Many couples achieve results within the first 6 months of their attempt to conceive. In 85% of unprotected couples, pregnancy is expected to occur within 1 year. Within the next 36 months, 50% of the remaining couples will conceive.
The main symptom of infertility is the inability to get pregnant. This condition may have no other symptoms.
In some cases, a woman with an infertility problem may have abnormal menstrual bleeding, while a man with an infertility problem may have hormonal problems such as hair growth or some changes in sexual function.

If you haven't been trying to have a baby for more than a year, you don't need to worry too much about infertility. You can contact your doctor in the following situations:
• If you are thinking of getting pregnant, are over 30 years old and have not had menstrual bleeding for 6 months
• If your menstrual periods are irregular or painful; have pelvic pain, endometriosis, or recurrent miscarriage
• If you have a history of low sperm count, testicular, prostate or sexual problems

Before starting infertility tests, you should be aware that this process requires responsibility and commitment. Your doctor may want to know your sexual habits and give you advice about them if necessary. The necessary tests and trial periods can take months. In one-third of couples with infertility problems, no cause can be found. (Infertility of unknown cause)

The evaluation period can be expensive and uncomfortable, and there is no guarantee that you will get pregnant after all the tests and examinations.

Tests for Men to Diagnose Infertility

The testicles of a non-infertile man should produce enough healthy sperm to be able to ejaculate. Tests for men are to understand whether these processes are damaged.

• General Physical Examination: It is about the examination of genital organs, medical history, past diseases, drugs used and sexual habits.

• Sperm Analysis: The most important test in male infertility is sperm analysis. Your doctor may ask you to give a sperm sample one or more times. The sperm sample is obtained by masturbation and examined in the laboratory in terms of quantity, color, presence of infection, sperm count, shape and motility of sperm.

• Hormone Tests: These are blood tests to examine the testosterone level and other male hormones.

• Ultrasound of the Rectum and Testicular Bag: Your doctor may order an ultrasound to diagnose the presence of sexual problems such as retrograde ejaculation.

What is Spermiogram? Why Is It Done?

While it is possible to determine the causes of female infertility with a large number of tests, a single test can inform us about infertility in male patients. Here this test is "Spermiogram (Semen analysis)".

Sperm Test, Sperm Analysis

In male infertility, the most important test that a person should have is the sperm test.

What is Sperm Test?

The purpose of the test is to microscopically examine the fertility potential of the sperm in the patient.

When Should Sperm Test (spermiogram) Be Done?

If couples who have had a regular and unprotected sex life for one year cannot conceive, the first test doctors will ask from male patients is the sperm test. When couples encounter such a situation, they should have a sperm test.

How is the Sperm Test Done?

Before having a sperm test, the person should abstain from sexual intercourse for 3-4 days. There should be no discharge (sleep, etc.) in these 3-4 days. After this 4-day abstinence, the patient is asked to ejaculate into a sterile container by masturbation in the special sperm delivery rooms of the andrology laboratories specialized in this branch. Since the first drops coming out of the penis are very important, they should definitely not be carried out of the container and if they are overflowed, the staff should be informed. In the sperm sample taken from the person, expert technicians perform the sperm examination by considering the main important criteria such as the number, shape, movement and fluidity of the sperm. In order to obtain a healthier result, a sperm sample should be given twice within 3 to four weeks.

Semen (ejaculate, semen, sperm sample)

The fluid that comes from the man as a result of ejaculation is called semen (sperm sample). In the sperm test examination, the number of sperms, the shape of the sperm (morphology), the motility of the sperms and their quantity are examined, as well as the amount of the semen (sperm) sample taken, its pH, color, presence of leukocytes, fructose amount, liquefaction time (Semen solubility) and the evaluation is made.

There are several different criteria in sperm test evaluation. “Kruger criteria” is a microscopic evaluation method that specifically considers deformities in sperm. According to the Kruger order, the sperms are evaluated according to the disorders in the head, middle part and tail structure. By applying a special staining process, the shape (morphology) characteristics of the sperm are examined and the fertility capacity of the sperm sample is determined.

Tests for Women in Diagnosing Infertility

The ovaries of a woman who is not infertile must regularly release an egg each month, allowing the reproductive system to meet the egg and sperm and become an embryo. The reproductive organs of the woman should be healthy and functional.

After asking questions about your medical history, menstrual cycles, sexual habits, your doctor will ask you to undergo a general examination. This is called a gynecological exam and may also require certain tests:

• Ovulation test: A blood test requested to measure hormone levels and check if you are ovulating.

• Hysterosalpinography: It is performed to determine the clarity of the HSG tubes and whether they have the ability to fulfill their duties, to see the formations and anomalies occupying space in the cervical canal and uterus. Cervical insufficiency, tuberculosis, adenomyosis, fibroids and polyps can be identified with HSG. While the HSG is being drawn, an oily x-ray dye (opaque substance) is introduced into the uterus with the help of a cylindrical catheter passing through the cervix (cervix). By looking at the distribution of this opaque substance, it is tried to reveal the problems related to the intrauterine or fallopian tubes.

• Laparoscopy: It is an operation performed under general anesthesia and a thin telescope is inserted into the abdomen through the belly button to view the intra-abdominal organs. With laparoscopy, it is possible to directly observe diseases or problems related to the uterus, ovaries and tubes and to perform surgical intervention with instruments inserted through 3 - 5 mm holes opened in the lower abdomen. Ovarian cysts, ectopic pregnancies, uterine fibroids, tube surgery and endometriosis can be easily treated laparoscopically.

• Hysteroscopy: A way of looking inside the uterus. With the device called hysteroscope, the diagnosis or treatment of the problem related to the uterus can be made. Hysteroscopy can be used to diagnose certain conditions as well as for therapeutic purposes. For example; uterine adhesions, sections or fibroids can be removed by hysteroscopy. Hysteroscopy can be used for diagnostic purposes in cases such as abnormal bleeding, infertility, recurrent miscarriages, adhesions, and abnormal growths.

• Hormone Tests: These are blood tests to look at ovulation hormones, thyroid and pituitary hormones.

• Ovarian Reserve Test: It can be done to determine the potential activity of eggs after ovulation.

• Genetic Tests: It can be done to understand whether there is a genetic condition that causes infertility.

• Pelvic Ultrasound: Ultrasound is performed to examine the uterus and tubes.

The treatment of infertility may vary depending on the cause, how long you have been infertile, the age of the couples and many other personal characteristics. Some causes of infertility cannot be corrected. However, it is still possible to get pregnant with assisted reproductive techniques.

Treatment for Couples These approaches may concern men, women, or both.

Increasing the number of sexual intercourses. Having intercourse 2 or 3 times a week can increase fertility. However, too much ejaculation can also have an effect that reduces the quality of a man's sperm. Sperm can live up to 72 hours in a woman's reproductive system, and the egg can be fertilized up to 24 hours after ovulation.

What are the Treatment Options for Men in Infertility?

General Sexual Problems: Diagnosing impotence or premature ejaculation improves fertility. These can usually be treated with medication or behavioral approaches.

Absence of Sperm: If the absence of sperm is suspected, surgery, hormones or assisted reproductive techniques are used to correct the problem. For example, varicocele condition is usually corrected with surgery. If there is an obstruction that prevents ejaculation or if there is a back ejaculation situation, sperm is taken from the testicles by operation and injected directly into the egg in the laboratory with the microinjection method.

What are the Drug Treatment Options for Women in Infertility?

In infertile women with ovulation problems, fertility drugs are the most commonly used treatment. These drugs regulate or stimulate ovulation. In general, they work similarly to natural hormones such as FSH and LH. Commonly used fertility drugs are:

Clomiphene Citrate: This drug is taken orally and they stimulate ovulation in women with polycystic ovary syndrome or other ovulation problems. They encourage the pituitary gland to release FSH and LH.

Human menopausal gonadotropin (hMG): This drug is given as an injection to women who cannot ovulate spontaneously as a result of a pituitary gland defect. Unlike Clomiphene, which stimulates the pituitary gland, hMG and other gonadotropins stimulate the ovaries directly. This drug contains both FSH and LH.

Follicle Stimulating Hormone or FSH: FSH stimulates the ovaries to mature the ovarian follicles.

Human Chorionic Gonadotropin, (HCG): Used together with Clomiphene, hMG, FSH; stimulates the ovary to release the egg.

Gonadotropin-releasing hormone (Gn-RH) analogues: This treatment is for women whose ovulation function is irregular or who ovulate before the main follicle is mature enough during hMG treatment. Gn-RH analogs continuously send Gn-RH to the pituitary gland.

Aromatase Inhibitors: This class of drugs such as Letrozole (Femara) and Anastrozole (Arimidex) are approved for the treatment of breast cancer. Doctors may sometimes prescribe Letrozole to women who are unable to ovulate spontaneously and do not respond to Clomiphene Citrate therapy.

Metformin (Glucophage): This drug is used to support ovulation. It is used when insulin resistance is known or suspected to be the cause of infertility. Insulin resistance may also play a role in polycystic ovary syndrome.

Bromocriptine (Parlodel): It is used for women whose ovulation cycle is irregular due to high prolactin level. Bromocriptine restricts prolactin production.

Fertility Medicines and Risk of Multiple Pregnancy

Fertility drugs used in the form of injections increase the chance of multiple pregnancy. Oral fertility drugs such as clomiphene also increase the chance of multiple pregnancy, but to a lesser extent than the other. During the use of these drugs, the patient should be carefully monitored with blood tests, hormone tests and ultrasound to determine the follicle size. In general, the greater the number of fetuses, the greater the risk of preterm birth. Babies born prematurely may have health and developmental problems. These risks are most common in triplets.

The risk of multiple pregnancy can be reduced. If a woman needs HCG to trigger ovulation, and the ultrasound shows too many follicles developing, she and her doctor may decide to suspend HCG. Still, for many couples, the desire to become pregnant precludes the possibility of multiple pregnancies.

When there is a multiple pregnancy, the surgical removal of one or more fetuses increases the chance of survival of the remaining babies. There are also some emotional and moral aspects to this for many couples.

Depending on the situation, infertility can be treated with surgery.

Tube Blockages

Blockages and other problems with the tubes can usually be treated with surgery. It is possible to perform delicate operations on tubes with laparoscopic techniques.

Endometriosis (Chocolate Cyst)

Endometriosis-induced infertility is often difficult to treat. Even though it is not used in the treatment of infertility, thanks to the hormones in birth control pills, treatment and pain relief with their use are effective. If you have endometriosis, your doctor may treat you with ovulation therapy, where drugs regulate or stimulate ovulation, or with in vitro fertilization, where the egg and sperm are brought together in the laboratory and fertilized, and the embryo formed is injected into the womb.

However, if endometriosis is a problem with the embryo, then it can be removed laparoscopically or with robotic surgery. The gold standard in endometriosis surgery is to be performed with robotic surgery.

Myoma Treatment

If the size and location of myomas and polyps in the uterus are risky for the embryo, they can be removed with myomectomy surgery. Myomectomy can be performed with hysteroscopy as well as with laparoscopic and robotic surgery. Your doctor will choose which method is more suitable. However, Robotic myomectomy surgery is the gold standard in myomectomy operations as it causes minimal damage to the surrounding tissue.

