Infertility is defined as the inability to conceive after one year of unprotected sexual intercourse. (If the woman is over 35 years old, this period should be considered as 6 months). The term infertility is very broad and may not necessarily be related to a specific medical problem. In this case, you should consult a specialist for diagnosis and treatment.

On average, 10-15% of couples are affected by infertility problems. It should also be emphasized here that it is not possible for every couple to conceive quickly. Even when everything is normal in both the woman and the man, the chance of pregnancy for that month is at most 25%. In order to conceive, the woman must have regular and high-quality egg production (ovulation), the man must be able to produce healthy sperm, the fallopian tubes must be open and functional, and there must be a healthy uterus where the fertilized egg (embryo) can implant and grow.

Forty percent of infertility causes are related to the woman, 40 percent to the man, and the remaining 20 percent are cases where both partners have issues or no cause can be identified.

The causes of male infertility lead to numerical or structural problems in sperm. The causes may be familial, genetic, related to a disease (mumps), or due to an injury. Undescended testicles at birth cause serious sperm problems. Since chemotherapy treatment will seriously damage the cells in the testicles that produce sperm, it would be appropriate to freeze sperm before treatment.

There are numerous reasons related to women. The main causes are ovulation problems, blocked or damaged fallopian tubes, egg quality, egg count (ovarian reserve), and uterine problems that prevent embryo implantation.

If a couple has been unable to conceive after one year of unprotected intercourse, they should consult a specialist for the necessary examinations and treatments. If the woman is over 35 years old, this period should be considered as 6 months due to the decrease in egg count and quality, and the increased likelihood of genetic problems such as Down syndrome in the resulting pregnancy.

Certain tests will need to be performed to plan the most appropriate treatment. These include blood tests to measure hormone levels, ultrasound to evaluate the ovaries (preferably performed on the second day of the menstrual cycle), an HSG film to evaluate the uterine tubes, and blood tests to measure immunological factors to evaluate embryo implantation. A spermogram is performed for the male partner. If the results are abnormal, it is appropriate to repeat the tests after 3 weeks. A general urological evaluation may be required, and a scrotal Doppler ultrasound may be requested if varicocele is present. Hormonal tests may also be necessary for the male partner. If the female partner has advanced infertility, some coagulation factors and genetic tests may be necessary. Laparoscopy should not be considered a routine infertility procedure to evaluate the pelvis; hysteroscopy should be performed when there is suspicion of uterine fibroids, polyps, adhesions, or when there are repeated IVF failures.

When a specific cause of infertility is identified through testing, targeted treatments are administered. For example, if the fallopian tubes are blocked or damaged on both sides, IVF is performed; if there is a serious sperm problem, ICSI is performed; if there is azoospermia, TESE is performed; if there are ovarian cysts, endometriosis, and chocolate cysts, laparoscopy is performed; and if there is a mild sperm problem, simple intrauterine insemination (AI) can be performed. If no cause is found, i.e., in cases of unexplained infertility, the chances of pregnancy can still be increased with insemination. In cases of ovulation irregularities such as polycystic ovaries, ovulation treatment is performed with medication. In other words, after the examinations, the most appropriate treatment plan will be prepared for you, and your chances of success will be explained to you.

Certain factors increase the likelihood of infertility. Advanced age (over 35), polycystic ovary syndrome, endometriosis, previous pelvic infections, smoking and alcohol consumption, being underweight or obese, autoimmune diseases (thyroid diseases, type I diabetes), previous ovarian surgeries, previous miscarriages, congenital uterine anomalies, uterine polyps, septa, and fibroids are among these factors.

Most cases of male infertility are due to genetic factors, and therefore a family history is a risk factor. Testicular trauma, history of mumps, history of sexually transmitted diseases, smoking and alcohol use, certain psychiatric medications, exposure to chemicals, occupations that cause the testicles to be exposed to high temperatures, and radiation and chemotherapy treatments are risk factors for male infertility.

Each cause of infertility presents its own symptoms and complaints. For example, if there are ovulation problems, there may be delayed and irregular periods, and if there is endometriosis, there may be painful periods and pain during intercourse.

For this, you should see a doctor who specializes in infertility. Having a doctor who spends most of their time working on infertility and has an IVF certificate will make your treatment easier and increase your chances of getting pregnant. It would be appropriate to visit several centers and doctors and decide on the center where you feel most comfortable and secure. Feeling comfortable throughout your treatment will reduce your stress, increase your positive feelings and possibly your treatment success, and even if pregnancy does not occur, the psychological trauma this may cause will be easier to overcome.

When infertility is caused by a decrease in sperm count and quality, quitting smoking and alcohol if used, losing weight if overweight, using certain medications that can improve sperm quality, and undergoing insemination and IVF will help achieve pregnancy. When there is no sperm in the semen, IVF-ICSI must be performed using sperm obtained through surgical sperm retrieval (TESE).

There are certain tests that can measure a woman’s chances of becoming pregnant. These tests can be performed even when there is no desire for pregnancy, to determine if there is a problem. If a problem is found, no time is lost in trying to conceive. This is particularly important in marriages where the woman is over 30, so as not to waste valuable years. These tests are ovarian reserve tests. They provide an idea of the remaining egg count. They are mainly performed by measuring blood FSH and AMH levels. An FSH level above the normal range indicates a reduced chance of pregnancy. AFC (antral follicle count) refers to the number of small follicles in the ovaries as determined by ultrasound and is important in determining both the chances of pregnancy and the dosage of medication to be used. In addition to reserve tests, if there is a history of pelvic inflammatory disease and surgical intervention involving the tubes, an HSG (hysterosalpingogram) can be performed to examine the patency of the tubes.

