BASIC PRINCIPLES AND METHODS IN INFERTILITY TREATMENT

Induction of Ovulation: 

- The most common problem in  female  is the lack or decreased frequency of ovulation.  Polycystic Ovary Syndrome is the most common cause. Clomiphene Citrate or Letrozole use can achieve  ovulation and subsequently pregnancy in a significant proportion of these patients. If ovulation cannot be achieved with these medications or if the patient's FSH, LH hormones are insufficient, Gonadotropin treatment can be started.

- During these treatments, the patient is followed by ultranography. When the dominant follicle reaches a diameter of 18-20 mm, pregnancy is expected with timed  sexual intercourse.  Alternatively, when 18-20 mm in size is seen, hCG injection is performed to ensure ovulation, and sexual intercourse  is recommended around 36 hours after this injection.  A week after the ovulation serum level of Progesterone hormone can be  monitored  to ensure the ovulation.

Intrauterine Insemination – (IUI)

- It can used in couples with unexplained infertility and and minor sperm abnormalities. Ovaries are stimulated with COS. Preferably Clomiphene or Letrozole is used first. The goal is to get  2-3  mature follicles. Gonadotropin may be added to the treatment if these drugs are not enough. When the leading follicle (s) reaches the diameter of 18-20 mm, ovulation is triggered with hCG and the procedure is planned after 34-36 hours. As in semen analysis, sample is taken from man. It is processed in the laboratory to get more  progressive mobile and normal shaped sperms. The objective is to prepare a sample containing about 5-10 million motile sperm in 0.5 mL medium. This sample is slowly released into the uterine cavity with the help of a thin catheter. The goal is to leave more mobile sperm cells close to the eggs.

- Considering all the characteristics of the infertile couple, it should be decided whether or not IUI can be tried first . For Unexplained Infertility the rate of pregnancy per trial is around 10-15%.