WHAT IS INFERTILITY?

 

Couples who cannot achieve pregnancy within 1 year despite regular sexual intercourse (the ideal frequency of sexual intercourse for pregnancy to occur is 2-3 times a week) should be investigated for infertility.

In cases where the woman is 35 or older, has menstrual irregularities, has a known disease related to the uterus, ovaries or tubes, or has male infertility problems, the investigation should be started without waiting 1 year.

The chance of pregnancy for a couple without infertility is around 20% each month. Approximately 57% of couples who do not use protection can conceive in the first 3 months, 72% within 6 months and 85% within 1 year.

 

INVESTIGATION OF INFERTILITY

 

Infertility is 40-50% due to female factors, 30-40% due to male factors, and 20-25% due to both male and female factors. In approximately 10-15% of couples, no cause can be found when investigated.

It is important for couples to attend the first meeting together and bring all previous tests with them. In the first meeting, a detailed history will be taken and questions will be asked about both couples’ past infections, surgeries, previous treatments, how often they are together, and family diseases.

First of all, in order to investigate the male factor, a semen analysis is performed after 2-5 days of sexual abstinence. If the semen analysis performed at 2-3 month intervals is normal, there is no male factor. In the evaluation of the woman, a general systemic examination is also important, in addition to the examination of the reproductive organs.

One of the most important tests in women is the evaluation of ovarian capacity with vaginal ultrasonography. Ovarian capacity in women begins to decrease with age. Ovarian reserve may decrease at an early age in those with a family history of early menopause, previous ovarian cyst surgery, or endometriosis.

It is important to evaluate the capacity of the ovaries and their response to medications with hormone tests (FSH, LH, ESTRADIOL, TSH, PROLACTIN, AMH) to be performed on the 2nd or 3rd day of the menstrual period.

Whether the woman’s tubes are open or not is evaluated with HSG-hysterosalpingography (uterus film). The tubes can be blocked due to infections or previous surgeries. Tuberculosis is also one of the important causes in our country. If there is a blockage in the tubes on the HSG film, it would be most appropriate to perform IVF directly, in some cases, laparoscopy may be required.

Ovulation disorders also cover a significant portion of the causes of infertility. Normally, one of the mature eggs in the ovaries develops and cracks every month, and ovulation occurs. The absence of ovulation is called anovulation. Ovulation is normal in 85% of women who have regular menstrual cycles. Ovulation may not occur without menstrual irregularity. If the absence of ovulation is due to insufficient hormones secreted from the brain, ovulation can be achieved with treatment.

The most common condition that causes ovulation disorders is polycystic ovary syndrome. In polycystic ovary syndrome, ovulation is rare or absent. This results in menstrual irregularity and infertility problems. In addition to improving ovulation in these patients, weight control is very important to reduce metabolic risks in later ages. Ovulation can be regularized in 80% of women who use ovulation drugs, and almost half of them can get pregnant in the first 6 months.

In some cases, it may be necessary to additionally evaluate the abdominal and uterine cavity with laparoscopic and hysteroscopic methods.