İnfertilite Tanısında Kullanılan Yöntemler
Özet
Bu yazı, hem kadın hem de erkek partnerlerin eş zamanlı değerlendirilmesini içeren infertilite tanı yöntemlerini kapsamlı bir şekilde ele almaktadır. Kadınlarda tanı süreci detaylı öykü ve fizik muayene ile başlamakta, vücut kitle indeksi, jinekolojik geçmiş ve endokrin bozukluk belirtileri incelenmektedir. Ovulasyonun tespiti için bazal vücut ısısı takibi, progesteron ve LH hormonu ölçümlerinden faydalanılırken, over rezervi AMH, bazal östradiol ve FSH düzeyleriyle değerlendirilmektedir. Fallop tüplerinin açıklığı HSG veya HyCoSy yöntemleriyle, uterin kavite ise salin infüzyon sonohisterografi ve histeroskopi ile görüntülenmektedir. Şüpheli endometriozis ve pelvik yapışıklık durumlarında ise laparoskopiye başvurulmaktadır. Erkek infertilitesi değerlendirmesinde de öykü ve fizik muayenenin ardından temel laboratuvar testi olarak semen analizi (sperm sayısı, hacmi, hareketliliği ve morfolojisi) uygulanmaktadır. Sperm konsantrasyonunun düşük olduğu vakalarda total testosteron, LH ve FSH ölçümlerini içeren endokrin testler ile skrotal veya transrektal ultrasonografi ve genetik testler (karyotip analizi, Y kromozomu mikrodelesyonu, CFTR mutasyonu) yapılmaktadır. Tüm bu yöntemler, çifte özel doğru tedavi planının sunulmasını sağlamaktadır.
This text comprehensively covers infertility diagnostic methods, involving the simultaneous evaluation of both female and male partners. In women, the diagnostic process begins with a detailed history and physical examination, analyzing body mass index, gynecological history, and signs of endocrine disorders. For the detection of ovulation, basal body temperature tracking, progesterone, and LH hormone measurements are utilized, while ovarian reserve is evaluated through AMH, basal estradiol, and FSH levels. Fallopian tube patency is visualized using HSG or HyCoSy methods, and the uterine cavity is assessed via saline infusion sonohysterography and hysteroscopy. Laparoscopy is performed in cases of suspected endometriosis and pelvic adhesions. In the evaluation of male infertility, following history and physical examination, semen analysis (sperm count, volume, motility, and morphology) is applied as the core laboratory test. In cases with low sperm concentration, endocrine tests including total testosterone, LH, and FSH measurements, as well as scrotal or transrectal ultrasonography and genetic tests (karyotype analysis, Y chromosome microdeletion, CFTR mutation) are conducted. All these methods ensure the provision of an accurate, customized treatment plan for the couple.
Referanslar
Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril, 2020; 113(3); 533-535. DOI: 10.1016/j.fertnstert.2019.11.025.
Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril, 2015; 103(6); e44-50. DOI: 10.1016/j.fertnstert.2015.03.019.
Bauman, J.E. Basal body temperature: unreliable method of ovulation detection. Fertil Steril, 1981; 36(6); 729-33. DOI: 10.1016/s0015-0282(16)45916-9.
McCarthy, J.J., Jr. and H.E. Rockette. Prediction of ovulation with basal body temperature. J Reprod Med, 1986; 31(8 Suppl); 742-7.
Wathen, N.C., L. Perry, R.J. Lilford, et al. Interpretation of single progesterone measurement in diagnosis of anovulation and defective luteal phase: observations on analysis of the normal range. Br Med J (Clin Res Ed), 1984; 288(6410); 7-9. DOI: 10.1136/bmj.288.6410.7.
Ecochard, R., H. Boehringer, M. Rabilloud, et al. Chronological aspects of ultrasonic, hormonal, and other indirect indices of ovulation. Bjog, 2001; 108(8); 822-9. DOI: 10.1111/j.1471-0528.2001.00194.x.
Coutifaris, C., E.R. Myers, D.S. Guzick, et al. Reprint of: Histological dating of timed endometrial biopsy tissue is not related to fertility status. Fertil Steril, 2019; 112(4 Suppl1); e116-e124. DOI: 10.1016/j.fertnstert.2019.08.080.
Dag, Z.O. and B. Dilbaz. Impact of obesity on infertility in women. J Turk Ger Gynecol Assoc, 2015; 16(2); 111-7. DOI: 10.5152/jtgga.2015.15232.
Evers, J.L., P. Slaats, J.A. Land, et al. Elevated levels of basal estradiol-17beta predict poor response in patients with normal basal levels of follicle-stimulating hormone undergoing in vitro fertilization. Fertil Steril, 1998; 69(6); 1010-4. DOI: 10.1016/s0015-0282(98)00080-6.
