Infertility is the absence of pregnancy in a couple of childbearing age despite having regular sexual intercourse for at least one year without using any birth control method. The inability of a couple who has previously been pregnant or has a child to become pregnant despite their will is called “subsequent infertility” (secondary infertility). A woman who has no problems and has a regular sexual life has a 20-25% chance of conceiving within a month.
How common is it?
Approximately 10-15% of married couples of reproductive age have infertility. In the examinations made in infertile couples, it was determined that the cause was in men in 40%, in women in 40%, and in both men and women in 10%. In 10% couples, no cause can be found. This condition is called unexplained infertility. In developed societies, there is a tendency to postpone the desire for children to advanced ages due to education and career expectations. In women in their late 30s and early 40s, ovarian reserves and reproductive capacity begin to decline. This situation results in more couples resorting to assisted reproductive methods (in vitro fertilization). In our country, infertility affects not only the couple concerned, but also a wide social circle. Especially when the treatment process is prolonged, these couples feel a great social and psychological pressure on them. In fact, this has a negative impact on the treatment process.
How is the couple applying for infertility evaluated?
The couple is evaluated together. Their sexual life and frequency of intercourse are questioned.
one.) First of all, a semen analysis (spermiogram) is requested in men. After three days of sexual abstinence, the semen analysis is evaluated. The amount is more than 2 ml, the number of cells (sperm) ml. More than 20 million per year, the motility rate of cells should be more than 50%, the rate of normal cells should be more than 30%. After a while, a second analysis is requested from the person whose abnormality is detected in the semen analysis and is sent to a urology specialist for evaluation.
2.)The causes of infertility in women can be examined under 4 headings.
a.) Ovulation disorders: It constitutes 30-40% of the causes of infertility in women. If the woman’s menstrual cycle is normal and the menstrual cycle is between 25-35 days (the period from the first day of one menstrual period to the first day of the next), ovulation problems are not usually observed. Body temperature monitoring in order to detect ovulation in women, 21-23 days of menstruation. Methods such as checking the progesterone hormone on the first day of pregnancy, performing an intrauterine sampling (endometrial biopsy) 3-4 days before the expected menstrual bleeding, and monitoring the ovulation cell with ultrasonography can be used. In addition, FSH, TSH and prolactin hormones should be checked.
Egg cell tracking with ultrasonography
b.) Causes of the ovarian ducts (tuba uterina) and the inner lining of the abdomen (peritoneum): It constitutes 30-40% of the causes of female infertility. The main problems in the canals occur due to previous inflammatory diseases, endometriosis or adhesions and obstruction due to previous surgeries.
Developed dense adhesions around the ovary and canal.
Foci and adhesions due to endometriosis in the inner lining of the abdomen (peritoneum) also adversely affect pregnancy.
Adhesions due to endometriosis behind the uterus, around the ovaries and ducts.
For the evaluation of the canals and the diagnosis of endometriosis, medicated film of the uterus (hysterosalpingography-HSG) and laparoscopy should be performed.
c.) Factors originating from the uterus:Certain numbers and sizes of fibroids, polyps, intrauterine adhesions (may develop after abortions) and congenital anomalies in the uterus can cause infertility.
Medicated film of the uterus (HSG), ultrasonography and sometimes MRI can be used to diagnose factors originating from the uterus.
d.) Causes arising from the cervix (cervical factor): It is responsible for 5% of the cases. It occurs because some negative factors in this region negatively affect the passage of the male cell (sperm). It is evaluated with some tests after sexual intercourse.
e.) Cases whose cause cannot be determined: Despite all these examinations, there are cases of infertility in which a problem cannot be detected. These are called cases of “unexplained infertility”. It has a 10% rate.
How is infertility treated?
Treatment is based on the underlying causes.
1-) The treatment of men is arranged by urologists.
2-) Ovulation disorders in women are treated with drugs
a.) If the canals are completely clogged, the woman is young and wants more than one child, surgical opening of the canals can be attempted. If this method is not suitable, assisted reproductive techniques (in vitro fertilization) are recommended. Chocolate cysts, adhesions and other lesions due to endometriosis can be treated with laparoscopy. b.) Myomas, polyps, adhesions and congenital anomalies in the uterus can be treated with different surgical techniques.
c.) Vaccination is recommended for problems arising from the cervix.
d.) Vaccination or in vitro fertilization treatments are also recommended in cases of unknown infertility.
Factors such as the age of the woman, the duration of infertility, and the ability to tolerate the treatment process play a role in determining the treatment method. In cases of long-lasting infertility of unknown cause, there is a very intense psychological pressure on the couples. This negatively affects the treatment process. The best example of psychological pressure is that these couples can have children spontaneously a few years after they have no expectation of children. Indeed, couples who have been treated for years and lost their hope can have children by themselves after a while.