The first step in infertility treatment is to understand why pregnancy has not occurred. For couples seeking infertility treatment in Izmir, we do not immediately proceed with in vitro fertilization (IVF); instead, we first evaluate both female and male factors together.
In the infertility evaluation conducted by Assoc. Prof. Dr. Funda Göde, potential causes are systematically investigated for each couple, and treatment options are planned based on the couple’s findings.
According to the World Health Organization’s 2025 infertility guidelines, infertility is defined as the failure to achieve pregnancy within 12 months despite regular, unprotected sexual intercourse. The same guidelines state that both the female and male partners must be evaluated simultaneously during the assessment process.
The AUA/ASRM male infertility guidelines also emphasize that a male evaluation is necessary to establish an appropriate treatment plan, and that an incomplete male evaluation may lead to unnecessary and invasive procedures for the female partner.
We do not follow the same approach for every couple undergoing infertility treatment. First, we work together to identify the underlying cause of the difficulty in conceiving. For some couples, we can proceed with ovulation tracking, hormone testing, a hysterosalpingogram, a semen analysis, or lifestyle adjustments. In some cases, however, we may need to consider assisted reproductive technologies such as artificial insemination, in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Our goal throughout this process is to determine the right treatment for you at the right time.
Infertility, medically known as infertility, is the inability to achieve pregnancy despite regular, unprotected sexual intercourse. In medical evaluations, it is defined as the failure to conceive within a certain period of time despite regular, unprotected intercourse.
Infertility does not mean that a couple will never be able to have children. Rather, it indicates that an underlying cause—whether related to the woman, the man, or the couple—that makes conception difficult needs to be investigated.
For women under 35, evaluation is recommended if pregnancy does not occur within 12 months despite regular, unprotected intercourse.
For women 35 and older, this period is considered to be 6 months. The ASRM committee opinion states that earlier evaluation and treatment may be considered for women over 40.
If there is menstrual irregularity, amenorrhea, known or suspected tubal or uterine disease, endometriosis, suspected male factor infertility, sexual dysfunction, or a history of chemotherapy or radiation therapy, an expert evaluation is recommended without delay.
Secondary infertility is defined as the inability to achieve pregnancy again despite having had a previous pregnancy. The World Health Organization defines primary infertility as the absence of any previous pregnancy, and secondary infertility as the inability to achieve pregnancy after at least one previous pregnancy.
What you need to know about secondary infertility is not limited to the points mentioned above. Secondary infertility can also be caused by factors related to both the woman and the man. At this point, advancing age is among the common risk factors for couples.
Infertility may be related to female factors, male factors, causes affecting both partners, or unexplained infertility.
Causes of female-factor infertility may include ovulation disorders, blocked fallopian tubes, uterine issues, endometriosis, diminished ovarian reserve, and hormonal imbalances.
Male-factor infertility may be related to issues with sperm count, motility, or morphology. Varicocele, hormonal disorders, genetic causes, anatomical issues, and ejaculation problems are also considered male factors.
Unexplained infertility refers to a situation where no clear cause capable of preventing pregnancy is identified in initial evaluations. In such cases, ovulation patterns, fallopian tubes, and sperm analysis have been assessed; however, current tests have not identified a definitive cause preventing pregnancy.
However, I would like to clarify something here. A diagnosis of unexplained infertility should not be interpreted as meaning that the chance of pregnancy has been completely eliminated. We develop a treatment plan by evaluating age, duration of infertility, ovarian reserve, the condition of the fallopian tubes, and the results of the semen analysis together. While monitoring or artificial insemination may be appropriate for some couples, in other cases, in vitro fertilization (IVF) may be considered.
Irregular ovulation, blocked or damaged fallopian tubes, and structural issues within the uterus can affect the chances of pregnancy. For this reason, these factors are evaluated together during infertility assessment.
A semen analysis evaluates sperm count, motility, and morphology. Morphology refers to the shape of the sperm. These results are among the key data points in understanding male factors.
Infertility does not always present with symptoms. For most couples, the first sign is the failure to conceive despite regular intercourse.
In women, menstrual irregularities, absence of menstruation, frequent or infrequent periods, breakthrough bleeding, severe menstrual cramps, chronic pelvic pain, increased hair growth, and acne may require evaluation. According to the ASRM committee guidelines, menstrual irregularities, suspected tubal or uterine disorders, endometriosis, and sexual dysfunction are among the reasons for immediate evaluation.
In men, there may often be no obvious symptoms. If there is decreased libido, erectile dysfunction, ejaculation problems, small testicles, or abnormalities in semen analysis, an evaluation for male infertility is performed. The AUA/ASRM guidelines note that hormonal evaluation may be warranted in these cases.
Diagnosing infertility can be a multi-step process. The evaluation is conducted by considering the medical history, physical examination, ovulation patterns, hormone tests, ovarian reserve, fallopian tubes, uterus, and semen analysis together.
In women, menstrual cycle, ovulation patterns, AMH test, hormone tests, ultrasound, and hysterosalpingography (HSG) may be evaluated. The AMH test provides information about ovarian reserve; however, it should not be interpreted as the sole determinant of the chance of natural pregnancy.
