Prof.Dr.Birol Vural- İnfertilite| www.tupbebeknet.com

1. How Does Pregnancy Occur?

In a woman, an egg is selected each month and thrown into the tuba (fertilization canal). If there is no sperm in the environment, the egg that is thrown after 24-48 hours degenerates. If there is sperm in the environment, the sperm and egg cell combine to form a zygote. If at least one of these factors is missing, infertility occurs.

The inability to conceive despite one year of regular intercourse is called infertility . The most important factor in infertility treatment is to start treatment as soon as possible. Because with increasing age, fertility decreases in women. For example, while the probability of getting pregnant monthly at the age of 30 is 20%, this rate is 5% over the age of 40. If you are not able to conceive within one year under the age of 35, and within 6 months if you are over the age of 35, you must consult a doctor.

2. Infertility Evaluation:

a. Serological tests: Hbs Ag, Anti-HBs, Anti-HCV, Anti-HIV I+II, Rubella IgG, Rubella IgM, Toxo IgG, Toxo Ig

b. Hematological tests: blood group, complete blood count

c. Hormone tests: FSH,LH, Testosterone, 17-OH Progesterone, DHEA-SO4, Androstenedione (these tests will be given on the 3rd day of menstruation), free T4, TSH, prolactin and AMH test.

D. Transvaginal Ultrasonography: Detailed evaluation of the uterus and ovaries is provided.

e. Sonohysterography (aqueous ultrasonography): In the presence of polyps etc. suspected in transvaginal ultrasonography , ultrasound is performed by injecting fluid into the uterus.

f. HSG (hysterosalphingography): Uterine film. It is done between 2-4 days after the end of menstruation.

g. Spermiogram: Sperm count is done from semen in men. 3-5 days after sexual abstinence.

h. Hysteroscopy and laparoscopy: It is the endoscopic examination of the inside and outside of the uterus. Routine is not desired, it can be requested if there is a space-occupying condition in the uterus or if there is a problem in the permeability of the tubes.

3. Causes of Female Infertility:

If there is no known disease in the male factor, the sperm count is sufficient. Urology consultation is requested from men with abnormal sperm count and/or erection/ejaculation problems. IVF is performed for those with a total motile sperm count below 5 million. Vaccination is recommended for those who have 10-15 million sperm, while vaccination or in vitro fertilization is decided according to the situation for those with 5-10 million sperm.

Female Infertility: 3 basic studies are conducted. Ovulation, open tubes and uterus. Depending on the problem occurring in these, treatment is planned.

If there is no cause of infertility in the man or woman, it is called unexplained infertility. Direct IVF is attempted over 37 years of age. If under the age of 37, vaccination 3 cycles are performed, if no response is obtained, IVF is performed.

1. Pelvic inflammatory disease: After previous ovarian and uterine inflammation, obstruction and adhesions may develop in the patient's tubes and uterus. This may prevent you from getting pregnant on your own.

2. Fibroids: Myomas occur in 1 out of every 4 women of reproductive age. While subserous (attached outside the uterus) fibroids are not associated with infertility, submucous (inside the uterus) fibroids are the cause of infertility and miscarriage. Intramural fibroids develop between the muscle mass of the uterus. Although its relationship with infertility is controversial, treatment should be individualized.

3. Ovarian cysts: They are usually water-filled cysts and pass spontaneously. However, cysts that persist for more than 3 months, cysts with solid areas and paillary protrusions are the group that should be investigated. It is necessary to exclude a possible malignancy (malignant) in these patients. Ovarian cysts may be associated with infertility by compressing or preventing ovulation.

4. Endometrioma (Chocolate cyst): These are cysts that develop as a result of the growth of the inner lining of the uterus (endometrium) within the ovarian tissue. Endometriosis can occur anywhere in the inner lining of the abdomen. As a result of progressive adhesions, the patient experiences painful menstruation, pain in the groin, painful intercourse and infertility.

5.Hydrosalphinx:

It is the swelling and loss of function of the tubes due to past infections. It is beneficial to take the hydrosalphinx tube before IVF, as it is a factor that halves the success of IVF. Past ovarian and uterine infections can also cause adhesions in the abdomen.

