Unexplained Infertility


The pregnancy rate of a couple whose reproductive system is basically healthy is around 15-20% in a month. Even if all systems are normal, 80-85% of pregnancy is not realized, it is explained by the nature trying to protect the health of the human generation or by a problem that may prevent reproduction in couples. Development of a healthy egg and fertilization with a healthy sperm, division of the fertilized egg into healthy cells, a healthy journey of the embryo, the number of cells of which is increasing regularly, in the tubes, adhesion of the healthy enlarged blast cell to the intrauterine tissue and its healthy development; are the principles of the normal development process of pregnancy. The fact that the failure at any stage of this mechanism results in a pregnancy does not seem to be a necessity for a healthy process. If pregnancy occurred at any point in the process despite the problem, pregnancy may end with a miscarriage depending on the severity of the problem, and if the problem is compatible with life (such as Down syndrome, single gene diseases and some structural diseases), pregnancy can continue. At this point, we try to scan the problems in pregnancy and detect them in the early weeks.

If the gynecological examination of the woman is completely normal, in the presence of healthy ovulation, and the sperm factor is completely normal in the male, that is, if the pregnancy is not achieved in a couple of years, the condition is called unexplained infertility. The process that creates difficulties in conception occurs at any stage of the reproductive system, but we may not be able to explain the reason despite the high-tech examination we have.

If we list the reasons;

1) A problem in the structure of the egg,

2) Although the tubes are open, a situation preventing egg or embryo movement in the inner structure of the tube

3) A problem with the acceptance of pregnancy in the uterus,

4) The problem of sperm’s ability to fertilize the egg despite the normal number, movement or structure, s

5) Cervical problems that will prevent sperm from exceeding the cervix,

6) Mild endometriosis (may affect the tubes, ovaries, egg quality and intrauterine tissue) can occur at any point in the reproductive system.

In unexplained infertility, the natural pregnancy rate per month is 3-5%. These couples must be informed about this figure and they should not lose their hope that they can conceive naturally during the waiting period. If the woman is under 35 and the ovarian reserve is good, if the infertility period is short, if the couple is not in a hurry, it may be possible to wait for a while and leave the pregnancy for a natural period. It would be appropriate not to extend this period over 1 year. Here, whether the treatment should be done or not, the level of stress that will be attributed to the couple should be well adjusted and the decision should be made accordingly. Since delaying the process of initiating treatment can also reduce the chance of pregnancy of the couple, the physician-patient relationship should be kept in touch during this process.

If the woman is under 35 and the infertility period is less than 3 years, vaccination can be tried. For vaccination, one or two eggs are created by applying medications orally, subcutaneously or intramuscularly (ovulation induction), and when the egg reaches the appropriate size and the intrauterine tissue is sufficient, a needle is made under the skin to mature and crack the egg. If more than two eggs are formed, the process should be cancelled (to eliminate the possibility of triplets) 36 hours after the needle, the concentrated sperm previously prepared by centrifugation is given to the intrauterine tissue by crossing the cervix with a special cannula. This treatment can be repeated two or three times. Vaccination therapy is cheaper, easier, and requires less follow-up. Pregnancy rate per application is around 15-20%. In other words, we try to catch the pregnancy rate per month of the couples who do not have any problems. The pregnancy rate after three applications can reach 35-40%.

* If the ovarian reserve decreases in women over 35 years of age

* If the infertility period is more than 3 years

* If two or three vaccinations have failed

* In vitro fertilization can be recommended for women over 40 years of age. In infertility, the rate of pregnancy per cycle in infertility treatment is 55-60% in young mother candidate, while the average success is about 40 as the age progresses.

In vitro, many eggs are formed by applying drugs under the skin or intramuscularly. When the eggs reach the correct size, a needle is made under the skin to ripen the egg, and 36 hours after this needle, the eggs are collected under local or general anaesthesia. Among the collected eggs, good quality sperms are placed in mature and good quality eggs by microinjection, and fertilization and division stages are expected. Depending on the situation and age, one or two embryos are inserted into the uterus.

For waiting, vaccination or IVF, the physician and the couple determine the needs through mutual good communication, and the best approach is determined according to the needs of the couple, medically and spiritually. The imposition on the choice of treatment is a stress factor, it will be appropriate to make the best decision together with the couple by reviewing the options. While making an IVF can be unattractive and unnecessary, waiting for unnecessary time or vaccination can also reduce the chance of pregnancy in the long term.