Infertility is defined as the inability of a person to conceive a child or carry a pregnancy to full term despite regular, unprotected sexual intercourse for at least 12 months. Infertility affects 10-15% of couples in the reproductive age group, one out of every 6 women receives professional help due to infertility.
In women, infertility may be caused by factors such as ovulation disorders, fallopian tube damage or blockage, endometriosis, or age-related decline in fertility. In men, infertility may be caused by factors such as low sperm count, poor sperm motility, or sperm abnormalities.
Other factors that can contribute to infertility include hormonal imbalances, chronic illnesses, and lifestyle factors such as smoking, excessive alcohol consumption, and obesity. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and those who follow a very low-calorie or restrictive diet. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight.
The chance of conceiving each month depends on various factors such as age, health, and fertility of both partners. For a healthy and fertile couple, the chance of conceiving in a given month is generally around 20-25%. This rate reaches 85-90% in 12 months. However, it's important to note that this rate can vary depending on various factors such as age, lifestyle, and underlying medical conditions.
Age is a crucial factor that affects the chances of conceiving, as women get older, the chance of conceiving gradually decreases. This decline begins in the early 30s and accelerates in the 40s. This is mainly because women are born with a finite number of eggs, and as they age, the number and quality of eggs decrease.
The chance of a 30-year-old woman conceiving in a given month is around 20%. This rate declines to 5% by the age of 40 and less than 1% by the age of 45. Similarly, the chance of miscarriage also increases as women age.
However, it's important to note that these statistics are based on average rates and may not apply to everyone. Various factors can affect fertility, and some women may have a higher or lower chance of conceiving than the average rates.
The age of the couple is an important factor to consider as fertility declines with age. The sooner the couple seeks medical help, the higher the chances of success in achieving a pregnancy.
Medical history: The first step in diagnosing infertility involves taking a detailed medical history of both partners, including their sexual history and any past medical conditions or treatments that may be affecting their fertility.
Gynecologic examination: General examination and examination of reproductive organs are of great importance in the evaluation of women. The examination findings may constitute a clue in terms of determining the cause of infertility. Samples are taken from the cervix and inside the vagina if needed.
Transvaginal ultrasonography shows the structure of the reproductive organs, uterus and ovaries and ovarian reserve, which plays an important role in the planning of the treatment and in determining the chance of success of the treatment.
Ovulation Testing: Ovulation testing can help determine if a woman is ovulating and if her ovaries are releasing eggs regularly. This can be done using blood tests, urine tests, or ultrasound.
Hysterosalpingography (HSG): An HSG is an X-ray procedure that uses dye to see if the fallopian tubes are open and if the shape of uterin cavity is normal. It also defines congenital anomalies and pathologies of the inner wall of the uterus (polyps, fibroids, adhesions of the inner wall of the uterus).
A catheter is inserted into the opening of the cervix through the vagina. A contrast liquid is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open.
It should be done within 1-2 days after the end of menstruation. It is known that the sensitivity and specificity of HSG is approximately 65% and 84%. It does not provide information about adhesions and endometriosis around the tube. If more than 2 years have passed, it is necessary to repeat the HSG. HSG may also have a therapeutic role. Tubes closed with mucus plugs can be opened with pressure while contrast material is administered during extraction.
Semen Analysis: A semen analysis is performed on the male partner to evaluate the quantity and quality of sperm in the semen.
Ovarian Reserve Testing: A woman's ovarian reserve helps to predict whether she can produce an egg or eggs of good quality and how well her ovaries are responding to the hormonal signals from her brain.
The most common tests to evaluate ovarian reserve is a blood test for follicle-stimulating hormone (FSH),estradiol, antimullerian hormone (AMH),done on the 2nd or 3rd day of the period.
Transvaginal ultrasound shows antral follicle count (the number of follicles or egg sacs seen during the early part of a menstrual cycle).
Other blood tests: Thyroid stimulating hormone (TSH) and prolactin (PRL) levels are useful in identifying thyroid disorders and hyperprolactinemia, which can cause fertility, menstrual irregularities, and recurrent miscarriages.
In women with hirsutism (including facial and/or chest or mid-abdominal hair),blood tests for dehydroepiandrosterone sulfate (DHEAS),17-α hydroxyprogesterone, and total testosterone should be considered.
The progesterone level measured in the second half of the menstrual cycle can help determine if ovulation has occurred.
Laparoscopy: Laparoscopy is a surgical procedure that allows to examine the pelvic organs directly. This is typically done to check for any blockages, scar tissue, or other abnormalities.
Genetic Testing: Genetic testing can be done to check for any genetic abnormalities that may be affecting fertility.
It is important to note that the diagnostic tests performed may vary depending on the individual's situation and the suspected cause of infertility. A comprehensive evaluation is necessary to accurately diagnose the underlying cause of infertility.
Infertility is a condition that affects both men and women and can be a source of emotional distress and frustration for couples trying to conceive. However, there are a number of treatments and interventions available to help treat infertility and achieve a successful pregnancy. Once a diagnosis is made, the treatment plan will depend on the underlying cause of infertility. Treatment options may include medications to stimulate ovulation, surgery to correct anatomical abnormalities, or assisted reproductive technologies such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
The couple should discuss the situation with their doctor so that they have a clear understanding of the benefits, risks and costs of each treatment option and can choose the most appropriate treatment plan for their individual needs and conditions. At our fertility Clinic in Istanbul we decide the treatment according to the patients’ needs.
Emotional support is very important during the diagnosis and treatment of infertility and affects the success rate of the infertility treatment. Infertility is a stressful and emotional experience for a couple, and psychological counseling or support can be helpful in managing the emotional impact of infertility and treatment.
Prof. Dr. Nilgün TurhanGynecology, Obstetrics and IVF Treatment Specialist
PROF. DR. NILGÜN TURHAN
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