Infertility 2nd degree what to do. Department of Obstetrics and Gynecology. Diseases of the reproductive organs

When specialists diagnose 2nd degree infertility - secondary infertility occurs if a woman has had a pregnancy, it does not matter whether it ended in a successful birth or the pregnancy was interrupted. The diagnosis itself is established when pregnancy does not occur in a couple who regularly have sexual intercourse without using contraception for one year. This category also includes women who experience chronic miscarriages.

Causes of 2nd degree infertility

The most common cause of 2nd degree infertility is abortion, since on average 10-20% of women who have had an abortion experience complications leading to reproductive health disorders. In 50%, there is an exacerbation of chronic inflammatory diseases of the genital area.

In addition, causes of secondary infertility include:

• presence of polycystic ovary syndrome;
• presence of uterine fibroids;
• miscarriages;
• the onset of an ectopic pregnancy;
• complicated childbirth;
• the presence of external genital endometriosis;
• the occurrence of hormonal imbalances in women;
• onset of early menopause;
• the presence of other gynecological diseases, as well as an unbalanced diet.

The main cause of 2nd degree infertility includes the occurrence of infectious and inflammatory processes of the uterus and its appendages. In addition, the occurrence of secondary infertility may be associated with dysfunction of the thyroid gland, endometriosis, various intoxications (alcohol, smoking, drugs), injuries to the genital organs (for example, received during operations). But to the most common reason Secondary infertility refers to the presence of long-term, often hidden inflammatory processes of the genital organs that occur after difficult childbirth, miscarriages, abortions, complicated by the addition of an infection. The peculiarity of these processes is that in most cases they are caused not by one infectious agent, but by several, which significantly complicates treatment.

A woman's age can also be a cause of 2nd degree infertility. This is explained by the fact that over the years, chromosomal changes begin to occur in a woman’s ovaries, leading to infertility and the risk of giving birth to a defective child.

But the cause of secondary infertility does not always lie in the woman’s health problems. If the spouse has low sperm count, then difficulties with conception are also possible. Often low sperm viability is the result of increased blood pressure or diabetes mellitus, as well as alcoholism.

In addition to all of the above, the failure of pregnancy can be explained by the biological incompatibility of the couple, which means the impossibility of identifying or explaining the cause of infertility.

Treatment of 2nd degree infertility

The process of treating second degree infertility is a rather complex and labor-intensive process that can last several years, and as a result lead to success if the woman strictly follows all the doctor’s prescriptions and recommendations.

The beginning of treatment for secondary infertility is a thorough diagnosis of the reasons that caused it. To begin with, an anamnesis is collected, then, using various laboratory methods and procedures, the doctor evaluates hormonal levels, patency of the fallopian tubes, the condition of the uterus, etc. Prescribing individual treatment is possible only after the factors that prevent pregnancy have been determined.

As a rule, antibiotics, antifungal and antiviral drugs are prescribed to treat grade 2 infertility. Treatment is carried out in short courses, and it is necessary to combine the use of these drugs with immunomodulators. At the same time, it is necessary to identify and treat acute and chronic diseases of all organs and systems that contribute to a decrease in immunity.

Second degree infertility causes serious concern among doctors. Often it is not possible to determine the reasons that provoked the problem. According to statistics, up to 35 out of 100 couples have difficulty conceiving. About half of them suffer from second-degree infertility. To choose a correction technique, it is necessary to examine both partners, and also to know about the course and result of previous pregnancies.

What it is?

With second-degree infertility, partners have difficulty conceiving if they have previously had pregnancies. It doesn’t matter how they proceeded or how they ended. This diagnosis is more often given to women than to their partners. However, an examination is necessary for both spouses in order to reliably determine the causes of violations and choose the appropriate correction method.

The diagnosis is made after one year of unsuccessful attempts to conceive with regular sexual activity without the use of contraceptives. In women over 35 years of age, the problem is reported after 6–9 months of unsuccessful attempts.

If it is not possible to get pregnant with regular unprotected sex within a year, the married couple is diagnosed with “1st degree infertility.” Secondary infertility is diagnosed when attempts to become pregnant are futile, despite the fact that a previously normal or pathological pregnancy occurred. That is, second degree infertility in women is determined if she has already had pregnancies in the past, regardless of whether she gave birth to a child, had an abortion, had a miscarriage, or was an ectopic pregnancy. In a man, the second degree of infertility is established if he has previously become a father or a woman has become pregnant from him, but the ability to fertilize has been lost.

Statistics say that primary infertility is observed more often among married couples in our country, although this may be due to the fact that spouses who already have a child are less likely to turn to doctors with this problem.

