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Endometriosis, (chocolate cyst) endometrium normally found only in the uterus
benign, sensitive to the hormone estrogen, where the tissue is located in a tissue outside the uterus,
is an inflammatory disease. Endometrium tissue is the tissue that normally lines the lining of the uterus.
tissue, which proliferates every menstrual cycle to prepare for pregnancy, pregnancy
in the absence of a menstrual cycle, it is broken down and shed during menstruation, and is excreted through the vagina with menstrual blood.
is excreted. In endometriosis (chocolate cyst), this tissue is formed in an abnormal way.
Points outside the uterus are called foci of endometriosis. Endometriosis
foci may be small or very diffuse. Most often located in the pelvic region, but
It can also occur in different areas, such as the intestines and diaphragm. Endometriosis (chocolate
cyst) inflammation, dysmenorrhea (painful menstruation), dyspareunia (pain during sexual intercourse),
chronic pain and infertility. These symptoms are very mild in some patients, while in others
may cause severe complaints in patients.

WHY DOES ENDOMETROSIS (CHOCOLATE CYST) OCCUR?
The exact cause of endometriosis is not yet known. The most likely theory is retrograde
is mesnstruation. This means that with menstruation, which happens every month, some of the blood flow
endometriosis as a result of flowing backwards through the tubes into the abdomen instead of flowing out
(chocolate cyst) foci are thought to be formed. However, in most women, menstruation
while some of the blood flows into the abdomen, most do not develop endometriosis (chocolate cyst), this
also suggest that there may be additional factors. Some of the alternative theories include
cells or embryonic remains from the developmental period in the womb
endometriosis (chocolate cyst) may be developing or the blood circulation or lymphatic system
endometriosis is the formation of endometriosis by the spread of endometrial cells throughout the body. All these
theories include the body’s inability to clear endometrial cells outside the uterus, immune
system may also play a role in the development of endometriosis.
In studies, endometriosis has also been associated with some genetic abnormalities.

ENDOMETRIOSIS (CHOCOLATE CYST) IS A COMMON DISEASE
WHO IS AT RISK?
The prevalence of endometriosis is difficult to determine precisely because some patients
is asymptomatic and definitive diagnosis is made surgically. In the reproductive age group
It is estimated that approximately 10 percent of women suffer from endometriosis.
The incidence increases to around 50 percent in infertility patients.
Endometriosis is most common in the 25-35 age range, but it can also occur before menstruation or
It can also be seen after menopause.
Factors that increase the risk of endometriosis (chocolate cyst) – nulliparity (not giving birth
early menstruation (before the age of 11) or late menopause, short menstrual cycles (≤27
days), heavy menstrual bleeding, conditions that prevent the flow of menstrual bleeding (such as cervical
stenosis, müllerian anomalies )
Factors that reduce the risk of endometriosis (chocolate cyst) – multiparity (multiple
giving birth), long breastfeeding intervals and late menstruation (after the age of 14)

WHICH TYPE OF ENDOMETRIOSIS (CHOCOLATE CYST) PATIENTS HAVE
WHAT ARE THE SYMPTOMS?
Common symptoms in patients with endometriosis (chocolate cyst) are as follows:
– Chronic abdominal/pelvic pain
– Infertility
– Dysmenorrhea (painful menstruation)
– Dyspareunia (pain during sexual intercourse)
– Heavy menstrual bleeding
More rare symptoms include bowel and bladder dysfunction (pain, urgency
sensation, increased frequency) low back pain, irregular menstruation, low back pain, chest pain , chronic
fatigue.
Some endometriosis (chocolate cyst) patients may be asymptomatic. These patients
It is usually diagnosed incidentally while undergoing surgery for another reason.

THE RELATIONSHIP BETWEEN ENDOMETRIOSIS (CHOCOLATE CYST) AND INFERTILITY
How endometriosis impairs fertility is unclear and depends on the stage of the disease.
theories exist.
Mild endometriosis (chocolate cyst) triggers inflammation, the secretion of
secretions called cytokines and chemokines and immune cells in the ovary, tube and endometrium
impairs its function. This impairs the maturation of the eggs, fertilization and
affects its implantation into the tissue.
Advanced endometriosis additionally causes anatomical distortion and adhesions
in the uterus. This can affect the release and collection of the egg, the movement of the sperm, in the uterus
may cause irregular contractions, impair fertilization and embryo transport.

ENDOMETRIOSIS (CHOCOLATE CYST) TREATMENT
Treatment is planned according to the severity of the patient’s endometriosis-related pain. The patient’s pain
If possible, it is managed with medical (medication) treatment and in cases where it is not sufficient, surgery
is considered.
Mild or moderate pain (i.e. pain that does not interfere with work)
for patients with endometriosis (chocolate cyst), nonsteroidal anti-inflammatory drugs (NSAIDs) and
birth control drugs hormone therapy (estrogen progestin combinations, progestin
preparations, subcutaneous implant, medicated intrauterine device (i.e. spiral). Hormone
treatment aims to suppress endometriosis that is sensitive to the hormone estrogen. This is
treatments have few side effects and are sufficient for most patients. After three to four months of this dual treatment
then the patient is re-evaluated. Women who have benefited from the treatment can continue until they want to get pregnant or
may continue this treatment until menopause. Some physicians use a gonadotropin-releasing
with hormone (GnRH) analogs (naferlin, leuprolide, buserelin, goserelin, triptorelin)
endometriosis (chocolate cyst) treatment.
In cases of severe pain (e.g. pain that interferes with work), the above treatments
endometriosis (chocolate cyst) whose pain cannot be adequately treated or recurrent
patients, additional therapies for diagnosis and treatment (GnRH analogs, aromatase inhibitors)
can be started.
Endometriosis (chocolate cyst) whose pain does not respond to treatment with the mentioned medications
our next option for diagnosis and treatment is endometriosis surgery. This
surgery can be performed with open or closed technique, but it has many advantages compared to open surgery
laparoscopy (closed surgery) is primarily preferred. Endometriosis (chocolate
cyst) surgery, the foci of endometriosis are removed and adhesions are opened.
Surgical treatment is conservative if the endometriosis patient has a desire for pregnancy and is young.
(preserving uterine and ovarian tissue). Endometriosis not planning pregnancy
(chocolate cyst) patients, taking into account their age, the uterus and ovaries
surgical treatment can also be planned.

INFERTILITY TREATMENT IN ENDOMETRIOSIS (CHOCOLATE CYST)
In the treatment of women with endometriosis who have infertility and want to become pregnant
we can’t use birth control pills. In the treatment of endometriosis-related infertility, the priority
Our option is in vitro fertilization. In women with pain due to endometriosis, non –
We provide pain control with steroid anti-inflammatory drugs. Endometriosis (chocolate cyst)
surgeries used to be recommended for women who wanted to become pregnant, but nowadays
surgical removal of endometriosis (chocolate cyst) may decrease ovarian reserve
and is not preferred in the first step because it is thought to reduce the chances of pregnancy.

TREATMENT OF DEEP ENDOMETRIOSIS
Deep endometriosis, the disease affects the uterosacral ligaments (the ligaments that hold the uterus), the lower abdomen
into the depths of the cavity inside, spreading to the intestines, ureters or bladder
is the name given. In symptomatic patients with deep endometriosis, hormonal therapy and non
Treatment with steroidal anti-inflammatory painkillers is appropriate. However, ureteral, intestinal obstruction
or surgical treatment is applied in women whose complaints do not improve with medication.

TREATMENT OF ENDOMETRIOSIS (CHOCOLATE CYST) OUTSIDE THE PELVIC AREA
Rarely around the upper abdomen, diaphragm, abdominal wall, chest, anus and vagina
endometriosis can be seen. In these cases, it is important to prevent the progression of endometriosis and
with gonadotropin-releasing hormone (GnRH) analogues (hormonal therapy) to control
ovaries are suppressed, estrogen production decreases and estrogen-sensitive endometriosis
tissue growth can be limited.
Treatment of endometriosis causing ureteral or intestinal obstruction
is surgery.

LAPAROSCOPIC (CLOSED) ENDOMETRIOSIS SURGERY
The best treatment method for women who do not respond to drug treatment in endometriosis
laparoscopic endometriosis surgery. Laparoscopic surgery involves a large incision in the abdomen
endometriosis foci with the help of a camera by entering with devices through small holes without opening
nerve transection procedures can also be performed, in which the pain-transmitting nerve fibers are damaged to treat the pain.

