If pregnancy cannot be achieved despite regular and unprotected intercourse for one year after marriage, infertility can be mentioned
. Because pregnancy is achieved in 85% of couples during this period. In other words, approximately 15% of couples of reproductive age in society face this problem. However, in the group where the female age is over 40, this rate increases to 25%.
What are the causes of infertility in men and women?
The cause of infertility is approximately 50%. 50% belongs to women and men.
To reveal the cause of infertility in men;
urological examination is performed with spermiogram, testosterone, FSH and Prolactin measurement in the blood.
Spermiogram – Normal semen is 2-5 ml and contains at least 20 million sperm
in each milliliter, and more than 50% of them are motile. It may contain very few white blood cells. If
sperm values are below normal, then hormone analyzes are also performed. During the urological examination, the condition of the testicles and the presence of varicocele are checked. Varicocele causes the veins that carry blood to the testicles to expand, slowing down blood flow. This causes an increase in temperature inside the testicle
and sperm quality and motility are negatively affected.
Evaluation of the woman
Cervix – This is the area between the uterus (endometrium) and the vagina. is openness. A clear
sticky egg white-like fluid is secreted from here, allowing sperm to easily reach the endometrium during
ovulation time. Other times it thickens and forms a plug. If
the consistency of this fluid is not thinned at the time of ovulation, it becomes very difficult for the sperm to reach the egg.
Tubes - They are located on both sides of the uterus and carry the eggs ready for fertilization into the uterus.
To understand whether these are open or not, it is necessary to take a medicated film called HSG (Hysterosalpingogram).
This procedure is performed within a few days after the end of menstruation.
A medicine that can be seen on an White lines again on the side
show the tubes. Tubes not visible or obscured Failure to spread the medicine administered into the oral cavity may indicate that the tube is blocked. Any filling defect in the uterus may suggest that there is an adhesion
or a space-occupying lesion.
Peritoneal factor – Sometimes, your doctor may decide according to the results of HSG or USG. She may want to perform laparoscopy to see if there is an adhesion or endometriosis in the abdomen.
The best time for this is a few days after the end of menstruation. The procedure is performed under anesthesia
. The uterus, tubes, ovaries, intestines, liver, stomach and appendix are observed with a telescope passed through a trocar inserted into the abdomen through a 1 cm incision made in the navel.
In addition, a half cm insertion is made through the groin. Other surgical procedures can be performed with the help of instruments passed through auxiliary trocars. It can also be checked that the tubes are not open by administering blue dye through a cannula placed inside the uterus. Afterwards, the inside of the uterus is observed with hysteroscopy
with the help of a camera to determine whether there is a pathology here, and if there is, it is treated at the same time.
Evaluation of the ovaries – There are two and It is located on both sides of the uterus. They contain
eggs and play an important role in hormonal function. Eggs grow under the influence of the hormone called FSH
which is released from a gland in the brain called the pituitary, and
they secrete another hormone called estradiol. It matures around the 14th day of menstruation and becomes ready for fertilization. LH causes the egg, which is ready for fertilization, to crack and be thrown into the abdominal cavity. If there is a sperm in the environment at that time, the egg is fertilized. To understand whether a woman is ovulating, FSH, LH and progesterone hormone levels can be measured in the blood
. It is also possible to understand by biopsy from inside the uterus.
Causes of female infertility
Myomas – These are benign tumors originating from the muscles in the uterine wall. They can be single or more
. Its size can range from the size of a pea to the size of an orange
and sometimes even larger. They usually grow outside the uterine wall, but
There are also some that grow into the uterus. They are quite common tumors and their incidence is quite high in women between the ages of 30-
45. Myomas that grow into the uterus can cause miscarriage, premature birth or infertility. Myomas can grow during pregnancy
. Myomas, especially those that grow inward, should be removed before in vitro fertilization.
Endometriosis - It is the condition in which the tissue lining the uterus is outside the uterus.
It adheres to the ovaries or other organs in the abdomen and becomes filled with blood during each menstrual period. /p>
dollar. Since this blood is trapped in the tissue, first vesicles and then cysts form. In advanced stages
scar tissue and adhesions form. This can cause chronic groin pain.
