Vol. 5, Issue 1 (2016)
Analysis of risk factors of different forms of infertility in women of reproductive age
Infertility is not only a medical pathology, but a social phenomenon as well that affects not only the demographics but, often causes the family problems, psychological discomfort and decreases social activity of couples. Primary and secondary infertility are 47% and 52% respectively. The main factors that contribute to the development of secondary female infertility include inflammation after abortion (62%), surgical and gynecological surgery (33.4%), abnormal births (4.6%). Tubal-peritoneal infertility is often associated with PCOS (43.3%), endometriosis (23.7%), uterine cancer (24.4%), abnormalities of the genital organs (4.4%). Studying the range of viral and bacterial factors that induce infertility of couples points to the significant role of chlamydial infection. In Europe primary infertility (69-73%) dominates due to a low share of abortions and sexually transmitted infections (STI), high socio-economic level and a qualified medical service. Factors that contribute to the development of STI are low level of education and culture, social causes, early sexual activity, frequent change of sexual partners. Among the primary causes of infertility the hypothalamic-pituitary-ovarian failure dominates and all the related ovulatory changes that frequently develop into problems with menstrual cycle. The cervical pathology (cervical factor) as the cause of infertility is confirmed by various researchers. The frequency of cervical factor infertility reaches 20%. Uterine and cervical factors occur in 5-17% of cases. They are associated with intrauterine interventions; abnormal childbirth and abortion, complicated infections; traumatic lesions of the uterus and cervix. Cervical factor includes the presence of anti-sperm antibodies in cervical mucus, changes in cervical mucus properties when hormonally imbalanced, anatomic changes in the cervix, exo- and endocervical inflammation. Uterine form of infertility is mainly related to the occurrence of intrauterine synechiae and abnormalities of the uterus. Uterine factor is more common in countries with a high percentage of female genital infections, infectious complications after delivery and intrauterine interventions. Recently, more attention is given to immune factors of infertility, the determination of anti-sperm antibodies in cervical mucus, blood, peritoneal and follicular fluids. The frequency of immune factor is 2-5%. Infertility is observed when there are uterine fibroids, ovarian tumors, congenital anomalies of the female genital organs. The combination of uterine fibroids with tubal-peritoneal factor, external genital endometriosis, PCOS, ovarian tumors is observed in 40-60% of patients with infertility.