Infertility Evaluation in Turkey: testing the couple to find the real cause before treatment
When a pregnancy does not come, the most useful first step is rarely to rush into treatment — it is to find out, clearly and together, why. Many couples arrive after months or years of trying, often having been pushed toward IVF in their home country before anyone explained what was actually wrong. A structured infertility evaluation looks at both partners, because the cause lies with the man in roughly 40 to 50 percent of cases and with the woman in a similar share. With Associate Professor Dr. Cengiz Andan in Turkey, we begin by mapping the cause precisely — semen, ovulation, ovarian reserve, tubes and uterus — and only then build a plan that fits your age, your findings and your wish to have a child. For couples living abroad, we set out the whole process in advance, plainly and based on evidence.
At a glance
- What it is: Infertility is the failure to conceive after about twelve months of trying (six months if the woman is over 35); the evaluation always assesses both partners.
- How the cause is found: semen analysis for the man, plus ovulation, ovarian reserve (AMH), tubal and uterine testing for the woman.
- Fertility outlook: about 85 percent of couples have an identifiable cause, and once it is known the plan is far more focused.
- Time in Turkey: most core tests fit within one menstrual cycle, often grouped into a short visit of a few days.
- Starting from abroad: begins with an online pre-consultation using your existing results; reports are prepared for your doctor at home.
What exactly is infertility, and is it really a "couple" problem?
Infertility is defined as the failure to achieve pregnancy after twelve months of regular unprotected intercourse, or after six months when the woman is over 35. It is genuinely a shared condition: a male factor contributes in roughly 40 to 50 percent of cases, a female factor in about 35 to 50 percent, and often both partners contribute together. Around the world it affects close to one in six people of reproductive age, so it is far more common than many couples realise. Because the cause can sit with either partner, a proper evaluation never looks at only one of you.
When should a couple seek an infertility evaluation?
The usual trigger for an evaluation is twelve months of regular, unprotected intercourse without a pregnancy, and this is the point at which testing is reasonable for most couples. The threshold drops to six months when the woman is over 35, because time matters more as ovarian reserve declines. It is also sensible to start sooner when there are warning signs — irregular or absent periods, known endometriosis or fibroids, previous pelvic surgery or infection, or a prior abnormal semen test. Earlier assessment in these situations simply avoids losing months that count.
Source: American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM), committee opinion on the infertility workup
What are the main causes of infertility in a couple?
Most infertile couples have one or more of three main causes: a male factor, an ovulation problem, or a tubal-pelvic factor. Ovulatory disorders account for roughly 25 percent of diagnoses, and about 70 percent of women who do not ovulate have polycystic ovary syndrome. Tubal and pelvic factors — including endometriosis and adhesions — explain a further share, while a male factor is found in roughly 40 to 50 percent of couples overall. Identifying which of these applies is the entire purpose of the evaluation, because each points to a very different treatment.
| Main factor | Approximate share | Typical first test |
|---|---|---|
| Male factor | ~40-50 % | Semen analysis |
| Ovulatory disorder | ~25 % | Mid-luteal progesterone |
| Tubal / pelvic factor | ~15-40 % | Tubal X-ray (HSG) |
| Unexplained | ~15-30 % | Diagnosis of exclusion |
Source: American Academy of Family Physicians (AAFP), review on the evaluation and management of infertility
How is the man tested, and why is the semen analysis first?
The semen analysis is the cornerstone of the male assessment and is one of the very first tests done for any couple, because a male factor is so common and the test is simple. It measures the number, movement and shape of the sperm, and an abnormal result is found in a large share of infertile couples. A single low result is not the final word — values vary, so the test is often repeated, and hormonal or genetic tests are added when the count is very low. Assessing the man early prevents months of investigating only the woman while a treatable male factor goes unnoticed.
How is ovulation checked in the woman?
Confirming that ovulation is happening is a core part of the female evaluation, since ovulatory disorders cause about a quarter of all infertility. The simplest confirmation is a mid-luteal progesterone blood test, drawn about seven days before the expected period, which rises when an egg has been released. Irregular or absent periods are themselves a strong clue that ovulation is disturbed, and polycystic ovary syndrome lies behind the large majority of these cases. Where ovulation is the problem, it is also one of the more treatable causes, which makes confirming it worthwhile.
