Reproductive health Is a state of complete physical, mental and social well-being in the absence of diseases of the reproductive system at all stages of a person's life.
Reproductive system Is a set of organs and systems of the body that provide the function of reproduction (childbirth).
The foundations of reproductive health are laid in childhood and adolescence. In order for healthy children to be born, every modern person must know how to maintain their reproductive health.
The sex of a person is laid in the first weeks of intrauterine development of the fetus. In the eighth week, when the fetus weighs about four grams, the genitals begin to form. The obvious external differences between boys and girls are the result of the work of sex hormones synthesized by the sex glands. Male sex hormones are called androgens, and female sex hormones are called estrogens. Androgens and estrogens are initially present in the body of opposite sexes, but the ability to reproduce is achieved only after the completion of the process of puberty.
The predominance of estrogens in the female body determines the cyclical processes that take place with the participation of the central nervous system. Even during puberty in girls, due to hormones, the contours of the body are rounded, the breasts increase, the pelvic bones become wider - in this way their body is gradually preparing for the fulfillment of the future function of reproduction.
The male body is stronger than the female due to androgens, although it is not always more enduring. It is no coincidence that nature has assigned the most important mission of bearing a child to a woman.
The state of reproductive health largely depends on the lifestyle of a person, as well as on a responsible attitude towards sex. Both affect the stability of family relations, the general well-being of a person.
An unwanted pregnancy is a negative factor affecting the state of reproductive function. Often a woman is faced with a difficult choice: to have a child or have an abortion. This problem is especially difficult to solve during adolescence. Abortion, especially during the first pregnancy, can cause serious mental trauma and in many cases even lead to irreversible reproductive disorders. At the same time, the decision to give birth often jeopardizes further studies, other life plans, therefore, each situation must be considered individually and carefully. For these situations to occur less frequently, adolescents need to have a mature understanding of the importance of reproductive health and the concept of family planning.
Family planning is necessary to accomplish the following tasks:
the birth of the desired healthy children;
maintaining the health of women;
achieving harmony in psychosexual relationships in the family;
implementation of life plans.
For many years, family planning was limited to birth control. However, first of all, this is ensuring the health of a woman who is able to give birth to children exactly when she herself wants it. In other words, family planning - This is the birth of children at will, and not by chance. The right to family planning is an internationally recognized right of everyone.
Family planning helps spouses consciously choose the number of children in the family, the approximate dates of their birth, plan their lives, avoiding unnecessary worries and worries.
The optimal age for the birth of children is 20 - 35 years. If pregnancy occurs earlier or later, it usually progresses with complications, and the likelihood of health problems in the mother and child is higher. The intervals between childbirth should be at least 2 - 2.5 years; this allows a woman to regain strength, maintain her health and the health of future children. In this regard, it should also be emphasized: abortion is by no means the best method of birth control; it can be avoided by using modern methods of contraception (prevention of unwanted pregnancy).
The teenager should not be isolated with his problems. He should know that a wise and tactful adult is always ready to help him.
Reproductive function is negatively affected by stress, especially chronic stress, nutritional quality, lifestyle. This happens not only under the influence of excessive factors, but also with toxicosis in pregnant women, when adaptation to changes during pregnancy becomes insufficient due to the low level of physical health of the mother.
Smoking affects sexual health, affects the exchange of sex hormones N Shirren found that people who smoke have half the sexual activity
Alcohol somewhat increases sexual desires, since it removes the inhibitory effect of upbringing and the external environment, but disrupts an erection.
The more a person drinks, the less sexual powers she has, the quality of the germ cells worsens.Under the influence of large doses of alcohol, the manifestation of sexual reflexes changes
Human sexuality can bring not only joy and happiness, but also great suffering, since many infectious diseases are sexually transmitted. These diseases are called sexually transmitted diseases. Most of them are not cured if diagnosed in time, but the damage caused by their pathogens affects reproductive health. "
Sexually active people, often change partners, should periodically undergo a medical examination, especially after changing a sexual partner, not to self-medicate.
In short, in order to maintain reproductive health, you need to follow a healthy lifestyle, eat well and properly, do not drink, do not smoke, do not get sexually transmitted infections (remember their consequences), use contraceptives (if you have an abortion, then it is also not a fact, that everything will end well)
Since the early 1990s, there have been negative shifts in the reproductive health of the female population. Gynecological morbidity is growing, the incidence of sexually transmitted infections remains at a high level, and the number of complications of pregnancy and childbirth is increasing.
