38 medical and social aspects and consequences of infertility. Infertility as a socio-medical problem
The relevance of the chosen topic lies in the need to increase the birth rate in Russian Federation to overcome the difficult demographic situation
object is infertility.
Subject: the role of social workers in the prevention of infertility.
aim control work is to study the causes of infertility in men and women and the role of social workers in the prevention of infertility.
Barren marriage.
Infertility- the inability of persons of working age to reproduce offspring. A marriage is considered infertile if a woman's pregnancy does not occur within a year of regular sexual activity without the use of contraceptives and methods. Infertility can be male or female. The male factor in a childless marriage is 40-60%.
Therefore, the diagnosis of infertility in a woman can only be made after the exclusion of infertility in a man (with positive tests confirming the compatibility of sperm and cervix).
Female infertility can be primary (in the absence of a history of pregnancy) and secondary (in the presence of a history of pregnancy). There are relative and absolute female infertility. Relative- the possibility of pregnancy is not excluded. Absolute - pregnancy is not possible. According to the WHO classification, the main groups of causes of infertility are distinguished:
violation of ovulation 40%
tubal factors associated with pathology of the fallopian tubes 30%
gynecological inflammatory and infectious diseases 25%
unexplained infertility 5%
The primary incidence of infertility, according to official statistics, was in 1998. 134.3 per 100,000 women. In total, 47,322 women applied for infertility during the year. These are married women who want to have children and who have applied to a medical institution, therefore, the real level of infertility is much higher. According to special studies, the number of infertile marriages in Russia is 19%, according to international experts 24-25%. Thus, one in five married couples cannot have children.
The causes of infertility are socially determined, being the result of abortions, sexually transmitted, gynecological diseases, and unsuccessful births. Infertility often develops during childhood. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortions, healthy lifestyle life and optimal sexual behavior.
Infertility is an important medical and social problem, as it leads to a decrease in the birth rate. By solving the problem of infertility, it would significantly improve the reproduction rates of the population. Infertility is an important socio-psychological problem, as it leads to socio-psychological discomfort of spouses, conflict situations in the family, and an increase in the number of divorces.
Social and psychological trouble is manifested by a decrease in interest in ongoing events, the development of an inferiority complex, a decrease in overall activity and performance. In marriage, coarsening of morals, antisocial behavior (extramarital affairs, alcoholism), aggravation of selfish character traits, a violation of the psycho-emotional sphere and sexual disorders in spouses can be observed. Prolonged infertility creates a large neuro-psychic tension and leads to divorce. 70% of infertile marriages end.*
Diagnosis of infertility is carried out by antenatal clinics, family planning service. And in some cases, inpatient treatment in gynecological departments is required.
"Infertility as a social and medical problem".
1. Fruitless marriage.
2. Female and male infertility.
3.Abort as a social phenomenon.
4. The role of social workers in the prevention of infertility.
Relevance chosen topic is the need to increase the birth rate in the Russian Federation to overcome the difficult demographic situation
object is infertility.
Subject: the role of social workers in the prevention of infertility.
The purpose of the control work is to study the causes of infertility in men and women and the role of social workers in the prevention of infertility.
Barren marriage.
Infertility- the inability of persons of working age to reproduce offspring. A marriage is considered infertile if a woman's pregnancy does not occur within a year of regular sexual activity without the use of contraceptives and methods. Infertility can be male or female. The male factor in a childless marriage is 40-60%.
Therefore, the diagnosis of infertility in a woman can only be made after the exclusion of infertility in a man (with positive tests confirming the compatibility of sperm and cervix).
Female infertility can be primary (in the absence of a history of pregnancy) and secondary (in the presence of a history of pregnancy). There are relative and absolute female infertility. Relative- the possibility of pregnancy is not excluded. Absolute - pregnancy is not possible. According to the WHO classification, the main groups of causes of infertility are distinguished:
violation of ovulation 40%
tubal factors associated with pathology of the fallopian tubes 30%
gynecological inflammatory and infectious diseases 25%
unexplained infertility 5%
The primary incidence of infertility, according to official statistics, was in 1998. 134.3 per 100,000 women. In total, 47,322 women applied for infertility during the year. These are married women who want to have children and who have applied to a medical institution, therefore, the real level of infertility is much higher. According to special studies, the number of infertile marriages in Russia is 19%, according to international experts 24-25%. Thus, one in five married couples cannot have children.
