Subfertility: philosophy and methodology of the problem. Part II




subfertility, infertility, causes of subfertility, management of subfertility


The review-philosophical work is devoted to the problem of subfertility. The low fecundity of a part of individuals who are within the fertile population is one of the most urgent social and medical problems of modern society. Usually there are no obvious reasons for fertility decline in subfertile people. The work considers a paradigm in which the low existing fertility in a part of the population is able to find an explanation in connection with the existence of various normal variants of the development of organs and tissues of the reproductive system.

Normally the time to pregnancy in subfertile individuals is increased. Timing in general is a major factor in optimizing the management of a couple with unexplained infertility which should be taken into account in the management of infertility.

The work presents modern terminology used in reproductive medicine. The paper shows the methodological problems that can arise in the assessment of individual fertility potential. A “fertility scale” is presented that can help in assessing fertility and determining the algorithm for management of infertile couple. The modern understanding of the etiology of subfertility/infertility is showed. The role of evidential and causal decision theory used for understanding of the pathogenesis of fertility decline is discussed. Also the philosophical view on the problem of unexplained infertility and outlines approaches to its solution, which are based on the diagnosis of anatomical and physiological (physical) features of the reproductive system of subfertile individuals are presented.

Part II of the article considers the cause-effect relationships characteristic of subfertility and infertility, as well as methods that allow better understanding of such connections. The problem of heterogeneity of compared statistical series, the role of external and internal factors in the development of subfertility and infertility, a number of factors affecting fertility decline, the obligatory conditions for conception and the place of violations of these conditions in the structure of infertility causes, the role of “obvious” and “non-obvious” fertility will discussed. Main principles for optimization of conception conditions and the modern approaches to the management of couples with unexplained infertility are set out in the continuation of the article. The special role of transvaginal sonography in the study of the nature of subfertility and the diagnosis of the reproductive system development features is shown.

