What is Infertility?
If a couple is unable to conceive despite having unprotected sexual intercourse for a year, it is advisable to consult a fertility clinic with a suspicion of infertility.
For couples under 35 years old, pregnancy should occur within a year, while couples over 35 should achieve pregnancy within six months if everything is normal. During investigations at a fertility clinic, both partners will be evaluated, and these assessments are made based on percentages: 40% of the causes are attributed to the female partner, 40% to the male partner, 10% are due to both, and 10% are classified as unexplained infertility. Investigating from cause to result is essential.
Causes of Infertility in Women
The causes of infertility in women may include:
- Ovulation disorders: Hormonal deficiencies such as Polycystic Ovary Syndrome and conditions like Hypogonadotropic Hypogonadism.
- Hormonal imbalances: Underactive or overactive thyroid hormones.
- Structural problems in reproductive organs: Blocked fallopian tubes due to previous infections or congenital absence of tubes, uterine shape abnormalities, septum, double uterus, or single tube.
- Evaluation of polyps and fibroids: These conditions are also significant.
Additionally, chocolate cysts (Endometriomas) and endometriosis can affect egg quality and may spread to the fallopian tubes and the endometrial cavity. These conditions can lead to adhesions that prevent proper ovulation. Transvaginal ultrasound can identify chocolate cysts, and free fluid in the posterior uterine cavity can indicate menstrual blood reflux. An HSG (hysterosalpingography) is performed to evaluate the condition of the tubes and assess their patency and the state of the uterine cavity.
Causes of Infertility in Men
In men, a sperm analysis performed after 3-4 days of sexual abstinence will help assess sperm count, motility, and morphology.
If no sperm is found, this condition is termed Azoospermia, and the patient will be referred to a urology clinic for examination. The examination will consider whether the patient has had any febrile illnesses, trauma to the testicles, or a family history of infertility.
Infectious diseases are evaluated for their impact on sperm ducts and quality. Following this, a scrotal Doppler, hormone tests, and, guided by the infertility laboratory, a chromosome analysis may be requested. With the help of these ancillary tests, the urologist specializing in infertility will decide on the appropriate procedures. These procedures include PESA, TESA, and MICRO TESE. They are performed under spinal anesthesia either as a biopsy or through a small incision in the testicle. The patient will be informed of the results, whether positive or negative, on the same day or the following day. Treatment will be shaped by the evaluation of both partners.
