What is infertility?

Infertility is defined as the absence of pregnancy within 1 year despite regular sexual intercourse. This period is considered to be 6 months in cases of female age 35 and over. For this reason, if the female is over 35 years old or if there is any finding in the history and physical examination that may be associated with infertility, investigations should be initiated earlier.

For pregnancy to occur, sexual intercourse must occur at least once a week. In cases where sexual intercourse is less frequent, the chance of pregnancy decreases. The ideal frequency of sexual intercourse for pregnancy to occur is 2-3 times a week.

Investigating Infertility

The first test to be done is semen analysis and should be repeated at least twice at intervals of 2 months. If the semen analysis is normal, there is no problem in the man. A man with a normal semen analysis does not need to be examined. Simultaneously with the semen analysis, it should be checked whether the woman is ovulating or not. For this purpose, 19-21. A simple hormone test (progesterone in the blood) is done between days and weeks. 95% of women who have regular periods ovulate regularly.

One of the most important tests in women is the determination of ovarian capacity (ovarian reserve). For this purpose, antral follicles (tiny cysts containing eggs) in the ovaries are counted by performing an ultrasound vaginally during the menstrual period. If there are less than 6 antral follicles in the two ovaries, it means that the ovarian capacity has decreased. In women, ovarian capacity starts to decrease from the age of 37 and it becomes very difficult for a woman to have a child after the age of 44. Sometimes ovarian capacity decreases earlier. Ovarian capacity should be evaluated very carefully, especially in women with a family history of early menopause, women with previous ovarian cyst removal, women with a single ovary removal, women with a history of endometriosis, and heavy smokers (more than 10 per day).

In couples with normal semen analysis, ovulation and ovarian capacity, it is investigated whether the woman’s tubes are open. For this, uterine tube film (HSG-hysterosalpingography) should be taken. Although HSG is a simple and often painless procedure, it can technically cause cramps in the uterus due to rapid and pressurized administration of the drug. The procedure should be done immediately after the end of the menstrual period. In this way, the uterus is better seen and the possibility of a very early pregnancy after the ovulation period is eliminated. With HSG, the uterine cavity and tubes are evaluated. It can be understood whether the tubes are open and if they are closed, at what level they are closed. In particular, the case that one tube is closed from the place where it is adjacent to the uterus sometimes depends on the contraction of the tube as a result of pressurized medication. In this case, there is a false congestion, not a real one. With HSG, it is less likely to understand the adhesions in the abdomen and their severity. Although HSG gives information about whether the tubes are open or not, it does not give information about the function of the tubes.

In women who do not have any findings in their history and physical examination, a procedure called laparoscopy can be performed, which allows observing the inside of the abdomen with the help of a telescope. Although laparoscopy used to be a very common technique in the past, its use in diagnosis is very limited today. Today, laparoscopy is only recommended for therapeutic purposes.

There are also tests that are used in infertility research, but whose importance has not been fully proven. These include immunological studies (antisperm antibodies) and postcoital testing (examination of the fluid in the cervix for the presence of sperm after intercourse). These tests are not recommended.

A minimalist approach is recommended in investigating infertility. Performing unnecessary tests will lead to a waste of both time and money.

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