Author Biographies

И. З. Гладчук, Odesa National Medical University

MD, professor, head of the Obstetrics and Gynecology Department №1

В. В. Дощечкин, Clinic of reproductive medicine “Remedi”, Odesa

Obstetrician gynecologist high category, head of the clinic 


  1. Leridon, H., Spira, A. “Problems in measuring the effectiveness of infertility therapy.” Fertil Steril 41 (1984): 580–6.
  2. Lapach, S.N., Chubenko, A.V., Babich, P.N. Statistical methods in biomedical research using Excel. Kyiv. Morion (2000): 320 p.
  3. Tuzova, R.V. Molecular genetic mechanisms of the evolution of the organic world. Genetic and cellular engineering. Minsk. Belarus. Science (2010): 85–7.
  4. Podolskiy, D.E., Korzhenevitch, A.I. Genetic polymorphism as an adaptive norm of the organism. Pinsk. PolesGU (2015): 363–4.
  5. Weber, W. “Populations and genetic polymorphisms.” Mol Diagn 4.4 (1999): 299–307.
  6. “Analysis of genotypic variants of the polymorphism of the CYP2C9 gene in the Uzbek population.” International Medical Journal 4 (2012): 106–9.
  7. Siasi, E., Aleyasin, A. “Four Single Nucleotide Polymorphisms in INSR, SLC6A14, TAS2R38, and OR2W3 Genes in Association with Idiopathic Infertility in Persian Men.” J Reprod Med 61.3–4 (2016): 145–52.
  8. Gordeeva, E.G., Shileiko, L.V., Pankratova, O.S., Kurilo, L.F. “The frequency of aneuploidy in gametes in fertile males.” Genetics 47.6 (2011): 828–35.
  9. Gordeeva, E.G., Sorokina, T.M., Shileiko, L.V., et al. “Frequency of occurrence of gametes with aneuploidy in men with reproductive disorders.” Medical genetics 2 (2013): 18–24.
  10. Altukhov, Y.P. Genetic processes in populations: Tutorial. 3-rd ed., revised and add. Moscow. ICC “Akademkniga” (2003): 431 p.
  11. Altukhov, Y.P., Kurbatova, O.L. “Problems of adaptive norms in human populations.” Genetics 26.7 (1990): 583–97.
  12. Eschenbach, D.A. “Infertility caused by infection.” Contemp Obstet Gynecol 32 (1987): 29–46.
  13. World Health Organization. “Infections, pregnancies, and infertility: perspectives on prevention.” Fertil Steril 47(1987): 964–8.
  14. Soper, D.E., Brockwell, N.J., Dalton, H.P., Johnson, D. “Observations concerning the microbial etiology of acute salpingitis.” Am J Obstet Gynecol 170 (1994): 1008–14.
  15. Eckert, L.O., Hawes, S.E., Wolner-Hanssen, P., et al. “Prevalence and correlates of antibody to chlamydial heat shock protein in women attending sexually transmitted disease clinics and women with confirmed pelvic inflammatory disease.” J Infect Dis 175 (1997): 1453–8.
  16. Kasius, J.C., Fatemi, H.M., Bourgain, C., et al. “The impact of chronic endometritis on reproductive outcome.” Fertil Steril 96.6 (2011): 1451–6. DOI: 10.1016/j.fertnstert.2011.09.039
  17. Kasius, J.C., Broekmans, F.J., Sie-Go, D.M., et al. “The reliability of the histological diagnosis of endometritis in asymptomatic IVF cases: a multicenter observer study.” Hum Reprod 27.1 (2012): 153–8. DOI: 10.1093/humrep/der341
  18. Cates, W. Jr, Rolfs, R.T. Jr, Aral, S.O. “Sexually transmitted diseases, pelvic inflammatory disease, and infertility: an epidemiologic update.” Epidemiol Rev 12 (1990): 199–220.
  19. Mayaud, P. “The role of reproductive tract infections.” In: Boerma, J.T., Mgalla, Z., eds. Women and infertility in sub-Saharan Africa: a multi-disciplinary perspective. Amsterdam. Royal Tropical Institute Press (2001): 71–108.
  20. World Health Organization. Prevalence and incidence of selected sexually transmitted infections: methods and results used by WHO to generate 2005 estimates. Geneva. World Health Organization (2011).
  21. Novy, M., Eschenbach, D., Witkin, S. “Infections as a Cause of Infertility.” Glob libr women’s med (2008). DOI: 10.3843/GLOWM.10328
  22. Westrom, L.V. “Sexually transmitted diseases and infertility.” Sex Transm Dis 21 (1994): 532–7.
