Evaluation of women;
First of all, it is very important whether the woman has regular menstrual periods. It is known that most women with regular menstruation do not have ovulation problems. Still, it is useful to request certain hormone tests. For example, thyroid hormones and milk hormones.
Then, the woman's uterus and ducts are evaluated by taking a medicated film (HSG). This film evaluates whether the channels are open and whether they appear normal. If both channels appear to be blocked, then it is not possible for the sperm to pass through these channels and fertilize the egg, and to find out whether they are really blocked, a procedure called Laparoscopy is usually performed to look inside the abdomen.
If the canals are found to be closed during this procedure and can be repaired by surgery, they can be repaired, but if they cannot be repaired, there is nothing to do but resort to in vitro fertilization.
1- PROBLEMS WITH TUBE - UTERINARY CHANNELS
The tubes on both sides of the uterus host the egg and sperm to meet and the sperm to fertilize the egg. Problems related to the tubes are responsible for 25-35% of childless women. Before in vitro fertilization, when a problem was detected with the tubes, the only solution was to open the blocked tube with surgery. However, the success of this method is limited and pregnancy is almost impossible in cases of severe damage to the tubes. With the introduction of the in vitro fertilization method, the patients who benefited most from this method were those who had problems with the tubes. Currently, if there is no fluid accumulation in the tubes, there is high success in in vitro fertilization treatment in infertility problems due to duct obstruction.
Damage and blockages in the tubes may be due to previous and untreated inflammatory diseases, some microbes transmitted through sexual contact, tuberculosis, previous surgeries such as ovarian cysts or appendicitis, and endometriosis. The best way to investigate whether there is a disease related to the tubes is a medicated uterine film called hysterosalpingography. With this method, the inside of the uterus and tubes are visualized; Irregularities in the uterus and whether the tubes are open can be checked. Sometimes, due to pain and spasm during the procedure, a tube that is actually open may appear to be closed. In patients with problems with the tubes, laparoscopy, which is a more detailed examination method, may be recommended, or direct treatment can be performed and a surgical method or in vitro fertilization can be attempted.
2- OVULATION DEFECTS
Another problem that has an important place among the causes of infertility in women is ovulation-related defects. Ovulation defects either arise directly from the ovary, or some centers in the brain that regulate the functioning of the ovaries may cause problems. Treatment is based on determining what the problem is. In fact, among the causes of infertility, if there is no other additional problem, the problem that is easiest to treat is considered to be the ovulation problem, and it can usually be overcome with medication without the need for in vitro fertilization treatment. However, sometimes in cases where no results are obtained, in vitro fertilization treatment must be applied.
3- POLYCYSTIC OVARIAN SYNDROME
It is the most common disease that causes ovulation problems. It has symptoms such as menstrual irregularity, which mostly occurs in the form of infrequent menstruation, inability to menstruate without taking medication, hair growth, and weight gain. An increase in the male hormone testosterone may be observed. Ultrasonography shows many tiny cysts like a string of pearls in the ovaries.
Obesity is also observed in approximately half of patients with polycystic ovary syndrome. Long-term health problems such as disorders in sugar metabolism and increased risk of cardiovascular diseases may also be observed in these patients. Therefore, patients with polycystic ovaries need to be treated even if they have no complaints. Today, drugs that regulate sugar metabolism, such as Metformin, have begun to be used in the treatment of these patients. Metformin use also makes it easier for the patient to lose weight. In addition, after the use of this drug, spontaneous ovulation may occur in women who have not ovulated before, or patients who have not previously responded to ovulation drugs may become responsive to these drugs.
Diet is as important as medication use in patients with polycystic ovary syndrome and overweight. Losing weight for the patient can improve many disorders, including ovulation. However, losing weight is a form of treatment that is easy to say but also very difficult to implement.
