Main Gynecological Diseases Treated by the Doctor
In 50–60% of couples facing difficulty conceiving, a male factor plays a role. The male factor can be assessed quickly and non-invasively via semen analysis (spermiogram).
The female factor is much more multifaceted. Diagnosis is structured across 5 diagnostic levels:
- Vagina (infectious factors)
- Uterine cervix (cervical factors)
- Uterus (endometrial and myometrial factors)
- Fallopian tubes (tubal and peritoneal factors)
- Ovaries (ovulatory and endocrine factors)
1. Vagina (Infectious Factor)
It is essential to rule out active genital infections. Vaginal smear diagnostics and STI screenings represent the first step in female fertility workups. When pathogenic microflora is identified, targeted treatment is prescribed for both partners simultaneously.
2. Uterine Cervix (Cervical Factor)
The cervical factor is diagnosed in approximately 5% of infertile couples. It is primarily evaluated via postcoital testing (Kurzrok-Miller or Sims-Huhner test), which examines sperm motility and survival in cervical mucus. If antisperm antibodies are suspected, a mixed antiglobulin reaction (MAR test) is performed. If conservative therapy is ineffective, intrauterine insemination (IUI) offers an effective solution.
3. Uterus (Endometrial & Structural Factor)
Intrauterine pathologies must be ruled out: endometrial polyps, hyperplasia, insufficient endometrial maturation, chronic endometritis, and intrauterine adhesions (synechiae). Diagnostic ultrasound in different cycle phases and hysteroscopy serve as gold standards. Other structural causes include intramural/submucous fibroids or adenomyosis, which can be treated via minimally invasive hysteroscopic or laparoscopic surgery.
4. Fallopian Tubes (Tuboperitoneal Factor)
Tubal dysfunction is among the most common causes of female infertility. The fallopian tube is where fertilization occurs; the developing embryo is then transported over 5 days by the action of tubal ciliated cells into the uterine cavity for implantation.
Infections often lead to salpingitis, peritubal adhesions, and tubal occlusion. Adhesions distort the anatomy, drastically increasing the risk of ectopic pregnancy. If occlusion occurs at the fimbrial end with fluid accumulation (hydrosalpinx), the delicate inner mucosal lining is damaged, often necessitating laparoscopic salpingectomy prior to IVF.
Diagnostic methods to evaluate tubal patency:
• Hysterosalpingo-contrast sonography (HyCoSy): Ultrasound assessment of tubal flow with approximately 60–80% accuracy.
• Hysterosalpingography (HSG): Fluoroscopic X-ray examination using contrast media.
• Diagnostic and operative laparoscopy with chromopertubation: The definitive gold standard. It allows direct visual inspection of the pelvis, precise assessment of tubal patency using dye, lysis of adhesions, and simultaneous excision of peritoneal endometriosis.
5. Ovaries (Ovulatory & Endocrine Factor)
The hallmark of healthy ovarian function is regular ovulation, monitored by serial follicular ultrasound and hormone profiling (evaluating thyroid hormones, prolactin, and ovarian reserve markers such as AMH). In cases of anovulation or polycystic ovary syndrome (PCOS), targeted medical ovulation induction is initiated.
In patients with treatment-resistant PCOS, laparoscopic ovarian drilling (thermocauterization) can puncture the thickened ovarian cortex, restoring spontaneous ovulatory cycles and significantly improving natural conception rates.
Overcoming infertility requires a thorough, systematic diagnostic strategy and personalized treatment.
If spontaneous pregnancy is not achieved within one year of targeted therapy and regular intercourse, assisted reproductive technologies (IVF / ICSI) are recommended.