Laparoscopic endometriosis surgery has many advantages over open surgery
are available. The main advantages of laparoscopic surgery are smaller surgical scar, less
risk of bleeding and infection, faster recovery, intra-abdominal pain that can be seen after surgery
adhesions are less common in laparoscopic surgery, less postoperative pain and
Laparoscopic endometriosis treatment with laparoscopic surgery enables the diagnosis and treatment of endometriosis precisely by removing and examining the focus. At the same time, it can enable endometriosis patients with infertility (infertility) to become pregnant with uterus-ovarian protective conservative method. Laparoscopic endometriosis surgery and IVF treatment, vaccination
Assisted reproductive techniques, such as assisted reproductive techniques, can increase the chances of pregnancy in patients with endometriosis.

Nerve transection : Laparoscopic uterosacral nerve ablation (LUNA) and presacral
neurectomy (PSN), the nerve that transmits pelvic pain in endometriosis
can treat pain by controllably damaging the fibers.

Treatment of endometriosis with laparoscopic surgery, advanced laparoscopic surgery
It is an operation that requires experience and skill. All problems related to endometriosis
solution, both in treatment with laparoscopic surgery and when you want to have a child.
With IVF treatment, we are at your side throughout the treatment process with our experienced doctor staff.

Operative Sperm Removal from the Testicles

TESE is used in patients who have no sperm cells in their ejaculate (azoospermia).
It is a minimal operation to obtain sperm from the testicles where sperm is produced.
Azoospermia is an advanced male infertility problem. Sperm ducts
problems in sperm production due to obstruction (obstructive azoospermia) or without obstruction
(non-obstructive azoospermia).

The main causes of azoospermia (no sperm in semen) are
Blockage in the sperm ducts
Undescended testicle
Hormonal problems
Congenital absence of sperm ducts
Genetic causes
Some medicines
Some infections
Radiation exposure
There are also cases of azoospermia of unknown cause.
In these azoospermia patients, after a detailed infertility evaluation, sperm
the appropriate technique for obtaining the sperm. A surgical operation from the epididymis
MESA, a method of sperm retrieval from the epididymis with a needle, PESA, a method of sperm retrieval from the testis with a needle.
TESA, which is a method of sperm retrieval, or TESE, which is a method of sperm retrieval by biopsy from the testicle
sperm can be obtained with the operation. Today, however, the most modern and
The successful one is the TESE operation.

TESE is a procedure performed under general or local anesthesia and takes about 2 hours. Testicle
It is visualized with a microscopic operation by making 1-2 cm incisions. This visible sperm
sperm cells are selectively removed from the ducts.

WHO IS SUITABLE FOR TESE OPERATION?
All patients with azoospermia (patients with no sperm in semen) are eligible for TESE.
is a candidate. Patients undergo genetic examination before the operation. Sex determinant in men
Y chromosomes are examined. On the Y chromosome is the chromosome responsible for sperm production.
Problems in the AZF region are detected. Patients with dysfunctional AZF area will benefit from TESE
will not be seen. However, unless there is a major problem in the AZF area, azoospermic
TESE can be easily applied to patients.

IS TESE A RISKY OPERATION, DOES IT DAMAGE THE TESTICLE?
Since TESE involves making incisions in the genital area, even if they are very small, slight bleeding or
there may be pain. Painkillers can be used. Since the procedure is in the genital area, hormonal
may have an effect on regularity, but this effect is short-lived, and the TESE procedure has no health or sexual
no permanent damage to function has been observed.

CAN TESE OPERATION BE REPEATED?
If the number and quality of the sperm taken with the TESE operation is sufficient for the procedure, a second
The sperm taken from the operation site can be frozen and used again when necessary.
However, when the frozen tissue is thawed, good quality sperm may not always be obtained. This
in which case a second TESE operation may be necessary. Likewise, with the first TESE operation
If the number and quality of the sperm collected is found to be insufficient, a second TESE operation may be performed.
In summary, this operation can be repeated until a high quality and sufficient number of sperm is obtained. TESE
If the operation is to be repeated, it would be correct to have 6 months between the two procedures.

WHAT IS THE SUCCESS RATE OF TESE OPERATION?
Although the success rate of the TESE procedure varies from person to person, it is estimated that 40 percent of patients with azoospermia
In 60% of cases, good quality and sufficient number of sperm can be obtained.

WHAT SHOULD I PAY ATTENTION TO BEFORE TESE OPERATION?
Blood pressure and blood sugar levels of people with chronic diseases such as hypertension and diabetes
It should be checked before TESE operation. If medications such as blood thinners are used, TESE
These medications should be discontinued one week before the operation under the supervision of a doctor.

THINGS TO CONSIDER AFTER TESE OPERATION
WHAT ARE THESE?
No hospitalization is required after TESE operation, 2-3 hours under observation
They can be discharged after being kept.
Heavy physical activities should be avoided for 10 days after TESE operation.
Those who have micro TESE surgery should not take a shower immediately.

It is not recommended to have sexual intercourse for 10 days after TESE operation.
Dressing should be done 48 hours after TESE operation. Sutures used in TESE
Since it dissolves spontaneously in about 1 week, there is no need to remove the stitches.
Patients are advised to wear tight underwear for 10-15 days after TESE.

The placenta is a lining that forms on the inner wall of the uterus during pregnancy, popularly known as the baby’s partner.
is an organ. It is connected to the baby by the umbilical cord and is a substance between the mother’s blood and the baby’s blood.
exchange of nutrients. Through the placenta, nutrients and oxygen pass from the mother’s blood to the baby, while waste
substances pass from the baby’s blood into the mother’s blood and are excreted from the body. In this way, the nutrients
Another function of the placenta is to secrete certain hormones important for pregnancy.
The placenta is a very important organ during pregnancy, but after birth it
The placenta is completed and is separated from the uterine wall by uterine contractions and excreted from the body.

What are placenta adhesion anomalies?
However, sometimes all or part of the placenta adheres deeply to the uterine wall, this is called
placenta adhesion, which we call placenta acreata, increata and percreata.
anomalies occur. Adhesion of the placenta to the uterus is called placenta accreta, placenta
placenta increata, when it adheres to the serosa layer outside the uterus.
If it progresses as far as the placenta, it is defined as placenta percreata. The most severe placenta
In perforation, the placenta can progress like a tumor to the bladder and extrauterine organs.

Why are placenta acreata, increata and percreata risky?
In these anomalies, in which the placenta adheres to the uterine wall, the placenta can be detached from the uterus after birth.
cannot be separated. Forced separation is because the placenta is a very bloody organ.
because it can cause severe bleeding. Therefore, placenta acreata, increata and
Patients with percreata should be followed more closely than other pregnant women and their treatment should be planned specially.

How common are placenta acreata, increata and percreata?
Placental adhesion anomalies occur approximately once in 600 women. 63 percent of these
placenta acreata is the mildest. This is followed by placenta increata with 15 percent and placenta acreata with 10 percent.
followed by placenta perforata.

Why do placenta acreata, increata and percreata occur?
Although the cause of placental adhesion anomalies is not known for certain, some possible theories are
is present. In a normal pregnancy, the endometrium tissue in the uterus
In preparation, it thickens, forming a tissue called a decidua for the placenta to attach to. The uterus
damage to the tissue due to previous surgery, etc., resulting in a decrease in the decidua during pregnancy.
underdevelopment can cause the placenta to attach incorrectly to the uterus
is being considered. One of the new theories is the scarring that occurs after damage to the uterine tissue.
fibrin deposition in the uterine tissue, which causes the placenta to invade and adhere to the uterus.
is one of the factors. 80 percent of patients with placenta accreta have had a previous cesarean section
a history of childbirth, curettage or myomectomy (surgery to remove fibroids) supports these two theories.
support.

