Infertility Treatment

What Is Infertility? When Should You See a Doctor?

Infertility is the failure to achieve pregnancy within a certain period despite regular sexual intercourse. According to the generally accepted definition, if a woman is under 35 years of age, it is recommended to consult a specialist after 1 year of unprotected intercourse without achieving pregnancy; if she is over 35, this period is 6 months. Infertility is not solely a woman’s problem; approximately 30-40% of cases are caused by female factors, 30-40% by male factors, 10-20% by factors affecting both partners, while in about 10-15% of cases, no clear cause can be found despite all investigations (unexplained infertility).

In addition, it may be beneficial to see a doctor earlier (without waiting 1 year or 6 months) in the following situations:

• The woman being over 40 years of age.
• Irregular or painful menstrual cycles, absence of menstruation (amenorrhea).
• A known diagnosis of endometriosis or Polycystic Ovary Syndrome (PCOS).
• A history of pelvic inflammatory disease (PID) or a sexually transmitted infection.
• A history of recurrent pregnancy loss (miscarriage).
• A known sperm problem in the man or a history of testicular issues (undescended testis, trauma, infection).
• A history of cancer treatment such as chemotherapy or radiotherapy.
• A history of previous abdominal or pelvic surgery.

What Are the Possible Causes of Infertility? The Comprehensive Evaluation Process

There are many factors that can lead to infertility. To plan the correct treatment, both the female and male partner must first be thoroughly evaluated in order to identify the underlying cause(s). The evaluation process conducted by Prof. Dr. Nuray Bozkurt in Ankara generally includes the following:

1. Possible Female Causes and Evaluation:

• Ovulation Problems: One of the most common causes. Irregular ovulation or complete absence of ovulation. This can be caused by conditions such as PCOS, thyroid disorders, excessive exercise, excessive weight loss or obesity, hypothalamic problems, and premature ovarian insufficiency. Evaluation involves hormone tests (FSH, LH, E2, Prolactin, TSH, AMH) and follicle tracking with ultrasound.
• Tubal Problems: Blocked or damaged fallopian tubes prevent the fertilized egg from reaching the uterus. Past infections (PID), a history of ectopic pregnancy, endometriosis, or abdominal/pelvic surgeries can damage the tubes. Evaluation is performed using hysterosalpingography (HSG) or, sometimes, laparoscopy.
• Uterine Factors: Structural problems within the uterus can prevent the embryo from implanting. These include congenital uterine anomalies (such as a uterine septum), intrauterine adhesions (Asherman’s syndrome), myomas (fibroids) pressing on the uterine cavity (submucosal myoma), or large endometrial polyps. Evaluation is performed with ultrasound (especially 3D or saline infusion sonography-SIS), HSG, or hysteroscopy.
• Endometriosis: A condition in which the inner uterine lining grows outside the uterus. It can cause tubal adhesions, ovarian dysfunction, or fertilization/implantation problems. Diagnosis is usually made by laparoscopy, although it may be suspected based on history and examination.
• Advanced Maternal Age: As age advances, egg quantity and quality naturally decline, which lowers the chance of conception and increases the risk of miscarriage.
• Cervical Factor: Problems related to the cervix (previous surgeries, infections) or issues with mucus quality can make it difficult for sperm to pass through.

2. Possible Male Causes and Evaluation:

• Sperm Production or Function Disorders: The most common male cause. This includes conditions such as a low sperm count (oligospermia), reduced motility (asthenospermia), abnormal shape (teratospermia), or a complete absence of sperm (azoospermia). Causes may include genetic issues, hormonal disorders, infections, varicocele, certain medications, or environmental factors. The primary evaluation test is semen analysis (spermiogram). Hormone tests, genetic tests, or a urology examination may be requested if necessary.
• Blockage of the Sperm Ducts: Congenital or acquired (due to infection or surgery) blockages in the ducts (epididymis, vas deferens) that carry sperm out of the testes.
• Other Causes: Sexual dysfunction (erectile issues, ejaculation problems), certain systemic diseases, and medications used.

3. Unexplained Infertility:

• These are cases in which pregnancy does not occur despite all standard tests (hormones, semen analysis, tubal/uterine evaluation) being normal. It is seen in approximately 10-15% of couples.

Taking all these possible causes into account, Prof. Dr. Nuray Bozkurt plans and interprets the necessary tests based on the couple’s history and initial findings.

Infertility Treatment Methods: Personalized Options Offered in Ankara

Infertility treatment involves steps determined by the underlying cause, the couple’s age, the duration of infertility, and personal preferences, generally progressing from simple to complex. The main treatment methods that can be applied or that patients can be referred for under the guidance of Prof. Dr. Nuray Bozkurt in Ankara are as follows:

1. Lifestyle Changes and Counseling:

• This may be the first step of treatment. Factors such as reaching a healthy weight, quitting smoking and alcohol, eating a balanced diet, managing stress, and timing intercourse correctly (targeting the ovulation period) can increase the chance of pregnancy.

2. Ovulation Treatments (Ovulation Induction):

• One of the first-line treatments for women with ovulation problems (especially PCOS) or unexplained infertility.
• The ovaries are stimulated with oral medications (Clomiphene Citrate or Letrozole) or low-dose subcutaneous hormone injections (Gonadotropins), aiming for the development of one or a few eggs.
• Egg development is monitored with ultrasound and the time of ovulation is determined. The couple is advised to have timed intercourse during this period, or insemination is planned.

