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Female Infertility Signs and Treatment in Istanbul



The vagina is basically the area of sexual intercourse. After male ejaculation occurs, the vagina acts as a reservoir for the sperm.


Congenital anomalies of the vagina: Septum means division. It can be transverse and longitudinal. Septum can cause both sexual intercourse problems and infertility by preventing sperm from reaching the cervical canal. The diagnosis is made by simple genital examination.


VAGINAL INFECTIONS: Various microbial agents can cause infection in the vagina. There are secreting glands in the vagina that prevent this area from staying dry. As a result of the infection, the secretion increases in these glands and the secretion acquires a microbial property and changes in color. Just as there is an increase in nasal secretion and color change with flu infections, the same can occur in the vagina. This may prevent pregnancy by shortening the life and negatively affecting the movement of the sperm remaining in the vagina after intercourse. This type of infection can be diagnosed and treated by a simple genital examination. Sometimes, even just treating this infection makes pregnancy possible. For this reason, any discharge with a different color and smell should be taken seriously and treated not only for pregnancy but also for general health.




The cervical canal and cervix play an important role in the passage of sperm from the vagina into the uterus and from there into the tubes. The congenital closure of the cervix, infection and adhesions in the cervical canal can cause problems in the passage of sperm.


Previous surgical interventions on the cervix: Especially, cauterizing the cervical wounds for therapeutic purposes or removing a part of the cervix (conization) may disrupt the normal structure of the cervical region. A simple genital examination and, if necessary, the taking of a medicated uterine film will help the diagnosis.




INFECTIONS: Infections originating from the intrauterine tissue usually occur as a result of an infection originating from the vagina or cervix spreading to the uterus. Since the intra-uterine tissue is the area where the embryo is placed, adhesions that may occur in this area after infections may prevent pregnancy.


Especially Tuberculosis infection likes to settle in the uterus and tubes. This microbe causes adhesion in the tube and uterus. It is characterized by the tuberculosis microbe reaching the uterus and tubes through blood circulation after the tuberculosis infection that usually occurs in the lung, resulting in infection and then adhesions.


If you have been diagnosed with tuberculosis before (Pulmonary Tuberculosis) and have been treated and you have a problem conceiving, you should consult a specialist!


Adhesions in the uterus and tubes can be easily seen in HSG, the medicated uterine film. Again, if necessary, evaluation can be made by a special camera system called intra-uterine HISTEROSCOPY and a laparoscopy method in which the uterus and tubes are examined by placing the camera system in the tubes through the abdomen.


Congenital Shape Disorders of the Womb:


After the right and left halves of the uterus are formed separately, they unite and a single uterus is formed. We can think of it as the two halves of an apple coming together.


Problems that may occur during this process can cause structural problems in the uterus. Among these, there are 2 problems that may cause problems for us.


UTERINE SEPTUM (Intrauterine partition or curtain):After the two halves of the uterus unite, it occurs as a result of the partition either not disappearing at all or only partially disappearing. In this case, pregnancy does not occur or results in miscarriage. Although the diagnosis can be made by ultrasonography, the best method is to examine the uterus with medicated uterine film (HSG) or Magnetic Resonance MRI.


After the diagnosis is made, the uterine cavity is made into a single cavity by cutting this compartment with the HISTEROSCOPY method.


UTERUS UNICORNUS (Half uterus): It is the absence of the right or left half of the uterus. This condition often leads to premature births or miscarriages, and rarely to conceiving. Diagnosis is made with uterine film and UTERUS MRI.




MYOM: Myoma is formed as a result of abnormal proliferation of cells in a certain area in the uterine section called myometrium. There are three types of fibroids.


one-Fibroids can grow out of the uterus. These types of fibroids do not prevent pregnancy. However, if its size exceeds 5 cm, it may cause problems after conception. These types of fibroids grow from the uterus into the abdominal cavity.


2nd-It remains confined within the uterine wall. It does not put pressure on the intrauterine cavity. It does not directly affect getting pregnant. Operation is not always necessary, and if the size of myoma is larger than 5 cm, the operation is recommended. 3-It grows into the intrauterine cavity and occupies the intrauterine cavity. These types of fibroids are a direct obstacle to pregnancy formation and must be surgically removed.


Myoma is diagnosed by ultrasonography. Whether or not it is pressing on the uterine cavity is determined by uterine film or, more reliably, hysteroscopy. This type of fibroids can be removed from the abdomen by entering the uterus with a camera, which we call closed surgery or hysteroscopy, depending on the size of the myoma.


Intra-uterine Adhesions (ASHERMAN'S SYNDROME)


Adhesions may occur after previous curettage or hysteroscopy operations in the uterus, especially due to abortions. These adhesions prevent sufficient thickening of the membrane tissue that covers the intrauterine cavity, ie the endometrium, and the embryo from being embedded in the uterus. We call these adhesions formed in the intrauterine cavity after operations ASHERMAN SYNDROME.