  23. Araújo Viana, G., Cela, V., Ruggiero, M., et al. “Endometritis in Infertile Couples: The Role of Hysteroscopy and Bacterial Endotoxin.” JBRA Assist Reprod 19.1 (2015): 21–3. DOI: 10.5935/1518-0557.20150006
  24. Scholes, D., Stergachis, A., Heidrich, F.E., et al. “Prevention of pelvic inflammatory disease by screening for cervical chlamydia infection.” N Engl J Med 334 (1996): 1362–6.
  25. Pinto, V., Matteo, M., Tinelli, R., et al. “Altered uterine contractility in women with chronic endometritis.” Fertil Steril 103.4 (2015): 1049–52. DOI: 10.1016/j.fertnstert.2015.01.007
  26. American society for reproductive medicine. “Revised American Society for Reproductive Medicine classification of endometriosis.” Fertil Steril 67 (1997): 817–21.
  27. American society for reproductive medicine. “Endometriosis and infertility.” Fertil Steril 86 Suppl. 4 (2006): s156–60.
  28. Hughes, E.G., Fedorkow, D.M., Collins, J.A. “A quantitative overview of controlled trials in endometriosis-associated infertility.” Fertil Steril 59 (1993): 963–70.
  29. Antsiferova, Y., Sotnikova, N., Bogatova, I., Boitsova, A. “Changes of apoptosis regulation in the endometrium of infertile women with tubal factor and endometriosis undergoing in vitro fertilization treatment.” JBRA Assist Reprod 18.1 (2014): 2–6. DOI: 10.5935/1518-0557.20140084
  30. Edwards, R.G., Purdy, J.M. Human conception in vitro. Proceedings of the first Bourn Hall Meeting, Bourn Hall, Cambridge, Sept. 3–5, 1981.
  31. Edwards, R.G. The history of assisted human conception with especial reference to endocrinology. Exp Clin Endocrinol Diabetes 104.3 (1996):183–204.
  32. Edwards, R.G., Steptoe, P.C., Abraham, G.E., et al. “Steroid assays and preovulatory follicular development in human ovaries primed with gonadotrophins.” Lancet 2 (1972): 611–5.
  33. Gardner, D.K., Weissman, A., Howies, C.M., Shoham, Z. Textbook of assisted reproductive techniques. Laboratory and clinical perspectives. 2-nd ed. London; New York. Taylor & Francis Group (2004): 984 p.
  34. Brinsden, P.R., Ed. Textbook of in vitro fertilization and assisted reproduction. 3-rd ed. Bourn Hall Clinic; Bourn Cambridge. Taylor & Francis (2005): 688 p.
  35. Kulakov, V.I., Leonov, B.V., Kuzmichev, L.N., Eds. Treatment of female and male infertility. Assisted reproductive technologies. Moscow. Medical News Agency (2005): 592 p.
  36. Yuzko, O.M., Yuzko, T.A., Rudenko, N.G. “Status and prospects of the use of assisted reproductive technologies in the treatment of infertility in Ukraine.” Neonatology, Surgery and Perinatal Medicine 2.4 (6) (2012): 26–9.
  37. Dakhno, F.V., Kaminskyi, V.V., Yuzko, O.M., et al. Assisted reproductive technologies for infertility treatment. Tutorial for doctors-students of institutions (faculties) of post-graduate education. Ed. by prof. F.V. Dakhno, prof. V.V. Kaminskyi, prof. O.M. Yuzko. Kyiv (2011): 338 p.
  38. Grishchenko, V.I., Shcherbina, N.A., Lipko, О.P., et al. “The place and role of laparoscopy in the diagnosis and treatment of gynecological diseases.” International Medical Journal 10.2 (2004): 71–3.
  39. Bouquet de Joliniere, J., Librino, A., Dubuisson, J.B., et al. “Robotic Surgery in Gynecology.” Front Surg 3 (2016): 26. DOI: 10.3389/fsurg.2016.00026
  40. Dubuisson, J.B. Laparoscopic anatomy of the female genital tract. Normal and pathological aspects. Karl Storz MediaService (2014): 74.
  41. Davydovskiy, I.V. The problem of causality in medicine (etiology). Moscow. State Publishing House of Medical Literature (1962): 176 p.
  42. Abrao, M.S., Muzii, L., Marana, R. “Anatomical causes of female infertility and their management.” Fertil Steril 98.2 (2012): 302–7.
  43. Medrano-Uribe, F.A., Enríquez-Pérez, M.M., Reyes-Muñoz, E. “Prevalence of uterine anatomical anomalies in mexican women with recurrent pregnancy loss (RPL).” Gac Med Mex 152.2 (2016): 163–6.