3. Insemination (IUI – Intrauterine Insemination):

• A procedure in which a prepared sperm sample is placed directly into the uterus.
• Usually applied together with ovulation induction in cases such as unexplained infertility, mild male factor, or cervical factor.
• It is a simpler and less costly method than IVF. Prof. Dr. Nuray Bozkurt performs this treatment at her clinic.

4. Surgical Treatments:

• Performed to correct structural problems causing infertility.
• Laparoscopy: A camera is inserted into the abdomen to perform procedures such as removing endometriosis implants, releasing tubal adhesions (not always successful), and treating ectopic pregnancy.
• Hysteroscopy: A camera is inserted into the uterus to perform procedures such as cutting a uterine septum, releasing intrauterine adhesions, and removing submucosal myomas or polyps.
• Microsurgery: Delicate operations performed to open blockages in the tubes (success rate is low).
• Varicocelectomy: A surgical procedure performed (by a urologist) to improve sperm parameters when the man has a varicocele (enlargement of the testicular veins).

5. IVF (In Vitro Fertilization) and Advanced Assisted Reproductive Techniques:

• The most effective assisted reproduction technique. It is based on retrieving eggs from the body, fertilizing them with sperm in the laboratory, and transferring the resulting embryo into the uterus.
• It is used in situations such as blocked/damaged tubes, advanced age, severe male factor, severe endometriosis, or the failure of other treatments.
• ICSI (Intracytoplasmic Sperm Injection): Injection of a single sperm directly into the egg (especially in cases of male factor infertility).
• PGT (Preimplantation Genetic Testing): Genetic screening of embryos in couples with a risk of genetic disease or recurrent IVF failure.
• Embryo Freezing (Cryopreservation): Freezing and storing quality embryos that are not transferred, for use in future attempts.
• When IVF or advanced techniques are required, Prof. Dr. Nuray Bozkurt refers couples to experienced centers in Ankara and can follow the process.

What Affects Success in Infertility Treatment?

The success of treatment depends on many factors:

• The woman’s age: The most important determinant.
• The cause of infertility: Some causes (e.g., IVF for tubal blockage) are easier to treat than others.
• Duration of infertility: The chance of success may decrease as the duration lengthens.
• Ovarian reserve and sperm quality.
• The treatment method applied.
• The couple’s general health status and lifestyle habits.
• The experience, technology, and laboratory quality of the clinic/center where the treatment is performed.

The Psychological Dimension of Infertility Treatment and Support Mechanisms

Receiving an infertility diagnosis and going through the treatment process can lead to intense stress, anxiety, disappointment, hopelessness, depression, and relationship problems for couples. Coping with this emotional burden is as important as the success of the treatment.

• Open Communication: It is very important for couples to talk openly about their feelings with each other and to support one another.
• Gathering Information: Having accurate and sufficient information about the process can help manage anxiety by reducing uncertainty.
• Realistic Expectations: It is necessary to accept that treatments may not always succeed on the first attempt and to approach the process with patience.
• Social Support: Talking with trusted family members or friends can be comforting. However, since comments from others can sometimes be hurtful, it is important to be mindful of who you share with and how much.
• Professional Help: Getting support from a psychologist, therapist, or couples counselor can be very helpful in coping with emotional difficulties, improving communication skills, and learning stress management strategies.
• Support Groups: Coming together with other couples going through similar experiences creates a sense that you are not alone and offers an opportunity to share experiences.

Infertility Treatment in Ankara: Prof. Dr. Nuray Bozkurt’s Comprehensive and Holistic Approach

Prof. Dr. Nuray Bozkurt provides care for couples experiencing infertility at her clinic in Ankara, in the light of scientific data and with a holistic, personalized approach:

• Comprehensive Evaluation: She conducts a detailed diagnostic process involving both the female and male partner in order to accurately determine the cause of infertility.
• Personalized Treatment Strategy: Together with the patient, she creates the most suitable treatment plan (lifestyle changes, medication, insemination, surgery, or referral for IVF) based on the findings, the couple’s age, expectations, and circumstances.
• Performing First-Line Treatments: She successfully performs treatments such as ovulation tracking, ovulation induction, and insemination (IUI) at her clinic.
• Necessary Surgical Interventions: She can perform diagnostic and simple therapeutic surgical procedures such as hysteroscopy, or refer patients to experienced centers for more complex surgeries.
• Reliable Referral: When IVF or other advanced assisted reproductive techniques are required, she guides couples toward experienced, ethically committed centers and specialists in Ankara with high success rates.
• Ongoing Communication and Support: At every stage of treatment, she listens to couples with understanding, provides detailed information, answers their questions, and offers both medical and emotional support throughout this challenging process. Being easily accessible during and after treatment (0538 983 18 78)(0312 284 00 12) is important.
• Pregnancy Follow-up: She monitors the precious pregnancies achieved through treatment with the same care and attention.

If you are having difficulty having a child, it is important to take the first step to learn the reasons behind this and discuss the treatment options tailored to you. Remember that you are not alone and that there are many possible solutions. For a comprehensive evaluation and expert support, you are invited to meet with Prof. Dr. Nuray Bozkurt at our clinic in Ankara. To make an appointment and begin this journey together, please contact us at 0538 983 18 78.