According to recent studies, in 45% of cases, secondary infertility of a couple is caused by reasons on the part of the man, in 35% by the woman, and in 20% there are problems on both sides or the provoking factor could not be identified. It is worth noting that the later a married couple consults doctors, the lower their chances of having a child will be. We recommend waiting period for conception and attempts – 12 months.

Why does secondary infertility develop?

From the above, we can conclude that such a condition as secondary infertility in women is acquired. And it can appear for a number of reasons.

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Age of spouses

Among the first reasons for the diagnosis of 2nd degree infertility is the woman’s age, because her fertility, that is, the ability to conceive a child from a biological point of view, directly depends on it. A woman giving birth over the age of 25 will already be called by doctors an old woman; some women will laugh at this, while others will even feel offended. But, one way or another, after 25 years, women often have problems with fertility, and after 35 years, the chances of becoming a mother decrease sharply.

While women aged 20-35 years go through 1 or 2 menstrual cycles without ovulation during the year, those 35 years old and older can have about 7 anovulatory cycles. This is why doctors recommend that women think about motherhood before the age of 35 age. Secondary infertility in women over 35 years of age is diagnosed in 25% of cases.

A man also has less chance of becoming a father with age. During the aging process, the male body produces less testosterone, which affects sperm quality. However, the fertile age for men is longer than for women. It begins at the age of 12-15, that is, the age when sperm begins to be actively produced in the body. If a man does not have diseases that affect sperm production or make sexual intercourse impossible, he remains fertile almost until the end of his life.

Thyroid dysfunction

Everything in the body is interconnected. Hormones synthesized by the thyroid gland affect sex hormones. Hypothyroidism is one of the causes of secondary infertility in women. The most common condition is primary hypothyroidism, which develops due to damage to the thyroid gland as a result of an autoimmune disease. Due to the lack of hormone production by the thyroid gland, the production of testosterone, the male sex hormone, increases. As a result, a woman experiences suppression of ovulation, disruption of the menstrual cycle, and also experiences external changes characteristic of men: body features, excessive facial hair growth. Thyroid hormones influence the maturation and release of the egg from the ovary.

The cause of malfunction of the thyroid gland is iodine deficiency in the body. Experts believe that in our country every woman experiences a deficiency of this microelement to one degree or another.

Lack of progesterone

Progesterone is considered the main hormone of pregnancy. If its production is impaired, the woman cannot become pregnant or the fertilized egg is not able to fixate in the uterine cavity and a miscarriage occurs. Even the menstrual cycle may not indicate a lack of progesterone in the female body, that is, it will be normal. You can determine its deficiency without testing by measuring basal temperature - if there is not enough progesterone, it will not change at different periods of the cycle. It is best to take a blood test for progesterone on day 22 of a cycle with a duration of 28 days.

Diseases of the reproductive organs

Inflammatory processes in the genitals are usually caused by a sexually transmitted infection. While in men the main danger is a developing infection, in women, second degree infertility can be provoked by complications of previous diseases, such as adhesions of the fallopian tubes, making them impassable, weakening of ovarian function. With gynecological diseases, the quality of the mucus lining the cervix deteriorates. It becomes excessively viscous or thin, which prevents sperm from moving normally towards the egg.

Gynecological diseases, which include uterine fibroids, polycystic ovary syndrome, endometriosis, hyperplasia, and polyps, can also be causes of secondary infertility. Any formations that disrupt the structure of the uterus prevent the embryo from implanting into its wall. This is why pregnancy does not occur.

Important: a previous abortion in 50% of cases causes the development of inflammatory diseases of the reproductive system.

Psychological attitude

The psychological state directly affects the functioning of the endocrine system, which, as already mentioned, is interconnected with sex hormones. In medicine, there are even such conditions as stress and examination amenorrhea, in which the functioning of the organs of the reproductive system is disrupted due to worries and worries.

A woman’s sudden weight loss or rapid weight gain is a kind of stress for the body. “Jumps” in weight are considered a negative factor that provokes secondary infertility.

Depending on the cause that caused secondary infertility in women, treatment for this condition is selected. A married couple needs to be examined for the presence of urogenital infections, donate blood for hormones, the woman must undergo a gynecological examination and transvaginal ultrasound, and the man is prescribed a spermogram. If these tests do not determine the cause of secondary infertility, a blood test may be recommended to check for antisperm antibodies in the woman's body, which block sperm and prevent conception. If tubal obstruction is suspected, the woman is recommended to undergo laparoscopy.

