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 life.

Groups of diseases caused by genetic risk.

Chromosomal and genetic hereditary diseases (Down's disease, hemophilia and others).

· Hereditary diseases that arise under the influence of external factors (gout, mental disorders, etc.).

· Diseases with a hereditary predisposition (hypertension and peptic ulcers, eczema, tuberculosis, etc.).

6. Infertility as a social and medical problem. Infertile marriage. Female and male infertility. The role of social workers in the prevention of infertility.

Infertility- inability of persons of working age to reproduce. A marriage is considered infertile if a woman does not become pregnant within a year of regular sexual activity without the use of contraception.

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.

Timely consultation with a doctor regarding menstrual irregularities, inflammatory processes of the genital organs how to prevent infertility.

Male infertility.

Factors influencing male infertility: malformations of the genital organs, surgery on the genital organs, trauma, inflammation, chronic diseases, sexually transmitted diseases, alcoholism, drug addiction, substance abuse, endocrine factors.

The male factor accounts for 40-60% in a childless marriage. Consequently, a diagnosis of infertility in a woman can be made only after excluding infertility in a man (with positive tests confirming the compatibility of sperm and the 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 cannot be excluded. Absolute - pregnancy is not possible. According to the WHO classification, the main groups of causes of infertility are distinguished:

· ovulation disorder 40%

tubal factors associated with fallopian tube pathology 30%

· gynecological inflammatory and infectious diseases 25%

· unexplained infertility 5%

The causes of infertility are socially determined, being a consequence of abortions, sexually transmitted diseases, gynecological diseases, and unsuccessful births. Infertility often develops in childhood. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortions, 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, disturbances in the psycho-emotional sphere and sexual disorders in spouses can be observed. Long-term infertility creates great neuropsychic tension and leads to divorce. 70% of infertile marriages are dissolved.* Diagnosis of infertility is carried out by antenatal clinics and family planning services. And in some cases, inpatient treatment in gynecological departments is required.

Family planning- this is freedom in deciding the number of children, the timing of their birth, the birth of only desired children from parents who are 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 while breastfeeding, reducing the number of conflicts between spouses;

· guarantees the birth of a healthy child in case of an unfavorable prognosis for the offspring;

· contributes to the decision about when and how many children a given family can have;

· increases the responsibility of spouses to future children, cultivates discipline, helps to avoid family conflicts

· provides the opportunity to have a sexual life without fear of an unwanted pregnancy, without exposing yourself to stress, to freely continue your studies, master a profession, and build a career;

Enables husbands to mature and prepare for future fatherhood, helps fathers provide for their family financially. Childbirth is regulated in three ways:

1. Contraception

2. sterilization

CONTRACEPTION.

In economically developed Western countries, more than 70% of married couples use contraceptives. About 400 million women in developed countries use various methods of contraception to prevent unwanted pregnancy.

Giving 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 sex and hygiene education, and 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 mortality from them, surgical sterilization of women and men has been allowed in Russia since 1990.

It is performed at the request of the patient if there are appropriate indications and contraindications for surgical sterilization. There are only three social indicators: 1. age over 40 years;

2. presence of 3 or more children

3. age over 30 years with 2 children

However, sterilization cannot be regarded as the optimal way to prevent pregnancy; it is not very popular among the population.

Abortion is the artificial termination of pregnancy. According to modern medical standards, abortion is usually performed up to 20 weeks of pregnancy or, if the gestational age is unknown, when the fetus weighs up to 400 g.

Abortion methods are divided into surgical, or instrumental, and medical. Surgical methods involve removing 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 medications.

Medical abortion

Medical abortion is performed up to 9-12 weeks of pregnancy, depending on the recommendations and regulations in a particular country. In Russia, the limit for medical abortion is usually lower: up to 42 or 49 days from the beginning of the last menstruation. The medication method is a safe method of abortion and is recommended by WHO for pregnancy up to 9 weeks. There are also schemes for conducting medical abortion for the second trimester of pregnancy.

Medical abortion is usually performed using a combination of two drugs: mifepristone and misoprostol. According to Russian standards, the patient can receive these drugs only from her doctor and takes them in his presence. The free sale of medical abortion products is prohibited. In regions where mifepristone is not readily available, medical abortion is performed using only misoprostol.

