Not being able to have children is medically defined as not being able to become pregnant within 1 (one) year despite having sexual intercourse frequently enough without using any contraceptive method. For example; If there are 100 couples who want to have a child today, only 15 of them can become pregnant in the first month, at the end of 6 months, this figure reaches 60, and at the end of 1 year, 85 of them can become pregnant.
Out of 100 people who cannot become pregnant. 15 of them consult a doctor to get medical help. In this case, the most important influencing factor is the age of the couples and the frequency of sexual intercourse.
In our country and all over the world, medical evaluation, treatment and follow-up of couples who cannot have children create a financial burden on the family's economy.
Since it is an expensive treatment, cost support is low by insurance companies abroad and as a health policy in our country, and the entire burden falls on the family.
A careful evaluation must be made before proceeding with treatment in couples who cannot have children.
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Both men and women should undergo this evaluation.
The reasons for not being able to have children can be examined in 4 groups. They are male factor, female factor, tubal factors and unexplained factors.
Male factor: Before laboratory analysis, it is important to take a good anamnesis from the patient. Medications used, previous surgical operations on the genital area, smoking or alcohol use, working conditions, chemicals he may be exposed to at work, stress, etc. After this, Semen analysis is the single most important examination. When the sperm is evaluated in the laboratory, a report is prepared regarding the number, movement and sperm quality and is evaluated by the doctor.
Female factor: As in men, the first step in women starts with a good anamnesis. In addition to what is questioned about the man, his age at first menstruation, the regularity of his menstrual periods, the amount of menstruation, and whether his menstruation is painful or not should be carefully investigated. Painful menstruations may be associated with endometriosis. Whether she has used an intrauterine device (spiral) before, vaginal discharge and groin pain should be questioned.
Excessive body hair growth or, conversely, hair loss should be investigated. Milk coming from the nipple is caused by high levels of prolactin hormone. may be related.
Regardless of socioeconomic level, a major deficiency in our country is that women do not keep menstrual diaries.
Initial Laboratory Tests on the Female Factor: The first days of menstruation, routine blood tests, blood group determination and FSH, Prolactin and E2 should be checked.
In addition, rubella and chickenpox screening should be done and if negative, vaccination should be considered before pregnancy.
Progesterone can be checked on the 21st day of menstruation. Clomiphene Challenge Test (CCT) or AMH (Anti-müllerian hormone) test, which we call ovarian reserve and which we use to measure the capacity of the ovaries, can be performed if necessary.
Tubal Factor: Another test that should be done before starting treatment is the ovaries and uterus. Hysterosalphingography (HSG - Hysterosalphingography) should be performed, which sees the connection between the two and gives us information about the condition of the tubes where fertilization takes place.
Since this procedure is a painful procedure for the woman, it can be evaluated with your doctor if it is performed under anesthesia.
Hysteroscopy can also be considered during the examination phase to view the inside of the uterus with a video camera and to solve possible problems.
Treatment can be planned after all these are evaluated for couples who have not been able to have children.
Couples should consult with the first doctor. What they need to know in their match: This treatment requires patience, strength and support.
A long treatment period also increases the stress factor, especially in women. The negative effects of stress on women's reproductive health are inevitable.
It is important to reduce the stress factor during this treatment process. It may even be beneficial to get psychological support during this process.
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