If pregnancy does not occur despite regular and unprotected sexual intercourse during 12 ovulation cycles, this is called infertility. Although this 1-year period is an important criterion to talk about infertility, 12 months should be reduced to 6 months if the age of women is 35 and over. The absence of pregnancy is not the only factor in infertility, recurrent miscarriages can also be an aspect of infertility.
Infertility is extremely common. It is estimated that about 1 out of every 6 couples cannot have children. Infertility, which can be female-induced, male-induced or both female and male-induced, is a health problem that can be extremely complex, and although it is possible to diagnose it with advanced diagnostic methods, in some cases the cause cannot be determined.
Therefore, having a general knowledge about the female reproductive system makes it easier to understand what female-induced infertility is.
Women, unlike men, are born with all their egg reserves. Every 21-35 days starting from puberty, the egg cell in the ovaries matures, the follicle in which the maturing egg is located cracks, and the egg moves to the fallopian tubes. Fertilization can occur if it encounters sperm in the fallopian tubes. In the absence of fertilization, the egg continues to move towards the uterus and, together with the thickening uterine membrane, is thrown vaginally out of the body, which is what is called a menstrual period.
Female infertility refers to situations in which the factors making pregnancy difficult are related to the female reproductive system. During the evaluation process, ovulation patterns, ovarian reserve, tubal patency, uterine structure, accompanying diseases, and the partner’s sperm analysis are assessed together.
For those seeking female infertility treatment in İzmir, the first step is not to choose a treatment directly, but to investigate in the correct order why pregnancy has been delayed. Age, menstrual pattern, previous surgeries, infection history, ultrasound findings, and hormone tests are planned accordingly. Thus, the treatment decision is based not on a single test result, but on the couple’s overall clinical picture.
For pregnancy to occur naturally, ovulation, the fallopian tubes, sperm, the uterine environment, and the embryo implantation process must work together. When there is a disruption in the parts of this chain related to the female reproductive system, female infertility may become an issue.
From the patient’s perspective, the most confusing point is often this: having regular menstrual cycles does not always mean that all the conditions necessary for pregnancy are suitable. Factors such as tubal condition, intrauterine problems, endometriosis, or egg quality may also affect the chances of pregnancy. Therefore, during the diagnostic process, instead of focusing on a single finding, the overall picture must be clarified step by step.
No. Female infertility means that at least one of the causes making pregnancy difficult is related to the female reproductive system. Unexplained infertility, on the other hand, is considered when no clear female factor, male factor, or obvious finding explaining delayed pregnancy can be identified in the basic evaluations.
Pregnancy does not occur within the same timeframe for every couple. However, if pregnancy has not been achieved within 12 months despite regular unprotected intercourse, an infertility evaluation should be performed. Earlier consultation may be necessary if the woman is 35 years of age or older, has menstrual irregularities, or has a known history of gynecological disease.
Failure to achieve pregnancy despite regular intercourse is the most fundamental condition requiring evaluation. This symptom alone does not establish a diagnosis; however, it is the starting point for investigating the reason for delayed pregnancy.
Infrequent menstruation, long menstrual intervals, or absence of menstruation may be associated with ovulation disorders. Pregnancy may also be delayed in women with regular menstrual cycles. Therefore, decisions are not made based solely on menstrual patterns.
Severe menstrual pain, chronic pelvic pain, pain during intercourse, or pain during bowel movements or urination may require evaluation for endometriosis. If these complaints occur together with delayed pregnancy, medical consultation should not be postponed.
Experiencing two or more pregnancy losses may require a separate evaluation. In such cases, not only the formation of pregnancy but also whether the pregnancy can continue healthily within the uterus is assessed. Intrauterine polyps, submucosal fibroids, intrauterine adhesions, or congenital uterine anomalies may be included in the evaluation process in some patients.
Causes of female infertility may include ovulation patterns, ovarian reserve, tubal condition, uterine structure, hormonal profile, and endometriosis.
The NICE 2026 Fertility Problems guideline also addresses fertility problems related to female factors under clinical headings such as ovulatory disorders, tubal/uterine conditions, and endometriosis.
For the condition previously known as PCOS, or polycystic ovary syndrome, the name PMOS was proposed in 2026. PMOS stands for Polyendocrine Metabolic Ovarian Syndrome. This terminology aims to better reflect that the condition is not explained solely by ovarian cysts, but may also include hormonal, metabolic, reproductive, dermatological, and psychological features as a multisystem condition.
