Will we ever have children?

About one-fifth of married couples complain of not having children despite the passage of one year and maintaining a regular sexual life. Half of them have a problem with men. Then, the examinations are started and the source of the defect is found and the treatment phase is started. Sometimes, pregnancy can be seen naturally while still in the examination phase. In the end, all possible treatments are tried and when it is understood that there is no child naturally, in vitro fertilization is recommended.

In general, half of the couples can get pregnant on the first try. As the number of attempts increases, this chance tends to decrease. However, after unsuccessful IVF attempts, natural pregnancy is also possible with the effect of the treatments taken at this time. We encounter such pregnancies in a quarter of couples undergoing IVF. It is not possible to give an exact number on how many times IVF is performed. Here, the age and egg quality of the woman and the quality of the sperm in the man are the determining factors. In this way, we call individuals “infertile” who have the hope of being treated but have not been pregnant. In addition, if there is no hope of treatment, in other words, if it is certain that pregnancy cannot be achieved, these cases are considered as “sterile”.

To call a man sterile, all hope must be gone. However, with today’s technology, we can now get results even in very difficult cases. There are several diseases in which it is understood that the man has no chance of becoming a father at the first meeting. Chief among these are genetic disorders such as congenital deficiency of some genes on the Y chromosome and XO syndrome, in which there is no Y chromosome at all. Men whose testicles are not in place on examination and cannot be found in the abdomen with surgical interventions are also considered sterile.

In 1-2% of the male population, no dead or live sperm are found in sperm analysis and it is expressed as azoospermia. However, in one third of them, we can obtain sperm to be used in IVF. Indeed, the TESE method has been a great chance for these men to become fathers. However, the pregnancy success of the sperm obtained from the testis is about fifty percent. If the IVF did not hold or mature sperm did not come out in the first try, the same processes start again. This is how a group reaches a happy ending. Well, if no pregnancy has been achieved in the in vitro fertilization trials, can it be said that there will be no more children? No, there is absolutely no such limit. If mature sperm cells come out with TESE, whether in the semen or in the testicles, the chance of having a boy still continues. How long the treatments will continue depends on the health status and patience of the spouses. Of course, the economic dimension of the process should also be considered. At the last stage, the use of immature sperm and stem cells in IVF comes to the fore. Early stage sperm cells that have reached certain genetic maturity can achieve pregnancy at a rate of 5-8% with new techniques. On the subject of stem cells, although a proven treatment method has not yet entered into routine clinical practice, scientific studies continue at full speed. It should be noted that until 1993, nothing could be done in azoospermia cases that did not improve with treatment. When the TESE method emerged, half of these couples had the chance to have children. A similar development can always occur after that.

The birth of a child is possible with the healthy development of the embryo, which will be formed by the union of the sperm and egg cell, in the uterine bed of the expectant mother. Each of these stages occurs through highly complex biological mechanisms. There are many factors that we have yet to uncover. Therefore, it is not possible to say whether a failed attempt, whether with natural unions or IVF, is caused by the sperm, the egg, or the genital tract in the woman. Men with very low sperm counts may also be able to get pregnant, and it may not be seen in those whose tests are completely normal. For example, no matter how healthy the sperm is, if there is a deficiency in the mechanism that will support the development of the embryo in the egg, it means that no results will be obtained without that test. Unfortunately, we cannot always test the molecular process in the internal structure of gametes. Such cases are defined as “unexplained infertility”. However, in order to be able to say unexplained infertility, all the necessary investigations must be completed within the framework of today’s possibilities. On the other hand, probability calculation is also in question in the healthy matching of the genetic materials of the sperm and egg during fertilization. In other words, the “luck” factor should also be considered. We don’t know at what trial this “luck” factor will laugh.

As a result, the hope of conceiving a child will always continue for couples who have sperm and eggs, and who do not have any problems in the female reproductive system, apart from some genetic defects. The right thing is for spouses to go together, without worrying about whether the problem is with the man or the woman.

Prof. Dr. Kaan Aydos


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