1. Comprehensive History:
Age, height, weight, chronic disease history, work, infertility duration, average frequency of sexual intercourse, previous infections and surgeries, information about previous pregnancies, if any, and medical records, menstrual cycle, menstrual quantity, chronic pelvic pain, recent rapid weight gain or loss, hair growth, discharge of milk from the nipple.
2. Examination and Tests:
Vaginal speculum examination; Visualizing the cervix, checking for signs of infection, performing a pap smear.
Evaluating the uterus and ovaries with vaginal ultrasonography.
Recognizing a significant portion of congenital or acquired abnormalities involving the uterus with standard 2-dimensional ultrasonography. or it is possible to suspect. Using 3D vaginal ultrasonography increases diagnostic sensitivity. Uterine and Tubal Film (HSG) can also provide additional information in this regard. In some cases that cannot be detected by ultrasonography and HSG, it may be necessary to perform hysteroscopy for diagnostic purposes.
The presence of a mass that affects or deforms the inner lining of the uterus (Endometrium), such as myoma and polyp. If clear images cannot be obtained with standard ultrasonography in the diagnosis of pathologies affecting the uterus, Sonohysterography (Saline Infusion Sonograghy) may provide clearer results.
-- Evaluating the ovarian reserve in vaginal ultrasonography performed after the menstrual period is very important in making a treatment plan. The structures in the ovary that contain potential egg candidates are called Antral Follicles. In each menstrual cycle, one of these develops and ovulation occurs. In women of childbearing age, Antral Follicle Count (AFC) should be between 5-10 in each ovary.
Hormonal Tests performed on an empty stomach on the 2-3rd day of menstruation: Although they vary depending on the woman's history and findings, the most frequently performed ones are; FSH, LH, PROLACTIN, TSH, ESTRADIOL and AMH. AMH is especially important in drug dose adjustments during the In Vitro Fertilization treatment process in patients with low or high ovarian reserve.
HSG (Uterine and Tubal Film): It is an interventional examination performed in the radiology unit after the end of menstruation and before the ovulation period. Infection and is not performed in the presence of active bleeding. It is an examination based on administering contrast material from the cervix to the uterus with the help of a special cannula or catheter after appropriate preparation and recording and evaluating the instant image. The internal shape of the uterus, the internal width, course and length of the tubes and the passage of contrast material from the tubes to the abdominal cavity are evaluated.
Sperm Analysis
- It should be done after 3-5 days of sexual abstinence, preferably in an In Vitro Fertilization Center.
- For abnormal results, a new test should be done after 2-3 months. analysis should be made.
- Slightly lower values than normal should not be immediately interpreted as abnormal. It should not be forgotten that there may be significant deviations in the values of men who have children.
- Limit Values;
Volume: 1.5 ml
Number: 15 million/ml
Mobility: Proactive 32%
Volume: 1.5 ml p>
Morphology: 4%
- Terminology of abnormal values in sperm analysis
Oligospermia: The count is less than 15 million/ml
Azospermia: No sperm in the sample
Asthenospermia: The number of motile sperm is less than expected
Teratospermia: The number of morphologically abnormal sperm is high
Hysteroscopy : It can be used in cases with intrauterine mass or deformity in ultrasonography or HSG.
Laparoscopy: It can be performed according to the patient's examination and clinical findings. If there is a cystic or solid mass in the ovaries on ultrasonography, if there are signs of enlargement, obstruction or stenosis concerning the tubes on HSG, or if there is menstrual or non-menstrual pelvic pain suggestive of endometriosis, it would be appropriate to perform laparoscopy before treatment.
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