The rare occurrence of placenta accreta in the first pregnancy is due to the uterine bicornus (uterus at birth).
heart-shaped), adenomyosis, uterine fibroids such as fibroids in the inner wall of the uterus
pathologies, endometrial damage at the microscopic level, endometrial
function, affecting the adhesion of the placenta.
Who is at risk for placenta acreata, increata and percreata?
History of cesarean section: The most important risk factor for placenta acreata is a history of cesarean section.
is to have a cesarean section. As the number of caesarean sections increases, the risk of placental adhesion anomalies also increases. First time
the risk of placenta acreata after cesarean section was 3 percent, 11 percent after the second, and 11 percent after the third
The risk of placenta accreta after cesarean section increases to 40 percent!

Placenta Previa : A condition in which the placenta is close to the cervix or closes the cervix
is called placenta previa. The decidua to which the placenta attaches in the area near the cervix
The placenta cannot attach to the uterus in a healthy way due to insufficient tissue. This can lead to
Therefore, placenta accreta is usually associated with placenta previa.
Abortion History : Abortion damages the endometrium tissue in the uterus, which can lead to
increases the chance of the placenta sticking.
Uterine surgeries : uterine surgery such as myomectomy (fibroid removal surgery)
may increase the risk of placenta accreta as it may damage the tissue.
Fibroids in the inner wall of the uterus (submucosal fibroids): Due to endometrial damage
placental adhesion may be impaired.
Intrauterine adhesions (e.g. Asherman syndrome): Placenta due to endometrial damage
adhesion may be impaired.
Multiparity (having had many births)
Advanced maternal age: Pregnancies over 35 years of age have a higher risk of placenta acreata.

What are the symptoms of placenta acreata, increata and percreata?
Placenta acreata is usually asymptomatic throughout pregnancy.
Rarely, it may cause vaginal bleeding towards the last weeks of pregnancy. But mostly
placenta acreata and other placental adhesion anomalies during routine pregnancy examinations
detected by ultrasound.
How are placenta acreata, increata and percreata diagnosed?
Placenta acreata can be detected by ultrasound in routine pregnant examinations.
In patients with suspicion, imaging methods such as MRI and maternal blood alpha-
fetoprotein test can also be used. AFP levels are elevated in placenta acreata, increata and percreata
monitored.

How are patients with placenta acreata, increata and percreata followed?
Placenta acreata usually does not cause any problem during pregnancy. The most important problem is birth
after the placenta does not detach spontaneously and attempts to detach the placenta
is that it causes serious threatening bleeding. In patients diagnosed with placenta acreata
prenatal planning is done.

The only delivery option in patients with placenta acreata, increata and percreata is cesarean delivery.
Generally, delivery is planned at 34.-36 weeks.
Due to the risk of bleeding, blood bank blood transfusion is performed in the blood bank before delivery.
is prepared. Because it is a risky delivery, patients with placenta accreta
cannot be operated, delivery is planned in a center with appropriate intensive care conditions.
Treatment of patients with placenta acreata, increata and percreata
In most of these patients, the removal of the baby is followed by a hysterectomy (surgical removal of the uterus
removal) is necessary. Placenta accreta is a complication of postpartum hysterectomies (removal of the
removal) is the cause of about half of them. Because it is a risky operation, placenta
cesarean sections for patients with acreata, increata and percreata must be performed by an experienced surgeon.
must be done by

In patients with placenta accreta, if the patient wants to have a baby again, uterine protection
(conservative) surgery may be tried. In this surgery, the placenta is removed after the baby and the adhering
The parts are scraped with a curette and bleeding is tried to be stopped with additional sutures or tamponade. However.
there is a high risk of bleeding, if the bleeding cannot be stopped, again to save the patient’s life
It should be known that the uterus can be removed.
In patients with placenta increata and percreata, the only treatment option is hysterectomy.
removal of the placenta) The risk of complications is even higher when the placenta has advanced outside the uterus
will be high. In such operations, it is recommended to use a bladder (urinary bladder) and ureter
urologist, an anesthesiologist experienced in acute blood loss, and an obstetrician and gynecologist.
will perform the surgery as a team.

Why are placenta acreata, increata and percreata surgeries risky?
Especially those that cannot be diagnosed before birth due to the very high risk of bleeding.
patients are at risk of maternal and infant death due to blood loss. Blood transfusion related
reactions may occur. In cases where the placenta is outside the uterus due to adhesions
neighboring organs (bladder, ureter, intestines) may be injured. Hence placenta acreata,
It is extremely important that an experienced surgeon performs increata and percreata surgeries.

Hysteroscopy is a procedure in which a tube-like device with a camera called a hysteroscope is inserted through the vagina into the uterus.
inside the uterus, the points where the tubes open to the uterus and the cervical canal with a camera
visualization procedure.

WHAT ARE THE TYPES OF HYSTEROSCOPY?
While hysteroscopy is used for diagnostic purposes thanks to its imaging capability (diagnostic
hysteroscopy), but also with some accompanying devices, so that some
It also provides the possibility of treatment for diseases (operative hysteroscopy). Hysteroscopy can be performed in office conditions or
hysteroscopy can be performed in the operating room, and many gynecological problems can be solved with a mild anesthesia.
can be treated with minimal intervention.
Hysteroscopy can be performed in both office and operating room conditions. Office hysteroscopy
is a diagnostic hysteroscopy performed under local anesthesia for imaging purposes.
Small procedures can also be performed with some office hysteroscopy devices. Small polyps can be removed,
Spirals left in the uterus can also be removed from the cervix with office hysteroscopy. Office hysteroscopy
hysteroscopy allows patients to be treated more comfortably, with less risk and at a lower cost.
they have the opportunity to be.

IN WHICH DISEASES IS HYSTEROSCOPY USED?
Hysteroscopy can be performed to investigate the cause of abnormal bleeding and menstrual irregularities.
Fibroids and polyps in the uterus can be diagnosed with hysteroscopy and operative
can be treated by removing the uterus.
Intrauterine adhesions, uterine curtains or congenital uterine anomalies
hysteroscopy enables diagnosis and treatment.
Tissue sample with hysteroscopy for diagnosis of pathologies in the inner wall of the uterus (endometrial)
can be removed.
Intrauterine hysteroscopy in case of recurrent miscarriages or recurrent IVF failure
can be visualized to see if there is a cause.
A spiral (intrauterine device – IUD) or foreign bodies that are not visible from the outside can be detected by hysteroscopy.
can be removed.
In the evaluation of infertility, hysteroscopy allows the inside of the uterus to be examined.

ADVANTAGES OF HYSTEROSCOPY
Hysteroscopy allows the inside of the uterus to be evaluated without an incision. Uterine fibroids, polyps
pathologies inside can be removed by hysteroscopy from the inside, without surgery. Patients can be seen on the same day
can be discharged and return to normal life in a very short time after hysteroscopy.

WHO SHOULD NOT UNDERGO HYSTEROSCOPY?
Hysteroscopy is contraindicated in the following cases:
●Pregnancy
Active pelvic infection (for example, genital herpes infection, i.e. genital warts)
Cervical or uterine cancer
Excessive bleeding can make imaging difficult during hysteroscopy, but this is a
hysteroscopy is not a contraindication and can be performed in the presence of bleeding.

IS HYSTEROSCOPY A PAINFUL PROCEDURE?
Hysteroscopy is a painful procedure because local or general anesthesia is applied during hysteroscopy.
it is not.

IS HYSTEROSCOPY A RISKY PROCEDURE?
Hysteroscopy is a safe, very low-risk procedure.

HOW LONG DOES A HYSTEROSCOPY PROCEDURE TAKE?
The duration of hysteroscopy varies from procedure to procedure. Hysteroscopy for diagnostic purposes
While it takes 10 minutes, operative hysteroscopy can take up to 1 hour depending on the procedures performed.

WHAT SHOULD I PAY ATTENTION TO AFTER HYSTEROSCOPY?
– Hospitalization is not required after hysteroscopy except in special cases, and the patient should be under anesthesia.
After it has passed, it is discharged after a few hours of follow-up.
Sexual intercourse is not recommended for 10 days after hysteroscopy.
It is not recommended to swim in the pool, bathtub and sea for 15 days after hysteroscopy. Standing shower
is recommended.
There may be spotting bleeding and mild groin pain for a few days after hysteroscopy.
Painkillers can be used for the pain.

