The volume of diagnostic measures largely determines the effectiveness of the prescribed therapy course. The success of treatment depends on how quickly and correctly been diagnosed. Infertility Diagnosis should begin with a survey of both partners, as this will not delay the whole complex process of establishing the causes of the disease. The percentage of male and female factors in the structure of the causes of infertility is about the same, so do not waste your time and examine only the first woman.

An integrated approach to inspection

When you select a volume examination in each case of the disease should not resort to standard schemes or diagnostic algorithm. From this mechanical approach is necessary to get rid of. Otherwise, it may lead to negative aspects associated with diagnostic errors.

It is important to collect the history of the disease - how long infertility, whether previous pregnancies and how they run, which used a couple of methods of contraception for the purpose of contraception. Next, you need to find out details of all past illnesses, including on the part of the reproductive system. If it turns out that the woman violated menstrual function, it is necessary to analyze the situation before the development of disorders. Violations can be of different nature - absence of menstruation (amenorrhea primary or secondary), delayed, scanty or abundant in the number of lost blood. When endocrine disorders that cause infertility, often suffering menstrual function, so it is important for every woman to conduct monthly menstrual calendar. For a doctor it would be a huge benefit for the assessment of the nature of violations and diagnosis.

In a survey of women should be sure to evaluate the process of ovulation, from the standpoint of endocrine diseases is fundamental. The process of conception is possible only upon the occurrence of ovulation in a woman, and if this process is disrupted, respectively, we can talk about the origin of infertility. Confirm the presence of ovulation is possible with the help of some diagnostic methods with high information content:

• Assessment of the dynamics of growth, maturation of the follicle during ultrasound (we recommend using a vaginal probe). If there was a full ovulation, the follicle burst at the site found a yellow body, he is no longer the dominant follicle is determined and found some liquid in the space pozadimatochnogo
• determination of blood progesterone hubbub Progesterone - norm and pathology   (defined in the middle of the second phase of the cycle)
• confirmation of ovulation by a special urine test "Kliaplana 'action is based on the presence of the hormone LH peak before ovulation Ovulation - How to determine as accurately as possible? . If the test is positive, then after 24-36 hours of ovulation
• one of the routine methods is the measurement of basal temperature, or in the rectum. The method is highly informative, but now has lost its relevance since the use of more modern diagnostic procedures

Diagnosis of endocrine disorders also includes a study of the level of hormones in the blood. To get the full information about the level of violations is necessary to hormonal examination during the cycle several times. In the first phase of the research is done from the fifth to the seventh day, in the second phase - from 22 to 24 days. Men also determine the content of sex hormones, particularly testosterone, which is essential not only for differential diagnosis, but also for monitoring the effectiveness of hormone therapy (replacement therapy or HRT).

Possibilities of laboratory and instrumental investigations

Suspicion of tuboperitoneal factors have diagnostic value of different instrumental methods. Get sharp image tubes, the uterus, you can use X-ray study (hysterosalpingography). To conduct the procedure should be the second phase, wherein the contrast agent is injected with a special syringe into the cervical canal Cervical canal - the path traversed by every person   and make a series of shots. Based on how the filling of the contrast agent, inferring the presence of lesions (obstruction of pipes, pathology inside the womb - polyps, adhesions, and others). This study has a number of contraindications - any infectious diseases, inflammation of the reproductive organs, suspected pregnancy. In the diagnosis of infertility to help other methods, such as pertubatsiya kimograficheskaya, ehogisterosalpingoskopiya.

The reliability of the results of such a study is from 60% to 80%. The most accurate and complete information is provided by diagnostic laparoscopy, as you can visually assess the condition of the reproductive system and to assess the severity of lesions. During laparoscopy, it is possible to determine how much is expressed adhesive process and at the same time carry out a surgical correction. This method of examination is an operational method, so there is some risk of complications associated with the surgery. As you can compare the diagnostic value of laparoscopy Laparoscopy - why is it necessary?   and transvaginal gidrolaparoskopiyu. Access is made through the vaginal vault, thus there is absolutely atraumatic and complete examination of the genitals. Another advantage of this method is that there is no formation of adhesions. Experts recommend the use of transvaginal gidrolaparoskopii method as a screening at the earliest stages, when a woman is only addressed to the doctor in connection with the problem of infertility.

