Causes and symptoms of infertility in women. Barren marriage

Unfortunately, gynecologists around the world are faced with cases of infertility every day. Against the background of an increase in the number of abortions and cases of infection with sexually transmitted diseases, the problems of infertility are becoming more acute and relevant for modern people.

ATTENTION!!!
A married couple is considered infertile if the expected pregnancy does not occur within 2 years of regular unprotected sexual activity.

Today, according to statistics, out of 100 married couples, 15 are infertile. Spouses who are able to have as many children as they want are unlikely to fully understand the misfortunes of those who are deprived of the opportunity to become parents. Every year, millions of women have abortions, but on the other side there are those who make every effort to give life to at least one child. I would like to remind you that, despite the achievements of science in the field of human reproduction, only 15-20% of all infertile couples have the fortunate opportunity to conceive and give birth to a child.

Causes of male infertility

Few people know that in 40% of cases of infertile marriages, the culprit is the man. That is why both spouses must undergo an infertility examination. Only in this case can we hope for a positive result.

There are many reasons male infertility. Firstly, malformations or underdevelopment of the testicles or vas deferens. It happens that during fetal development, both or one testicle does not descend into the scrotum. Spermatozoa are very sensitive to elevated temperature(and in abdominal cavity it is higher than in the scrotum), so their development is suspended or completely stopped.

Secondly, infertility in men, as in women, can be caused by various inflammatory or infectious diseases and their consequences. Infertility often occurs as a result of gland dysfunction internal secretion, which directly affects the development of sperm. Alcoholism, excessive smoking and serious diseases accompanied by an increase in body temperature (malaria, typhus and others) directly affect the ability to fertilize.

The opinion that impotence provokes infertility is wrong. Sexual impotence and infertility have nothing to do with each other. A man with a weakened erection can easily become a father, and vice versa, a sex giant may be unable to inseminate.

Causes of female infertility

The causes of infertility in women are not much different from those in men. Abnormalities or underdevelopment of the genital organs (mainly the uterus and fallopian tubes), makes conception impossible. The most common cause of female infertility is inflammatory diseases (often occurring in every second woman after an abortion). The fallopian tubes become difficult to pass or become completely stuck together, leaving the woman at risk of ectopic pregnancy or infertility.

Like inflammation, sexually transmitted diseases do not go away without leaving a trace. Advanced forms of syphilis, chlamydia, mycoplasmosis, ureaplasmosis, genital herpes and a number of other diseases lead to infertility. Ovarian dysfunction is also one of the most common causes of inability to conceive. The eggs either do not mature at all (no ovulation), or ovulation occurs incorrectly. Such a disorder can occur genetically during puberty, or much later: after childbirth or abortion.

Infertility treatment

Treatment of infertility involves eliminating the causes that interfere with conception. If these are sexually transmitted infections, then both partners undergo treatment. If a woman has hormonal disorders, then under the supervision of an experienced gynecologist-endocrinologist it is necessary to restore hormonal levels. Obstruction of the fallopian tubes and adhesions also need to be treated. If the main cause of infertility is associated with a violation of the quality of sperm in a man, then in this case he is prescribed special diet and drugs.

In the most difficult situations When other treatments do not produce positive results, modern doctors have unique artificial insemination technologies.

Infertile couples should not despair. Get examined, get treatment, go towards your dreams! Everyone who really wants it has a chance to become a parent.

I recommend reading my book How to overcome infertility and give birth to a healthy child, which was published in 2013 by Phoenix Publishing House. With the help of this book you will be able to use all available opportunities for successful conception child.

Causes of infertility, for which married couples seek help from endocrinologists or gynecologists, are extremely numerous. The problem of infertility is especially relevant today, when against the background sharp increase cases of abortion and the spread of sexually transmitted infections, some couples end up in difficult situation with the inability to conceive or bear a fetus.

What to do in such situations? To begin with, of course, find out the causes of infertility, following a pre-prepared examination plan in such situations.

Hello! From today's article, read about the main causes of infertility in married couples. But first, a few words about the very concept of an infertile marriage. So, in what cases should you apply for medical assistance, and in which ones is it too early to sound the alarm about possible infertility? The answer is below...

INFERTILITY is...

In previous years, a couple was considered to be infertile if, over the course of two years of MANDATORY regular sexual activity (and always without protection), the planned pregnancy did not occur. Now this period has been shortened by half, that is, already a year after regular sexual activity and the absence of pregnancy, you should think about going to a gynecologist-endocrinologist.

According to statistics, the situation today is such that almost every 6-7 couples experience difficulties conceiving a child. This means that 15 out of 100 married couples have some kind of problem with fertilization. The causes of infertility will be different in each case, which is why it is so important individual approach and drawing up a special treatment regimen for each situation.

Another interesting statistical fact: only 17-20% of infertile couples get a chance to become parents after successful treatment infertility, and this is taking into account all the achievements of reproductive medicine today!

Causes of infertility in men

In approximately 30% of all cases of infertility, the cause of this problem lies in the male body. Fortunately, it is much easier and cheaper to examine men for infertility than women. Here are two main groups of reasons for this:

changes in the quality and/or quantity of sperm;
sexually transmitted infections.

