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Frequently asked Questions
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What is Infertility?
We call infertility when the couple cannot achieve pregnancy despite 1 year of regular and unprotected sexual intercourse. 85-90% of couples can get pregnant within 1 year. At the end of 1 year, we do tests to find the reason for those who cannot get pregnant. However, for women over the age of 35, we limit this period to 6 months.
Should We Always Wait For This Time?
In some cases, there is no need to wait for these periods. In the presence of frequent menstruation, infrequent menstruation problems, painful menstruation, pain problem during sexual intercourse, low amount of semen expelled in men, enlargement of the testis, pain in the testicle, a history of infection of the genitals in both men and women, and a history of surgery, an obstetrician can be consulted without waiting. .
What are the Causes of Infertility?
A. Women's reasons:
ovulation problems
Tubes are clogged
Endometriosis
Causes of the uterus
unexplained infertility
B. Causes related to men:
Conditions that cause low sperm count in the sperm analysis test:
There may be some hormonal disorders that disrupt the sperm production process in the testicles.
Depending on the insufficiency of the testicles itself, there may be cases of producing less or no sperm.
There may be a blockage in the ducts that serve to expel the sperm produced in the testicles. Or it may be the case that the channels are not congenital.
Due to sexual dysfunction (impotence)
It is due to the sperm being thrown back into the urinary bladder instead of being thrown out.
How to Ovulate Problem in Women:
Women have follicles containing the egg cell in their ovaries, and every month a follicle grows and cracks with the effect of some hormones secreted from the brain. The event we call ovulation is the event that the follicle is cracked and the egg is thrown out of the ovary. Ovulation problem may be caused by insufficient stimulation of the ovaries by the hormones secreted from the brain. Or it may be due to ovarian failure. On the other hand, in the case of polycystic ovary syndrome, follicle development and ovulation are not regular. In addition, in cases where the prolactin level, which we call the milk hormone, is high, and the thyroid gland does not work properly (in hypothyroidism), we see ovulation problems.
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How do we know if there is an ovulation problem?
It can be assumed that there are practically no problems with ovulation in women with regular menstruation. However, sometimes there may be ovulation problems even if we have regular periods. In people with ovulation problems, the length of our menstrual cycle is longer than 35 days. So they see delayed menstruation. If there is a deficiency in the hormones secreted from the brain, these people do not menstruate at all, but they can menstruate by using drugs. If there is an ovulation problem due to high milk hormone, milk coming from the nipple is seen. The most common condition we see in our patients with ovulation problems is polycystic ovary syndrome. In addition to menstrual irregularity, these people also experience hair growth problems. Metabolic problems are also at the forefront in polycystic ovary syndrome. There are problems of obesity, insulin resistance, susceptibility to diabetes. These problems both cause difficulties in infertility treatments and increase the risk of some problems during pregnancy.
What is Polycystic Ovary Syndrome? Can you talk a little more in detail?
Polycystic ovary syndrome is a condition in which there are many follicles in the ovaries. These are not true cysts. A large amount of hormones are secreted from these follicles. In order for the follicle, or egg, to develop properly, the hormone level in the ovary must be balanced. The amount of hormone secreted in excess prevents follicle development and ovulation. The aim of treatment in these patients is to ensure ovulation.
If there is no other condition that requires IVF treatment, we first try to ovulate with 6-month pill treatment. If we cannot achieve pregnancy, we switch to needle treatments that we use for egg development and add vaccination treatment.
Finally, we apply in vitro fertilization treatment to people who still cannot conceive. In these cases, there is a risk of excessive ovarian stimulation syndrome, which we call Ovarian Hyperstimulation Syndrome, in needle vaccination and IVF treatment. Therefore, it is very important to adjust drug doses. We also have a risk of multiple pregnancy due to over-response. Our goal in infertility treatment is to achieve a singleton pregnancy. Because in multiple pregnancy, we may encounter many problems, especially premature birth.
In addition, the risk of conditions such as miscarriage, gestational diabetes, gestational hypertension, premature birth, fetal death in the womb increased during pregnancy, especially in obese patients with polycystic ovary syndrome. That's why we recommend losing weight with a diet and exercise program before starting treatments. In addition, with weight loss, menstruation and ovulation problems may improve and there may be a chance to become pregnant on their own.
How to Understand if the Tubes are Open and What Kind of Situations Cause a Blockage in the Tubes?
With the uterine film (HSG) taken at the end of menstruation, it can be understood whether the tubes are open or not. For the tubes that are closed in the film, it is necessary to confirm that the tubes are closed by laparoscopy. Sometimes, spasm develops in the tubes while filming, and the tubes that are actually open may appear to be closed. Previous pelvic (intra-abdominal) infections, endometriosis disease, previous pelvic surgeries may cause adhesions around the uterus and tubes, causing obstruction and fluid accumulation in the tubes.
Since the egg and sperm come together in the tube and the fertilization process takes place in the tubes, there is no chance of conceiving naturally or by vaccination in women with both tubes closed. In these cases, IVF treatment is required. In addition, if there is a fluid accumulation in the tubes, which we call hydrosalfinx due to adhesions, this fluid sometimes flows into the uterus and prevents the embryo from adhering to it, reducing our IVF treatment success. These tubes must be removed before treatment.
What is Endometriosis?
Endometriosis is when the inner layer of the uterus, which we call the endometrium, is thrown out with menstrual bleeding every month, on the membrane covering the abdominal cavity.
