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 6 months). The term infertility is quite broad and may not always be associated with a specific medical issue. In this case, you should consult with a specialist for diagnosis and treatment options.

On average, 10-15% of couples are affected by infertility problems. It is important to emphasize that it is not possible for every couple to conceive quickly. Even when everything is normal in both the woman and the man, the chances of pregnancy in any given month are at most 25%. To achieve pregnancy, the woman must have regular and high-quality egg production (ovulation), the man must 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.

The causes of infertility are attributed to women in approximately 40%, to men in 40%, and the remaining 20% are due to issues in both partners or unexplained causes.

The causes of male infertility lead to numerical or structural problems in sperm. These causes can be familial, genetic, related to a disease (such as mumps), or due to an injury. Undescended testes from birth can lead to serious sperm issues. Chemotherapy treatment can also cause significant damage to the sperm-producing cells in the testes, so sperm freezing prior to treatment would be advisable.

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

If a couple has been trying to conceive for 1 year without success despite unprotected intercourse, they should consult a specialist for necessary examinations and treatments. If the woman is over 35 years old, the chances of reduced egg quantity and quality, as well as an increased risk of genetic issues such as Down syndrome in a potential pregnancy, make it advisable to consult a specialist after 6 months.

To plan the most appropriate treatment, several tests need to be conducted. These include blood tests to measure hormone levels, ultrasound to evaluate the ovaries (preferably done on the 2nd day of the menstrual cycle), HSG (hysterosalpingography) to assess the fallopian tubes, and blood tests to measure immunological factors for evaluating embryo implantation. For men, a spermogram is performed. If the results are abnormal, it is recommended to repeat the test after 3 weeks. A general urological evaluation may be required, and if varicocele is present, a scrotal Doppler ultrasound should be performed. Hormonal tests may also be necessary for men. In women, advanced testing may include blood clotting factors and genetic tests. Laparoscopy should not be considered a routine infertility procedure; it should only be performed if there is suspicion of fibroids, polyps, a septum, or adhesions in the uterus, or if there are recurrent IVF failures. In such cases, a hysteroscopy should be performed.

Once a specific cause of infertility is identified through investigations, targeted treatments are applied. For example, if both fallopian tubes are blocked or damaged, in vitro fertilization (IVF) is recommended; in cases of severe sperm problems, ICSI (intracytoplasmic sperm injection) is used; if there is azoospermia, TESE (testicular sperm extraction) is performed; laparoscopy is done for ovarian cysts, endometriosis, and chocolate cysts; and for mild sperm issues, simple intrauterine insemination (IUI) may be performed. If no cause is found, meaning unexplained infertility, IUI may still be used to increase the chances of pregnancy. In cases of ovulation disorders like polycystic ovary syndrome, ovulation treatment with medication is provided. After the evaluations, the most suitable treatment plan will be prepared for you, and the chances of success will be explained.

Certain factors increase the likelihood of infertility. These include advanced age (over 35), the presence of polycystic ovary syndrome (PCOS), endometriosis, previous pelvic infections, smoking and alcohol consumption, being underweight or obese, autoimmune diseases (such as thyroid disorders, type I diabetes), previous ovarian surgeries, past miscarriages, congenital uterine anomalies, intrauterine polyps, septum, and fibroids.

Most cases of male infertility are related to genetic factors, making a family history of infertility a risk factor. Other risk factors include testicular trauma, a history of mumps, sexually transmitted infections (STIs), smoking and alcohol use, certain psychiatric medications, exposure to chemicals, occupations that cause prolonged heat exposure to the testes, and treatments such as radiotherapy and chemotherapy.

Each cause of infertility has its own signs and symptoms. For example, if there are ovulation problems, there may be menstrual delays and irregularities. In the case of endometriosis, symptoms may include painful menstruation and pain during intercourse.

For this, you should visit a doctor specialized in infertility. A doctor who spends most of their time working on infertility treatments and holds an IVF certification will facilitate your treatment and increase your chances of pregnancy. It would be advisable to visit several clinics and doctors, and choose the one where you feel most comfortable and secure. Feeling at ease during your treatment will reduce your stress, increase your positive emotions, and likely improve the success of the treatment. Even if pregnancy does not occur, the psychological impact will be easier to overcome.

