Infertility is defined as the inability of couples to have children despite wanting no contraception for a year. It affects 10-15% of couples in the reproductive age group, and one in every 6 women receives professional help due to infertility.
The probability of an unprotected couple getting pregnant in one month is 20-25%. This rate reaches 85-90% in 12 months. However, age is an important factor; as women get older, the chance of getting pregnant gradually decreases. This decline begins in the early 30s and accelerates in the 40s.
After the age of 40, the monthly pregnancy rate may decrease to approximately 1.5%. For these reasons, while the waiting period to achieve pregnancy is one year for young patients, it is 6 months for those over the age of 30 due to psychological and biological effects. For this reason, the patient's age should be taken into consideration and the patient should not be given unnecessary hope or time-consuming interventions should be made.
The reasons that may lead to infertility should be discussed in detail with the gynecologist. Duration of infertility, previous pregnancies, if any, treatments applied, operations (laparoscopy, laparotomy, etc.), menstrual cycle, age of first menstruation, painful menstruation, discharge of milky white fluid from the nipple, medication use, contraceptive methods used to date, Past infections (tuberculosis, hepatitis, etc.) and habits (alcohol, smoking, etc.) are evaluated. General examination and examination of reproductive organs are of great importance in the evaluation of the woman. During the examination, findings that may constitute a clue to determining the cause of infertility may be detected.
During the examination, samples from the cervix and vagina are taken for this purpose and subjected to examination. During the examination, a swab test (Pap-smear) is used, which allows the preliminary identification of cervical diseases. It is important to take it.
Ultrasonography evaluates the structure of the reproductive organs, uterus and ovaries. Diseases or changes that may occur in these organs or their neighborhoods are identified and their relationship with infertility is investigated. Problems that hinder treatment are resolved. During ultrasonography, "ov", which plays an important role in choosing the treatment to be applied in the future and determining the chance of success of the treatment. "ovarian reserve" is evaluated. In addition, the reserve of the ovaries and their response to drug stimulation are evaluated with hormone tests (FSH, LH, E2, Prolactin and TSH) to be performed on the 2nd or 3rd day of menstruation and, when necessary, AMH test.
Approximately 45% of the causes of infertility may be due to male-related problems. The most basic laboratory method in investigating the male is semen analysis. Since this test is cheap and easy, it should be performed on all patients who apply for infertility. Whether the woman or the man has had children before It does not change the necessity of performing sperm analysis. Surgeries related to the man's childhood and development periods (such as hernia surgery, varicocele surgery) are questioned. In the examination for systemic diseases, diabetes, diseases of the nervous system and their past and current treatments are learned. Febrile diseases Causes of infection such as testicular inflammation (orchitis) caused by mumps during adolescence, sexually transmitted diseases, and tuberculosis are investigated.
In addition, chemicals, toxic gases, drugs (chemotherapy drugs, cimetidine, etc.) found in the workplace or in the environment are investigated. sulfasalazine, nitrofurantoin, testosterone preparations), frequent hot baths or hot work environments, radiation, alcohol and cigarette use are investigated. These factors are important because they negatively affect sperm production.
Is It Possible to Treat Infertility?
In order to reveal the causes of infertility, it is necessary to conduct various studies and evaluate the test results. The most important thing to pay attention to in the treatment of infertility is the correct diagnosis and, accordingly, choosing the right treatment methods.
In the problems related to infertility, 45 percent are caused by men and 45 percent are caused by women. For the remaining 10 percent, no cause can be found. This is called 'unexplained infertility'. The most important factors that determine the road map of infertility treatment; The woman's age, how long she has been infertile, the general condition of her ovaries and the man's sperm count are the qualities of the sperm. After all these are evaluated, infertility treatment can be planned. Ned of infertility It is observed that infertility rates are increasing worldwide. Although infertility occurs due to genetic reasons and various diseases, it can also cause infertility due to reasons such as malnutrition, smoking and alcohol use, and stress.
Age is an important factor in infertility. If we look at the general average, it has been observed that the probability of getting pregnant decreases slightly in women aged 35 and decreases significantly after the age of 40. In addition, the possibility of miscarriage is quite high in women after the age of 40.
If we examine other reasons that cause infertility in women, in addition to blockages in the tubes, various infections and sexually transmitted diseases can also prevent pregnancy naturally. Monogamy is important to protect against such diseases. Obesity can also cause infertility in women. For this reason, when pregnancy is decided, weight control should be ensured and a healthy diet should be maintained. There may be many reasons that can cause infertility in men. Radiotherapy or chemotherapy used in cancer treatment can cause serious damage to sperm.