In the treatment of the disease, in those who do not want to have children, birth control pills can be used to regulate menstrual periods. In women who want to have children, clomiphene citrate (Klomen, Gonaphen, Serophen) is used first, and gonadotropin hormones administered in the form of injections are used in patients who do not respond to this drug. The risk of multiple pregnancy with these drugs is 30-50%.
In patients whose treatment with medication is not successful, laparoscopy and cauterization of the ovaries can also ensure ovulation. This treatment is not the first treatment option, but should be considered in patients resistant to drug treatment and should be performed by experienced people.
The last treatment option for patients with polycystic ovaries and desire to have children is the application of in vitro fertilization.
4- HYPERPROLACTINEMIA, HIGH MILK HORMONE
Prolactin hormone is the hormone responsible for milk secretion. Its excess causes infertility in both women and men.
Prolactin secretion is affected by factors such as stress, exercise, hunger-satiety, and sleep. In order to get accurate results from the hormone analysis, the test should be done in the morning on an empty stomach. Thyroid functions should also be investigated while prolactin analysis is performed. In patients with an underactive thyroid gland, the TSH hormone secreted to stimulate this gland may also cause an increase in prolactin.
In patients with very high prolactin levels, it should be investigated whether there is a tumor in the pituitary gland that secretes this hormone.
Treatment of hyperprolactinemia is done with medications, and a positive response to treatment is usually obtained.
5- ENDOMETRIOSIS
Endometriosis is the presence of the endometrium, the inner layer of the uterus, outside the uterus, especially in the ovaries, the inner abdominal membrane (peritoneum) and rarely in other parts of the body. Endometriosis cysts found in ovaries are also called chocolate cysts (endometrioma) because their contents are brown and dark in consistency. Just as the inner lining of the uterus sheds with bleeding during menstrual periods, symptoms such as bleeding and therefore pain occur in foci in other areas.
The most important symptoms of endometriosis are pain during menstrual periods, pain during sexual intercourse and difficulty in getting pregnant. Endometriosis is a disease seen in women of reproductive age. Although some patients have no symptoms, it is only revealed in examinations performed due to inability to become pregnant.
Treatment of endometriosis is mainly surgical, treatment with drugs can only be considered as an adjunct. Today, surgeries performed with imaging systems called laparoscopy are preferred in the surgical treatment of endometriosis. The advantage of this method is that the patient recovers and stands up more quickly after surgery and there are fewer surgical scars on the abdomen. In drug treatment, depending on the patient's condition, birth control pills for pain and monthly injection treatments in the postoperative period may be considered to prevent recurrence of the disease. In vitro fertilization methods should be considered in patients who cannot achieve pregnancy within 1 year after surgery.
6- CAUSES OF INFERTILITY RELATED TO THE STRUCTURE OF THE UTERIN
Some congenital uterine deformities can cause infertility. In addition, problems such as polyps and myomas in the uterus, adhesions in the cervix, intrauterine adhesions due to previous infections or abortions can also make it difficult to get pregnant. These problems must be eliminated for pregnancy.
7- ANTISPERM ANTIBODIES
Some substances that act against sperm can be found in both men and women. These substances can be searched in the serum or cervix.
Antisperm antibodies can prevent the sperm from merging with the egg, make sperm motility difficult, or impair the growth of the fertilized egg. Today, antisperm antibody research is not accepted and practiced by everyone interested in this field.
The first treatment option for those with positive antisperm antibodies is intrauterine insemination, also known as vaccination. In this method, the prepared sperm are injected directly into the uterus, passing the cervix, thus protecting them from the harmful effects of antisperm antibodies. In cases where this method does not yield results, in vitro fertilization and microinjection should be considered.
Today, antisperm antibodies are not researched as much as they used to be, and they seem to have lost their former importance, especially after the introduction of vaccination and in vitro fertilization treatments. Even if the presence of antisperm antibodies is detected, if vaccination and in vitro fertilization methods are to be used, no additional treatment is applied.
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