Understanding Infertility
What is infertility? Infertility is defined as the inability to achieve pregnancy after 12 months of regular, unprotected sexual intercourse. Couples who have sexual intercourse two to three times per week without using contraception but are still unable to conceive may need fertility evaluation.
Infertility often develops without noticeable symptoms. Many couples realize there may be a fertility problem only after trying to conceive for a long period without success.
Age plays an important role in fertility evaluation:
- Women under 35 years old should seek medical evaluation after 12 months of unsuccessful attempts.
- Women between 35 and 39 years old are advised to seek evaluation after 6 months.
- Women over 40 years old should generally consult a fertility specialist after 3 months.
When infertility is suspected, couples should consult a gynecologist or fertility specialist for a comprehensive evaluation.
Infertility Evaluation
During infertility assessment, both partners are usually evaluated to determine the possible cause of fertility problems.
Female Fertility Tests
Several tests may be performed to evaluate female fertility, including:
- Hormone blood tests
- Ovulation monitoring
- Basal body temperature tracking
- Hysterosalpingography (HSG) to evaluate the uterus and fallopian tubes
- Ultrasound examinations
- In certain cases, laparoscopy or hysteroscopy
These tests help specialists assess ovarian reserve, ovulation function, and uterine health.
Male Fertility Tests
For men, the most important initial fertility test is semen analysis (spermogram).
Additional evaluations may include:
- Genetic testing
- Hormone testing
- Testicular biopsy in selected cases
These tests help determine sperm production and overall male reproductive potential.
The Relationship Between Age and Infertility
Age is one of the most important factors affecting fertility, particularly for women.
Women are born with a fixed number of eggs, and this number gradually decreases throughout life. As women age:
- The number of remaining eggs declines
- Egg quality decreases
- The risk of chromosomal abnormalities increases
Eventually, when the ovarian reserve is depleted, menopause occurs.
Although male fertility lasts longer than female fertility, age can still influence sperm quality and reproductive health.
Egg Quality and DNA Changes With Age
Egg cells may develop genetic abnormalities over time due to:
- Natural aging processes
- Environmental influences
- Biological mechanisms that favor higher-quality eggs earlier in life
Eggs with genetic abnormalities may still be fertilized, but pregnancies resulting from these eggs have a higher risk of miscarriage.
Hormonal changes associated with aging may also reduce the likelihood of achieving pregnancy.
Evaluating Ovarian Reserve
Evaluating ovarian reserve is an important step for women who are planning pregnancy or fertility treatment.
Two of the most common tests used to assess ovarian reserve are:
FSH (Follicle Stimulating Hormone)
FSH levels are usually measured on day 3 of the menstrual cycle. Higher FSH levels may indicate a reduced ovarian reserve.
AMH (Anti-Müllerian Hormone)
AMH testing is widely used to evaluate ovarian reserve. This hormone is produced by ovarian follicles and reflects the remaining egg supply.
Lower AMH levels may indicate decreased ovarian reserve.
Ovarian Reserve Assessment Based on AMH Levels
Approximate interpretations of AMH levels include:
- Below 0.4 ng/ml – Very low ovarian reserve. IVF success may be limited and egg donation may be considered.
- 0.7 – 1.0 ng/ml – Reduced ovarian reserve. Fertility treatment may be recommended.
- 1.0 – 1.96 ng/ml – Moderately reduced ovarian reserve.
- 1.96 – 4.2 ng/ml – Normal ovarian reserve.
- Above 4.2 ng/ml – May indicate polycystic ovary syndrome (PCOS).
Male Fertility and Age
Men generally have a longer reproductive lifespan because sperm production continues throughout life.
Sperm production begins at puberty and continues for many years. A full sperm production cycle typically takes about 72 days.
However, male fertility can still be affected by factors such as:
- Decreasing testosterone levels
- Prostate conditions
- Erectile dysfunction
- Environmental and lifestyle factors
Although sperm production does not stop completely, sperm quality may gradually decline with age.
Infertility Is Not the End of the Journey
Modern reproductive medicine offers many treatment options for couples struggling with infertility.
For couples who experience repeated unsuccessful IVF attempts, treatments such as egg donation or sperm donation may significantly increase the chances of pregnancy.
Donor treatments often have higher success rates because donors are carefully selected and medically screened.
With advances in fertility medicine, pregnancy success rates in appropriate patient groups can reach 60–70% or higher.
Couples experiencing infertility should remember that modern fertility treatments continue to evolve, offering new solutions and hope for building a family.