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FREQUENTLY ASKED QUESTIONS:

WHAT IS VACCINATION?

Intrauterine insemination (vaccination) is applied in men with low sperm count and motility or in the diagnosis of unexplained infertility. Before vaccination, drugs that provide egg formation are given, and after the cracking injection (36 hours later), the sperm sample taken from the man is washed and the dead sperm are thrown into the uterus of the woman with an injector. Vaccination is done at most 3 times. It is usually applied to men with sperm count between 5-15 million.

WHAT IS IVF?

In vitro fertilization (IVF) is the process by which sperm and egg are brought together in a laboratory environment to ensure fertilization. It is preferred in cases with blocked tubes and without severe male factor, who cannot conceive naturally.

Gonadotropins stimulate the growth of eggs in the ovary

Eggs that reach a certain maturity are cracked by giving a cracking needle and after 36 hours the eggs are collected.

Collected eggs are placed in a test tube or petri dish with culture medium and combined with sperm from the male.

What are my treatment alternatives when diagnosed with infertility?

First, consult your doctor and determine if there is any pathology in the woman or the man. Treatment will be shaped according to ovulation disorder in women, clogged tubes or a pathology in the uterus. These treatments can be only ovulation treatment (pill-needle) or surgery that requires hysteroscopy / laparoscopy, vaccination or IVF treatment. In the male factor, the treatment varies according to the existing problem, this can be simply an infection treatment, a minor surgery due to varicocele, It could be vaccination or in vitro fertilization. As a result, infertility treatment varies according to the problem in men or women.

How old can I get pregnant?

Ovarian capacity in women decreases with age. After the age of 35, the decrease begins, and after the age of 40 it accelerates. IVF can be done up to age 44.

What are the causes of female infertility?

Ovulation disorders, premature aging of the ovaries, hormonal imbalances, pathologies such as polyps and fibroids in the uterus, clogged tubes, chocolate cyst (endometrioma) in the ovaries.

MALE INFERTILITY

In men, sperm production begins in the testicles with the effect of FSH and LH hormones released from the pituitary gland. Sperm production takes about 3 months. The matured sperms that complete this process are ejected into the channels. A deficiency in any step that affects sperm production and transport is seen as male infertility.

The treatment plan also changes depending on the source of the problem. That is, is the problem in sending a signal from the pituitary to the testis, is it in the production of sperm in the testis, or is the ducts blocked and sperm is produced but cannot be excreted? To understand all this, our most basic test is the sperm count, which we call spermiogram. If there is an abnormality in this, the urologist should examine you in detail and analyze the source of the low sperm production.

Factors that can affect sperm production in men:

1. Alcohol

2.Cigarette

3. Heat (working in a hot environment, sauna, wearing tight pants)

4. Medication (some drugs can affect sperm)

After a minimum of 2 days of sexual abstinence, the spermiogram is checked. Sperm count, motility and shape characteristics are important in the spermiogram. If these are lower than normal, it may prevent having a child. In order to say an abnormal result, the test must be repeated at two different times.

Treatment is planned according to the source of the problem. Techniques such as artificial insemination (vaccination), IVF (in vitro fertilization), ICSI (microinjection) are the methods used for conception. In inoculation, semen is taken, washed to remove harmful substances and dead sperm, and then delivered to the woman's uterus through a special catheter. In IVF, the sperm count is too low to be vaccinated or it is done after 3 unsuccessful vaccinations. It is done in a laboratory environment by combining sperm and egg (VF) or by injecting sperm into the egg (ICSI). IVF or ICSI is a situation that requires advanced technology and equipment and can be performed by centers with an IVF unit.

How are male causes diagnosed?

Sperm count is done after 3-5 days of sexual abstinence. Sperm count, motility and morphology are checked. If there is deterioration in these parameters, it is recommended to be examined by the urologist. If there are more than 1 million leukocytes in the sperm, infection treatment, if there is varicocele, testicular shrinkage, if there are problems in sexual intercourse, a urology doctor together with the assessment.