Secondary infertility is diagnosed if a woman has previously become pregnant. It is possible to cope with the disease if you visit a gynecologist-reproductologist in time. It arises for a number of reasons, the main of which are: age, lifestyle and incompatibility of partners.
When attempts to get pregnant within a year of active sexual life without the use of contraceptives are unsuccessful, the specialist diagnoses "infertility". There are many reasons for this, and in order to correctly indicate the determining factor, it is necessary to conduct a comprehensive examination.
What is secondary infertility
Women who have previously been pregnant face difficulty conceiving. To establish a diagnosis, it does not matter whether the pregnancy ended in childbirth or not. The secondary involves difficulty in conceiving when a couple has a baby, while it is not possible to become pregnant or endure the next one. Often a woman and a man have children from other partners, and joint conception does not work.
There is an international classification of diseases according to the 10th revision (ICD-10). Secondary infertility ICD 10 is information about a disease associated with the problem of conceiving a child. Secondary infertility ICD-10 implies a specific code that informs the specialist about the cause of the underlying ailment (from No. 97.1 to No. 97.9).
Causes
The causes of the disease are the age of future parents, health, sperm motility in a man, the lifestyle of spouses, their compatibility and the presence of infectious or other diseases.
In men
Secondary infertility in a man means difficulties in conceiving a second and subsequent child. The main reasons are availability. Fertility is affected by prostatitis, urethritis, epididymitis. In the event that a man underwent surgery on the scrotum, after surgery, there is a high probability of complications, and as a result, problems with conception.
Whatever the cause of the disease in a man, only a qualified specialist is able to diagnose it. In 95% of cases, with timely access to a doctor, it is possible to achieve positive dynamics.
Common factors of the disease in men are also:
- genital trauma;
- endocrine disorders/diseases;
- chemotherapy;
- taking hormonal drugs;
- alcohol, drug use, smoking;
- taking anabolics (when building muscle mass);
- frequent visits to the bath and / or sauna;
- eating disorders;
- chronic stress.
Among women
Secondary infertility in women occurs due to age. Many women give birth to their first child when they are young. Subsequent pregnancy is carefully planned, by this time the woman is well over 30.
Giving birth at this age is the norm today, but it should be understood that fertility is decreasing by this age mark, which means that it is much more difficult to conceive a baby. According to statistics, secondary infertility (ICD-10 code) is put by a quarter of all women after 35 years.
There are also gynecological diseases. Often, the difficulty in conception arises from previous abortions. It happens that a woman does not have any obvious reasons, but pregnancy does not happen. In this case, it is necessary to exclude biological incompatibility with a partner.
Of great importance is the lifestyle that a girl who is planning a pregnancy adheres to.
Causes of secondary infertility in women:
- ectopic pregnancy and miscarriages;
- polycystic ovaries and uterine fibroids;
- burdened childbirth;
- external genital endometriosis;
- early menopause;
- bad habits;
- improper nutrition;
- emotional overload.
Also a common cause. Due to their instability, the menstrual cycle is confused, and it is much more difficult to catch ovulation if it occurs.
Definition in men
To determine secondary infertility in men, you should undergo a complete examination. You need to visit a urologist, undergo a set of tests and procedures. To make a diagnosis, take:
- blood for hormones and infections;
- smear from the urethra;
- Ultrasound of the prostate;
- spermogram.
Diagnosis in women
After a year of unsuccessful attempts to get pregnant, a woman turns to a reproductive specialist. To diagnose the cause of the disease, you should:
- take an analysis for infections, hormones, antisperm bodies;
- determine the patency of the fallopian tubes;
- undergo an ultrasound of the uterus, ovaries.
If the examination is not enough, the woman performs other manipulations: laparoscopy, hysteroscopy and others.
Symptomatic manifestations
This disease is a consequence of pathologies, which are extremely difficult to notice. In a woman, the symptoms are expressed more clearly than in a man.
Among women
It is possible to notice signs of secondary infertility in most cases during a gynecological examination or during the examination.
Symptoms that a woman will certainly notice are:
- inflamed vagina;
- disorders;
- increased / decreased body weight;
- chronic diseases.