In Vitro Fertilization (IVF Treatment):

It is the most effective assisted reproductive technique. The eggs of the woman are collected, they are combined with the sperm taken from the man in the laboratory, the fertilized eggs, that is, the embryos, are placed in the uterus within 3-5 days before fertilization. IVF treatment is recommended when both of the woman's tubes are blocked. It is also used in many conditions such as endometriosis, unexplained infertility, cervical infertility, male-induced infertility and ovulation disorders. The chance of multiple pregnancy increases with IVF treatment because more than one embryo is usually transferred to the expectant mother. In addition, blood values and hormone values are frequently checked in this treatment.

Electro or Vibrating Alert for Ejaculation:

This method is used to obtain sperm. This treatment is applied to men who have spinal cord injury and are otherwise unable to produce sperm.

Obtaining Sperm by Operation:

This technique is based on the operation of removing sperm from the testicles. It can be used when the sperm duct is blocked.

Microinjection (ICSI):

It is based on the principle of injecting a sperm into the egg obtained as in normal IVF treatment. Microinjection can be applied to couples who cannot achieve pregnancy with other methods. In men with low sperm count, microinjection is a factor that increases success.

Assisted Hatching:

This technique helps the embryo attach to the uterus. It can be applied in repeated failures.

Some patients undergoing IVF treatment experience a blockage problem in their tubes. In cases where this obstruction occurs at the ends of the uterus, secretions accumulate in the tubes and these affect the embryos in a toxic way. As a result, the probability of conceiving is reduced by 50%. This problem experienced by the patients in question can be understood with the HSG method.

When the same problem is seen in the ultrasound evaluation, one of the options to remove or connect the tubes is applied. In cases where the removal of the tubes is on the agenda, the procedure is performed by entering the abdomen from the umbilicus using a laparoscopy camera; In cases where the procedure cannot be performed, tubes are tied in order to disconnect it from the uterus.

Removing Tubes

In cases where the obstruction in the patient's tubes is caused by the accumulation of the fluid called "Hydrosalpenx", the tubes are removed by laparoscopy. In patients who have adhesion problems due to previous abdominal surgery and therefore cannot be applied laparoscopy, the tubes are treated by connecting them from the area where they are adjacent to the uterus.

In patients with fluid accumulation in their tubes, the success of achieving pregnancy decreases by 30% to 50%.

Couples with genetic risk have the advantage of giving birth to a healthy baby with this screening method. After the genetic examination of the embryos before the transfer, healthy embryos are transferred and this result can be achieved. PGD, which is a recommended method for older patients with chromosomal anomaly, enables pre-detection of pregnancy disorders such as Mediterranean anemia and sickle cell anemia.

The PGD Method is a diagnostic method that serves the goal of IVF treatments, “To ensure that healthy babies are born into the world, not too many”. Thanks to this method, many couples at risk of having a diseased child can be analyzed before the transfer.

With the PGD method, a diagnosis can be made by revealing the problems of women who have abortion due to a chromosomal disorder problem or who have unsuccessfully tried in vitro fertilization treatments, who have chromosomal anomalies in their eggs at advanced ages and who carry genetic risk.

In simple terms, one cell is taken from the embryos obtained in method applications and these are examined in terms of genetics. In this way, the possibility of transferring unhealthy embryos is prevented from the very beginning.

Contributing to the birth of healthy babies, which is the main purpose of IVF treatments, PGD has become a method that patients can learn and access more easily thanks to the developing opportunities. The application of PGD for Embryo Screening in patients with recurrent miscarriage or unsuccessful attempts and in advancing ages leads to debates in terms of benefits and harms. .

The embryo freezing method, which enables the embryos obtained in IVF treatments to be preserved for later use, increases the probability of success in the treatments, while at the same time brings economic and mental advantages to the patients. Especially for embryos that are thawed for reuse, it is a serious comfort that the patient is not taken to a new process.

In the first years of its application, it was observed that the embryos preserved by freezing were lost in terms of viability and quality when thawed for later transfer, and this problem was prevented with the developed vitrification method.

For the embryo freezing method, the patients' consent is obtained and after that, the embryos are kept in special environments for a certain period of time. The method has a special value for these patients, as patients younger than 35 years of age are allowed to transfer one embryo in the first two trials, within the framework of the law enacted in Turkey. The embryos of the patients who approve the embryo freezing process can be kept for a period of 5 years, provided that the contract is renewed every year. Embryos of patients who do not give consent are destroyed by adhering to the protocols determined by law.

In IVF treatments, it is aimed to prevent multiple pregnancies by transferring a maximum of 2 embryos, and the remaining embryos can be frozen optionally. Thus, if needed, these embryos are thawed and reused, and the patient does not undergo any new treatment. In addition, this kind of convenience ensures that psychological and economic problems can be prevented beforehand. The embryo freezing method, which can also be applied in our country, allows embryos to be stored for 5 years, subject to the consent of the couples.

In the freezing or thawing processes carried out in practice, first of all, balancing and cooling is done with chemical substances called “Cryoprotectant”. Then, storage in -196 degrees liquid nitrogen, and after dissolution, the embryo is taken from the chemical environment and left in special culture solutions. Thus, it is aimed to provide further development.

In classical IVF and microinjection treatments, pregnancy rates of 25% to 40% can be achieved with this method. The patients in whom 40% can be obtained are those who can achieve pregnancy with fresh embryos or whose embryos have been frozen without transfer.

Chip baby is one of the most technological methods of recent times. This is a type of method related to sperm selection. As a result, the better the sperm we can choose among millions of sperm, the higher the success rate will be. There are actually many methods for choosing a good sperm. In the method we call microchip, the sperms are selected with a slightly different method. Sperm race in very thin channels, then healthy sperm accumulate in one place, unhealthy sperm die on the way anyway, especially sperm with DNA damage accumulate in another place. We use the sperm on the side with healthy sperms in IVF. In fact, this is how it is in the natural process. First, the sperm enter a race, they cross the cervix, they cross the uterine cavity, they cross the ovaries, and there is a race in the meantime. The best sperm reach the egg. Microchip technology is actually a technology that imitates this.

Is the chip baby technology applied by the decision of the people?

Chip baby is just one of the techniques applied. We apply many techniques for IVF. We can monitor the division time and division rate of embryos one by one with a camera. We can then look at the retrospective records and select better embryos. Therefore, chip baby technology is a method related to sperm selection. As for when we apply this, if we are successful with a standard IVF placement, it is fine, but if we have failed a few times, we go into the details. We use new techniques. While using these techniques, we present them to our patients. We are talking about choosing the best sperm with the chip baby method, watching the embryo with a camera, and other details.

What is the embryoscopic method?

We store cells, embryos in a device called an incubator. The temperature of the incubator is 37 degrees, that is, the same as body temperature. According to the old technology, we wonder if the egg is fertilized, take it out of the incubator, examine it under the microscope, and put it back, then we take it out of the incubator again and check whether it has split. Of course, at this time, the egg interacts with the environment. Heat or other factors are affecting the egg that leaves the incubator. Of course, it affects productivity. Later, camera methods came to the fore. By observing the embryo completely from the outside with the camera inside the incubator, we can observe when it divides, when it multiplies, how many cells it has. We can even give these records to our patients. We call the embryoscope to watch the embryo inside the incubator.

It is the method used in case of a problem in the case called "implantation".

Implantation is called implantation when the embryo placed in the uterus continues to divide and grows, and after it reaches a certain size, it ruptures the surrounding Zona Pellucida membrane and is embedded in the inner layer of the uterus (Endometrium). If the embryo cannot tear this membrane, pregnancy does not occur. According to studies, more than 50% of women who apply for treatment cannot get pregnant because of this.

With the assisted nesting method, it is aimed to remove the embryo by tearing the membrane around it. For this, before the transfer to be made, a small hole is opened in the dice and the transaction is performed. Mechanical, chemical or laser methods are used in the process.

Some countries, including Turkey, impose restrictions on the number of embryo transfers. Accordingly, legal regulations have been brought in Turkey and 1 embryo transfer has been made mandatory in the first two in vitro fertilization trials of patients younger than 35 years of age. The only chosen method of blastocyst transfer has been a great advantage for patients living in countries where this requirement has been imposed.

The most important feature of single-selected blastocyst transfer is that it has the most similarity to pregnancy obtained by normal means. It is possible to select embryos with high development potential that can be kept in the laboratory for five to six days in application processes. This feature increases the possibility of positive results and eliminates the possibility of facing multiple pregnancy.

After the discovery and implementation of this method, treatment became possible for many men who were considered impossible to have children due to the absence of sperm in the semen. With the introduction of the Micro-TESE Method among the treatment methods, the hope of these patients to become fathers is becoming a reality.

In micro-TESE applications, testicular tissue is examined with the help of a special microscope and the samples taken from here are taken to the laboratory for examination. When the desired result is obtained, that is, when sperm can be obtained, the process of injecting the eggs is applied. In some cases, freezing is done if necessary.

While sperm is obtained in all patients with obstruction in the sperm carrier channels, the same success can be achieved in half of the patients with production disorders due to the discomfort.

These are the methods applied for the purpose of searching sperm in the testicles. It is possible to find sperm in all of the Obstructive Azoospermia patients caused by obstruction and in half of the Nonobstructive Azoospermia patients caused by production disorder.

In the application, a small incision is made and the “Tunica Albuginea” sheath around both testicles and the sac in which the testicles are located is opened. Then, tissue examination is made under the microscope and samples are taken from the large canals and the application is completed by suturing the incisions. In some publications, it has been argued that this application causes less damage to the testicular tissue than other methods.

While the viability rate of frozen sperm after thawing and the potential to create pregnancy provide positive results in Obstructive Azoospermia cases, the same situation has not been certain in Nonobstructive Azoospermia cases. In these cases, where there are problems in freezing and thawing processes due to structurally defected sperms, careful selection of sperm can be made and freezing can be preferred for later use. However, it is more correct to use fresh sperm in cases of Nonobstructive Azoospermia.

-It has been determined that in patients with Obstructive Azoospermia, surgical procedures can be performed up to 7 times, and sperm can be searched and found in all procedures.

- It has been determined that TESE can be applied up to 6 times and sperm can be collected in patients who have nonobstructive azoospermia and who can find sperm in TESE procedures.

- It was determined that 15% of the nonobstructive azoospermia patients who could not obtain sperm in the first TESE application could obtain sperm in the second TESE application.

-The pregnancy rate obtained with the first TESE application and repeated TESE applications is the same.

One of the problems frequently encountered in patients who apply to IVF clinics is the inability to reach a pregnancy result despite the embryo development being achieved. In general, the reason for this problem is that the embryo cannot tear the membrane surrounding it and cannot settle on the uterine wall (endometrium). The method of thinning the embryo membrane is used to solve this problem, and thus, a significant increase in the pregnancy rate achieved by the patients is observed.