Medical abortion with a combination of mifepristone and misoprostol results in complete abortion in 95-98% of women. In other cases, abortion is completed using vacuum aspiration. In addition to incomplete abortion, the following complications may occur during a medical abortion: increased blood loss and bleeding (probability 0.3%-2.6%), hematometra (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”), dilation and curettage (sharp curettage, “curettage”) and dilation and evacuation. The choice of one method or another depends on the duration of pregnancy and the capabilities of a particular medical institution. In Russia, surgical abortion is also often called the procedure of dilatation and curettage.

1.Vacuum aspiration

Vacuum aspiration, along with medical abortion, is a safe method of abortion according to WHO and is recommended as the main method of abortion for up to 12 weeks of pregnancy. During manual (that is, manual) vacuum aspiration, a syringe with a flexible plastic tube (cannula) at the end is inserted into the uterine cavity. Through this tube, the fertilized egg with the fetus inside it is sucked out. With electric vacuum aspiration, the fertilized egg is sucked out using an 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 during dilation and curettage. According to WHO, the incidence of serious complications requiring hospital treatment after vacuum aspiration is 0.1%.

2.Dilatation and curettage

Dilation and curettage (also acute curettage, commonly known as “curettage”) is a surgical procedure in which the doctor first widens the cervical canal (dilation) and then scrapes out the walls of the uterus using a curette (curettage). Dilatation of the cervix can be carried out using special surgical dilators or by taking special medications (in this case, the risk of tissue injury and the subsequent development of cervical insufficiency is greatly reduced). Before the procedure, the woman must be given pain relief and sedatives.

3.Dilatation 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 this stage. However, second trimester abortions are generally more dangerous and more likely to cause complications than earlier abortions. The dilation and evacuation procedure begins with dilation of the cervix, which can take anywhere from a few hours to 1 day. An electric vacuum suction is then used to remove the fetus. In some cases, this is enough to complete the abortion; in other cases, surgical instruments are used to complete the procedure.

4.Artificial birth

Induced childbirth is an abortion method used in the later stages (starting from the second trimester of pregnancy) and is an artificial stimulation of labor.

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Infertility is a serious problem in reproductive medicine, in which there is a combination of social, mental and physical ill health in the family.

Physical illness is an illness of a married couple as a whole.

Social factors of infertile marriage include: decreased social activity of the most productive group of the population; the different influence of the frequency of infertile marriage on the demographic situation in the population and the state as a whole.

Mental ill-being is characterized by lability of the nervous system, the formation of an inferiority complex, and the development of severe psychosexual disorders. And in the end, all this becomes the cause of either unstable family relationships or leads to their destruction altogether.

By studying the structure of infertile marriage, it is possible to obtain data on the state of reproductive health of the population, which in turn indirectly characterizes the level and quality of medical care, as well as the level of general and medical culture of the population.

When the frequency of infertile marriage is 15% or more, a socio-demographic problem of national scale arises. In recent years, for our country, the problem of infertility can already be considered as such for the following reasons:

1) infertile marriage in Russia is about 14%;

2) increased mortality;

3) decreased birth rate;

4) excess of mortality rates over birth rates;

5) an increase in the number of divorce cases and in recent years the number of divorces has exceeded the number of marriages;

6) increase in the general morbidity rate of the population;

7) equality of the number of abortions and births or even exceeding the number of the former.

Thus, the problem of infertility in marriage for Russia is not only a medical problem, but a socio-demographic one on a national scale.

Infertility is the inability of a mature organism to conceive.

Infertile marriage - absence of pregnancy after 12 months of regular unprotected sexual activity.

There is a distinction between male and female infertility. It can be absolute and relative. Absolute infertility means that the possibility of pregnancy is completely excluded (absence of organs, abnormal development of the genital organs). Relative - the possibility of pregnancy cannot be excluded.

Infertility can be primary, when there is no indication in the anamnesis of the presence of at least some pregnancy, subject to regular unprotected sexual activity, and secondary - when there have been previous pregnancies (even ectopic, non-developing), but confirmed either visually (presence of a fetus) or histologically, or according to ultrasound examination (ultrasound), but after these pregnancies for 1 year with regular unprotected sexual activity, the next pregnancy does not occur.

More on the topic Infertility - a socio-demographic problem:

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2. Dependence of the development of autopsychological competence on professional, career and socio-demographic parameters

Question: Infertility as a socio-medical problem is one of the pressing problems of humanity. What are the main forms of infertility and treatment methods?

Answer: Gulnara Sultangyzi- Candidate of Medical Sciences, ultrasound specialist, gynecologist at the Ömür Medical Center.