What is ovarian reserve, and what do AMH and antral follicle count show?
Ovarian reserve describes how many eggs remain, and it is assessed mainly with anti-Mullerian hormone (AMH), the antral follicle count on ultrasound, and sometimes day-3 FSH. AMH is the more stable marker because it changes little across the cycle; a level above about 1 ng/mL is generally considered normal, while a lower value can indicate diminished reserve. These markers fall with age — studies show AMH declining by roughly 6 percent and the antral follicle count by about 4.5 percent per year, with a steeper drop after the mid-thirties. It is important to understand that these tests reflect the quantity of eggs, not their quality, so we always read them alongside your age and history rather than in isolation.
| Test | What it assesses |
|---|---|
| AMH (anti-Mullerian hormone) | Stable marker of egg quantity |
| Antral follicle count (ultrasound) | Visible resting follicles |
| Day-3 FSH | Older hormonal marker of reserve |
Source: European Society of Human Reproduction and Embryology (ESHRE), guidance on ovarian reserve testing
How are the tubes and the uterus assessed?
Checking that the fallopian tubes are open and the uterine cavity is normal is essential, because a blocked tube or a cavity lesion can prevent pregnancy on its own. Tubal patency is most often tested with a hysterosalpingogram (HSG), a short X-ray using dye, while transvaginal ultrasound assesses the uterus and ovaries. In one fertility series, at least one blocked tube was found in about 25 percent of women evaluated, most commonly at the proximal end. Where endometriosis, fibroids or scarring are suspected, hysteroscopy, laparoscopy or MRI may be added to complete the picture.
Source: National Institute for Health and Care Excellence (NICE), guideline on fertility assessment and treatment
How much does the woman's age change the picture?
Age is one of the strongest single factors in fertility, because both the number and the quality of eggs decline over time. The fall in ovarian reserve accelerates after the mid-thirties, with markers such as AMH dropping noticeably faster from around 36 onward. This is why the same set of results is read differently at 32 and at 39, and why the evaluation is often compressed into a shorter time frame for older women. We use age not to discourage anyone, but to set a realistic pace and to avoid losing months that genuinely matter.
What happens if every test comes back normal?
When a full evaluation of both partners finds no clear cause, the couple is given a diagnosis of unexplained infertility, which applies to roughly 15 to 30 percent of cases. This label does not mean there is no path forward; it means the standard tests did not isolate a single problem, and around 85 percent of couples overall do have an identifiable cause once testing is complete. Treatments such as ovulation induction, intrauterine insemination and IVF remain effective options in this group. The honest message is that "unexplained" is a starting point for a plan, not a dead end.
What happens after the evaluation is finished?
Once the results of both partners are in, they are reviewed together to build a cause-directed plan rather than a one-size-fits-all referral. Depending on the findings, the next step may be lifestyle and timing advice, ovulation induction, surgery to correct a tubal, uterine or endometriosis problem, intrauterine insemination, or IVF. Because conditions such as endometriosis, fibroids and tubal disease often sit behind the infertility, treating the underlying cause can sometimes restore natural fertility or improve the success of later treatment. The plan is always discussed openly, with the benefits and limits of each option set out clearly.
What is our approach to the infertility evaluation?
Our approach rests on one principle: find the real cause first, treat both partners as one unit, and avoid pushing anyone toward heavy treatment before the picture is clear. We assess each couple as a whole — semen, ovulation, ovarian reserve, tubes and uterus, read together with age and history — and we build the plan around your wish to have a child. Where a treatable problem such as endometriosis, fibroids or a tubal factor is found, we address it directly, and where IVF is the right path we coordinate it rather than presenting ourselves as a standalone laboratory. As Associate Professor Dr. Cengiz Andan and our team, we believe that running the whole assessment with one responsible specialist makes a real difference, both to trust and to the clarity of the result.
Why does experience matter in a fertility evaluation?