The first group of reasons is caused by pathologies such as underdevelopment/malformations of the vas deferens or testicles. If one or both testicles do not descend into the scrotum during fetal development, cryptorchidism develops, which can also cause a decrease in the number or quality of sperm, and male infertility in the future.

Male reproductive cells are very sensitive to high temperatures. Considering the fact that the temperature in the abdominal cavity is always higher than in the scrotum, significant changes occur in the spermogram in men with such problems.

Smoking, alcohol abuse, and some serious illnesses, in which there is a significant increase in body temperature (typhoid, malaria, etc.) play a huge role on the ability of men to conceive a child.

Infectious and inflammatory diseases in men can also often cause infertility in a married couple. That is why every man with a similar problem, along with his companion, must be examined for sexually transmitted infections (chlamydia, mycoplasma, gardnerella, ureaplasma, cytomegalovirus, herpes virus, etc.).

INTERESTING FACT

The common belief that men with impotence are necessarily infertile is not true! Infertility and weakened erection are in no way related to each other. In some cases, a hypersexual man may be completely unable to conceive, and vice versa - a man with sexual impotence can become the parent of large offspring without any problems!

Causes of infertility in women

In women, the cause of infertility can also be underdevelopment or abnormalities in the structure of the genital organs. First of all, this, of course, concerns the fallopian tubes and uterus. Inflammatory processes in the pelvic cavity and genital infections - one of common reasons the impossibility of conception in the fair half of humanity.

The cause of inflammation in most cases is previous abortions. If there are problems with the patency of the fallopian tubes, a woman may also be at risk of infertility or ectopic pregnancy.

Quite often, women with infertility are found various disorders hormonal background. This may be a dysfunction of the ovaries, overproduction of prolactin by the pituitary gland (), increased TSH level(primary hypothyroidism), impaired production of follicle-stimulating hormone, etc.

Various disorders in hormonal background require consultation with an experienced endocrinologist. In some cases, the endocrinologist and gynecologist work together to resolve issues related to infertility.

Another reason for an infertile marriage is the immunological incompatibility of partners. Solving this problem is extremely difficult. The article "" lists the main diseases and pathologies due to which women and men most often fail to become parents.

How to treat infertility?

The answer to this question is very complex and voluminous. I repeat, in each case everything is decided individually, depending on the previous medical history, the presence concomitant diseases, results of laboratory and instrumental examinations.

In a simplified version, we can say that infertility should be treated by trying to eliminate the cause that led to it. If it comes to infectious diseases, then both partners must be fully treated with a course of specific antibiotic therapy, which will be compiled by the treating gynecologist or reproductive specialist.

Subject to availability hormonal disorders An endocrinologist comes into play, and his task is to completely eliminate the main obstacle to the conception of a future life.

Adhesions in the pelvis and obstruction of the fallopian tubes also require a competent approach to treatment. It must be said that examination for tubal obstruction is carried out almost at the very end of diagnosing the causes of infertility, when, according to the results of previous studies, no problems can be detected.

If there are deviations from the norm in the spermogram, the man is prescribed drug treatment, as well as special diet therapy.

In severe cases, after many unsuccessful attempts to become parents, a couple can resort to the extracorporeal technique artificial insemination(ECO). Of course, this is not a panacea for infertility, but in a sufficient percentage of cases, a couple still manages to achieve their goal with the help of IVF. More details about IVF will be in a separate issue, for those who do not want to miss the release of the article.

In conclusion, we note that there is no need to despair if for a long time you fail to become happy parents. Be thoroughly examined, treated by competent specialists, plan, and you will definitely succeed! It is important to believe in this and never give up halfway!

Examination of an infertile couple

People tend to remain silent about what bothers them. But water does not flow under a lying stone, and this approach will not lead to success.

So, you took a very important, decisive first step and went to the doctor. It should be remembered that infertility is a problem for two people, so the presence of a partner at the first consultation is not only desirable, it is absolutely necessary.

It is extremely important to choose a good and modern clinic and a doctor you would trust. Usually, already at the first meeting, it becomes clear whether you can build a relationship in the future, or whether it is worth going in search of another specialist.

During your appointment, the doctor will ask each of you in detail about previous diseases(naturally, they will concern not only gynecology and urology), operations, medications that you may be taking, methods of birth control that you have used previously. The gynecologist will conduct initial examination women, their partner will be examined by a urologist. Sometimes it is not superfluous to consult a professional psychologist.

Types of infertility

Infertility can be primary - when partners have not had a single pregnancy during their life, and secondary - when there have been pregnancies (it does not matter whether they ended in the birth of a child).

Infertility is not just an abstract concept. It could have several completely different reasons. As for men, disturbances are manifested in the quantity or composition of sperm. For women, everything is much more complicated. Pathology can affect the endocrine glands, creating obstacles to the maturation and release of the egg from the ovaries (). The fallopian tubes, through which the egg and sperm move towards each other and where fertilization occurs, may be damaged or completely blocked due to adhesions. Another reason may be the aggressive composition of cervical mucus, which damages sperm. In addition, the uterus itself or its cervix may have irregular structure. Sometimes at the very thorough examination The cause of infertility cannot be determined. In this case, they speak of infertility of unknown etiology.