"Recently, infertility has become a kind of scourge of society. According to WHO, male infertility currently occurs in 50-60% of cases of infertile marriage, and in some regions of our planet this figure is close to 70%. Today there are about 400 thousand people in Azerbaijan suffer from infertility, most of whom are men.

Infertility (lat. - sterilitas) is called the lack of ability to fertilize in women (female infertility) and in men (male infertility).

In the first year of marriage, pregnancy occurs in 80-90% of women; the absence of pregnancy after 3 years of marriage indicates that the chances of its occurrence decrease every year. A marriage is considered infertile if pregnancy does not occur after more than two years of sexual activity without the use of contraception.

Female infertility can be absolute and relative. Infertility is considered absolute if there are deep irreversible pathological changes in a woman’s body that completely exclude the possibility of conception. Infertility is considered relative if the cause that caused it can be eliminated.

A woman can become infertile for many reasons and to identify this, it is necessary to undergo appropriate medical examination for subsequent treatment. The same applies to men.

The medical and social significance of the consequences of an infertile marriage is primarily associated with psychological dissatisfaction due to the fact that parental potential remains unrealized, which leads to neurosis, the formation of an inferiority complex, a decrease in overall life position and activity, and even the destruction of families. This explains the need to comprehensively examine a couple seeking medical help in order to identify the true cause of the existing problem.

Working with a married couple allows you to outline a general examination plan, the sequence of diagnostic procedures and avoid possible mistakes. Quick and correct identification of the cause of infertility in a married couple is the main factor that determines the success of the therapy.

When treating infertility, the Ömür clinic uses a special comprehensive program. Each procedure in its composition has its own purpose. Here, according to indications, hirudotherapy is used for congestion of the pelvic organs, physiotherapy, acupuncture for excitation of the nervous system, herbal medicine and much more.”

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According to WHO, on average, about 5% of the population is infertile due to the presence of anatomical, genetic, endocrine, or unpreventable factors. On average, every 7th married couple in Russia cannot conceive a child on their own due to reproductive disorders.

In some regions of Russia, the incidence of infertility is 10-15% and can reach 20%.

Social, medical and economic factors influence a couple when deciding to have a child. The European Health Strategy emphasizes the importance of maintaining reproductive health and the priority of measures to restore it.

Infertility in Russia today is a problem to which it is necessary to seek approaches not only at the level of the married couple and the attending physician, but also at the state level. The problem of diagnosing and treating infertility, organizing medical care for infertile couples is extremely relevant in obstetric and gynecological practice and in medicine in general.

In addition, recently women have increasingly come to the need to realize their childbearing function at a later reproductive age, when they have established themselves in the profession and acquired a certain financial status necessary for the full care of the child and his upbringing.

Women over 35 years old face various problems when conceiving, bearing and giving birth to children. Difficulties in realizing childbearing function are often associated with a burdened medical history and the onset of natural decline of childbearing function. Besides,

surgical interventions on the ovaries for cysts, apoplexies, and benign neoplasms significantly affect the ovarian reserve. Taking into account the fact that the number of follicles in a woman is formed during the period of intrauterine development, with an initially reduced follicular apparatus, even resection of a small area of ​​the ovary will significantly affect the patient’s ability to conceive.

Surgical interventions on both the appendages and the uterus have a negative impact on reproductive function. It is known that instrumental removal of the fertilized egg, curettage of the uterine mucosa, and other surgical interventions on the uterus adversely affect the condition of the endometrium. Lack of pregnancy can often be associated with the development of chronic endometritis, the formation of intrauterine synechiae, and damage to the basal layer of the endometrium.

If it is possible to use hormonal and barrier methods of contraception, a large percentage of women resort to abortion as the main method of birth control, and in most cases instrumental removal of the fertilized egg is performed, and only in 3-4% of cases more gentle methods of termination of pregnancy are used. All this adversely affects the condition of the endometrium and, as a consequence, reproductive health.

Risk factors for tubal-peritoneal infertility, along with surgical interventions, also include some sexually transmitted infections. According to various sources, from 5 to 15% of people who are sexually active have chlamydial infection.

Chlamydia causes inflammatory diseases of the pelvic organs, and typical of this infection is the formation of adhesions in the pelvis, resulting in disruption of the patency of the fallopian tubes, which is the cause of ectopic pregnancy and tubo-peritoneal infertility.

