligozoospermia well influence a spermatogenesis and in some cases liquidate B.

Therapy of an aspermatism comes down to treatment of diseases, it caused (see. Azoospermism , Aspermatism , Necrospermia ). At an oligozoospermia the combination therapy is recommended by gonadotropic hormone and hormone of a thyroid gland.

Treatment by testosterone can be useful at some forms of an oligozoospermia and an asthenospermia.


Table 1. The clinicodiagnostic characteristic of anomalies of development and the diseases leading to female infertility

Table 2. The clinicodiagnostic characteristic of the states and diseases leading to male infertility *

  • At tabulation is used I. M.

Porudominsky's monograph «Infertility at men», M., 1964.


Table 3. The clinicodiagnostic characteristic of female and male infertility at immunological havocs

the Bibliography

Mayzel E. P. Klinika and therapy of infertility of the woman, D., 1965, bibliogr.; Nikolaev M. F. Fabric therapy at gynecologic diseases, Akush. and ginek., No. 5, page 64, 1953; Nikolovn. Page ipapazovb. Infertility in a family, the lane with bolg., Sofia, 1971, bibliogr.; Pobedinsky M. N. Infertility of the woman, M., 1949, bibliogr.; Pokrovsk V. A. Genital tuberculosis, Voronezh, 1947, bibliogr.; Rozovsky I. S. Diagnosis of infertility, M., 1961, bibliogr.; With y z of An about in and K. N. Treatment of female infertility, Kiev, 1971, bibliogr.; Parts-to about in and A. V. O of genital function at women after the ascending gonorrhea, Ka-zansk. medical zhurn., No. 3, page 51, 1961; Bernoth E. u. Bernoth B. Die Sterilitat der Frau, Lpz., 1973, Bibliogr.; Funck-Brentano P., Bayle H. et Palmer R. Sterility, P., 1954; Israel S. L. Diagnosis and treatment of menstrual disorders and sterility, N. Y., 1959, bibliogr.

Endocrine B.

Anaemic H. I. The long-term results of operational treatment of a syndrome of sclerocystic ovaries (Matte — Leventalya), Akush. and ginek., No. 2, page 29, 1970, bibliogr.; Davydov G. H. Treatment of dysfunctional uterine bleedings in a climacteric electrostimulation of a neck of uterus, in the same place, JSfc 4, page 33, 1963; Shmakin K. N., etc. Fundamentals of endocrinological gynecology, M., 1966; The Crimean M. L., P e of t at x the island and L. V. and With m of e of t of N and to V. P. Complex treatment of infertility at a syndrome of sclerocystic ovaries, Akush. and ginek., JsTs 6, page 20, 1972, bibliogr.; L of e of m of e of N e-va 3. L. and Homasuridze A. G. Treatment of anovulation pergonal-500, Probl, endocrinins, and gormonoter., No. 2, 2. 35, 1972, bibliogr.; Manuylova I. A. and Pshenichnikova T. Ya. Diagnosis and treatment of endocrine forms of infertility, Akush. and ginek., No. 6, page 17, 1972; P about z about in with to and y I. S. and To and r and l-l about in and E. A. Znacheniye of genetic disorders in genesis of disorder of menstrual function of the woman, Owls. medical, No. 6, page 124, 1973; Strugatsky V. M. and Tolcheevav. And. Treatment of a hypo-ovaria at patients with genital infantility with electrostimulation of a neck of uterus, Akush. and ginek., No. 12, page 36, 1970; Heifetz S. N. Infertility of an endocrine origin at women, M., 1970; Cooper H. E. and. lake of Hereditary factors in the Stein — Leventhal syndrome, Amer. J. Obstet. Gynec., v · 100, p. 371, 1968, bibliogr.; Intersexuality in vertebrates including man, ed. by C. N. Armstrong a. A.J. Marshall, L. — N.Y., 1964; Staem-mlerH. J. Die zentral bedingte Ovarial-insuffizienz, Dtsch. med. Wschr., S. 1129, 1970.

B. at men

Kagan S.A. Pathology of a spermatogenesis, L., 1969; Pier N and r E. The general spermatology, the lane with it., Budapest, 1969, bibliogr.; P about r at d au-mpnsky I. M. Besplodiye at men, L., 1964, bibliogr.; Roleder G. Physiology and pathology of sexual intercourse, the lane with it., page 146, M., 1929; Holtsovb. H. Functional frustration of the men's sexual device, page 79, L., 1926; Bonner G. Die Dehydrierungsfahigkeit der menschlichen Spermatozoen in ihrer Be-ziehung zur Fertilitat, Klin. Wschr., S. 756, 1947; Garduno A. Mehan D. J. "Testicular biopsy findings in patients with impaired fertility, J. Urol. (Baltimore), v. 104, p. 871, 1970; Kaiser B. u. Dietz M. Dehydrierungs-aktivitat des Sperma und Fertilitatspotenz, Derm. Wschr., Bd 126, S. 1072, 1952; M o-e n with h G. L. Mannliche Fruchtbarkeit, in book: Biol. u. Path. d. Weibes, hrsg. v. L. Seitz u. A. I. Amreich, Bd 3, S. 159, B. — Wien, 1955; Nordlander E. Male sterility, diagnosis, etiology and treatment, in book: North ass. obstet. gynec., p. 220, Lund, 1950; Sulmoni A. u. Goor W. Diagnose und Therapie der mannlichen Fertili-tatsstorungen, Ther. Umsch., Bd 29, S. 266, 1972; Tonutti E. u. a. Die Mannliche Keimdruse, Struktur, Funktion, Klinik, Stuttgart, 1960, Bibliogr.; W e i s-m a η η A. I. Spermatozoa and sterility, N. Y. — L., 1941, bibliogr.

L. P. Bakuleva; I. M. Porudominsky, V. H. Stepanov (male infertility), I. S. Rozovsky (and.).

Яндекс.Метрика