Abortion remains a serious problem with adverse effects on reproductive health. As you know, abortion is always an operation that worsens a woman's health. Complications associated with abortion are manifested by infections of the genital tract, menstrual disorders, damage to the pelvic organs and tissues. One of the negative aspects of abortion is criminal or risky abortion, the outcome of which is often maternal death or disability. Every year in the world about 70 thousand women die as a result of unskilled abortion, a much larger number of women contract genital tract infections, injuries and traumas.
At present, the absolute number of abortions has decreased 3.5 times compared to 1995. On the whole in the republic in 2005 for the first time the ratio of the number of births to the number of abortions reached 1: 0.6,which is due to the purposeful work of the family planning service and teenage offices.
A serious problem to ensure safe motherhood is teenage pregnancy,according to the level of which Belarus until 2005 was among the countries with high indicators. The teenage pregnancy rate in most Western European countries ranges from 5 to 25 per 1000 girls aged 15-19. The highest rate in Belarus was in 1992 (110 per 1000 adolescent girls). In the last decade this indicator has decreased and amounted to 37.9 per 1,000 girls aged 15-19 in 2004, in 2005 - 13.4. The number of abortions in this age group in comparison with 1995 has decreased by 87.9%. The use of contraception by young people in our republic is significantly lower than the indicator of developed European countries (12%). A specific feature of adolescent abortions is a high percentage of termination of the first pregnancy (49.4%).
An important factor that reduces the reproductive potential of the population is reproductive losses due to miscarriage.One in five pregnancies is terminated by spontaneous miscarriage or premature birth.
Over the past decade, the rates of gynecological morbidity in women of reproductive age have increased:
inflammatory processes of the ovaries and fallopian tubes - 3.5 times;
endometriosis - 2.8 times;
erosion of the cervix - 2 times;
menstrual dysfunctions - 5.8 times;
uterine fibroids - 1.9 times;
There is an acute problem oncological diseases of the female reproductive system, of which more than half are breast cancer. The incidence rates of cancer of the uterine body have increased in the republic from 17.1 to 23.4 per 100 thousand of the female population. There is an increase in the incidence of ovarian cancer, and the incidence of young women under 24 has increased more than 4 times.
Reproductive health and sexually transmitted infections.
The level of diseases caused by sexually transmitted infections (STIs) remain high.There is an increase in the incidence of STIs among children and adolescents. In Belarus, as in other countries, more than half of the cases of the disease occur in the young age of 15-24, when most young people are little aware of these infections. Adolescent girls are biologically more vulnerable to sexually transmitted diseases than adults because their reproductive systems are not fully developed and are less immune to infections.
Inflammatory processes in STIs, as a rule, are of a sluggish nature. Flowing unnoticed, they acquire a chronic course, cause dysfunctions of the ovaries, fallopian tubes and can lead to infertility; often complicate the course of pregnancy, leading to spontaneous miscarriages, infection, congenital infections of the fetus.
The socially significant diseases include syphilis and gonorrhea. Their consequences are chronic inflammatory diseases of the genitourinary system, deterioration in the health of the offspring, and a decrease in general immunity. Often, gonorrhea causes adhesions that lead to infertility.
Peak incidence syphilisin Belarus it was noted in 1996, when 21.6 thousand new cases of this infection were registered, including more than three thousand cases in adolescents aged 15-19. Since 1996, the incidence of syphilis in general has decreased by 3.5 times. Among pregnant women in 2004, syphilis was registered in 202 women, of whom 74 were terminated, 8 children were born with congenital syphilis.
During the same period, the total incidence gonorrheadecreased by half. At the same time, the incidence of gonorrhea in adolescents aged 15-19 is 5 times higher than the overall incidence of this infection.
"Childbirth reserve groups".
The unfavorable demographic situation, the deteriorating health of the female population requires new approaches to planning and preparing families for pregnancy and childbirth, since the value of having a healthy child has increased significantly both for each family and for society as a whole.
At present, the republic has adopted and is improving a system of dynamic monitoring of women of the "delivery reserve group" (BRG), which includes women aged 18-40 years, planning to expand their reproductive needs. There are five health groups among GDHs.
