What does infertility mean ?

According to medical terminology, infertility refers to the inability of a couple to conceive despite having unprotected sexual intercourse and regular intercourse 3-4 times per week for a period of one year without achieving pregnancy.

If any couple has difficulty conceiving and desires to have children, they may want to assess potential risk factors that may contribute to infertility. These risk factors include irregular menstrual cycles, history of accidents or surgeries involving the reproductive organs, such as the fallopian tubes or testes. Consultation with a physician is recommended without waiting for a full year, especially for women over the age of 35.

The cause of male infertility.

Men often face issues related to a low sperm count, abnormal sperm movement, or abnormal sperm shape, which can be caused by various factors such as:

• Genetics: Certain genetic factors can result in lower-than-normal sperm production or the inability to produce sperm at all.
• Medications: The use of certain medications, such as chemotherapy drugs, radiation therapy, drugs used for treating addiction, smoking, alcohol consumption, or medications for certain diseases, can affect fertility.
• Chronic diseases: Conditions like diabetes, thyroid disorders, or hormonal imbalances can impact male fertility.
•  Severe trauma or surgeries: Severe injuries or surgeries involving the reproductive organs can lead to fertility problems.

Causes of female infertility

• Increasing age: As women get older, they may experience increased stress, weight-related issues, improper diet, smoking, alcohol consumption, or substance abuse, all of which can affect fertility.
• Chronic diseases: Conditions like diabetes, thyroid disorders, or hormonal imbalances can impact female fertility.
• Abnormalities of the reproductive organs since birth: Some women may have congenital abnormalities that affect their reproductive system.
• Fallopian tube blockage: Blockages in the fallopian tubes caused by inflammation or previous surgeries can prevent fertilization.
•  Abnormal functioning of the ovaries: Irregular or absent ovulation, presence of cysts, or abnormal egg quality can affect fertility.

How do doctors determine the causes of infertility in patients?

• Doctors will take a medical history from both the female and male sides.
• For females, they will inquire about menstrual cycles, menstrual pain, medical history such as previous cases of pelvic inflammatory disease or any sexually transmitted diseases.
• For males, they will inquire about any accidents, sterilization procedures, infections in the reproductive system or organs, etc.
• A general physical examination will be conducted to assess the overall health of the body.
• Semen analysis will be performed for males.
• For females, internal examinations such as ultrasound will be conducted to assess abnormalities in the uterus, fallopian tubes, or ovaries. Dye may be injected into the uterus, followed by an X-ray to detect abnormalities in the uterus and fallopian tubes.

When abnormalities that are the cause of infertility are identified, doctors will address those causes first. For example, if there is a problem with uterine fibroids affecting pregnancy, surgery may be performed to remove the fibroids. If addressing the cause does not result in natural conception, doctors will provide counseling to the couple and may consider using assisted reproductive technologies to achieve pregnancy.

Assisted reproductive technologies that aid in achieving pregnancy:

Due to the various causes of infertility in both females and males, doctors will first investigate the causes and address the root problem. If natural conception is not possible, they will consider suitable methods based on factors such as success rates, costs, complications, and minimal discomfort. Assisted reproductive technologies include:

1. Intrauterine Insemination (IUI):

Suitable for males with abnormal sperm and females with good uterine conditions and unobstructed fallopian tubes. The procedure involves stimulating ovulation and injecting the male partner’s prepared sperm into the uterus on the day of ovulation.

2. Gamete Intrafallopian Transfer (GIFT):

This is an older technique that is no longer commonly used. It involves stimulating the ovaries, collecting the eggs via laparoscopy, combining the eggs with prepared sperm, and placing the mixture back into the fallopian tubes to achieve fertilization within the body.

3. Zygote Intrafallopian Transfer (ZIFT):

ZIFT is currently a widely used method for assisted reproduction. It is suitable for couples with blocked fallopian tubes, problems with egg fertilization due to hormonal imbalances, or poor sperm motility. The procedure involves stimulating the ovaries, collecting the eggs through laparoscopy, fertilizing the eggs with prepared sperm in the laboratory, culturing the resulting embryos for 3-5 days, and then transferring them back into the fallopian tubes for implantation and subsequent pregnancy. The success rate per cycle is approximately 30-40%.

4. Intracytoplasmic Sperm Injection (ICSI):

ICSI is a step within the process of in vitro fertilization (IVF). It is used in cases where the male partner has poor-quality sperm. The best sperm are selected under a microscope and directly injected into the egg, allowing fertilization to occur. After culturing the embryos for 3-5 days, they are transferred back into the uterus. The success rate per cycle is approximately 30-40%.

Preparation for “Assisted Reproduction Technology”

• Women should not wait until they are over 35 years old to conceive because there is a risk of chromosomal abnormalities in the fetus and the risk of miscarriage. Therefore, it is advisable to consult a doctor early on, without waiting for advanced age, as increasing age decreases the success rate of pregnancy.
• Prepare for optimal health by quitting smoking and avoiding alcohol consumption.
• Undergo a physical examination to identify and treat any other diseases before starting infertility treatment.
• Exercise regularly, get enough rest, and avoid stress.

Preparation for sperm collection for male infertility treatment:

• Refrain from ejaculating for at least 3 days but not more than 7 days to accumulate an adequate amount of sperm.
• Avoid smoking and alcohol consumption.
• Exercise regularly and get enough rest.
• Minimize stress.

Menstrual cycle signals indicating difficulty conceiving:

• The menstrual cycle should be regular, with a duration of 21-35 days. If it is more frequent or further apart, there may be abnormalities in ovulation, often found in women who are overweight or have higher-than-normal male sex hormones.
• Scanty menstrual flow may indicate thinning of the uterine lining or a disorder in the endometrium.
• Excessive menstrual flow may indicate uterine fibroids or the presence of abnormal tissue within the uterus.
• Menstrual flow longer than usual, such as with thickened uterine lining or the presence of uterine fibroids.
• Some symptoms unrelated to menstruation, such as frequent urination, frequent constipation, or palpable masses in the lower abdomen, may be caused by the presence of abnormal tissue pressing on nearby organs, such as the bladder or intestines.

If any abnormalities suggesting “difficulty conceiving” are suspected, women who want to have children should consult a doctor to determine the causes and address them before it’s too late. These conditions directly impact our physical health, not only the issue of infertility.

Tips to Increase the Chances of Getting Pregnant Before Consulting an Expert Physician

• s of ovulation: Ovulation usually occurs on days 14-16 of the menstrual cycle, starting from the first day of menstruation. This method is applicable only for women with regular menstrual cycles of 28-30 days.
• Men should abstain from sexual intercourse at least 2-3 days before ovulation to allow the accumulation of sperm.
• Certain lubricants contain spermicidal substances that should be considered before use.
• Increased age of both husband and wife can make it more difficult to conceive.
• Obesity in men can reduce sperm count and sperm quality.
• Obesity in women is often associated with menstrual problems and irregular ovulation.
• Alcohol consumption, certain medications, exposure to toxins, and smoking can affect the quality and quantity of sperm. For example, nicotine in cigarettes can affect the quality of sperm and may reduce sexual desire. Therefore, it is advisable to avoid smoking.
• Stress and lack of physical activity can affect hormones and sexual desire.
• Heat can affect the quality of sperm, so it is advisable to avoid excessive exposure to heat, such as hot baths, hot tubs, and riding motorcycles in hot weather, as it may reduce sperm production.