One of the chemical, mechanical and laser methods is applied for the treatment of the patients in question. Thus, a small hole is made in the membrane around the embryo or a thinning process is applied and it is possible for the embryo to come out.

It is a method that is beneficial in treatments, but it is not correct to refer to it with terms such as extraordinary or miracle.

The Embryo Bonding Method can increase pregnancy rates in couples who have had repeated unsuccessful attempts and in elderly female patients. An adhesive called “Glue” is used in application processes.

We can recommend this method to our patients because of the positive results we obtained in two studies that we conducted on women older than 39 years who had repeated unsuccessful attempts.

The fact that the embryos have the opportunity to survive in the culture liquids in the laboratories for a long time also positively affects the pregnancy. The use of this method, together with the developments experienced, enables the selection of high quality embryos and reduces the possibility of multiple pregnancy by using fewer embryos in the transfer process. This method lays the groundwork for applications where embryos can be examined for viability.

Another benefit other than these is that it allows biopsy of the inner cell layers of the blastocyst (Trophoectoderm) in clinics that include preimplantation genetics. Thus, this non-embryonic tissue does not cause any ethical discussion.

It is a method used for research purposes today. Although it was brought to the agenda in early 1990 with the claim that the culture mediums were insufficient for the embryos to reach the advanced developmental stage, it was out of preference with the development of sequential culture mediums that allow embryo development until the 5th to 6th day. The Endometrial Co-culture method is based on the development of a small piece taken by endometrial biopsy from the uterus one month before the treatment with cell culture in the laboratory and monitoring the embryos on the formed cell layer.

In the Spandorfer study published in 2003, it was suggested that this method increases pregnancy rates in couples who experience repeated unsuccessful attempts, but this view was not supported by any other research. The factor that makes the study insufficient is that it was not conducted on randomly selected randomized groups and it is not clear whether it has an independent effect from controlled trauma in the uterus on the increase in pregnancy rates.

With IVF treatment, the chance of pregnancy arises for a patient whose both tubes are blocked. IVF treatment is also used in the following situations:

• Endometriosis

• Unexplained infertility

• Infertility conditions related to the cervix

• Male infertility

• Ovulation disorders

With assisted reproductive techniques, there is a greater chance of pregnancy in the following situations:

• Patients who respond to infertility drugs and ovulate naturally

• Patients who have a healthy uterus

There is less chance of pregnancy with assisted reproductive techniques in the following situations:

• Female patients over the age of 40

• Female patients with early menopause and no longer ovulating

• Female patients with incurable uterine scar tissue, fibroids and polyps

In vitro fertilization is the most preferred assisted reproductive technique. The treatment process begins with the woman using infertility drugs to stimulate her ovaries so that she can produce more eggs than normal. There are follicles in the ovaries. These follicles are fluid-filled sacs.

When the eggs are mature enough, they are retrieved from the ovaries. The follicle fluid containing the egg is taken and placed in a container. Eggs are examined under a microscope. After the incubation period in the laboratory, the washed sperm are added to the vessel. Fertilization and early embryo development take place in this vessel. After 2 - 3 days, the fertilized eggs, that is, the embryos, are transferred to the uterus. This procedure is done with the help of a soft and flexible catheter.

The risks associated with IVF treatment are related to the use of medication and the operation to retrieve the eggs.

Some of these risks are:

• Bleeding

• Infection

• Damage to nearby organs

• Ovarian Overstimulation Syndrome

• Multiple pregnancy risk

Studies show that babies born with assisted reproductive techniques do not have more abnormal conditions than babies born normally.

After your initial evaluation by your doctor, you should make another doctor's visit before starting IVF treatment. During this visit, you will discuss with your doctor about your treatment plan. During one of your doctor's visits, your uterus can be measured with the help of a catheter. Catheter; It is a thin, flexible tool that is used to place the embryo in the womb. Since the catheter is first inserted into the cervix and then into the uterus, the size, shape and direction of the uterus can be determined by the measurement. This is beneficial in embryo placement. Blood tests will be done to identify any infections you or your partner may have.

A sperm sample is requested from the man so that it can be analyzed. If an abnormal situation is encountered in the sperm analysis, another sample may be requested for further examinations.

Nurses will tell you about your treatment plan and how you should use your medications.

Stimulating the Eggs:

The IVF treatment process begins in the menstrual cycle, depending on the egg stimulation process. (about a week before the woman's period) During this period, the woman uses GnRH analog drugs to stimulate her eggs. This drug effectively reduces the release of hormones that control the development of eggs in the ovaries. When you have your period, vaginal ultrasound and blood tests are performed to check whether the drug reduces egg development. If it has not decreased, the drug treatment is continued for another week or two. When the function of the ovaries temporarily ceases completely, true stimulation therapy begins. Hormone therapy is applied for about 10 days to stimulate the ovarian follicles. Blood tests and ultrasound will be needed throughout treatment to determine follicle sizes. The use of the drug continues for about 10 - 12 days. When adequate egg stimulation is achieved, another hormone, hCG, is injected. Eggs are collected 36 - 38 hours after hCH injection.
 

Egg Collection and Fertilization of Eggs:

Egg retrieval is performed under anesthesia. Egg retrieval usually takes between 20 and 50 minutes. The fluid taken from the follicles is immediately taken to the embryology laboratory. In the laboratory, eggs are placed in a special solution and placed in the incubator. The length of time the eggs will spend in the incubator depends on how mature they are. On the day of egg collection, the male collects the sperm sample by masturbation and delivers it to the laboratory. The sperm sample can also be collected outside the center in special cases. In particular, couples who may have difficulties in giving sperm samples outside the home by masturbation without a partner can obtain sperm samples at home. After the sperm is obtained, it should be delivered to the embryologists at the center within a maximum of 1 hour. If this period is more than 1 hour; The male sample should obtain in the center. If it is obtained outside the center; The sample should be delivered to the IVF laboratory at room temperature (without exposure to excessive heat or cold), without exposure to light. In rare cases, a second sperm sample may be requested on the same day. The next step is to combine the eggs with the sperm. The fertilization rate of eggs is usually 80%. Eggs are checked 24 hours after retrieval. Fertilization also took place during this time. If deemed necessary, some embryos can be frozen and stored. If pregnancy does not occur after treatment, frozen embryos can be used for the next transfer. In this way, the patient will not repeat the egg stimulation process again. The patient is discharged within 2 - 4 hours after the procedure and is asked to rest at home for 24 hours. It is natural to have pain in the waist, in the groin similar to menstrual pain, red or brown bleeding (from the chamber) in the form of drops within 1-2 days after the egg collection process. Such bleeding does not have a negative effect on the chance of pregnancy as it is not from the uterus.

You may need to inform your doctor if any of the following conditions occur:

a) Fever higher than 38 degrees by measuring

b) Excessive vaginal (from the chamber) bleeding (some bleeding is normal)

c) Very severe and persistent pain (some pain is normal)

d) Weight gain of more than 1 kg in 2 consecutive days

e) Inability to urinate with increasing pain 8-10 hours after the procedure

Embryo Transfer:

Embryo transfer is done within 1-3 days after the eggs are retrieved. The number of embryos to be transferred depends on the quality of the embryo, but the legal limit is three in our country. After the embryo transfer process, you need to rest for 2 days. 12 days after embryo transfer, a blood pregnancy test (blood beta hCG) is performed. Even if there is bleeding that is thought to be compatible with menstruation, a pregnancy test must be performed because sometimes there may be vaginal bleeding due to the embryo being placed in the uterus even though pregnancy occurs. If the test is positive, that is, if there is a pregnancy, the ultrasound is checked after about 3 weeks.

To begin with, the couples are examined and an anamnesis form (information given by the patient about the disease and the environment) is prepared for the couples by listening to the diseases they have experienced and their treatments, if any, the results of pregnancy and birth events, etc. All previous examinations and treatment reports, if available, are reviewed, and additional required analyzes are performed if necessary, and the results are added to this form. If it has not been done, a spermiogram (sperm test) is requested for the male. For this reason, the man should not have had intercourse (ejaculated) for 3 days before coming to the first examination.

Routine tests requested during normal pregnancy for treatment are valid for this treatment. As requested from the couples (complete blood count, blood group, tsh, hepatitis tests, torch...) and in addition to this, ultrasound examination is requested from the expectant mother. Apart from this, if necessary, the uterine film hsg is taken again.

IVF or ICSI, which is the treatment method to be applied in line with the new tests applied, old tests and Gynecological Examination, is decided. Afterwards, all necessary information is given to the patient couple about the treatment and methods that make up the ovulation treatment, which is the continuation of the treatment, and the treatment and methods that make up the IVF process.

Important Note: When you come to your first appointment, please bring with you all the tests you have had about infertility, film results, surgery reports, if any, etc.

After your initial evaluation by your doctor, you should make another doctor's visit before starting IVF treatment. At this visit, you will discuss your treatment plan with your doctor. During one of your doctor's visits, your uterus can be measured using a catheter. Catheter; It is a thin, flexible tool that is used to place the embryo in the womb. Since the catheter is first inserted into the cervix and then into the uterus, the size, shape and direction of the uterus can be determined by the measurement. This is beneficial for embryo implantation. Blood tests will be done to identify any infections you or your partner may have.
A sperm sample is requested from the man so that it can be analyzed. If an abnormal situation is encountered in the sperm analysis, another sample may be requested for further examinations.
Nurses will tell you about your treatment plan and how you should use your medications.

Stimulating the Eggs:

The IVF treatment process begins in the menstrual cycle, depending on the egg stimulation process. (about a week before the woman's period) During this period, the woman uses GnRH analog drugs to stimulate her eggs. This drug effectively reduces the release of hormones that control the development of eggs in the ovaries. When you have your period, vaginal ultrasound and blood tests are performed to check whether the drug reduces egg development. If not, the drug treatment is continued for another week or two. When the function of the ovaries temporarily ceases completely, true stimulation therapy begins. Hormone therapy is applied for about 10 days to stimulate the ovarian follicles. Blood tests and ultrasound will be needed throughout treatment to determine follicle sizes. The use of the drug continues for about 10 - 12 days. Once sufficient egg stimulation is achieved, another hormone, hCG, is injected. Eggs are collected 36 - 38 hours after hCH injection.

