Infertility means that a woman cannot get pregnant despite regular sexual intercourse for 1 year. Approximately 84% of couples can get pregnant after 1 year. However, for women over 35 years of age, this period should be considered as 6 months.
Evaluation is possible for couples who cannot achieve pregnancy within the mentioned period. In approximately one third of the couples who cannot achieve pregnancy, the reason is male-related factors, while female factors are effective in one third of the couples, and in the remaining couples, it develops due to both female and male factors or no problems can be detected. In approximately 15-20% of couples, there is no detected obstacle to be able to get pregnant. We call this condition unexplained infertility.
Evaluation of both the man and the woman is important in couples who have trouble getting pregnant.
*Evaluation of the Man:
Firstly, the detailed story of the man should be recorded. Details such as the man’s developmental history in childhood, adolescence development, sexual life, previous infection, surgery, exposure to environmental toxins (working in a very hot environment or in the paint industry, etc.) and treatment that may be toxic to reproductive cells (chemotherapy and radiotherapy) should be questioned.
Parameters such as height, weight, body muscle-fat distribution, hair growth pattern, external view of the genital area and breasts should be examined by physical examination. Especially in the case of low testosterone, a decrease in hair growth and atrophy in the genital organs can be seen.
Sperm analysis is the first analysis to be performed. Sperm count and motility are evaluated from the sample produced by masturbation after 2 to 6 days of sexual abstinence. If abnormal values are observed, the test should be repeated after a few weeks. If the semen volume is low or if a hormonal problem is suspected clinically, blood FSH, LH, total testosterone and prolactin levels should be checked. In addition, chromosomal analysis and the presence of Y chromosome microdeletion should be checked in those with azoospermia.
* Evaluation of the Woman:
Firstly, the detailed history of the woman should be recorded. Details such as her developmental history in childhood, her development in adolescence, sexual life, previous infection, surgery and treatment that may be toxic to reproductive cells (chemotherapy and radiotherapy) should be questioned.
Knowing about the menstrual pattern is important. The condition of having no menstruation, that is, Amenorrhea, can be an indicator of ovarian failure or lack of ovulation and creates an obstacle to pregnancy. However, in case the menstrual intervals are longer than 35 days, namely, in the presence of oligomenorrhea, ovulation may not be present or it may be irregular. Therefore, this may not be an absolute cause of inability to get pregnant. However, this condition will make getting pregnant difficult.
The general body condition and body hair growth should be checked in the physical examination, and ultrasonography should be performed to evaluate the internal genital organs. Hormonal evaluation can be performed in patients deemed necessary as a result of the examination. For this purpose, measuring the levels of FSH, LH, estradiol, TSH and prolactin in the blood may be necessary.
Genetic tests: These tests can be performed in patients having a low ovarian reserve at an early age, in the presence of recurrent pregnancy loss, in case of amenorrhea and when clinically suspected.
Hysterosalpingography (HSG): HSG can be performed to evaluate the uterine structure and tubal permeability in women that is seen as necessary. The most suitable period for HSG is the first days after the end of menstruation. By injecting the liquid-based opaque material into the uterus with a cannula placed through the cervix, serial radiographs are taken and images are taken during the passage of the opaque material through the uterus and tubes.
Office/Operative Hysteroscopy: It is an imaging application that allows monitoring the inside of the uterus and the areas where the tubes are opened into the uterus by inserting a light source through the natural opening in the cervix. When a congenital anomaly such as polyps, fibroids or uterine septum is suspected in ultrasonography or HSG, the procedure can be planned. In addition to diagnosis performed during hysteroscopy, corrective surgery can also be performed in the same session.
Sonohysterography: The method allows imaging of the inside of the uterus with transvaginal ultrasonography, which is performed by injecting saline solution into the uterus with a cannula inserted through the cervix. Therefore, the presence of polyps and fibroids occupying space in the uterus can be understood and various congenital uterine anomalies can be recognized.
Laparoscopy: It is a method of imaging the intra-abdominal structures by passing a light source through the incisions of 5 to 10 mm in the abdominal skin. By confirming the presence of endometriosis with laparoscopy, staging status can be defined. In addition, tubes can be removed in the presence of hydrosalpinx or adhesions can be opened.
However, all these imaging methods are performed when necessary. They do not need to be done routinely in every case.