  44. Harris-Glocker, M., McLaren, J.F. “Role of female pelvic anatomy in infertility.” Clin Anat 26.1 (2013): 89–96. DOI: 10.1002/ca.22188
  45. Allahbadia, G.N. “Oral Drugs for Unexplained Infertility.” J Obstet Gynaecol India 66.1 (2016): 1–5. DOI: 10.1007/s13224-015-0805-7
  46. Gelbaya, T.A., Potdar, N., Jeve, Y.B., Nardo, L.G. “Definition and epidemiology of unexplained infertility.” Obstet Gynecol Surv 69.2 (2014): 109–15. DOI: 10.1097/OGX.0000000000000043
  47. Templeton, A.A., Penney, G.C. “The incidence, characteristics, and prognosis of patients whose infertility is unexplained.” Fertil Steril 37 (1982): 175–82.
  48. Collins, J.A., Crosignani, P.G. “Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management.” Int J Gynaecol Obstet 39 (1992): 267–75.
  49. Moghissi, K.S., Wallach, E.E. “Unexplained infertility.” Fertil Steril 39 (1983): 5–21.
  50. Gudeloglu, A., Brahmbhatt, J., Parekattil, S. “Definitions and Epidemiology of Unexplained Male Infertility.” In: Unexplained Infertility: Pathophysiology, Evaluation and Treatment. Eds: G.L. Schattman, S. Esteves, A. Agarwal. Springer Sciences (2015): 7–12.
  51. Gudeloglu, A., Brahmbhatt, J.V., Parekattil, S.J. “Medical management of male infertility in the absence of a specific etiology.” Semin Reprod Med 32.4 (2014): 313–8. DOI: 10.1055/s-0034-1375184
  52. Popovich, I., Windsor, B., Jordan, V., et al. “Methodological quality of systematic reviews in subfertility: a comparison of two different approaches.” PLoS One 7/12 (2012): e50403. DOI: 10.1371/journal.pone.0050403
  53. Gleicher, N. “Cost-effective infertility care.” Hum Reprod Update 6.2 (2000):190–9.
  54. Blackwell, R.E., Team, W.M. “Hidden costs of infertility treatment in employee health benefits plans.” Am J Obstet Gynecol 182.4 (2000): 891–5.
  55. Child, T. “Optimising the management of patients with infertility.” Practitioner 257.1759 (2013): 19–22.
  56. The Practice Committee of the American Society for Reproductive Medicine. “Optimal Evaluation of the Infertile Female.” Fertil Steril 82 Suppl. 1 (2004): S169–72.
  57. The Practice Committee of the American Society for Reproductive Medicine. “Optimal evaluation of the infertile female.” Fertil Steril 86.5 Suppl 1 (2006): S264–7. DOI: 10.1016/j.fertnstert.2006.08.041
  58. ESHRE Capri Workshop Group. “Economic aspects of infertility care: a challenge for researchers and clinicians.” Hum Reprod 30.10 (2015): 2243–8. DOI: 10.1093/humrep/dev163
  59. Pfeifer, S., Butts, S., Dumesic, D., et al.; The Practice Committee of the American Society for Reproductive Medicine. “Diagnostic evaluation of the infertile female: a committee opinion.” Fertil Steril 103.6 (2015): e44–50. DOI: 10.1016/j.fertnstert.2015.03.019
  60. World Health Organization. WHO guidelines on the standardized examination and diagnosis of infertility of couples. Translate from English. R.A. Nersesyan. Moscow. MedPress (1997): 91 p.
  61. Smetnik, V.P., Tumilovich, L.G. Non-operative gynecology: a guide for doctors. St. Petersburg. SOTIS (1995): 224 p.
  62. Fertility assessment and treatment for people with fertility problems. National Collaborating Centre for Women’s and Children’s Health Clinical Guideline Commissioned by the National Institute for Clinical Excellence. Published by the RCOG. London (2012).
  63. Chaika, V.K., Popova, M.V., Akimova, I.K., et al. Infertile marriage: a practical guide. Donetsk NMU named after Maxim Gorky. Donetsk. Lavis (2012): 383 p.
  64. Marshburn, P.B. “Counseling and diagnostic evaluation for the infertile couple.” Obstet Gynecol Clin North Am. 42.1 (2015): 1–14. DOI: 10.1016/j.ogc.2014.10.001
  65. Zaporozhan, V.N., Zelinsky, A.A., Verbitskaya, I.B. Actual problems of gynecology of childhood: method. recommendations for doctors-cadets and interns. Кyiv (1999): 30 p.