Egg Collection and Fertilization of Eggs:

Egg retrieval is performed under anesthesia. Egg retrieval usually takes between 20 and 50 minutes. The fluid taken from the follicles is immediately taken to the embryology laboratory. In the laboratory, eggs are placed in a special solution and placed in the incubator. The time the eggs spend in the incubator depends on how mature they are. On the day of egg collection, the male collects the sperm sample by masturbation and delivers it to the laboratory. The sperm sample can also be collected outside the center in special cases. In particular, couples who may have difficulties in giving sperm samples outside the home by masturbation without a partner can obtain sperm samples at home. After the sperm is obtained, it should be delivered to the embryologists in the center within 1 hour at the most, if this period is more than 1 hour; The male sample should obtain in the center. If it is obtained outside the center; The sample should be delivered to the IVF laboratory at room temperature (without exposure to extreme heat and cold), without exposure to light. In rare cases, a second sperm sample may be requested on the same day. The next step is to combine the eggs with the sperm. The fertilization rate of eggs is usually 80%. Eggs are checked 24 hours after retrieval. Fertilization also took place during this time. Some embryos can be frozen and stored if deemed necessary. If pregnancy does not occur after treatment, frozen embryos can be used for the next transfer. In this way, the patient will not repeat the egg stimulation process again. The patient is discharged within 2 - 4 hours after the procedure and is asked to rest at home for 24 hours. It is natural to have pain in the waist, in the groin similar to menstrual pain, red or brown bleeding (from the reservoir) in the form of drops within 1 - 2 days after the egg collection process. Such bleeding does not have a negative effect on the chance of pregnancy as it is not from the uterus.
You may need to inform your doctor if any of the following conditions occur:
a) Fever higher than 38 degrees by measuring
b) Excessive vaginal (from the chamber) bleeding (some bleeding is normal)
c) Very severe and ongoing pain (some pain is normal)
d) Weight gain of more than 1 kg in 2 consecutive days
e) Inability to urinate with increasing pain 8-10 hours after the procedure

Embryo Transfer:

Embryo transfer is done within 1-3 days after the eggs are retrieved. The number of embryos to be transferred depends on the quality of the embryo, but the legal limit is three in our country. After the embryo transfer process, you need to rest for 2 days. 12 days after embryo transfer, a blood pregnancy test (blood beta hCG) is performed. Even if there is bleeding that is thought to be compatible with menstruation, a pregnancy test must be performed because sometimes there may be vaginal bleeding due to the embryo being placed in the uterus even though pregnancy occurs. If the test is positive, that is, if there is a pregnancy, the ultrasound is checked after about 3 weeks.

Ligation or Removal of Tubes
Some patients undergoing IVF treatment experience a problem of obstruction in their tubes. In cases where this obstruction occurs at the ends of the uterus, secretions accumulate in the tubes and these affect the embryos in a toxic way. As a result, the probability of conceiving is reduced by 50%. This problem experienced by the patients in question can be understood with the HSG method.

When the same problem is seen in the ultrasound evaluation, one of the options to remove or connect the tubes is applied. In cases where the removal of the tubes is on the agenda, the procedure is performed by entering the abdomen from the umbilicus using a laparoscopy camera; In cases where the procedure cannot be performed, tubes are tied in order to disconnect it from the uterus.

PGD (Preimplantation Genetic Diagnosis)
The PGD Method is a diagnostic method that serves the goal of IVF treatments, “To ensure that healthy babies are born into the world, not too many”. Thanks to this method, many couples at risk of having a diseased child can be analyzed before the transfer.

With the PGD Method, a diagnosis can be made by revealing the problems of women who have miscarriage due to a chromosomal disorder problem or who have unsuccessfully tried IVF treatments, who have chromosomal anomalies in their eggs at an advanced age, and who carry genetic risk.

In simple terms, one cell is taken from the embryos obtained in method applications and these are examined in terms of genetics. Thus, the possibility of transferring unhealthy embryos is prevented from the very beginning.

Embryo Freezing Method
The embryo freezing method, which enables the embryos obtained in IVF treatments to be preserved for later use, increases the probability of success in the treatments, while at the same time brings economic and mental advantages to the patients. Especially for embryos that have been thawed for reuse, it is a serious comfort that the patient is not taken into a new process.

In the first years of its implementation, it was observed that the embryos preserved by freezing were lost in terms of viability and quality when thawed for later transfer, and this problem was prevented with the developed vitrification method.

For the embryo freezing method, the consent of the patients is obtained and after that, the embryos are kept in special environments for a certain period of time. The method has a special value for these patients, as patients younger than 35 years of age are allowed to transfer one embryo in the first two trials, within the framework of the law enacted in Turkey. The embryos of the patients who approve the embryo freezing process can be kept for a period of 5 years, provided that the contract is renewed every year. Embryos of patients who do not give consent are destroyed by adhering to the protocols determined by law.

Single Selected Blastocyst Transfer
In some countries, including Turkey, restrictions are imposed on the number of embryo transfers. Accordingly, legal regulations on the subject have been brought in Turkey and 1 embryo transfer has been made mandatory in the first two IVF trials of patients younger than 35 years of age. The only chosen method of blastocyst transfer has been a great advantage for patients living in countries where this requirement has been imposed.

The most important feature of single-selected blastocyst transfer is that it has the most similarity to pregnancy obtained by normal means. It is possible to select embryos with high development potential that can be kept in the laboratory for five to six days in application processes. This feature increases the possibility of positive results and eliminates the possibility of facing multiple pregnancy.

Micro-TESE Method
After the discovery and implementation of this method, treatment became possible for many men who were considered impossible to have children due to the absence of sperm in the semen. With the introduction of the Micro-TESE Method among the treatment methods, the hope of these patients becoming a father is becoming a reality today.

In Micro-TESE applications, testicular tissue is examined with the help of a special microscope and the samples taken from here are taken to the laboratory for examination. When the desired result is obtained, that is, when sperm can be obtained, the process of injecting the eggs is applied. In some cases, freezing is done if necessary.

While sperm is obtained in all patients with obstruction in the sperm carrier channels, the same success can be achieved in half of the patients with production disorders due to the discomfort.

Thinning of the Embryo Membrane
One of the problems frequently encountered in patients who apply to IVF clinics is the inability to reach a pregnancy result despite the embryo development being achieved. In general, the reason for this problem is that the embryo cannot tear the membrane surrounding it and cannot settle on the uterine wall (endometrium). The method of thinning the embryo membrane is used to solve this problem and thus a significant increase in the pregnancy rate achieved by the patients is seen.

In vitro fertilization is the process of artificially fertilizing the egg cells taken from the woman and the sperm cells taken from the man in the laboratory environment and placing the obtained embryo in the mother's womb after it reaches a certain size, following the evaluations made after the couples who have problems conceiving in vitro fertilization apply to the hospital.

In vitro fertilization can be applied in two ways according to the clinical results of the patient. The first is the classical method IVF "in-vitro fertilization" and the second is ICSI "Microinjection (Intracytoplasmic sperm injection)".

The expansion of IVF from these two applications is the fertilization of the egg by one of the sperm by leaving the sperm taken from the father around the egg taken from the mother in a special environment in the laboratory.

Microinjection is the injection of a live sperm selected from the man into the egg taken from the woman. Today, this method is more preferred.

Who is IVF applied to?
In cases where the couple is not protected and cannot get pregnant within 1 to 2 years despite the desire for a child.
Both tubes are clogged.
Severe infection, ectopic pregnancy, tuberculosis, etc. as,
Polycystic ovary syndrome.
Severe sperm disorder in the male (number, low motility).
Problems caused by the late age factor in women.
The absence of sperm in the semen, in the medical term azoospermia.
Endometriosis is when the endometrioma, which is the inner layer of the uterus, is located outside the uterus, especially in the ovaries, peritoneum and rarely in other parts of the body.
Women with common intra-abdominal adhesions.
In patients with a complex disorder that occurs as a result of abnormal functioning of the ovaries and some glands due to hormonal imbalance in women.
Fibroids (cysts) that cause infertility, although they are known as benign tumors.
Unexplained infertility. (For this reason, the patient is first treated by vaccination, if the result is not obtained, in vitro fertilization is applied.)

It can increase the amount of menstruation and prolong their duration. In addition, premenstrual spotting, intermittent bleeding and prolonged menstruation can be seen in fibroids.

As the fibroid grows, it pushes the endometrial tissue and therefore the surface area of this tissue increases. As the area suitable for bleeding increases, the amount of bleeding also increases. Initially, the duration of bleeding does not change, only the amount of blood lost increases. Then gradually the time starts to get longer. This excess bleeding causes anemia after a while, that is, "anemia".

Pain in fibroids usually occurs due to degenerations. It may be a gradually increasing groin pain, or it may appear as an acute pain. Sometimes patients may complain of cramp-like pain. Low back and groin pain and a feeling of fullness in the groin are the symptoms encountered with fibroids.

The fibroid core behaves as if it were a foreign body and the uterus contracts to expel this foreign body. The person perceives these contractions as pain. A severely enlarged fibroid can also cause pain by pressing on the surrounding tissues and nerves. Here, complaints such as low back pain are more common.

Urinary symptoms such as frequent urination by pressing on the bladder may cause complaints such as constipation and tenesm by pressing on the large intestine.

Fibroids can sometimes be the cause of infertility. However, fibroids can be held responsible for infertility after other causes of infertility are investigated and eliminated. Depending on the region and size of the fibroids, they may be a cause of infertility, but not every patient with fibroids is infertile.

Sometimes the reason that brings the patient to the doctor may be swelling or enlargement of the abdomen. Weak patients may notice swelling in their abdomen.

Not all fibroids need to be surgically removed. Patients who do not have pain, pressure sensation, irregular and excessive bleeding complaints are checked regularly and myoma size is monitored. Patients who are considering pregnancy in the future or patients who will go through menopause are followed in this way.

Myomas that cause complaints and grow rapidly should be surgically removed. Surgery in which only fibroids are removed by leaving the uterus is called myomectomy. The location and size of the fibroid determines the type of surgical procedure.

Myoma Treatment with Hysteroscopy
Fibroids located in the uterine cavity can be removed by surgical hysteroscopy. With the hysteroscope placed in the uterus, only fibroids located in the uterus are removed.

Laparoscopic Myoma Treatment (Laparoscopic Myomectomy)
Surgical laparoscopy can be used to remove fibroids located on the outer wall of the uterus. Through a thin incision, the abdomen is entered with the laparoscope, and the fibroids are removed. Patients usually recover within two days.

Robotic Myoma Treatment (Robotic Myomectomy)
In robotic myomectomy surgery, myoma is made with much smaller incisions compared to laparoscopy. With the advantages of robotic surgery, it minimizes damage to the surrounding tissue. Since the incision is small and bleeding is less, it heals much faster. In robotic surgery, the most important advantage of which is the protection of the surrounding tissue, the possibility of experiencing problems during future pregnancy is almost non-existent.

If the fibroids are very large or numerous, laparotomy, which is a larger intervention than other methods, can be applied. It takes four to six weeks for the patient to recover after surgery. Patients who have undergone myomectomy may need to have a cesarean section if they give birth in the future.

Hormone therapy can be used to reduce pain. Hormones can help slow the growth of endometrial tissue. Among the most used hormone treatments; birth control pills, gonadotropin-releasing hormone (GnRH) agonists, progestin and danazol. However, many women cannot get rid of their pain with medication; because drugs do not remove adhesions or scar tissue that cause pain.

Medication is not suitable for every woman. Many drugs also have some side effects related to hormone therapy. Still, some women prefer pain relief to the side effects of medications.

Birth Control Pills:
Birth control pills are often prescribed for the symptoms of endometriosis. The hormone present in these pills regulates the regularity of the menstrual cycle; It provides painless and short time. There is no evidence that birth control pills shrink endometriosis or increase fertility.

