Infertility and miscarriage: causes, prevention and treatment

Obstetrician-gynecologist, deputy chief physician of the TrustMed clinic for medical work Irina Vladimirovna Sergeyko

A few words about the clinic and your work

The TrustMed Clinic is young, it has been operating since March 2015, but it already offers a full range of outpatient services:

• treatment of inflammations;
• treatment of endocrine diseases;
• treatment of cervical pathologies;
• pregnancy planning and management;
• termination of pregnancy (unfortunately), naturally, at the request of the woman.

Of course, first we persuade you to keep the child, if possible.

Over 20 years of work, I have accumulated vast experience in managing pregnancies with complications and oncology. No pregnancy scares me. I can take on any case. Naturally, it also happens that related specialists are involved so that the treatment is comprehensive. Our patient receives a full range of services, we do not isolate him or her, especially if it is a complex case. We can always involve outside specialists or refer him or her somewhere.

Our goal is for any pregnancy, even the most complex, to end with the birth of a healthy child in a healthy woman.

Infertility: causes, associated diseases

Infertility is the absence of pregnancy within a year of regular sexual activity with the same partner. There are many reasons for infertility. When a woman comes with complaints of infertility, we explain that it can be either one reason or a whole series of them.

The main causes and types of infertility:

• hormonal;
• related to inflammation;
• adhesive process;
• obstruction of the fallopian tubes;
• functional - occurs against the background of stress, difficult situations, exhausting work and even banal lack of sleep;
• male factor of infertility (we also examine men);
• incompatibility of partners.

It is necessary to have conversations with the woman and extract possible reasons from her. A person does not always realize that he is doing something wrong in life, he looks at himself objectively.

There are also other factors of infertility. For example, certain extragenital diseases - diabetes, thyroid pathologies and other diseases. We identify this, make a treatment plan and manage the woman together with other specialists in this area.

Functional infertility is quite common.

For example, a woman, who has never been pregnant, has no accumulated negative experience, is in constant stress, tension, fatigue. Her reproductive function is simply blocked by nature. The body seems to understand that now is not the time to get pregnant, self-preservation comes to the fore. In this case, the gynecologist manages the patient together with a psychologist. We conduct special sessions, explain what is necessary:

• normalize sleep and nutrition;
• don't overload yourself at work;
• take a long vacation to reprogram yourself.

As soon as a woman comes out of this state, she immediately gets pregnant, we don't even prescribe anything.

Another case, when there was a negative experience (ectopic pregnancy, non-developing pregnancy, threat of miscarriage, unsuccessful birth). The woman, of course, is afraid of a repeat of the scenario:

• what if there is another ectopic pregnancy, and she has one tube left;
• what if there is another miscarriage or something else.

All this is also the doctor's job, it is necessary to present it correctly, explain the person's case. In my practice, there are many examples when the second and subsequent pregnancies ended with the birth of one or more completely healthy children. You need to work with the person, work through all these issues. Every doctor is partly a psychologist. It happens that it is enough to just talk - the patient, leaving, says thank you, I understood everything, although she was not prescribed anything. And she comes to the next appointment with a solved problem.

Infertility can be caused by heredity and genetic diseases.

If doubts arise in this regard during the discussion, then I send the person to a geneticist. We exclude genetic factors. Next come factors associated with blood clotting, this is a separate subsection of science.

Therefore, you need to examine the person, you need to talk and during the appointment identify the causes, of which there may be several, and they all affect each other in combination. Or even one cause, for example, a completely healthy girl, but there is obstruction of the tubes. This will be the leading factor.

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And if, for example, there is a chronic inflammatory process, resulting in obstruction of the tubes, then chronic endometritis - this is already a complex of infertility factors. Naturally, we approach everyone individually. Someone needs surgery, someone needs tablet treatment, there are methods and recommendations for any condition. Although a general approach is also acceptable.

Postcoital test: checking compatibility and solving the problem

Previously, all clinics used to conduct a postcoital test - a study of partners for compatibility. Now it is undeservedly forgotten - due to the complexity of implementation. It must be done immediately, that is, a woman comes after sexual intercourse, gives the material, and a lab technician immediately studies it on special equipment. Today we have a slightly different practice - they take the test, and the courier takes it to the lab. And this test needs to be done right away, because then the material loses its qualities. The test is very informative: it can tell you, even without numbers, what the woman's hormonal status is, what kind of sperm the man has, whether the partners are compatible or not.

It happens that a man is fertile, healthy, he has good sperm, but when this sperm gets into the woman's genital tract, a certain factor is activated that reduces the motility and activity of sperm.

It is in the genital tract that the so-called mucus can be secreted, which has a detrimental effect on sperm. We still cannot understand why this happens. Moreover, this same woman is compatible with one man, but not with another, and her own and beloved husband may be the "unsuitable" one.

