Infertility of the 2nd degree is diagnosed in women who have already given birth or were pregnant, but the pregnancy for some reason was interrupted. There are many different pathologies leading to the development of such problems in the reproductive system.
What is 2nd degree Infertility?
Gynecologists diagnose infertility of the 2nd degree to women who have already had their pregnancies. In this case, it does not matter whether they ended in childbirth or for some reason were interrupted. In other words, the second degree of infertility occurs against the background of impaired reproductive capacity.
Talk about secondary infertility can be when the couple have problems with childbearing, despite the fact that they adhere to the rules that increase the possibility of conception. These include:
- frequent sexual contacts that occur on the 11-18th day of the menstrual cycle (if you count days from the first day of bleeding);
- the frequency of sexual relations (no more than a day, but at least twice a week);
- use of sexual positions that favor conception;
- refusal to use lubricants, etc.
If any of these requirements were not met, then infertility may well not be.
In general, according to statistical data, approximately 10% of couples are considered infertile. In this situation, both partners need to be examined. According to reviews, in a third of such cases, the problem is found in women, in another third (according to some reports – in half) – in men. The remaining third are those couples where both partners have reproductive health problems.
Classification of Infertility in Women
There are several types of infertility (depending on the etiological factors):
1. Physiological (the period before puberty, menopause);
2. Congenital (anomalies in the development of the organs of the reproductive system, underdevelopment of the reproductive organs – infantilism);
3. Acquired (the consequence of the transferred diseases of the sexual apparatus);
4. Voluntary (use of contraceptives of different mechanism of action);
5. Temporary (a consequence of psychoemotional shocks, depression, immunity problems, starvation, severe climate change, and the period of breastfeeding);
6. Permanent (resulting from partial or complete removal of the genitals).
Infertility Risk Factors
Factors contributing to the development of a woman’s secondary infertility:
- a woman belongs to the age group over 35;
- in anamnesis there were unexplained pregnancies;
- in the patient, in connection with neuroendocrine pathologies, the menstrual cycle is broken;
- a woman suffered a sexually transmitted disease
genital endometriosis in the anamnesis;
- on the genitals of the woman repeatedly performed surgical manipulations (about ovarian cysts, inflammation of appendages, ectopic pregnancy, neoplasms, and also cesarean section or plasty of the fallopian tubes).
Women at risk need to be examined in detail, even when they seek medical help on a matter not related to infertility treatment (here we are talking about the identification of potentially infertile marriages).
Causes of 2nd degree Female Infertility
For 2nd infertility, women have several causes.
1. Age group. The advanced age of a woman is a common cause of secondary infertility, because it determines the activity of the reproductive system of the female body. Statistics show that after 25 years a woman’s chances of becoming a mother are reduced, and after 35 the probability of pregnancy decreases even more. At this age, without ovulation, up to 7 menstrual cycles can occur, whereas in 20-35 years during the year there may be only 1-2 cycles without ovulation. Approximately 25% of all clinical cases of infertility of the second degree fall on this age group.
2. Psycho-emotional status. The psychological state of a woman affects her hormonal background. If it is exposed to stress or nervous strain, it can lead to disturbances in the functioning of the reproductive system. Sharp weight loss or obesity for the body is a real stress, which can also cause secondary infertility.
3. Somatic diseases of the reproductive system. Inflammatory processes of infectious nature in the female reproductive system can cause problems with conception. Infertility of the second degree can be associated with complications of other pathologies, for example, spikes in the fallopian tubes or abnormal ovaries. The presence of diseases of the reproductive system leads to a deterioration in the quality characteristics of the natural lubricant (it can become excessively liquid or too viscous), which will interfere with the movement of spermatozoa towards the egg. In addition, common causes of infertility are the following diseases: endometriosis, polyps, hyperplasia, uterine fibroids, polycystic ovary, the presence of tumors in the thickness of the uterus.
4. Postponed abortion. This operation can provoke infertility, in view of the development of the inflammatory process in the reproductive system.
5. Disruption of the thyroid gland. All organs and systems in the body are interrelated. The production of sex hormones is influenced by hormones that synthesize the thyroid gland. Among the main causes of infertility of the second degree, experts identify hypothyroidism (a decrease in the functional activity of the thyroid gland). This leads to oppression of ovulation and violation of the menstrual cycle. Failures in the thyroid gland can be caused by iodine deficiency.
6. Lack of progesterone. This hormone provides an offensive and a normal course of pregnancy. With its deficiency, a woman cannot become pregnant or will have frequent miscarriages at an early gestation period. Determine the lack of this sex hormone can be, having passed the appropriate analysis or by measuring the basal temperature.
For the emergence of secondary infertility in women there are many reasons, so this pathology needs a thorough diagnosis, based on the results of which the attending physician will be able to choose methods of treatment taking into account the individual characteristics of the patient.
Diagnosis of 2nd degree Infertility
The main study for a man is a spermogram (analysis of seminal fluid). This survey can identify possible causes of problems with conception or exclude them.
The list of diagnostic procedures for women is much broader.
1. Gynecological examination. This is the initial stage of diagnosis. During the visit, the doctor will conduct a survey, collect an obstetric history and perform an examination of the patient. Based on the data obtained, the specialist will conduct differential diagnostics and set the direction for further actions.
2. Analyzes for the presence of infections. Identify their presence in the female body will help a comprehensive examination, including a study of the composition of the smear from the vagina and a blood test.
3. Analyzes for the content of hormones. The woman gives them, if there is a violation of the menstrual cycle, hair appears in unusual places, there is a sharp set of weight. The specialist in this case appoints a series of tests that are delivered on certain days of the cycle.
4. Ultrasonic examination of small pelvis. Examination of pelvic organs is performed several times during the cycle, which makes it possible to evaluate the work of the ovaries (determine whether ovulation occurs), the activity of the mucous membrane of the uterus and the condition of the pelvic organs as a whole. Sometimes an ultrasound examination of the thyroid gland is prescribed.
5. A detailed study of the cervix. Diagnosis helps to identify the presence of atypical cells on the cervical mucosa, which is not always noticeable during routine examination.
6. Endoscopic research. This list includes such procedures as:
- hysteroscopy (examination of the uterine cavity);
- hysterosalpingography (determination of patency of the fallopian tubes);
- examination of the ovaries with laparoscopy (a diagnostic procedure that is performed through small incisions in the anterior wall of the abdomen with the help of special optical instruments).
7. Postcoital test. The study makes it possible to determine whether there are antisperm antibodies produced by the human body against antigens of spermatozoa in the body of a man or woman.
Infertility Treatment (“Duphaston”, “Utrogestan”, “Clomid”)
The process of treating infertility of the second degree is quite complex and laborious: it can take several years. Treatment will be successful provided that the patient accurately fulfills all the prescriptions and recommendations of the attending physician.
In inflammatory processes in the reproductive organs, antibacterial therapy, antiviral and antifungal agents are used, in some cases immunomodulators are used.
In connection with the risk of dysbiosis, prebiotics, probiotics and enzyme preparations are often prescribed. Restoration of the disturbed hormonal background is carried out by preparations “Duphaston“, “Utrogestan“, “Clomid“, etc.
Surgical correction is appointed in the absence of positive results from drug treatment. Sometimes the results of surgery also do not lead to a long-awaited pregnancy. Then the doctor poses the question of artificial insemination (IVF), where the introduction of spermatozoa occurs directly into the uterine cavity.