If it is in the ovaries, we call it a chocolate cyst (endometrioma), and if it is in the uterine muscle layer, we call it adenomyosis. The characteristic of these cases is that people feel pain during menstruation and during sexual intercourse. Those who have such complaints should definitely be examined by a gynecologist and a specialist specialized in reproductive endocrinology and in vitro fertilization.
Endometriosis affects the reproductive potential of women negatively. Ovarian reserve decreases somewhat in these cases. It can also cause blockages, adhesions and fluid accumulation in the tubes. Ovarian capacity of patients should be evaluated by transvaginal ultrasonography performed on the 2nd day of menstruation and by AMH and hormone profile. In these patients, an HSG (uterus film) should be taken.
We do not recommend direct surgery for those who are infertile or who wish to become pregnant. We do not recommend surgery, especially for those with low ovarian reserve. Because surgery reduces the ovarian reserve even more. In addition, these cysts are likely to recur. Repeated surgeries are even more detrimental to the ovarian reserve. In IVF treatment, it is necessary to be careful during the egg collection process. It is necessary to collect chocolate cysts without touching them. If chocolate cysts are entered, there is a risk of abscess development in the ovaries. In addition, the long-term suppression treatment of these cases before embryo transfer increases the chance of pregnancy. Active disease is controlled with suppression therapy. The effects of toxic substances released from endometriotic foci on the inner lining of the uterus are reduced.
What is Low Ovarian Capacity? What is Low AMH?
It means that the number of eggs in the ovaries of the woman is lower than that of the women of the same age group and that it is below some threshold values (Antral Follicle Count <5-7, AMH<1.1). This is a situation that occurs naturally as women get older. In addition, egg quality and genetic structure deteriorate with age. Especially in women over 38 years of age, the quality decreases significantly. We also encounter decreased ovarian capacity in young women.
Finally, we apply in vitro fertilization treatment to people who still cannot conceive. In these cases, there is a risk of excessive ovarian stimulation syndrome, which we call Ovarian Hyperstimulation Syndrome, in needle vaccination and IVF treatment. Therefore, it is very important to adjust drug doses. We also have a risk of multiple pregnancy due to over-response. Our goal in infertility treatment is to achieve a singleton pregnancy. Because in multiple pregnancy, we may encounter many problems, especially premature birth.
In addition, the risk of conditions such as miscarriage, gestational diabetes, gestational hypertension, premature birth, fetal death in the womb increased during pregnancy, especially in obese patients with polycystic ovary syndrome. That's why we recommend losing weight with a diet and exercise program before starting treatments. In addition, with weight loss, menstruation and ovulation problems may improve and there may be a chance to become pregnant on their own.
How to Understand if the Tubes are Open and What Kind of Situations Cause a Blockage in the Tubes?
With the uterine film (HSG) taken at the end of menstruation, it can be understood whether the tubes are open or not. For the tubes that are closed in the film, it is necessary to confirm that the tubes are closed by laparoscopy. Sometimes, spasm develops in the tubes while filming, and the tubes that are actually open may appear to be closed. Previous pelvic (intra-abdominal) infections, endometriosis disease, previous pelvic surgeries may cause adhesions around the uterus and tubes, causing obstruction and fluid accumulation in the tubes.
Since the egg and sperm come together in the tube and the fertilization process takes place in the tubes, there is no chance of conceiving naturally or by vaccination in women with both tubes closed. In these cases, IVF treatment is required. In addition, if there is a fluid accumulation in the tubes, which we call hydrosalfinx due to adhesions, this fluid sometimes flows into the uterus and prevents the embryo from adhering to it, reducing our IVF treatment success. These tubes must be removed before treatment.
What is Endometriosis?
Endometriosis is when the inner layer of the uterus, which we call the endometrium, is thrown out with menstrual bleeding every month, on the membrane covering the abdominal cavity.
If it is in the ovaries, we call it a chocolate cyst (endometrioma), and if it is in the uterine muscle layer, we call it adenomyosis. The characteristic of these cases is that people feel pain during menstruation and during sexual intercourse. Those who have such complaints should definitely be examined by a gynecologist and a specialist specialized in reproductive endocrinology and in vitro fertilization.
Endometriosis affects the reproductive potential of women negatively. Ovarian reserve decreases somewhat in these cases. It can also cause blockages, adhesions and fluid accumulation in the tubes. Ovarian capacity of patients should be evaluated by transvaginal ultrasonography performed on the 2nd day of menstruation and by AMH and hormone profile. In these patients, an HSG (uterus film) should be taken.
We do not recommend direct surgery for those who are infertile or who wish to become pregnant. We do not recommend surgery, especially for those with low ovarian reserve. Because surgery reduces the ovarian reserve even more. In addition, these cysts are likely to recur. Repeated surgeries are even more detrimental to the ovarian reserve. In IVF treatment, it is necessary to be careful during the egg collection process. It is necessary to collect chocolate cysts without touching them. If chocolate cysts are entered, there is a risk of abscess development in the ovaries. In addition, the long-term suppression treatment of these cases before embryo transfer increases the chance of pregnancy. Active disease is controlled with suppression therapy. The effects of toxic substances released from endometriotic foci on the inner lining of the uterus are reduced.
What is Low Ovarian Capacity? What is Low AMH?
It means that the number of eggs in the ovaries of the woman is lower than that of the women of the same age group and that it is below some threshold values (Antral Follicle Count <5-7, AMH<1.1). This is a situation that occurs naturally as women get older. In addition, egg quality and genetic structure deteriorate with age. Especially in women over 38 years of age, the quality decreases significantly. We also encounter decreased ovarian capacity in young women.
:2022-07-26 09:16:26