GnRH Agonists:
GnRH is a hormone that helps keep the menstrual cycle under control. GnRH agonists are drugs that are similar in nature to human GnRH but are often stronger than natural ingredients. GnRH agonists deactivate the ovaries, lowering estrogen levels. This procedure creates a temporary process similar to menopause.

GnRH agonists can be given by needle, by an implant, or by nasal spray. Usually, the endometriosis patches shrink and the pain is relieved. GnRH also helps relieve pain during sexual intercourse. Women using GnRH may experience hot flashes, headaches and vaginal dryness.

Treatment with GnRH usually takes around 6 months. You will start menstruating again 6 to 10 weeks after you stop using GnRH. Endometriosis symptoms may recur in half of women who have used GnRH, especially if their symptoms are severe.

Progestin:
The hormone progestin is also used to shrink patches of endometriosis. Progestin fights the effects of estrogen on tissue. Menstruation does not occur while using progestin. Progestin can be taken in the form of injections or pills.

Danazol:
Danazol is a synthetic hormone that shrinks endometrial tissue. It is taken in pill form and prevents you from menstruating.

Danazol works very well in reducing pelvic pain and pain during sexual intercourse. Endometriosis symptoms usually return within 6 weeks after you stop taking the medication. Side effects of danazol include weight gain, acne, voice changes and hair growth.

Danazol treatment is not suitable for everyone. Women with liver, kidney and heart problems cannot use danazol.

Endometriosis surgery is recommended for patients with a diagnosis of infertility, those with bilateral chocolate cysts, adolescents, patients with low ovarian reserve, and patients who have had previous recurrent operations. Endometriosis is a disease that seriously reduces the patient's comfort of life. If the pain is very intense and affects his daily life, surgical treatment and drug treatment may be recommended together. Surgery is the most effective treatment in terms of reducing pain and increasing life comfort.

Surgery can be done to remove Endometriosis and surrounding scar tissue. Healthy ovaries and normal fallopian tubes are left inside to increase the chances of a possible pregnancy.

The operation is successful in terms of both pain relief and infertility treatment, but the symptoms may return over time. Many patients are treated with both surgery and medication to prevent recurrence of the disease. One third of women who have had an operation may need another operation within 5 years. If the patient's pain is very severe and does not go away, if he does not want to have children, the doctor may recommend removal of the uterus, tubes and ovaries. After this operation, the patient does not menstruate again and cannot become pregnant.

Endometriosis Surgery can be performed openly by lapatomy, or it can be performed laparoscopically with a closed method. However, with the developing technology and treatments, Robotic Surgery is the gold standard in Endometriosis surgery.

Do not damage the ovarian reserve: Endometriosis surgery is often applied for the treatment of infertility. The surgeon's experience is very important in endometriosis surgery. In endometriosis surgery, the ovarian tissue outside the cyst wall should not be damaged. One of the most important reasons why robotic surgery is the gold standard in endometriosis surgery is that it causes minimal damage to the surrounding tissue due to small incisions, 3-dimensional vision and the ability of the arms to move like a human wrist inside. If the ovarian tissue is damaged, the eggs found here may be damaged and the patient may face early menopause and infertility problems in the future. Avoiding damage to the ovaries, tubes and uterine tissue is the most important point in chocolate cyst surgery.

Opening adhesions: Chocolate cyst is not as sweet as its name, but unfortunately it is sticky like chocolate. Pain is related to intense adhesions. The opening and correction of these adhesions during surgery is of great importance for pregnancy treatment and reduction of pain.

Removal of deeply located endometriosis nodules:  Endometriosis does not occur only in the uterus. Deep endometriosis is a condition that spreads between the vagina and the rectum to the uterine ligaments, intestines, urethra, or deep into the abdomen. In this condition, which is defined as Deep Infiltrative Endometriosis, it is a surgery that requires a multidisciplinary approach, not only in gynecological diseases but also in general surgery urology units.

The experience of the doctor is of great importance in the surgery of “deep infiltrative endometriosis”. During the surgery, it is necessary to free the area between the uterus and the intestine and the ureter. In the treatment of deep endometriosis that causes severe inguinal abdominal pain, removal of chocolate cyst and ovarian cysts will not be sufficient, but deep infiltative endometriosis nodules should also be removed. It is very important not to damage the surrounding tissue, nerves and organs in deep endometriosis surgery. Therefore, deep endometriosis surgery should be performed by experienced doctors. Robotic surgery as a surgical treatment minimizes the risk. However, the same treatment can be applied by performing laparoscopic surgery with an experienced doctor.

Follicles form in the ovaries every month, similar to cysts. Follicles produce the hormones estrogen and progesterone and release the egg when you ovulate. Sometimes a monthly normal follicle continues to grow, in which case it is called a functional cyst. This means that this cyst formed during the normal function of the menstrual cycle.

There are 2 types of functional cysts:

Follicular Cyst: Towards the middle of the menstrual cycle, the pituitary gland in your brain releases the hormone LH, signaling this follicle to release the egg. When everything goes according to plan, the egg leaves the follicle and begins its journey towards the fallopian tubes, where fertilization will take place.

Follicular cyst occurs when the LH surge does not occur. As a result, the follicle does not crack and does not release the egg. Instead, it grows and turns into a cyst. Such cysts are generally harmless, rarely painful, and usually disappear spontaneously within 2-3 menstrual cycles.

Corpus luteum Cyst: When the LH hormone is increased and the egg is released, the cracked follicle begins to produce greater amounts of estrogen and progesterone to enable pregnancy. This altered follicle is now the corpus luteum. Sometimes, however, the exit gate of the egg is blocked and fluid builds up inside the follicle, causing the corpus luteum to form a cyst.

Although this cyst usually resolves spontaneously within a few weeks, it can also form a 7 cm cyst; It can cause internal bleeding, cause rotation of the ovary, interfere with the blood supply, and cause abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sudden severe pain.

A large ovarian cyst can cause abdominal discomfort. If a large cyst is pressing on your bladder, you may need to urinate more often.

Some women may develop cysts that are asymptomatic but are discovered during a pelvic exam. Cystic structures formed after menopause may be precursors of cancer. These factors make regular examination important.

The following types of cysts are rarer than functional cysts:

Dermoid Cyst: Since these cysts are formed from cells that produce human eggs, they can contain tissues such as hair, skin, and teeth. They are rarely cancerous, but they can enlarge and displace the ovary normally. This increases the chance of painful rotation of the ovary, called ovarian torsion.

Endometrioma (Chocolate Cyst): These cysts develop as a result of endometriosis. Endometriosis is the settlement of the endometrium, which is found in the inner layer of the uterus and spills out every month in the form of menstrual bleeding, in a place outside the uterus in the body. This tissue can attach to the ovary and grow there.

Cystadenoma: These cysts are formed from ovarian tissue and have a water-like liquid or slimy material inside. They can grow up to 17 cm and cause ovarian torsion.

A cyst may be found during pelvic examination. If a cyst is suspected, your doctor may order further tests to determine the nature of the cyst and whether you need treatment.

In general, doctors ask many questions to diagnose a cyst.

Shape
Size
Composition: If it is filled with liquid, is it a single type of liquid or mixed?

To determine the nature of the cyst, your doctor may perform the following procedures:

Pregnancy test: A positive pregnancy test may indicate that the cyst is the Corpus luteum.

Pelvic ultrasound: With this device, it gives an image of the uterus and ovaries from the abdomen or through the vagina.

Laparoscopy: With the help of the laparoscope, your doctor can see the ovaries and remove the cyst.

CA 125 Blood Test: If you have an ovarian cyst that is partially solid, you are at risk of cancer and your doctor may order a CA 125 blood test. The CA 125 blood test may also be ordered when it is not a cancerous condition, such as endometriosis.

Treatment may vary according to your age, the nature and size of the cyst and your complaint. Your doctor may recommend:

Observation: If you are in your reproductive years, you have no complaints and you have a simple fluid-filled cyst on ultrasound; your doctor may recommend waiting and re-examination in 1 - 3 months. Observation includes regular follow-up with ultrasound.

Birth Control Pills: Your doctor may recommend birth control pills to prevent the formation of new cysts in future menstrual periods. With birth control pills, your chances of getting ovarian cancer are also reduced.

Operation: If the cyst is large, does not resemble a functional cyst, and continues to grow, your doctor may also recommend surgical removal.

Some cysts can be removed without the need to remove the ovary, known as a cystectomy. Your doctor may also suggest removing a damaged ovary and leaving the undamaged one. This is also called an oophorectomy. Both procedures do not harm your fertility. By not removing at least one ovary, estrogen production continues.

If your cyst is cancerous, your doctor may recommend a hysterectomy (removal of both the ovaries and uterus). After menopause, the formation of cancerous cysts increases. As a result, most doctors recommend the operation for cystic structures formed after menopause.

Protection

While there is no sure way to prevent an ovarian cyst from growing, early diagnosis can be made with regular pelvic exams. Also, watch for changes in your monthly menstrual cycle, observe symptoms, and contact your doctor in case of adverse events.

Menopause symptoms in women are undoubtedly among the most curious about menopause. During this period, the secretion of estrogen hormone in women decreases, and accordingly, ovulation decreases or stops. This condition causes atrophy of the urinary tract, which can cause hot flushes, palpitations, sweating, weakness, depression, osteoporosis, a tendency to develop arteriosclerosis, reluctance to sexual intercourse, dryness in the genitals, painful intercourse and urinary incontinence.

Menopause, which also shows symptoms in terms of mental aspects, causes easy irritability, insomnia, mental tension, forgetfulness, introversion and sexual reluctance. However, these conditions can show symptoms not only as a sign of menopause, but also as a precursor to other diseases. Such symptoms should not be neglected and a specialist should definitely be consulted.

There is no complete answer to the question of how long the menopause period lasts in women, which is quite a curiosity. This situation differs for each person. Normally, it passes between 3-5 years. However, depending on this person, it may take 10 years for some people and 1 year for others. In a woman who is in the menopause period, there is a decrease in bone mass and bone destruction increases. In addition, lower urinary tract infections are common. On the other hand, one of the most important problems is cardiovascular diseases. This is related to the decrease in estrogen hormone.

It should be known that sexual desire does not occur due to menopause. Because for women, sexuality is a type of behavior that can be learned. Therefore, postmenopausal sexuality in women can become more colorful than before, which is very natural. However, there may be a decrease in sexual desire during the depression attacks and adjustment phase that may occur during the menopause entry phase. In this case, it is possible to get rid of it by getting support with the right methods and applying treatments without panicking.

In women, whom it is very difficult to overcome alone, during the menopause period, people around the person have great duties. During this period, it is very important for the spouse and children to be understanding and to help the woman, that a woman can easily cope with this difficult process thanks to the support and consolation of her relatives.

As a result, the woman goes into great trouble due to the cessation of menstruation and the loss of her fertility, and the physical and mental problems she experiences make this period very difficult.

Stress urinary incontinence A small amount of urinary incontinence occurs during physical activities such as coughing, sneezing, and exercise.

