What is infertility? Upon admitting to the IVF center, the couple has a meeting with the doctor. During the meeting, the duration of their marriage, the number of their weekly intercourse, for how long they desire to have a baby, their sexual problems if any, previous pregnancies f any, their medical history, treatments for having a baby if any, woman's menstrual cycle pattern, addictions such as smoking and alcohol, are questioned. The couple is required to answer the questions with frankness, and not to keep anything secret or hide any issue with a feeling of embarrassment. Following the meeting, the man and woman are examined in full detail. In woman, vaginal discharge is evaluated via a physical or pelvic exam and cervical screening (Pap smear test) is done during the gynecological examination. Besides, a transvaginal ultrasound is performed to examine the woman's reproductive organs such as the cervix, the uterus, fallopian tubes and ovaries to detect whether there is any anatomical abnormality.Height, weight and blood pressure of the couple are measured as well.he purpose of infertility evaluation is to perform required examinations and tests to find out whether there is a reason preventing the couple from having a baby and apply the most appropriate treatment in case of the detection of any reason. The examinations and tests required for the evaluation of the infertility Despite having regular and unprotected intercourse for 12 months, the pregnancy rate in couples aging between 23 and 35 corresponds to 84%, this rate increases to 92% at the end of 24 months in the same age group.Despite having sex with the desire of having a child, 8% of couples may not be able to conceive even after two years. Infertility is not a problem associated with just women. The infertility causes associated with maleand female factors are almost equal.Aging is one of the most important causes of infertility. Female fertility starts to reduce around the age of 40 and over, while male fertility starts to decline around the age of 55 and over. Both the quantity and quality of sperm and egg decline with aging. Obesity and smoking are other factors that negatively affect the reproductively of both males and females. a) Acquired Duck Obstructions: Despite the production of sperm in testicles, sperm can't be transported to the penis for ejaculation due to ejaculatory duct obstruction caused by various factors such as urogenital infection (especially gonorrhea and genital tuberculosis), trauma, prostatitis, vesiculaseminalis cysts or stones, previous surgeries on reproductive organs or nearby organs.In this case, cause-oriented treatment should be applied.
Infertility is defined as not being able to get pregnant despite the couples have regular and unprotected intercourse at least 3-4 times a week for at least a certain period with the desire of having a child. This period corresponds to a year for couples younger than 35 years of age and 6 months for couples older than 35.However, if the woman has previously or newly diagnosed with a reproductive disorder such as endometriosis, congenital uterine anomalies, irregular menstrual cycle and pelvic inflammatory disease, a treatment is required to correct the disorder. If pregnancy does not occur despite having regular intercourse after treatment, the above-mentioned periods for the diagnosis of infertility is 6 months for women younger than 35 and 4 months for women older than 35.About 13 to 15 percent of couples at reproductive age are infertile. Infertility is not a problem associated with just women. About 30-40 % of infertility cases are related to male alone factors and about 40-50 % might be attributed to female alone factors. In some cases, it has been observed that about 25 % of couples have infertility associated with both male and female infertility factors. In about 10-15 % of couples, no identifiable cause may be detected for their infertility despite all medical investigations. Considering this fact, couples willing to have a baby are required to be evaluated together.
A hysterosalpingogram (HSG) is an important test of female fertility potential. It is performed to evaluate the uterine cavity and fallopian tubes for any abnormalities or obstruction that may cause infertility.HSG is an outpatient procedure performed under anesthesia or local anesthesia. A radiopaque substance is injected into the uterine cavity through a cannula placed in the cervix.X-ray pictures are taken during the procedure to provide a permanent record of the condition of the tubes and the uterine cavity. n case of any doubt concerning any problem, a hysteroscopy (an endoscope used for the visual examination of the uterine cavity) and/or laparoscopy (entering the abdomen with an optical instrument) can be performed to confirm the diagnosis and provide treatment if necessary.
Semen analysis is an important test to determine the sperm count, shape and motility. The male partner is required to abstain from intercourse or masturbation at least 2-5 days before providing a semen sample for analysis preferably at the IVF center.
In general, women with regular menstruation are considered to ovulate. The detection of the ovulation is generally performed via ultrasound monitoring.
Basal follicle stimulating hormone and anti-Mullerian hormone and antral follicle count are the most widely used ovarian reserve tests. Within the first 5 days of the woman's menstrual cycle, usually on cycle day 2-3, follicle-stimulating hormone (FSH) and estradiol are checked. Besides, antral follicle count is performed via vaginal ultrasonography. Anti-Mullerian hormone test can also be performed at any time in the menstrual cycle.
Serum prolactin and thyroid stimulating hormone (TSH) tests can also be performed. High prolactin levels can interfere with the sperm production, and abnormal TSH levels can interfere with the ovulation.
Infertility Causes
Problems Associated with Woman Factor
Endometriosis is a condition where cells that normally line the uterus start to grow outside the uterus on the lining of fallopian tubes or any other tissue or organ in the abdominal cavity. Almost 35% of women applying for the infertility test are diagnosed with endometriosis. Endometriosis can directly impact fertility and lead to infertility in women by distorting not only the anatomy of the pelvis causing pelvic adhesion but also the anatomy of the fallopian tubes by causing adhered or scarred fallopian tubes. Although medication or surgical therapies help ease the pain, endometriosis can't be cured completely. In patients with mild to moderate endometriosis, intrauterine insemination (IUI) is tried first to achieve pregnancy. If pregnancy can't be achieved after trying several intrauterine insemination (IUI) cycles, In Vitro Fertilization (IVF) is recommended as an alternative.
Problems Associated with Male Factor
b) Congenital Undeveloped Sperm Duct (Congenital Bilateral Absence of the Vas deferens):This congenital disorder occurs when tubes (vas deferens) that transport sperm out of testes fail to develop properly.İt is often seen in the absence of both the vesiculaseminalis (seminal vesicles) and a major part of the epididymis.Although the testes usually develop and function normally, sperm cannot be transported to become part of semen due to the absence of vas deferens.This condition can occur alone or along with cystic fibrosis, which is an inherited disease.
Nearly 50-80% of men with cystic fibrosis have a congenital bilateral absence of vas deferens.If severe male infertility is associated with the factors mentioned, the treatment should not be delayed. TESA or Micro TESE microscopic surgical methods are used to search and harvestsperm from the epididymis or testes. At this point, the procedures should always be carried out by an expert urologist.
Infertility