During the transition period, patients and healthcare professionals are expected to encounter both terms together. Therefore, PCOS / PMOS may be evaluated together with infrequent menstruation, long menstrual intervals, increased hair growth, acne, ovulation disorders, and certain metabolic findings.
Diminished ovarian reserve refers to a lower-than-expected number of eggs in the ovaries. As age advances, ovarian reserve and fertility capacity may decline. Although tests such as AMH, antral follicle count, and FSH contribute to the evaluation, they may not independently indicate the chances of pregnancy.
For pregnancy to occur, the egg and sperm must meet within the fallopian tubes. Blocked tubes may make this encounter difficult. Previous infections, ectopic pregnancy, abdominal surgery, or pelvic surgery may necessitate tubal evaluation.
Endometriosis is defined by the presence of tissue similar to the uterine lining outside the uterus. In the ACOG 2026 guideline, endometriosis is described as a chronic, inflammatory, estrogen-dependent disease associated with pain, infertility, and reduced quality of life.
Fibroids, polyps, intrauterine adhesions, and congenital uterine anomalies may affect the formation or continuation of pregnancy in some patients. If suspicion exists, methods such as ultrasound, saline sonography, HSG, or hysteroscopy may be used. The appropriate method is determined according to the patient’s findings.
Thyroid disorders, elevated prolactin levels, insulin resistance, weight changes, and certain metabolic conditions may be associated with menstrual irregularities. These tests are not requested in the same way for every patient. They are planned according to the patient’s history, examination, and ultrasound findings.
Female infertility is not diagnosed with a single test. The evaluation is planned together with medical history, gynecological examination, ultrasound, selected hormone tests, tubal patency assessment, and sperm analysis. The aim is to understand at which stage the pregnancy process is being hindered.
During the first consultation, age, menstrual pattern, duration of attempts to conceive, previous surgeries, infection history, pain complaints, and previous pregnancies are questioned. Male evaluation is also part of the process.
Hormone tests are selected according to the patient’s history. AMH and antral follicle count may provide information about ovarian reserve; tests such as FSH, LH, estradiol, TSH, or prolactin may be requested according to clinical findings.
Through vaginal ultrasound, the ovaries, antral follicle count, cysts, fibroids, suspected polyps, and uterine structure may be evaluated.
To determine whether the fallopian tubes are open, HSG or HyCoSy may be used in appropriate centers. In cases of suspected intrauterine pathology, saline sonography or hysteroscopy may be considered.
Laparoscopy is not the first-line approach for every patient; however, it may be added to the evaluation if there is significant suspicion of endometriosis, previous infection, ectopic pregnancy, or tubal disease.
Treatment for female infertility is planned according to the underlying cause identified during diagnosis. Therefore, before asking “Which treatment?”, the primary goal is to clarify “At which stage is pregnancy not occurring?”
In patients with ovulation irregularities, medications supporting ovulation and timed intercourse planning may be considered.
Insemination treatment, also known as intrauterine insemination (IUI), involves placing prepared sperm into the uterus during the ovulation period. It may be considered in cases where the fallopian tubes are open, sperm parameters are suitable, and in some unexplained infertility cases.
The NICE 2026 guideline recommends that after a certain trial period in unexplained fertility problems, IUI and IVF options should be evaluated by discussing patient preferences, risks, and benefits.
IVF treatment may be considered in cases such as severe tubal damage, certain diminished ovarian reserve situations, advanced age, long-standing infertility, endometriosis, or failure to achieve results with previous treatments. In tubal factor infertility, age and the severity of tubal damage may alter the treatment pathway. In some patients surgery, and in others IVF, may be considered the more appropriate option.
Surgical treatment may be considered in cases of intrauterine polyps, submucosal fibroids, intrauterine adhesions, or certain endometriosis cases. Hydrosalpinx, meaning fluid-filled dilation of the fallopian tube, is also evaluated separately before IVF. The NICE 2026 guideline states that laparoscopic salpingectomy or tubal occlusion may be recommended before IVF in the presence of hydrosalpinx.
The same treatment pathway may not be suitable for every patient with female infertility. Ovulation monitoring, insemination, surgical evaluation, or IVF treatment options are planned according to the couple’s clinical picture. In your search for an IVF specialist in İzmir, you may consult with Funda Göde to learn the steps your female infertility treatment process in İzmir may involve.