The causes of infertility are socially determined, being the result of abortions, sexually transmitted, gynecological diseases, and unsuccessful births. Infertility often develops in childhood. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortion, promoting a healthy lifestyle and optimal sexual behavior.
Infertility is an important medical and social problem, as it leads to a decrease in the birth rate. By solving the problem of infertility, it would significantly improve the reproduction rates of the population. Infertility is an important socio-psychological problem, as it leads to socio-psychological discomfort of spouses, conflict situations in the family, and an increase in the number of divorces.
Social and psychological trouble is manifested by a decrease in interest in ongoing events, the development of an inferiority complex, a decrease in overall activity and performance. In marriage, coarsening of morals, antisocial behavior (extramarital affairs, alcoholism), aggravation of selfish character traits, a violation of the psycho-emotional sphere and sexual disorders in spouses can be observed. Prolonged infertility creates great neuro-psychic tension and leads to divorce. 70% of infertile marriages end.*
Diagnosis of infertility is carried out by antenatal clinics, family planning service. And in some cases, inpatient treatment in gynecological departments is required.
Abortion.
According to experts, from 36 to 53 million abortions are performed annually in the world, i.e. every year, about 4% of women of childbearing age undergo this operation. In Russia, abortion remains one of the methods of birth control. In 1998 1,293,053 abortions were performed, which is 61 per 1,000 women. If at the end of the 80s 1/3 of all in the world, then since the beginning of the 90s, thanks to the development of family planning services, the frequency of abortions has been gradually decreasing. However, in Russia, compared with other countries, they still remain high.
In most countries of the world, abortion is legal. Only for 25% of women in the world, the reproduction of a legal aorta is not available (mostly they are residents with a pronounced clerical influence or a small population). In all European countries ah, with the exception of the Republic of Ireland, Northern Ireland and Malta, abortion is permitted. IN different countries There are various laws that govern the procedure for terminating a pregnancy.
L.V. Anokhin and O.E. Konovalov
1. Laws allowing abortion at the request of a woman. In most European countries, abortion can be performed up to 12 weeks of pregnancy, in the Netherlands up to 24 weeks, in Sweden up to 18 weeks. The age at which a girl can independently decide on an abortion:
UK and Sweden - after 16 years
Denmark and Spain - after 18 years
Austria - after 14 years.
In a number of countries (Italy, Belgium, France), a woman is given 5-7 days without fail to think and make an informed decision. These laws operate in countries where 41% of the world's population lives.
2. Laws allowing abortion for social reasons. About 25% of women in the world have the right to an abortion for social reasons.
3. Laws restricting the right to abortion. In a number of countries, abortion is allowed only in case of a threat to the woman's physical or mental health: congenital deformities, rape. Approximately 12% of the world's population live in conditions where the right to abortion is restricted.
4. Laws prohibiting abortion under any circumstances.
In the USSR legislation on abortion, three stages can be distinguished:
Stage 1 (1920-1936) - legalization of abortion.
2. stage (1936-1955) - the prohibition of abortion.
3rd stage (1955 to our time) - permission for abortion.
Currently, in Russia, any woman has the right to have an abortion at a gestational age of up to 12 weeks. Artificial termination of pregnancy for medical reasons is carried out with the consent of the woman, regardless of the gestational age. The list of medical indications is determined by Order of the Ministry of Health No. 242 dated 12/12/96, artificial termination of pregnancy up to 22 weeks of pregnancy can be performed with the consent of the woman for social reasons.*
The system of prohibitions, including abortion, does not lead to the desired results. The ban on abortion and the lack of family planning programs lead to an increase in the number of criminal abortions. Teenagers use criminal abortion to terminate their first pregnancy. At the same time, in developing countries, more than half of maternal deaths are due to criminal abortions.
But even legal abortion has a serious negative impact.