WHO IS SUITABLE FOR IVF TREATMENT?
– IVF is suitable for women who have had both tubes surgically removed or due to a previous infection.
is the first choice of treatment for damaged and dysfunctional sperm.
– Low sperm count, or no sperm in semen, low sperm motility
ICSI in male infertility (infertility) such as low sperm in normal structure
(intracytoplasmic sperm injection) method can be used for IVF treatment. More mild
IUI (intrauterine insemination) method may be preferred in these cases.
– Older mothers with diminishing ovarian reserve and quality may benefit from IVF.
– In cases such as PCOS (polycystic ovary syndrome), endometriosis, other treatments can help to conceive.
When it is not possible to achieve pregnancy, in vitro fertilization can be used.
– In vitro fertilization treatment with PGD (preimplantation genetic testing) for couples with genetic diseases
can have a healthy baby.
– If no problems are found in the examinations but still cannot conceive
success with vaccination and IVF treatment in patients with unexplained infertility (infertility)
can be
Surgery for ovarian or testicular tumors, radiotherapy or chemotherapy
for those who will receive in vitro fertilization by freezing and storing sperm or eggs before treatment
can be used in treatment.

WHAT IS THE SUCCESS RATE OF IVF TREATMENT?
In a good center, 50-55% success rate can be achieved in IVF treatment under appropriate conditions.
However, the success rate of IVF treatment varies from couple to couple due to different factors.

WHAT ARE THE FACTORS AFFECTING SUCCESS IN IVF?
The most important determinant of the success of IVF treatment is the age of the woman. In vitro fertilization
While it is very successful in younger women, it is less successful in women over 40. This is because
is because the number of eggs decreases with age and, consequently, there are fewer eggs available for IVF treatment.
egg collection, decreased egg quality and increased risk of chromosomal abnormalities.

Advanced age, smoking, ovarian removal, chemotherapy, radiotherapy,
conditions with low ovarian reserve, such as early menopause, resulting in fewer eggs
can be found in the fallopian tubes, which reduces the success of IVF treatment.
– Infections in the fallopian tubes due to previous infections, surgery or endometriosis
epithelial tissue may be damaged, the end opening into the abdominal cavity may become blocked and fluid may enter the tube.
may accumulate. This condition is known as hydrosalpenx. Hydrosalpinges can prevent conception
makes it difficult and reduces the success rate of IVF treatment. In this case
laparoscopic (closed) surgery to remove the tube and treatment is provided and in vitro fertilization treatment
success can be increased.
– Smoking decreases the success rate of IVF, albeit minimally. Therefore, we advise smokers
We advise them to quit smoking during the IVF treatment process.
– The effect of fibroids on IVF success depends on their location, within the uterine cavity.
fibroids reduce the chances of success, whereas fibroids unrelated to the cavity have no effect on IVF treatment.
does not seem to have an impact.
• The patient has had a live pregnancy before, successful in vitro fertilization treatment
increases the likelihood of success. However, if the patient has had previous miscarriages, success in IVF treatment
does not lower your chances.
– In repeated IVF treatments up to approximately the fourth failed IVF treatment
the rate of success did not decrease. When failure occurs, couples become hopeless.
should not be discouraged, as high success rates can still be achieved in the next IVF treatment.
-IVF treatment may be less successful in obese women.
Sperm immobility, severe sperm deformities, sperm in semen
(azoospermia) are factors that make it difficult to achieve success in IVF treatment.

HOW LONG DOES IVF TREATMENT TAKE?
IVF treatment is started on the 2nd or 3rd day of menstruation. The development of the eggs is monitored,
suitable eggs are then collected and fertilized with sperm. The embryo is then fertilized
is transferred to the uterus at the same time. With this process, IVF treatment takes about 15 to 18 days. In vitro fertilization
The woman does not need to be hospitalized during the baby treatment. Scheduled appointments
can continue her routine life by commuting back and forth.

IS MY CHOICE OF IVF CENTER IMPORTANT?
Choosing the right IVF center is important in terms of staff, techniques and equipment.
is one of the most important factors in success. The IVF team is knowledgeable and experienced
is extremely important. In vitro fertilization treatment in our clinic, our experienced physicians
with the latest and most reliable techniques.

 

BABIES BORN WITH IN VITRO FERTILIZATION ARE GENETICALLY OR
WILL THEY HAVE DEVELOPMENTAL PROBLEMS?
Babies born with IVF treatment may have genetic problems or other developmental problems.
no different from babies. In addition, no difference was observed in the continuation of their lives in the studies.

MY IVF TREATMENT WAS UNSUCCESSFUL, SHOULD I TRY AGAIN?
In cases where IVF treatment is unsuccessful, when the expectant parents are ready
IVF treatment can be repeated. There is no upper limit for the number of repetitions of IVF treatment.
If the first attempts are unsuccessful, the couple should not despair. First time
the reason for failure in the trials is investigated in more detail and the next IVF treatment
the chances of success can be increased. However, if pregnancy has not occurred in the first 3 IVF treatments
the chances of success are predicted to be low. However, couples can continue IVF treatment after the 4th-5th unsuccessful attempts. After the 10th attempt
We see couples who have a baby even after IVF treatment.

HORMONE DRUGS USED IN IVF TREATMENT ARE HARMFUL
IS IT?
The drugs used in IVF treatment may have temporary side effects that are not serious, but permanent
they do not have any side effects. Hormone drugs used in IVF treatment have many
After control, it is released to the market and used in treatment all over the world.

HOW DO I KNOW IF I AM PREGNANT DURING IN VITRO FERTILIZATION TREATMENT?
Pregnancy test 12 days after embryo transfer by checking the beta-hCG hormone in the blood
is done. This will show whether the IVF treatment was successful or not.

DOES THE RISK OF MISCARRIAGE INCREASE WITH IVF TREATMENT?
The risk of miscarriage increases between pregnancies that occur normally or with in vitro fertilization.
There is no difference in terms of the difference.

Fibroids are benign, estrogen-sensitive tumors that arise from muscle tissue in the uterus.
Fibroids can be located inside the uterus, on the outer surface of the uterus, embedded in the uterine wall or in a
They may be attached to the uterus with a stalk. The most common benign tumor in women
Fibroids can start to appear with puberty. In women of reproductive age
The incidence of fibroids increases with age. In most, but not all, patients
After menopause, fibroids shrink with the decrease in estrogen.

WHAT ARE THE RISK FACTORS FOR FIBROIDS?
Having one or more births reduces the chance of fibroids.
Women who menstruate before 10 years of age are more likely to develop fibroids. With the transition to puberty
Increased estrogen is associated with an increased risk of fibroids.
Most studies show an association between fibroids and obesity.
Excessive alcohol consumption, especially beer, increases the risk of fibroids.
Smoking inhibits the enzyme aromatase, which converts testosterone to estrogen in the body.
decreases the amount of fibroids. Interestingly, recent studies have shown that smoking may be linked to fibroids by this mechanism.
reduces the likelihood of occurrence.

WHAT ARE THE SYMPTOMS ASSOCIATED WITH FIBROIDS?
Most fibroids are small and asymptomatic and can be detected by a chance imaging method.
They can also cause the following complaints in some patients:
– Prolonged, frequent and excessive menstrual bleeding (menorrhagia, metrorrhagia)
– Intermediate bleeding
– Anemia due to blood loss
– Dysmenorrhea (painful menstruation)
– Dyspareunia (painful sexual intercourse)
– Pain in the abdomen and groin
– Feeling of pressure and pressure in the lower abdomen
– In fibroids that grow towards the bladder, it is difficult to make all urine as a result of pressure.
Difficulty or frequent urination, rarely inability to urinate.
– Difficulty in defecation due to pressure in fibroids growing towards the intestines, constipation
can be seen.
– Fibroids in the uterine cavity can cause recurrent miscarriages or difficulty conceiving.
may be the cause.

HOW ARE FIBROIDS DIAGNOSED?
– Most fibroids are well-circumscribed and hypoechoic with ultrasound performed through the abdomen or vaginally,
may appear as round masses.
– Cervical fibroids can be seen during speculum examination.
– Hysteroscopy can show fibroids in the uterus. The uterus through the vagina with a thin device
the fibroids in the uterus are visualized with a camera by entering into the uterus, and at the same time the treatment
may also be used.
Hysterosalpingography, MRI or tomography can also be used to diagnose fibroids, but most
it is not always necessary. Ultrasound and hysteroscopy, which provide diagnosis and treatment together, and
laparoscopy will usually be sufficient.

