The diagnosis of «infertility» in the medical record does not mean at all that you will never be lucky enough to cuddle your baby to your chest. Irina Kuranosova, Candidate of Medical Sciences, Reproductologist and Gynecologist, Deputy Chief Physician of the Yauza Clinical Hospital, is sure of this. /span>
Can a reproductive specialist always help?
“Perhaps, there are only two cases when a reproductologist is unable to help a woman get her child biologically — this is either surgical removal of the ovaries, or a critical decrease in the follicular reserve due to age or premature exhaustion. If specialists do not have any technical ability to obtain the patient's own eggs, the option of using donor oocytes is possible. In other cases, it is almost always possible to find a solution. Even the absence of fallopian tubes is not an obstacle to motherhood: for example, IVF technologies will help. Removal of the uterus is also not a verdict: doctors can offer a surrogacy program to a married couple, and the parents will eventually receive a biologically native baby. >
Kuranosova Irina Yuryevna 
expert
Despite the optimism of doctors and truly magical modern technologies, in real life, the problem of infertility in most cases is a complex of medical pathologies. Sometimes the search for the cause of miscarriage or inability to conceive turns into a real quest. To successfully pass it, the patient and the gynecologist have to work closely with doctors of various specialties.
Endocrinologist
“It happens that a young, flowering woman passes an examination for infertility without any visible problems. She has a regular menstrual cycle, all organs are available and work perfectly. At first, a gynecologist or reproductologist may not even have the idea to check the patient for the level of a single hormone — prolactin, — says Irina Kuranosova, PhD, reproductive specialist and gynecologist at the Yauza Clinical Hospital. — But this hormone is very insidious: an increase in its level is not manifested either by weight gain or cycle jumps — nothing at all, except for the impossibility of conception. But the endocrinologist, having prescribed a blood test for a hormonal profile, will instantly identify the problem. In fortunate cases, after a month of taking the appropriate pills, a woman can become pregnant.
If we are talking about the so-called anovulatory, that is, associated with the absence of ovulation, infertility, the endocrinologist is almost always involved in the treatment. Is thyroid dysfunction to blame? Are the adrenal and pituitary glands working properly? Maybe it's overweight as a consequence of polycystic ovaries and insulin resistance? Or, on the contrary, is a critical weight deficit to blame? Only an endocrinologist has the right to answer these questions and prescribe competent treatment.
Iron, calcium, magnesium, protein deficiencies can form disorders at the endocrine, ovulatory, level and ultimately lead to infertility.
Gastroenterologist and dentist
It happens that the patient is absolutely healthy with point of view of a gynecologist and an endocrinologist, and the andrologist has no complaints about her partner. But the problem may not be where you are looking for it.
“When talking in detail with a woman, a reproductologist should ask questions about the functioning of the gastrointestinal tract or problems in the oral cavity — an unpleasant smell, stomatitis, gingivitis, etc. This may well become a new working hypothesis,” explains Irina Kuranosova, PhD, fertility specialist and gynecologist at the Yauza Clinical Hospital. — The fact is that the imbalance of the flora in the oral cavity is most likely accompanied by dysbiosis of the gastrointestinal tract, and almost always in such cases we see violations of the vaginal flora — for example, a low concentration of lactobacilli and a change in the pH environment. Under such conditions, spermatozoa become less mobile, inactive, incapable of fertilizing the egg. In this case, referring the patient for consultation and treatment to a gastroenterologist and dentist is a sure step towards a successful pregnancy.
Psychotherapist
A special topic for conversation is the psychological factor in the problem of infertility. It comes up when doctors of different specialties exclude all possible pathologies in their profile, and it remains only in the darkness of someone else's soul to look for the causes of failures. It is far from always possible for a woman to independently realize and present to the doctor as a specific complaint her fears or the consequences of long-standing psychological traumas that today block her path to motherhood. And far from always she perceives her gynecologist as a friend or adviser, before whom she can open her soul. Then a psychotherapist comes to the rescue.
“I think the proportion of psychogenic infertility will increase due to the COVID-19 pandemic,” says Irina Kuranosova, PhD, reproductive specialist and gynecologist at the Yauza Clinical Hospital. — A well-known fact: during the Great Patriotic War, many women, even without weight loss, experienced anovulation and amenorrhea — the body understood that conception should not be allowed in a monstrously stressful situation. And now we can say that we are living in an infectious war. On the one hand, a woman is afraid to plan a pregnancy for fear of getting infected: who knows what the consequences will be for herself and the fetus? On the other hand, getting acquainted with a huge number of amateurish opinions about vaccines, she is afraid to vaccinate, which supposedly can lead to infertility. Against the background of these fears, the brain gives a task to the ovaries — let's postpone the pregnancy for now! — and blocks full ovulation.”
“Up to 15% of all cases of infertility are the so-called infertility of unknown origin. But I am absolutely convinced that in five, seven, ten years, with the development of clinical and reproductive medicine, with the advent of new diagnostic methods, this percentage will be significantly lower.”
Immunologist
“If the female body is saturated with antibodies, is allergic to pollen, flowering, and so on, it can react aggressively to a short-term pregnancy,” says Irina Kuranosova, PhD, reproductive specialist and gynecologist at the Yauza Clinical Hospital. — After all, the embryo has ½ someone else's genetics — dad's. Therefore, if the patient immediately announces herself as an allergy sufferer, we simply do not begin to solve the problem of infertility until we receive the conclusion of the immunologist: everything is in order, the condition is compensated to an acceptable stage, the woman does not take drugs that are contraindicated during pregnancy or is transferred to approved drugs. .
An immunologist is also attracted if IVF attempts over and over again end in miscarriages or the pregnancy freezes at an early stage.
There is no hurry
you are unable to conceive within a year of regular intercourse without the use of contraceptives and you are under 35 years of age. Don't panic if you don't get pregnant after a month, three or five months after the man and woman decided «we should go now.»
“Exhale, calm down, don’t scroll through other people’s Instagrams in anxiety, don’t listen to anyone and put off the tests,” advises Irina Kuranosova, PhD, reproductive specialist and gynecologist at the Yauza Clinical Hospital. — The husband is not on a business trip, do you live together? Is the cycle regular? Are all important organs in place? Then give yourself freedom and do not rush to seek medical help. Any doctor is obliged to respond to the patient's request with actions: prescribe examinations, perform certain manipulations, and there is always a risk of getting to a not entirely conscientious specialist who will certainly find something to «treat». Don't hurt yourself!»
Important note: if partners are 35+, the deadline is reduced to six months. Over the years, a woman's follicular reserve progressively decreases, the level of anti-Müllerian hormone, which is responsible for reproductive potential, drops in both parents, and in this case it just makes sense to hurry up and give specialists more time to identify a possible problem and choose ways to eliminate it.