If you have had a curettage before for any reason and now your bleeding has decreased during your menstrual periods and you have problems with getting pregnant, consult a specialist! There is no rule that adhesion occurs after every curettage procedure. However, as the number of curettage increases, the risk will increase. Again, non-sterile conditions will increase this risk.


These adhesions can be light, medium or very intense. These dense adhesions will reduce the amount of menstruation. There may be adhesions without decreasing the amount of menstruation. The diagnosis of these adhesions can be made by uterine film or histerscopy.




Endometrial polyp occurs as a result of the proliferation of cells in a region in the endometrium layer that covers the intrauterine cavity. It is usually characterized by having a stem. Imagine a nut with its stem in the intrauterine cavity. Or consider the sebaceous glands formed on the face.


When polyps occupy the region where the embryo arrives and settles, it can prevent pregnancy. Considering the intrauterine cavity, not every polyp may prevent pregnancy. The size of the polyp and its location in the uterus are important. Polyps that exceed 1 cm and are located in the middle and upper part of the intrauterine cavity may prevent pregnancy. Polyps can be easily taken by entering into the uterus with a camera using the Hysteroscopy method when necessary. It may not be necessary to surgically remove every polyp. Therefore, patients should be evaluated carefully.




Tubes have a very important function in the female reproductive system:


  1. To catch the egg cell released from the ovary towards the abdominal cavity.
  2. Being a bridge between sperm and egg meeting each other
  3. To host the fertilization event.
  4. Hosting the embryo after fertilization
  5. Helping the embryo to reach the womb.

The most common problems with tubes are blocked tubes or adhesions around the tube.


The most important cause of blockage in the tubes is infections. Infections caused by a bacterium, especially tuberculosis and chlamydia, can cause blocking of the tubes. Both or one of the tubes can be blocked.


Chlamydia infection is especially common in younger ages. Especially creates an infection in the cervical canal. This infection usually shows no symptoms or very few symptoms. It has an insidious course. The bacteria spreads from the cervical canal to the uterus and tubes and can cause blockage in the tubes. Sometimes, bacteria can cross the tubes and reach the abdominal cavity or even the ovaries, causing widespread infections in these areas. This is called PELVIC INFLAMMATORY DISEASE. In this case, severe fever and abdominal pain occur. Some women may even be mistakenly diagnosed with appendicitis due to severe pain.


Tuberculosis germ usually settles in the lungs. However, although not always, it can spread through the blood and cause infections in the uterus and tubes. As a result, it causes blockage or adhesions in the tubes.


Operations related to appendicitis or intestines, ovaries or uterus may cause adhesion around the tubes. Adhesions may occur around the tube after cyst operations on the ovaries, caesarean section related to the uterus, myoma operations, and operations related to the large and small intestines.


Endometriosis: It is a disease that develops in the peritoneum, tubes and ovaries of the endometrium layer, which is the intrauterine layer, and causes bleeding in these areas in each menstrual period. Although not always, many women may have severe abdominal pain during the menstrual period. These pains may hinder the ability to work and may cause the patient to be bed-ridden during menstrual periods. It may require the use of strong painkillers in each menstrual period. Menstrual periods can become a nightmare for the woman.


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The last part of the tube adjacent to the ovary is called fimbria. This part is fringed and created to catch the egg. The fimbria and adhesions around it will prevent the tube from catching the egg. In other words, the egg cannot be taken into the tube. This will also prevent pregnancy.




  1. WITH HSG, UTERUS GRAPHY WITH MEDICINE: It is a method in which the uterus and tubes are viewed by taking an x-ray film by giving a special fluid that can be seen in x-rays through the uterus. This substance will paint all the areas it passes through and if the tubes are open, it will pass through the tubes into the abdominal cavity.


The fluid given from the cervix will first pass into the cervical canal, then into the uterus, through the uterus to two tubes, namely canals, and then from the end of the tubes to the abdominal cavity.

Since this special x-ray fluid will paint all the areas it passes through, it will give information about the cervical canal, intrauterine cavity and tubes.

If there is an obstruction in the tubes, it will not be painted after the obstructed area and cannot be seen on the x-ray.




Uterine film It should be taken within the first 3 days immediately following the end of the menstrual period. Because this time is considered a window when there is no possibility of pregnancy. In the later days of the cycle, the uterine tissue will begin to thicken, so wrong diagnoses can be made about the uterine cavity.




When the uterine film is done with experienced hands and under adequate equipment and technical conditions, it is an almost painless or slightly painful method. Again, as a precaution, you can use painkillers 1 hour before the procedure. Although it is thought that there is no need for anesthesia, if you are very worried, this film can be taken while under anesthesia for a very short time. If the technical equipment is sufficient and the one taking the film is experienced in this regard, the film will be of good quality and you will feel less pain. Be sure to ask if the procedure is performed UNDER SCOPY at the radiology center or hospital where you will have the uterine film taken!

