15 percent of the population is considered infertile. Infertility is described as not having a baby after 6 months of unprotected intercourse.
Infertility is increasing in modern communities. In men declines in sperm count due to toxic environment and possible evolutionary effects is noted. Also women due to educational and career concerns are married at a later age. Average menopausal age ranges between 48 and 52 in women. We now know that, several years before the menopause women are unable to bear children due to the diminished ovarian function.
Historically, the menopausal age did not change and the chance of having a baby is very slim as the female approaches menopause. Therefore we recommend that all women especially with the family history of early menopause should have a baby at an earlier age. All the infertility treatments and even IVF cannot be successful if women’s ovarian function is diminished.
How is the infertile couple being approached?
First evaluation will be the male partner. Two or three sperm counts one month apart are ordered and evaluated. WHO (World Health Organization) and Krugers` criteria is used to analyze the sperm parameters.
If the sperm count is abnormal, hormonal tests and ultrasound of the testes is performed. This way, hormonal and vascular problems may be detected. In male infertility however, medical and surgical therapies are getting less and less popular due to high failure rates.
Therefore for male infertility, currently artificial insemination or IVF/ICSI is recommended, depending on sperm count results.
For women, cycle day 3 hormone levels will be ordered.
If these are normal, ovulations are monitored with ultrasound.
If there is an ovulation problem it is treated by oral medications or hormonal injections, monitored by ultrasound.
If the ovulation is normal, then Hysterosalpingography ( X-ray of the uterus and tubes) is performed to rule out the tubal blockage.
If there is a problem with the tubes, laparoscopic correction is tried in certain cases. However, in recent years due to highly successful IVF/ICSI results, tubal surgery is performed less often.
In some couples no cause is found. This is called as unexplained infertility. In this group, firstly 3 to 6 months of ovulation induction treatment is given. If this is unsuccessful, artificial insemination is used for 3 to 6 months as well. If all these fail, then IVF/ICSI should be performed
The age of woman is a serious factor. If the age is over 40, the chance of getting pregnant is lessened, so the classical non-IVF treatments should be given for a short time only. Therefore IVF/ICSI is used earlier and more often.
Please click on the IVF/ICSI section and also read FAQ for further information