Endometriosis is one of the leading causes of infertility and is seen in approximately 40% of women with reproductive age problems. It is not exactly known by what mechanism it causes infertility
, but it is not known exactly yet
blockages that occur as a result of damage to the tubes or the sperm-egg relationship due to certain substances secreted by the tissue
Malfunction and lack of fertilization are among the possible mechanisms. These
patients can be treated medically or surgically. Medical treatment – by creating false pregnancy or
false menopause, the patient's ovulation function is stopped and menstruation is prevented. Thus, activation of endometriosis foci is prevented. This treatment
lasts approximately 6 months. However, it may relapse when medications are stopped. This treatment is mostly applied to patients who do not want to have children. Surgical treatment is usually performed on patients who want to have children, using a method called laparoscopy under anesthesia. Here, through a 1 cm incision at the level of the navel, a telescope with a camera on the back is inserted into the abdomen and all organs are observed and the pathologies detected are detected by 2 5 mm wide instruments inserted through the groin
It is treated by. The aim is to destroy endometriosis foci by burning or cutting
and to open any adhesions.
Ovarian cysts – They are fluid-filled sacs. Increasingly It is common, most of the cases are well-behaved and are under 35 years of age. In the presence of these cysts, ovulation may stop, or the mechanical effect caused by the pressure of the cyst on the tubes may prevent the egg and sperm from uniting, leading to infertility. Cysts that have reached a certain size can be evacuated under ultrasound guidance or laparoscopically
and the removed cyst content is separated for cytopathological examination and the cyst wall is separated for histopathological
examination. Some cysts are prone to recurrence and after being evacuated, birth control pills can be used until in vitro fertilization
if in vitro fertilization is to be performed.
Polycystic Ovary Syndrome – These patients have menstrual irregularity, hair growth. They may come with complaints of obesity, obesity and infertility. Additionally, acne on the face may be an indicator of increased male hormone levels in the blood. It can sometimes be seen in cases where the adrenal gland and thyroid gland do not work well and in cases of insulin resistance. Menstrual irregularity, blood tests and ultrasonography are helpful in diagnosis. Since the patient ovulates less than other women, she becomes pregnant in a longer period of time
Intra-Abdominal Adhesions – Between the internal reproductive organs or between these organs and the intestines
p>
These are band-shaped tissues. These usually develop after a previous surgery (appendicitis, ovarian cyst, etc.), infection (Chlamydia, Gonorrhea) or endometriosis. Adhesions cause kinks in the tubes, preventing the egg and sperm from traveling inside the tube. They are usually treated surgically, if success is not achieved, in vitro fertilization is applied.
Decreased Ovarian reserves – Ovarian reserves normally start to decrease after the age of 35
and in our country, the average At the menopause age of 48, functions come to a complete halt
and the woman enters menopause. Sometimes this condition begins to occur in women in their 20s and 30s. Especially those who have previously had surgery on the ovary (due to cysts or endometriosis) are at risk. Decreasing ovarian reserves means fewer eggs developing each month. In this case, FSH level It increases in the blood, the period between two periods first shortens and then becomes longer, and the amount of menstruation decreases. An idea can be obtained by measuring the levels of FSH and estradiol hormones in the blood taken on the 3rd day of menstruation. Additionally
ovarian reserve can be evaluated by measuring the ovarian volume and the amount of follicles in it in ultrasonography
. Such patients should receive in vitro fertilization treatment without waiting too long.
Early Ovarian failure – This occurs in cases of menopause before the age of 40.
Although the cause is generally unknown, chromosomal disorders , immune system
diseases and thyroid diseases may cause it. This situation can also be revealed by blood tests
. If the patient has no eggs left, in vitro fertilization treatment cannot be applied.
Conditions that Cause Infertility and Can Be Treated
Ovulation disorder
Unexplained infertility
Recurrent pregnancy losses
Myomas
Endometriosis
Ovarian cysts
Polycystic ovary Syndrome
Intra-abdominal masses or adhesions
Cervical mucus problems
Immune system problems
Tubal diseases
Male-related causes
Cases resistant to clomiphene
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