Female Fertility Can Be Affected by Multiple Factors
Several factors influence female fertility.
A woman’s fertility is at its peak between the ages of 20 and 30. A significant decline in fertility occurs after the age of 37, as both the quantity and quality of eggs decrease.
Irregular Menstrual Cycles
Irregular menstrual cycles are often associated with ovulation disorders. Factors contributing to irregular cycles may include polycystic ovary syndrome (PCOS), being underweight or overweight, or hormonal imbalances.
Infections and Surgeries
Infections and surgeries in the pelvic area can lead to adhesions in the reproductive organs, preventing eggs from traveling through the fallopian tubes to the uterus.
Endometriosis is a common problem that can hinder pregnancy in two different ways. It can create lesions in the reproductive organs that interfere with ovarian function and cause scar tissue. In patients with endometriosis, the hormonal balance of the uterus may also be unfavorable for pregnancy. However, many women with endometriosis can still conceive successfully.
Certain chronic illnesses can complicate fertility, so their presence is assessed during basic examinations.
Assessment of Female Fertility
Examinations are conducted to determine 1) whether egg maturation and ovulation occur normally, 2) the status of hormonal function, and 3) the anatomical condition of the reproductive organs. The primary methods used are ultrasound examinations and blood tests. Diagnostic information can also be obtained during treatment.
1. Ovulation Assessment
In cases of regular menstrual cycles (25-35 days), egg maturation and release usually occur normally.
Ultrasound examination is the best method for assessing ovulation.
Ovulation test (LH test) can be performed at home using a urine sample. The test is moderately reliable.
Progesterone, also known as the corpus luteum hormone, can be measured with a blood test. Progesterone levels rise significantly after ovulation.
2. Hormone Tests
Blood tests for hormones are used to assess ovarian function and reserve and provide indications of the likelihood of pregnancy.
FSH and LH measure ovarian function and reserve.
TSH measures thyroid function.
PRL (prolactin) is the milk hormone. Excessive secretion of prolactin inhibits ovarian function.
Progesterone, the corpus luteum hormone, is essential for pregnancy initiation and maintenance.
3. Assessment of Anatomical Condition
Ultrasound examination is the primary method for examining the structure and function of a woman’s reproductive organs. It allows monitoring of follicle growth and ovulation, counting the number of available follicles (Antral Follicle
Count, AFC), which measures the ovaries’ capacity to produce eggs, and helps assess the ovarian reserve.
The structure and thickness of the uterine lining, especially the endometrium, are examined in all fertility investigations and treatments.
A test to determine the patency of the fallopian tubes (hydrosonography, salpingosonography) is part of the basic fertility examination. The test helps determine whether the uterine cavity is normal and whether the fallopian tubes are open.
Hysteroscopy and laparoscopy are sometimes required when an anatomical abnormality requiring treatment is detected by ultrasound examination, such as a polyp, ovarian tumor, endometriosis, or fibroid. These procedures are performed in a hospital setting.
4. Uterine Lining Biopsy
It is often asked why a well-developed embryo transferred to the uterus does not implant. Could it be that the uterus rejects the embryo? The uterus does not actually reject the embryo, but the implantation window, the time when the embryo can attach, can vary individually. This means it can be either earlier, later, or sometimes significantly shorter than usual. A significantly short implantation window may be related to anatomical abnormalities of the uterus, for example.
After failed embryo transfers, individual determination of the implantation window may be considered. In this case, a biopsy of the uterine lining is taken at the exact time of implantation. The sample is then analyzed for the activity of nearly three hundred individual genes, which allows for the determination of an individual and optimal implantation window. The results of this test are permanent for the patient, meaning they can be applied in future treatments, and if necessary, the timing of embryo transfer can be adjusted based on the research. When the transfer timing is corrected based on the research, pregnancy outcomes are significantly improved.