  66. Infertile marriage. Monograph. Translation from English. Ed. by R.J. Pepperell, B. Hudson, K. Wood. Moscow. Medicine (1986): 336 p.
  67. Bulavenko, O.V. Insufficiency of the lutein phase: clinic, diagnosis and treatment. Thesis abstract for MD degree. Kyiv (2008).
  68. Helmerhorst, F.M., van Vliet, H.A., Gornas, T., Finken, M.J. “Intrauterine insemination versus timed intercourse for cervical hostility in subfertile couples.” Obstet Gynecol Surv 61.6 (2006): 402–14.
  69. Brosens, I., Gordts, S., Valkenburg, M., Puttemans, P. “Investigation of the infertile couple: when is the appropriate time to explore female infertility?” Hum Reprod 18.8 (2004): 1689–92.
  70. Davis, A., Madhvani, K., Lee, L. “Investigating fertility problems.” BMJ 345 (2012): e6173. DOI: 10.1136/bmj.e6173
  71. Roux, C., Berdin, A., Amiot, C. “Management in medically assisted procreation of an infertile couple.” Rev Prat 64.10 (2014): 1432.
  72. Serov, V.N., Prilepskaya, V.N., Ovsyannikova, T.V. Gynecological endocrinology. 4-th ed. Moscow. MedPress (2013): 528 p.
  73. Kulakov, V.I., Leonov, B.V., Kuzmichev, L.N., et al. Treatment of female and male infertility. Moscow. MIA (2005): 592 p.
  74. Gynecology: national leadership. Ed. by V.I. Kulakov, I.B. Manukhin, G.M. Savelieva. Moscow. GEOTAR-Media (2011): 1088 p.
  75. Belisle, S., Pierson, R.A.E. CFAS Consensus Document for the Investigation of Infertility. Montreal, Quebec. Canadian Fertility and Andrology Society (2002).
  76. World Health Organization. WHO laboratory manual for the examination and processing of human semen. Fifth Edition. World Health Organization, Department of Reproductive Health and Research (2010): 287 p.
  77. Leushuis, E., van der Steeg, J.W., Steures, P., et al. “Semen analysis and prediction of natural conception.” Hum Reprod 29.7 (2014): 1360–7.
  78. Gladchuk, I.Z., Semeniuta, O.M., Onishchenko, Y.V. “Comparative analysis of the effectiveness of treatment methods for women with polycystic ovary syndrome and hyperprolactinemia: retrospective study.” Woman Health 2 (2014): 121–3.
  79. Gladchuk, I.Z., Semeniuta, O.M., Onishchenko, Y.V. “Definition of efficiency of different approaches in treatment of infertility for patients with PCOS and hyperprolactinemia.” Journal of Health Sciences 04.01 (2014): 225–32.
  80. El-Toukhy, T.A. “Unexplained subfertility: a pragmatic approach.” J Obstet Gynaecol 22.3 (2002): 239–42.
  81. Gunn, D.D., Bates, G.W. “Evidence-based approach to unexplained infertility: a systematic review.” Fertil Steril 19 (2016). DOI: 10.1016/j.fertnstert.2016.02.001
  82. Verhulst, S.M., Cohlen, B.J., Hughes, E., Те Velde, E. “Intra-uterine insemination for unexplained subfertility.” Cochrane Database Syst Rev 18.4 (2006): CD001838.
  83. Siristatidis, C., Bhattacharya, S. “Unexplained infertility: does it really exist? Does it matter?” Hum Reprod 22.8 (2007): 2084–7.
  84. Ray, A., Shah, A., Gudi, A., Homburg, R. “Unexplained infertility: an update and review of practice.” Reprod Biomed Online 24.6 (2012): 591–602. DOI: 10.1016/j.rbmo.2012.02.021
  85. Altmäe, S., Stavreus-Evers, A., Ruiz, J.R., et al. “Variations in folate pathway genes are associated with unexplained female infertility.” Fertil Steril 94.1 (2010): 130–7. DOI: 10.1016/j.fertnstert.2009.02.025
  86. Hendershot, G.E., Mosher, W.D., Pratt, W.F. “Infertility and age: An unresolved issue.” Fam Plann Perspect 14 (1982): 287.
  87. Greil, A.L., McQuillan, J., Johnson, K., et al. “The hidden infertile: infertile women without pregnancy intent in the United States.” Fertil Steril 93 (2010): 2080–3.
  88. Conti, S.L., Eisenberg, M.L. “Paternal aging and increased risk of congenital disease, psychiatric disorders, and cancer.” Asian J Androl (2016). DOI: 10.4103/1008-682X.175097