First group- healthy women who do not have chronic diseases, in whom no deviations from the norm were found during the examination. The main tasks of their dynamic monitoring are the prevention of the occurrence of diseases, the prevention of unwanted pregnancy, the promotion of a healthy lifestyle, and the prevention of sexually transmitted infections.
Second group- practically healthy women who have undergone acute or chronic diseases with a stable recovery, in the absence of complaints, violations from all organs and systems, with normal working capacity. The tasks of the clinical examination of this group are the prevention of recurrence of the transferred diseases, together with other specialists, the solution of questions about the preparation for the planned pregnancy, taking into account the transferred extragenital pathology.
Third group- persons suffering from gynecological diseases (chronic inflammatory diseases of the female genital organs, benign tumors of the uterus, endometriosis, menstrual disorders, infertility, recurrent miscarriage, anomalies in the position and development of female genital organs, etc.). The main task of the prophylactic medical examination is treatment and rehabilitation in order to fully restore the reproductive function.
Fourth group- women suffering from extragenital pathology. Control over their health should be carried out with other specialists (therapists, endocrinologists, surgeons, urologists, neuropathologists). Preparation for pregnancy and childbirth of this group of dispensary observation should be carried out taking into account the nature and stage of compensation for extragenital disease. The selection of contraception is carried out depending on the existing pathology.
Fifth group- women suffering from both gynecological and extragenital pathology. The tasks of dispensary observation include: individual selection of contraceptive methods, solving the issue of the possibility of carrying the desired pregnancy and preparing for it.
Pregravid preparation.
In addition to solving the above tasks, women of HRD should be provided with information about the need for pre-conceptional preparation 3-6 months before the expected pregnancy.
Pregravid preparation includes:
Medical genetic counseling;
Screening for sexually transmitted diseases, their treatment;
Elimination of occupational hazards and social risk factors;
Identification and rehabilitation of foci of infection;
Medication preparation by creating antioxidant protection of the cells of the reproductive apparatus, eliminating the deficiency of macro- and microelements. For this purpose, folic acid, vitamin E, iron preparations, various vitamin and mineral complexes, antioxidants are recommended.
Family planning.
The family is the union of a man and a woman, giving rise to their rights and obligations in relation to each other, to children, based on kinship, raising children, community of life, interests, mutual care.
Family planning- the birth of the desired healthy children at the optimal time for the couple. Most babies nowadays are born from accidental pregnancies.
Family planning:
Helps regulate the onset of pregnancy at the optimal time to maintain the health of the mother and child;
Reduces the risk of infertility;
It makes it possible to avoid conception during lactation, accidental pregnancy;
Determines the number of children in the family and the intervals between births in accordance with the health status of the parents;
Provides for the choice of the method of contraception, which increases the responsibility of the spouses and prevents conflicts;
Provides the opportunity to build a career, avoiding the stress of unplanned pregnancy, sexually transmitted diseases;
Gives the man time to mature and prepare for fatherhood.
One of the family planning methods is contraception.
Contraception Is the prevention of unwanted pregnancy with minimal harm to one's own health and with the preservation of a decent, satisfying sexual life. The contraceptives recommended for adolescents must meet the modern requirements for contraception.
Principles of teenage contraception:
1. High efficiency (reliability) - this criterion is determined by the Pearl index (the number of pregnancies in 100 women who have used a certain method for one year). Pearl Index
2. The availability of contraceptives (availability on the pharmaceutical market, affordability, ease of use, ease of use, the possibility of using in adverse conditions).
3. Safety (determined, first of all, by harmlessness to health).
4. Reversibility (restoration of fertility after the cancellation of the method).
5. Individual approach (includes taking into account contraindications and background diseases, assessing social factors, character traits, parity, life plans, adolescent's attitude to the problem of contraception, behavioral stereotypes, bad habits).
Questions for self-control:
1. what is the demographic situation in Belarus?
2. Reproductive health status of women in Belarus.
3. Reproductive health concept.
4. Abortion as a method of birth control in Belarus and its consequences.
5. Childbirth reserve groups.
6. What does pre-conception preparation include?
7. Family planning principles.
8. Modern methods of contraception.
9. Contraception in different age periods.
The issue of preventing pregnancy, sooner or later, concerns almost all of us - both men and women. Using contraceptives wisely is a sure step towards maintaining your health. What methods of contraception are most common in the current period, their pros and cons - this is what should not be ignored today.
