Problems with the tubes, or so-called tubal factor, are one of the most common “culprits” for infertility in a woman. These are the fallopian tubes in which sperm cells reach the egg, and through where, after the fertilization, the new expectant life needs to reach the uterus. It is understandable why any obstacle or problem on this "highway" may prevent conception.

The tubes may have been damaged due to past abdominal surgery, endometriosis or infections of the genitals. The tubes may be blocked by adhesions (membranes), which interfere with their natural movements; may be clogged or both. The tubes may be affected in different zones - at the end from the side of the uterus, at the end from the side of the ovary, or even along their entire length.


If there is a problem with the tubes, it is important to know:

• This is not a judgment on merits. Thirty years ago the tubal factor was incurable, but with the first successful In vitro procedure the medicine found out how to deal with the problem. Thanks to the method "In vitro" millions of women worldwide have given birth to healthy children.

• Treatment of problematic pregnancy is not applied before the condition of the tubes is checked.


These are a wide range of problems that may prevent ovulation and consequently, the separation of a suitable egg for fertilization.

These problems are associated with the secretion of the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary. The disrupted balance in their synergic functioning leads to lack of ovulation.

The reason may be due to other serious problems - previous surgical treatment on the pituitary gland, pituitary tumors, brain tumors or interruption of the connections between the brain and the pituitary.

You have to be aware that the problems with ovulation are mostly functional and are rarely due to diseases (less than 1%).

These conditions are treated with medications and in most of cases do not require an In vitro procedure.


This means inflammation of the pelvic organs (uterus, fallopian tubes, ovaries, etc.), which are located in the female pelvis. The consequences of these infections most often lead to the main factor of female infertility - a blockage of the fallopian tubes.

The pelvic inflammatory disease may be due to many different reasons and in fact wearing inappropriate clothes is almost never a reason for this disease: The actual reasons may be:

• Diseases, transmitted sexually;

• Inflammation of other organs in the pelvis, which has affected the pelvis (appendicitis, kidney inflammation, severe inflammation of the bladder);

• Curettages, performed with unsterile instruments;

• Improperly installed spiral into the uterus;

Rarely may it happen through the blood circulation when there is another inflammation in your body.

Important to know: not any inflammation causes an obstruction or blockage of the tubes.

MYOMA /fibroids

The uterus is composed of specific muscle - myometrium that surrounds the mucosa called endometrium. This is where the embryo attaches itself and the pregnancy is carried to term. The muscle with its outer portion is involved in the birth of the baby, causing contractions, and with its gentle inner layer it also helps the implantation of the embryo. Therefore, its integrity is of great importance for the childbearing function of a woman.

A very large percentage of women aged over 35 have the same problem. In the myometrium are formed some benign ) tumors (very rarely malignant) – fibroids, that distort the uterine and cause irregular bleeding, inflammatory changes of the endometrium, menstrual pain, contractions, and thus, block the vents of the fallopian tubes and significantly deplete the fertility of a woman, and her ability to carry a pregnancy to term.

How do myomas cause problems?

The important factor in this case is the position of the myoma in the uterus, not its size. There are large myomas that do not hamper the pregnancy, but there are some myomas that block the penetration of the sperm in the fallopian tubes, damage and deform the inside of the uterus, and this is how the sperm deviates from its direction or impedes the implantation of the embryo.


Becoming more and more common and worrying, this condition causes a halt of a woman’s menstruation or the functioning of a woman's ovaries before she reaches the age of 35.

What does this mean?

Girls are born with all the eggs that later should ripen in their ovaries. When their puberty begins, the egg’s maturation starts as a periodical cycle, usually one egg each month.

In the ovary there is a great number of immature eggs waiting to carry out their mission. When their number begins to decline rapidly, gynecologists call this condition depletion of the ovarian reserve. This process reaches a point when no immature oocytes remain in the ovaries and, thus a premature menopause occurs.

The reasons that cause this condition, in most cases, are complex or still remain a mystery.

Nowadays, only a few of these reasons are known to the medicine:

  • Treatment of cancer: chemotherapy and radiotherapy affect the gentle ovarian tissue and often lead to depletion of the ovarian reserve (cured girls fall into premature menopause).
  • Autoimmune and systemic diseases: a very broad range of serious diseases, such as systemic lupus, Raynaud's syndrome, dermatomyositis, scleroderma, etc), may lead to a condition in which a woman’s organism "attacks" its own ovaries, thus slowly and gradually it destroys its own function and a woman’s capability to produce offspring. This does not necessarily mean that if any of you have a similar disease, you will necessarily suffer from early menopause. Our advice in these cases is to consider your plans for having a baby as soon as possible.
  • Your lifestyle: Factors such as too much smoking and excessive amount of stress are other factors that are relevant to early menopause. It has been proven that women with active social life and jobs, requiring a lot of responsibility, are much more likely to experience the condition in which their ovaries cease to function prematurely.
  • · Genetic causes: if your mother or grandmother has had an early menopause, it may also happen to you, but it does not mean that it is 100% sure.
  • · However, we should not speculate when it comes to a condition such as a depletion of ovarian reserve.
  • · If you respond with difficulty to stimulation or you have disturbances in your ovulation, this does not necessarily mean a depletion of the ovary functions, because this condition may be a result from at least ten other reasons.
  • · The real reason for your condition can be most precisely defined by a specialist in reproductive medicine. Therefore, we advise you, if you have any doubts or symptoms of depletion of your ovarian reserve, do not wait too long, and immediately contact the Center for Reproductive Health.