CAN FIBROIDS TURN INTO CANCER?
Fibroids are benign masses, however, sarcoma, which is a malignant tumor, is very rare.
Care should be taken in follow-up in terms of the possibility of transformation.

TREATMENT OF FIBROIDS
Asymptomatic, small and not growing during one year of follow-up, seen in pregnant women or
Fibroids that occur close to menopause do not require treatment. These fibroids can be treated
They are monitored and followed up with ultrasound examination.
They cause complaints that interfere with daily life, are indistinguishable from other tumors, rapidly
fibroids that grow and interfere with pregnancy should be treated.
The main treatment for uterine fibroids is surgery, but the size of the fibroid, its location, the patient’s age and
Appropriate treatment is selected according to the child’s wishes.

DRUG TREATMENT FOR FIBROIDS
Medicines can relieve the symptoms of excessive bleeding and pain caused by fibroids, but they can also prevent fibroids from forming.
they do not eliminate it. For this, hormonal birth control pills, hormonal spirals
can be used. A group of drugs called GnRH agonists can temporarily shrink fibroids and
can be used before surgery. However, the definitive treatment for fibroids is surgery.

SURGICAL TREATMENT OF FIBROIDS
Our two main surgical treatments for fibroids are myomectomy and hysterectomy. However, there are
There are also new treatment options, but not yet in patients who are planning a pregnancy.
is not preferred because it has not been shown to be effective.
Myomectomy surgery is the removal of only fibroids while preserving the uterus. Thus, the woman
can have a child after fibroid surgery. Smaller incision, less bleeding, more
laparoscopy offers many advantages such as rapid recovery, diagnosis and treatment.
or myomectomy by hysteroscopy are the techniques of choice. Submucosal fibroids(
fibroids in the inner cavity of the uterus) can be removed by hysteroscopy without an incision in the abdomen. Many
In patients with large or multiple fibroids, open surgery may be preferred.
Hysterectomy surgery is the removal of the uterus together with the fibroids. Together with
The ovaries may or may not be removed. Hysterectomy for large fibroids, other treatments
when it is not useful, when there is no desire to have children. Again, primarily laparoscopic
hysterectomy, or hysterectomy with open surgery.
Embolization is one of the new approaches in fibroid treatment. In this procedure, the blood vessels
certain substances are injected into the vessels to block them and thus the fibroids can be reduced in size. Longer
studies are ongoing in terms of its effect on pregnancy in the period

MRI-guided ultrasound surgery is another new approach. In this technique, ultrasound
waves are directed to the fibroid with the help of MRI and the fibroid is tried to be treated with this effect.
The effects of this treatment on women who want to become pregnant are still under study.

IS THERE A POSSIBILITY OF RECURRENCE OF FIBROIDS AFTER SURGERY?
Unfortunately, there is a five-year recurrence rate of fibroids in patients who have undergone fibroid surgery.
It is around 50%. However, 7 percent of these fibroids require reoperation.

WHEN CAN I GET PREGNANT AFTER FIBROID SURGERY?
It is recommended not to get pregnant for 3-6 months after fibroid surgery. After this period, the uterus
You can get pregnant because the healing will be complete.

CAN I HAVE A NORMAL DELIVERY AFTER FIBROID SURGERY?
Most of the time, cesarean delivery is recommended after fibroid surgery in order not to take risks. However
In very superficial fibroids, normal delivery can also be attempted.

LAPAROSCOPIC MYOMECTOMY (CLOSED MYOMA SURGERY)
Laparoscopic (closed) fibroid surgery is performed under general anesthesia. Laparoscopic
(closed) fibroid surgery can be considered as 5 stages:
First, several 1-2 cm incisions are made in the abdomen, one in the navel and the others under the navel. Abdomen
is inflated with carbon dioxide gas and through one of the incisions a camera device called a laparoscope is inserted.
The uterus, ovaries and neighboring organs can be easily seen. Through other incisions
laparoscopic laparoscopic surgery by inserting devices in the form of thin tubes that will be used in surgery.
(closed) uterine fibroid surgery is performed.
After the preparation is completed, the outer wall of the uterus is cut, the fibroid is found and the uterus
It is removed by separating it from the wall.
After the fibroid is removed from the uterus, the incision in the uterine wall is repaired by suturing.
The fibroid is removed out of the abdomen through incisions. If it is a large fibroid, a morcellator
It is removed by breaking it into small pieces inside the abdomen with a device called a moreelation. This procedure is called moreelation.
is called.

Laparoscopy instruments are removed from the abdomen and the small incisions are closed with sutures and the operation is terminated.

WHICH FIBROIDS CAN BE REMOVED WITH LAPAROSCOPIC (CLOSED) SURGERY?
Generally, laparoscopic (closed) surgery is preferred for fibroids smaller than 15 cm.
Multiple fibroids can also be removed by laparoscopic (closed) surgery. Number of fibroids
and its size as well as its location are also effective in the choice of surgery.

WHAT ARE THE ADVANTAGES OF LAPAROSCOPIC (CLOSED) FIBROID SURGERY?
– In laparoscopic (closed) fibroid surgery, the incisions are smaller and the scar remains less.
– There is less pain after laparoscopic (closed) fibroid surgery. Patients recover from surgery
They can start walking and going to the toilet in a short time after surgery.
Patients with laparoscopic (closed) fibroid surgery can be discharged faster. Patients
discharged 1 day after laparoscopic uterine fibroid surgery and back to normal work within 1 week
they can go back to their lives.
There is no risk of hernia formation in laparoscopic (closed) fibroid surgery.
Laparoscopic (closed) fibroid surgery is more likely to cause infection than open surgery.
is low
Fewer unwanted intra-abdominal adhesions after laparoscopic (closed) fibroid surgery
is seen. This is safer for subsequent intra-abdominal surgeries and pregnancies.

In the treatment of infertility, a number of tests are used to determine a woman’s fertility.
help is sought. One of the most important markers of a woman’s fertility potential is the ovary.
(ovarian) reserve. The purpose of ovarian reserve evaluation is to assess the
to be able to identify patients and guide them in the right way and if they want pregnancy
is to prevent a delay. The AMH level is also one of the best tests of egg reserve.
What is ovarian reserve?
Ovarian reserve refers to the number of follicles (eggs) in a person’s ovaries and, in part
quality.
Who is tested for ovarian reserve?
Women over 35 years of age who cannot conceive despite 6 months of regular unprotected sexual intercourse
or those with a family history of early menopause, some genetic disorders affecting the ovaries
diseases, endometriosis patients, patients with ovarian removal (oophorectomy),
in patients undergoing ovarian surgery (such as ovarian cyst), chemotherapy and radiotherapy
It is appropriate to evaluate ovarian (ovarian) reserve in smokers.
Is ovarian reserve related to age?
The number of follicles (eggs) in a woman’s ovary and the quality of the eggs are the most important determinants.
The important factor is the age of the person. Women’s eggs develop in the womb and last a lifetime.
they carry these eggs. When a woman is born, she has about 1-2 million eggs,
After childbirth, these eggs do not multiply, but rather become fewer and fewer with age. Every menstrual cycle
one egg matures and is released from the ovary. Sometimes more than one is released. Menopause
Towards the end of menopause, the eggs start to run out. Too few eggs in a menopausal woman
remained.
What are other factors that reduce ovarian reserve?
Endometriosis (chocolate cysts) can affect ovarian reserve. Pregnancy
If desired, surgery of endometriosis (chocolate cyst), especially in the ovary, with ovarian (
ovarian (ovarian) reserve will decrease, so surgical treatment should be avoided as much as possible before pregnancy.
should be avoided and medication should be tried.
Radiotherapy and chemotherapies: Due to the effects of chemotherapy and radiotherapy on the ovaries
the option of egg freezing can be considered beforehand.

Ovarian surgeries: Operations to remove ovarian cysts or operations to remove the ovary for cancer, etc.
Ovarian reserve will also decrease in operations where the ovary is removed due to cancer, etc.
Especially cyst operations should be performed with maximum care to protect the eggs.
is important in terms of ovarian reserve.

What are the tests that show ovarian reserve?
There is no test that shows ovarian reserve one hundred percent. Our most important parameter is age
However, the tests that best reflect ovarian (ovarian) reserve are the AMH test and
is antral follicle counting by ultrasound.