In men
A man may be completely unaware of the presence of diseases that have led to further difficulties with conception. Usually there are no symptoms at all. He can lead an active sexual life, feel completely healthy, but not capable of conception. As a rule, a man finds out about this after a long period of time, when the partner underwent a complete examination and made sure that she was healthy. That is why, experts recommend not to waste time and examine both partners at once.
Methods of influence
There are quite a few ways to deal with the problem. Specialists use both medical and surgical methods. It all depends on the underlying disease.
Traditional treatment
Drug treatment of secondary infertility involves taking medications that are prescribed exclusively by a specialist.
The doctor prescribes hormonal, antiviral, immunological, antibacterial drugs or antibiotics - it depends on the true cause of infertility. Treatment of secondary infertility in women involves the use of traditional methods:
- psychotherapy;
- drug treatment;
- hormone therapy;
- laparoscopy;
The first is in the mood of the patient, his getting rid of negative memories. It is important to make a woman or a man forget about the difficulties with conception, believe in himself and a positive outcome.
Hormone therapy involves stimulating the maturation of the egg. This method is used if a woman is diagnosed with endocrine infertility.
Laparoscopy is performed on a woman with polycystic ovaries, obstruction of the tubes.
Indication for in vitro fertilization is obstruction of the fallopian tubes or infertility of unknown origin. During the procedure, an egg is removed from the female body and artificially fertilized. Then they are placed for development in an incubator, where special conditions are created. Then they are transferred to the uterus.
Treatment with folk remedies
With secondary infertility, the couple turns to traditional medicine recipes. So, if a man has low-quality sperm, it is recommended to take mummy. 0.2 gr. It should be mixed with freshly squeezed carrot or sea buckthorn juice. Take according to 1:20 in the morning on an empty stomach. It is desirable to use this remedy in a course - 25-28 days, then a month break.
Of the folk remedies, the mountaineer bird is effective. It can be purchased at every pharmacy, taken as an infusion. Cooking is extremely simple, you need to mix the mountaineer with boiling water in the proportion of 1 cup of grass per 1 liter of water.
An excellent solution would be field wormwood. This plant is very beneficial for women's health. To prepare a decoction, you need to pour 200 ml of hot water a tablespoon of dry grass. Infuse for three hours, then bring to a boil, strain. Drink a decoction two to three times a day for ½ cup.
Recipe: pour a tablespoon of grass with a glass of boiling water, place the container in a dark, warm place or wrap it in a towel and insist for two hours. It is recommended to use several times a day.
Adam's root is an excellent remedy: pour 2 teaspoons of the plant with hot water. Infuse for two to three hours, then drink 4 times a day.
Forecast
There are many reasons for difficulty conceiving, and the complexity of treatment depends on how serious it is. Infertility in women on average takes a year or more.
However, even with the most positive result after treatment, you need to wait at least three months, or even six months, to start trying to conceive. Often the course of therapy is repeated more than once.
male infertility. The inability of a man's body to produce or deliver enough healthy sperm to a woman's body to conceive. In rare cases, the cause of the disease is a chromosomal pathology. Risk factors include smoking and alcohol abuse. Age doesn't matter.
In about one in three couples who have difficulty conceiving a child, the male suffers from infertility. A man's ability to reproduce depends in part on producing enough healthy sperm that one of them is likely to fertilize an egg; and partly from the ability to deliver sperm to the vagina during intercourse. If problems occur at any of these stages, a man can become infertile.
In contrast to female infertility, the causes of which can be relatively easily identified, the causes of male infertility are less easily identified. During a medical examination, the cause of infertility can be found out only in 1 out of 3 applied patients.
Problems with sperm production. The production of non-viable, slow-moving spermatozoa or an insufficient number of healthy spermatozoa can have various causes. Normally, testicular temperature is about 1°C lower than body temperature. Any factor that raises the temperature of the testicles can lead to a decrease in the number of sperm produced.
Certain lifestyle habits, such as smoking, drinking alcohol, using certain medications or recreational drugs, and even wearing tight clothing, can reduce the quality and quantity of sperm produced. The function of sperm production can be impaired as a result of some chronic diseases. Diseases that affect the urethra, such as hypospadias, or the scrotum, such as varicocele, can also reduce a man's fertility. In addition, male infertility can develop as a result of medical procedures, such as surgery, chemotherapy, or radiotherapy for serious conditions such as testicular cancer.