In men, the basic evaluation begins with a semen analysis. The reproductive history and the results of one or more semen analyses are interpreted together. Therefore, when referring to an infertility test, it should be understood as a customized evaluation process for the couple rather than a single procedure.
The answer to the question “How is infertility treated?” depends on the underlying cause. Age, ovarian reserve, ovulation patterns, the condition of the fallopian tubes, uterine evaluation, semen analysis, and previous treatment history are all considered together.
The WHO 2025 guidelines recommend that decisions regarding infertility treatment be made by considering the benefit-risk balance, patient preferences, feasibility, cost, and available resources.
In suitable patients with diagnosed ovulation disorders, ovulation monitoring and medication treatments may be considered. For ovulation disorders associated with polycystic ovary syndrome (PCOS), the 2023 international PCOS guidelines consider letrozole as a first-line pharmacological option in suitable patients.
Intrauterine insemination (IUI) is performed by introducing sperm prepared to coincide with the timing of ovulation into the uterus in selected couples. It may be considered in cases of mild male factor infertility, ovulation problems, or certain unexplained infertility cases.
In vitro fertilization (IVF) may be considered in cases of blocked fallopian tubes, severe male factor infertility, advanced age, diminished ovarian reserve, certain unexplained infertility cases, or when previous treatments have been unsuccessful.
Intracytoplasmic sperm injection (ICSI) is a laboratory technique in which a single sperm is injected into the egg. It may be considered in cases of significant sperm-related issues or in selected situations where laboratory conditions require it. Therefore, the question “Classic IVF or ICSI?” can be answered on a case-by-case basis for the patient and the couple.
In vitro fertilization is not the first option for every couple undergoing infertility treatment. When deciding on a course of treatment, we first try to understand the underlying cause of the difficulty in conceiving. Ovulation patterns, the condition of the fallopian tubes, ovarian reserve, sperm analysis, and age are key factors in this decision.
For some couples, it may be possible to proceed with ovulation monitoring or intrauterine insemination (IUI). IVF may be considered if the fallopian tubes are blocked, there is a significant decline in sperm quality, ovarian reserve is low, or previous treatments have been unsuccessful.
The most appropriate starting point in infertility treatment is to listen to the couple’s history without rushing and to plan the initial evaluations together. This is because each couple’s age, pregnancy history, menstrual cycle, ovarian reserve, fallopian tube status, and sperm analysis are unique.
During the initial evaluation, both female and male factors that may complicate conception are addressed together. If deemed necessary, the process is clarified through tests such as the AMH test, hormone tests, ultrasound, hysterosalpingography, or semen analysis.
For couples considering fertility treatment options in Izmir, such as artificial insemination or in vitro fertilization (IVF), the approach is based on an accurate diagnosis rather than immediately opting for a single method. In some cases, ovulation monitoring or artificial insemination may be sufficient. In other situations, IVF may be recommended.
The goal of infertility evaluation with Assoc. Prof. Dr. Funda Göde is to systematically examine factors that may affect the chances of pregnancy. Following the evaluation, options such as ovulation monitoring, intrauterine insemination, or in vitro fertilization are discussed based on the couple’s specific situation. The personalized infertility treatment process in Izmir does not follow a standard protocol. Age, test results, pregnancy history, and the couple’s expectations are all evaluated together.
During the initial consultation, a medical history is taken, previous test results are reviewed, and new tests are scheduled if deemed necessary. Our goal is to clarify the situation before starting treatment and to create the most appropriate treatment plan for the couple.
To learn more about infertility treatment and the personalized evaluation process in Izmir, please contact Assoc. Prof. Dr. Funda Göde.
References
Infertility may be associated with ovulation disorders, blocked fallopian tubes, uterine issues, endometriosis, a diminished ovarian reserve, or problems with sperm quality. In some couples, no clear cause may be identified.
While a low AMH level may indicate a diminished ovarian reserve, it does not necessarily mean infertility on its own. It is evaluated in conjunction with age, ultrasound findings, menstrual cycle regularity, history of previous pregnancies, and other tests.
A woman’s age, ovarian reserve, sperm analysis results, the condition of the fallopian tubes, uterine structure, underlying medical conditions, and history of previous treatments can all affect the success rate of infertility treatment. For this reason, the treatment plan is tailored to the couple’s specific findings.
The first step is usually to investigate the cause. For suitable couples, ovulation monitoring, medication, or insemination may be considered. In some cases, IVF treatment may be planned sooner.
As women age, their ovarian reserve and egg quality may decline. For this reason, if pregnancy is delayed—especially after age 35—the evaluation process should not be postponed.
When choosing an IVF specialist, it is important to consider their experience in the field of infertility, their approach to evaluating the couple as a unit, their ability to clearly explain the process, and their commitment to avoiding unnecessary procedures. Trust-building communication helps ensure the treatment process proceeds smoothly.
Not:Bu içerik genel bilgilendirme amaçlıdır, tanı ve tedavi yerine geçmez. Kişisel tanı ve tedavi planı için hekim değerlendirmesi gerekir.
