Pregnancy Consideration and Infertility
First, it is necessary to correct a common misconception. Most couples postpone their desire to have children for various reasons. At the forefront of these reasons is the misconception that they can have a child whenever they want. The likelihood of this desire being fulfilled in the first 6 months is dependent on the woman's age. Particularly, even in the younger group under 35 years of age, the success rate is only 70%. For those who have previously been pregnant, this rate is known to be 85%. These rates decrease further with advancing age.
Pre-Pregnancy Evaluation
It is important for prospective mothers considering pregnancy to be evaluated beforehand and informed about the presence of any existing conditions or potential problems that may arise during pregnancy. In addition to maintaining a balanced diet at least one to two months prior to the intended conception date, starting folic acid supplementation is crucial for the healthy development of the upcoming embryo.
Definition of Infertility
Infertility is defined as the inability to conceive despite unprotected intercourse and the desire for pregnancy over a period of one year. For women over 35 years of age, this waiting period is 6 months. If pregnancy does not occur within this timeframe, the first step should be to consult a doctor. The prevalence of infertility among married couples is approximately 15%.
Causes of Infertility
Common causes of infertility include:
- Male factors and sperm-related issues
- Low ovarian reserve or ovulation problems in women
- Structural or functional disorders in the genital tract.
Thus, it is necessary to evaluate the infertile couple together. As can be understood from this, a good sperm, a quality egg, and the proper functioning of anatomical structures that allow natural fertilization are essential requirements for pregnancy. Both men and women share equal responsibility for infertility.
Basic Tests
Among the basic tests to be conducted, the easiest and most prioritized is the evaluation of the male partner and semen analysis. Following this, the woman should undergo hormonal evaluation and ultrasound assessment of the ovaries. The basic screening is completed with the radiological imaging of the genital tract to evaluate the uterine cavity and the function and patency of the tubes. The best and most reliable test is pregnancy itself. That is, having had a previous pregnancy is the best indicator of the ability to conceive again. However, there are some exceptions. Specifically, certain operative deliveries, genital system diseases experienced after pregnancy, and associated structural and functional disorders in the genital tract can also lead to infertility.
Semen Parameters and Treatment Methods
If the semen parameters are abnormal in these basic tests, an evaluation of the male partner and a urological examination may be necessary. Infertility treatment may involve intrauterine insemination or in vitro fertilization (IVF) techniques, and sperm can be obtained using microsurgical methods if needed.
In women, treatment may be administered orally or through injection to ensure ovulation. The treatment of simple cysts seen in the ovaries may not always be necessary. If there are structural disorders in the genital tract, some can be corrected surgically. If a hysterosalpingogram indicates blockage in the tubes, and this is confirmed by a laparoscopy for a definitive diagnosis, direct IVF treatment is required as part of assisted reproductive therapies.
Assessment of Progress
In some cases, no cause can be found with basic tests, and more advanced methods are pursued. However, despite all examinations, no obstructive cause for childbearing is found in 15% of infertile couples, with reports indicating that this figure can reach 37%. In this case, it is referred to as unexplained infertility. When classical treatment methods fail, assisted reproductive techniques are employed. The earlier these methods are initiated, the higher the chance of conception.