Contraception - prevention of unplanned pregnancy in case of accidental or regular sex life. Problems of contraception have been facing humanity since time immemorial, and in ancient times there were attempts to use certain methods of contraception.
Of 100 women of reproductive age, 36 do not use any
contraceptives: 4 - because they are infertile, 7 - have been sterilized,
5 - due to pregnancy, 13 - due to the absence of a partner, 7 - for various other reasons.
And 64 women practice contraception.
So, according to the mechanism of action, contraceptives can be divided into:
- Hormonal birth control pills
- Intrauterine contraception (introduction of a special spiral or loop into the uterus)
- Barrier contraception (condom, intravaginal diaphragm, tampons, sponges)
- CHEMICAL CONTRACEPTION (use of spermicidal drugs, etc.)
- Prolonged, that is, "long-term" hormonal contraception (the introduction into the body of drugs that protect against pregnancy for a period of three months to five years)
- Postcoital contraception - the use of special hormonal pills or the introduction of a spiral into the uterus within 3-5 days after intercourse
- Natural methods prevention of pregnancy (abstinence from sexual intercourse on certain days of the menstrual cycle)
- Sterilization (surgery to ligate the vas deferens in men and the fallopian tubes in women)
Content
To avoid abortions, it is necessary to explain to the younger generation in a timely manner what is meant by the term sex life, how to lead it correctly. Such upbringing helps to avoid rash acts on the part of young people, to protect the sexual sphere from pathologies, to exclude fatal events for their future.
What is Reproductiveness
The Ministry of Health, in order to reduce the number of abortions performed, the risk of early, unwanted pregnancy, has introduced certain norms that have been spreading among the masses for more than a decade. Reproductiveness is the ability to reproduce, to continue the human race. To maintain the health of the reproductive system, everyone must know the existing methods of contraception, take a responsible approach to the issue of family planning, procreation.
Human reproductive health
The biggest threat to humans is diagnosed infertility. Such a disease develops in the same way in the female and male body, and prevents procreation. More often it is an acquired condition, it is considered a consequence of abortion, pathologies and immoral sexual life. Everyone perceives the reproductive health of a person in his own way, however, according to the WHO standards, it is the mental, physiological, social readiness of an individual to begin sexual activity in order to procreate.
Women's reproductive health
The upbringing of girls influences their worldview already in adulthood. If parents from early childhood instill modesty, decency and selective attitude towards representatives of the opposite sex, a woman's reproductive health does not cause concern. If children are not aware, then an unplanned pregnancy is not the only complication that comes their way. Infections and venereal diseases, which are diagnosed in modern youth, are not excluded. Statistics show that the consequences can be the most tragic for a woman and her family.
Male reproductive health
The male factor of infertility is no less common in modern medicine. If a woman is not pregnant within six months after giving up all methods of contraception, there is a serious health problem. Male reproductive health is due to two factors - spermatogenesis and potency. The cause of the pathological process is stress, chronic fatigue, a lack of vitamins in the body, an improper lifestyle, bad habits, and internal diseases.
Reproductive health of adolescents
In adolescence, it is important to ensure the reproductive health of adolescents in order to protect them from reckless actions in the future. This important period begins with the onset of menstruation in girls and emissions in boys, but these are not the only changes in the reproductive system of the younger generation. Since adolescents do not adhere to body hygiene, enter into early marriages, choose drug addiction, smoking, and alcohol in life, the reproductive function decreases. The problem in modern society is taking on a global scale.
Reproductive health of the population
In conditions of insufficient ecology, the reproductive health of the population suffers noticeably. This global problem is being addressed at the national level to protect today's youth. A number of social programs have been developed, the main purpose of which is to explain to the population and all its social classes what health is at the reproductive level. In addition, tell about preventive measures aimed at ensuring the impeccable condition of the human genital area. The organization of such a process guarantees the physical and moral well-being of the population.
Factors affecting reproductive health
Such a concept arises even during the pregnancy of a woman who, even while carrying a fetus, must ensure its health at the reproductive level. For this, in modern gynecology there is such a definition as pregnancy planning. It is required to examine future parents - a woman and a man, to exclude congenital diseases, genetic pathologies. If diseases are identified, then they need to be treated in a timely manner, to prevent complications for the intrauterine development of the fetus. Factors affecting reproductive health are separately studied by modern medicine.