The value of an experienced specialist in a fertility evaluation lies less in ordering tests than in reading them correctly together. Associate Professor Dr. Cengiz Andan brings 18 years of experience, more than 2,000 laparoscopic operations and over 500 endometriosis surgeries, which matters because pelvic disease is a frequent and correctable cause of infertility. A complication rate kept low, at around 2 percent, reflects the value of high surgical volume when a procedure is genuinely needed. At the same time, we are clear that no test or treatment guarantees a pregnancy, and that results vary from person to person.
How long does the evaluation take, and how does home follow-up work?
A complete evaluation of both partners is usually finished within one menstrual cycle, roughly four to six weeks, because several tests are timed to specific cycle days. Many of these can be grouped into a short visit, especially when first results are shared in advance. The question most couples ask is what happens after they fly home: if a question or problem arises, we remain reachable, coordinate with your doctor at home, and continue the follow-up remotely. Your results and reports are prepared so that your own physician can take over your care without gaps.
Home country or Turkey — what is the difference?
For an infertility evaluation, the difference between your home country and Turkey lies not in quality but in access and cost. The same tests, the same international guidelines and the same laboratory standards apply in both; the gap comes from the exchange rate and lower operating costs, which lower the price without lowering the standard. For many couples there is a second difference that matters as much: completing the whole assessment quickly, with one responsible specialist, instead of waiting months between scattered appointments.
| Criterion | Your home country | Turkey |
|---|---|---|
| Quality / standard | Very high | Very high |
| Waiting time | Often long | Usually short |
| Single-specialist continuity | May change | One responsible specialist |
| Cost | Higher | Lower |
How does the process, stay and follow-up work from abroad?
For couples coming from abroad, the process starts digitally before any travel and is completed during a short stay in Turkey. You first share your history and any prior results, then discuss the plan and an approximate cost in an online pre-consultation. When testing is scheduled, the core assessment can often be grouped into a visit of a few days, timed to the right point in the cycle. Results and reports are prepared in a form you can hand to your doctor at home, and the follow-up continues remotely.
How does a second opinion and online pre-consultation work?
A second opinion is one of the most valuable steps for couples who have been told IVF is their only option but want to understand why. When you share your imaging and existing results, we review them, explain what the tests do and do not show, and discuss openly whether a cause-directed step might come before assisted treatment. These conversations take place as a paid online pre-consultation and let you clarify your situation before travelling; they do not replace an in-person assessment. You can make first contact simply, through the form or by WhatsApp.
Frequently Asked Questions
After about twelve months of regular unprotected intercourse without pregnancy, or after six months if the woman is over 35 or there are known risk factors such as irregular cycles or previous pelvic surgery.
Yes. A male factor is involved in roughly 40 to 50 percent of cases, so a semen analysis is part of the very first round of testing for every couple, alongside the assessment of the woman.
AMH (anti-Mullerian hormone) reflects the size of the remaining egg pool. A value above about 1 ng/mL is usually considered normal, while a lower value may indicate diminished ovarian reserve. AMH reflects quantity, not the quality of the eggs.
Most women feel cramping similar to a strong period during the few minutes of the test. It does not require general anaesthesia and discomfort settles quickly afterwards.
Many of the core tests are timed to the menstrual cycle, so a complete evaluation of both partners is usually finished within one cycle, roughly four to six weeks.
Often the key tests can be grouped into a short visit, especially when initial results are shared in advance through an online consultation. The exact timing depends on where you are in your cycle.
Not entirely. A normal result is reassuring, but in some couples a hidden male contribution remains, which is why both partners are reviewed together rather than the man being dismissed after one test.
About 15 to 30 percent of couples have unexplained infertility, where standard tests find no clear cause. This does not mean nothing can be done; treatments such as insemination or IVF are still effective options.
Yes. Your test results, reports and findings are prepared so you can share them with your doctor at home, and your follow-up can continue remotely.
Yes. Female fertility declines with age and ovarian reserve falls faster after the mid-thirties, so the evaluation is often done more quickly and the plan adjusted when the woman is older.
The online pre-consultation is a paid service that lets you review your situation before travelling. Payment and process details are shared before the appointment.
Because infertility is shared between partners, it is ideal when both are assessed, but the evaluation can begin with whichever partner is available and the other can be tested shortly after.
