INfertility (Infertility) TESTS
Infertility is defined as the absence of pregnancy despite regular sexual life for one year without the use of birth control methods. In general, 8-12% of couples in the world have infertility problems. As there are many known causes of infertility related to male and female individuals, the number of infertile couples whose cause cannot be determined is quite high. However, thanks to the developing treatment methods, most of them can have children.
Other factors leading to infertility in male individuals:
- Genetic Factors: Like Klinefelter’s syndrome.
- Mumps after puberty
- Hypospadias
- Cystic Fibrosis
- Receiving radiation therapy in the area close to the testicles
- Some chronic diseases: such as anemia, Cushing’s syndrome, diabetes and thyroid disease.
- Some drugs; Anti-inflammatories such as sulfosalazine, anabolic steroids used by athletes, chemotherapy, illegal drug use (cocaine, marijuana..), long-term acetaminophen use.
- Age
- Excessive alcohol consumption
- Obesity
- Mental stress
Possible causes of sperm related infertility:
It is thought to constitute 1/3 of infertile couples.
Abnormal semen structure cannot effectively transport sperm to the egg.
The reasons for these problems in men;
- Could be a medical condition: It could be a testicular inflammation, cancer, or a surgical intervention.
- The testicles may have been exposed to excessive heat: Causes include an undescended testicle, Varicocele or varicose veins in the scrotum, use of saunas or hot tubs, wearing tight clothing, and working in hot environments.
- Ejaculation disorders: If the ejaculation channels are blocked, semen can be emptied into the bladder.
- Hormonal imbalance: Hypogonadism can cause, for example, testosterone deficiency.
Possible causes of infertility in women;
- Age
- Smoking: It negatively affects both sexes
- Alcohol use
- Obesity, nutritional disorders, severe weight loss
- Vitamin and mineral deficiencies; Folic Acid, B-12, Iron, Zinc deficiency
- Exercise; Too little or too much can negatively affect fertility
- Sexually transmitted infections
- Exposure to chemical substances; pesticides, metals, solvents
- Mental stress
Medical Conditions Causing Female Infertility;
- Ovulation disorders; It is the most common cause of female infertility.
- Premature ovarian failure; ovary stops working before age 40
- Polycystic ovary syndrome
- Hyperprolactinemia; If the woman is not pregnant and does not breastfeed, if prolactin is high, it affects ovulation and fertility.
- Poor egg quality; Having eggs that are damaged or contain genetic defects
- Thyroid problems can disrupt hormone balance
- Chronic conditions; like cancer
- Problems in the uterus or fallopian tubes impair the transport of the egg to the uterus
- Some treatments and drugs; anti-inflammatories, chemotherapy, radiotherapy, illegal drugs
- Infertility of unknown cause
In most cases of unknown infertility, inflammatory processes may be involved or antibodies may have developed against hormones, clotting factors, and reproductive tissues such as testicles and ovaries. Endometriosis is an important factor stimulating inflammatory processes.
Infertility is a very common problem and many factors can cause it. However, today’s developing technology and treatment methods provide treatment success and solve the problem in most of the couples experiencing this problem. The first and biggest step in these treatments is to determine the factor that causes infertility. In order to achieve this, there are versatile studies that are both applied in the clinical environment and tested in the laboratories.
Before proceeding with the research for the diagnosis, it is always essential to take the history of the couples and perform the physical examination with the principle of “there is no disease, there is a patient”. After this stage, the order and priority of the research to be done may change according to the situation of the couples, but some examinations should be done in infertile couples.
The tests to be performed in infertile couples can be listed as follows:
- Hormonal tests;
- Estradiol (E2),
- Progesterone,
- FSH,
- LH,
- AMH
- Prolactin ,
- TSH,T3,T4,
- Total and Free Testosterone
- Cervical Smear
- Serological Tests;
- HBsAg,
- Anti-HBs,
- Anti HCV,
- Anti HIV,
- Rubella IgG/IgM,
- Toxoplasma…
- Other Biochemical Tests;
- Urine Test
- Blood Type,
- Complete Blood Count,
- Rh Factor,
- Antibody Titer,
- FAC (Fasting Blood Sugar)
- OGTT(Oral Glucose Tolerance Test)
- Chromosal evaluation if necessary,
- Other Microbiological Tests and Cultures;
- Chlamydia
- Gonorrhea
- Radiological Examinations;
- Ultrasound of the Urogenital System
- Hysterosalpingography (HSG)
Infertility Tests for Male Individuals;
- Spermiogram
- Volume
- pH
- Sperm Concentration
- Total Sperm Count
- Motility
- Morphology
- Vitality
- Amount of Leukocyte
- Hormonal Analysis
- Radiological Examinations
- Vasography
- Transrectal USG; Prostate, Seminal Vesicle and Ampulla Part of Vas Deferens is Evaluated
- Venography; Used in the Diagnosis and Treatment of Varicocele
- Scrotal USG
- Abdominal USG
- Testicular Biopsy if necessary
In some cases, if pregnancy does not occur, couples should be investigated without waiting for one year.
These situations are:
- Infrequent menstrual periods: The menstrual cycle is expected to be between 21-35 days. If the cycle lasts more than 35 days, it is necessary to investigate.
- Women aged thirty-five and over: After this age, the number of eggs in women decreases, egg quality and the probability of having a genetically normal egg decrease.
- Presence of a history of pelvic infections or sexually transmitted diseases (such as chlamydia, gonorrhea)
- In the presence of uterine fibroids or endometrial polyps
- If a man has semen abnormalities, diagnosis and treatment processes should be started without wasting time.
Couples may also encounter infertility problems when they want to have a child again after taking a break for a while after having a child. By definition, it is the situation where pregnancy does not occur despite one year of unprotected sexual intercourse. As an approach, after the clinical history and physical examination, the necessary examinations and investigation of the couples are followed.