The use of ovulation-stimulating drugs in patients with infertility problems,

Application of assisted reproductive techniques,

Feathering problems,

Inability to menstruate,

In cases of tubal obstruction, opening of the tubes is performed by micro surgical methods.

What is infertility?
The reduction of reproductive capacity against desire is called infertility. In other words, without applying a preventive method, despite a regular sexual life (sexual intercourse on average twice a week is considered a regular sexual life), the absence of pregnancy for a year is called infertility. According to the World Health Organization’s (WHO) definition of infertility, this period is two years.

Infertility is evaluated in 2 classes:

A- Primary infertility,
B- Secondary infertility.

The fact that no pregnancy has occurred before is called primary infertility, in contrast, the fact that another pregnancy has occurred despite the fact that a pregnancy has occurred before is also called secondary infertility.

The incidence of infertility varies depending on the cultural and social structure differences of societies. On average, 15% of couples are infertile. About 1/5 of married women go to the doctor because of infertility. It is thought that this figure is over 15% for our country.

On average, the time required for half of women who have never given birth in normal society to become pregnant is 5 months. In other words, half of the women who have never given birth become pregnant in the first 5 months and the remaining half in the second five-month period.

The possibility of a pregnancy increases in direct proportion to time. According to this, while the chance of a couple achieving pregnancy in a 3-month period is 57%, this rate increases to 85% at the end of 1 year. With another year of waiting, that is, at the end of the second year, the chance of pregnancy reaches 93%.

It is necessary to know very well the conditions necessary to conceive, and what needs to be done step by step to investigate these conditions.

The woman’s health should be suitable for carrying a pregnancy. In other words, a woman should be physically and spiritually fit for pregnancy.

A man should be able to produce seed cells at a level that will form a pregnancy and be able to deliver these cells outside.

A woman should be able to mature eggs regularly from the ovaries and deliver these cells to the outside.

This expelled egg should be able to be captured by the ovarian canal and move through this canal to the fetal bed.

A man and a woman should be in a relationship at the right time.

After this relationship, the male’s seed cells should be able to travel a long way up the woman’s body and reach the egg moving through the canal.

The male’s seed cell should be able to pierce the egg.

Both seed cells that meet each other should be able to reach the nest to accommodate themselves as a single cell.

It is necessary that this nest has the equipment to maintain this union to the end.

Causes of infertility in men
About 30-50% of couples without children?the problem in you is caused by a man. The causes of infertility in men are mainly grouped into two main groups.

1. Production disorders that affect the number and quality of sperm.
2. Blockages in the ducts that carry sperm out.

The cause of these problems in men cannot be explained in 30-40% of cases. When the cause of the disorders in sperm quality and number cannot be found, a number of experimental drug treatments are applied. However, these treatments have not been shown to have any effectiveness. The introduction of the microinjection technique since 1992 is a turning point in the treatment of male infertility, and high pregnancy rates are achieved even in cases of severe male infertility with this technique.

1. Disorders of sperm production

Sperm production and maturation disorders are the most common problems in male infertility cases. Production disorder may be related to sperm count, as well as it may be related to weakness of sperm movements or abnormality of sperm shapes (Morphology) that prevent fertilization of a woman’s egg.

In order for a man’s sperm to be considered normal, is his sperm count at least 20 million/ml, his motile sperm rate is 30%, and his structurally normal sperm rate is 4%?it should be on reputation. If the sperm values are below the above, there begin to be significant difficulties in obtaining pregnancy by natural means. Many factors can negatively affect spermiogenesis (the production and maturation of sperm cells).

Inflammatory diseases

Some bacteria and viruses cause ovarian inflammation in men. About 25% of men who have an inflammatory disease from their ovaries?it creates an infertility problem in the den.

Hormone disorders

The condition of having a disorder in the hormones that control the production of the hormone testosterone, which is a male hormone.

Environmental problems

Radiation and drugs used for cancer treatment can disrupt sperm production.

