Women who fail to get pregnant despite one year of regular, unprotected sexual intercourse should consult a physician. Women aged above 35 do not need to wait for a whole year.
In the first diagnosis, the couple is scanned for any genetic disorder. Women are checked for any previous operations concerning the ovaries, diagnosed cystic diseases (such as endometriosis), irregular menstruation or ongoing hormonal issues (polycystic ovary syndrome, thyroid disorders, metabolic syndromes, etc.).
Patients are also asked about any previous infections that affected the uterus or ovaries, or other operations into the abdomen.
As for men, they are inquired and checked in detail about a history of operations on the testes, presence of varicosele, inflammatory disease after puberty, genetically transmitted disorders, or working conditions which expose testes to heat, pressure or contact with toxins.
After your first examination, it will become clear which tests will be demanded of you to determine whether you are eligible for IVF or not. Under normal circumstances, factors related to the man can be easily determined with the spermiogram analysis, preceded by a three-day sexual abstinence period.
The analysis on women requires more detail. The ovary reserve and any problems related to the uterus are easily detected in the examination; however, hormone tests must be demanded. HSG (Hysterosalpingography), also known as a uterus X-ray, is not required in each case, and will be demanded by your physician only if they suspect something. Further detailed tests may be necessary depending on the specific needs of every couple.
In the first examination, the patients are informed about reproductive physiology. During this awareness-raising phase, which is a form of patient education, the physicians focus on which days are best suited for conception and whether the couple has sexual intercourse at the right time.
Moreover, the couple is informed that even if everything went perfectly well, the possibility of conception in a given menstrual cycle is only 25%. Women willing to get pregnant are recommended to start taking folic acid at least two months prior.
Following patient education, couples are informed about the examinations and tests that will follow.
The progestoreone level in the blood is measured in the middle of the second half of the menstrual cycle. Its level indicates whether ovulation has taken place or not.
It is performed to check whether the tissue lining the interior of the uterus, the endometrium, has developed normally or not.
It provides information about the dimensions of the uterus and ovaries. The patient is checked for any malformation of the uterus, myomas, cysts in the ovaries, and the thickness of the endometrium is examined. Normally, the size of the egg prior to ovulation is between 18 and 20 mm, and the ultrasound helps determine whether the egg has such a size.
This is a mandatory test since 40% of the factors causing infertility are related to the man. After at least two days of sexual abstinence, the volume and consistency of the semen is examined in a sample obtained via masturbation.
Congestion or excessive enlargement of the uterine channels (hydrosalpinx) is an important factors causing infertility. Hysterosalpingography (HSG) is performed at the end of the menstrual cycle. Aside from the structure of the channels, it may also reveal the presence of myomas or polyps on the inner walls of the uterus. There are also studies pointing to an increase in spontaneous pregnancies following HSG.
It is performed to shed further light on any pathologies detected in the HSG or in cases of intraabdominal disorders (adhesion, endometriosis).
Laparoscopy is now the most preferred method of closed surgery in all gynecological issues except delivery.
Endoscopic surgery is dubbed closed surgery. Since it causes less bleeding, most people tent to call it “bloodless surgery”. Nowadays, numerous gynecological diseases are recognized and operated on in this way. In this type of surgery, the abdominal cavity is visualized with the help of a camera and flashlight instead of large incisions, and the entire surgery is performed with small incisions by means of specially designed instruments.
Through a single 1-cm incision in the navel, it is possible to directly visualize not only the uterus, ovaries and tubes, but all the structures within the abdomen. When these surgeries were first applied, the surgeon used the camera much like binoculars to try and identify the disorder. Today, technology provides us with much more ease in this regard. We look at a TV monitor and perform the operation by using our instruments with skill. Without the sense of touch, we visualize a three-dimensional environment on a two-dimensional screen, and perform important interventions in a closed space. There are very few things that could limit a skilled laparoscopist.
In this procedure, when the patient is under anesthesia, the abdominal cavity is inflated by releasing carbon dioxide into the abdomen. As such, a space is created within the abdomen, and the intestines are set apart from the uterus, ovaries and tubes. A tiny camera is introduced into the abdomen via the navel, and the entire operation is completed without bleeding and pain, by means of only a few millimetric incisions on the skin.
What are the advantages of laparoscopic surgery for the patient?
It is a rather comfortable operation for the patient. In a very short time following surgery, patients get back on their feet, start to eat normally, and suffer much less pain. Some patients may go home on the same day or the next day. The optical devices that we use function like a microscope, helping us detect and stop bleeding in even the smallest blood vessels. While such bleeding can lead to intra-abdominal adhesions after an open surgery, and result in pain or infertility problems, and this risk is eliminated in laparoscopic surgery.
Other advantages of laparoscopic surgery are microsurgical procedures and operations in hard-to-reach spots. In operations on the ovaries, especially in women who have not yet had children, it is crucially important to remove only the diseased tissue and to leave intact the remaining healthy tissue.
Laparoscopy is used in the treatment of many gynecological disorders:
❖ Ovary cysts
❖ Cancer surgery
❖ Tubal ligation adn tubal congestion
❖ Ectopic pregnancy
❖ Intrauterine surgery
❖ Inguinal pain that does not respond to treatment
❖ Urinary incontinence
Which operations can be performed with this technique?
Almost all gynecological operations can be performed in this manner. The easiest ones are operations for diagnostic purposes. Here, the surgeon analyzes the organs within the abdomen, the form of the uterus, and the relation between the ovaries and tubes. A specially colored liquid is administered via the uterus to control whether it can pass through the tubes, so as to check for a possible problem seen among infertility patients. If a problem is detected, the diagnostic operation is transformed into a therapeutic operation so as to eradicate the diagnosed problem right away. For instance an ectopic pregnancy may be so severe as to threaten a pregnant woman’s life or cause huge complications. When this problem needs to be resolved via surgery, a laparoscopic operation is a comfortable and swift solution for the patient.
In women who want to have children, especially in cases of hydrosalpinx, or damage-induced swelling in the tubes, it is necessary to cut off the connection between the tubes and the uterus before IVF treatment. Laparoscopic surgery is a practical method which is highly effective in such cases as well.
The elimination of adhesions between intrabdominal organs (adhesiolysis) improves the patient’s comfort level and alleviates their pain. The tubes return to their normal activity, increasing the chances of spontaneous pregnancy.
The same surgery is performed for birth control purposes (tube ligation) in elder women who do not want to have children, since it is very difficult to reverse. Just think of it: Previously tubal ligation used to be a huge operation, causing patients to remain hospitalized and suffer severe pain. Now, however, thanks to laparoscopic surgery, they can go home on the night of the surgery and quickly resume their normal life.
Chocolate cysts (endometrioma) and disorders, and dermid cysts (which contain tissues such as hair, teeth or fat) have a special place in laparoscopic surgery. This type of surgery is highly effective in stopping the suffering of patients with advanced stage endometriosis. In women of reproductive age, this surgery has been set as the gold standard for protecting the ovarian reserve.
The hysteroscopy procedure is a closed surgery which is performed via the vaginal channel, rather than the abdomen. Local or general anesthesia is applied, it lasts a short time, and does not require hospitalization. Just like laparoscopy, the hysteroscopy procedure employs camera, monitor, and special equipment; however, this time, the area of intervention is the interior of the uterus. It is a groundbreaking technique for treating medical problems within the vagina.
A myoma or polyp formed within the uterus can thus be removed in a one-day procedure, without having to open up the abdomen. This method can also help overcome intrauterine malformation, thereby turning a fresh page in the lives of women who would not otherwise have children.