  89. Menken, J., Trussell, J., Larsen, U. “Age and infertility.” Science 233.4771 (1986): 1389–94.
  90. The ACOG Committee on Gynecologic Practice & The Practice Committee of the ASRM. “Female age-related fertility decline. Committee Opinion No. 589.” Obstet Gynecol 123 (2014): 719–21.
  91. The Practice Committee of the ASRM. “Aging and infertility in women.” Fertil Steril 86 Suppl. 4 (2006): S248–52.
  92. Steiner A.Z., Jukic, A.M. “Impact of female age and nulligravidity on fecundity in an older reproductive age cohort.” Fertil Steril (2016). DOI: 10.1016/j.fertnstert.2016.02.028
  93. Mascarenhas, M.N., Flaxman, S.R., Boerma, T., et al. “National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys.” PLoS Med 9.12 (2012): e1001356. DOI: 10.1371/journal.pmed.1001356
  94. Swanton, A., Child, T. “Reproduction and ovarian ageing.” J Br Menopause Soc 11.4 (2005): 126–31.
  95. Rowe, T. “Fertility and a woman’s age.” J Reprod Med 51.3 (2006): 157–63.
  96. Baird, D.T., Collins, J., Egozcue, J., Evers, L.H. “Fertility and ageing.” Hum Reprod Update 11.3 (2005): 261–76.
  97. ESHRE Capri Workshop Group. “A prognosis-based approach to infertility: understanding the role of time.” Hum Reprod 32.8 (2017): 1–4. DOI: 10.1093/humrep/dex214
  98. Hvidman, H.W., Bentzen, J.G., Thuesen, L.L., et al.; ESHRE Capri Workshop Group. “Infertile women below the age of 40 have similar anti-Müllerian hormone levels and antral follicle count compared with women of the same age with no history of infertility.” Hum Reprod (2016).
  99. Jones, E.F., Forrest, J.D. “Contraceptive failure rates based on the 1988 NSFG.” Fam Plann Perspect 24.1 (1992): 12–9.
  100. Fu, H., Darroch, J.E., Haas, T., Ranjit, N. “Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth.” Fam Plann Perspect 31.2 (1999): 56–63.
  101. Curtis, K.M.; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. “U.S. Medical eligibility criteria for contraceptive use, 2010.” Available from: [], last accessed Aug 27, 2018.
  102. Killick, S.R., Leary, C., Trussell, J., Guthrie, K.A. “Sperm content of pre-ejaculatory fluid.” Hum Fertil (Camb) 14.1 (2011): 48–52. DOI: 10.3109/14647273.2010.520798
  103. Kovavisarach, E., Lorthanawanich, S., Muangsamran, P. “Presence of Sperm in Pre-Ejaculatory Fluid of Healthy Males.” J Med Assoc Thai 99 Suppl. 2 (2016): S38–41.
  104. Polis, C.B., Bradley, S.E., Bankole, A., et al. “Typical-use contraceptive failure rates in 43 countries with Demographic and Health Survey data: summary of a detailed report.” Contraception 94.1 (2016): 11–7. DOI: 10.1016/j.contraception.2016.03.011
  105. Wadhwa, L., Rani, P., Bhatia, P. “Comparative Prospective Study of Hysterosalpingography and Hysteroscopy in Infertile Women.” J Hum Reprod Sci 10.2 (2017): 73–8. DOI: 10.4103/jhrs.JHRS_123_16
  106. Uysal, A., Alkan, G., Kurtoğlu, A., et al. “Diminished ovarian reserve in women with transfusion-dependent beta-thalassemia major: Is iron gonadotoxic?” Eur J Obstet Gynecol Reprod Biol 216 (2017): 69–73. DOI: 10.1016/j.ejogrb.2017.06.038
  107. Levron, J., Yerushalmi, G.M., Brengauz, M., et al. “Comparison between two protocols for thawed embryo transfer: natural cycle versus exogenous hormone replacement.” Gynecol Endocrinol 30.7 (2014): 494–7. DOI: 10.3109/09513590.2014.900032
  108. Le, Q.V., Abhari, S., Abuzeid, O.M., et al. “Modified natural cycle for embryo transfer using frozen-thawed blastocysts: A satisfactory option.” Eur J Obstet Gynecol Reprod Biol 213 (2017): 58–63. DOI: 10.1016/j.ejogrb.2017.04.010
  109. Park, H.J., Lee, G.H., Gong du, S., et al. “The meaning of anti-Müllerian hormone levels in patients at a high risk of poor ovarian response.” Clin Exp Reprod Med 43.3 (2016): 139–45. DOI: 10.5653/cerm.2016.43.3.139