2. Structural disorders

Complete or partial blockages that prevent sperm from leaving the testicles, which are the place of production, can be the cause of infertility. These blockages can be congenital, as well as due to a later infection. A surgical intervention that has been tested can also cause blockage.

Male problems are at the forefront in about 40% of families suffering from infertility problems. The development of examination techniques in recent years has revealed that many previously unexplained problems are again related to male sperm. For this reason, the examination of a man should not be neglected even if there is a significant problem in a woman. Even for men who have children from previous marriages, this examination should definitely be carried out.

1. Ovulation disorders

Ovulation disorders are the most common cause of infertility in a woman, and when ovulation disorder is mentioned, it is understood that ovulation is absent at all or irregular and infrequent. Infrequent or absent menstruation often indicates an ovulation disorder, but ovulation disorders can also be encountered in cases where menstruation is completely regular.

Ovulation disorders can be mainly grouped into three groups.

1-The inability of hormones that stimulate egg production in the ovaries to be secreted from the brain stem due to a congenital deficiency,

2-Secretion of the milk hormone prolactin from the brain stem more than usual,

3-Polycystic ovary syndrome.

2. The tubes are damaged or blocked

Partially or completely blocked tubes prevent sperm and egg from meeting, making fertilization and pregnancy impossible. This damage to the tubes can be due to many causes, such as a previous infection, endometriosis, or intra-abdominal adhesions left after a previous surgery. Sexually transmitted infections in developed countries are the most important cause of damage to the tubes. The tuberculosis microbe taken in childhood in our country can also cause irreversible damage to the tubes.

3. Endometriosis

Endometriosis is expressed as the development of tissue lining the inside of the uterus (Endometrium) outside the uterus. Endometriosis, just like the tissue lining the inside of the uterus, is sensitive to hormones and bleeds during menstruation. These micro-hemorrhages that occur in the abdomen cause inflammation of the inflammatory glands over time, creating an inflammatory state and causing adhesions.

Endometriosis causes cyst formation when it settles in the ovaries. These cysts are called endometriomas. About 50% of women with endometriosis?they need to be treated so that they can have children. Again, about 25% of women who applied for infertility due to infertility? endometriosis is detected in her.

4. Problems of the cervix

Structural disorders in the cervix, belonging to infection, or related to the secretion (Mucus) in this area can be the cause of infertility. Mucus secreted in the cervix facilitates the transport of sperm through the genital tract. The amount and nature of mucus changes during the cycle under the influence of the hormones estrogen and progesterone. Benign tumors such as polyps or surgical procedures applied to this area may be the cause of infertility.

5. Allergic causes

Although allergic causes can be the cause of infertility, their diagnosis and treatment are difficult. Since the effectiveness of the treatment of allergic conditions is unclear and the pregnancy rates of those who are treated or cannot be treated are very different, the necessity of measuring them routinely is being discussed.

Disorders of ovulation in women
A woman who normally menstruates regularly ovulates on the days coinciding with the middle period of two periods. Ovulation disorder is suspected in women with irregular menstruation. But regular menstruating women may also have an ovulation disorder.

The approach to a woman with an ovulation disorder is very important.
Here, the dialogue between the patient and the physician is very important. First of all, it is necessary to determine the condition that causes the ovulation disorder. Many hormonal disorders, thyroid diseases, adrenal gland diseases, excessive obesity, excessive weakness, excessive stress, intense exercise disrupt a woman’s ovulation pattern.

Ovulation treatment requires patience
The goal in this treatment is to try to imitate the natural event as much as possible. During a natural menstrual period, one egg matures and your period is 12.-14. it is cracking on its days. If a woman menstruates spontaneously, there is a great chance that she will respond to simple treatments. In women of this type, it will be a priority approach to treat with simple and cheap drugs for 3-6 months without initially examining the hormones. At the beginning of the drugs used for this purpose, drugs containing clomiphene come. Usually your period is 5. it starts on the day and is used for five days. During the use of this medication, it is appropriate to monitor egg development with vaginal ultrasonography. Treatment is started at the lowest doses and increased by one pill during each menstrual period. However, the chances of responding to more than three pills are extremely low. After the dose that provides ovulation is determined, ovulation is achieved with the same dose for at least 3 menstrual periods. Having ovulation is not enough to get pregnant. Even if there are no other factors, the chance of getting pregnant during a menstrual period is 20%. For this reason, the family should know the length of this treatment period well and should not get impatient.