Problems of age

It is known that the ability to become pregnant decreases with age. Therefore, if you are over 35 years old or have an irregular menstrual cycle, you should not wait a year - you can consult a doctor after 6 months of unsuccessful attempts.

If about age-related decline reproductive function While women have no doubts, the issue remains controversial regarding their partners. The highest ability to fertilize is observed in men aged 35, then by the age of 45 it quickly decreases, although paternity remains possible after 70 years. But, according to research, the older the father is, the higher the risk of having a child with Down syndrome. This happens because male reproductive cells also undergo aging.

Material prepared by Tatyana Bochaeva, doctor

Statistics show terrifying figures: in Russia, every sixth married couple is infertile. And for most spouses, the absence of children is a real grief. The priest and doctor Father Sergius Filimonov shares his experience and knowledge with the readers of the site: what are the causes of infertility, how to overcome them, and how to treat infertility as a curse or as an opportunity to realize oneself in a different capacity?

prot. Sergiy Filimonov

Chapter 1. Medical causes of infertility in marriage

(gynecologist-endocrinologist Yu. Yu. Toropkova)

Infertility in marriage is one of the most important and complex medical and social problems. The proportion of infertile marriages in Russia ranges from 8 to 17.5% and currently has no downward trend. There are regions (mainly megacities) in which this figure reaches 24–29%, while a level of 15% represents serious threat for demographics.

In other words, every 6–7 pair of Russians (i.e. about 7 million) for their reproductive period(15–49 years old) are faced with the problem of infertility.

So, a marriage is considered infertile in which, for one reason or another, occurring in the body of a woman or a man, or both spouses, pregnancy does not occur with regular sexual activity without the use of any contraception within 12 months. given that childbearing age spouses.

It is customary to distinguish between primary and secondary infertility, female and male. Primary infertility in women is called infertility, in which pregnancy has not occurred even once since the onset of unprotected sexual activity; secondary - pregnancy occurred in the past, but after that there is no pregnancy for 1 year of regular sexual activity without the use of contraceptives.

The frequency of female infertility ranges from 40 to 50%, and there are 3 main groups of reasons:

Endocrine (35–40%). Endocrine forms of infertility are always associated with disruption of the ovulation process (maturation and release of the egg from the ovary) and are often accompanied by disturbances in menstrual function;
Tubal-perinatal (30–74%). C is the most common, most studied and most difficult form of infertility to correct. In this group of patients, there are anatomical and functional disorders of the fallopian tubes, when it is difficult (or impossible) for the advancement of the egg to the place of its attachment (implantation) in the uterine cavity. Such conditions are not uncommon after inflammatory diseases of the pelvic organs, abortions and other intrauterine interventions, operations, incl. and gynecological, after which the risk of adhesions in the pelvis increases.
Gynecological diseases (1.5–28%). The most common cause in this group is genital endometriosis - serious illness, requiring long-term and persistent treatment.
There are also: absolute female infertility, when the possibility of pregnancy is completely excluded (absence of the uterus, ovaries, abnormal development of the genital organs), and so-called unexplained infertility (4.8–7.6%), the cause of which cannot be determined by currently used research methods. succeeds.

The term " relative infertility“is used when a woman and a man are capable of having children each separately outside of marriage, but if they live together for a long time, their marriage is infertile. IN recent years More and more attention is being paid to the problem of male infertility, the frequency of which in infertile marriages also reaches 40-50%, and in combination with infertility in the wife - 15-20%.

Male infertility is the inability of reproductive cells to mature male body to fertilization. There are secretory (associated with a violation of the process of spermatogenesis) and excretory (arising from a violation of sperm secretion) infertility.

Due to the fact that the frequency of female and male factors infertility is the same, and every fourth married couple has a combination of several factors, the examination almost always begins with a joint conversation with the married couple to exclude psycho-sexual and iatrogenic causes and assess the state of physical health of both spouses. Working with a married couple allows you to outline a general examination plan and sequence diagnostic procedures. Subsequently, the examination is carried out by a gynecologist and an andrologist in parallel.

In clinical practice, the evaluation of infertile couples always begins with the men. If the results of a semen examination (spermogram) do not reveal any pathology, then no other studies are performed in men; if problems are identified, then it is shown full examination and treatment with the participation, often, of many specialists: a urologist, endocrinologist, surgeon, andrologist, and sometimes a sex therapist. Infertility in men occurs as a result of various pathological processes in the body, providing negative impact on internal organs, endocrine glands, central nervous system. It is impossible not to take into account the increase in the prevalence of anomalies in the development of the genital organs and the frequency of infectious and inflammatory diseases, the influence harmful factors environment, urbanization, widespread and uncontrolled use of drugs, allergization of the population.

Therefore, the most justified in the treatment of male infertility is examination in large specialized centers with the participation of several specialists and carrying out complex, staged, individually selected therapy, where each stage is sequential, clearly limited in time and aimed at performing a specific task.