* "Organization of the work of the antenatal clinic"
on the woman's body.
Abortion is the cause of secondary infertility in 41% of cases.
After an abortion, the frequency of spontaneous miscarriages increases by 8-10 times.
About 60% of primiparous women over the age of 30 suffer from miscarriage caused by first abortions. In young women who terminate their first pregnancy with an abortion, the risk of developing breast cancer increases by 2-2.5 times.
The role of social workers in the prevention of infertility.
Within the competence social services it is possible to provide the population with specialized medical and psychological advice on the regulation of childbearing. Family planning- this is freedom in deciding the issue of the number of children, the timing of their birth, the birth of only desired children from parents ready for a family.
Family planning:
helps a woman regulate the onset of pregnancy at the optimal time to preserve the health of the child, reduce the risk of infertility; reduce the risk of contracting sexually transmitted diseases;
makes it possible to avoid conception during breastfeeding, reducing the number of conflicts between spouses;
guarantees the birth healthy child in case of unfavorable prognosis for offspring;
contributes to the decision about when and how many children a particular family can have;
Increases the responsibility of spouses to future children, cultivates discipline, helps to avoid family conflicts.
Provides the opportunity to have sex without fear unwanted pregnancy, without exposing yourself to stress, freely continue your studies, master a profession, build a career;
It gives husbands the opportunity to mature and prepare for future fatherhood, helps fathers provide for their families financially.
Childbirth is regulated in three ways:
1. Contraception
2. sterilization
CONTRACEPTION.
In economically developed countries of the West, more than 70% of married couples use contraceptives. About 400 million women in developed countries use various methods contraception to prevent unwanted pregnancy. Over 30 years of family planning services around the world, more than 400 million births have been avoided.
In Russia, the proportion of couples who use contraception against unwanted pregnancies is lower than in the economically developed countries of Europe, but there are no official statistics. Statistical records are kept only on the number of intrauterine devices and hormonal contraception. So, in 1998, 17.3% of women of childbearing age with intrauterine devices and 7.2% of those using hormonal contraception were under observation. It should be noted that while the number of women using spirals has not changed significantly since 1990, the number of women using hormonal contraception has increased by 4.3 times. Special Studies show that in Russia approximately 50-55% of married couples are regularly protected from pregnancy.
The relevance of the chosen topic is the need to increase the birth rate in the Russian Federation to overcome the difficult demographic situation
object is infertility.
Subject: the role of social workers in the prevention of infertility.
The purpose of the work is to study the causes of infertility in men and women and the role of social workers in the prevention of infertility.
INFERTILITY MARRIAGE.
Infertility- the inability of persons of working age to reproduce offspring. A marriage is considered infertile if a woman's pregnancy does not occur within a year of regular sexual activity without the use of contraceptives and methods. Infertility can be male or female. The male factor in a childless marriage is 40-60%.
Female infertility can be primary (in the absence of a history of pregnancy) and secondary (in the presence of a history of pregnancy). There are relative and absolute female infertility.
Relative- the possibility of pregnancy is not excluded.
Absolute - pregnancy is not possible.
According to the WHO classification, the main groups of causes of infertility are distinguished:
- violation of ovulation 40%
- tubal factors associated with pathology of the fallopian tubes 30%
- gynecological inflammatory and infectious diseases 25%
- unexplained infertility 5%
The primary incidence of infertility, according to official statistics, was in 1998. 134.3 per 100,000 women. In total, 47,322 women applied for infertility during the year.
The causes of infertility are socially determined, being the result of abortions, sexually transmitted, gynecological diseases, and unsuccessful births. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortion, promoting a healthy lifestyle and optimal sexual behavior.
Infertility is an important medical and social problem, as it leads to a decrease in the birth rate. Infertility is an important socio-psychological problem, as it leads to socio-psychological discomfort of spouses, conflict situations in the family, and an increase in the number of divorces. fertility infertility social
Social and psychological trouble is manifested by a decrease in interest in ongoing events, the development of an inferiority complex, a decrease in overall activity and performance. In marriage, coarsening of morals, antisocial behavior (extramarital affairs, alcoholism), aggravation of selfish character traits, a violation of the psycho-emotional sphere and sexual disorders in spouses can be observed. Prolonged infertility creates great neuro-psychic tension and leads to divorce. 70% of infertile marriages are dissolved.