Urge incontinence is the involuntary incontinence that develops after the sudden urge to go to the toilet when the bladder is full or empty. Especially the sound of water (eg washing dishes), cold drinks or exposure to cold can trigger this condition. In this situation, which can occur unexpectedly, even during sleep, excessive urinary incontinence is seen.

Stress and urge urinary incontinence are seen together in mixed urinary incontinence.

Functional urinary incontinence: Untimely urinary incontinence due to physical disability, external obstacles, or thinking or communication disorders that prevent the individual from going to the toilet. It can be seen in conditions such as limitation of movement, diabetes, heart failure, hypercalcemia (higher than normal calcium level in the blood), atrophic urethritis, constipation (constipation), acute confusion (blurring of consciousness). In some cases, the triggering cause is temporary or reversible.

Overflow urinary incontinence is an unexpected low amount of urinary incontinence due to the obstruction of bladder outlet or the inability of the bladder muscle to contract, due to a full bladder.

Transient urinary incontinence is occasional urinary incontinence, often due to infection or drug use.

Continuous urinary incontinence Fistulas, which often develop following pelvic surgery or difficult delivery, can cause Continuous urinary incontinence.

Often, causes such as mood disorders or depression can cause loss of urinary control. Sudden fear or emotional changes may be accompanied by urinary incontinence.

Urinary incontinence while laughing: It is rarely seen, usually in young girls. It is the occurrence of partial or complete urination during or immediately after laughing.

Urinary incontinence during sexual intercourse Incontinence that occurs during vaginal penetration or orgasm (sexual intercourse or masturbation)

The ideal treatment for this type of urinary incontinence is surgery. For this purpose, the most common and most effective surgical treatment is the placement of a patch under the urinary tract. Resembling a small fishing net, this patch also supports the urethra and prevents urinary incontinence. This patch can be put in 4 ways:

TVT (Tension free Vaginal Tape):

The operation is performed vaginally. A small 1 cm incision made under the urethra is entered with a needle, and the patch is placed under the urethra and the patch arms are kept behind the pubic bone.

TOT (Trans Obturator Tape):

The operation is performed vaginally. The patch is placed under the urethra by hooking through the "obturator" hole on both sides of the pelvis.

Mini-sling: The operation is performed vaginally. It is the placement of a patch piece shorter than 20 cm in length and approximately 1 cm in width under the urethra. Since a short patch is used in this surgery, long anatomical distances are not covered.

Prepubic sling: Operation is performed vaginally. A small 1 cm incision made under the urethra is inserted with a needle, the patch is placed under the urethra, and the patch arms are kept in the anterior part of the pubic bone.

It is the situation where a part of the patch is visible (excursion) due to the inability to cover the placed patch by the body. It is not usually a life-threatening condition. Under local anesthesia, it is sufficient to cut the visible part and simply suture the tissue. If the apparent size of the patch is less than 0.5 cm and the patient is in menopause, estrogen cream treatment may be sufficient without the need for surgery.

Bleeding may occur, especially if the hook injures a vital vessel during the operation. After the operation, inability to urinate, abdominal and groin pain, fistulas, numbness in the feet and difficulty in walking may occur. It is very important that this operation is performed in a fully equipped center and by doctors who are experts in their field.

“Burch colposuspension” is one of them. Which operation will be performed on which patient is decided after the evaluation of the patient.

This examination should be performed in appropriate patients. For example, patients who have had surgery for urinary incontinence before, but whose complaints continue, those with urinary incontinence with a sudden urge to void, those with severe genital organ prolapse, those with unclear complaints on this subject; These tests can be applied in the presence of a history of urinary retention (inability to pass urine even though the bladder is full), the patient is older than 65 years, urinary incontinence at night, and in the presence of known or suspected neurological disease.

There are various opinions about the place of medical treatment in stress urinary incontinence. In particular, drug treatment can be planned in urinary incontinence with a sudden urination, which is called overactive bladder.

Medications can have some side effects in the medical treatment of urinary incontinence. These can be listed as:

• dry mouth
• Constipation
• blurred vision
• Headache
• feeling dizzy
• clouding of consciousness
• Tiredness
• memory impairment
• psychotic behavior
• Insomnia
• Nausea
• Tachycardia (Increased heart rate)
• Orthostatic hypotension (lower blood pressure when standing up)
• mental disorder called delirium

Who should not use drugs in the medical treatment of urinary incontinence?

• closed angle glaucoma
• muscle disease called myasthenia gravis
• Heart diseases with conduction disorder
• These drugs should not be used in case of gastrointestinal obstructions (stomach or intestinal obstructions).

There is no clear information on when the drug should be discontinued if the patient's complaints subside. Because the symptoms may reappear shortly after stopping the drug intake. With the consent of the patient, it is appropriate to discontinue these drugs 3 months after the end of the complaints.

Since it is operated with incisions smaller than 1 cm on the abdominal wall, the patient has less pain after surgery compared to open surgery and provides much faster recovery. The length of stay in the hospital is reduced and it provides a quick return to daily life. Since it is made with small incisions, the risk of damaging the surrounding tissue is almost completely eliminated, but this risk still exists in open surgery. Due to less blood loss, robotic surgery minimizes the risk in elderly or risky patients.

The movements of the camera and surgical arms are limited in laparoscopic surgery. However, in robotic surgery, the camera and surgical arms are much more flexible and comprehensive. In laparoscopic surgery, camera clarity is less, whereas in robotic surgery, a three-dimensional and clearer image can be obtained. While the hand vibrations of the doctor are reflected on the laparoscope devices in laparoscopic surgery, there is no such possibility in robotic surgery and the risk of damaging the surrounding tissue is negligible in robotic surgery. In long operations such as cancer surgery, the possibility of making mistakes and being distracted by the doctor in robotic surgery is eliminated because he sits down. The patient recovers faster and experiences much less pain due to all factors.

Robotic surgery is a surgical method that combines the best aspects of laparoscopic surgery and open surgery. Performing robotic surgery in the removal of fibroids that are too large to be removed by laparoscopy prevents factors such as larger incision, higher blood loss and damage to the surrounding tissue in open surgery. At the same time, greater mobility and vision capabilities allow to prevent complications in laparoscopic surgery.

The most important risks in myoma surgeries are the rupture of the uterus and the problems that may occur in future pregnancies. With Robotic Myomectomy, these possibilities are reduced to almost zero.

After placing the robotic instruments on the patient with 2 10 mm and 2 8 mm incisions, an incision is made in the area of the fibroids. After the fibroids are separated from the uterine wall, the uterine wall is repaired in 2 to 3 layers and the removed fibroids are broken up and removed through the small hole.

The biggest advantage of robotic myomectomy is that it is the safest method for future pregnancies. Since the incisions are small, pain and blood loss are less. Since the incisions are very small, scarring is almost negligible. It provides the possibility of discharge on the same day and a faster return to daily life.

In this method, a tiny incision is made near the navel, and the abdomen is inflated with carbon dioxide gas. An instrument called a laparoscope is inserted into the pelvic cavity and images of the uterus, ovaries and neighboring pelvic organs are taken. Then the operation is done through other small incisions made in the abdominal wall. The fibroid is removed through extra-small incisions in the uterine wall or a small incision in the vagina. (colpotomy)

Laparoscopy uses smaller incisions than laparotomy, thus shortening the post-operative recovery period. Some surgeons have specific rules for determining when laparoscopy can be performed regarding the size and number of fibroids. However, there is no consensus on this. A surgeon may use this technique only for fibroids outside the uterus and easy to reach. An experienced surgeon can remove even very large fibroids by laparoscopy.

Laparoscopic myomectomy usually does not require hospitalization, and the recovery period is between a few days and 2 weeks. It has very important advantages over open surgery.

Hysteroscopic myomectomy may be recommended to treat submucosal fibroids, i.e. fibroids that bulge and protrude in the uterine cavity.

General or spinal anesthesia is used in hysteroscopic myomectomy. A small, lighted instrument called a resectoscope is inserted through the vagina, which can cut through the tissues. Attached to the instrument is a tube that releases a clear fluid and expands the uterine cavity so that it is possible to examine the uterine walls.

Subsequently, the fibroid is dissected with the aid of a resectoscope until it aligns with the surface of the uterine cavity. The removed tissue is cleaned by washing with the liquid that expands the uterus.

In hysteroscopic myomectomy, hospitalization is usually not required, the recovery period is less than a week.

Abdominal myomectomy is performed under general anesthesia. The uterine cavity is reached through one or two incisions:

- Vertical incision: It is an incision starting from the middle of the abdomen and extending to the pubic bone below the navel. The vertical incision gives the surgeon greater access to the uterus and reduces bleeding. Some surgeons recommend using a vertical incision if the uterus appears to be enlarged, as if it were carrying a 16-week pregnancy. This incision is also useful if the fibroid is a connective tissue between the uterus and pelvic wall.

- Horizontal incision: It is an incision above the pubic bone. Because it follows natural skin lines, a thinner wound causes less pain. However, there is less access to the pelvis; this is also an important issue if the uterus is large or disrupted.

During the operation, the surgeon examines the uterus visually and fibroids with the help of hand. He makes an incision in the uterus up to the level of the fibroid, grasps the fibroid with instruments and pulls it away from the normal uterine tissues. It then repairs the uterus.

After the operation, medical team members monitor your condition in the patient's room. Once the effects of the anesthesia wear off, you will go to your room for observation.

He can give morphine and similar drugs to keep the pain under control. Many hospitals now have systems that are under your control, where you press a button and send a sedative to your vein when you have pain.

Usually the next day you switch to oral medications instead of intravenous drugs. You can have the IV inserted until you can get fluids and you can't start consuming solid foods right away. Medical team members encourage you to start walking as soon as possible because this reduces the risk of post-operative complications.

When you are discharged from the hospital, your doctor will prescribe painkillers, inform you about how to take care of the incision site, diet list and activities. You should avoid activities such as driving, heavy lifting, climbing stairs. You should abstain from sexual intercourse and tampon use for up to 6 weeks. Again, it's natural to have vaginal discharge during this time.

Abdominal myomectomy requires a hospital stay of 2-3 days. Recovery takes 4 to 6 weeks.

Myomectomy has a very low complication rate. However, the surgeon performing the operation is very important. The risks of myomectomy are as follows:

- Excessive blood loss: There is a network of blood vessels in the uterus and fibroids stimulate the growth of new vessels to provide blood flow to them. In other words, during myomectomy, extra precautions should be taken against the risk of excessive bleeding. These measures include blocking the flow from the uterine veins and injecting drugs around the fibroids to compress the blood vessels.

- Scar Tissue: Incisions made to the uterus to remove fibroids may cause adhesions (adhesions that can develop after the operation). Adhesions can block the development of the fertilized egg in the uterus, but this condition rarely develops. Outside the uterus, they can interfere with nearby structures, resulting in blocked tubes or intestinal knotting.

- Development of New Myomas: Myomectomy does not prevent the development of new myomas. Tiny tumors that are not seen during the operation may enlarge and cause symptoms. It is possible for new fibroids to develop as well. Women with only one fibroid are less likely to develop new fibroids than those with multiple fibroids. If fibroids recur, repeat myomectomy, hysterectomy, or other procedures may be done.