Factors affecting reproductive health
The first sign that a woman's condition is not all right is a disturbed menstrual cycle. As a result, the lack of stable ovulation and the inability to safely conceive a child. Sexual activity decreases, and the problem needs to be addressed at the gynecological level. Other factors affecting reproductive health can be divided into several categories:
- External causes: stress and chronic fatigue, bad habits and harmful production, unhealthy diet and a sedentary lifestyle, medication and psychosexual factors.
- Internal causes: infections, iodine deficiency and dysfunction of the endocrine system, hormonal imbalance and androgen deficiency, depletion of the body and immune imbalance, androgen deficiency and testosterone deficiency, folic acid deficiency.
Prevention of reproductive health disorders
In order to avoid an extremely undesirable deterioration in sexual function at any age of the patient, it is required to approach publicly available preventive measures with special responsibility. Knowing about them is required from the beginning of puberty, while adhering to the rest of your life, bringing to the consciousness of your own offspring. So, effective and reliable prevention of reproductive health focuses on such social and psychological complexes for each person:
- development of measures for the productive treatment of the genital area from viral, infectious diseases;
- treatment of psychological diseases; sexual dysfunction;
- planning pregnancy, the beginning of the first sexual relationship;
- prevention of sexually transmitted diseases;
- development of measures against infant and maternal mortality;
- treatment of androgen deficiency, hormonal imbalance;
- conducting lectures, seminars on the topic of early sexual life;
- explaining to the population the rights in relation to receiving assistance for young families;
- lectures on early pregnancy, sexually transmitted diseases, their symptoms.
Reproductive health care
To exclude androgenic insufficiency and other problems of the genital area, it is necessary to take care of the reproductive system and not only. The first step is to avoid a large number of sexual partners, exclude unprotected sex with strangers from your daily life, timely treat diseases of the reproductive system, and eliminate the risk of an unplanned pregnancy. Other reproductive health interventions that apply equally to women and men are:
- maintaining the reproductive health of both sexual partners with the help of vitamin therapy;
- the use of folic acid when carrying a fetus;
- provision of favorable environmental factors for planning, nursing pregnancy;
- prevention of early abortion;
- study of social issues of family planning.
Video: Protecting Women's Reproductive Health
Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can diagnose and give recommendations for treatment, based on the individual characteristics of a particular patient.
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Reproductive health of men, women and adolescents. Influencing factors and prevention of reproductive health
Reproductive health is a complex term and everyone understands it differently. If you follow the generally accepted definition that the World Health Organization gave this phrase, it means complete psychological, social and physical readiness to engage in sexual relations with the aim of procreation. Moreover, a person's reproductive health implies the absence of any infections and other unfavorable conditions of the body that can affect the unfavorable outcome of pregnancy, the impossibility of re-conception or the birth of a defective child.
Factors affecting reproductive health
There are just an incredible number of aspects that can negatively affect the ability to have offspring. So, what prevents the preservation of reproductive health:
- too early onset of sexual activity and its negative consequences;
- infections and diseases that are sexually transmitted;
- amoral behavior;
- poor environmental conditions and poor quality food;
- genetic disruptions and hormonal disorders;
- an abundance of addictions and so on.
The reproductive health of a man, as well as of a woman, must be preserved from infancy. This implies a timely examination by the appropriate doctors, compliance with the rules of personal hygiene of the child and the daily routine. can be triggered by many factors, such as alcoholism, steroid use, the habit of wearing tight underwear or taking a long steam bath.
Reproductive period
This term refers to a part of a man's or a woman's life during which they are able to safely conceive, bear and give birth to a child. This indicator is calculated differently in different countries as it is influenced by many statistical indicators. However, it is generally accepted that a woman is ready for procreation when her first menstruation begins, and the reproductive phase ends at the onset. The optimal age for a man should not exceed 35-40 years. Human ontogenesis and reproductive health are integral parts of each other. This fact is due to the fact that at each stage of his development, a person can, independently or under the influence, worsen or improve the quality of his life and the ability to reproduce his own kind.