Genetic factors as general biological constants. Genotype as a set of genes, healthy and pathologically altered, received from parents. Mutations are changes in genes that occur throughout an individual's lifetime.
Groups of diseases caused by genetic risk.
Chromosomal and gene hereditary diseases(Down's disease, hemophilia and others).
· Hereditary diseases arising under the influence of external factors (gout, mental disorders, etc.).
· Diseases with hereditary predisposition (hypertension and peptic ulcer, eczema, tuberculosis, etc.).
6. Infertility as a social and medical problem. Barren marriage. Female and male infertility. The role of social workers in the prevention of infertility.
Infertility- the inability of persons of working age to reproduce offspring. A marriage is considered infertile if a woman's pregnancy does not occur within a year of regular sexual activity without the use of contraceptives and methods.
Infertility can be male or female.
Causes of female infertility: impaired egg maturation, impaired patency or contractile activity of the fallopian tubes, gynecological diseases. Endocrine causes of female infertility.
Seek immediate medical attention for menstrual irregularities, inflammatory processes of the genital organs how to prevent infertility.
male infertility.
Factors affecting male infertility: genital malformations, genital surgery, trauma, inflammation, chronic diseases, sexually transmitted diseases, alcoholism, drug addiction, substance abuse, endocrine factors.
The male factor in a childless marriage is 40-60%. Therefore, the diagnosis of infertility in a woman can only be made after the exclusion of infertility in a man (with positive tests confirming the compatibility of sperm and cervix).
Female infertility can be primary (in the absence of a history of pregnancy) and secondary (in the presence of a history of pregnancy). There are relative and absolute female infertility.
Relative - the probability of pregnancy is not excluded. Absolute - pregnancy is not possible. According to the WHO classification, the main groups of causes of infertility are distinguished:
violation of ovulation 40%
tubal factors associated with pathology of the fallopian tubes 30%
gynecological inflammatory and infectious diseases 25%
unexplained infertility 5%
The causes of infertility are socially determined, being the result of abortions, sexually transmitted, gynecological diseases, and unsuccessful births. Infertility often develops in childhood. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortion, promoting a healthy lifestyle and optimal sexual behavior. Infertility is an important medical and social problem, as it leads to a decrease in the birth rate.
In marriage, coarsening of morals, antisocial behavior (extramarital affairs, alcoholism), aggravation of selfish character traits, a violation of the psycho-emotional sphere and sexual disorders in spouses can be observed. Prolonged infertility creates great neuro-psychic tension and leads to divorce. 70% of infertile marriages are terminated.* Diagnosis of infertility is carried out by antenatal clinics, a family planning service. And in some cases, inpatient treatment in gynecological departments is required.
Family planning- this is freedom in deciding the issue of the number of children, the timing of their birth, the birth of only desired children from parents ready for a family.
Family planning:
helps a woman regulate the onset of pregnancy at the optimal time to preserve the health of the child, reduce the risk of infertility; reduce the risk of contracting sexually transmitted diseases;
makes it possible to avoid conception during breastfeeding, reducing the number of conflicts between spouses;
guarantees the birth of a healthy child in case of an unfavorable prognosis for offspring;
contributes to the decision about when and how many children a particular family can have;
increases the responsibility of spouses to future children, cultivates discipline, helps to avoid family conflicts
· provides an opportunity to have a sexual life without fear of unwanted pregnancy, without exposing yourself to stress, continue their studies, master a profession, build a career;
It gives husbands the opportunity to mature and prepare for future fatherhood, helps fathers provide for their families financially. Childbirth is regulated in three ways:
1. Contraception
2. sterilization
CONTRACEPTION.
In economically developed countries of the West, more than 70% of married couples use contraceptives. About 400 million women in developed countries use various methods of contraception to prevent unwanted pregnancies.
