Infertility is the failure to achieve a pregnancy after one year of regular, unprotected intercourse. Because female fertility declines with age, starting an evaluation after six months is recommended if the woman is 35 or older; over the age of 40, evaluation can be done without waiting. Earlier evaluation is appropriate if there are irregular periods, endometriosis, previous tubal surgery or pelvic infection, or a known problem in the male partner.
Assessing the couple together
The reason for not achieving a pregnancy may lie with the woman, the man or both; sometimes no cause is found on basic tests. For this reason, the assessment is carried out as a couple. The consultation covers the menstrual pattern, previous pregnancies, past surgery and infections, current medicines, smoking and alcohol use, and weight. Stopping smoking, reaching a healthy weight and taking folic acid before pregnancy are general steps recommended during this process.
Basic tests
- Ovulation: the menstrual pattern is reviewed, and hormone tests are carried out if needed.
- Ovarian reserve: an AMH test and an ultrasound follicle count may be done. These tests help with treatment planning; on their own, they do not show the chance of pregnancy.
- Fallopian tubes: whether the tubes are open is assessed with an X-ray of the uterus and tubes (HSG) or a similar imaging method.
- Uterus: examined with ultrasound and, if needed, with a camera inside the uterus (hysteroscopy).
- Male partner: the basic test is semen analysis. Depending on the result, a urology assessment may be needed.
Ovulation monitoring
In women who do not ovulate regularly, medicines that stimulate ovulation (tablets or injections) may be used. During this process, egg development is monitored with ultrasound on certain days (follicle tracking), and the timing of intercourse is planned. In cycles where medicines are used, regular monitoring is needed because of risks such as multiple pregnancy and overstimulation of the ovaries.
Referral for advanced methods
- Intrauterine insemination (IUI): sperm prepared in the laboratory is placed inside the uterus with a thin catheter around the time of ovulation.
- IVF / ICSI: eggs are collected and fertilized in the laboratory, and the resulting embryo is placed in the uterus.
Which method is suitable is decided according to the woman’s age, the ovarian reserve, the condition of the tubes, the semen parameters and how long the couple has been trying. IVF treatment is carried out in assisted reproduction centers licensed by the Turkish Ministry of Health. When considered necessary, the couple is referred to these centers for advanced treatment.