For women, the most important and diagnostic meaningful methods examinations are to assess ovulation and tubal patency. To do this, the center’s doctor may conduct a number of studies, for example:

blood assessment for hormonal profile. The level of 6–7 hormones in blood plasma taken on a certain day of the menstrual cycle is determined; sometimes hormonal tests are performed;
Ultrasound monitoring of ovulation. This method allows you to directly observe the growth of the follicle in the egg of a woman’s ovary and the degree of readiness of the inner mucous membrane of the uterus to receive a fertilized egg;
checking the patency and characterization of the internal lumen of the fallopian tubes using x-ray or ultrasound.
In some cases, to identify the causes of infertility, ultrasound of the thyroid and mammary glands, radiographic or computer examination skulls, consultations with doctors of related specialties and even medical genetic counseling.

Currently at the final stage of the examination with female infertility carry out endoscopic methods diagnostics: laparoscopy and (or) hysteroscopy. Without the use of these methods, the cause of infertility in marriage is considered unknown. In addition, laparoscopy is not only the final stage diagnostics, but also the first stage of treatment of female infertility.

Endoscopic technologies allow for low-traumatic microsurgical correction of identified changes in the pelvic organs - separation of adhesions, restoration of patency of the fallopian tubes, coagulation of foci of endometriosis, removal of ovarian tumors, surgical treatment some diseases of the uterus - without subsequent pronounced adhesions.

In conclusion, it should be noted that a consistent assessment of all parts of a complex reproductive system men and women are a necessary condition for staging correct diagnosis, while the set of diagnostic techniques depends on clinical picture specific disease and is strictly individual for each married couple. If it is impossible to promptly and quickly conduct a complete clinical and laboratory examination, it is necessary to promptly refer the married couple to a specialized medical institution for a final diagnosis, remembering that delaying the examination reduces hopes of success in restoring reproductive function.

In our region, 5 large centers deal with infertility issues:

Russian-Finnish clinic “Ava-Peter” (Nevsky pr., 22–24, t. 325–92–72, 312–30–65),
Clinic of Reproductive Medicine at the Institute of Obstetrics and Gynecology named after. TO. Otta;
clinic "Avicenna" in Pushkin;
infertility treatment center at the Military Medical Academy;
infertility treatment center at the Military Medical Academy in the Sestroretsky district of the city. St. Petersburg.
In addition, in many antenatal clinics There are gynecologist-endocrinologist offices.

Chapter 2. Infertility - medical and spiritual reasons

Father Sergius, please tell us about the causes of infertility.

There are medical and spiritual reasons for infertility. If we talk about medical reasons, there are about 30 diseases that can cause infertility. Various medical centers and institutions advise people about the problem of childlessness. Spouses submit the appropriate medical tests, based on the results of which they determine which side of the couple is the reason why a child cannot be born in the family. When it is determined which side is weak in relation to the birth of children, then the spouse with “low potential” for childbearing is examined for various diseases, especially chronic diseases of the genital area, which may be an obstacle to normal childbearing. Specialists who treat infertility in men are andrologists, urologists, and in women – gynecologists.

After an appropriate examination, treatment is carried out - conservative or surgical, if necessary. For example, when adhesive processes in the area of the fallopian tubes or if their patency is poor, it is possible to improve the latter both by conservative methods and with the help surgical methods– removal of adhesions in the area of the fallopian tubes in certain time when childbearing is most possible. That is, the doctor’s painstaking work with each married couple is required.

In means mass media a lot is said about methods of artificial insemination. Is it possible to resort to them if treatment is ineffective?

There are various techniques artificial insemination. According to our church canons, according to the materials of the Jubilee Council of Bishops of the Russian Orthodox Church in 2000, they are not acceptable. The only acceptable method is the so-called “natural fertilization method,” in which the husband’s semen, obtained during marital relations, is introduced by a doctor into the area of the uterus. Thus, fertilization of the egg occurs after a natural relationship between husband and wife, in addition, with this method the integrity is not violated family union, since only the sex cells of both spouses are used. In the case when a third party intervenes in the process of childbirth, for example, if a donor’s seed is used for artificial insemination, an element of sinfulness is introduced... Outwardly, it would seem that there is no fact of treason, however, a foreign element is introduced into the family. This is tantamount to a woman entering into an illegal marital relationship with a stranger in order to give birth to a child. Although there is no physical component of sinful relationships here, at the same time, the genetic material of a stranger is introduced into a woman’s egg, i.e., prodigal intercourse is obtained with the help of medical technology. Exists a whole series methods of this type of artificial insemination claim, when a third party intervenes. For some of them it is used donor egg a stranger's woman, who, after fertilization with her husband's seed, is implanted in the uterus. Such methods are also unacceptable, since in this case a foreign element invades the family. There is even a psychological phenomenon when a woman who has been implanted with such an egg feels something alien in her body, unusual for her.

Please tell us about the method in vitro fertilization. How should an Orthodox person treat him?