Granting women the right to reproductive health care include family planning, is a fundamental condition for their full life and the realization of gender equality. The realization of this right is possible only with the development of the planning service, the expansion and implementation of the "Safe Motherhood" programs, the improvement of sexual and hygiene education, the provision of contraceptives to the population, especially young people. Only this approach will help solve the problem of abortion and STDs.
STERILIZATION.
In order to protect women's health, reduce the number of abortions and deaths from them, since 1990, surgical sterilization of women and men has been allowed in Russia.
It is performed at the request of the patient in the presence of appropriate indications and contraindications for surgical sterilization. There are only three social indicators: 1. age over 40;
2. having 3 or more children
3. Age over 30 with 2 children
However, sterilization cannot be regarded as the best way to prevent pregnancy; it is not very popular among the population.
Abortion is an artificial termination of pregnancy. According to modern medical standards, abortion is usually carried out before 20 weeks of gestation or, if the gestational age is unknown, with a fetus weighing up to 400 g.
Methods of abortion are divided into surgical, or instrumental, and medical. Surgical methods involve the removal of the fetus using special instruments, but do not necessarily involve surgery. Medical or pharmaceutical abortion is the provocation of spontaneous abortion with the help of drugs.
medical abortion
Medical abortion is carried out before 9-12 weeks of pregnancy, depending on the recommendations and norms in a particular country. In Russia, the limit for medical abortion is usually lower: up to 42 or 49 days from the start of the last menstruation. The medical method is a safe method of abortion and is recommended by WHO for gestational age up to 9 weeks. There are also schemes for medical abortion for the second trimester of pregnancy.
Medical abortion is usually done with a combination of two drugs: mifepristone and misoprostol. According to Russian standards, a patient can only get these drugs from her doctor and takes them in his presence. The free sale of medical abortion products is prohibited. In areas where mifepristone is not readily available, medical abortion is performed using misoprostol alone.
Medical abortion with a combination of mifepristone and misoprostol results in a complete abortion in 95-98% of women. In other cases, abortion is completed by vacuum aspiration. In addition to incomplete abortion, the following complications may occur with medical abortion: increased blood loss and bleeding (probability 0.3% -2.6%), hematometer (accumulation of blood in the uterine cavity, probability 2-4%). For their treatment, hemostatic and antispasmodic drugs are used, the duration of therapy is 1-5 days.
Surgical methods of abortion
Abortion by surgical methods, that is, using medical instruments, is carried out only by specially trained medical workers in medical institutions. The main instrumental methods of abortion are vacuum aspiration ("mini-abortion"), dilatation and curettage (acute curettage, "curettage"), and dilatation and evacuation. The choice of one or another method depends on the gestational age and on the capabilities of a particular medical institution. In Russia, surgical abortion is also often called the procedure of dilation and curettage.
1.Vacuum aspiration
Vacuum aspiration, along with medical abortion, is a WHO-assessed safe method of abortion and is recommended as the primary method of abortion before 12 weeks' gestation. With manual (that is, manual) vacuum aspiration, a syringe with a flexible plastic tube (cannula) at the end is inserted into the uterine cavity. The fertilized egg with the fetus inside it is sucked out through this tube. With electric vacuum aspiration, the fetal egg is sucked out using electric vacuum suction.
Vacuum aspiration leads to complete abortion in 95-100% of cases. This is an atraumatic method that virtually eliminates the risk of uterine perforation, endometrial damage and other complications that are possible with dilatation and curettage. According to WHO, the incidence of serious complications to be treated in a hospital setting after vacuum aspiration is 0.1%.
2. Dilatation and curettage
Dilation and curettage (also acute curettage, colloquially "curettage") is a surgical procedure in which the doctor first widens the cervical canal (dilatation) and then scrapes the walls of the uterus with a curette (curettage). Cervical dilation can be carried out using special surgical dilators or by taking special drugs (in this case, the risk of tissue injury and subsequent development of cervical insufficiency is greatly reduced). Before the procedure, the woman must be given anesthesia and sedatives.
