We can talk about infertility if a couple cannot conceive despite a one-year, unprotected, regular sexual intercourse. The probability of a couple getting pregnant per month is about 20%, and at the end of a year, the probability of getting pregnant is around 85%.

However, it does not necessarily have to wait a year to start research or treatment; The age of the woman, menstrual pattern, ovarian reserve, existing diseases such as endometriosis or polycystic ovary syndrome and diseases in men are important.

In order to get pregnant, a quality egg, a quality sperm must be fertilized in the tube, fertilized egg finally adhered to the uterine wall-endometrium-implantation and development there. For these, in general terms; regular menstruation, open tubes, no problems in the uterus and normal sperm are needed.

Couples have an equal role in inability to conceive. About half of the causes of infertility belong to men and half to women, and there is a group whose cause we cannot find or explain. Men's reasons; It causes problems in sperm count, shape and movement. The main reasons for women are; ovulation problems, tube and pelvis (the part of the abdomen where the uterus and ovaries are located) problems, and again the cause of which we could not find out.

Evaluation of the infertile couple: Evaluation of the couple begins with the medical history and physical examination, then gynecological examination and ultrasonography are performed. And in line with the information obtained from here, examinations are requested. In general, the examinations; It starts with a spermiogram-sperm analysis from a man and a hormone analysis that will be done on the 2nd or 3rd day and 21st day of menstruation (more precisely, 1 week before the expected menstruation) from the woman. Our aim with these examinations is to determine the number, shape and movement of sperm in men, and ovarian reserve and whether there is ovulation in women.

Spermiogram test: After 2-3 days of sexual abstinence from men, this period should not exceed 5-7 days, sperm sample is taken. Here, especially the sperm volume, number, motility and shape are evaluated. If the values ​​do not fall between the reference values, the test is repeated after 3-4 weeks. According to the results to be obtained from here, the male is directed to advanced tests in terms of endocrine, urology and genetics.

The duration of sexual abstinence is 48 hours - 7 days
Second sample is taken after 7 days – 3 months
Suitable operating temperature 20 °C – 37 °C
Suitable collection method:
Non toxic sterile container
It's okay not to use condoms
Convenient laboratory transportation < 1 hour
Limit values ​​for fertility (5 percentiles);
Sperm volume 1.5 ml (1.4–1.7)
Total sperm count in ejaculate 39 million (33–46)
Sperm concentration (ml) 15 million (12-16)
Vitality 58% (55–63)
Progressive motility 32% (31–34)
Total progressive motility 40% (38–42)
Morphologically normal sperm 4.0% (3.0–4.0)

Evaluation of ovulation:

There are some methods to detect whether ovulation has occurred. One of them: the menstrual cycle, ovulation is present in the majority of women with regular menstruation. Therefore, the best timing to conceive naturally is to have intercourse every other day, within 10 days of the end of your period. While the egg can stay alive in the tube for 24 hours, the sperm can stay alive in the cervix for 2-5 days. Therefore, the chance of conceiving before ovulation is higher than the chance of conceiving after ovulation, because the egg lifespan is short. Serum progesterone level is the method used in commonly. The serum progesterone level is checked one week before the expected menstrual period. Another method is basal body temperature monitoring, body temperature is at the lowest level at the time of ovulation, other methos are: LH hormone level in the urine, Endometrial biopsy, But these last three methods are not applied very often, If ovulation does not occur, thyroid hormones, milk hormone (hyperprolactinemia), pituitary gland, which are known to prevent ovulation, should be evaluated from serum levels of hormones secreted from brain centers called hypothalamus. The following hormones are usually requested from women presenting with infertility complaints:

2 or 3 days of menstruation in the morning : FSH, LH, estradiol (E2),
or any day and any hour AMH,
or any day in the morning, TSH, free T4, prolactin

Evaluation of the uterus: Congenital uterine anomalies, fibroids, intrauterine adhesions, intrauterine endometrial polyp, fibroi), cesarean scar defect (istmocele, niche) may adversely affect conception. It is important to research and identify them. To detect intrauterine pathologies, uterine film (HSG), ultrasonography, sonohysterography (aqueous ultrasonography) and hysteroscopy, which is the best method, are used. Magnetic imaging is also utulized in uterine problems.

Evaluation of tubes and adnexal adhesions: In the evaluation of tubes and adnexal adhesions: uterine film (HSG) and laparoscopy are used, less frequently sonohysterography (aqueous ultrasonography) and chlamydia antibody testing. Uterine film does not have to be done for every infertile women before the treatment, depending on the situation: the timing of the uterine film is decided according to the history of the woman, whether she has had previous surgery, whether she has frequent infections, whether she has a disease such as endometriosis, which is accompanied by adhesions.

Uterine film is made 2-3 days after the end of menstruation, intercourse should be avoided during this period and there should be no genital infection in the woman. The pain that occurs during the uterine film is not unbearable. Laparoscopy, on the other hand, is the method that best shows whether the tubes are open and adnexal adhesions, but it is not the first choice because it is surgery and laparoscopy is usually performed when there is a problem in the uterine film.


Unexplained (unexplained) infertility:

If pregnancy cannot be achieved despite the normal sperm test, ovulation in the female and the tubes being open, it is called unexplained infertility. In this case, the probability of conceiving without treatment for couples is between 1-4% per month. With treatment, the chances of pregnancy increase.

Ovarian reserve tests:

One of the most important indicators in achieving pregnancy is the age of the woman. While the rate of conception is good until the age of 30, this probability stops between 30-35, decreases after 35 and decreases after the age of 40, but the chance is never impossible until menopause. The most important marker after age is the ovarian reserve, for this, the frequently performed tests today are (not all of them have to be done, but the appropriate test is selected):

Antral follicle count by ultrasonography on 2nd or 3rd days of menstruation (2-10 mm sized eggs),

And FSH, ESTRADIOL, INHIBIN B level,on the 2nd or 3rd days of menstruation in the morning,

AMH level on any day of the menstrual cycle,