Methods of in vitro fertilization are not blessed by the church, since this also uses genetically foreign material, that is, the integrity of the family and marital union is violated. In addition, the donor semen used in these techniques is obtained artificially, and not as a result of natural marital relations. It is also important that when using in vitro fertilization, there is no physical connection between a man and a woman, so the secret of childbirth is taken beyond the boundaries human body. The act of giving the spouses to each other, which is necessary for the birth of a new life, does not occur. Life is born in a test tube. What happens at this moment to the embryo outside the mother’s body, how physical illnesses he will be exposed to how fallen spirits influence him - this is a big question. One of the serious problems of in vitro fertilization is that in a number of centers, when implementing this technique, so-called extra fertilized cells are produced, which are already new life. These cells are reduced, that is, killed. This means that if four eggs have been fertilized and the woman only wants one child, only one egg will be transferred to her. What to do with the remaining three embryos? They can be frozen or edited. Thus, a child is born through the simultaneous killing of two or three unborn siblings. The life of one at the expense of the death of another is considered unacceptable by the church. Therefore, all types of in vitro fertilization are not blessed by the Church. This was approved in the materials of the Anniversary Council of Bishops of the Russian Orthodox Church in 2000, in Chapter 12 “Problems of Bioethics.” The issues are discussed in some detail there. various kinds overcoming infertility, it tells what spouses should do if they do not have children.

What spiritual reasons can lead to infertility?

There can be many reasons. I will try to list the main ones. I will rely on the works of Elder Paisius the Svyatogorets, who in volume 4, called “Family Life,” answers questions about the birth of children, the difficulties of childbearing and the problem of infertility. When asked why certain women develop infertility, Elder Paisios answers as follows: “Some infertile women did not marry when they should have done so, and therefore now spiritual laws apply to them. Some picky girls start choosing grooms: “No, I don’t like this one, and I don’t like that one.” Having promised a guy to marry him, such a girl simultaneously looks at the other, then says “no” to the first, and he wants to commit suicide, instead of counting it as a blessing that she deceived him, at least before they got married, not after. Eh, what kind of family will such a girl create? And there are women who are barren because in their youth they lived a chaotic, sinful life. There are also those whose infertility is caused by poor nutrition, because many foods contain a whole bunch of chemicals and hormones.”

About girls who are promiscuous sex life It can be noted that in such cases there are two components that can lead to infertility - medical and spiritual. Women with such a lifestyle are very likely to develop various infections, which can lead to various chronic diseases of the genital area, which entails the inability to bear children. The spiritual component is that the Lord can allow such a girl to be punished for her desire to “have fun” (that is, to satisfy her lust as much as possible) and not give children for such a depraved life.

The next reason that Elder Paisius notes: “There are also married couples who want to have a child as soon as they get married. And if the birth of the child is delayed, then they begin to worry and worry. How can they give birth to a child if they themselves are full of anxiety and mental anxiety? They will give birth to a child when they have driven out anxiety and mental anxiety from themselves and have directed their lives along the right spiritual track.

Sometimes God deliberately delays and does not give children to some married couple. Look: after all, He gave the Holy Fathers Joachim and Anna, and the Holy Prophet Zechariah and Elizabeth a child in old age in order to fulfill His eternal plan for the salvation of people.

Spouses must always be ready to accept the will of God into their lives. God does not abandon a person who trusts himself to Him. We don’t do anything, but how much God does for us! With how much love and generosity He gives us everything! Is there anything that God cannot do?...

Having children depends not only on the individual. It also depends on God. Seeing that spouses who are experiencing difficulties in having children have humility, God can not only give them a child, but also make them have many children. However, seeing persistence and selfishness in the spouses [God does not fulfill their desires, because] by fulfilling their request to have children, He will satisfy their persistence and selfishness. Spouses must completely surrender themselves to God. They must say: “My God, You care about our good, “Thy will be done” ().” In this case, their request will be fulfilled. After all, God’s will is fulfilled when we say “Thy will be done” and with trust in God we entrust ourselves to Him. But although we say “Thy will be done,” we simultaneously insist on our own will. Well, what can God do for us in this case?”

The next reason for infertility may also be the selfishness of the parents, but manifested in the opposite way, when a young family delays the birth of a child, reasoning that children are a concern, and that first they need to finish their studies, get on their feet, earn money for an apartment, build a dacha, buy a car, and now then it will be possible to have a child (not “God will give a child,” but rather “let’s have a child,” like a cat or a dog). When the Lord sees such an attitude towards God’s blessing for childbearing, a disregard for the commandment “Be fruitful and multiply,” then after some time, when the family already has everything - an apartment, a car, and a job, He does not give children. And such a family can no longer have anything other than cats and dogs. Although from the medical side there are no obstacles to this.

Elder Paisios identifies two more possible reasons infertility. “God does not give many people children so that, by loving the children of the whole world as their own, these people will help their spiritual rebirth.” Elder Paisios gives the following example: “One man had no children, but when he left the house, children from neighboring houses ran to him and surrounded him with love. They didn't let him go to work. You see: God did not give this man his children, but He gave him the blessing so that all the children in the neighborhood would love him as a father, and he would help them spiritually. God’s judgments are an abyss.”

“And in other cases, God does not give spouses children in order to give birth to some orphan.” Elder Paisios talks about one of his Christian acquaintances - a lawyer, a man of spiritual life. One day the elder stopped to stay with him for a day and met his wife, who also led a pious life, helping many poor children. She complained that the Lord did not give her children, to which Elder Paisios answered her reproachfully: “You, sister, have more than five hundred children. And you're still complaining? Christ saw your good will. And he will reward you for it. Now, helping the spiritual rebirth of so many children, you are a better mother than many others. You are leaving behind all the mothers of many children! And the reward that you receive will also be much greater, because by being reborn spiritually, children spiritually secure their future in eternal life.”