3. Dilation and evacuation
Dilation and evacuation is an abortion method used in the second trimester of pregnancy. WHO recommends it as the safest method of abortion at these times. However, second trimester abortions are generally more dangerous and more likely to result in complications than earlier abortions. The dilation and evacuation procedure begins with cervical dilatation, which can take anywhere from a few hours to 1 day. After that, an electric vacuum suction is used to remove the fetus. In some cases, this is sufficient for a complete abortion, in other cases, surgical instruments are used to complete the procedure.
4.Artificial childbirth
Artificial childbirth is a method of abortion used in the later stages (starting from the second trimester of pregnancy) and is an artificial stimulation of labor.
Infertility in marriage is one of the most difficult stressful situations. The personal qualities of childless spouses differ significantly from people of the same age and social status who have children. Psychological tests characterize great instability, fear, self-doubt, difficulties social contacts. The feeling of guilt for the absence of children in the family is higher among women. At the same time, in these same patients, such qualities as quickness of reaction, a sense of tension and emotions are more developed, indicating the presence of a permanent focus of mood depression.
Despite convincing data on significant psychological deviations of spouses in infertile marriages, the question of what is primary in this pathology has not yet been resolved: did the absence of children lead to psycho-emotional disorders or did such deviations cause reproductive disorders? functions.
A similar situation arises when considering the psychosexual problems of infertile marriages. About 30% of patients in infertile marriages have deviations from the normal patterns of sexual behavior.
A very serious sign of sexual instability in men is the occurrence of disturbances and ejaculation. The study of sperm for compatibility (postcoital test) has a particularly pronounced negative effect.
There may be a "vicious circle": absence of children - the need to be investigated - violation of sexual activity - fear that the violation of sexual activity in the future will not allow to have offspring.
The establishment of such a diagnosis as azoospermia (the complete absence of spermatozoa in the ejaculate) leads to a violation of potency in men in more than half of the cases. The cause and frequency of impotence are in direct correlation with the psychological reaction of the wife to the news of a serious violation of spermatogenesis in her husband. Fortunately, such a violation of potency is temporary, it can recover in 2-4 months spontaneously or under the influence of psychotherapy.
The causes of psychosexual disorders in patients in infertile marriages can be very different. It takes a lot of patience of the doctor, tact when taking an anamnesis to determine the nature of the individual, the characteristics of marital relations, including sexual ones.
It is necessary already at the first visit to the spouses to try to establish normal psychological contact with patients, to try to bring patients to an independent decision on the need for a particular study. It is especially important to explain what this or that diagnosis means and how to treat it.
Violations in reproductive system are of a very complex nature. Along with changes in the central regulatory links, severe disturbances can occur in the gonads themselves. So, in the ovaries, all follicles at different stages of development can die simultaneously during a period of stress. The most persistent are the primary follicles that are in a state of functional rest. But they can also die with prolonged exposure to stress factors. In the male gonads, the death of germ cells also occurs at different stages of their development (azoospermia, or severe oligospermia appears). After normalization external conditions the processes of folliculogenesis (as well as the processes of spermatogenesis) are able to recover.
Research recent years it is shown that unstable personalities, unsure of themselves, weak-willed, under psychological influence family members or others at work, may lag behind in sexual development if the situation arose in early childhood or puberty. In women, infertility is possible due to impaired implantation or early spontaneous abortions, in men - due to impaired potency.
The main measures to prevent the described pathology are the reasonable upbringing of children: girls have feelings of future motherhood, and boys have fatherhood; necessary correct .
Therapy of psychosexual disorders as causes of infertility or as concomitant conditions of infertility has not yet been clearly defined.
The first step should be to identify the reasons that caused such a situation. This task is very difficult, since standard diagnostic methods have not yet been developed. Attempts to use autogenic training have significantly improved the estimated indicators of psychological tests, but the frequency of occurrence is still low.
Of great importance in the future will be the ability to determine biological rhythms using optimal timing to stimulate reproductive function.
Summing up the data presented in the brochure on the physiology and pathology of the reproductive function in women and men, I would like to emphasize once again: the function of reproducing healthy offspring in humans as highly social beings is not only a biological task. All of us - both doctors and people who are far from medicine in their profession - have a great responsibility for the health of future generations.
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