The accumulation of somatic pathology, decreased ovarian reserve, poor quality of oocytes, as well as the high risk of having a child with a genetic pathology negatively affects the health of the offspring. Thus, the birth of a healthy child becomes especially important. This problem can be solved by conducting a comprehensive examination of married couples and medical genetic counseling. Prevention of the birth of offspring with genetic pathology consists of preimplantation genetic diagnosis of PGD.

Infertility is often accompanied by the development of psychological problems, disruption of sexual relationships, and a decrease in quality of life. Often, infertility is the cause of family breakdown due to unrealized reproductive motivation, so the number of divorces among infertile couples is, on average, 6-7 times higher than similar indicators in the population. In addition, disruption of social and psychological adaptation due to unrealized reproductive function affects behavior in society.

The development of reproductive medicine, including technologies aimed at treating infertility, has acquired significant relevance due to changes in the health status of the population and socio-economic policy. Significant progress in the treatment of severe forms of infertility has become possible due to the development of assisted reproductive technologies (ART). According to some data, the effectiveness of ART in the treatment of infertility ranges from 30% to 40%, depending on a particular pathology. Timely treatment of infertility in young couples is cost-effective and leads to pregnancy during the first year of treatment, while the effectiveness of therapy decreases significantly with increasing age of patients. In case of long-term infertility and late reproductive age, ART is practically the only way to solve the problem of childlessness.

Technical progress and accumulated experience in the use of assisted reproductive technologies have significantly increased the effectiveness of IVF programs. However, the pregnancy rate in programs after IVF does not exceed 30% per embryo transfer, which corresponds to 10-15% pregnancy per stimulated cycle.

Interest in the problem of infertility and ART determined a comprehensive study of high-tech techniques. Thus, attempts have been made to predict the results of ART programs. According to Amirova A.A., significantly significant characteristics that determine a negative result were the older reproductive age of the spouses, secondary infertility, and a decrease in the concentration of sperm in the ejaculate; family history of infertility on the female side, previous diseases of the urinary system.

Ranking of factors influencing the development of infertility made it possible to identify a priority group in the provision of medical care. Tasova Z.B. in her dissertation work talks about the need for timely identification of groups of women with an increased risk of developing infertility.

When studying the availability of ART, some authors noted that obtaining medical services for the treatment of infertility is not financially accessible for many citizens. “If the availability of ART in Russia were similar to that in Denmark, then, while maintaining current family policy programs, the total fertility rate could increase significantly, which would significantly slow down the aging of the population.” Economic studies have shown that government costs for IVF cycles are fully recovered from tax revenues due to the increase in population as a result of the use of ART. According to data received

Isupova O.G. and Rusanova N.E., for many patients from the provinces, the costs of travel and accommodation exceed the cost of IVF.

Some studies separately examined the issue of medical, social and economic effectiveness of ART, with an emphasis on assessing the family budget and quality of life before and after the birth of a child. Thus, a positive outcome from the use of ART significantly improves the quality of life of a married couple, contributes to a more rational use of the family budget, and improves the social and mental functioning of a married couple.

The problem of a patient’s choice of a clinic where assistance is provided with the use of ART remains extremely relevant. The main parameters that force a woman to go to one particular clinic or another are the effectiveness of the IVF procedure in former clinic patients and the lack of IVF centers in some regions.

Despite the comprehensive study of the problem of infertility and modern reproductive technologies, problems remain, the solution of which will improve the effectiveness of treatment.

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- inability of persons of working age to reproduce. A marriage is considered infertile if a woman does not become pregnant within a year of regular sexual activity without the use of contraception. Infertility can be male or female. The male factor accounts for 40-60% in a childless marriage.

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 cannot be excluded.

Absolute - pregnancy is not possible.

According to the WHO classification, the main groups of causes of infertility are distinguished:

• · ovulation disorder 40%
• tubal factors associated with fallopian tube pathology 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 issues during the year.

The causes of infertility are socially determined, being a consequence of abortions, sexually transmitted diseases, gynecological diseases, and unsuccessful births. Prevention of infertility should be aimed at reducing gynecological morbidity in women, preventing abortions, 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 ill-being is manifested by a decrease in interest in current events, the development of an inferiority complex, and a decrease in overall activity and performance. In marriage, coarsening of morals, antisocial behavior (extramarital affairs, alcoholism), aggravation of selfish character traits, disturbances in the psycho-emotional sphere and sexual disorders in spouses can be observed. Long-term infertility creates great neuropsychic tension and leads to divorce. 70% of infertile marriages are dissolved.