The incidence of infertility increases as women age! “Infertility is defined as the inability of a couple to have children after 12 months of unprotected care. It is seen in 10-15% of couples and this rate has not changed in the last 50 years. Women of reproductive age have a 15-18% chance of getting pregnant in one menstrual period, and 85-90% of them get pregnant at the end of a year. The incidence of infertility increases with the increasing age of women. Delaying the age of having children due to women’s more active participation in business life has led to a proportional increase in age-related factors among the causes of infertility.”
Causes of infertility
- Factors Related to Women
35% of infertility causes are women-related factors.
- 5-10% of these are factors related to the cervix.
- Factors related to the uterus include congenital anomalies, pathologies such as fibroids, adenomyosis or polyps, infections and past infections, adhesions due to abortion or other surgical interventions.
- Obstruction of the tubes: Another important cause of female infertility is obstruction in the tubes due to reasons such as surgical interventions, infections or endometriosis, or structural deterioration even if it is open.
- Again, one of the most important factors related to women is ovulation disorders.
- Another important factor causing female infertility is endometriosis.
- Apart from these, problems such as stress and depression can also increase the risk of infertility, although not proven.
- Male factor:
In 35% of infertile couples, the problem is caused by the man. Defects in sperm count, shape and movement are the most common male-related causes of infertility. In addition, varicocele, congenital occlusion of the channels through which sperm pass, or disorders in sperm production due to genetic reasons and sexual dysfunction can also cause male infertility.
- In 20% of couples, problems related to men and women can cause infertility together.
- Unexplained infertility: In 10-15% of couples, no problem can be detected in man or woman with routine tests. This group is called “unexplained infertility”.
- Environmental factors and toxins: Factors such as smoking, substance abuse, alcohol use, excessive diet and exercise can increase the risk of infertility in men and women. There are studies showing that Biphosphenol (BPA), which is considered among the environmental toxins, causes infertility in men.
Investigation of infertility
Infertility investigation should be started in women up to the age of 35 who fail to conceive despite one year of unprotected intercourse, and after 6 months in women over the age of 35.
History: The first stage of infertility research is to obtain a detailed history from the couples. Here, questions such as previous systemic and sexual diseases, surgical procedures, duration of infertility, previous pregnancy and miscarriage, and a history of previous marriage related to a second marriage are addressed.
Tests to be done: Today, only 3 tests are sufficient for infertility. Detailed tests are for research purposes only and do not affect the treatment process. First of all, we start the research process with the test we call “spermiogram”. If the sperm values are normal, the uterine film (HSG) is checked to investigate the problems in the uterus and whether the tubes are open, and the progesterone levels in the blood at a certain period of the menstruation are checked for the evaluation of ovulation. Another important test is the evaluation of the ovaries in ultrasound for the evaluation of ovarian reserve and, if necessary, the level of AMH in the blood.
Examination: Apart from a general physical examination, it is very important to evaluate the uterus and ovaries in women. If a problem is detected in the sperm values, the man should also be evaluated by the urology.
Treatment in infertility is determined by factors such as the reason for not having children, the age of the woman, the duration of infertility and ovarian reserve. Couples under the age of 30, with good ovarian reserve and no significant problems detected in the tests, can be followed up to 3 years without starting treatment. The most important factor affecting the treatment decision is the age of the woman. To summarize briefly:
- Ovulation disorders: In these couples, the ovaries can be stimulated for 6-12 months and pregnancy can be achieved by 40-50% as a result of stimulating the ovaries only with pills. In unsuccessful couples, “vaccination” and then “in vitro fertilization” methods are applied.
- Unexplained infertility: In these couples, treatment is usually started with “vaccination” and in case of failure, “in vitro fertilization” treatment is started.
- Blocked tubes: Depending on the woman’s age, the cause of the obstruction, the location and degree of obstruction in the tube, the tubes can be opened primarily by microsurgery, but nowadays, “in vitro fertilization” treatment is applied to most of these couples. In addition, if there is fluid accumulation in the tubes due to obstruction in these patients, it is recommended to remove the tubes to increase the chance of pregnancy before in vitro fertilization.
- Endometriosis: Depending on the degree of the disease, surgical treatment can be tried or reproductive techniques such as “vaccination” or “in vitro fertilization” can be applied directly.
- Male factor: Methods of obtaining sperm from the testicles are used in patients with no sperm seen in the tests, using the methods we call “in vitro fertilization” and TESA-TESE. Sperm can be found surgically in approximately 50% of this group of patients. Apart from this group, the treatment method to be chosen is determined according to the severity of the disorders in the spermiogram. In couples with mild disorders, first of all, “vaccination” can be done, while in severe disorders, “microinjection-in vitro fertilization” treatment is applied.
Additional treatments that increase success in IVF
In order to increase the chance of success in IVF, giving various vitamins and supplements, hormonal supplements such as testosterone and growth hormone, scratching the uterus, selecting normal embryos by looking at the genetics of the embryos, PRP applications to the uterus or ovaries, magnetic methods or large-scale microscopes for sperm selection. Many methods are tried, such as using the best sperm. However, unfortunately, there is not enough data to definitively show the effectiveness of these methods. For this reason, it is necessary to be careful about these methods, which significantly increase the cost of treatment, and to present objective data when informing the couple.