If the reason for the impossibility of pregnancy is progesterone deficiency, hormone therapy is prescribed. You can raise the level of progesterone by taking vitamins B and E. Correcting the diet also helps; protein foods should predominate in it: meat, fish, cottage cheese, beans.

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When hypothyroidism is detected in a woman, the first step is to compensate for the deficiency of thyroid hormones. Women living in areas with iodine deficiency are prescribed medications that increase iodine levels in the body.

Hormonal therapy can also be prescribed to a man if the spermogram results show a decrease in sperm concentration or poor motility.

Urogenital infections are treated with etiotropic drugs, immunostimulants and painkillers. The type of etiotropic drug is selected depending on the causative agent of the disease. In addition to antibacterial agents for internal use, antiseptics can be prescribed for external processing genitals.

Causes of 2nd degree infertility in women

1. miscarriages and ectopic pregnancy;
2. decreased reproductive function due to age;
3. obstruction of the fallopian tubes;
4. problematic childbirth;
5. SPIA;
6. wrong lifestyle.

Risk factors

Factors contributing to the development of secondary infertility in a woman:

• woman refers to age group over 35 years old;
• history of miscarriages;
• the patient, due to neuroendocrine pathologies, has a disrupted menstrual cycle;
• woman suffered from sexually transmitted diseases
• history of genital endometriosis;
• surgical manipulations were repeatedly performed on the woman’s genitals (for ovarian cysts, inflammation of the appendages, ectopic pregnancy, neoplasms, as well as C-section or tubal plastic surgery).

Women at risk need detailed examination even in cases where they seek medical help on an issue not related to the treatment of infertility (here we are talking about identifying potentially infertile marriages).

2 Stages, types and their main symptoms

There is a huge variety of forms of infertility, each of which has its own characteristics:

View	Manifestations
Endocrine (hormonal)	It occurs due to hormonal imbalances in a woman’s body. There is a lack of ovulation (the release of a mature egg from the ovary). This is due to injuries to the pituitary gland, hypothalamus, excess prolactin, tumors and inflammation of the ovaries
Royal	Formed against the background of uterine pathologies (underdevelopment, duplication, tumors) or intrauterine interventions (artificial termination of pregnancy, i.e. abortion)
Tubal-peritoneal	Appears due to obstruction of the tubes or tubes and ovaries
Infertility caused by endometriosis	Occurs in 30% of cases
Immune	The presence of antisperm antibodies is noted in the girl’s body, i.e. immunity that is developed against sperm or the embryo
Unknown cause	Infertility does not have an exact cause (in 15% of patients) or is a combination of several factors (in 50% of cases)

In addition, there is absolute infertility, which is characterized by the fact that girls experience anatomical changes that do not allow them to conceive a child (absence of ovaries, fallopian tubes, uterus, etc.). The causes of relative infertility can be corrected.

Gynecologists distinguish three degrees of infertility:

• First degree infertility (primary) is characterized by the fact that the patient has not had any pregnancies and she consulted a doctor for the first time. It is the result of an acquired or congenital pathology of the female reproductive system.
• Second degree infertility is secondary, in which the woman has already had pregnancies and childbirth, and repeated attempts at conception are unsuccessful.
• Third degree infertility is absolute infertility, which is associated with pathology in the woman’s genitourinary system.

In addition to the absence of pregnancy, some patients may experience irregular periods, bleeding or spotting. Pain in the lower abdomen occurs during the menstrual cycle or several days before its appearance. Patients complain of dry skin and acne.

Occurrence

In total, 15% of married couples in Russia are diagnosed with infertility. At the same time, these statistics take into account all cases, regardless of whether they occurred on the part of a man or a woman. Of this percentage, approximately half of the cases relate specifically to secondary infertility. Most often it develops with pathologies on the part of the man (45% of cases) or, less often, on the part of the woman (35%). In all other cases, both partners have a problem, or the cause of the pathology could not be established.

Classification

There are several types of infertility (depending on etiological factors):

• physiological (the period before puberty, menopause);
• congenital (anomalies in the development of the organs of the reproductive system, underdevelopment of the genital organs - infantilism);
• acquired (consequence of previous diseases of the reproductive system);
• voluntary (use of contraceptives of different mechanisms of action);

• temporary (consequence of psycho-emotional shocks, depression, problems with immunity, fasting, sudden climate change, as well as the period of breastfeeding);
• permanent (occurring as a result of partial or complete removal of the genital organs).

