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INFERTILITY AND THE REASONS THEREOF
If there is no resulting pregnancy in a couple in child-bearing age after at least one year of regular intercourse with no contraceptives, it is called “infertility”. If the couple have a history of pregnancy, or have a child, and there is no pregnancy, it is called “secondary infertility”. The chance of pregrancy within a month in a woman who has no problems and a regular sex life is about 20-25%.
How often is it seen?
Approximately 10-15% of married couples in reproductive age have infertility. Studies carried out on infertile couples have shown that in approximately 40% of the cases the reason is in the male, in 40%, in the female, and in 10%, in both the male and the female. And in 10% of the couples, no reason has been found. This situation is called unexplainable infertility. In advanced societies, there is a tendency to postpone the wish for a child to later ages due to education and career expectations. In females ovarian reserves and the capacity for fertility starts to decline toward the end of thirties and the beginning of forties. This results in more couples applying for auxiliary reproduction methods (test tube babies). In our country, infertility does not only affect the concerned couple, but also a wide social environment. Especially in cases where the treatment period is prolonged, these couples feel under a great social and psychological pressure. Actually, this situation also has an adverse effect on the treatment process.
How is a couple applying because of infertility evaluated?
The couple is evaluated together. Their sex life, and the frequency of their intercourse are questioned.
1. Firstly, a spermiogramme is requested from the male.
The spermiogramme carried out after three days of sexual abstinence is evaluated. Üç günlük cinsel perhizden sonra yapılan meni tahlili değerlendirilir. The amount should be more than 2 ml., cell count (sperm) more than 20 million per ml., cell mobility ratio more than 50%, and normal cell ratio more than 30%. A second analysis is required from a person whose spermiogramme has shown abnormalities, and is sent to a urology expert for evaluation.
2. Infertility in a female can be studied under four headings.
a. Ovulation defects: This makes up approximately 30-40% of infertility reasons in females. If the female’s menstruation cycle is normal, and between 25-35 days (from the first day of one menstruation to the first day of the next menstruation) usually there is no problem with ovulation. In order to establish ovulation in the female, methods such as checking body heat daily, checking progesterone hormone in the 21-23 days of the menstrual period, taking samples 3-4 days before the expected date of menstruation from within the uterus (endometrial biopsy), checking the ovulation cell by ultrasonography may be used. Furthermore, FSH, TSH and prolactine hormones should be checked.
Ovulation cell pursuit by ultrasonography.
b. Reasons related to fallopian tubes (tuba uterina) and the peritoneum: These make up 30-40% of infertility in females. The main problems in the tubes consist of previously suffered infectious diseases, endometriosis or adherence and embolisation due to previous operations.
Intensive adherence developed in and around ovaries and fallopian tubes.
Foci and adherence in the peritoneum due to endometriosis can also have a negative effect on pregnancy.
Adherence due to endometriosis behind the uterus and around the ovary and the tubes.
For the evaluation of the tubes and diagnosis of endometriosis, an iatric film of the uterus (hysterosalpingography-HSG) must be taken and laparoscopy carried out.
c. Factors arising from the uterus: A certain number and size of myoma, polyps, interuterine adherences (may develop after curettage) and birth anomalies in the uterus may cause infertility.
Two polyps inside the uterus
The hysteroscopic removal of the adherences inside the uterus.
Various shapes of birth defects of the uterus.
An iatric film (HSG) of the uterus to diagnose factors arising from the uterus, ultrasonography, and sometimes, MRI may also be used.
d. Reasons arising from cervical factors: These are responsible for about 5% of the cases. This is caused by the adverse impact on the passage of the male cells (sperms) of some negative factors in this area. Evaluation is made by some tests carried out after sexual intercourse.
e. Cases where the cause cannot be determined: In spite of all these studies and research, there are cases of infertility where a problem has not been found. These are called “unexplained infertility cases”. They have a ratio of 10%.
How is the treatment for infertility carried out?
1- The treatmment of the male is carried out by urologists.
2- Ovulation deficiencies of the female are treated with medication.
- If the tubes are completely blocked, and the female is young and wants more than one child, surgically clearing the tubes may be tried. If this method is not suitable, auxilliary reproduction methods (in vitro fertilisation) may be recommended. Chocolate cysts, adherences and other leisons due to endometriozis may be treated by laparoscopy.
- Myomas, polyps, adherences and birth anomalies may be treated by different surgery techniques.
- Emplastration is recommended in cervical problems.
- In infertility cases where the reason is unknown, emplastration or in vitro fertilisation are recommended.
- In establishing the treatment method, factors such as the age of the female, period of infertility, her toleration of the treatment, play a big part. Long lasting infertility cases with no known reason cause a very intense psychological pressure on the couple. This has a negative effect on the treatment. The best example of this psychological pressure is seen when, several years after the couple’s expectation of a child has ended, they have a child completely naturally. Really, couples who lose their hopes after years of treatment may, after a while, have a baby by themselves.