It happens that the Lord does not give children to a family, not as a punishment, but as a special providence, so that through these people some unfortunate child abandoned by his parents would receive help.

There are other causes of infertility. These include the so-called generational curses– when a mother or father curses their children. Sometimes, when children bother their parents, instead of their parental blessing, they send reproaches to the children, which can “work” as curses. For example, when a mother tells her daughters: “May you be empty” or sends them to evil spirits. Elder Paisios also gives a similar example. When such a mother then repented of her curses, the life of her daughters settled down and the Lord gave them children.

There are also “generational” sins against God and against one’s neighbor, when the Lord punishes with infertility for sins committed against Him. For example, if someone destroyed churches, removed crosses, cut icons, laughed at the Church, the Lord can send infertility to the family through a generation until people realize and atone for this sin. I know of a case where a priest renounced his priesthood after the revolution and then died without repentance. In subsequent generations, there were never boys in this family, and if they were born, they then died before reaching adulthood. There are known cases when in the 30s children were forced to renounce their parents publicly, in the work collective, at the institute. Such sins against God, desecration of the Church, blasphemy, renunciation of parents often affect the next generation or, after a generation, one of the grandchildren. Sometimes people commit sins against their neighbor - they dig up gravestones and build their own house out of them, or commit other blasphemous acts.

Is it possible that the absence of children is due to a phenomenon that some people call “damage” or the “evil eye”?

Of course, “damage” and “evil eye” are not church concepts. But some people use this terminology. By this we should understand the envy that some people sometimes have evil people. For example, this can happen if one woman is jealous of another - beautiful, financially prosperous, married and happy in her marriage. Out of envy, it may turn out that this woman will have everything, but she will not give birth to children. There are cases when, out of pride, the Lord can deprive a woman of a child if she mocks another, more unfortunate woman, deprived of the happiness of motherhood. The Lord can deprive a mocker of her child and close her womb so that she herself will no longer be able to have children due to her pride and exaltation over her neighbor.

Infertility can also be sent as a test of a person's faith. The materials of the Jubilee Council of Bishops and the patristic teaching indicate that infertility can be considered as a cross that the Lord places on a married couple. The cross, in which the married couple must show patience, humility, and trust in the will of God. Vivid examples are Abraham and Sarah, who prayed for about 90 years for the birth of a child, Zechariah and Elizabeth, Godfather Joachim and Anna. Their children were blessed when they were born after so much prayer, patience, and trust in God. A test of faith may be important point for such a married couple, when the couple shows their loyalty to God, when they do not murmur against God, they thank God for the sorrow they send. This test of faith may at some point end for the couple, and a woman childless for 20 years may give birth to many more children.

Infertility may also be due to the fact that the Lord delays the birth of children according to His special providence for this family, wanting to arrange the fate of any abandoned child. I know some families in which it happened that the woman conceived a child as soon as the spouses showed a desire to adopt an orphan from orphanage. There were couples who carried this intention to completion and as soon as they brought an orphan into their home, they were soon expecting their own baby, and in this way two children appeared in this family at once - one adopted and the second, whom the Lord sent, having resolved the womb of a previously barren woman. women. Moreover, when doctors examined such women, they did not find pathologies in them that prevented childbearing. But the will of the Lord was such that these families would raise not only their own child, but also an adopted one.

Very important for solving the problem of infertility is the sanctification of church marriage. In the prayers for the consecration of a church marriage there are words that call for God’s blessing on a woman’s womb so that she is fruitful. Unbelieving husbands sometimes neglect this important sacrament, and the Lord does not give a woman the opportunity to become a mother until the marital union is sanctified by the grace of church marriage. There are also cases where women who were diagnosed with infertility, who lived for many years with their husbands in officially registered but unmarried marriages, conceived children within a few days after the wedding.

There are several other causes of infertility that can be considered. When the Lord sees that a possible child in a family will be very sick or profoundly disabled, He allows this baby not to be born. From church patericons, there are cases when mothers, under the threat of losing a child, fervently and earnestly prayed to God, the Lord revealed to them through certain saints that their prayer was objectionable, because this child would be born a villain, a murderer, a blasphemer. If the mothers did not retreat, wanting to fulfill their will at all costs, to satisfy their maternal egoism, the Lord allowed the birth of such children who later became scoffers of the family.

The case of the Decembrist Pestel, whom his mother begged for when he was dying of diphtheria at the age of five, is well known. The Lord then showed her that her son would recover, but would end his life on the gallows. That's how it all happened later. The mother later repented, but it was too late, the Lord had already answered her prayers. Therefore, the prayer “Lord, not as I want, but as You want” is very important.

The Lord may not give children because the husband and wife are unprepared to raise a child, because one of the spouses is irresponsible or malicious, or because of the possibility of mutual infidelity. For example, if there are constant quarrels and scandals in the family, the husband and wife are selfish, are not ready to sacrifice themselves for the sake of the child, are not ready to take care of him, give him their love, the Lord, foreseeing this, delays the birth of the child for several years until the married couple matures until everything is settled in the family, until the husband and wife come to an agreement. A child must be born in love. If from the very beginning of his life he experiences the anger of his parents towards each other and towards himself, then what will this child grow up to be, what will happen to his soul, what will he absorb from such parents?