Diagnostics

Secondary infertility in women is diagnosed using several methods. Depending on the woman’s condition, preference may be given to one or another method. Typically, to determine the cause of the condition, the following studies are carried out:

1. Colposcopy to determine the presence of endometriosis (since such secondary infertility is quite common);
2. Blood test for hormones to determine hormonal balance;
3. Ultrasound to detect tumors and, sometimes, endometriosis;
4. Assessment of fallopian tube patency;
5. Postcoital test to exclude the presence of immunological causes.

Other methods may be prescribed as additional ones, but the basis for diagnosing this disease is precisely the studies described above.

Diagnosis of 2nd degree infertility

The most common cause of 2nd degree infertility, both among the fair sex and among the stronger sex, is hormonal imbalance. The birth and maturation of germ cells is hampered, which leads to changes in the reproductive organs that are extremely inconvenient for fertilization. Also, dysfunction of the thyroid gland also leads to hormonal imbalance, thereby drawing a connection between infertility and the thyroid gland.
Often, 2nd degree infertility occurs in women as a result of abortions, and associated cleaning of the uterus, often not of very high quality and accuracy. After all, when pregnancy is artificially terminated, inflammation of the uterus and appendages, and a disease such as endometriosis, can occur, and all this is a direct path to infertility.
The most common type of infertility is secondary infertility.

Why does it happen?

Second degree infertility in women can have various causes. Most often it is caused by one of the following:

1. The presence of adhesions in the genital organs as a result of an inflammatory process, surgery or previous childbirth;
2. Injuries to the reproductive system as a result of pregnancy, childbirth or surgery;
3. Hormonal imbalance for one reason or another;
4. It is extremely rare to develop immunological infertility with the development of antisperm antibodies to the sperm of the partner from whom pregnancy previously occurred;
5. Immunological infertility when changing partners;
6. Reduced tube patency as a result of adhesions, the presence of fibroids, etc.;
7. The presence of endometriosis, which does not allow the embryo to attach to the affected uterine mucosa.

In some cases, other reasons for the development of this condition are possible. In particular, there is still such a thing as idiopathic infertility or infertility of unknown origin. This is a condition in which the causes of the phenomenon cannot be accurately determined. This means it is impossible to cure it.

Causes of 2nd degree infertility in men

1. chemical effect on the body;
2. all kinds of injuries, as well as diseases of the genital organs;
3. smoking, alcoholism and drug addiction;
4. taking certain medicines, such as antibiotics and hormones;
5. poor nutrition;
6. depression.

Sources

• https://moeditya.com/pregnancy/vedenie/besplodie-2-stepeni
• https://EmpireMam.com/beremennost/besplodie/stepeni-besplodiya.html
• https://o-krohe.ru/besplodie/2-stepeni-u-zhenshchin/
• https://fraumed.net/pregnancy/infertility-and-problems/2-stepeni.html
• https://vashamatka.ru/patologii/besplodie/besplodie-2-stepeni.html

Many married couples who already have one child and decide to have a second child are faced with the fact that conception does not occur for a long time. A man and a woman are perplexed why the first time the pregnancy occurred without problems, but the second time it does not work out. This is the question they turn to doctors with. And after careful examination, they make a diagnosis of “second degree infertility.”

Causes of the problem

So, it becomes clear that secondary infertility or, as it is also called, second-degree infertility means the inability of a couple to conceive a child a second time, after a successful first pregnancy. Logically speaking, we can assume that the cause of the problem is acquired. What could be a barrier to successful conception? Let's start with men. Their reasons are:

1. Infections of the genitourinary system.
2. Varicocele.
3. Chronic diseases of internal organs.
4. Head injuries.
5. Diabetes.
6. Taking anabolic drugs.
7. Drug addiction, alcoholism.

Second degree infertility is more common in women. Their problems are caused by the following factors:

1. Age. The favorable period for the birth of a baby is the age period from 18 to 35 years. Gynecologists recommend planning your first birth before age 28. As for the second, there are women who decide to give birth both after 18 years and at 45. But still, the thirty-year threshold is the beginning of the wear and tear of a woman’s reproductive system. It quickly fades away after 35.
2. Disturbances in the endocrine system. Most often, these are hormonal imbalances, which can make themselves felt by disturbances in the menstrual cycle and irregular ovulation. The putuitary and adrenal glands often malfunction.
3. Inflammation of the genitourinary system. This is a wide range of ailments, including chronic adnexitis, infectious inflammation as a result of abortion. Often women experience adhesions of the fallopian tubes. They interfere with patency and conception.
4. Immunological reasons. Sometimes a woman’s body begins to synthesize antisperm substances. Such antibodies perceive male sperm as a foreign agent and suppress it. Therefore, conception does not occur.
5. Lifestyle. The basis of reproductive health, as well as appearance women - her lifestyle. If she is a heavy smoker, drinks often, eats fast food, and is obese, then what kind of reproductive health can we talk about?