  • Endometriosis is one of the most tricky conditions that specialists in reproductive medicine have to deal with. This is a condition in which the uterine lining becomes implanted and grows inside the uterus. It prevents the normal function of the ovaries, the tubes and the uterus, lowers the embryo’s quality and reduces the ability of the egg to be fertilized.


  • Pain: The pain depends on the places where the endometriosis has implanted itself. The pain may be felt along the entire lower part of the abdomen, in the vagina and even in the waist .The pain may be constant, only during the menstrual cycle, during sexual intercourse, when the bladder is full at the time of ovulation. You can have all of the symptoms, some of them or just not have any, depending on where the endometriosis is located.
  • Important: Endometriosis pain is a non-specific symptom. If you feel some pain, this does not mean that you necessarily have endometriosis.
  • Untimely bleeding: bleeding between two consecutive menstrual cycles, after intercourse, blood in your urine or excrements, can also be due to endometriosis, but again we would like to outline that all of these symptoms may be a due to many other reasons.
  • Unruptured follicle Syndrome : Known as a Luff syndrome this is one of the unpleasant complications, or mainly, a symptom of endometriosis. In simple words: the follicle grows and inside it there is an egg. The time for ovulation comes but it does not occur. Slowly and gradually the follicle becomes a small cyst (about 4 cm). This cyst begins to turn into yellow body i.e. it is luteinizing. The egg remains trapped and ends its mission without success.
  • Similar to the above symptoms, the reason for the Luff syndrome of unruptured follicle may be due to some other problematic zones (for example, adhesions around the ovaries). And yet, when after tracking several monthly cycles, it has been defined that the follicle has not burst, you should think of endometriosis as a diagnosis. Deliberately we say "several" because almost every woman happens to have an unruptured follicle during her monthly cycles. But when it happens regularly - then there is a problem.


  • Ultrasound examination: Endometrial foci cannot be seen via ultrasound examination, except when they are located deep in the ovary, in the formation of so-called 'chocolate' cysts.
  • Laparoscopy: The only 100% reliable method for the diagnosis of endometriosis is the surgical method and usually this is the laparoscopy method. Laparoscopy is an endoscopic intervention, in which in the abdomen of a woman is inserted a special device through a small incision, below the navel, in order the physician to examine the pelvic organs.

It may be surgical, with medications or a combinaction from both of them, usually the surgery is performed first and then follows the treatment with medications.

  • Surgery includes the removal of adhesions, burning with electricity or laser the endometriomas to which there is access. This is what your physician does during a laparoscopy procedure or during an open surgery. We should mention that chocolate cysts of endometriosis are treated only surgically.
  • Medical treatment: Endometriosis feeds (as well as the lining of your uterus) with your hormones and more particularly this is the estradiol. The estradiol makes the endometrium grow and prepare for implantation, and in the same time theendometriomas grow slowly. Therefore, drug therapy is associated with medications that stop the production of estrogens. When there are no estrogens, endometriomas slowly dry up. The general idea is the ovaries´ function to be suppressed which will stop the spread of the endometriosis foci.
  • Important to know: Even after a successful course of treatment, endometriosis may reappear in a large percentage of cases.


This is a problem in which a woman's hormones are out of balance. The natural condition is when the egg maturation and the growth of the follicles stop at some stage of their development. When the follicle starts to grow, but in the middle of that stage it stops growing, then the ovulation does not occur. During the next cycle begins to grow another follicle, which also stops growing. Thus, in both ovaries are accumulated a lot immature follicles that cannot reach their stage of growth. Such ovaries, with many immature follicles, are called polycystic ovaries.

The Polycystic ovarian disease is characterized by increased production of male hormones in a female body, more difficult absorption of glucose, called glucose resistance, and in many cases overweight.


When the hormone prolactin is elevated, it blocks the ovulation and prevents the implantation of the embryo in the uterus. The higher prolactin levels can be a sign of a functional disorder, as well as a sign of benign tumors of the pituitary gland, called prolactinoma.

You should know that any stress on the body causes a rise in prolactin.

Therefore, this hormone analyses is carried out in the morning after a good night’ sleep, and after a minimum of 15 minutes rest in the laboratory.


Medications, thyroid problems, cancers/oncological diseases and their treatment


Late puberty, the primary lack of a monthly cycle, Cushing's disease, thalassemia in its worst forms, kidney disease and diabetes can lead to a lack of fertility in women.


High doses of caffeine, alcohol and cigarettes, advanced reproductive age, low weight or overweight

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