If the male has a history of mumps, has undergone surgery for undescended testicles, or works in a profession involving exposure to chemicals, it would be appropriate for him to have a spermogram.

The most important stage in IVF treatment is the laboratory procedures stage. There are three classic stages in IVF. These are: 1) Stimulating the ovaries with daily injections to obtain multiple eggs, 2) Retrieving the resulting follicles through egg retrieval (OPU) and fertilizing the retrieved eggs with selected sperm for embryo formation, and 3) After fertilization, the resulting embryos are stored in incubators in the laboratory for 2-5 days until they are transferred to the uterus. Ultimately, preparing the sperm through various procedures, selecting the healthiest ones, and combining the mature eggs with these sperm are all processes that must be performed with special care and precision. The embryologist’s experience, the quality of the equipment and materials used, the quality of the liquid medium in which the embryos are stored, and the care taken throughout these processes are very important factors that directly affect embryo quality and the chances of pregnancy. For this reason, the laboratory at the center where you undergo IVF treatment should be at least as reliable as your doctor. In a sense, the laboratory is the heart and kitchen of the IVF center.

These treatments include insemination and in vitro fertilization. They are specialized treatment methods that utilize advanced technology products to enhance fertility.

The success rate depends on the cause of infertility, the woman’s age, egg and sperm quality (and therefore embryo quality), the number of embryos transferred, the positive outcome of the uterus’s ability to hold the embryo (implantation), previous treatment failures, the experience of the physician and center, and the care taken in laboratory procedures. In general, the success rate is around 40%.

Medications used in infertility treatment are administered to regulate ovulation, support the development of high-quality eggs, and increase the chances of embryo implantation in the uterus. The most commonly used drug groups include ovulation-inducing drugs (clomiphene citrate, letrozole), gonadotropin hormones (FSH, LH injections), egg-breaking injections (hCG or GnRH agonists), and progesterone supplements that regulate the uterine environment. The choice of medication used in treatment is determined by the doctor on an individual basis, depending on the woman’s age, ovarian reserve, hormone levels, and treatment protocol.

These treatments include vaccination and in vitro fertilization. They are specialized treatment methods that utilize advanced technology products to enhance fertility.

Excess weight in both men and women is associated with reduced chances of pregnancy. Excess weight also increases the cost of IVF treatment by requiring more medication and increases the likelihood of miscarriage if pregnancy occurs. Being at an ideal weight for the prospective mother is important not only for increasing the chances of pregnancy but also for continuing the pregnancy and having a healthy child. Additionally, deficiencies in iodine, vitamin D, zinc, and selenium also reduce pregnancy success rates. For these reasons, achieving an ideal weight and maintaining a balanced diet before IVF treatment positively impacts success rates and, if pregnancy occurs, ensures a healthier and complication-free pregnancy process.

Endometrial polyps can reduce the chances of pregnancy through various mechanisms. Therefore, in infertile patients with endometrial polyps, their removal is expected to increase pregnancy success rates. Performing this procedure hysteroscopically is a low-cost and practical option.

When there are no suspicious clinical findings, pelvic ultrasound imaging is normal, and the cause of infertility is clearly due to a male factor, performing laparoscopy on the patient is unnecessary. It is appropriate to perform laparoscopy when the patient’s complaints, history, or risk factors suggest pelvic pathology. Laparoscopy should be performed in the presence of hydrosalpinx, severe endometriosis, and endometrioma (chocolate cyst), especially if previous IVF attempts have failed.

If there is a definite cause of infertility outside the uterus, such as male factor infertility, and there is no history of familial uterine anomalies and the woman is under 35 years of age, evaluation of the uterine cavity is not part of routine investigations in infertile couples. Otherwise, uterine evaluation can be performed by ultrasound, hysterosalpingography, or hysteroscopy, depending on whether there are any complaints.

Hysteroscopy is valuable before IVF in women over 35 years of age, in cases of abnormal uterine bleeding, and in other suspicious situations. Hysteroscopy should also be performed if there have been two previous failed IVF attempts. During hysteroscopy, the removal of polyps and submucosal fibroids, the cutting of any intrauterine septum, the separation of adhesions, and the treatment of any infection detected are procedures that will increase pregnancy success.

In IVF cycles using microinjection, the normal fertilization rate of eggs is approximately 70-80%. A lower rate is likely due to egg quality, which in turn depends on the medication protocol used during ovarian stimulation, genetic factors, and the timing of egg retrieval. If none of the eggs are fertilized, the treatment cycle will be canceled.

Hormone tests performed as part of infertility assessment primarily predict how the ovaries will respond to medication. This allows the most effective dose of medication to be determined. Secondly, since low ovarian reserve has a negative impact on pregnancy success with IVF treatment, hormonal assessment of ovarian reserve provides valuable insights for predicting success prior to treatment. Ovarian reserve tests include FSH/estradiol on day 3 of menstruation, inhibin-B, and AMH tests that can be performed on any day of the cycle. The most valuable test for predicting the ovaries’ response to treatment is AMH.