Treatment of second degree infertility

So, if the causes of second degree infertility are lifestyle, then this can be corrected, although it will take a lot of time. And it will also take a lot of time to treat diseases that lead to secondary infertility. This may take more than a year. And the treatment process begins with establishing the exact causes of the problem.

For this purpose, after collecting anamnesis, a specialist prescribes the following diagnostic studies: study of hormonal levels, sperm motility, fallopian tube patency, and cytological studies. Depending on the established reasons, a woman or a man (sometimes both, if we are talking about infectious diseases) prescribe antiviral drugs, immunomodulators, antibacterial agents. Treatment of chronic diseases and inflammatory processes of partners is mandatory.

Nowadays, the results of treatment of second degree infertility are in most cases high. But every rule has its exceptions. Therefore, sometimes a woman, despite all her efforts, fails to become pregnant naturally. But even in this case, medical advances come to the rescue. And the couple can use the method in vitro fertilization. This is the implantation of an egg into a woman’s uterus, previously fertilized in a laboratory. Another option is, that is, carrying a fertilized egg by another woman.

When a diagnosis of “second degree infertility” is made, you should strictly follow all medical prescriptions and change your lifestyle if you want to have a child. Only in this way, with patience and endurance, can you get a chance for successful conception.

Especially for- Elena TOLOCHIK

Secondary infertility is a diagnosis that has become a death sentence for women who have already had a pregnancy, regardless of whether it ended in childbirth or miscarriage. This is the difficulty or even impossibility of getting pregnant again.

2nd DEGREE INFERTILITY AS A GLOBAL PROBLEM

- this is one of the global problems humanity. Moreover, it can occur in women who have had miscarriages, i.e. for some physiological characteristics or health problems. And also for those who cannot get pregnant for the second, third, etc. once. This disease is classified as 2nd degree infertility in women.

Its causes are mainly attributed to age. After all, a woman’s fertility declines with age. And after 35 years, almost every fourth person is no longer able to get pregnant. After all, it is not for nothing that nature has laid down that the reproductive age of every woman is 15-30 years, after which the joy of motherhood may never come. But still, there are many reasons when secondary infertility is diagnosed; let’s try to talk about the main ones.

CAUSES OF SECONDARY INFERTILITY

Among the main female diseases that affect the development of secondary infertility, but which can be cured, the following should be highlighted:

• inflammation of the fallopian tubes or ovaries;
• inflammation of the uterus, vagina;
• dysfunctional uterine bleeding;
• etc.

Of course, these health problems appear after a miscarriage when damage occurs to the endometrial layer, without which the fertilized egg simply cannot attach to the uterus and develop.

Reasons include injuries to the genital organs, even wrong mode nutrition, biological incompatibility of partners, etc.

Is secondary infertility treatable?

We have analyzed the diagnosis of stage 2 infertility, what it is, and now we need to decide whether it is treatable. The specialists of the Dobromed clinic responsibly declare that this disease can and should be treated. After all, it is fraught not only with the possibility of never giving birth, but also with problems with general women's health, because it occurs as a result of acquired diseases of the genital organs.

Almost any disease can be treated. The most important thing is to contact a specialist in time, who will make a diagnosis and prescribe treatment. And then you will have a chance to experience the joy of motherhood.

CLINIC FOR THE TREATMENT OF FEMALE SECONDARY INFERTILITY

First of all, treatment of 2nd degree infertility – This is an urgent visit to the Dobromed clinic.

When to visit the doctor? If you have been trying to conceive a second child for a year, but there is no result. This is the first sign that you may be diagnosed with stage 2 infertility. However, don't panic. As mentioned above, it is curable. The most important thing is to identify the cause. And only a specialist can do this using modern diagnostic equipment, which is available in our clinic.

Before you are diagnosed with stage 2 infertility, you will pass everything (in addition to the general ones, infections, hormones and antibodies are added), and will also pass:

• initial examination;
• thorough examination using an ultrasound machine;
• procedure for tubal patency – ;
• examination of the uterus - .

In addition, laparoscopy may be required. This is effective, as it will not only help make a diagnosis, but also immediately eliminate the cause. Your partner will also be examined. Everything will be almost the same scenario, only male procedures.

If the diagnosis is confirmed, the specialist will prescribe effective treatment. And rest assured, the problem will be solved. Therefore, do not delay your visit to the specialists of the Dobromed clinic, and then, through joint efforts, secondary infertility will become a thing of the past. Make an appointment with experienced gynecologists at the Dobromed clinic today.