Contents
She is male and female, high and low. And it is different for everyone.
This term – fertility – occurs very often in conversations about topics around pregnancy. And those who are faced with infertility know everything about it in general. Well, if you are lucky, until now you have not had to think about your fertility, but you are determined to become a mother, then the book “Ab Ovo. A guide for expectant mothers: everything about the peculiarities of the female reproductive system, conception and preservation of pregnancy “especially for you. The book was written by Seda Baimuradova, MD, obstetrician-gynecologist, together with her colleagues. The result is the most detailed guide to female fertility. We publish an excerpt from it today – with the permission of the publishing house “Bombora”.
MD, obstetrician-gynecologist, hemostasiologist, specialist in miscarriage
What is fertility?
Fertility is the ability to produce offspring, fertility. It can be high, normal and low.
Female fertility includes:
the ability to conceive a child;
the ability to bear fruit;
the ability to give birth.
The reproductive (or fertile, or childbearing) age of a woman is 15–49 years. Depending on the degree of fertility, a woman’s life can be divided into the following periods.
1. Childhood (up to 8 years old).
The girl is born with a large number of eggs in the ovaries. However, before reaching puberty, they cannot go beyond the ovaries, respectively, conception is impossible.
Fertility is low.
2. Puberty (8-18 years).
The formation of the menstrual cycle occurs. The girl begins to ovulate: now the eggs are able to leave the ovary. At first, this process is irregular. Then, in the absence of hormonal disorders and a tendency to them, ovulation becomes regular, and the girl goes into fertile age.
3. Puberty (18–45 years old).
This period, in turn, is divided into:
early reproductive;
flowering (time of maximum fertility);
late reproductive.
4. Premenopause, or premenopausal (up to 45 years old, before the cessation of menstruation).
The oocyte supply is depleted, ovulation becomes irregular and gradually disappears.
5. Menopause (time of cessation of menstruation + 1–2 years).
For two years after the cessation of menstruation, a woman may have sudden ovulations. If a partner has fertile sperm, even an unplanned pregnancy is possible.
The time of the onset of menopause is individual and depends on various factors.
6. Postmenopause (menopause).
Male fertility is related to sperm quality. First of all, its characteristics are assessed, such as:
sperm count;
sperm motility;
the number of pathological forms.
Do not think that only the sperm count matters and if it is normal, then everything is fine. Their morphology is also important – appearance and structure. Abnormal spermatozoa are incapable of conception, as are inactive and inactive ones.
In men, reproductive age also begins at the age of 15, but unlike women, it has no boundaries. Of course, every year the degree of fertility decreases, which is associated with a gradual deterioration in the qualitative and quantitative characteristics of sperm. However, despite this, a man in the absence of bad habits and chronic diseases can be capable of conceiving for many years.
It is worth remembering that fertility and sexual activity in men are not the same thing. A man can be extremely sexually active and at the same time sterile, and vice versa.
How to determine fertility
Independently
Of course, fertility is easiest to determine empirically: stop contraception and try to become a mother. If you are not planning to become pregnant yet, and you want to know whether you are fertile or not, then you can resort to other methods.
1. Come to an appointment with a gynecologist, go through all the standard examinations and make sure that you are healthy.
2. Make sure the cycle is regular.
3. Determine ovulation at home. For example, make tests.
Many women experience it on a monthly basis. Someone notes the appearance of mucous transparent discharge in the middle of the menstrual cycle. And you can determine ovulation by rectal (basal) temperature.
Even 15 years ago, measuring rectal temperature was considered one of the main diagnostic methods for assessing ovulation. Now gynecologists prefer to prescribe ultrasound and hormone tests to patients. However, rectal temperature can still tell a lot for both the patient and the doctor.
Its measurement is carried out within three months. This procedure allows you to find out if you ovulated at least once, and if so, on what day.
How to measure rectal (basal) temperature
It is measured in the morning after a full sleep (at least 6-7 hours), in a state of complete rest and lying in bed. As a rule, the most accurate values can be obtained by measuring the temperature with a mercury thermometer in the rectum. Based on the data received, a graph is drawn up.
The menstrual cycle consists of follicular, ovulatory and luteal phases. In the first phase of the cycle, which begins with the onset of menstruation, estrogens are actively synthesized in the woman’s body, which have a positive effect on proliferation – the proliferation of body tissue by cell multiplication by division – the endometrium. This period is characterized by consistently low temperature readings on the graph, therefore it is called hypothermic.
Around the middle of the cycle, an egg matures in the follicle. Its exit from the ovary (ovulation) is accompanied by a change in the hormonal background of the woman, after which progesterone, the main hormone of pregnancy, begins to be produced normally. This biologically active substance, affecting the centers of thermoregulation in the brain, provokes an increase in temperature indicators by about 0,4-0,6 ° C.
If fertilization does not occur, the level of progesterone begins to decline, menstruation comes, and the body again enters the follicular phase of the cycle.
For anovulatory cycles (without ovulation), the following features are characteristic:
no drop in basal temperature in the middle of the cycle;
in the luteal phase, the basal temperature is low, since the corpus luteum, which synthesizes progesterone, is not formed.
It is possible to assess the fertility of a partner only by spermogram. The fact that he has children does not mean anything.
Medical methods
1. Spermogram
It will help to assess the quality of the partner’s sperm. It is necessary to prepare for this study, in particular, to refrain from sexual intercourse for some time (enough sperm should accumulate in the semen). The biomaterial should be handed over where it is possible to evaluate it fresh, without freezing and transportation. You cannot draw conclusions from one spermogram. You need to complete this research at least twice, taking a break between them.
If the indicators are deviated, it is necessary to contact an andrologist – a specialist in diseases of the male genital area, infertility in men. He will conduct an additional examination and determine the cause.
It can be:
Inflammatory processes. You will need to be tested for infection. Anti-inflammatory treatment and antibacterial therapy are indicated. After graduation, the quality of the sperm does not immediately improve.
Hormonal disorders in a man. They are not as rare as we think. In this case, an additional examination is prescribed with the definition of male sex hormones, adrenal hormones, thyroid gland, central nervous system, prolactin.
Overweight. It interferes with normal spermatogenesis. To lose weight, the partner is put on a diet.
Anatomical reasons. First of all, it will be necessary to carry out surgical treatment.
2. Hormonal research
As we already know, male and female hormones of the ovary, adrenal glands, thyroid gland and nervous system are involved in human reproduction. There are quite a few of them. To find the weak link, surveys are needed.
3. Menstrual calendar
It will help to assess the regularity of menstruation and ovulation. Methods for determining ovulation can be as simple (for example, measuring rectal temperature for a month or using urine test strips), or more complicated with a visit to the doctor for an ultrasound scan over several days for several months.
4. Examination, ultrasound
The doctor will examine the external genitalia, cervix, take smears to assess the state of the vaginal microflora. Determine with the help of ultrasound the thickness of the endometrium in the uterine cavity. Reveals / excludes anatomical changes in the uterus and appendages (fibroids, endometriosis, ovarian cysts, tumors in the small pelvis, malformations of the uterus and appendages, blood flow in the arteries of the uterus).
5. Hysterosalpingography, ultrasound, diagnostic laparoscopy
With the help of them, the doctor will check the condition of the fallopian tubes, in particular, their patency.
6. Other research
Identify / exclude more complex causes of fertility disorders: immunological, genetic (according to laboratory blood tests), disorders in the HLA, blood coagulation system.