Assoc. Prof. Sabri Berkem Ökten
Infertility
Infertility, which means the inability to have a child despite regular sexual intercourse, is diagnosed if a couple cannot conceive after 6 months if the woman is over the age of 35, and after 1 year if the woman is under 35. Approximately 10-15% of couples seek medical assistance due to infertility.
But why is there such a difference in waiting times based on a woman’s age? As women age, their egg reserve declines (fertility is lost with menopause), and not only does the number of eggs decrease, but the quality of the eggs also begins to deteriorate (the frequency of chromosomal abnormalities such as Down syndrome increases with age). Thus, as women age, the chances of becoming pregnant decrease due to a reduced number and quality of eggs. Therefore, waiting for about a year for a young woman to conceive naturally before starting additional investigations and treatments usually does not result in a waste of time. However, as women age and if there is an underlying cause that prevents pregnancy, it is best not to wait for more than 6 months to investigate and, if necessary, seek treatment in order not to be late.
First, let’s briefly talk about how pregnancy occurs. The most important point for pregnancy is the union of a healthy egg cell with a healthy sperm. The egg cell develops in the ovary and travels towards the fallopian tube after ovulation. After intercourse, some of the millions of sperm in the vagina pass through the cervix, some reach the uterus, and some travel towards the fallopian tube and meet the egg cell there. One of the sperm penetrates into the egg cell and fertilization occurs. The fertilized egg cell moves from the tube to the inside of the uterus (endometrium) and pregnancy begins with its attachment there (implantation). Hormonal, anatomical, and various other factors that affect one or more of these steps can lead to infertility.
Causes Related to Men: In couples who seek treatment for infertility, 30% of the cases are due to male-related factors. Various abnormalities in sperm count, motility, and morphology can lead to the inability to have children. In addition, erectile dysfunction, which is the inability to achieve an erection, and penis deformities can also make intercourse difficult and prevent natural conception.
Advanced Maternal Age: The number and quality of eggs decrease with age, and the chances of natural fertilization and healthy embryo formation also decrease. Nowadays, as the age for planning to have children has shifted to later ages compared to the past, the number of visits to infertility clinics has also increased.
Diminished Ovarian Reserve / Early Menopause: Sometimes, even at a young age, low ovarian reserve is detected due to various reasons, and the chances of achieving pregnancy decrease. Don’t forget to learn about your egg reserve during your routine gynecological examinations.
Blocked Fallopian Tubes: The tubes that connect the uterus and ovaries can be blocked for various reasons (such as past ectopic pregnancy surgery, infection, etc.), which prevents sperm and egg from coming together and fertilization from occurring.
Ovulation Problems: 25% of women who seek treatment for infertility have ovulation problems as the cause. Polycystic ovary syndrome, being overweight or underweight, or other causes that cause hormonal irregularities can cause ovulation problems.
Endometriosis: Endometriosis is seen in 10-15% of women of reproductive age, while this rate is approximately 30% in women who complain of infertility. Although it usually causes symptoms such as painful menstrual periods, chronic pelvic pain, painful intercourse, and infertility, it can also be detected during routine examinations without showing any signs. Depending on where endometriosis is located, it can cause adhesions or blockages in the tubes and prevent pregnancy. If it affects the ovaries (endometrioma or chocolate cyst), it can negatively affect the quality and quantity of eggs, causing infertility in 30-50% of cases.
Reasons related to the uterus (Uterine factors): The presence of formations such as fibroids or polyps in the uterus can prevent the embryo from implanting and can be a barrier to pregnancy. Sometimes, adhesions in the uterus (adhesion) can occur due to previous procedures (such as curettage) or infections, and can also prevent a healthy environment for the embryo to attach to. Another reason is the presence of congenital structural abnormalities in the uterus, such as deformities or curtains (septum), which can also prevent the formation of a healthy pregnancy. Fertility can be regained with surgery depending on the underlying cause.
Unexplained infertility: Sometimes, despite normal sperm values, open tubes, normal ovulation, and normal uterine structure, i.e. no visible cause in the woman and man, pregnancy cannot be achieved. This condition is seen in about 15% of infertile couples and can be treated with assisted reproductive techniques.
If you are considering having a child, do not forget to have a routine gynecological examination beforehand.