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Infertility is the inability to conceive naturally during a year of regular sex life.

Diagnosing infertility

Infertility is the inability to conceive naturally during a year of regular sex life, with no contraception used. For reference:

35 % of couples have natural pregnancy after first 3 months
55 % of couples – after 7 months
10 % of couples – after a year

Algorithm of providing medical care for patients with infertility (using Compulsory Medical Insurance)

Step 1. Visiting a medical facility (usually Maternity Clinic) which has a license for medical practice in obstetrics and gynecology

Step 2. Preliminary diagnostics and treatment of infertility causes by a doctor in Maternity Clinic within 9-12 months in accordance with the Order of the Ministry of Health No.107N. If, after establishing the cause of infertility, the treatment, including laparoscopic and hysteroscopic correction, stimulation and therapy of the male factor of infertility, is recognized as ineffective (no pregnancy for 9-12 months), patients are referred for treatment with the use of ART (IVF). In accordance with decision of panel of doctors, women over 35 years old can be sent for treatment with the use of ART before the expiration of the specified period.

Step 3. Establishing diagnosis “infertility”1 and medical examination to determine the indications and identify possible contraindications to IVF

Step 4. Referral of a patient from the Maternity Clinic to the Commission for obtaining a quota for IVF using the Compulsory Medical Insurance

Step 5. The patient receives IVF treatment as part of the Compulsory Medical Insurance Program (using a quota) in a chosen facility which has a license medical practice in obstetrics and gynecology with the use of assisted reproductive technologies, and participates in the implementation of territorial assistance of the Compulsory Medical Insurance Program (this information is available on the Compulsory Medical Insurance websites of your region and in your insurance company)

*various forms of female infertility: tubal blockage, endocrine and immunological, as well as male factor, ICD 10 codes N 97, N 97.0, N 97.1, N 97.3, N 97.4, N 97.8, N 97+N 97.4, N 97.9.

The equipment of our embryological laboratories and the high qualification of specialists - cryobiologists, embryologists, geneticists – all of this allows us to preserve eggs, sperm and embryos for a long-time using cryopreservation.
Mikhail AlekseevClinical Laboratory Diagnostic Doctor

Diagnosis of infertility in a woman includes various examinations, which are planned individually for each patient. The causes of reproductive disorders in women are diverse and their treatment can be long-lasting. In some cases, ART (assisted reproductive technologies) are the methods of choice for more successful treatment of infertility. Today, for many forms of both male infertility and female infertility, an effective method of treatment is:

artificail fertilization
In vitro fertilization
ICSI
artificail insemination etc.

Medical examination algorithm

To conduct an accurate and complete examination, a doctor needs to perform several procedures. The first step in the diagnosis will be a complete gynecological examination with an ultrasound of the genitalia. After that, spouses (partners) will have to take a set of laboratory tests, which help to identify the presence of STDs and prescribe their treatment.

In some cases, additional procedures, such as examination of tubal patency, assessment of ovulation, ultrasound monitoring during one cycle, analysis of hormones in the blood, may be required. An accurate examination of the uterine cavity will require a hysteroscopy procedure to determine the presence of diseases that cannot be detected by ultrasound or a routine examination.

If all these diagnostic techniques have not identified the causes of infertility, the doctor prescribes a laparoscopy procedure. In this case, internal organs need to be examined with an optical tube through a special puncture in the abdominal wall. The procedure is performed under anesthesia.

Diagnostics of unexplained infertility

If both spouses have normal indicators of reproductive function, but the desired pregnancy does not come, the following diagnoses may be made:

immunological infertility
unexplained infertility

Immunological infertility - excessive immune reaction in woman, when sperm is perceived as foreign and are destroyed (rejected).

Immunological compatibility of couple can be checked using several special tests:

Postcoital test – assessing number and mobility of sperm in cervical mucus sometime after intercourse
Kurzrock-Miller test - microscopic examination of mucus taken from the cervical canal, along with the husband's sperm
Determination of antisperm antibodies in the cervical mucus, produced in the female body against the partner's sperm

The purpose of the tests is to assess the survival rate of sperm when it enters cervix. When using methods of artificial insemination, immunological incompatibility does not affect the result, therefore, the above tests must be carried out if a couple plans treatment and in the future - natural conception or artificial insemination, thereby deciding to "step over" the problem.

But there is a solution, and it is IVF. It allows a couple to bypass the existing obstacles on the way to conception.

Treatment of hormonal disorders
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Correction of hormonal disorders ensures pregnancy in 70% of cases of endocrine infertility. Hormone imbalance can have a negative effect on the maturation of an egg, lead to the formation of many small cysts in the ovaries, lead to an ovulatory failure. If such a violation is the only cause of infertility, then the treatment is to correct hormonal imbalance and stimulating the maturation of the egg, which leads to pregnancy.
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Treatment of infertility in case of having tumors
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In this case, surgical intervention will be required: for example, with pathology of the uterus - intrauterine synechiae (adhesions), myoma nodules, barriers, endometrial polyps. With uterine myoma, a conservative (i.e., organ-preserving) myomectomy is performed - a surgery on a uterine body, during which a benign tumor is removed. Modern surgical methods allow to perform syrgeries with minimal trauma, do not require long-term hospitalization, or are generally performed on an outpatient basis.
Depending on the location of the nodules, the most convenient surgical access is chosen: laparoscopy, which allows removal of myoma (myomectomy) in almost any localization of neoplasms up to 11 cm in diameter; and hysteroscopy which allows to remove myoma nodules up to 4 cm in diameter and which are located in the uterine cavity
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Infertility treatment with sactosalpinx or hydrosalpinx
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There are some types of pathology that require a particularly careful approach of the doctor. For example, if we are talking about sactosalpinxes, accompanied by irreversible degenerative changes and are the site of chronic infection. It is known that the presence of hydrosalpinx reduces the frequency of pregnancy in ART programs by half. Sactosalpinx or hydrosalpinx is an accumulation of fluid in a fallopian tube with the formation of a false tumor. Reconstructive surgery for sactosalpinxes is not effective, therefore, such formations must be removed at the stage of preparation for the procedure by laparoscopic tubectomy (removal of tubes).
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Resection of ovary
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Doctors consider ovarian resection undesirable. Such a surgery is very unfavorable for the follicular reserve, therefore this method is not used to treat retention formations and in polycystic ovary syndrome.
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For women

Diagnosing infertility

Algorithm of providing medical care for patients with infertility (using Compulsory Medical Insurance)

Medical examination algorithm

Diagnostics of unexplained infertility

Treatment of hormonal disorders

Treatment of infertility in case of having tumors

Infertility treatment with sactosalpinx or hydrosalpinx

Resection of ovary

If you still have any questions