- Birth Complications: Having had a myomectomy may cause some complications in childbirth. If your surgeon had to make a deep incision in the uterine wall during the operation, the delivering doctor may have to perform a cesarean section to prevent cracking of the uterus during delivery.

- Impossibility to Rearrange the Structure of the Womb: Your surgeon may have to cut the muscle wall, leaving a gap in order to remove the fibroids. It will require multiple stitches to close it. Rarely, the uterus may need to be removed if the bleeding is severe or has failed to realign the uterus.

To minimize the risks of myomectomy, your doctor may recommend:

- Iron Supplements and Multivitamins: If you have iron deficiency due to the severity of your menstrual bleeding, your doctor may recommend that you take iron supplements before surgery.

- Hormone Therapy: Another strategy for correcting anemia is hormone therapy before surgery. Your doctor may recommend that you use Gn-RH agonists, birth control pills, or other hormone treatments to stop or reduce menstrual bleeding. When given as therapy, Gn-RH agonists block the production of estrogen and progesterone, stopping menstruation and thus allowing you to store hemoglobin and iron.

- Treatment for Shrinking Myomas: Some hormonal treatments, such as Gn-RH therapy, cause fibroids and the uterus to shrink, allowing the surgeon to use a minimally invasive surgical approach (a smaller horizontal incision instead of a vertical incision, or laparoscopy instead of open surgery). Gn-RH agonists produce menopausal symptoms in most women. (such as hot flashes, night sweats and vaginal dryness) However, these ailments end with the end of the drug use.

Abdominal hysterectomy is not recommended very often nowadays, but in some cases it may be preferred by your doctor. It is the process of removing the uterus with an incision made from the abdomen, such as a cesarean section.

Laparoscopic hysterectomy is the procedure of removing the uterus with the help of laparoscopic devices through holes of a few cm from the abdomen. It provides much faster recovery compared to open surgery, and pain and blood loss are much less. Since there will be much smaller incisions in laparoscopic surgery, the scar is much smaller.

Robotic surgery can be considered the gold standard in hysterectomy, as in all operations. Because, in hysterectomy surgeries, with its clearer vision and more effective tools, it allows us to dominate the whole area as in open surgery, while minimizing the damage to the surrounding tissue with smaller incisions, it allows you to have a faster recovery and a less risky operation.

You can have surgery without any scars in hysterectomy surgeries. It is possible to perform surgery without scars in both laparoscopic surgery and robotic surgery methods.

It is the process of removing the uterus with laparoscopic equipment by making a small incision in the vagina.

Removal of the uterus through the vaginal route heals much faster than incisions made from the abdomen. The patient returns to daily life much faster. Your doctor will guide you after vaginal hysterectomy. You do not need to have stitches removed after a vaginal hysterectomy because the stitches will fall out after 30 days. However, vaginal hysterectomy unfortunately cannot be performed in all patients. There are factors that should be considered after the operation, in short, we can list the things to be done after vaginal hysterectomy as follows. You should avoid contact with hot water for the first few days, it is forbidden to have sexual intercourse, to lie in the sea, pool or tub for 40 days.

In the Single Port method, which can be performed with laparoscopic and robotic surgery, the uterus can be removed with an incision made from the navel. Since the navel is already hollow, the incision to be made through it will not appear as a scar in any way. It carries the advantages and risks of Robotic surgery and Laparoscopic surgery, which are the methods used in surgeries performed with the single port method.

Before the uterus removal operation, examinations are requested as in all surgeries. If there is no special condition before hysterectomy, 8 hours of fasting is required. In addition, sometimes the patient may need an enema the night before.

It is inconvenient to have sexual intercourse for 4 to 6 weeks after the surgery. Heavy lifting, heavy sports and strenuous activities should not be done for a month.

Liquid nutrition is recommended for a few days after hysterectomy.

The risks associated with anesthesia that may occur in every surgery are valid for hysterectomy. The most important factor in hysterectomy surgery is the damage that may occur in the surrounding tissue and organs and the health problems that may occur due to these. Therefore, as in all surgeries, it is very important for your doctor to choose the most suitable surgical method for you.

Slight bleeding may occur one week after Hysterectomy Uterine Removal Surgery. The patient should see this spotting and bleeding as normal because it is a temporary condition.

Hysterectomy surgery does not cause vaginal discharge. Vaginal discharge after surgery is due to reasons such as infection independent of the surgery.

After hysterectomy, removal of the uterus, patients may have a feeling of bloating and abdominal distension due to delayed gas output.

In order for menopause to occur, it must be taken in the ovaries together with the uterus. Menopause does not occur in hysterectomy operations where the ovaries are not removed.

If a hysterectomy is performed, where the uterus and ovaries are removed together, menopause occurs and post-operative hot flushes and sweating, which are symptoms of menopause, occur.

Most of the diseases that cause uterus removal operation are actually diseases that cause pain and burning during sexual intercourse. Since these diseases are treated, sexuality will actually be much more painless and painless.

It is thought that sexual reluctance will occur after hysterectomy, since the hormone level decreases, but studies have shown that this is a false bias. Your doctor may recommend hormone supplementation after hysterectomy surgery.

Some research for post-hysterectomy confirms this. However, it shows that the possibility of gaining weight after the observed process is related to the structure of the woman. In other words, it is not a case that every woman gains weight after hysterectomy.

It is the process of cleaning endometriomas due to endometriosis by opening from the abdomen with an incision such as a cesarean section. Although it is not preferred very often with the developing techniques today, open surgery may be required in some cases. Recovery time is much longer than other methods.

Laparoscopic endometriosis surgery is performed with a laparoscope through small incisions in the abdomen. In laparoscopic endometriosis surgery, the area is examined in detail with cameras and the endometrial tissues are cleaned. Since the incision is much less, recovery is much faster. Pain and other surgery-related symptoms are much less.

With laparoscopic endometriosis surgery, which is one of the conservative endometriosis surgical methods, infertility caused by endometriosis is eliminated.

Endometriosis surgery is both much more comfortable and less risky with the robotic surgery method, which includes the best aspects of open surgery and laparoscopic surgery. Because Endometriomas are sticky tissue. Detailed and fine workmanship is required. With the possibilities of robotic surgery, this becomes much easier. Elimination of infertility for pregnancy in robotic endometriosis surgery is much more possible with the physician's ability to arrange the ovaries and uterus perfectly. After robotic endometriosis, the incisions are smaller compared to all methods, and since the blood loss is much less, recovery is much faster.

Eğer bebek beklentisi yoksa ve şikayetler çok yoğunsa endometriozisin en kesin tedavisi rahim alınması diyebiliriz. Endometriozis tekrarlayabilen bir hastalıktır. Histerektomi oluşmasını kalıcı olarak önleyebilir. Hangi histerektomi yöntemi ile yapılması gerektiğine doktorunuz ile beraber karar verebilirsiniz.

Before the operation, standard tests (blood, urine, EKG, etc.) should be performed. Vaginal ultrasound is used to determine the cysts and their size, as well as cystourethroscopy for endometriotic lesions in patients with bloody urine, and colonoscopy if bloody stools are present. In addition, MRI can be used for location and preoperative planning for the diagnosis of deep endometriosis. Before the operation, you must inform your doctor about the medications you regularly use. Before the operation, your diet rich in vitamin E is valuable for the operation process.

Open surgery can be used if the ovarian cysts are large or malignant. Open Ovarian Cyst Surgery is performed under general anesthesia. Like a Caesarean incision, an incision is made into the area of the cyst and the cyst is removed. However, with today's techniques, performing these operations with closed method or robotic surgery is used more frequently due to rapid healing and minimal tissue damage.

Ovarian cysts are removed by entering with the laparoscope through small incisions to be made just below the navel. Recovery in laparoscopic ovarian cyst surgery is much faster and painless.

With robotic ovarian cyst surgery, all ovarian cyst surgeries can be performed, regardless of size and malignancy. With its high vision quality, minimal damage to the surrounding tissue and millimetric incisions, it can be considered the best surgery in terms of postoperative comfort and recovery of the patient.

Prolapse of organs in women is called Pelvic Organ Prolapse. Weakness of pelvic muscles or reduction of connective tissue causes pelvic organs to sag.

If the findings of vaginal enlargement and numbness in intercourse are found in the examinations, urinary incontinence may be due to vaginal relaxation syndrome and can be treated with vaginal tightening operation.

If there is sagging of the vaginal walls, urinary incontinence can be prevented by surgery on the posterior wall of the vagina, surgery on the anterior wall of the vagina, cystocele or rectocele repair operations.

If there is urinary incontinence due to uterine prolapse, urinary incontinence can be treated by hanging the uterus at a young age and hysterectomy at an advanced age.

Vaginal tightening surgeries are frequently performed in urinary incontinence surgeries, as the causes of urinary incontinence include vaginal problems. Pelvic floor muscles are strengthened. According to the patient's request, labiaplasty, genital tightening and filling operations, which are inner and outer lip aesthetics, can be performed in the same operation.

Asherman syndrome does not make conception impossible, but it can pose serious risks to the fetus, resulting in distressing cases such as miscarriage and stillbirth.

If you have Asherman Syndrome, your doctor will be much more careful because of a risky pregnancy. Because Asherman's syndrome increases the risk of placenta previa, placenta increta, excessive bleeding and threatens the health of both the mother and the baby.

If Asherman's syndrome is present in pre-pregnancy controls, surgery is recommended to avoid these risks. You can become pregnant one year after surgery.

If Asherman's syndrome is suspected, a blood sample is first taken to rule out other possibilities. With ultrasound, the thickness of the uterus and the follicles are examined.

For diagnosis, your doctor may recommend you an HSG (hysterosalpingogram). HSG is the X-ray of the uterus by injecting a special dye into the uterus.

The best method for the diagnosis of Asherman syndrome is hysteroscopy. With the hysteroscope, it is inserted from the cervix into the uterus and the uterus can be examined clearly.

Asherman syndrome is treated with hysteroscopy. In the hysteroscopy procedure, small surgical instruments are placed on the tip of the hysteroscope and the adhesions are cleaned. Antibiotic treatment to prevent post-procedure infection and estrogen hormone supplementation to regulate the intrauterine wall are recommended.

Asherman's syndrome can recur even with treatment. That's why your doctor may suggest waiting a year for pregnancy. If you have Asherman's syndrome, it does not cause intense pain and if you do not have a pregnancy plan, treatment may not be needed.

Myomektomi her ne kadar kanser oluşumuna neden olmasa da doğurganlığı azaltıcı etkisi vardır. Bunun önüne geçmek adına rahimde bulunan miyomların temizlenmesi gereklidir. Bu aşamada uzman görüşüne de bağlı olarak olacağınız myomektomi operasyonu doğurganlık kabiliyetinizi ciddi oranda arttıracaktır.