There are also known couples in which the wives could not give birth to children and went to many doctors, knocking on doorsteps. At the same time, their husbands humiliated and insulted them, reproaching them with the impossibility of childbearing. These women underwent all kinds of medical procedures, but nothing helped. Subsequently, these husbands cheated on their wives and left for other families. And women who were infertile married other men and successfully gave birth to children. Their infertility turned out to be imaginary. The Lord, foreseeing that the husband and wife are not ready to preserve the marital union, that the collapse of the family is possible, sometimes allows that a child will not be born into this family, because he will remain an orphan from a young age.

Next time we will talk about the sequence of necessary spiritual actions that a believing married couple can resort to in order for a child to be born into their family.

Chapter 3. Infertility - ways to overcome it

What is the sequence of spiritual actions for a believing couple to have a child in the family?

We will not now touch on the issues of infertility in an unbelieving family, far from the Church. Let's not talk about people who lead a sinful lifestyle. Let's talk about those spouses who have entered into a legal marriage and go to Church, but have not been able to give birth to a child for several years.

The first question that spouses should ask themselves is whether their marriage is married or unmarried. In prayers for the consecration of a church marriage, the grace of God is especially invoked so that it is good-born: “Yes, show that your will is a legal marriage, and from it the creation of children. Lord our God, remember Thy servant and Thy handmaid and bless them, give them the fruit of the womb, good children, like-mindedness of soul and body." Therefore, believing spouses whose marriage is not celebrated, first of all, require church consecration of the marriage.

If, after some time, children are still not born in this family, it is necessary to resort to the help of both medical diagnostic methods and church sacraments.

Medical diagnostics are carried out by various medical centers called reproductive centers, women's reproductive health centers or family and marriage centers. In different cities they have different names, but you can find them in any directory.

Data modern medicine indicate that there are more than 30 medical causes of infertility. Therefore, sometimes it takes time to discover the cause. First, they find out whose health – the husband’s or the wife’s – prevents the birth of children. After a thorough diagnosis, one or another type of conservative (medicinal) or surgical (if required) treatment is carried out. I repeat - the question of choosing a treatment method is decided depending on the cause of infertility.

Spouses should have an unshakably firm position regarding which methods are church-blessed, bound, and which are impermissible from the point of view of Christian Orthodox ethics. What methods are not blessed by the Church are described in detail in the materials of the Anniversary Council of Bishops of the Russian Orthodox Church in 20002. You can read about this in Orthodox periodicals, talk with your confessor, or with Orthodox biomedical ethicists. There are now Societies in many cities Orthodox doctors, where experts can answer which new medical techniques overcoming infertility are permissible and which are not.

If medical treatment turns out to be ineffective, or has enough complex character, spouses can and should resort to church sacraments, asking for God’s help to overcome their illness.

What arsenal of means does the Russian Orthodox Church have at its disposal to help spouses with their problem?

First of all, spouses should pay attention to whether their incorrect church life is interfering with the birth of children - how churchgoers they are, whether they confess correctly, how often they partake of the Holy Mysteries of Christ, what their confessor tells them.

That is, the first place to start is with a thorough examination by the spouses themselves of the quality of their Christian life, their relationship with their confessor. The confessor, by the will of God, can reveal which path they should follow, what prayers to read, what sacraments to resort to. If, as a result of a thorough examination of his life and repentance, the Lord reveals some kind of generational sins (we talked about this in the previous conversation), they must be confessed to the confessor and prayed for in a certain way. You need to understand that the mistakes of your grandmothers, grandfathers, and great-grandfathers affect your life.

To atone for their sin, you can ask your confessor for some kind of penance or church blessing (for example, performing a canon of repentance or reading certain prayers of repentance). Or to make such spiritual replenishment that can appease God.

Spiritual replenishment includes such situations when, for example, in order to atone for the sin of a mother who committed an abortion, her barren daughter takes on the feat, with the blessing of the priest, to care for children in an orphanage, visit orphans, and visit maternity hospitals (if there is a maternity hospital in the parish) , baptize dying babies out of fear for the sake of a mortal, help women who do not want to give birth, who are persuaded to terminate their pregnancy, so that they do not take this step. So you will commit the opposite of your ancestral sin.

Another example: if a great-grandfather kicked an orphan out of the house, then his granddaughter or great-granddaughter, who has become infertile, must take care of the orphans: provide them with some kind of care or become the orphan’s godmother. I have already said that often infertile spouses take children from an orphanage, and after a while the Lord allows them the fruit of their womb and gives them their own children. The same happens in cases when infertile couple or one of the spouses makes some kind of spiritual compensation for the sins that their ancestors committed.

In addition to the Sacraments of Repentance and Communion of the Holy Mysteries of Christ, there is also the Sacrament of Unction in the Church. Infertile spouses can turn to the priest with a request that it be performed on them. Usually Unction is performed during Lent, in some dioceses - during the Nativity Fast. Sometimes the Sacrament of Revelation is performed upon the arrival of the relics of the holy saints of God, who have a special gift to help the sick. So, for example, unction in the St. Petersburg diocese was performed during the transfer of the holy relics of St. healer Panteleimon.