If the spermiogram is normal;

 Clomiphene (3 months)
  ¦  ¦
  ¦  ¦
 Pregnancy(+) Pregnancy(-) I) ---" Hormone profile ---" Problem(+)---" Treatment
  ¦
  ¦ II)HSG a) ---" Bilateral closed = IVF
  ¦
  ¦ b) ---" On = Continue treatment
  ¦
  ¦
 Clomiphene + IUI (3-5 months)
  ¦
 Needle Therapy (6 months)

If ovulation cannot be achieved with clomiphene, or if pregnancy does not occur despite ovulation, then what should be done? In this case, first of all, some hormones related to reproduction in a woman’s blood need to be measured. According to the result to be obtained from these hormone values, the treatment plan may change. If a woman cannot menstruate on her own, reproductive hormones should be looked at initially. In a woman with low reproductive hormone values, the chances of treatment with medication are extremely low. In these women, needle therapy should be started directly. Ovulation development should also be closely monitored with vaginal ultrasonography during this treatment.

The cause of unexplained infertility
In cases of infertility that cannot be revealed with the possibilities of medicine today, there is an unexplained infertility (idiopathic infertility). Sperm infection disorders that cannot be detected by tests, Decapitation of the egg and the presence of some disorders in the movement of the tubes are among the assumptions put forward.

The existence of psychological factors that play a role in cases of unexplained infertility is not completely clear. It is known that stress can have negative effects on the female reproductive system and hormone balance. However, the cause-and-effect relationship is unclear here. In other words, is it stress due to infertility, or is infertility due to stress. It is reported that pregnancies occur naturally when stress disappears. Especially in couples who cannot get answers to infertility treatments, sometimes spontaneous pregnancy can occur during the months when the treatment is stopped and the couple is given a chance to rest.

The term unexplained infertility shows the limit of today’s diagnostic methods. With the advances in diagnostic methods, the number of couples included in this group will also decrease.

Diagnosis of infertility
In couples who are admitted with infertility problems, some tests should be performed to explain the cause of infertility, the cause of infertility. The first of these is sperm analysis performed in a man and uterine film (hysterosalpingography) in a woman in order to evaluate the permeability of the uterus and tubes. In addition, hormone tests to assess a woman’s hormonal status and the capacity of her ovaries are also performed on the third day of menstruation. Recently, the location of diagnostic laparoscopy may be controversial and may be used in some special cases.

Treatment (Vaccination)
Insemination is mostly applied in cases of unexplained infertility, where there are problems with the cervix, where there are slight disorders in sperm count and mobility, or where there are no problems belonging to the couple.

The number of sperm taken from a man for insemination is purified from all liquids except sperm cells by undergoing various washing processes in laboratory conditions, sperm cells are concentrated in a very small liquid, and the number mobility rate is increased. Then this fluid is passed through the cervix with the help of a thin catheter and delivered directly into the uterus.

This treatment works best in cases where the mucus secreted from the cervix prevents the passage of sperm into the uterus. Insemination is also used with lower success rates in cases of unexplained infertility and mild male infertility. It has been shown that the chance of pregnancy is very low after six applications, where the highest pregnancy rates are in the first three applications. It may be considered to switch to assisted reproductive techniques after three inseminations performed under appropriate conditions. Especially in cases of unexplained infertility, about 25% of couples?in in vitro fertilization, there is a major fertilization disorder caused by sperm or egg in IVF practice. The chance of pregnancy with insemination treatment is about 30% as a result of six applications.