A decrease in sperm production can also occur with hormonal disorders or chromosomal defects. Insufficient production of the male sex hormone testosterone by the testicles can lead to a decrease in the number of healthy sperm in the semen. Since the secretion of testosterone is under the control of the pituitary gland, diseases of this organ, such as its tumor, can also reduce the reproductive functions of a man. In rare cases, low testosterone levels can be due to a chromosomal abnormality such as Klinefelter's syndrome. The most common cause of low sperm count is idiopathic oligospermia, in which the sperm count in semen is reduced for unknown reasons.
Problems with the delivery of sperm. Spermatozoa may not enter the vagina due to many factors. The most obvious reason for this is erectile dysfunction, the inability to achieve and maintain an erection. Other causes include damage to the epididymis or the vas deferens (the ducts that carry sperm). Such lesions are often the result of sexually transmitted diseases such as gonorrhea. Infertility can occur in men who have retrograde ejaculation, in which seminal fluid flows back to the bladder if the bladder valve does not close completely, which can occur after prostate surgery.
The doctor will ask the patient about their general health, sex life, and perform a thorough examination, including examination of the genital area. In addition, a man may be required to provide a semen sample. If the number of spermatozoa is insufficient or if they are characterized by inactivity or non-viability, further tests will be carried out, such as a blood test that establishes the level of hormones.
The choice of treatment method depends on the diagnosis. If testosterone levels are low, injections of this hormone may be given. In case of impotence or retrograde ejaculation, artificial insemination can be used, in the latter case, sperm can be isolated from the urine. Damage to the epididymis or vas deferens can be corrected by microsurgical surgery. If the body produces only a small amount of healthy sperm, they can be collected directly from the epididymis. The egg will then be fertilized in a process called intracytoplasmic injection.
female infertility- the inability of a woman to naturally conceive a child. The risk increases with age, with women over the age of 35 most often affected. In rare cases, the disease is caused by a chromosomal pathology. Risk factors include stress, as well as increased physical activity and being overweight or underweight.
In about half of the cases in couples who do not have the opportunity to conceive a child, the woman is infertile. The ability to conceive decreases with age, in most cases falling by the age of 35, which makes it difficult for women older than this age to get pregnant.
There are a number of women's diseases that can affect one or more of the processes necessary for pregnancy.
Problems with ovulation. common cause female infertility is the impossibility of releasing a mature egg from the ovary, which normally occurs every monthly cycle. Ovulation is controlled by a complex interaction of hormones produced by the hypothalamus (a part of the brain), the pituitary gland, and the thyroid gland. A common and highly treatable disease leading to female infertility, is polycystic ovary syndrome, which can be accompanied by hormonal imbalance, which makes ovulation impossible. Thyroid diseases, such as hypothyroidism, can also lead to the development of hormonal imbalance, which affects the frequency of ovulation. A similar imbalance can be observed in diseases of the pituitary gland, such as prolactinoma, a benign tumor of the pituitary gland. The causes of ovulation disorders are different and not always known at this point in time. Sometimes women who have taken oral contraceptives for many years may need some time to restore their normal hormonal cycle after giving up contraception. Heavy exercise, stress, obesity, or being underweight can also affect hormone levels.
Early menopause is also accompanied by ovarian failure. Ovarian dysfunction sometimes develops for no apparent reason, but may also be the result of surgery, chemotherapy, or radiotherapy. In rare cases, there is a pathology of ovarian development due to a chromosomal abnormality, such as, for example, Turner's syndrome.
Problems with fertilization and egg movement. The path of the egg from the ovary to the uterus can be blocked if the fallopian tube is damaged. Damage to the fallopian tube can occur as a result of an inflammatory process in the pelvic region, which, in turn, can develop as a complication of sexually transmitted diseases, such as chlamydial cervicitis. Such infections can occur without symptoms and can only be diagnosed when you see a doctor about infertility.
Endometriosis, a disease characterized by the formation of fibrous tissue and cysts in the pelvic region, can also affect the fallopian tubes, which blocks the path of the egg to the uterus.