Reproductive health care
Each state develops a set of legislative acts that establish the rights of the population to reproduce. The main measures taken in this area include:
- provision of free medicine;
- prevention of reproductive health disorders;
- passing compulsory medical examinations;
- explanatory work by social workers;
- increasing the level of material and moral well-being of the population, and so on.
Reproductive health and behavior is largely dependent on parenting tactics that are used in the family. After all, it is the close people who have the greatest influence on the young member of society and wish him only the best.
Reproductive health criteria
In order to assess the ability of a person to reproduce, a special system of general and specific criteria was created, such as:
The reproductive health of a person and society should become the norm of behavior of the population of any country, since it is through joint efforts that it is possible to correct the ever worsening demographic situation.
The modern data on the problem of reproductive function restoration are presented. Further achievements in this area can be associated with fundamental research at the molecular and genetic level, the development of the latest technologies and the improvement of methods for organizing the treatment process. Modern data on the problem of restoring reproductive function are presented. Further achievements in this area can be associated with fundamental research at the molecular and genetic level, the development of the latest technologies and the improvement of methods for organizing the treatment process.
Keywords:
reproductive health, infertility, assisted reproductive technologies, endoscopy.
The preservation and restoration of reproductive health is the most important medical and state task, the successful solution of which determines the possibility of reproduction of the species and the preservation of the gene pool.
The decline in the birth rate and the spread of small children have led to a fundamental change in the structure of medical care. If earlier most of the problems of a woman's reproductive period were associated with miscarriage, now a married couple is faced with the task of avoiding unwanted pregnancies, giving birth to the desired children, regulating the intervals between pregnancies, controlling the choice of the time of birth depending on the age of the parents and determining the number children in the family. The interrelation of these parameters characterizes a woman's reproductive behavior and is ensured by her reproductive health. It is known that if the frequency of infertile marriages reaches or exceeds 15%, then the problem of infertility in this case acquires state importance. According to researchers, the frequency of infertile marriages in our country is 12-15% and tends to grow. In this regard, the problem of diagnosis and treatment of infertile marriage is extremely relevant in obstetric and gynecological practice and in medicine in general.
Before making a comprehensive conclusion about the cause of infertility, you should consider the possible influence of geographic and socio-economic factors. Genital tuberculosis is common in Scotland, the Mediterranean and Southeast Asia, but is unusual in Australia, with the exception of immigrants. Obstruction of the fallopian tubes due to gonococcal infection is common in parts of Africa and New Guinea, while in Western countries the consequences of complicated abortion are more common cause of obstruction, especially where they are prohibited. In Western countries, the nature and frequency of some pathological disorders leading to infertility can be explained by socio-economic reasons. So, endometriosis and ovulation disorders are more common in women belonging to the wealthy classes, while the poor are characterized by obstruction of the fallopian tubes due to infection.
Medical and sociological research carried out at the Center showed that in 93% of women infertility leads to mental and social discomfort, reduces social adaptation, professional activity, and increases the number of divorces. Thus, infertility is important not only for individuals, but has an impact on society as a whole, reducing the social and professional activity of this population group.
The last decades of the outgoing century are characterized by significant advances in the diagnosis and treatment of various forms of infertility. Suffice it to say that if at the beginning of the 20th century there were practically no scientifically based methods of treating infertility, then at the end of the same century the problem of diagnosing and treating infertility can be considered fundamentally solved. The main scientific achievements that made it possible to solve the problem of infertility were:
1. Deciphering the mechanisms of endocrine control of a woman's menstrual cycle. Numerous experimental and clinical studies have made it possible to understand the basic patterns of follicular growth, ovulation and development of the corpus luteum, to characterize the features of gonadotropic regulation of these processes. The obtained data, combined with the results of studying the secretion of sex and gonadotropic hormones in the dynamics of the menstrual cycle, served as the basis for creating ideas about the system of relationships that ensure the cyclic activity of the woman's reproductive system. As a result of scientific research, hormonal drugs have been synthesized: estrogen-gestagenic (oral contraceptives), gestagens, antiestrogens, gonadotropins, gonadotropin-releasing hormones, agonists and antagonists of gonadotropin-releasing hormones. Modern obstetric and gynecological practice cannot be imagined without the use of hormonal drugs. The range of their application is extensive; contraception, treatment of endocrine forms of infertility, stimulation of superovulation in the in vitro fertilization program, prevention and treatment of severe gynecological diseases such as endometriosis, hyperplastic processes in the uterus and mammary glands, uterine fibroids, cancer. The past decades can rightfully be called the era of hormonal drugs.
