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Diagnosis of female infertility

Deterioration in ovulation

Critiria: The menstrual cycle is a period of time beginning with the onset of menstruation and ending with the onset of the next. The maximum duration of the cycle is 28 days, but the interval from 21 to 35 days is also accepted as normal. During this period, the female reproductive system undergoes various endocrine and morphological changes.

The menstrual cycle is mainly divided into three phases:

Follicular phase: The ovum undergoes development and development before fertilization. It, together with the cells and the liquid, forms a small cell, called a follicle. The main hormones that are produced in this phase are the ectopic ones that cause the endometrium (endometrium) to develop.
Ovulatory phase: it is connected to the follicle on the follicle and separated on the egg.
Lateral phase: after ovulation, the cells enclosing the ovary undergo changes and form a type of yellowed body. It has different sizes and types of progepton, which changes the endometrium and prepares it for the implantation of the embryo. The duration of this phase is usually 12-14 days.
Deviations: Menstruation due to menorrhoea or irregular menstruation most often lead to ovulation failure. Other abnormalities in ovulation with LUF syndrome (non-type of follicle after induction of ovulation by the endocrine system) and insufficiency of blood flow.

Tests:

  • determination of the basal body temperature;
  • determination of ovulation through urinary testing;
  • ultrasonic tracking(follicometry)
  • dynamic determination of the hormonal balance through full-scale studies.

Treatment: Medical or operative treatment in order to restore the normal process of ovulation. Specific tretment is to be undergone if this treatment fails:

  • replacement, enhancement or reduction of gonadotropin-releasing hormone (GnRH);
  • Replacement and separation of the follicle-stimulating (FHH) and luteinizing (LH) chormone;
  • replacement and adjustment of the serum levels of the progesterone during the lutal phase;
  • In case of reduced ovarian function or complete loss of ovarian function, a treatment program is applied for in vitro fertilization with donor egg cells.

Cervical factors

Critiria: During the normal ovulatory menstrual cycle, the ectogens synthesized by the so-called granulous cells, increase the amount of cervical muscle and change its characteristics.This allows the spermatozoa to move easily and to enter the woman’s reproductive tract.

Deviations: The effects of cervical mycosis are affected by certain defects of the cervix, treatment of the cervix as a result of abnormal resultsfor PAP test (radiotherapy, laser treatment, conization) and application of specific medications.

Tests:

Post-coital test (PCT) evaluates the interaction between the cervical mucus and the seminal fluid after sexual intercourse. This test isolates the cervical myal from the cervical canal and evaluates it under microscopic observation.
The pH of the cervical muscle is an important factor for the survival of spermatozoa. Loq pH values do not allow spermatozoa to undergo this first physiological breakdown in the female reproductive system.

Treatment: Different hormonal and non-hormonal methods are used.:

  • Going around the cervical muscle through intrauterine insemination;
  • Conceptual treatment, through the preparation of long-term medication and supplementation of other drugs. Example: replacing CC (сlоmірhеne сіtrаtе) with аrоmаtаѕе іnhіbіtоr when inducting the ovulation.

Uterine body

Critiria: The normal uterus creates the conditions for implantation of the developing embryo. The uterine mucosa (endometrium) changes under the influence of estrogens and progestogens and prepares for the reception of the developing new substance.

Deviations: The normal development of the endometrium is hindered by the development of ovulation or by the use of certain medications. Certain anatomical anomalies related to the uterine body or uterine cyst can also prevent normal implantation of the uterus. Other negative factors are intrauterine reactions from previous surgical procedures or tumor formations originating from the uterine mucosa or uterine body.

Tests:

Hysterosalpingography (НЅG), hydrotubation under ultrasonic control (sonohisterography) and histeroscopy.

Treatment:

Changes in the type of medication used for ovulation indication or the use of additional hormonal therapy, which may be similar.
Surgical treatment of anatomical defects and pathological changes in the endometrium and uterine body.

Tubal factor
Critiria: The main function of the fallopian tubes is to transfer the fertilized egg to the uterine body.

Deviations: Factors lead to infertility, which prevent the “capture” of the egg from the fallopian tube, the attainment of the sperm or the uterus.

Tests: Hysterosalpingography (НЅG), hydrotubation under ultrasonic control (sonohisterography), laparoscopy and laparotomy.

Treatment:

Surgical treatment – in the presence of small discharges in the distal line of the fallopian tubes
For the last 25 years, fertilization in vitro fertilization (IVF) has been the main treatment for infertility.

Peritoneal factors:
Critiria: Peritoneal cavity is an area of the human body where the organs of the genital and digestive systems are located. It creates the environment, in which the ovaries normally develop, where the interaction between the fallopian tubes and the ovaries takes place, leading to the entry of the egg cell into the fallopian tube and fertilization by spermatozoa.

Deviations:

Factors that can cause infertility:

  • Existence of ingrows received after operative intervention;
  • Presence of consequences in connection with a previous inflammatory process in the small pelvis;
  • Endometriosis (presence of cells from the uterine mucosa outside their normal place in the uterine cavity) – can lead to contractions that interfere with the interaction between the ovaries and the fallopian tubes. Endometriosis may be the cause of infertility, regardless of the presence of fallopian tubes., This is due to the separation of specific local factors of inflammation from endometrial inflamation areas.

Tests: The basic method for diagnosis is laparoscopy.

Treatment:

Operative – to prevent the endometriosis caused by the disease;
Combined – operative and medical treatment;
IVF treatment is a method choosen when previous techniques are unsuccessful.

Prices

Each case is unique and needs different diagnosis and treatment. Here you can see a breakdown of all prices that interest you.

1. First gynecological examination60 BGN
2. Secondary gynecological examination30 BGN
3. Ultrasonic examining50 BGN
4. Foliculometry50 BGN
5. ColposcopyKoлпocĸoпия (with included gynecological examining)40 BGN
6. 3D echography80 BGN
7.Examination, placement of the spiral and ultrasound control of the spiral80 BGN
8.Inspection and removal of the spiral50 BGN
9.Attachment of the spiral (does not include examine)30 BGN
10.Detachment of the spiral (doesn’t include examination)15 BGN
11.Cyst aspiration including cytology360 BGN
12.Cervical biopsy50 BGN
13.Diathermocoagulation of the cervix60 BGN
14.Polypectomy ((incl. biopsy)50 BGN
15.Treatmen of  condylomas, herpes etc. of the vagina and vulva30 BGN
16.Hydrotubation – test for permeability of the fallopian tubes130 BGN