Not every cause of infertility can be prevented. Certain conditions such as age, genetic structure, previous illnesses, endometriosis, tubal problems, or ovarian reserve may develop outside a person’s control. Nevertheless, some steps may help reduce risks and prevent delays in evaluation for women planning pregnancy.
Many different factors may contribute to an increased risk of female infertility:
Hormonal imbalance caused by obesity or excessive thinness may impair ovulation processes.
Smoking not only threatens overall health but may also reduce egg quality.
Diseases causing hormonal changes, such as PCOS and primary ovarian insufficiency, may prevent pregnancy from occurring.
Since age is one of the most effective infertility risk factors, it should be discussed in greater detail.
Women are born with a finite ovarian reserve, and as they age, the chances of pregnancy decrease. Advancing age, an extremely common risk factor in female infertility, is associated with reduced egg numbers, decreased egg quality, and other health problems.
In a study conducted in the United States by the National Survey of Family Growth involving 12,000 women:
It has also been shown that infertility rates may vary depending on environmental and socioeconomic factors, and that female infertility rates are higher in Eastern Europe, North Africa, and the Middle East.
For those seeking female infertility treatment in İzmir, the first step is not to choose a treatment directly, but to evaluate in the correct order why pregnancy has been delayed.
During the first consultation, the patient’s medical history is reviewed, and a gynecological examination and ultrasound are performed. If necessary, hormone tests, ovarian reserve assessment, hysterosalpingography, or advanced imaging methods may be planned. The same tests are not required for every patient; the evaluation is shaped according to the patient’s findings.
When attending the appointment, menstrual dates, duration of attempts to conceive, previous surgeries, infections, miscarriage or ectopic pregnancy history, medications used, and any previous test results should be shared.
In patients applying for infertility treatment in İzmir, the aim is to clarify the reason delaying pregnancy and reduce unnecessary procedures. IVF Specialist Assoc. Prof. Dr. Funda Göde creates the treatment plan in female infertility evaluations according to age, ovarian reserve, tubal condition, uterine findings, accompanying diseases, and the couple’s clinical history.
In this approach, the same treatment is not recommended for every patient. In some patients, follow-up or ovulation regulation may be sufficient, while in other situations insemination or IVF treatment may be considered. The determining factor is not a single test result, but the interpretation of all evaluation findings together.
Fertility generally declines gradually with age. As a woman gets older, her ovarian reserve and chances of pregnancy may be affected. For this reason, if plans for pregnancy are delayed beyond age 35, an earlier evaluation is recommended.
The most common symptom is the failure to conceive despite regular, unprotected intercourse. Irregular periods, severe menstrual cramps, chronic pelvic pain, or recurrent miscarriages may also require evaluation.
There is no single answer to this question. The likelihood of a successful treatment depends on age, the underlying cause, ovarian reserve, the condition of the fallopian tubes, uterine findings, and the partner’s semen analysis. In some cases, simple monitoring may be sufficient. For other patients, insemination, surgery, or in vitro fertilization (IVF) may be considered.
Low AMH levels may indicate a diminished ovarian reserve, but this does not necessarily mean that pregnancy is impossible. AMH is not used as a test to definitively predict spontaneous pregnancy. It can help assess ovarian response during assisted reproductive treatments.
If both fallopian tubes are blocked, it becomes difficult for the egg and sperm to meet. If only one tube is open, pregnancy cannot be completely ruled out provided other conditions are favorable. For this reason, tubal patency is evaluated in conjunction with age, ovarian reserve, sperm analysis, and any underlying medical conditions.
Endometriosis is a chronic condition that can be associated with pain, infertility, and a reduced quality of life. An evaluation should be conducted if a patient experiences severe menstrual cramps, pelvic pain, pain during intercourse, or a missed period. During the diagnostic process, medical history, physical examination, and imaging findings are considered together.
No. IVF is not the first option for every patient. Ovulation induction, timed intercourse, intrauterine insemination, surgical treatment, or monitoring may be appropriate for some patients. The decision regarding treatment is made after evaluating the cause of infertility and the couple’s clinical presentation.
Note: This content is for general informational purposes only and does not replace diagnosis or treatment. A physician evaluation is required for personal diagnosis and treatment planning.