  110. Hipp, H., Crawford, S., Kawwass, J.F., et al. “National trends and outcomes of autologous in vitro fertilization cycles among women ages 40 years and older.” J Assist Reprod Genet 34.7 (2017): 885–94. DOI: 10.1007/s10815-017-0926-2
  111. Tanaka, K., Chua, J., Cincotta, R., et al. “Hysterosalpingo-foam sonography (HyFoSy): Tolerability, safety and the occurrence of pregnancy post-procedure.” J Obstet Gynaecol (2017): 12716. DOI: 10.1111/ajo.12716
  112. Ludwin, I., Ludwin, A., Wiechec, M., et al. “Accuracy of hysterosalpingo-foam sonography in comparison to hysterosalpingo-contrast sonography with air/saline and to laparoscopy with dye.” Hum Reprod 32.4 (2017): 758–69. DOI: 10.1093/humrep/dex013
  113. Doshchechkyn, V.V. “Identification of intact fallopian tubes using the new non-contrast ultrasound technique `The Mobile Hydroacoustic Window`.” J Biomedical Biosocial Anthropology 27 (2016): 161–6.
  114. Doshchechkyn, V.V. “Transvaginal MHW-sonography: new possibilities in evaluating the function of the fallopian tubes.” J Biomedical Biosocial Anthropology 28 (2017): 175–80.
  115. Ohannessian, A., Loundou, A., Gnisci, A., et al. “Unexplained infertility: live-birth’s prognostic factors to determine the ART management.” Minerva Ginecol (2017). DOI: 10.23736/S0026-4784.17.04085-0
  116. Geisler, M.E., Ledwidge, M., Bermingham, M., et al. “Intrauterine insemination – No more Mr. N.I.C.E. guy?” Eur J Obstet Gynecol Reprod Biol 210 (2017): 342–7. DOI: 10.1016/j.ejogrb.2017.01.016
  117. Kurjak, A., Chervenak, F.A. Donald School Textbook of Ultrasound in Obstetrics and Gynecology. Parphenon publishing Group (2003): 800 p.
  118. Kurjak, A., ed. Ultrasound and infertility. CRC press, Inc. (1089): 223 p.
  119. Demidov, V.N., Zykin, B.I. Ultrasound diagnosis in gynecology. Moscow. Medicine (1990): 224 p.
  120. Zykin, B.I., Bulanov, M.N. “Dopplerography of the ovaries.” In: Dopplerography in gynecology. Moscow. The Real Time (2000): 93–8.
  121. Zykin, B.I., Proskuryakova, O.V., Bulanov, M.N., et al. “Standardization of ultrasound in gynecology. I. Echographic standards.” Echography 2.3 (2001): 285–8.
  122. Chizen, D, Pierson, R. “Transvaginal ultrasonography and female infertility.” Glob libr women’s med (2010). DOI: 10.3843/GLOWM.10326
  123. Collins, J., Woodward, P. “Radiological evaluation of infertility.” Seminars in Ultrasound, CT and MRI 16 (1995): 304–16.
  124. Thurmond, A.S. “Imaging of female infertility.” Radiol Clin North Am 41.4 (2003): 757–67.
  125. Sella, T., Laufer, N. “Introduction: Imaging in reproduction.” Fertil Steril 105.6 (2016): 1379–80. DOI: 10.1016/j.fertnstert.2016.04.026
  126. Groszmann, Y.S., Benacerraf, B.R. “Complete evaluation of anatomy and morphology of the infertile patient in a single visit; the modern infertility pelvic ultrasound examination.” Fertil Steril 105.6 (2016): 1381–93. DOI: 10.1016/j.fertnstert.2016.03.026
  127. Harrison, R.F., Thompson, W., Bonnar, J., Eds. Fertility and Sterility: The Proceedings of the XIth World Congress on Fertility and Sterility, Dublin, June 1983. Imprint Kluwer Academic Publishers Publication. Dordrecht, Netherlands.
  128. Tscherne, G. “Hormonal disorders, menstrual irregularities and future fertility.” Gynakol Geburtshilfliche Rundsch 43.3 (2003): 152–7.
  129. Neill, J.D., Ed. Knobil and Neill’s Physiology of Reproduction. Third Edition. St. Louis, MO. Elsevier-Academic Press (2006).
  130. Florman, H.M., Ducibella, T. “Fertilization in mammals.” In: The Physiology of Reproduction, Vol. 1. Ed. by J.D. Neill. St. Louis, MO. Elsevier-Academic Press (2006): 55–112.



How to Cite

Гладчук, И. З., & Дощечкин, В. В. (2018). Subfertility: philosophy and methodology of the problem. Part II. REPRODUCTIVE ENDOCRINOLOGY, (42), 8–15.



Interdisciplinary problems