Robotik operasyonalar tıbbın pek çok alanında olduğu gibi jinekolojik operasyonlarda da büyük avantaj sağlar. Rahimde bulunan miyomların temizlenmesi ince ve hassas bir operasyonel işlem kabiliyeti gerektirir. Ayrıca çok küçük boyutta olan bu istenmeyen dokuların tespit edilmesi de kalıcı bir tedavi şansı için oldukça önemlidir. Bu noktada devreye yüksek çözünürlüğe sahip çok açılı görüntüleme imkanı sunan robot kameralar devreye girer.

Uzmana geniş bir perspektiften operasyon yapılacak rahim alanını izleme şansı veren yüksek teknoloji ürünü kameralar en küçük dokuların dahi arasına girebilir. Uzman tarafından kumanda edilen bu robot kameralar insan gözünün görmeyi başaramayacağı yerleri defalarca kez büyüterek uzmana gösterir. Bu sayede yüksek nitelikli bir görüş imkanına kavuşan uzman yüksek isabetle teşhis ve tespit yapma imkanına kavuşur. Teşhisin ardından miyomların temizlenmesi işlemine geçilir. Bu aşamada insan elinin girmekte çok zorlanacağı alanlara robot kollar yerleşir ve işlemi cerrahın yönlendirmesi ile gerçekleştirir. İnsan elinin hareket kapasitesinin birkaç katı manevra yeteneğine sahip olan

robot kollar milimetre hassasiyetinde yerlerde yüksek duyarlılıkla çalışabilir. Uzmanın ergonomik bir ortamda oturarak çalışmasına imkan veren bu sistem hata yapma olasılığını en alt seviyeye indirir.

Myomektomi Operasyonlarında Robotik Cerrahinin Avantajları

Myomektomi operasyonlarında robotik cerrahinin tercih edilmesi her şeyden önce uygulama etkinliği anlamında ciddi bir avantaj sağlar. Myomektomi sırasında rahimden bütün miyomların temizlenmesi tekrarlanma riskini ortadan kaldırır ve kalıcı tedavi şansı doğurur. Bu sayede hastanın gelecekte tekrar aynı işlemlere maruz kalmasının önüne geçilmiş olur. Myomektomide cerrahi işlemin robot kollar ile yapılması tam temizlik yapılması adına önemlidir.

Robotik cerrahinin teknik özelliğinden dolayı vücutta çok küçük çapta kesikler açılır ve robot kollar bu kesiklerden içeri girer. Bu durumda hastanın kozmetik kaygılar yaşamasının önüne geçerek ruhsal anlamda daha hızlı ve etkin bir toparlanma sunar. Robotik cerrahiye dayanan laparoskopik operasyonlar klasik açık ameliyatlara göre daha hızlı toparlanma ve iyileşme süreci sağlar. Hastalar hızlı bir şekilde taburcu olur ve birkaç günlük dinlenmenin ardından günlük aktivitelerine dönebilirler. Kan kaybının da daha az yaşandığı

robotik myomektomi operasyonları başka komplikasyonların görülme riskinin daha az olduğu operasyonlardır.

Robotik myomektomi operasyonundan sonra uygulanan işlemler genelde iki başlık altında toplanır. Bu başlıklardan ilki hastanın semptomlarının azaltılması ile ilgilidir. Hastada görülen pelvik ağrısı, kanama ve şişlik hissinden kurtulması için uzman tarafından öngörülen rahatlatıcı ilaç tedavisi uygulanır.

İkinci başlıkta ile miyomlar yüzünden azalan doğurganlık kabiliyetinin tekrar arttırılması hedeflenir. Myomektomi operasyonu geçiren kadınlarda yaklaşık 1 yıl sonra iyi anlamda gebelik yaşayan kadınların olduğunu ortaya koyan bazı araştırmalar vardır. Robotik myomektomiden sonra gebe kalmadan önce uterusun tam formuna kavuşması için 3 – 6 ay arası beklemek daha olumlu sonuçlar verecektir. Bu tür süreçleri uzman doktor eşliğinde planlamanız önerilir.

Yumurtalık yaşlanmasının en çok karşılaşılan iki nedeni genetik ve yaştır. Ardında günümüz koşullarında yaşanan stres, radyasyona maruz kalmak, doğal beslenememek, tütün ürünleri, alkol ve buna benzer bir çok nedenin etkileyici olduğu öngörülmektedir. 

Bunların yanı sıra yaşanan çikolata kisti, miyom, adet düzensizliği, adet görememe, hormonal hastalıklar, tiroid, kanser gibi bir çok rahatsızlıkta yumurtalık sayısına ve kalitesine olumsuz etkide bulunabilmektedir. 

Unutmamalısınız ki yumurtalık sayınızın iyi olduğunun belirteci ne düzenli regl olmanız ne de yaşınızdır. Bunlar önemli belirteçlerdir ama yüzde yüz doğrulayıcı değildir.

Yumurtalık yaşlanmasının kesin bir tedavisi vardır demek doğru değildir. Ancak gebe kalmak isteyen kadınlarda yumurtalık gençleşmesinde etkinliği yapılan araştırmalar doğrultusunda belirlenmiş rejeneratif hücre yenileme uygulamaları bulunmaktadır. Eğer yumurtalık rezervlerinde azalma var ise hemen gebelik düşünülmüyorsa yumurta dondurma veya embriyo dondurma uygulanabilir.

Farklı hücre tiplerine dönüşme yeteneğine sahip hücrelere kök hücre denir. Vücudumuzun derinliklerinde olan bu hücreler insanların hasar görmüş veya güçsüzleşmiş dokularını yenileme yeteneğine sahiptir. 

Rejeneratif Hücre Yenileme kök hücrelerin işlevlerini milyonlarca kez arttırarak bu süreci yaşlanma gibi etkileri geride bırakarak yapmayı hedeflemektedir. 

Kök hücre embriyodan, fetustan, kemik iliği kan ve yağ dokusundan elde edilebilirler. Embriyo ve fetustan kök hücre elde etmek istisnai durumlarda ve bazı ülkelerde mümkündür. 

Tedavi için kullandığımız hücreler ise embriyonik hücreler değildir. Yağ dokusundan özel olarak ayrıştırılabilen bağ dokusu kaynaklı hücrelerin yenilenme ve onarmadaki kabiliyetleri rejeneratif hücre yenilemede kullanılmaktadır. 

Rejeneratif hücre yenileme için kök hücre eskiden sadece kemik iliğinden alınmaktaydı. Ancak son yıllarda yapılan çalışmalar kök hücrelerin yağ dokusunda 500 kat daha fazla olduğu tespit edildi. Teknoloji ile beraber yağ dokusu içerisindeki kök hücreler ayrıştırılabilir hale geldi.

Büyüme etkileri yüksek yağ öncü hücreleri, fibroblastlar, endotel öncü hücreleri, endotel hücreleri ve stromal hücrelerin alınan yağ dokusundan ayrıştırılıp zenginleştirilmesidir. SVF ile elde edilen hücreler hastalık yaşlanma gibi hem genetik hemde dış faktörlerden kaynaklanan hasarların giderilmesi ve yenilenmesi için kullanılır.

Yumurta rezervi azlığında uygulanan SVF hastadan basit ve kolay ibr şekilde alınan yağ dokusunun özel bir sistemle etkili hücreleri ayrıştırarak canlılıklarına zarar vermeden alınması ile elde edilir.

Elde edilen kök hücre yumurtalıklara enjekte edilerek yumurtalıklarda uyuyan yumurtaların tetiklenmesi ve veya yeni yumurta oluşmasını sağlaması hedeflenmektedir. Düşük yumurtalık rezervi olan kadınlarda bebek sahibi olma ihtimalini yükseltmektedir.

P r p (Trombositten zengin plazma) işleminde amaç uyuyan yumurtalıkların uyandırılması ve güçlendirilmesidir. Menopoz problemi ile karşı karşıya kalan, ileri yaşta ve veya yumurtalık yaşlanması sorunu olan hastalar için önerilmektedir. 

Hastanın kendi kanından elde edilen trombosit hücreleri yenileme, iyileştirme ve dokuların damarlanarak yeniden canlanmasına olanak sağlamak amaçlı kullanılır. Bir çok hastalıkta uygulanan tedavi en çok cilt ve eklem sorunlarında gündemdedir. Ancak yumurtalıklara uygulamalar sonucunda ciddi olumlu sonuçlar alındığı görülmektedir. 

30 cc kan alınır ve labaratuarda hazırlanır bu sızı anestezi altında yumurtalıkların içine ultrasonografi veya laparoskopi ile enjekte edilir. Sonuçları için aylık olarak AMH, FSH, E2 düzeyleri bakılarak yumurtalık yenilenmesi takip edilir.

Lazerle idrar kaçırma tedavisi, minimal invaziv bir yöntemle idrar kaçırma sorununu çözmeye yönelik bir tedavi seçeneğidir. Bu yöntem, özellikle stres inkontinans tedavisinde etkili olup, kadınlarda pelvik taban kaslarının ve vajinal dokunun güçlendirilmesini sağlar. Devamı

Lazerle genital siğil tedavisi, siğilleri yok etmek için kullanılan modern ve etkili bir yöntemdir. Lazer enerjisi, siğil dokusunu hedef alarak bu dokuyu buharlaştırır ve sağlıklı cilt dokusunu korur. Bu yöntem, geleneksel cerrahi müdahalelere göre daha az invazivdir ve daha hızlı iyileşme sağlar. Devamı

Lazerle vajinal kuruluk tedavisi, vajinal dokuların yenilenmesini ve nem üretiminin artırılmasını hedefleyen modern bir tedavi yöntemidir. Lazer enerjisi, vajinal duvarlara kontrollü bir şekilde uygulanarak kolajen üretimini teşvik eder ve dokuların elastikiyetini artırır. Bu yöntem, vajinal kuruluğun neden olduğu rahatsızlıkları hafifletir ve vajinal sağlığı iyileştirir. Devamı

Lazerle vajinal enfeksiyon tedavisi, vajinal dokuların yenilenmesini ve vajinal flora dengesinin yeniden sağlanmasını hedefleyen modern bir tedavi yöntemidir. Lazer enerjisi, vajinal duvarlara kontrollü bir şekilde uygulanarak doku yenilenmesini teşvik eder ve enfeksiyonlara karşı direnci artırır. Bu yöntem, enfeksiyonların tekrarlama riskini azaltmaya yardımcı olur. Devamı

Lazerle rahim ağzı yarası tedavisi, rahim ağzındaki yaraların tedavi edilmesi için modern ve etkili bir yöntemdir. Lazer enerjisi, yaralı dokuların buharlaşmasını ve sağlıklı dokuların yenilenmesini sağlar. Bu yöntem, minimal invaziv olup, hızlı iyileşme süreci sunar ve cerrahi müdahale gerektirmez. Devamı

Lazerle vajinal estetik, vajinal dokuların sıkılaştırılması, gençleştirilmesi ve estetik görünümünün iyileştirilmesi için kullanılan minimal invaziv bir tedavi yöntemidir. Lazer enerjisi, vajinal dokuların kolajen üretimini artırarak dokuların sıkılaşmasını ve elastikiyetinin geri kazanılmasını sağlar. Devamı