By definition, infertility is the inability to achieve pregnancy despite the sexual intercourse that has been entered 2-3 times a week for at least 1 year without any protection.
How Do You Understand That You Are Infertile?
Infertility that develops without being related to another important disease does not cause a symptom that would reduce the quality of life or require treatment. The age you notice that you are infertile is a very important criterion for evaluation. For women under 35 years of age, the infertility suspect process is 1 year, between 35-39 years is 6 months and after 40 years is 3 months. If you are suspected of infertility, you should definitely refer to a specialist gynecologist or reproduction endocrinologist. Blood tests, hormonal analyzes, body temperature tracking, uterine film, laparoscopy and hysteroscopy for women are the techniques used when needed. For men, the basic test is spermiogram. Besides, genetic examination for diagnosis, sperm cell and pathologic evaluation by taking tissue from the ovaries of the male for diagnostic purposes may be necessary.
Age and Fertility Relationship
The age of the person has direct influence on infertility. Almost everyone is aware that as the woman’s age increases, the potential for becoming pregnant is diminishing.
Recent studies suggest that male age is also an effect on infertility even if not at the same level.
In recent years, the approach has been to wait at least 1 year to talk about infertility if the woman is under 30 years of age, but it has to be 6 months when the woman goes through the thirties.
The most significant difference in women which makes the age dominant is that they are born with the eggs they will produce during their lifetime. When a girl comes to the world, the number of eggs in her ovaries is definite. This individual does not produce any new egg cells during life. Some of these egg cells that coexist with puberty begin to mature. While one of these cells reaches fullness, the others deteriorate and lose their function. This cell, which reaches full maturity, is thrown out of the ovary by ovulation. When the egg cells are exhausted, menopause starts. During the aging process, the egg cells in the ovaries also deteriorate as a result of this process and DNA problems are more common in these old eggs. The causes of DNA problems are;
- In general the natural effects of aging
- Environmental factor
- First, the development of quality egg cells as a requirement for the mechanisms operating within the body of the woman and then the poor qualities.
Since these egg cells have problems in their genetic material, it is highly probable that pregnancies resulting from fertilization of such eggs will result in abortion. As the hormonal pattern also changes with age, successful pregnancy rates decrease in older women.
For women who consult to doctor for child treatment, the first plan is the ovary reserve which should be assessed, especially if the age is 30 or over. For this purpose, on the third day of menstrual bleeding, the Follicle Stimulation Hormone (FSH) is examined in the blood. The presence of a hormone is indicative of a low ovary reserve. Another test to assess ovaries is the Anti-Mullerian Hormone (AMH) test. Since AMH is produced only in developing small follicles, the blood AMH level most closely reflects the egg reserve that individual has. As the woman’s age increases, the size of the remaining microscopic follicular pool decreases. This decrease reflects to blood AMH level and the decrease in the number of antral follicles in the ultrasonography. Finally, the image on the transvaginal ultrasonography of the ovaries also provides very useful information about ovary functions.
Assessment of Ovarian Reserve of the Patient According to AMH Level
< 0.4 ng / ml. Very poor ovarian reserve, should not be tested in vitro fertilization treatment. Egg donation may be considered.
0.7 – 1.0 ng / ml . Ovary reserve less than normal – Pregnancy should not be considered a race against time, in vitro fertilization treatments should be tried.
1.0 – 1.96 ng / ml. Intermediate group. Must be decided according to examinations of the couple. In the presence of risk factors, IVF-based treatments should be foregrounded.
1.96 – 4.2 ng / ml. Normal ovary reserve. Treatment is selected according to the other examinations and characteristics of the couple (waiting, vaccination, in vitro fertilization etc.).
˃ 4.2 ng / ml. Possible PCOS phenomenon. There is a risk of OHSS during treatment.
Aging in men
Men are much luckier than women in terms of reproductive cells. Because a man’s testicles produce sperm throughout his life beginning with puberty. In other words, sperms in men which are the male reproductive cells never run out. The male sperm cycle lasts 72 days. So it takes 72 days to produce sperm from a cell. For this reason, aging does not have a negative effect on the sperm of men. A recent study has shown for the first time that aging diminishes the reproductive potential of men. More extensive work on this subject continues.
Even if sperm quality is not reduced, men may also experience problems regarding infertility due to aging. Among the reasons the following may be counted.
- Reduction in testosterone production
- Increase in prostate problems
- Erectile dysfunctions
- Environmental factors
- Reduction in frequency of sexual intercourse
Age is an important factor for both men and women in terms of having children. For this reason, couples planning to have children are advised not to be too late.
Infertility Is Not Your Fate!
All patients who can not become pregnant despite in vitro treatment attempts, can achieve excellent pregnancy chances with egg and sperm donation. These ratios are much higher than rates of pregnancy obtained with couples’ own eggs and sperm. This is thought to be due to the fact that donors have no problem of infertility and produce better eggs and sperm compared to infertile patients. With donation therapy, a pregnancy rate of 60-70% is obtained.