Infertility is the inability to conceive despite having regular sexual intercourse without using any contraceptive methods.
There are two types of infertility:
• Primary infertility: The inability to conceive despite at least one year of unprotected intercourse.
• Secondary infertility: The inability to conceive despite having had at least one previous pregnancy.
Infertility may be due to issues solely in the female partner (40-50%), solely in the male partner (30-40%), or in both partners (10-20%).
Causes of Female Infertility
During the natural conception process, an egg cell is released and travels through the fallopian tubes, where it meets the male sperm cell. Fertilization occurs, and the resulting embryo implants in the uterus, continuing the pregnancy process. However, one or more of the following factors can disrupt this natural process and prevent pregnancy:
In healthy women under 30 with a regular sexual life, the monthly probability of conception is around 25-30%. However, after the age of 35, and especially after 40, the chances of conception decrease significantly, while the risk of miscarriage increases.
The causes of female infertility include:
• Blocked fallopian tubes
• Irregular menstrual cycles
• Diminished ovarian reserve
• Previous infections or abdominal surgeries
• Endometriosis
• Ovulation disorders
• Elevated prolactin levels
• Polycystic Ovary Syndrome (PCOS)
• Premature menopause
• Uterine fibroids
• Pelvic adhesions
• Thyroid disorders
• History of cancer and cancer treatments
• Liver and kidney diseases
• Diabetes
• Obesity
• Excessive smoking and alcohol consumption
Diagnostic Methods for Female Infertility
For women under 30, a waiting period of one year is advised before seeking medical evaluation for infertility. However, for women over 35, this waiting period is reduced to six months due to the decline in natural fertility. After a general physical and pelvic examination, specific infertility tests may be performed, including:
• Ovulation Test: Hormone analysis to determine whether ovulation is occurring.
• Hysterosalpingography (HSG): A specialized X-ray with contrast dye to detect blockages or abnormalities in the uterus and fallopian tubes.
• Ovarian Reserve Testing: Hormonal tests performed at the beginning of the menstrual cycle to assess ovarian function and egg quality.
• Other Hormonal Tests: Includes tests for pituitary hormones, thyroid hormones, and androgenic hormones.
• Pelvic Ultrasound and Saline Infusion Sonogram
• Hysteroscopy: A minimally invasive endoscopic procedure used to evaluate the uterine cavity and cervix.
• Laparoscopy: A minimally invasive surgical procedure used to examine the uterus, ovaries, and fallopian tubes for blockages, endometriosis, or adhesions.
Causes of Male Infertility
The causes of male infertility include:
• Reduced sperm count and motility
• Structural abnormalities in sperm
• Absence of sperm in the semen (Azoospermia)
• Blockages in the reproductive tract
• Failure of sperm to be ejaculated
• Hormonal imbalances
• Undescended testicles
• Febrile illnesses during childhood, such as mumps during adolescence
• Genetic disorders
• Varicocele (enlarged veins in the scrotum)
• Sexually transmitted infections (e.g., syphilis, gonorrhea)
• Sexual dysfunctions (e.g., erectile dysfunction, premature ejaculation)
• Diabetes
• History of cancer treatments
• Infections
• Testosterone deficiency
• Excessive smoking and alcohol consumption
• Stress
Diagnostic Methods for Male Infertility
• Semen Analysis: Conducted after 3–4 days of sexual abstinence. The test evaluates sperm count, motility, and structural characteristics. In some cases, urine may also be analyzed for sperm retrograde ejaculation.
• Hormone Tests: To assess testosterone and other reproductive hormones.
• Genetic Testing
• Testicular Biopsy
• Imaging Techniques: Transrectal or scrotal ultrasound, vasography, brain MRI.
• Other Specialized Tests: DNA integrity analysis of sperm in semen.
Treatment Approaches for Female Infertility
Many women can achieve pregnancy with appropriate treatment, but some cases require more complex and long-term interventions.
• Ovulation Induction: Medications are used to stimulate the development and release of eggs.
• Intrauterine Insemination (IUI): Commonly known as "artificial insemination," this procedure involves placing healthy sperm directly into the uterus after ovulation to facilitate fertilization.
• Fertility Surgery: Surgical procedures to remove endometrial polyps, uterine septa, intrauterine adhesions, or certain fibroids.
• Assisted Reproductive Technologies (ART): The most widely used method is In Vitro Fertilization (IVF). This involves retrieving multiple mature eggs from the ovaries, fertilizing them with sperm in a laboratory setting, and transferring the resulting embryo(s) into the uterus.
Dr. Lecturer Tolga Şişli
Obstetrics and Gynecology Specialist
