How is infertility treated?

How is infertility treated?

your infertilitytreatment

Treatment of infertility should be directed towards the cause.

Waittreatment (if male and female are normal)

Waiting treatment can be applied in young patients with normal examination, normal uterus on ultrasonography (USG), normal both ovaries, normal inside of the uterus in the uterine tube film, both tubes open, sperm analysis normal, regular menstruation. Waiting treatment is to have regular sexual intercourse within 4-6 months immediately after the removal of the uterine tube film. Studies have shown that pregnancy rates are slightly higher after uterine tube film is taken. The explanation for this is that the mucous structures that sometimes block the tubes are opened by the administration of the radiopaque material in the uterine tube film. At this point, the uterine tube film is both a diagnosis and a treatment test. Click here to learn how to have regular sexual intercourse.

If pregnancy does not occur despite regular sexual intercourse for 4-6 months immediately after the removal of the uterine tube film, the waiting treatment is abandoned and the vaccination treatment, which is an advanced stage, is started.

In patients with endometriosis disease, waiting treatment can be performed after laparoscopic removal of the endometriosis foci and/or removal of the endometrioma. If the age of the patient is appropriate, a period of 1 year can be given.

in womanIf you have an ovulation problem:

Polycystic ovarian disease is the most common cause of ovulation disorders in women. High levels of milk hormone in women can also cause ovulation problems. For this reason, if the milk hormone is high, first of all, the milk hormone should be brought to a normal level. If there are thyroid gland disorders (TSH is checked), these conditions should be corrected first.

The reason for ovulation disorder may be that the walnut-sized pituitary hormone in the brain does not work. In this case, the woman has never had a period. In our country, our girls begin to menstruate between the ages of 12-14. Breast development in these patients is also incomplete.

After the concomitant causes of ovulation problems are corrected, the treatment is usually ovulation therapy. Ovulation treatment is done with pills or needle treatment.

If eggs are to be stimulated with pills (Clomiphene citrate) (sold in the market as Klomen, Gonafen, Serofen, Klomid) or letrozole (Femera), ultrasonography (USG) is performed on the patient with the onset of menstruation. If there are no follicles larger than 10 mm in both ovaries on USG, stimulation can be started. Although it varies according to the weight of the patient, the pill is used as 1×1, 2×1 or 3×1. The drug is started on the 3rd day of menstruation and used for 5 days. USG is done on the 10th day of menstruation. If there is a follicle larger than 18 mm in USG, a cracking needle is performed.

If eggs are to be stimulated with a needle (sold as Gonal-F, Puregon, Merional, Menapur, Menogon, Fostimon), ultrasonography (USG) is performed on the patient with the onset of menstruation. If there are no follicles larger than 10 mm in both ovaries on USG, stimulation can be started. Different doses of injection are started according to the patient’s weight and previous ovulation response. Although the method of application of the needle varies according to the type of needle your doctor gives you, it can be done from the hip into the muscle or into the subcutaneous tissue. Ovulation response is followed by USG controls. If there is a follicle of 17 mm or more, a cracking needle is performed.

If the male sperm is normal, normal sexual intercourse starts from the day of the cracking injection and sexual intercourse should be done on the 1st, 2nd and 3rd days.

Progesterone hormone is checked in the blood 1 week later to see if ovulation has occurred.

Since the addition of vaccination treatment to ovulation treatment ensures higher pregnancy rates, we usually also perform vaccination treatment. If there will be a vaccination treatment, the vaccination is done 36-40 hours after the cracking needle is given. Pregnancy rate of vaccination with needle is higher than that with pill.

If the ovulation problem is caused by the pituitary in the brain, pill treatment should definitely not be given. Treatment with Merional and Menogon should be done only. These two drugs are effective because they contain LH hormone as well as FSH.

Metformin treatment or laparoscopic puncture of the ovaries can also be performed to ensure ovulation in polycystic ovarian diseases. Click here for detailed information about polycystic ovarian disease.

