Despite the fact that the frequency of this problem in the society is now at a similar rate, there is no need for II. The number of couples who apply to infertility clinics is increasing day by day due to the increase in the population of reproductive age after the World War II and the improvement of medical diagnosis opportunities. It is known that the pregnancy rate of any couple in any month is around 15-20%. In general, it is seen that 85% of couples get pregnant within one year, and 93% at the end of the second year. In a study examining archives between 1550 and 1850 in England, it was determined that only 8% of women did not become pregnant in their lifetime.
Infertility is a health problem that has increasingly occupied the agenda of both society and the media in recent years. Many true and false statements are made about this issue, making it difficult to guide couples who cannot have children. Great strides have been made in the treatment of infertility, especially in the last ten years, and couples who were previously considered incurable have been given the opportunity to have children.
CAUSES OF FEMALE INfertility
1. Ovulation Disorders
Ovulation disorders are the most common cause of infertility in women, and when ovulation disorder is said, it is understood that ovulation is absent or irregular and infrequent. Infrequent or absent menses often indicate an ovulation disorder, but ovulation disorders can also be encountered in cases where menstruation is completely regular. Ovulation disorders can be grouped into three main groups.
– Inability to secrete hormones from the brain stem due to congenital deficiency of the hormones that stimulate egg production in the ovaries,
-Excessive secretion of the milk hormone prolactin from the brain stem,
-Polycystic ovary syndrome.
2. DAMAGED OR CLOGGED TUBES
Partially or completely blocked tubes prevent the sperm and egg from meeting, making fertilization and pregnancy impossible. This damage to the tubes may be due to many reasons such as previous infection, endometriosis or intra-abdominal adhesions after a previous surgery. In developed countries, sexually transmitted infections are the most important cause of damage to the tubes. Tuberculosis microbe acquired in childhood in our country can also cause irreversible damage to the tubes.
Endometriosis is defined as the development of the tissue lining the uterus (endometrium) outside the uterus. Endometriosis, like the tissue lining the uterus, is sensitive to hormones and bleeds during menstruation. These micro hemorrhages in the abdomen cause inflammation of the inflammatory glands over time and cause adhesions.
When endometriosis settles in the ovaries, it causes cyst formation. These cysts are called endometriomas. About 50% of women with endometriosis need treatment before they can have children. Endometriosis is found in approximately 25% of women who apply for infertility.
4. PROBLEMS OF THE ORAL OF THE cervix
Structural, infectious or mucus-related disorders in the cervix may be the cause of infertility. The mucus secreted in the cervix facilitates the transport of sperm through the genital tract. Under the influence of estrogen and progesterone hormones, the amount and quality of mucus changes during the cycle. Benign tumors such as polyps or surgical interventions applied to this area may cause infertility.
5. ALLERGIC CAUSES
Although allergic causes can be the cause of infertility, their diagnosis and treatment are difficult. The necessity of routine measurement of allergic conditions is discussed, since the efficacy of treatment is not clear and pregnancy rates are very different in treated and untreated patients.
CAUSES OF MALE INfertility
In approximately 30-50% of couples who do not have children, the problem is caused by the man. The causes of male infertility are gathered in two main groups.
1. Production disorders that affect the number and quality of sperm.
2. Blockages in the channels that carry the sperm out.
The reason for these problems in men cannot be explained in 30-40% of cases. When the cause of the disorders in sperm quality and number cannot be found, some experimental drug treatments are applied. However, these treatments have been shown to have no efficacy. The application of the microinjection technique since 1992 is a turning point in the treatment of male infertility, and high pregnancy rates are achieved with this technique even in cases of severe male infertility.
1. SPERM PRODUCTION DISORDERS
In male infertility cases, sperm production and maturation disorders are the most common problem. The production disorder may be related to the sperm count, as well as to the weakness of the sperm movements that prevent the fertilization of the female egg or the abnormality of the sperm shapes (morphology).
In order for the man’s sperm to be considered normal, the number of sperm must be at least 20 million/ml, the rate of motile sperm should be above 30% and the rate of structurally normal sperm should be above 4%. If the sperm values are below the above-mentioned, significant difficulties begin to be experienced in obtaining pregnancy naturally. Many factors can negatively affect spermiogenesis (production and maturation of sperm cells).
Some bacteria and viruses cause ovarian inflammation in men. Approximately 25% of men who have an inflammatory disease of their ovaries cause infertility problems.
A condition in which there is a disorder in the hormones that control the production of the male hormone testosterone.
Radiation and drugs used for cancer treatment can impair sperm production.
Complete or partial obstructions that prevent sperm from coming out of the testicles, which are the production site, may be the cause of infertility. These obstructions may be congenital or may be due to a later infection. A surgical intervention that has undergone tests can also cause obstruction.
Today, unexplained infertility (idiopathic infertility) occurs in cases of infertility that cannot be revealed with the possibilities of medicine. Sperm infection disorders that cannot be detected by tests, cracking of the egg and the existence of some disorders in its movement in the tubes are among the assumptions put forward.
The existence of psychological factors that play a role in unexplained infertility cases is not completely clear. It is known that stress can have negative effects on the female reproductive system and hormone balance. However, the cause-effect relationship is not clear here. In other words, is it stress due to infertility or infertility due to stress? It is reported that pregnancies occur naturally in the case of the disappearance of stress. Especially in couples who do not respond to infertility treatments, spontaneous pregnancy may occur in the months when the treatment is stopped and the couple is given a chance to rest.
The term unexplained infertility indicates the limitations of current diagnostic methods. With the advances in diagnostic methods, the number of couples included in this group will decrease.
DIAGNOSIS OF INfertility
In couples who apply with infertility problems, some tests should be done to explain the reason for infertility. The first of these is sperm analysis in men and uterine film (hysterosalpingography) in women to evaluate the permeability of the uterus and tubes. In addition, hormone tests to evaluate the hormonal status of the woman and the capacity of her ovaries are performed on the third day of menstruation. Recently, the place of diagnostic laparoscopy has been controversial, and it can be used in some special cases.
Insemination is mostly applied in cases of unexplained infertility where there are problems related to the cervix, mild disturbances in sperm count and motility, or no problems related to the couple.
The number of sperm taken from the man for insemination is subjected to various washing processes under laboratory conditions, and all liquids except the sperm cells are purified, sperm cells are concentrated in a very little liquid, and the rate of number motility is increased. Then, this liquid is passed through the cervix with the help of a thin catheter and given directly into the uterus.
This treatment works best when mucus from the cervix blocks the passage of sperm into the uterus. Insemination is also used in cases of unexplained infertility and mild male infertility, with lower success rates. It has been shown that the highest pregnancy rates are in the first three applications, and the chance of pregnancy is very low after six applications. After three inseminations in suitable conditions, it may be considered to switch to assisted reproductive techniques. Especially in cases of unexplained infertility, approximately 25% of couples experience a major fertilization disorder resulting from sperm or egg in IVF application. With insemination treatment, the chance of pregnancy is approximately 30% as a result of six applications.