Fluoroscopy is a method that enables the viewing on a screen of the passage of the substance given into the uterus and from there to the tubes after the drug is administered through the cervix. In this way, the film exposure is taken at the appropriate and right time, and the film that is shot is high quality. If the film is shot without a screen, the exposure may not be captured at the right times and may not provide us with sufficient clinical information. Uterine film under fluoroscopy is now a world-accepted method.

The uterine film takes approximately 10-15 minutes. You may have slight bleeding after the procedure.

We recommend that expectant mothers with an infection in the vagina or cervix should first treat the infection and then have the film taken. Otherwise, the infection in this area may spread into the uterus and tubes.




Laparoscopy is a method in which the entire abdominal area can be viewed directly from under the rib. In this method, the abdomen is entered with a special, thin instrument from the belly. The uterus, ovaries and both tubes are directly observed by placing a special camera through this device. Image recording is made simultaneously with the findings obtained.

In laparoscopy, the adhesions of the tubes, endometriosis, adhesions related to the uterus and ovaries can be diagnosed. In the same session, a special solution called methylene blue is given through the cervix and its passage through the tubes is observed.

The adhesions related to the tubes and large cysts in the ovary can be removed with this closed surgery method. Microsurgery can be applied to blocked tubes. This method is a simple, comfortable operation without any incision on the body.

If you are planning to have a child but you have not yet been able to conceive despite having a regular sexual life and waiting for a sufficient period of time (this period is 1 year for women under the age of 35, 6 months above the age of 35),

  1. Your partner's sperm analysis is normal
  2. If your periods occur at regular intervals

BUT: If your menstrual periods are extremely painful, these pains negatively affect your daily life and cause you to constantly take painkillers, or if you have a previous history of an operation related to appendicitis, ovaries or uterus, then laparoscopy may be the right method for you to investigate the reason for your inability to conceive.

Laparoscopy method is not a method that should be applied to everyone. However, it is a method that gives us a lot of information when necessary and that we can do at the same time as the surgical intervention, with a shorter hospital stay and recovery time.




The ovaries are the storehouse where female egg cells are stored; as well as being the organ in which hormones related to the reproductive system are produced.

Basically 2 hormones are produced by the ovary.

Estrogen: Estrogen hormone is a hormone produced from the follicle chosen to grow for that period. It provides thickening of the lining of the uterus and preparation for pregnancy.

Progesterone: It is a hormone produced from support cells in the follicle after the follicle is cracked and the egg cell inside is thrown into the tube. It stops the thickening of the intrauterine lining at a certain level and allows it to mature for pregnancy.(PRO: in favor of Gesteron: Pregnancy) ie this hormone supports pregnancy. Progesterone is not produced unless ovulation occurs. Balanced production of estrogen and progesterone hormone ensures regular menstruation.




FSH: The follicle stimulating hormone stimulates the growth of the egg follicle in the ovary. It starts to increase gradually from the beginning of the menstrual period. It increases the follicle to a size ready to crack (Approximately 17-22mm).

LH: Luteinizing hormone, on the other hand, allows the follicle that reaches a certain size to crack and the egg cell to leave the follicle and pass into the tube.

Egg cells in the ovary are stored in special structures called follicles. The follicle consists of the female egg cell, that is, the oocyte, the support cells that support the oocyte right around the oocyte, and, at the most exterior, the follicle wall that protects the egg from external influences.

This storage is used until the woman reaches menopause. There is no new follicle production after birth. The usage rate of follicles from this storage varies from person to person. With the depletion of the follicle in the warehouse, the woman enters menopause. Since the number of follicles and the rate of consumption of these follicles is not the same for each woman, the age of entry to menopause is different for each woman.

As the age progresses, both the number of follicles in the storage and the quality of the eggs in the remaining follicle decrease.

The female body has been created with such a perfect system that follicles containing high quality eggs are used in the young years of the reproductive age. The purpose of this is so that pregnancy can occur at a young age. After the age of 30, the number of quality eggs gradually decreases. Although there are no other problems related to this, the chance of naturally conceiving for expectant mothers aged 35 and over gradually decreases. 38 years and older are considered critical.




  1. Decrease in the number of follicles and quality eggs with age: In this case, problems in the structure and genetic structure of the egg may reduce the chance of fertilization with sperm.
  2. Irregularity in the production of hormones that control follicle growth from the brain.




  1. PROLACTIN (Prolactin elevation), 

    Excessive stress disrupts this balance between the brain and the ovary.

    Again, tumors and some diseases that disrupt the pituitary gland function that control ovarian functions in the brain disrupt the ovulation function.
  2. EGG CYSTS: Chocolate cysts reduce the number of follicles in the ovary and again negatively affect their quality.
  3. POLYCYSTIC OVARY SYNDROME: This syndrome has been specifically addressed.
  4. Radiation: Especially in women who receive radiation due to intra-abdominal tumors, the number and quality of eggs decrease.
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