You can also, with the blessing of your confessor, make pilgrimages to the relics of the holy saints of God and ask for their gracious help.

Some saints (for example, St. Sergius of Radonezh, St. Seraphim of Sarov) specifically petition for the birth of children. For example, many infertile women pray to St. David of Gareja or St. the prophet of God Elijah. In my memory, there is an example when one Christian woman, who had been infertile for about ten years, on the advice of a priest, decided to make a pilgrimage to the Holy Land, to Mount Carmel, to the cave where the prophet of God Elijah labored, and where women from all over the world come to resolve their infertility. She made a promise that if she had a boy, she would name him after the prophet Elijah. She became pregnant immediately, even while preparing for this trip (it must be said that she never got to the cave of St. Elijah), and went on a pilgrimage to holy places with a conceived child, who after the allotted time became the boy Elijah. Many such examples can be given.

The concept of “vowed children” has long been known in Rus'. When a family could not wait for a son for a long time or had no children at all, the couple made a vow to God to raise a future son for Him - to give him to become a monk or to some other service to God. And according to this vow, the Lord sent them children.

There are special places, special miraculous icons that provide gracious help to childless spouses. For example, the icon of the Mother of God Trooditissa, which is located in the Troodos mountains, Cyprus.

Once, in front of this icon, future parents begged the Mother of God for a child. They promised that they would ordain him as a monk. They had a boy. When he began to grow up (he was already eight or ten years old), his father and mother hesitated in their intention. And soon it happened that big stone fell off the mountain and flew a few centimeters from the child’s head. This was a warning to parents, a sign from God. They repented and as a result fulfilled their promise. The frescoes of this monastery depict Mother of God, Her belt and a large stone nearby are a reminder that the vows that are made to God must be fulfilled.

The birth of vowed children often happened in the past and happens quite often now. Anyone who will be in the Trooditissa monastery in Cyprus will see a huge photographic file of barren women of all nationalities, from all countries of the world, who, having visited this monastery, were relieved of childlessness and gave birth to two or three children after the prayer that the monks performed, putting on barren special belt. This is a huge file cabinet. I saw it myself when I visited this monastery and prayed in front of this icon.

I must say that one of my friend priests who visited the island of Cyprus, literally a week after praying in front of this icon (even without putting a miraculous belt on the mother), conceived a child who had only one or two percent probability of being born. Although the priest did not even ask for a child, but simply prayed in front of the icon, the Lord gave him a child.

Such special places, such holy saints, who are glorified by their gracious help to childless parents, exist both in the Holy Land and in every diocese. You can pray to them, make pilgrimages, order special prayer services, and then you can name him by the name of the saint who will help in the birth of the baby to glorify God’s miracle.

In addition, Orthodox spouses, of course, must resort to the help of shrines. During the pilgrimage, spouses can immerse themselves in holy springs, take water home, sprinkle it, and also be anointed with holy oil from lamps, from miraculous icons from the place of pilgrimage. All of this, done in prayer and faith, will help resolve the problem.

If, after repeated appeals to God, proper churching, resort to all the sacraments, pilgrimages to holy places, etc., children are not born, then you need to be patient. One must rely on the will of God.

Women and young married couples with similar problems often come to our temple. We usually advise spouses, if they want to have children, to set some kind of control period, a year or two, to establish their family life, learn not to be selfish and not live only for yourself. All this time (for a year or two) they will go to the temple for special prayers. In every diocese there are churches where priests perform prayer services for water and pray to the saints who provide grace-filled assistance to childless spouses.

If, after the appointed time, there are still no children, the husband and wife must decide whether they are ready to carry their life’s cross further, perhaps for many years, and patiently relying on the will of God, wait for the birth of their own child, or take an adopted one child. The Lord gives such an opportunity.

This period is also a time of seeking the will of God, exactly what path the Lord determines for this family. After all, the will of God is not immediately revealed to a person. Sometimes it takes a long time for it to become clear what kind of life the Lord wants for spouses, what destiny he has in store for them. Now it is necessary to know the will of God in order to conform one’s parental will to it.

And finally, the logical end of the entire series of spiritual actions that young parents perform is, in the event of the impossibility of getting pregnant, raising a foster child, adopted or in any form accepted into their family. And then, as the Lord wills.

Let us clarify once again where we should start – with a trip to the doctor or with a spiritual understanding of the illness?

I believe that we must begin our journey with the Church, by understanding what is happening together with our spiritual mentor, confessor or spiritual father. Because even on medical examination and treatment of churchly educated young spouses should take a blessing from their confessor. Having received God's blessing and the advice of their spiritual mentor, they can undergo certain medical events and at the same time ask for God’s help and resort to the grace-filled means of the Church.

Breviary. Following the rite of Wedding in the Moscow courtyard of the Holy Dormition Pskovo-Pechersky Monastery. Publishing house "Rule of Faith". 1995. pp. 117–118.

Anniversary Council of Bishops of the Russian Orthodox Church. Materials. Publishing Council of the Moscow Patriarchate a. Charitable Foundation "Christmas 2000". 2001