2. The introduction of endoscopic methods into clinical practice was the second most important stage, which ensured the effectiveness of diagnosis and treatment of infertility. Moreover, the advances in endoscopic surgical technologies have completely changed the approach to surgical interventions on the pelvic organs in women of reproductive age. If earlier the task of the surgeon was to remove the damaged organ or formation by gastrointestinal surgery, now the main goal is to eliminate pathological changes while maintaining the integrity of the reproductive organs and the reproductive function of a woman. The experience of the Center over the past 15 years of operation, consistent with world experience, clearly demonstrates the development of endoscopic technologies. If in the mid-80s laparoscopy among surgical interventions for infertility was 15%, while it was mainly a diagnosis, then by the end of the 90s all operations for infertility are performed only by endoscopic access, and all of them are surgical. At the first stages, laparoscopic interventions were performed for adhesions in the small pelvis and obstruction of the fallopian tubes, and the presence of previous gluttony, hydrosalpinxes, and masses in the small pelvis (uterine fibroids, large ovarian cysts) was regarded as a contraindication to endoscopic access. Currently, almost all gynecological operations, up to hysterectomy, can be performed endoscopically. Moreover, modern attitudes regarding the volume of surgical interventions have also changed in older women who are not interested in preserving reproductive function. Now many women are tuned in to carry out organ-preserving surgeries or surgeries without opening the abdominal cavity, which contributes to the priority of endoscopic methods in operative gynecology.
3. The most important and fundamental stage in the treatment of infertility was the development and introduction into clinical practice of methods of in vitro fertilization (IVF). This stage can be called final at this level of development of science and practice in solving the problems of infertility. The IVF method made it possible to realize the function of childbearing in such forms of infertility, which were previously considered absolutely unpromising for treatment: the absence or complete obstruction of the fallopian tubes, the absence or depletion of the ovaries, even the absence of the uterus is not an absolute obstacle to the birth of a child. However, the use of reproductive technologies and their successes are perceived by the public and by the researchers themselves ambiguously, a number of moral and ethical questions arise, for example, about the status of the human embryo, the age from which it is considered as a person protected by law, the legality of manipulations on the germ cells and human embryos as with medical and research purposes; the eligibility of freezing human embryos, oocytes and spermatozoa and their use for recipients; the rights and obligations of germ cell donors; the right to use a "surrogate mother", the right to choose the sex of the fetus without medical indications, etc. In Russia, these problems are practically not discussed by the public, and there are no legislative acts on most of the listed issues. Meanwhile, the solution of these problems is not a question of the future, but an urgent need of the present time.
The use of modern hormonal, ultrasound and endoscopic methods made it possible to diagnose the form of infertility and to determine the tactics of treating the patient within a few days of examination, whereas before it took months and even years. Thus, the economic feasibility of using precisely modern, highly informative diagnostic techniques is undoubted, despite their high cost. Despite the differences that are introduced by geographical and socio-economic factors, the identified causes of infertility can be grouped.
Traditionally and quite justifiably, endocrine forms of infertility are distinguished in the structure of infertile marriage - 30-40%; tubal peritoneal infertility - 50-60%; combined forms of infertility - 20-30%. Studies devoted to the diagnosis and treatment of endocrine forms of female infertility have led to some theoretical generalizations, which were the basis for therapeutic measures. So it was proved that anovulation is the cause of endocrine infertility in women, and the mechanism of anovulation is the same for all types of infertility; it consists in a violation of the implementation of connections in the hypothalamic-pituitary-ovarian system. Early detection, correct diagnosis of the type of violation, the use of adequate treatment methods leads to the onset of pregnancy in 60-90% of women, which allows us to consider the problem of implementing the function of childbearing in endocrine forms of infertility, in principle, solved. In addition, the treatment of endocrine forms of infertility is justified in medical and social aspects, since 82% of induced pregnancies endure and end with the birth of live children, and the health of the children born does not differ from the population norm. Childbearing contributes to the normalization of the social and psychological status of a married couple, strengthening family relations.
