Female Derived Causes of Infertility
20 out of every 100 couples who stopped contraception do not have children for one year. The couples applying with this complaint are taken in close communication and the detailed information about marriage and contraception times, previous methods of contraception, potential problems, if they have sexuality, frequency of coexistence, alcohol and cigarette use, stress levels, previous surgery and disease history, previously applied treatments if any, are recorded.
The causes of infertility are very diverse and we can begin to understand some of the causes with a history. However, for the determination of the cause or causes, some examinations are required. Basic tests are the evaluation of male factor with spermiogram, hormone tests for ovarian reserve, filming of medicated uterus for evaluation of intrauterine tissue and tubes.
Ovulation related problems can be examined in three groups:
* In the first group, the level of FSH and LH hormones, which should stimulate the ovaries from the sanral nervous system, is very low and as such, the process related to ovulation stimulation and egg development cannot take place. In this group called hypogodadotropic hypogonadism, FSH and LH hormones are given to the woman from the outside in order for ovulation to occur. The egg developed with these hormones injected every day is cracked when it becomes mature and vaccination can be applied, taking into account the age, male factor and other characteristics of the couple, or IVF treatment.
* In contrast to the second group, FSH and LH hormone levels are high. Despite being high, the number of eggs to be stimulated in the ovaries may be few or absent. According to the woman’s hormone levels and the measurement of the number of eggs called antral follicle on ultrasonography, there may be decreased ovarian reserve, pre-menopause or menopause. If there is a chance of treatment in this group, it should be included in the IVF program without wasting time.
* The third group includes polycystic ovarian syndrome, which is the most common cause of ovulation difficulties. Considering that this syndrome is seen in 12-15% of the normal female population, it is not appropriate to be considered as a disease. However, if it causes menstrual irregularity and ovulation, it appears as a cause of infertility. In addition, acne (acne) may cause hairiness and easy weight gain. There are a large number of egg candidates called pre-antral follicles below 5 mm in the ovaries. However, these egg candidates; they begin to pause and then regress in the process of egg development and disappear before effective egg development occurs. There is often a hormone production process in the ovaries that causes an increase in androgenic horns. The cause of acne and hair growth is explained by this androgenic hormone release.
When considered as a cause of infertility, what is needed to do in the polycystic ovary is to provide irregular or irregular ovaries. Here, medications can be administered orally or subcutaneously to stimulate the ovaries. When the eggs become mature, they are cracked again with a subcutaneous injection and then vaccination or in vitro fertilization is performed. IVF; For a woman with polycystic ovary and ovulation problems, the treatment of choice is not the first choice if the male factor is normal, the female is young and the tubes are open. Ovulation is provided first, if necessary, it is vaccinated 2-4 times, but if pregnancy is not achieved afterwards, advanced treatment methods are mentioned. Meanwhile, if there is a problem in the male factor, the female age is advanced and the ovarian reserve is decreasing, or the tubes are clogged, that is, if there are additional reasons for infertility, IVF can be considered in the foreground.
In women with polycystic ovaries with high body mass index, nutrition should first be regulated, movement should be increased, and if necessary, metformin should be used to correct insulin resistance. With lifestyle changes, weight loss and increasing metabolic rate increases pregnancy rates in many women and facilitates treatment in women who require treatment. Weight loss will also reduce the risks of diabetes, endometrium and breast cancer, which increase the risk in the following years in women with high weight polycystic ovaries.
In order for a woman to become pregnant, at least one tube must be healthy. The removal of the egg released by ovulation is provided by the tube, and the egg and sperm first join in the tubes. The embryo forms here, migrates into the uterus in the tube and settles into the uterus. In this case, the open and inner structure of the tube or tubes must also function properly.
Especially gynecological infections transmitted through sexual intercourse can cause damage when it reaches the tubes. Intraabdominal infections (such as appendicitis) or infections with severe adhesion in the abdomen, such as tuberculosis, will also adversely affect the tubes. Causes such as endometriosis and previous abdominal surgeries can also disrupt tube functions with adhesions.
In cases where both tubes are blocked, pregnancy will not be possible and IVF treatment will be required.
Congenital anomalies of the uterus
Among the congenital anomalies of the uterus, the most common or incomplete separation anomalies (uterine septum) that divides the inner tissue of the uterus, such as a curtain. Diagnosis is made with a good three-dimensional evaluation of intrauterine tissue and medicated uterus film, and the septum tissue extending down from the upper part of the uterus is cut through the hysteroscopic surgery to reach its normal structure and width.
Apart from that, more difficult uterus anomalies such as double uterus are tried to be produced according to what the problem is and its severity.
The presence of fibroids or polyp in the uterus
In order for the embryo to be placed in the intrauterine tissue in a healthy way, the intrauterine tissue called endometrium must be comfortable and appropriate thickness. Submucosal myoma and endometrial polyps that occupy the space in the intrauterine tissue will prevent the embryo from settling in the intrauterine tissue. Correction of these pathologies with hysteroscopic intervention alone can eliminate the problem and cause spontaneous pregnancy. In cases requiring treatment for infertility, the intrauterine tissue must be corrected beforehand.
Adhesion (synechia) in intrauterine tissue
The most common cause of intrauterine tissue adhesion is past abortions. As the number of abortions increases, the risk of adhesion increases. Apart from these, synechiae can also occur after hysteroscopical fibroids or polyp surgeries or after infections. The problem here is that the endometrium tissue, that is, intrauterine tissue, cannot be formed in sufficient thickness for the embryo to settle. It is diagnosed with medicated uterine film. Adhesions are corrected by hysteroscopy. It may require more than one session from time to time.
Fluid accumulation in tubes (hydrosalphenx)
It cannot provide pregnancy because it loses its tube function in the hydrosalphenx diagnosed with medicated uterine film. Meanwhile, the intrauterine tissue can also drain the liquid from time to time and prevent pregnancy in this way. The removal of tubes filled with laparoscopic fluid or blocking the tube entry through the hysteroscopic method should be done before embryo transfer, especially in cases where IVF is planned.