Genel Bilgiler | Burcindemirel

General Information

About Fertility...

Getting pregnant is a complex process that depends on many factors. For a woman to become pregnant through intercourse with a healthy partner, the following conditions must be met:

The man must produce healthy sperm, and the woman must produce healthy eggs.
Sperm must be ejaculated into the vagina during intercourse.
The cervix, uterus, and fallopian tubes must be open enough to allow the sperm to travel to the egg.
The sperm must have the ability to fertilize the egg once it encounters it.
The fertilized egg (embryo) must be able to implant in the woman’s uterus.
The embryo must be of sufficient quality.
Finally, for the pregnancy to continue, the embryo must be healthy, and the woman’s hormonal environment must be suitable for pregnancy development.

Infertility can occur even if just one of these factors is impaired.

The two most important factors affecting a healthy woman’s chance of becoming pregnant are her age and the length of time the couple has been trying to conceive.

For a healthy woman under 35 with regular menstrual cycles, having regular unprotected intercourse gives the following chances of conception:

After 1 month: 15–20%
Within the first 3 months: 20–35%
After 12 months: 80–85%
After 2 years: 90%

It's important to keep in mind that fertility rates are lower and pregnancy complications are more common in women over 35 and men over 50.

To achieve these pregnancy rates, couples should have sexual intercourse every 1 to 2 days during the fertile window.

Long periods of sexual abstinence can reduce sperm quality, and infrequent intercourse can reduce the chances of having sex around the time of ovulation, thereby lowering the likelihood of conception.

What is the best time for sexual intercourse?

The best time to have sexual intercourse is during the period called the 'Fertility Window' , when pregnancy is most likely to occur in a menstrual cycle. This window is usually the period from 4-5 days immediately before ovulation to 1 day after ovulation.

Ovulation occurs around 14 days before the next period, subtracting 14 days from the average cycle length for women with regular cycles to calculate. For example, a woman with a 28-day cycle will ovulate around day 14 of her cycle, while a woman with a 32-day cycle will ovulate around day 18 of her cycle.

We can say that the probability of pregnancy is highest if sexual intercourse is had at least every other day, including the 4-5 days immediately before ovulation and the 1-2 days after ovulation.

What is Infertility?

Infertility is defined as the inability to conceive in women under the age of 35, despite having unprotected sexual intercourse during the fertile period of one year. If you have been trying to conceive for a year or longer, it would be beneficial to be examined by an infertility specialist for infertility/sterility testing.

For women over the age of 35, this period is determined as 6 months in order not to delay infertility treatment if necessary.

If you have an underlying disease such as menstrual irregularity, amenorrhea, polycystic ovary (PCO), chocolate cyst, history of pelvic infection, being overweight or underweight, hypothyroidism, or if you are over the age of 40, it would be beneficial to see an in vitro fertilization specialist without delay when you decide to get pregnant.

If you and your partner have tried to have a baby and haven't been able to, there's no need to panic!

You are not alone. Today, at least 1 in 7 couples have trouble conceiving. It is perfectly normal to experience feelings of frustration, jealousy, anger, and stress when you are unsuccessful in trying to conceive. However, it should be a relief to know that you have medical options for solving this problem and that successful fertility treatments offer more hope than ever.

First Examination in Infertility

The initial fertility assessment can be done by your regular gynecologist if you have one, but ideally, it should be conducted by a fertility (IVF) specialist. It’s important to find a doctor you trust and feel comfortable with. If any abnormalities are detected in the semen analysis, your partner should be referred to a urologist specialized in male infertility.

During your first appointment, the fertility specialist will ask you and your partner some questions (medical history) and perform a physical examination to determine your health status and identify any possible causes of infertility. They will also want to see any previous reports and treatment records related to infertility for both you and your partner. Having these documents ready will help avoid unnecessary delays in planning your treatment.

Since infertility is fundamentally a couple’s issue, it’s much more appropriate to be evaluated as a couple. That’s why it is very valuable and important that both you and your partner attend the first consultation.

Some of the questions that might be asked during the first visit include:

The frequency and regularity of your menstrual cycle
Presence of pelvic pain
History of abnormal vaginal bleeding or discharge
History of pelvic infections
Previous pregnancies, miscarriages, or any birth defects in either family
Previously used birth control methods
Any surgeries you’ve had and other medical conditions

(Your partner will similarly be asked about any previous genital injuries, surgeries, infections, use of alcohol, smoking, medications, past children, and medical conditions.)

Your sexual relationship is also an important topic that needs to be investigated:

How long you’ve been trying to conceive
Frequency of intercourse
Any sexual dysfunctions such as difficulty with penetration or inability to have intercourse (e.g., vaginismus)
Whether lubricants are used during intercourse
Any issues your partner may have with achieving/maintaining an erection or with ejaculation

(Your doctor needs to be aware of your and your partner’s complete sexual and reproductive history, including previous relationships.)