Endocrine infertility in the overwhelming majority of cases does not depend on the nature of a woman's reproductive behavior and her reproductive history. Another thing is infertility of tubal-peritoneal genesis, the largest group of patients in the structure of infertile marriage. The main causes of these forms of infertility continue to be abortions, sexually transmitted infections, surgical interventions on the pelvic organs, performed by the method of celiac disease.
Our experience has shown that with the III-IV degree of the spread of the adhesive process in the small pelvis, sactosalpinx, obstruction of the only fallopian tube, in combination with an older woman's age, prolonged infertility, the presence of repeated surgical interventions or infection, the methods of endoscopic microsurgery are not very promising for the restoration of reproductive function women. The combined use of endoscopic and IVF methods makes it possible to realize reproductive function in 40-50% of women with tubo-peritoneal or absolute tubal infertility. Thus, the issues of preserving reproductive function and preventing infertility are the most relevant for this contingent of women. This includes health education, family planning counseling, contraception, and the identification and treatment of genital infections. For many years, infertility was considered a purely female problem, which largely led to the intensive study of this issue and the success achieved in the field of its diagnosis and treatment. At the same time, it is correct to consider the problem in the context of infertile marriage, highlighting female, male and combined factors of infertility. It is known that the share of female and male factors in the structure of infertile marriage is approximately equal. Advances in reproductive technologies have made it possible to introduce the ICSI method into clinical practice - the injection of spermatozoa into the cytoplasm of oocytes. Using this method, it is possible to solve the problem of paternity even in the most severe forms of male infertility. The successful solution of the problems associated with the diagnosis and treatment of infertility has led to the setting of new tasks, since the goal of infertility treatment is not only the onset of pregnancy, but primarily the birth of healthy children while maintaining the health of the woman. The development of methods for managing pregnancies resulting from the use of various methods of treating infertility, prevention of intrauterine fetal pathology is relevant today. In this regard, excessive enthusiasm for hormonal drugs used in miscarriage is hardly justified and indifferent to the health of the born child. Currently, a whole generation of children born using reproductive methods have reached childbearing age. Questions concerning the state of reproductive health of this contingent and the health of the third generation, i.e. children born by them are extremely relevant. No less urgent is the problem of the influence of the methods used to achieve pregnancy on the health status of the treated women. It is known that stimulation of ovulation and superovulation can lead to the development of severe forms of ovarian hyperstimulation syndrome, characterized by a disruption in the activity of all systems of the woman's body and posing a threat to her life. The solution of these issues becomes even more urgent in connection with the emerging social trend of having children by older women, more often over 40 years old.
There is no doubt that disease is better prevented than cured. Therefore, noting the undoubted successes in the field of restoration of reproductive function and treatment of infertility, all the same, the priority tasks should be considered complex medical and social measures aimed at preserving the reproductive health of the population. This is the regulation of reproductive behavior, prevention of unwanted pregnancy, reduction of the number of abortions, prevention of sexual infection. The implementation of these measures will contribute to the birth of healthy children in a natural way and reduce the role of reproductive technologies in the reproduction of offspring. Further advances in the restoration and preservation of human reproductive function are likely to develop in three main directions:
The first is fundamental research at the molecular and genetic level, which makes it possible to reveal the subtle mechanisms of the processes of folliculogenesis, ovulation, spermatogenesis, fertilization, nidation and implantation of an egg, and the pathological course of pregnancy. Knowledge of the above mechanisms will determine the effective implementation of a number of preventive and therapeutic measures in the restoration and preservation of reproductive function in women and men. The second is the further development of new medical technologies (methods of assisted reproduction, new drugs and schemes for stimulating ovulation, modification of endoscopic operations, the introduction of extracorporeal methods into obstetric and gynecological practice - plasmapheresis, plasma filtration, immunosorption, methods of blood photomodification, reduction of fetuses in multiple pregnancies), which will be carried out both on the basis of fundamental biological research in the field of reproduction, and on the basis of the development of medical technology.
And, finally, the third direction is the improvement of the methods of organizing the treatment process. Only a good organization will make it possible to really introduce new medical technologies developed on the basis of fundamental research results into practical health care.
The state of the reproductive health of the population is a subject of interest not only to medical practice, but also to the world community. The reproductive health of women stands out for its socio-political significance, since it is directly related to the health of children, and therefore - to the future of the state and nation.
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