Infertility Treatment Methods
Infertility is a condition in which the woman has never had a pregnancy before or cannot get pregnant again even though it has happened once. It is an expression used.
Women may experience infertility at some point in their lives. On average, this condition can be seen in 25 percent of women. Although fertility characteristics vary from person to person, women generally experience their most fertile period for pregnancy around the age of 25.
In addition, after 35, women's fertility begins to gradually decrease. However, the age factor is not an obstacle to having a healthy child.
If pregnancy is not possible even though the couples do not use any contraceptive methods, 'infertility' may be suspected. Newlywed couples may worry if pregnancy does not occur for a few months after marriage. Young couples should not rush to doubt infertility. Couples need to wait at least 1 year and, if pregnancy does not occur, start investigating the underlying reasons. Couples with a healthy sexual life (sexual intercourse an average of 2 times a week) for 1 year, They should keep trying.
Infertility is a very common problem today. Infertility may be caused by the man, the woman, or both people at the same time.
In cases of infertility, people may not have any symptoms. Infertility does not cause any discomfort in people. When the couples are evaluated in general, 15 percent of them cannot have children. When planning the treatment of infertility, it is taken into account the age of the person, how long they have not been able to have children, and whether they have any health problems.
45 percent of the general infertility problems are caused by men. Especially in recent years, the incidence of infertility in men has increased. There are various treatments for infertility in men. It is possible for a man with very few sperm to have a child.
There are various treatment options for infertility experienced by a woman. More detailed and challenging treatments are applied compared to men.
Factors Affecting Infertility Treatment
- The age of the expectant mother is one of the main factors affecting infertility treatment. It should not be forgotten that fertility ability will begin to decline after the age of 35.
- Candidate parents should avoid environments that may negatively affect the treatment. Especially hot environments such as Turkish baths, spas and saunas cause deterioration in sperm.
- Hard exercise and sports should be stopped 3 months before starting infertility treatment.
- The expectant mother should pay attention to her nutrition.
Things Researched in Physical Examination and Gynecological Examination.
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Weight and body mass index (While increased body mass index is associated with decreased fertility, abdominal circumference obesity is associated with insulin resistance)
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Development of secondary sex characters, body type (while development of secondary sex characters is insufficient in hypogonadotropic hypogonadism, short stature and mane-like neck are seen in Turner syndrome)
- Thyroid gland diseases (nodule in the thyroid gland, tenderness, size of the gland) While breast milk discharge, hair growth, and acne suggest an endocrine disorder, adrenal gland diseases, polycystic ovary r syndrome requires evaluation in terms of prolactin elevation and hyper-hypothyroidism.
- Sensitivity on examination is significant in terms of chronic pelvic pain and endometriosis.
- Structural anomalies of the vagina and cervix, discharge, uterus and tubes. It requires evaluation in terms of congenital anomalies, infection and cervical factor.
- On examination, the abnormal size of the uterus, irregularity of its structure and lack of mobility may be significant in terms of uterine anomalies, endometriosis and adhesions in the pelvis.
Evaluation of Ovulation
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Menstrual regularity (in women with ovulation, menstruation is regular, constant in amount and duration, and accompanied by pre-menstrual or menstrual complaints)
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Serum progesterone measurement: Serum progesterone levels reach their highest level 7-8 days after ovulation. In a menstrual cycle lasting 28 days, a serum progesterone level of > 3 ng/mL supports ovulation, but does not enlighten us about the quality of the luteal period. During a normal menstrual period, progesterone levels on Day 21, higher than 10 ng/mL, indicate a normal and healthy ovulation.
- Urine LH test: Ovulation can be monitored at home with urine LH test kits. and obtain information about ovulation time. Generally, urine that is not too concentrated or too watery is checked in the evening, starting from the 10th day of the menstrual period. Ovulation is expected 24-48 hours after the color change is detected.
Evaluation of Tubes
Hysterosalpingography (HSG): While providing information about the passage of the contrast material through the tubes and its distribution into the abdominal cavity after exiting the tube ends, it also detects congenital anomalies and pathologies of the inner wall of the uterus ( defines polyps, myomas, uterine inner wall adhesions). If there is sufficient experience, hysterosalpingo-contrast-ultrasonography is another effective method for HSG. It should be done within 1-2 days following the end of menstruation. It does not provide information about adhesions around the tube and endometriosis. It is necessary to repeat uterine implants that are older than 2 years. HSG may also have a therapeutic role. Mucus plug�
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