Since more than 25% of couples with infertility experience multiple contributing factors, it is crucial to assess all factors that may affect both of you.

During the first visit, you should also talk to your doctor about the emotional stress of infertility, as it is often difficult to discuss this with family and friends.

Don’t hesitate to inform your doctor about your concerns and disappointments, and be sure to ask any questions that need clarification.

After the initial discussion, a physical examination may be performed on you and your partner.

Another important topic to discuss during the first visit is what you should or shouldn’t do to maximize your chances of a healthy pregnancy.

Healthy eating, avoiding alcohol, smoking, and addictive substances, and starting prenatal vitamins may be recommended. If you are taking any medications, be sure to ask whether you should continue, stop, or adjust them. An immunity screening may be conducted to assess your risk of exposure to viruses that could affect pregnancy and to ensure your vaccinations are up to date. Additionally, you may be screened for genetic conditions that don’t affect you but could be passed on to a child.

Finally, a series of tests will be recommended for you and your partner.

Which Tests Are Performed?

Fertility tests are generally recommended:

12 months after trying to conceive for women under 35 if pregnancy has not occurred,
After 6 months for women over 35,
Immediately for women over 40 or younger individuals with the following health issues that could affect fertility.

These issues include:

A history of irregular menstrual cycles (cycles longer than 35 days or absence of menstruation),
Known or suspected conditions such as endometriosis, adhesions, fibroids, or polyps in the uterus, fallopian tubes, or abdominal cavity,
Known or suspected male infertility problems,
A history of cancer treatment in either partner.

Any infertility evaluation should investigate all potential contributing factors and include both partners. The initial testing should focus on the least invasive methods capable of identifying the most common causes of infertility. The speed and scope of the evaluation should consider the couple's preferences, age, duration of infertility, medical history, and findings from physical examination.

Ovarian Reserve Testing
The best indicator of egg quality is the age of the ovaries. Younger patients usually have healthy eggs with the correct number of chromosomes and a high chance of conception. In contrast, women over 40 may have eggs with chromosomal abnormalities, which can reduce fertility and increase the risk of miscarriage.

To evaluate ovarian reserve:

AMH (Anti-Müllerian Hormone): One of the most commonly used blood tests. AMH is released from antral follicles in the ovaries and is not affected by the day of the menstrual cycle. It provides a good indication of the number of antral follicles in the ovaries.
Antral Follicle Count (AFC): If possible, this involves counting small follicles (2–10 mm in diameter) in the ovaries using a vaginal ultrasound. Since AMH is produced by these small follicles, AMH levels are closely related to the number of small follicles.
FSH (Follicle-Stimulating Hormone): Another widely used test to assess ovarian reserve. It is measured in a blood sample taken in the early morning, on days 2 to 5 of the menstrual cycle, on an empty stomach.

Ovarian reserve testing is especially important for patients who:

Are over 35 years old,
Have a family history of early menopause,
Have only one ovary,
Have a history of ovarian surgery, chemotherapy, or pelvic radiotherapy,
Have endometriosis or unexplained infertility,
Have shown a poor response to ovarian stimulation with gonadotropins in previous treatment cycles.

Other Blood Tests

Thyroid-Stimulating Hormone (TSH) and Prolactin (PRL): Useful for identifying thyroid disorders and hyperprolactinemia, which can affect fertility, menstrual regularity, and increase the risk of miscarriage.
DHEAS, 17-α Hydroxyprogesterone, and Testosterone: Used to diagnose hormonal imbalances in the presence of hirsutism (excessive hair growth on the face, chest, or central abdomen).
Progesterone: A blood test done in the second half of the menstrual cycle can help determine whether ovulation has occurred.
Urinary LH Test: Detects the presence of LH in the urine to estimate the time of ovulation. The rise in LH occurs one to two days before ovulation and can help identify the fertile window—unlike serum progesterone, which confirms ovulation only after it has occurred.

Transvaginal Ultrasonography
This ultrasound examination performed via the vaginal route allows the doctor to examine the uterus and ovaries for ovarian reserve, cysts, fibroids, polyps, or structural abnormalities that may cause infertility.

Semen Analysis (Spermiogram)
Semen analysis is a critical part of infertility assessment. It provides information about sperm count, motility, morphology, and other characteristics that may be associated with male factor infertility. This test is required even if the man has fathered children previously.

Hysterosalpingography (HSG)
This X-ray procedure checks if the fallopian tubes are open and if the uterine cavity has a normal shape. A catheter is inserted through the vaginal canal into the cervical opening, and a contrast dye visible on X-ray is injected. This dye fills the uterus to evaluate its inner shape and then travels into the fallopian tubes to assess their length and openness by observing whether the dye exits from their ends.

To achieve the best results, infertility evaluations must be personalized according to each individual's specific conditions.