In some women, fertilization of an egg by a spermatozoon is impossible, because. the mucus normally produced by the cervix contains antibodies that destroy the partner's sperm before they can reach the egg, or is too viscous to prevent the fertilized egg from passing into the uterus.
Problems with the introduction of the egg into the lining of the uterus. If the lining of the uterus becomes damaged as a result of an infection, such as gonorrhea, implantation of a fertilized cell may not be possible. Hormonal problems can also cause the lining of the uterus to be insufficiently prepared to receive the egg.
Most of the reasons for female infertility, these days it is possible to identify during the survey. A woman can determine when she ovulates, or if she ovulates at all, by using a commercially available device, or by keeping daily records of basal temperature. If the doctor suspects that the patient is ovulating irregularly, she may periodically take a blood test for the level of the hormone progesterone during the menstrual cycle (it normally increases after ovulation). In addition, a series of ultrasound scans of the ovaries during the menstrual cycle can be carried out, which allows you to determine whether ovulation occurs, and a sample of uterine tissue can be taken from the woman to rule out the presence of pathology.
If the examination shows that a woman is not ovulating, she may have additional blood tests that determine the level of thyroid hormones and other hormones. To stimulate ovulation, the patient may be prescribed a drug course of treatment.
If a woman is ovulating normally and her partner's seminal fluid is also normal, the doctor will check for problems that may interfere with the fertilization of the egg by the sperm. For example, the patient may be asked if she is having sex while she is ovulating, and a sample of cervical mucus (collected no later than a few hours after intercourse) will be taken to test for sperm antibodies. If the test reveals the presence of antibodies, several treatment options are possible. For example, the partner's sperm can be injected directly into the uterine cavity, which prevents it from coming into contact with the mucus.
If the cause of infertility cannot be determined, further examination will be aimed at determining the presence of blockage of the fallopian tubes or uterine pathology. Methods used include laparoscopy. The choice of treatment method depends on the existing problem; microsurgery can be used for blocked tubes, and for endometriosis, a course of drug treatment is selected.
The International Classification of Diseases according to the 10th revision of diseases is a generally accepted structure that codes for specific diseases and their types. ICD-10 consists of three volumes: 1 - the main classification, 2 - instructions for use for users, 3 - alphabetical index to the classification.
This classification is intended more for physicians than for patients. In case of infertility, the ICD 10 code helps the doctor to find out the diagnosis of the patient who came to examine the patient, without conducting a diagnosis and taking an anamnesis.
Among women
Infertility is a condition that affects about 1 in 10 couples. This diagnosis is given to spouses if attempts to get pregnant within 1 year have not been successful. Approximately 50% of the absence of a child is due to female factors.
The most common causes of female infertility are:
- problems with ovulation;
- damage to the fallopian tubes;
- age (with its increase, a woman's fertility tends to decrease);
- problems with the introduction of the egg into the lining of the uterus.
Infertility according to ICD-10, associated with the absence of ovulation, has the code N97.0. This type of inability to conceive a child can be associated with hormonal imbalance, bulimia, anorexia, benign tumors and cysts on the ovaries, overweight, thyroid problems, constant stress, alcohol and drug abuse. Also, the lack of ovulation can be caused by extremely short menstrual cycles.
According to ICD-10, female infertility of tubal or uterine origin has codes N97.1 and N97.2. These types of a woman's inability to conceive can be caused by one of the following factors:
- inflammatory diseases of the female genital organs;
- endometriosis or fibroid formation;
- adhesive process in the small pelvis;
- chronic pathologies;
- previous ectopic (ectopic) pregnancy;
- congenital defect.
The drug DES, which is given to women to prevent miscarriage or premature birth, can lead to fertility problems in the unborn child.
Female infertility with the ICD-10 code N97.3 means problems with mucus from the cervical canal. Abnormal cervical mucus can also cause a prolonged lack of pregnancy. It prevents sperm from getting to the egg or making it difficult for them to penetrate.
Also distinguished are infertility associated with male factors (N97.4), other forms (N97.8) and an unspecified form (N97.9). If the infertility is primary, according to the ICD-10, the patient will have the N97 code. It means that a woman who is sexually active has never had a pregnancy. If infertility is secondary, according to the ICD-10, a code indicating the cause of the disease is put (from N97.1 to N97.9).