When the cause of infertility is a decrease in sperm count and quality, quitting smoking and alcohol, losing excess weight, using medications that can improve sperm quality, and performing intrauterine insemination (IUI) or IVF can help in achieving pregnancy. When there is no sperm in the semen, sperm can be obtained surgically through TESE (Testicular Sperm Extraction), and IVF-ICSI should be performed using the retrieved sperm.

There are certain tests that can measure a woman’s chances of getting pregnant. These tests can also be done to check for any potential issues, even if there is no immediate desire for pregnancy. If a problem is found, it can help avoid wasting time when trying for a pregnancy. This is particularly important for women over 30, to prevent losing valuable years in marriage. These tests are ovarian reserve tests, which provide an estimate of the remaining egg quantity. The primary tests involve measuring blood FSH and AMH levels. An elevated FSH level indicates a decreased chance of pregnancy. AFC (antral follicle count) is measured via ultrasound to count the small follicles in the ovaries, which helps determine both pregnancy chances and the dosage of medication needed. Aside from reserve tests, if there is a history of pelvic inflammatory disease or surgical interventions on the fallopian tubes, an HSG (hysterosalpingogram) can be done to assess the openness of the tubes.

If a male has a history of mumps, a previous undescended testicle surgery, or works in an occupation with exposure to chemicals, it would be advisable to perform a spermogram.

The laboratory phase is the most critical step in IVF treatment. Traditionally, there are three stages in IVF: 1) Stimulating the ovaries with daily injections to retrieve a large number of eggs, 2) Aspiration of the follicles (OPU) to collect the eggs, followed by fertilization with selected sperm to form embryos, and 3) The embryos are stored in incubators in the laboratory for 2-5 days until they are ready to be transferred into the uterus.

The preparation of sperm through various processes, selecting the healthiest sperm, and combining mature eggs with these sperm are all delicate and crucial procedures that must be done with care. The experience of the embryologist, the quality of the equipment and materials used, the quality of the media where the embryos are stored, and the attention given during each process are all vital factors that directly affect the embryo quality and pregnancy chances.

Therefore, the laboratory at the IVF center you choose should be as trustworthy as your doctor. In a sense, the laboratory is the heart and kitchen of the IVF center.

These treatments include insemination and IVF. They are specialized treatment methods that use advanced technology products to enhance fertility.

Başarı oranı infertilite nedenine, kadın yaşına, yumurta – sperm kalitesine (dolayısıyla embryo kalitesine), transfer edilen embryo sayısına, rahimin embryoyu tutabilme sürecinin (implantasyon) olumlu işlemesine, daha önceki tedavi başarısızlıkları olmasına, hekimin ve merkezin tecrübesine ve laboratuar işlemlerindeki özene bağlıdır. Genel olarak başarı oranı %40 kadardır.

Başarı oranı infertilite nedenine, kadın yaşına, yumurta – sperm kalitesine (dolayısıyla embryo kalitesine), transfer edilen embryo sayısına, rahimin embryoyu tutabilme sürecinin (implantasyon) olumlu işlemesine, daha önceki tedavi başarısızlıkları olmasına, hekimin ve merkezin tecrübesine ve laboratuar işlemlerindeki özene bağlıdır. Genel olarak başarı oranı %40 kadardır.

Bu tedaviler aşılama ve tüp bebeği içerir. Üremeyi güçlendiren ileri teknoloji ürünlerinin kullanıldığı özel tedavi yöntemleridir.

Başarı oranı infertilite nedenine, kadın yaşına, yumurta – sperm kalitesine (dolayısıyla embryo kalitesine), transfer edilen embryo sayısına, rahimin embryoyu tutabilme sürecinin (implantasyon) olumlu işlemesine, daha önceki tedavi başarısızlıkları olmasına, hekimin ve merkezin tecrübesine ve laboratuar işlemlerindeki özene bağlıdır. Genel olarak başarı oranı %40 kadardır.