•AMH (Anti-Müllerian Hormone) Test
AMH (anti-müllerian hormone) is a hormone found in the ovary, each containing an egg
is a hormone produced by the follicles that host it. AMH level, ovarian
(ovarian) egg reserve is one of the best markers of egg reserve. AMH is the same marker
decrease much earlier than the increase, so that the ovarian reserve may be reduced earlier and
is a sensitive marker. AMH is similar to other ovarian hormone tests (inhibin B and
It is also more closely associated with ovarian reserve than estradiol.
The AMH test is a blood test and is performed at any time during the menstrual cycle.
can be done.
In women, AMH levels gradually decrease as the amount of eggs decreases with age.
decreases and is monitored at levels too low to be detected in menopause.
In women under 35 years of age, low AMH levels may indicate early menopause.
is a stimulating condition. Patients in this situation should not be alarmed if they want to get pregnant,
should get pregnant with proper planning under the supervision of a physician or, if necessary, undergo treatment.
they must start.
In patients with polycystic ovary syndrome, a large number of small eggs that fail to mature
AMH levels may be above normal due to the presence of AMH cells. Some
AMH is also elevated in ovarian tumors.
AMH level also determines the response to treatment in patients for whom IVF (in vitro fertilization) is planned.
is also a useful marker for prediction. If the AMH value is below normal, the egg
reserve is low, fewer eggs can be collected and IVF in these patients
the chances of getting pregnant with treatment are lower. But even very low AMH levels,
As with other tests, it does not indicate that conception is not possible. High AMH level
indicates a risk for problems related to ovarian overstimulation, in vitro fertilization
The doses of medication used in treatment are adjusted accordingly.
In IVF treatment, the AMH test is a valuable guide for the course of treatment.
The collection of a sufficient number of eggs is important for the success of IVF treatment.
AMH <0.5 ng/mL: ovarian reserve is very reduced, the chance of pregnancy is lower.
AMH <1.0 ng/mL: ovarian reserve is reduced, limited number of eggs can be collected.
AMH between 1.0 -3.5 ng/mL: sufficient number of eggs can be collected.
AMH >3.5 ng/mL: a large number of eggs can be collected.

•

Basal FSH (Follicle Stimulating Hormone) and Estradiol
Basal FSH and estradiol are measured in the blood on days 2-4 of menstruation. FSH values are measured every menstrual
cycle, so a single FSH value is not reliable.
If FSH levels are consistently high (>10-20 IU/L), this indicates that the ovarian
reserve is diminished. Likewise, high estradiol (>60-80
pg/mL) indicates decreased ovarian reserve.
Since high estradiol will decrease FSH level with negative feedback, basal FSH
The value must be seen together with estradiol.

-Antral Follicle Count
Transvaginal ultrasound on days 2-4 of the menstrual cycle, 2-10 mm in diameter
follicles are counted. Since the number of antral follicles does not vary much from cycle to cycle
is a reliable test and is directly proportional to the patient’s number of remaining follicles (ovarian reserve).
is assumed to be.

•

Over Volume
Ovarian volume decreases with age and can be measured by ultrasound. Ovarian volume
its value in demonstrating reserve is lower than antral follicle count

-Inhibin B
Inhibin B is a hormone secreted from preantral and antral follicles. For this reason
The value of inhibin B in the blood also decreases with age. Inhibin B levels decrease between cycles
Since it varies, it is nowadays recognized that ovarian reserve
is not used in the evaluation.

-Clomiphene Citrate Challenge Test (CCCT)
Variability of hormone values (FSH, estradiol, inhibin B) used in this test
the test can be derived from basal FSH (follicle stimulating hormone) measurement or antral follicle
is not more sensitive than the census and requires additional medication.
CCCT (clomiphene) is now routinely used to assess ovarian reserve.
Citrate Challenge Test) is not used.

•

Home fertility tests

These kits measure FSH (follicle stimulating hormone) in urine on day 3 of menstruation
is not recommended. It is not recommended that the patient be evaluated by a professional.
There is a risk of misdirection.

I have low ovarian reserve, can I get pregnant?
Although these ovarian reserve tests can determine when fertility will end
Although it cannot be predicted, women with very low test values should try to avoid losing the chance of pregnancy.
should not postpone their plans too long; if they are unable to conceive, they should seek infertility research and in vitro fertilization.
treatment should be started. As a result, it is recommended to treat patients with low ovarian reserve.
patients have a chance of becoming pregnant, even if their chances are reduced.
Women with a family history of early menopause have earlier ovarian reserves.
can become exhausted. While a normal woman has difficulty conceiving after the age of 40, this
For patients, this process can start 5-10 years earlier. These women become mothers at a young age
is the right option.

Before surgery, radiotherapy, chemotherapy procedures where ovarian (ovarian) reserve will decrease
egg freezing can be considered.
Today, there are studies showing that stem cells are also present in the ovaries. These
research is ongoing for the production of new eggs from cells and ovarian reserve
for women who have been reduced in the number of pregnancies they can conceive.

What is the placenta?
The placenta is a lining that forms on the inner wall of the uterus during pregnancy, commonly known as the baby’s partner.
is an organ. It is connected to the baby by the umbilical cord and is a substance between the mother’s blood and the baby’s blood.
exchange of nutrients. Through the placenta, nutrients and oxygen pass from the mother’s blood to the baby, while waste
substances pass from the baby’s blood into the mother’s blood and are excreted from the body. In this way, the nutrients
Another function of the placenta is to secrete certain hormones important for pregnancy.
The placenta is a very important organ during pregnancy, but after birth it
The placenta is completed and separated from the uterine wall by uterine contractions and excreted from the body.
What is Placenta Previa?
Normally, the placenta can be located in the front, back, top or sides of the uterus. Placenta previa,
The placenta is located in the lower part of the uterus, covering the cervix. Placenta
in previa, if the placenta completely closes the cervix, the baby’s birth canal is closed
normal delivery cannot take place, the only delivery option is a caesarean section. Placenta previa is present in approximately 200
occurs in 1 pregnancy.
Types of Placenta Previa
Total placenta previa: The placenta completely covers the cervix. Total placenta previada
delivery can only be done by caesarean section. Total placenta previa accounts for 20 percent of placenta previas.
creates.
Partial placenta previa: The placenta partially closes the cervix.
Marginal placenta previa: The placenta is at the edge of the cervix but does not close it.
Low-lying placenta: The placenta does not close the cervix, the placenta
It is not previa but is located 2-5 cm from the cervix.
What Causes Placenta Previa?
The cause of placenta previa is unknown, but some factors can increase the risk of placenta previa.
increase the risk of developing a disease. The main risk factors can be summarized as follows:
If placenta previa was observed in a previous pregnancy, the risk of it occurring in other pregnancies is also increased.
The risk of placenta previa increases in patients who have had many cesarean sections. As the number of cesarean sections increases
The chance of the placenta being misplaced also increases.
Multiparity (more than one birth): In women who have already given birth
placenta previa is more common.

Advanced maternal age
Previous uterine surgeries (fibroid surgeries etc.)
Having had many abortions
Multiple pregnancy: increased risk of placenta previa due to the large placenta
is being considered.
Placenta anomalies
Cigarette smoking
What kind of symptoms does placenta previa cause?
The most characteristic symptom of placenta previa is sudden, painless vaginal bleeding. This
bleeding usually occurs after 28 weeks of gestation. Percent of patients with placenta previa
In 25%, the bleeding is accompanied by preterm labor.
In placenta previa, the uterus is usually soft palpated and no tenderness is seen.
How do we recognize placenta previa in the clinic?
Ultrasound is the most appropriate method for the diagnosis of placenta previa. It can be examined more clearly with Doppler.
Placenta previa can be diagnosed after the 24th week. In pregnancies in the 2nd trimester (2nd three
month) routine ultrasound examinations often show that the placenta is close to the cervix
is detected. However, as the pregnancy progresses, the uterus enlarges and the placenta can be pulled upwards. This is called
90 percent of placentas that are located close to the cervix at term move away from the cervix and settle normally when the pregnancy reaches term (after 37 weeks).
week), it is seen that it moves away from the cervix and settles normally. Therefore, after the 24th week
A previous diagnosis of placenta previa can be misleading.
What are the Risks of Placenta Previa?
The biggest risk for mother and baby in placenta previa is bleeding. Unrecognized placenta previa
cases may bleed enough to require a blood transfusion. This bleeding can be fatal for mother and baby.
can be of such a magnitude as to put you at risk, even removal of the uterus in cases where the bleeding cannot be stopped.
may be required. Bleeding can occur in patients with placenta previa during pregnancy and at delivery.
It can also be seen after birth.
In patients with placenta previa, adhesion disorders of the placenta to the uterine wall (placenta
acreata, increata, percreata) are more common than other pregnant women. In this case, the placenta
may not leave the uterus after birth, and when it does, it may still be life-threatening.
can cause bleeding. These patients with placenta previa may also require hysterectomy.
Frequent bleeding episodes in placenta previa, even if they are not life-threatening
may cause developmental delay.
Because of the low location of the placenta, in patients with placenta previa, the baby’s mother
The likelihood of having a side or breech position in the abdomen is also higher than in normal pregnancies,
These baby positions are also more risky positions for labor.
With placenta previa there is a higher risk of preterm labor, which is associated
prematurity (premature birth).