Diagnostics
In the first volume of the international classification of diseases, I indicate the examination methods necessary to determine the cause of infertility. Doctors use the following tests to evaluate a woman's reproductive system:
- blood test;
- examination of the chest and pelvic region using ultrasound;
- a sample of cervical mucus to determine the presence or absence of ovulation;
- laparoscopy to detect adhesions or scar tissue, view the condition of the pelvic organs.
An x-ray examination is also carried out, used in combination with a dye. Thus, it is easier for doctors to determine whether there is an obstacle in the fallopian tubes for the penetration of spermatozoa.
In men
Male infertility in the ICD-10 is a subclass of the department "Diseases of the male genital organs", this problem is assigned the code N46. Male infertility usually occurs due to poor sperm, insufficient sperm count, or problems with ejaculation. Sperm is considered bad if the life of the male germ cells is too short. Deviations from the norm are caused by one of the following factors:
- inflammation processes in the genitals;
- varicose veins in the scrotum;
- abnormally developed testicles.
There are a huge number of different syndromes that can lead to the inability to conceive a child naturally. Male infertility in ICD-10 is divided into three parts: 1 - male infertility, 2 - infertile marriage, 3 - different syndromes.
In the last section, infertility problems are noted, only ICD-10 codes were not included in separate articles or considered within the framework of the corresponding disease. These include problems with conception in men.
Diagnostics
Diagnosis of male infertility is carried out by a thorough history taking and physical examination of the patient. A man needs a semen analysis to determine the quantity and quality, a blood test to detect infections or hormonal problems, swabs from the urethra. You will also need to undergo a physical examination of the penis, scrotum, and prostate gland.
Infertility according to ICD-10 also has treatment regimens. The problem is treated using traditional methods, which include:
- taking drugs to increase sperm production;
- the use of antibacterial medicines for the treatment of infectious pathologies;
- taking hormones to improve hormonal imbalances.
Unfortunately, infertility cannot be prevented, especially when the problem is related to genetics or disease. However, reducing alcohol abuse, smoking and maintaining a healthy lifestyle reduce the likelihood of infertility in men.
Infertility microbial 10 - this disease is associated with the problem of conceiving a child. When a married couple regularly has unprotected sex for a year, but pregnancy does not occur.
Often a married couple, according to statistics, this is 35% do not have children, not through the fault of the woman, but because of male infertility. Therefore, to determine the cause of the disease, it is necessary to undergo a complete examination of both partners. If health problems are found in a woman and a man, complex treatment is prescribed mutually for a married couple.
Qualification
ICD-10 is the tenth revision of the International Classification of Diseases. Established normative document for all hospitals, which is used to record diseases, which describes the reason for visiting a doctor.
The ICD code has been used in all regions of the Russian Federation since 1997.
ICD 10 is qualified by the disease diagnosis code:
- 0 - problems with ovulation block the conception of the embryo.
- 1 - adhesions in the fallopian tubes, which makes it difficult to pass them.
- 2 - disease of the uterus.
- 3 - problems with the cervical canal.
- 4 - childlessness, which is caused by male factors.
- 8 - other varieties of childlessness.
Distinguish between primary female infertility and secondary disease, when the pregnancy was in the past, regardless of its outcome. Depending on all the factors and causes of the disease, effective treatment is prescribed.
To achieve a result, it is better to contact a medical institution with modern equipment and professional doctors.
Childlessness treatment
If there is a problem with the endocrine system, it is important to normalize the hormonal background of the body, the treatment of the disease is prescribed individually for each woman, after a diagnostic examination. If you are overweight, you need to adjust the diet, normalize body weight.
Often a woman cannot conceive a child due to adhesions and scarring in the pelvic area. To treat such female infertility, laparoscopy is used, it will help diagnose the disease and at the same time cope with the problem.
Often female infertility is associated with various gynecological diseases - uterine fibroids, endometriosis, polycystic ovaries, uterine deformity, problems with the cervical canal. All these diseases can be identified during the examination. If they are detected in the early stages, after proper treatment, you can become pregnant and give birth to a baby.
When diagnosing infertility, both spouses are examined, and mutual treatment is also prescribed.