Bu ilaçlar çeşitli amaçlara göre ayrılır. İlk grupta bazı hormonların salgılnmasını sağlayarak yumurtlamayı uyaran ilaçlar vardır. En çok kullanılanı klomifen sitrattır (klomen, serofen). Ağız yoluyla alınır. Aynı amçla injeksiyon şeklinde uygulanan ve üretilen yumurta sayısını arttıran FSH hormonu, yumurtlamayı tetikleyen LH ve hCG hormonları kullanılır. IVF tedavisi sırasında erken yumurtlamayı baskı altına almak için GnRH antagonistleri (cetrotide, orgalutran) ve GnRH agonisti (lucrin) kullanılır. Ayrıca progesteron ve estrojen hormonları rahimi embryo transferine ve tutunmaya hazırlamak için gereklidir. Bunların dışında transfer sonrası yardımcı ilaçlar kullanılabilir. Tüm ilaçların tarif edilen saat ve dozlarda alınması gebelik başarısı için çok önemlidir.

Excess weight in both men and women is associated with reduced chances of pregnancy. Additionally, excess weight increases the need for more medication during IVF treatment, raising the overall cost, and if pregnancy occurs, it also increases the likelihood of miscarriage. Being at an ideal weight not only increases the chances of pregnancy but also plays a crucial role in maintaining the pregnancy and ensuring the birth of a healthy child. Furthermore, deficiencies in iodine, vitamin D, zinc, and selenium can also reduce pregnancy success. For these reasons, achieving an ideal weight and maintaining a balanced diet before IVF treatment can positively impact success rates and, if pregnancy occurs, promote a healthier and complication-free pregnancy.

Endometrial polyps can reduce the chances of pregnancy through various mechanisms. Therefore, in infertile patients diagnosed with endometrial polyps, removing these polyps is expected to increase the chances of pregnancy. This procedure can be performed hysteroscopically, which is a low-cost and practical method.

If there are no suspicious clinical findings, and the pelvic ultrasound imaging is normal, laparoscopy is unnecessary when the cause of infertility is clearly identified, such as male factor infertility. However, laparoscopy is appropriate when the patient presents with symptoms, a history, or risk factors suggesting pelvic pathology. Laparoscopy should be performed in the presence of hydrosalpinx, severe endometriosis, and endometriomas (chocolate cysts), especially if there have been previous unsuccessful IVF attempts.

If there is a clear cause of infertility outside the uterus, such as male factor infertility, and there is no family history of uterine anomalies, and if the woman is under 35 years old, evaluating the uterine cavity is not part of routine infertility investigations. Otherwise, uterine evaluation can be done based on symptoms through ultrasound, hysterosalpingography (HSG), or hysteroscopy.

For women over 35 years old, with abnormal uterine bleeding, and in other suspicious cases, hysteroscopy is valuable before IVF. It should also be performed if there have been two previous unsuccessful IVF attempts. During the hysteroscopy, removal of polyps and submucosal fibroids, cutting of uterine septum if present, opening adhesions, and treating any infections detected can significantly increase the chances of pregnancy.

In IVF cycles using intracytoplasmic sperm injection (ICSI), the normal fertilization rate of eggs is typically around 70-80%. A lower fertilization rate is likely due to egg quality, the medication protocol used during ovarian stimulation, genetic factors, and the timing of egg retrieval. If none of the eggs fertilize, the treatment cycle will be canceled.

The hormone tests performed during infertility evaluation primarily help predict how the ovaries will respond to medications. This allows the determination of the most appropriate dosage for effective treatment. Secondly, since low ovarian reserve negatively impacts pregnancy success during IVF treatment, the hormonal evaluation of ovarian reserve provides valuable insights into predicting treatment success. Ovarian reserve tests include FSH/estradiol on day 3 of the menstrual cycle, inhibin-B, and the AMH test, which can be measured on any day of the cycle. The most valuable test for predicting ovarian response to treatment is AMH.