In cases of mild infertility, we sometimes try to achieve pregnancy by egg monitoring and most often by insemination. These couples may be couples with timing problems, those who have to work out of town, those with mild ovulation problems, those with borderline disorders in their spermiogram, and those with mild male factor.
The factors that cause infertility may originate from both men and women, and sometimes both factors may be present in the same couple.
First of all, if there is a reason for infertility, the investigation begins by trying to identify it.
Screening for male factors is made easier by performing a relatively simple spermiogram test. In the spermiogram, sperm count, motility and morphology percentages are evaluated. If there is a severe male factor problem, urology consultation is requested. In cases of mild and borderline disorders in male factors, vaccination can be performed, and in moderate and severe disorders, treatment for pregnancy can be done with in vitro fertilization - microinjection. In men whose sperm cannot be found in the spermiogram, our urology doctors first search for sperm using the tese, tesa and microtese methods, and if the sperm is found, it is frozen and an in vitro fertilization treatment plan is made.
In women, the research is a little more comprehensive. First of all, the hormone profile of women who cannot menstruate regularly should be determined, and if there is a hormonal disorder that will affect menstrual regularity and ovulation, it should be determined. These disorders may be in the hormones FSH and LH, which provide menstrual regularity, as well as in thyroid hormones or prolactin, also known as the milk hormone.
With HSG, known as medicated uterine film, both the shape of the uterus, the diagnosis of a mass occupying space inside the uterus, and the condition of the tubes are revealed as the main purpose. If a problem is detected in the uterus, polyps or myomas are removed by hysteroscopy. If there is a septum, it is cut and corrected. If there are adhesions, it is opened and the uterine cysts are prepared for intrauterine pregnancy. Chocolate cysts and endometriomas should be evaluated according to their diameter, and a separate investigation should be conducted for ovarian cysts that are thought to be characteristic.
Despite all these studies, no cause can be identified in at least 15% of couples. This The situation is called unexplained infertility. Sometimes we may have difficulties with our couples in explaining this situation and sometimes in choosing the treatment while making the treatment plan. Because we have couples where no problems can be detected, so why? They can get stuck on the question. Pregnancy requires harmony; sometimes the egg and sperm cells cannot meet, sometimes the failure to adhere to the uterus even though fertilization occurs may be due to unexplained reasons.
If there are no problems in the tubes and ovaries that can be corrected by surgical treatment, the male factor If there are no urological conditions that require surgical or medical treatment, couples who meet these conditions and cannot have children are now candidates for in vitro fertilization treatment.
Couples with a long period of inability to conceive, couples with at least two unsuccessful insemination treatments, those with low ovarian reserve, those with poor sperm count, motility and morphology, and those with both tubes blocked or removed are direct candidates for in vitro fertilization treatment. .
In vitro fertilization treatment consists of the stages of multiplying, growing and collecting the eggs of the expectant mothers with some hormonal drugs, creating embryos by fertilizing the collected eggs with the sperm of the prospective fathers by microinjection method, and finally transferring the embryo or embryos. This treatment is usually started on the 2nd or 3rd day of menstruation. The development and tracking process of eggs takes approximately 9-12 days. When the eggs are thought to have reached maturity, a cracking injection is given and the egg collection process, called OPU, is performed at the planned time. At the same time, a sperm sample is taken from the prospective father and mature eggs are fertilized with the ICSI - microinjection method. The next day, it is determined how many embryos have been fertilized in our embryology laboratory and the development of the embryos is followed.
Embryo transfer is performed between days 2-5, depending on the number and quality of embryos. The preferred method is to transfer the 5th day embryo, which we call blastocyst, as long as the number and quality of embryos are good.
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