Approach to the infertile couple
The instinct of having children throughout the history of humanity has affected women, men, relationships and marriages. For this reason, I evaluate a large number of couples, albeit with reasons and reasons for not having different children. I exchange information with each couple I have previously met or have just met, primarily on basic topics such as normal and spontaneous reproductive rates, timing of coexistence in order to conceive naturally, frequency of coexistence, medical histories, habits and lifestyles.
In women under the age of 35, the probability of conception of a couple (2-3 times a week) with a normal association is 20% in one month and 80% at the end of 1 year. At the end of two years, the pregnancy rate reaches 90%. Monthly conception rate decreases to 5-10% after the age of 40. Informing the couple at this point also determines which couple will be examined. In women over 35, the ovarian reserve is definitely evaluated after 6 months of unprotected time, or in a man who has undergone testicular surgery, sperm analysis can be performed early without waiting. If the woman’s ovarian reserve is very low and the couple wants to work for a natural pregnancy for a while, the spermiogram should be examined and the male factor should be made sure. Here, after evaluating the couple’s unique story correctly, a decision will be made for the examinations.
Basically, it is necessary to approach problems that can be easily solved first and then to request the necessary examinations. It is appropriate to request the woman’s reproductive tests after routine gynecological examination, taking pap smears, breast examination and mammography / breast ultrasonography if necessary.
These tests are basically considered in three main groups:
- hormone tests including the ovarian reserve of the woman,
- spermiogram showing the sperm characteristics of the man,
- medicated uterus film (HSG) showing the condition of the woman’s intrauterine structure and tubes
In gynecological examination, anatomical features of the vagina and cervix, presence of infection, nodularity and tenderness behind the vagina and cervix, two-dimensional and better three-dimensional evaluation of the intrauterine tissue, features of the uterine muscle structure, ovarian reserve and anatomy should be evaluated. Numerous data such as complete or incomplete partitions (uterine septum) in the intrauterine tissue (uterine septum), fluid accumulation in the uterus (hydrosalpenx), presence of polyp or fibroids in the uterus, evaluation of the number of eggs in the ovaries, with this examination and ultrasonography, are congenital defects of gynecological structures obtained.
Then it is necessary to start with the simplest, easiest, inexpensive treatment methods (such as egg follow-up, timely association, simple ovulation treatments and vaccination), after evaluating whether the couple has a fundamental problem by seeing hormone tests, sperm evaluation and medicated uterine film. Treatment is directed towards more advanced methods such as IVF, but some couples require direct advanced treatment methods (IVF) after evaluation.
If couples are to be prepared for in vitro fertilization, every detail must be carefully evaluated before the treatment and the couple must be informed correctly. IVF treatment is a team work in which the mother and father candidate is the most important part of the team.