In such cases, we perform insemination. This is not IVF: the husband's sperm is taken and injected directly into the uterus, bypassing the "protective" barrier. The method is simple in terms of implementation, safe as a treatment method and inexpensive. And a woman does not need to go to IVF! IVF is expensive, and there is a burden on the entire body. I am not saying that IVF is bad, there are just other, more gentle ways to conceive.

Miscarriage: problems and main causes

There are many reasons for miscarriage, but today the most numerous problems are associated with chronic inflammation, with the same endometritis. It is even believed that failures in IVF are more associated not with the incorrectness of the procedure, but with chronic endometritis.

Endometritis is an inflammation of the inner surface of the uterus. Now people are more liberated than those ten years ago. There are some infections that gynecologists do not treat, because they believe that they are opportunistic flora, but they still cause a sluggish inflammatory process. There are a lot of unsuccessful pregnancies due to inflammation. I would say that this is the primary reason, and I am not the only one who thinks so - our leading professors also express a similar opinion in articles and literature.

The second reason for miscarriage is hormonal problems: the egg has matured, met the sperm, but the quality of the egg itself is such that it does not allow the embryo to develop well further. This is influenced by thyroid problems and somatic diseases (missed or untreated).

The male factor is important.

After an unsuccessful pregnancy, attention is mainly paid to the woman, but we must not forget that the man also participates in this - by 50%. If there are any abnormalities in the sperm, then a good pregnancy will not happen, even when the woman has a healthy egg. This may be a non-viable or frozen pregnancy, because the problem is in the sperm themselves (their health or mobility).

Miscarriage is affected by environmental factors. For example, in the summer of 2010 there were forest fires, and in August in my practice there were many non-viable pregnancies. At that time, strokes and heart attacks became more frequent, that is, there was a certain surge in various diseases, including the impact on spermatogenesis. The environment cannot deteriorate without a trace - we breathe this air, drink this water. What we "put" into nature is what we get.

Inflammation of the uterine mucosa: treatment options

Sanitation is the selection of treatment, the identification of the microbe that is the cause, because the microbial spectrum is quite wide. Treatment regimens also vary greatly. They include not only antibacterial drugs, but also physiotherapy, drugs that improve blood flow, microcirculation, that is, these are large complexes that are selected individually: depending on a specific person, their tests, the duration of infertility, and their gynecological anamnesis. The anamnesis includes miscarriages, frozen pregnancies, and the birth of sick children. All this is weighed and the optimal treatment is selected.

Then we examine the husband. For example, a girl comes to me with a history of an unsuccessful pregnancy, I give her recommendations: "This is yours, and with this, your husband should see a urologist." We can't do without the husband. The poor woman is treated for years, and it turns out that the reason was not in her at all. This happens all the time, when women protect their husbands from going to the urologist, saying that men are afraid of it. Much, of course, depends on the relationship within the family, men often say so. Because taking a smear from a woman and a man are two completely different manipulations. It is necessary to talk about this, explain it.

The results are better for those couples who do it together. If a woman is a warrior alone in the field, then she still comes to this later, but having lost time and money.

Infertility prevention

You need to pay attention to the duration of sleep. It is not for nothing that now in many discussions the question is raised about how much sleep is needed, because a large number of problems with endocrinology and in other areas are associated with this. Sleep should be at least 8 hours, because a lot of processes occur during sleep that do not occur if a person does not sleep. Precursors of hormones, specific immune complexes, immune cells are formed. Why is a person often weakened? Due to the fact that he does not have enough production of these substances at night.

Next comes the normalization of nutrition. If a patient has any problems, I see an endocrinologist and a nutritionist. Obesity often has behavioral causes, when a person thinks that he eats little, but in fact his refrigerator does not close. Or the quality of nutrition: the patient says that he eats little, and when you start to find out, this "little" is constant chocolate bars in his pockets, chips, etc.

Giving up bad habits is a truism, and we should all come to this.

If you just think about it, there will be no point. You have to take and quit! It is optimistic that today's youth has a desire for a healthy lifestyle: it is fashionable not to smoke, not to drink, to play sports, to think about your health. And this should be supported, written about, made films, taught at school. There should be a national policy of a healthy lifestyle, designed to obtain healthy offspring, because that is what it all comes down to.

Development and improvement policy of the TrustMed clinic

An important factor is that our doctors attend congresses, read literature, participate in seminars and symposiums. After all, if a doctor stops doing this, it means the end of a career.

You always need to improve. Even if you are a doctor of science, a professor.

The more a doctor develops, the more he knows, he can’t live without it. For example, if I didn’t go to some congress or seminar, I already understand that something passed me by, I missed something. Therefore, all our doctors develop, because life is constantly changing, besides, very good congresses are now held and everything is open, unlike 20 years ago. Companies organize intensive seminars in beautiful places. Rather than lying on the couch, it is better to go and hear something interesting that will be useful later in practice. You debate, you can discuss something with the lecturer, it is wonderful. And you understand that something is suitable for treatment, and something is not. We are dealing with people, with their health, their life, the life of their children or future children, and it is important to understand whether you are going the right way.