Infertility Evaluation in Turkey: A Scientific Roadmap for Couples
What causes infertility? Learn about the evaluation process for men and women, essential tests like AMH and HSG, and personalized treatment options. Expert fertility care in Istanbul with Dr. Cengiz Andan.
A Detailed Guide for Couples Struggling to Conceive
The desire to have a child is one of the most natural and powerful emotions in a couple’s life. However, when pregnancy does not occur despite regular, unprotected intercourse, it can cause significant emotional stress. Medically defined as “Infertility,” this condition is not a final verdict of “you will never have children.” Rather, it is a signal that the reproductive system needs support.
According to the World Health Organization (WHO), approximately 10-15% of couples worldwide face this issue, and rates in Turkey align with global averages. Infertility can stem from a single cause or a combination of factors affecting both partners. Therefore, modern medicine does not look for the “problematic individual” but evaluates the “infertile couple” as a whole. At Dr. Cengiz Andan’s Clinic, our goal is to use accurate diagnostic methods without losing time and to draw the most appropriate treatment map tailored to each couple based on scientific data.
Is the Source Male or Female?
A common misconception is that infertility is solely a woman’s issue. However, biological facts and statistics show an equal distribution between genders. The breakdown is generally as follows:
- Female Factors: 35-40%
- Male Factors: 30-35%
- Combined (Both Partners): 15-20%
- Unexplained Infertility: ~10%
This table clearly illustrates why both partners must be evaluated simultaneously.
When Should Evaluation Begin?
Time is the most valuable asset in fertility treatment. The recommended time to seek medical advice depends on the woman’s age and medical history:
- Women Under 35: If pregnancy does not occur after 12 months (1 year) of regular intercourse.
- Women Over 35: Ovarian reserve declines faster after this age, so the waiting period is 6 months.
- Women Over 40 or High-Risk Cases: If the woman is over 40, has irregular periods, a history of ovarian/uterine surgery, or known endometriosis (chocolate cysts), evaluation should start immediately.
- Evaluation of the Female Partner: A Detailed Investigation
The female reproductive system is complex, ranging from hormonal balance to anatomical structure. Evaluation focuses on 4 main pillars:
- Menstrual Cycle and OvulationRegular periods are usually the first sign of healthy ovulation. However, irregular cycles, excess hair growth, or acne suggest ovulation issues. The most common cause in this group is Polycystic Ovary Syndrome (PCOS).
- Hormone Tests and Ovarian ReserveBlood tests performed on day 2 or 3 of the menstrual cycle check hormonal balance:
- FSH and E2: Measure the ovaries’ response to brain signals.
- TSH and Prolactin: Thyroid and milk hormone disorders can prevent pregnancy.
- AMH (Anti-Müllerian Hormone): The most reliable marker of ovarian reserve. It can be done on any day of the cycle. An AMH < 1 ng/mL indicates diminished reserve and limited time.
- Uterus and Tubes (HSG – Dye Test)Even if ovulation occurs, pregnancy cannot happen if the fallopian tubes—the meeting place for egg and sperm—are blocked. HSG (Hysterosalpingography)is the gold standard for checking tubal patency and detecting congenital uterine anomalies. Tubal issues are found in 20-30% of infertile women.
- UltrasoundHigh-resolution transvaginal ultrasound examines the uterine lining, fibroids, polyps, or ovarian cysts (like endometriomas) in detail.
- Evaluation of the Male Partner: Simple But Critical
Since male factors account for nearly half of infertility cases, male evaluation should never be skipped.
- Spermiogram (Semen Analysis)This is the first and most fundamental test for men. Performed after 2-7 days of abstinence, it evaluates:
- Count: Should be 15 million sperm per milliliter or more.
- Motility: At least 40% of sperm should be moving.
- Morphology (Shape): At least 4% of sperm should have a perfect (normal) shape.
- Hormonal and Physical ExamIf sperm parameters are abnormal, Testosterone and FSH levels are checked. A physical exam checks for Varicocele(enlarged scrotal veins), a correctable cause responsible for 15-20% of male infertility.
- Unexplained Infertility: Not “No Cause,” But “Undetected Cause”
In about 10-15% of couples, all tests (sperm, tubes, ovulation) come back normal, yet pregnancy doesn’t occur. This is called “Unexplained Infertility.” It may stem from molecular-level issues (e.g., fertilization failure) that current technology cannot detect. Treatment is planned based on the couple’s age and duration of infertility.
Success Rates and Treatment Options
Success in fertility treatment doesn’t come from a “one-size-fits-all” prescription. Success rates vary by age and cause:
- Ovulation Induction (Pills/Injections): Offers a 10-20% monthly pregnancy chance for simple ovulation issues.
- Intrauterine Insemination (IUI): Provides 10-15% success per month for mild sperm issues or unexplained cases.
- In Vitro Fertilization (IVF): Has the highest success rates, but is directly linked to female age:
- Under 30: 45-55%
- 35-37: 35-40%
- 38-40: 25-30%
- Over 40: Drops below 15%.
Conclusion: Having a baby is a team effort. Dr. Cengiz Andan and his team are with you, using the latest technologies and scientific approaches to help you realize your dreams. Early consultation is half the battle.