Before many women raises the question of how to treat uterine fibroids. But this is a serious condition that requires appropriate treatment of serious, that only by a specialist. Therefore, when the signs similar to uterine fibroids, it is not necessary first to apply different national methods, better immediately, without tightening refer to obstetricians and gynecologists.

What can offer the doctor for the treatment of uterine fibroids

First of all, the doctor will do an exam, and set the size of fibroids, its growth rate, location. The data he sootneset with symptoms of the disease, the presence of other diseases in women, its age and the desire or unwillingness to have children.

Only after analysis of all the data the doctor will be able to select the desired treatment strategy and the most suitable for this method.

The main objective of the treatment of fibroids in women of reproductive age is to suppress the growth of fibroids, recovery and preservation of the possibility of having children. This is achieved by means of hormone replacement therapy Hormone therapy - is it possible to fool nature?   and sparing operations.

Women in menopause and after menopause, the main task is to remove the fibroids, which destroys the health of the woman (the threat of severe iron deficiency anemia, degeneration of fibroids in the uterus sarcoma and so on). Therefore, fibroids often removed along with the uterus, once and for removing all threats to the health and lives of women.

Yet surgical treatment of fibroids is not mandatory now, even in old age. Modern methods of treatment of uterine small and medium size allows in many cases to use conservative treatment. Also today, new methods of treatment of uterine fibroids - uterine artery embolization, and the inhibition of growth of fibroids using focused ultrasound waves (FUS ablation).

How to treat uterine fibroids in women of childbearing age

In order to suppress the growth of fibroids while preserving reproductive function of women, today applied conservative and operative treatment methods. The conservative therapy includes effects on female hormones, which leads to the suppression of growth, and in some cases to reduce the size of uterine fibroids. Conservative methods of treating fibroids small and medium sizes. To do this, apply drugs related to the group of GnRH agonists and antigonadotropiny.

GnRH agonists or analogues - gonadotropin-releasing hormones hypothalamus cause complete suppression of ovarian function, ie, a temporary medical castration. This contributes not only to inhibit the growth, but also a decrease in tumor size. The mechanism of action of this group of drugs is associated with inhibition of the secretion of pituitary luteinizing hormone (LH), which leads to a reduction of the content in the blood of women of estrogen - oestradiol, and a temporary suppression of ovulation Ovulation - How to determine as accurately as possible? . After discontinuation of a number of the menstrual cycle is restored. The group of GnRH agonists are drugs such as goserelin, Zoladex, buserelin Buserelin - helps cancer , Triptorelin.

Group antigonadotropiny represented mainly Gestrinone and danazol. This synthetic steroid hormones having antiestrogenic activity. Their action leads to the suppression of uterine growth, tumor size but typically are the same.

It is used as a symptomatic treatment - removed due to uterine disorders - pain, decreased hemoglobin, and so on.

Surgical treatment to preserve fertility sparing use. Subserous (below the top of the serous membrane of the uterus) fibroids are removed laparoscopically through small incisions in the abdominal wall. To remove submucous fibroids (located under the inner lining of the uterus) used hysteroscope - the device that allows you to enter into the uterine cavity through the cervical canal. Both types of transactions are usually gentle and allow a woman to have children.

How to treat uterine fibroids in older women

After menopause, increases the threat of uterine bleeding Uterine bleeding outside of menstruation - a sign of a serious breach   and the development of severe iron deficiency anemia. It increases the threat of uterine degeneration into a malignant tumor - sarcoma. Therefore, treatment of uterine fibroids at this age often means complete deliverance from the threat by removing fibroids along with the uterus.

An alternative to this method may be uterine artery embolization, and the inhibition of growth of fibroids using focused ultrasound waves (FUS ablation). Both methods are used mainly in the case when not required to preserve fertility.

Moreover, whatever the primary treatment, symptomatic treatment eliminates symptoms such as pain, anemia and so on.

Uterine cancer is treated differently in women of different ages.

Galina Romanenko