INFERTILITY TREATMENT

Infertility is defined as the inability to achieve pregnancy despite regular, unprotected sexual intercourse (2–3 times per week) for at least one year.

It is a common health problem worldwide and can significantly affect a couple’s quality of life. In couples with a regular sexual life, approximately 90% will conceive within one year if no contraception is used. When pregnancy does not occur within this period, underlying medical reasons may exist in the woman, the man or both.

Infertility can be seen in both women and men and is influenced by many factors. Advancing age, especially in women, is one of the most important risk factors that reduces fertility potential.

If you wish to have a child but cannot conceive naturally, it is not realistic to expect this problem to resolve on its own. You should consult a specialist. By booking an appointment at our clinic, you can be examined by Obstetrics and Gynecology Specialist Op. Dr. Mahru Nurullayeva and have an individualized treatment plan tailored to your condition.

What Is Infertility?

Infertility is defined as the failure to achieve pregnancy after 12 months of regular, unprotected sexual intercourse. The cause may be related to the woman, the man, or both partners.

Studies show that approximately 15 out of every 100 couples experience infertility and require medical evaluation and treatment. About 35% of infertility cases are attributed to female factors, 35% to male factors and the remaining 30% to combined or unexplained causes.

Age, hormonal changes, obesity, smoking, alcohol use and various systemic diseases can all play a role in the development of infertility.

Causes of Infertility

The prevalence of infertility is similar in women and men; in both genders, approximately 30–40% of cases may be associated with reproductive problems.

After a detailed evaluation by an obstetrics and gynecology specialist, the underlying cause of infertility is investigated and an appropriate treatment strategy is developed. In some couples, no clear cause is identified despite comprehensive testing. This is termed “unexplained infertility” and accounts for around 15% of cases.

Male-Related Causes of Infertility

• Low sperm count
• Reduced sperm motility
• Abnormal sperm morphology (structural defects)
• Ejaculatory problems or obstruction of the reproductive ducts
• Testosterone deficiency
• Erectile dysfunction and other sexual disorders
• History of undescended testis
• Childhood febrile illnesses
• Genetic factors
• Azospermia and varicocele
• Diabetes mellitus
• Sexually transmitted infections (e.g. syphilis, gonorrhea)
• History of cancer treatment (chemotherapy, radiotherapy)
• Testicular and genital tract infections
• Heavy smoking and alcohol consumption
• Chronic stress and sleep deprivation
• Hormonal disorders

The cause of male infertility may be single or multifactorial. Following appropriate tests and urological evaluation, an individualized treatment plan is created.

Female-Related Causes of Infertility

• Irregular menstrual cycles
• Diminished ovarian reserve
• Blocked fallopian tubes
• Tubal damage or adhesions
• History of abdominal or pelvic surgery and infections
• Ovulation disorders
• Primary amenorrhea or very late onset of puberty
• Hyperprolactinemia (high prolactin levels)
• Endometriosis
• Diabetes and liver diseases
• Polycystic ovary syndrome (PCOS)
• Uterine fibroids
• Thyroid disorders
• Previous cancer treatments
• Excessive caffeine intake
• Smoking and alcohol use
• Obesity
• Stress and lack of sleep

Some lifestyle-related factors such as stress, smoking, alcohol use and poor sleep are common to both women and men. Modifying these risk factors can significantly improve fertility. In cases where infertility is secondary to underlying diseases or treatments, assisted reproductive techniques may be required.

For detailed information about infertility and assisted reproductive options, you can schedule an appointment with Obstetrics and Gynecology Specialist Op. Dr. Mahru Nurullayeva.

How Is Infertility Treated?

There are various treatment options for couples who have difficulty conceiving naturally. When planning infertility treatment, the following factors are evaluated:

• Age and general health of both partners
• History of previous pregnancies or miscarriages
• Duration of infertility
• Condition of the fallopian tubes
• Ovarian reserve and ovulatory function in the woman
• Sperm parameters in the man (count, motility, morphology)

Based on these findings, the most appropriate infertility treatment strategy is selected for the couple.

Initial Tests in Infertile Couples

When infertility is suspected, several basic tests and examinations are performed to identify possible causes and guide treatment.

In men, evaluation usually starts with:

• Semen analysis (spermiogram)
• Urological examination

Additional tests may be requested by the urologist if necessary.

In women, assessment includes:

• Pelvic examination and ultrasound
• Hormone tests to evaluate ovarian function
• Ovarian reserve tests
• Hysterosalpingography (HSG – X-ray of the uterus and tubes)

These baseline investigations help to clarify the main causes of infertility. Further tests may be added depending on the clinical situation.

Infertility Treatment Options

Infertility treatment is performed in a stepwise manner under the supervision of experienced specialists. The choice of method depends on the underlying cause, age and expectations of the couple.

Ovarian Stimulation

In ovarian stimulation, fertility medications are used to encourage the ovaries to produce one or more mature follicles. Treatment usually starts on day 2 or 3 of the menstrual cycle, using daily subcutaneous injections of FSH analogues administered into the abdominal wall with very fine needles.

Injections are preferably given at the same time each day. Follicle number and size are monitored by ultrasound, while hormone levels are checked through blood tests. Depending on the ovarian response, stimulation may last 1–2 weeks.

In the final days of treatment, additional injections may be used to prevent premature ovulation. In some women, an insufficient ovarian response may lead to cancellation of the cycle, after discussing the situation with the couple and planning alternative protocols.

Treatment with Fertility Medications

In women with ovulation disorders, oral or injectable medications can be used to induce regular ovulation. Oral medications enhance the body’s own hormonal mechanisms, whereas injectable drugs act directly on the ovaries.

Possible side effects include:

• Hot flashes
• Breast tenderness
• Nausea
• Mood changes
• Rarely, allergic reactions

For this reason, all treatments should be conducted under close medical supervision.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a procedure in which prepared sperm is placed directly into the uterine cavity during the woman’s ovulation period using a thin catheter.

IUI is particularly useful when:

• Fallopian tubes are open and healthy
• The cause of infertility cannot be clearly identified
• Sperm count or motility is mildly reduced
• There is difficulty in sperm passage through the cervical canal
• Sexual dysfunctions such as erectile dysfunction, premature ejaculation or vaginismus are present

Prior to the procedure, a semen sample is processed in the laboratory and the most motile and morphologically normal spermatozoa are selected. These are then gently injected into the uterus using a soft plastic catheter. The procedure is short, safe and usually painless.

Combined with ovulation induction, IUI has a pregnancy success rate of approximately 15–20% per cycle, depending on the couple’s age, sperm quality and tubal status.

In Vitro Fertilization (IVF)

In vitro fertilization (IVF) is an advanced assisted reproductive technique, mainly used in couples with severe fertility problems or those who did not respond to simpler treatments.

Under normal conditions, one egg matures each cycle. With IVF, hormonal medications are used to stimulate the ovaries to produce multiple follicles. Protocols may vary, but they generally combine medications that promote follicle growth and others that prevent premature ovulation.

Mature eggs are retrieved from the ovaries and fertilized with sperm in the laboratory to create embryos. These embryos are monitored for several days, and then one (or in selected cases, two) high-quality embryos are transferred into the uterine cavity.

Before embryo transfer, the number and quality of embryos, the probability of pregnancy and the risk of multiple gestation are discussed in detail with the couple. Embryo transfer is usually a short, outpatient procedure that does not require anesthesia and is well tolerated by most patients.