How are Placenta Previa Patients Followed?
– Due to all these risks we have mentioned, pregnant women with placenta previa are followed up more frequently.
should be taken care of. There may be no problems during pregnancy. Today, placenta previa
75 percent of pregnant women can continue their pregnancy until term (37 weeks).
– Placenta previa that starts bleeding is hospitalized and closely monitored. Not yet at term
in pregnancies that do not reach (less than 37 weeks), because the baby is still small, for the physician
Choosing to give birth or wait is a difficult dilemma. Gestational week, severity of bleeding, mother
and the condition of the baby. Early delivery of a baby with placenta previa
Although it can cause problems with prematurity, waiting can also be risky.
– In patients with placenta previa with little bleeding, the baby is still at the week of viability.
If not, the patient is closely monitored and waited until the baby’s lungs mature. If necessary
If the pregnancy is between the 24th and 34th week, lung maturation injections (celestone) are also given because of the risk of premature birth. In this way, with close follow-up, without risking the life of mother and baby
The pregnancy is tried to be maintained until the mida (37th week).
– In patients with placenta previa with a lot of bleeding, it is not advisable to wait. Mother and
the mother’s bleeding is stopped by inducing labor to protect the baby.

Childbirth in Patients with Placenta Previa
Placenta previa marginalis (the placenta is at the edge of the cervix but does not cover it)
normal delivery can be attempted in patients if the baby is in head position. All other
in patients with placenta previa, a cesarean section because normal delivery causes too much bleeding
the birth is carried out.
If there is active bleeding, it is best for mother and baby to deliver without waiting.
The primary goal in placenta previa is to keep the mother’s condition stable. By opening an intravenous line
the mother is given fluid support. A few units of blood are kept ready in case of need.
If the bleeding decreases or stops and the mother’s condition is stable, in pregnancies earlier than 36 weeks
the birth can be delayed for a while longer. So that the baby can receive the necessary medicines for lung maturation.
time can be bought to implement it.
I have placenta previa, what should I pay attention to?
– The follow-up and delivery of pregnant women with placenta previa must be carried out by a specialist experienced in risky pregnancies.
an obstetrician and gynecologist should perform the delivery. Birth with placenta previa
The hospital to be built is a 24-hour hospital, with an operating room team always ready, intensive care unit
center with a unit and a blood bank.
– You should avoid excessive physical activity because of the risk of bleeding in placenta previa.
Your doctor may also recommend bed rest.
– For the same reason, patients with placenta previa should not have sexual intercourse during pregnancy.
is prohibited.
– In patients with placenta previa, vaginal examination and
vaginal ultrasound is not performed. For this reason, the gynecology and obstetrics
It is a good idea to remind the specialists that you have placenta previa.
– Carry a list of people with the same blood type with you so that you can call them if needed.
you can keep it with you.
– If you bleed, you should contact your doctor immediately.

Intracytoplasmic sperm injection (microinjection)

Intracytoplasmic sperm injection (ICSI) is a method of in vitro fertilization,
under a microscope, we use a special technique in which we inject the sperm directly into the oocyte (egg) with a needle.
is an in vitro fertilization technique. ICSI (microinjection) is nowadays available for both men and women.
in the treatment of infertility (infertility).

DIFFERENCE OF ICSI (MICROINJECTION) FROM CLASSICAL IVF TREATMENT
WHAT IS IT?
In conventional IVF treatment, a large number of sperm cells are taken from the man and collected in the laboratory.
spermatozoa are placed around an egg cell taken from a woman in an environment
one of them is expected to fertilize the egg spontaneously. What happens in classical in vitro fertilization
the only difference between fertilization and normal fertilization is that fertilization takes place in a laboratory, not in the mother’s body.
realization.
In the microinjection (ICSI) method, one of the highest quality sperms from the man
is selected. It is injected into the egg cell under a microscope. So the sperm is injected into the egg
cell itself, it is inserted directly into the egg cell in the laboratory.
fertilization is achieved.

IN WHICH PATIENTS IS ICSI (Microinjection) TECHNIQUE USED?
Microinjection (ICSI) is often used to increase the success rate in IVF treatment.
It is a preferred practice, and the patient groups that are especially used are mainly these:
●Male-caused infertility (infertility): ICSI is the most successful treatment for male infertility.
If the sperm count (azoospermia), motility or normal sperm percentage (morphology) is too high
low, ICSI (microinjection) can be used with almost any type of sperm.
we can achieve fertilization.
If fertilization failed in the previous IVF treatment, this time ICSI
(microinjection) technique.
ICSI in case of structural problems in the eggs and no fertilization
(microinjection) to achieve fertilization.
Sperm antibodies: In some cases, the woman’s blood contains antibodies against sperm cells, called antibodies.
substances called antibodies can be seen. These antibodies help the sperm cell to fertilize the egg cell.
prevents it. In such cases, microinjection therapy (ICSI) may be beneficial.
If sperm had to be removed directly from the testicle or epididymal tissue by operative methods (
TESE, MESA, PESA etc. procedures) fertilization is achieved by ICSI (microinjection).
Unexplained infertility (infertility) where all examinations and investigations appear normal
patients can also use the microinjection technique (ICSI).

STEP-BY-STEP ICSI (MICROGENESIS)
1- Obtaining sperm – Sperm can be naturally extracted from the ejaculate (semen). Sperm in ejaculate
absence (azoospermia) or ejaculatory dysfunction, TESE (testicular
sperm extraction), MESA (Microsurgical epididymal sperm aspiration), PESA
(percutaneous epididymal sperm aspiration) techniques to remove sperm from the patient with a minimal operation.
with
2- Sperm selection – The sperm samples obtained are subjected to certain procedures such as centrifugation before ICSI.
processed to select a normal, live sperm for injection.
3- Egg collection and preparation – Eggs are retrieved from the woman in a tiny operation
With the enzyme hyaluronidase, the cells surrounding the egg, called cumulus, are removed.
Eggs in a phase suitable for fertilization are selected.
4- Injection of sperm into the egg – First, the egg is fixed with a tiny pipette.
Then the sperm is injected into the egg by passing through the egg membrane with a tiny injection pipette.
cell and the process is completed. This fertilization process is called microinjection (ICSI)
technique takes 10-20 minutes.
The embryo formed by the microinjection (ICSI) procedure is kept in an incubator for 2-3 days.
implanted in the woman’s uterus and followed by waiting for it to implant in the uterus and grow in a healthy way
It is done.

WHY IS ICSI (MICROINJECTION) AN ADVANTAGEOUS IVF TECHNIQUE?
Fertilization is more likely to be successful with the ICSI (microinjection) technique.
Fertilization can be successful even if only one sperm is collected from the father-to-be.

WHAT IS THE SUCCESS RATE OF ICSI (MICROINJECTION)?
The fertilization rate after ICSI (microinjection) is around 50-80 percent. Microinjection
(ICSI) has a higher success rate in fertilization and pregnancy than conventional IVF.
Sperm and egg quality and the age of the mother are very important for successful fertilization.
It is important that the best quality sperm and eggs are selected for microinjection (ICSI). Some
in some cases, fertilization may not occur even if the sperm is implanted into the egg without any problems or
Even if fertilization is successful, a healthy pregnancy may not start. However, if the mother is young, quality
If a sperm and egg are selected, the success rate increases to 80 percent.
An experienced embryologist, a high quality microscope and equipment, a suitable laboratory environment
It is very important to achieve success with ICSI (microinjection). In our IVF treatments, the most
For good results, we also use the ICSI (microinjection) technique.