If ovulation cannot be achieved in women despite needle therapy, IVF treatment should be planned. In a study we have done, we found that those with polycystic ovary had better pregnancy outcomes in IVF than the control group. This work can be found in my academic publications.

from the tubesproblems caused

With the uterine tube film, it is usually understood whether the tubes are open or not. If the tubes are blocked in the uterine tube film, it is not necessary to take the patient directly to IVF. Since the uterine tube film is a painful procedure and the patient is consciously taken, the patient may involuntarily contract himself. Due to pain, there is a contraction in the tubes and the special dye cannot pass through the tubes and they may appear to be clogged even though they are not actually clogged. The surest way to find out if the tubes are blocked is to do a diagnostic laparoscopy. In laparoscopy, a blue dye is given from the bottom while the patient is asleep and it is seen whether there is a passage through the tubes. If there is a passage through the tubes, there is no problem. The patient is directed to treatment as appropriate. If there is no passage through the tubes, it is tried to understand at what level the blockage is. If there is a blockage at the distal ends, these blockages can be opened laparoscopically (Distal fimbrioplasty can be performed). If the obstruction is close to the uterus, which we call proximal, it is difficult to treat. This clogged part is cut and the remaining tube can be sewn together again, but the sewn tube is likely to be clogged again. Therefore, it is necessary to direct these patients directly to IVF.

In some cases, the tubes lose their normal structure and function due to previous infections or advanced endometriosis disease. Widespread adhesions can be seen around the tubes. These conditions are easily seen in laparoscopy. In this case, since the tubes do not function, the patient should be directed to IVF treatment.

There is normally no liquid inside the tubes. The filling of the tubes with fluid is called hydrosalpinx, and this fluid is harmful to the sperm, the egg, and the fertilized egg. Since it also disrupts the structure of the tube, the chance of ectopic pregnancy is also high. Even in IVF treatment, it reduces pregnancy rates. Therefore, if a hydrosalpinx is detected, it must be removed laparoscopically. If it is not possible to remove the tube laparoscopically (in some cases, the tube may be very adherent and technically very difficult to remove), the procedure we call cornual ligation can be performed. In this method, the tubes are burned and cut from the place where they enter the uterus. In a study we have done, we have found that tube removal and cornual ligation have similar in vitro fertilization rates. This work can be found in my academic publications.

In the presence of a disease called endometriosis, which affects 7% of women, the structure of the eggs and tubes may be disrupted. The diagnosis of endometriosis is made laparoscopically. Laparoscopic burning or removal of endometriosis foci and removal of endometrioma in the ovaries increases the chance of pregnancy both in waiting treatment and in vaccination treatment. Click for detailed information about endometriosis.

from the wombproblems caused

If there are congenital uterine injuries, treatment is planned for the cause. The curtain in the uterus is the most common uterine injury and can cause infertility and recurrent miscarriages. This veil needs to be cut hysteroscopically. If a double uterus is suspected, first of all, the condition of the uterine injury should be clearly seen with MRI imaging or better still with diagnostic laparoscopy. In double uteruses, it can be combined with a single uterus by surgery, but it is not recommended because the success rate is not high. Pregnancy usually takes place in one of the wombs and continues. These patients have an increased chance of miscarriage and preterm delivery. If there is a single but half uterus, corrective surgery is not recommended in this case. The patient should be directed to the appropriate treatment.

If there are problems such as fibroids, pieces of flesh and adhesions in the uterus where the baby will adhere, they should be removed hysteroscopically and then directed to the appropriate treatment.

There may also be fibroids and pieces of flesh in the cervix. These should be removed hysteroscopically.

If the fibroid is not pressing into the uterus, it is not clear whether this fibroid causes infertility or causes miscarriage. In a study we have done, we have detected findings that fibroids may cause infertility by secreting certain substances, even though they do not put pressure on the uterus. This work can be found among my academic works. For this reason, you should discuss with your doctor in detail while the treatment of fibroids that do not press on the uterus is planned.

Forwardfemale age

As the age of the woman increases, pregnancy rates decrease and the probability of miscarriage increases. For this reason, it may be beneficial to start treatment early in the presence of advanced female age (37 and above). In these women, the reserve of the ovaries can be determined by some tests (Anti Müllerian Hormone (AMH), FSH, Estradiol on the 3rd day of menstruation, counting of egg precursors in both ovaries on the 3rd day of menstruation). In vitro fertilization treatment should be planned immediately for those with low reserves. Good ones can be vaccinated twice. If unsuccessful, IVF should be started. Click for detailed information about advanced female age and poor ovarian reserve.

in manif there is a problem

If there is a problem in the man, the treatment should be directed towards the cause. If there are conditions such as erection problem, backward discharge, their treatment should be done first. If the total number of progressively motile sperm in a man’s semen is less than 5 million, it is obvious that this patient will not benefit much from vaccination and should be referred directly to in vitro fertilization treatment. If the total number of advanced motile sperm is in the milk of 5 million, vaccination treatment is planned.

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