In the last 20 years, the problem of infertility and treatments have been discussed more frequently. In fact, it is suggested that the proportion of the problem of infertility does not increase, but that it is now more pronounced by society. Therefore, the number of applications for physicians to solve the problem has also increased.
Nowadays, the problem of infertility has been examined like other diseases and it has been possible to treat it with surgical methods. The primary role in the infertility treatment process seems to belong to the woman, especially in our country.
First, the woman goes to the doctor and is examined. On the other hand, semen analysis in infertility should be the first test. Today, the male factor ratio has increased to 60%. The problem of lack of sperm in ejaculate, which we refer to as azoospermia, is seen in about 10% of infertile couples.
From time to time we see that women have had eggs for a long time, but in fact they have a problem with their sperm. Late sperm analysis leads to such unnecessary follow-up.
As in other branches, there are sub-branches in gynecological diseases and obstetrics, and couples with infertility problems should apply to gynecologists who have accumulated knowledge and experience in this field.
Otherwise, we will see the couples who lose time with ovarian stimulant drugs for long periods of time and the chance to conceive will be lower as the time goes on.
Of course, infertility treatments are not just for IVF treatment. Pregnancy can also be achieved at considerable rates by means of ovulation induction with simple drugs, intrauterine insemination or endoscopic surgery.
However, a couple with an infertility problem will have a higher chance of getting pregnancy by being evaluated by an experienced physician in IVF centers where all these treatments are done together. By doing this they will not lose time neither money.
If only in-vitro fertilization is not performed at the in-vitro fertilization centers, what other treatments are applied? Evaluation of couples with recurrent pregnancy loss and follow-up and treatment to obtain healthy pregnancy, assessment of secondary infertile couples on request of second child, oocyte and embryo freezing in cancer survivor patients, evaluation of uterine anomalies and their hysteroscopic treatment, intrauterine insemination, gynecologic endoscopic operations such as laparoscopic myomectomy, cystectomy, salpingectomy and adhesiolysis and hysteroscopic polypectomy, septum resection, adhesiolysis and sperm freezing methods and preimplantation genetic analysis of embryos before embyo transfer are successfully performed in IVF centers.
Of course the medical staff and technical equipment of the center are gaining importance at this point. What should be done to be successful in infertility treatments? First of all, women’s age is very important. Especially today, as the marriage age and the age of having children become advanced, the elderly female patient group has increased. It is difficult to obtain pregnancy in these couples because the ovarian capacity decreases and egg quality decreases as the woman ages. The number of treatments is increasing, thus the financial burden is also increasing.
Usually couples wait until 40 years of age or until menstrual irregularities begin and then they go to the IVF centers. However, when the woman ages, the success of in vitro fertilization and infertility treatments decreases and falls below 20%. Contrary to popular belief, it becomes more difficult to obtain good results with these treatments in women above 40 years, and repeated treatment attempts are performed in this group of patients.
Therefore, if a couple wants a child and they are not pregnant within 12 months, the couple should apply to the IVF center and be investigated for the cause initially. If the basic evaluation does not reveal a problem, the physician may recommend to wait for a time period or go through the infertility treatment stages.
However, it is very important to evaluate the ovarian capacity of a woman. In particular, in women with decrease ovarian reserve, waiting may result in irreversible consequences. Therefore, treatment plan is better to be done with the couple.
Severe sperm problems, women whose both tubes are obstructed, women ages 38 and over, genetic problems, decreased ovarian capacity should better go directly to IVF treatment.
With the generally accepted number 3, this number increases when the female age progresses. In the medical literature, cases with more than 10 or even 20 in vitro fertilization treatments have been reported. However, there is no upper limit set by medical standards, and the material and moral characteristics of the family determine this number. It is known that high trial numbers do not threaten women’s health.
This is a false belief. Normally at least 10 eggs are growing each month and only one of them grows mature for that month, while others regress. In in vitro fertilization treatment, we stimulate those which will regress and grow them with drugs and injections so that a larger number of eggs will be collected at the end.
This process varies depending on the ovarian capacity and age of the woman and the treatment is completed within 15-40 days. Usually in vitro fertilization treatment takes 15-20 days.
The problem of infertility itself causes stress in couples. But being relaxed and trust in the team during this process is constructive for the couple’s moral and mental health. In this regard, you might consider getting help from a psychologist in the treatment center.
Sharing the treatment process with the family may sometimes increase your stress and it will be more appropriate to share your treatment with as few people as possible.
Banu Kumbak Aygun, M.D., Professor
Gynecology & Obtetrics