Polycystic ovary syndrome (PCOS) is one of the most common causes of infertility in women.
Polycystic ovary syndrome (PCOS), a disease seen in women of reproductive age
usually manifests itself during puberty. Main ovulatory dysfunction
(ovulation disorder) and hyperandrogenism (excess of male hormones).
The complaints caused by PCOS (polycystic ovary syndrome), a disease
may appear in a spectrum. The findings observed in PCOS can be categorized under 4 headings
we can evaluate :

• Symptoms of hyperandrogenism (male pattern signs) (for example: hair growth, in medical language
  hirsutism, moderate-to-severe acne, oily skin, male pattern baldness)
• Menstrual irregularity (e.g., long menstrual intervals, absence or irregular menstruation)
  bleeding)
• Polycystic ovaries (can occur in one or both ovaries)
  Obesity and insulin resistance

Because of this broad clinical spectrum, many cases may not have all of these features, which is
Therefore, it can sometimes be difficult to diagnose PCOS. Diagnosed with PCOS (polycystic ovary syndrome)
patients are more likely to develop metabolic syndrome, type 2 diabetes, cardiovascular disease and
increased risk of endometrial cancer, increased hair growth, treatment-resistant
Any woman with acne, menstrual irregularities or obesity complaints of PCOS (polycystic ovary
syndrome) is important to keep in mind.

• Hirsutism : In women, male pattern hair growth is called hirsutism. Androgen hormone
  production or increased sensitivity to these hormones. On the face and body in women
  hair growth known as quince hair is normal, while in hirsutism, hair growth on the upper lip, chin, chest, belly
  hard, dark hair growth on the top, under the navel, upper arms, thighs, back and waist
  is observed. It may be due to polycystic ovary syndrome (PCOS) or other diseases.

ASSOCIATION OF POLYCYSTIC OVARY SYNDROME WITH INFERTILITY
WHAT IS IT?
In a normal menstrual cycle, about 15-20 eggs mature each month in a woman.
and usually 1 of them matures completely. This matured egg
It is excreted from the ovary, enters the tubes and combines with the sperm. Polycystic ovary syndrome (PCOS)
patients who cannot mature due to problems in the maturation process of the egg.
The eggs form a cystic structure and ovulation rarely occurs. Therefore, people with PCOS
women take longer to conceive.

WHAT CAUSES POLYCYSTIC OVARY SYNDROME?
The cause of PCOS is unknown. Studies have shown that both genetic and non-genetic
factors contribute to the development of the syndrome.
Although the mechanism is not fully understood, recent studies suggest that the syndrome
insulin resistance may play a role. Insulin has a similar effect to LH hormone
increases androgen release from the ovaries. Another possible PCOS mechanism is
androgen hormones (male hormones) produced defectively in the adrenal gland. These
androgen hormones produced in excessive amounts cause symptoms such as hair growth, acne and
prevents the maturation of eggs in the ovaries. In PCOS
leads to the formation of polycystic structure in the ovaries. Therefore, in PCOS
inability to ovulate (anovulation) and infertility (infertility) are seen and women with PCOS
40% are infertile due to ovulation disorders. Another important problem in PCOS is
excess androgen is converted to estrogen by the aromatase enzyme, resulting in an unmet estrogen
exposure. This increases the long-term risk of breast and uterine cancer in PCOS patients.
increases.

HOW IS POLYCYSTIC OVARY SYNDROME (PCOS) DIAGNOSED?
The Rotterdam diagnostic criteria are currently used as diagnostic criteria. According to these criteria
Chronic inability to ovulate (anovulation) and consequent menstrual irregularity, menstrual
inability to menstruate (amenorrhea) or prolonged menstrual cycles (oligomenorrhea)
Clinical or laboratory signs of hyperandrogenism (excess male hormone):
hair growth (hirsutism), male pattern hair loss, acne, increased testosterone DHEASO4,
androstenedione
Polycystic appearance with numerous small ovarian follicles in the ovaries on ultrasonography
In the presence of 2 of these criteria, PCOS can be diagnosed.
However, other endocrinologic diseases must be excluded when investigating PCOS (thyroid
diseases, Cushing’s syndrome, congenital adrenal hyperplasia, hyperprolactinemia, etc.).

LIFESTYLE CHANGES IN POLYCYSTIC OVARY SYNDROME (PCOS)
WHY IS IT IMPORTANT?
Lifestyle interventions (diet, exercise and behavioral interventions) and weight loss
A treatment that improves insulin resistance and hyperandrogenism in PCOS, restores ovulatory cycles
and improve metabolic risk. In polycystic ovary syndrome
Even a weight loss of around 5-10 percent can lead to an improvement in menstrual patterns and
decrease in the number of pregnancies. Therefore, all women with PCOS who want or do not want to become pregnant
We recommend diet and exercise to lose weight as a first step.
Lifestyle changes and diet are usually followed by birth control pills and
drug treatment with antidiabetic pills (metformin) is started. PCOS (polycystic ovary syndrome)
the course of treatment is determined by the patient’s desire to become pregnant.
Infertility (infertility) is treated with in vitro fertilization (IVF).

POLYCYSTIC OVARY SYNDROME (PCOS) IN WOMEN WHO DO NOT WANT PREGNANCY
TREATMENT

Weight loss (lifestyle change with sports and diet)
Birth Control Pills: regulate the menstrual cycle as well as birth control, reduce hair growth and
reduces hyperandrogenic manifestations such as acne, protects the uterus from high estrogen exposure.
Metformin : improves insulin resistance, as an aid in the regulation of menstrual cycles
may cause ovulation to occur again.
Antiandrogenic Drugs : Used to improve symptoms such as hair growth and acne.

POLYCYSTIC OVARY SYNDROME (PCOS) IN WOMEN WHO WANT TO GET PREGNANT
TREATMENT

Weight loss (lifestyle change through sports and diet)
Ovulation-inducing drugs (clomiphene citrate, letrozole, gonadotropin)
Metformin: used to support ovulation therapy, improves insulin resistance.
Laparoscopic ovarian drilling: Ovaries are cut with electrocautery or laser in 4-5 small
burned by drilling holes. Not responding to weight loss and ovulation stimulants
used in patients
IVF (in vitro fertilization) treatment: In vitro fertilization in PCOS patients with infertility problems
pregnancy is possible with treatment.

PROGRESSING IN PCOS (POLYCYSTIC OVARY SYNDROME) PATIENTS
WHICH PROBLEMS CAN BE SEEN AT OLDER AGES?
In patients with polycystic ovary syndrome (PCOS), metabolic syndrome, sleep apnea, endometrial
(uterine) cancer and depression problems are more common than other people.
Most people with polycystic ovary syndrome (PCOS) are overweight or obese. Both obesity
both polycystic ovary syndrome (PCOS) high blood pressure (hypertension), impaired blood
increases the risk of diabetes, low HDL (good cholesterol), high LDL (bad cholesterol). This picture
all called meyabolic syndrome. This results in polycystic ovary syndrome
(PCOS) patients have an increased risk of heart attack, diabetes and stroke in later years. For this reason
It is extremely important for overweight polycystic ovary syndrome (PCOS) patients to lose weight.
Sleep apnea is also a common condition in patients with overweight ovarian syndrome (PCOS).
In sleep apnea, there are intervals when breathing stops during sleep. Sleep apnea
can lead to many problems, such as poor quality of life and distraction.
Endometrial cancer is cancer of the inner wall of the uterus. It is also popularly known as uterine cancer.
known as polycystic. The endometrium tissue in the uterus grows and multiplies under the influence of estrogen, polycystic
ovarian syndrome (PCOS) patients also have increased estrogen due to ovulation problems and
can cause uncontrolled proliferation of endometrial tissue and as a result
increased risk of endometrial cancer.
Finally, depression and anxiety are also more common in patients with polycystic ovary syndrome (PCOS).
can be seen.