Kwee, J., R. Schats, J. McDonnell, et al. The clomiphene citrate challenge test versus the exogenous follicle-stimulating hormone ovarian reserve test as a single test for identification of low responders and hyperresponders to in vitro fertilization. Fertil Steril, 2006; 85(6); 1714-22. DOI: 10.1016/j.fertnstert.2005.11.053.
de Vet, A., J.S. Laven, F.H. de Jong, et al. Antimüllerian hormone serum levels: a putative marker for ovarian aging. Fertil Steril, 2002; 77(2); 357-62. DOI: 10.1016/s0015-0282(01)02993-4.
Seifer, D.B., V.L. Baker and B. Leader. Age-specific serum anti-Müllerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertil Steril, 2011; 95(2); 747-50. DOI: 10.1016/j.fertnstert.2010.10.011.
Swart, P., B.W. Mol, F. van der Veen, et al. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril, 1995; 64(3); 486-91. DOI: 10.1016/s0015-0282(16)57781-4.
Lo Monte, G., G. Capobianco, I. Piva, et al. Hysterosalpingo contrast sonography (HyCoSy): let's make the point! Arch Gynecol Obstet, 2015; 291(1); 19-30. DOI: 10.1007/s00404-014-3465-4.
Soares, S.R., M.M. Barbosa dos Reis and A.F. Camargos. Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril, 2000; 73(2); 406-11. DOI: 10.1016/s0015-0282(99)00532-4.
Hamilton, J.A., A.J. Larson, A.M. Lower, et al. Routine use of saline hysterosonography in 500 consecutive, unselected, infertile women. Hum Reprod, 1998; 13(9); 2463-73. DOI: 10.1093/humrep/13.9.2463.
Smit, J.G., J.C. Kasius, M.J.C. Eijkemans, et al. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet, 2016; 387(10038); 2622-2629. DOI: 10.1016/s0140-6736(16)00231-2.
Tanahatoe, S.J., P.G. Hompes and C.B. Lambalk. Investigation of the infertile couple: should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination? Hum Reprod, 2003; 18(1); 8-11. DOI: 10.1093/humrep/deg034.
Arab, W. Diagnostic laparoscopy for unexplained subfertility: a comprehensive review. JBRA Assist Reprod, 2022; 26(1); 145-152. DOI: 10.5935/1518-0557.20210084.
Oei, S.G., F.M. Helmerhorst and M.J. Keirse. Routine postcoital testing is unnecessary. Hum Reprod, 2001; 16(5); 1051-3. DOI: 10.1093/humrep/16.5.1051-a.
Grześko, J., M. Elias, B. Maczyńska, et al. [Frequency of detection of Ureaplasma urealyticum and Mycoplasma hominis in cervical canal and the Douglas pouch of infertile and fertile women]. Med Dosw Mikrobiol, 2007; 59(2); 169-75.
Kallen, C.B. and A. Arici. Immune testing in fertility practice: truth or deception? Curr Opin Obstet Gynecol, 2003; 15(3); 225-31. DOI: 10.1097/00001703-200306000-00003.
Papanikolaou, E.G., V. Vernaeve, E. Kolibianakis, et al. Is chromosome analysis mandatory in the initial investigation of normovulatory women seeking infertility treatment? Hum Reprod, 2005; 20(10); 2899-903. DOI: 10.1093/humrep/dei151
Diamond, D.A., H.J. Paltiel, J. DiCanzio, et al. Comparative assessment of pediatric testicular volume: orchidometer versus ultrasound. J Urol, 2000; 164(3 Pt 2); 1111-4. DOI: 10.1097/00005392-200009020-00048.
Cooper, T.G., E. Noonan, S. von Eckardstein, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update, 2010; 16(3); 231-45. DOI: 10.1093/humupd/dmp048.
Sokol, R.Z. Endocrinology of male infertility: evaluation and treatment. Semin Reprod Med, 2009; 27(2); 149-58. DOI: 10.1055/s-0029-1202303.
Lotti, F. and M. Maggi. Ultrasound of the male genital tract in relation to male reproductive health. Hum Reprod Update, 2015; 21(1); 56-83. DOI: 10.1093/humupd/dmu042.
Meacham, R.B., D.K. Hellerstein and L.I. Lipshultz. Evaluation and treatment of ejaculatory duct obstruction in the infertile male. Fertil Steril, 1993; 59(2); 393-7. DOI: 10.1016/s0015-0282(16)55683-0.
Onur, M.R., I. Orhan, F. Firdolas, et al. Clinical and radiological evaluation of ejaculatory duct obstruction. Arch Androl, 2007; 53(4); 179-86. DOI: 10.1080/01485010701426448.
Bansal, S.K., D. Jaiswal, N. Gupta, et al. Gr/gr deletions on Y-chromosome correlate with male infertility: an original study, meta-analyses, and trial sequential analyses. Sci Rep, 2016; 6; 19798. DOI: 10.1038/srep19798.
Krausz, C., L. Quintana-Murci, S. Barbaux, et al. A high frequency of Y chromosome deletions in males with nonidiopathic infertility. J Clin Endocrinol Metab, 1999; 84(10); 3606-12. DOI: 10.1210/jcem.84.10.6040.
Bienvenu, T. and M. Claustres. [Molecular basis of cystic fibrosis and congenital bilateral agenesis of vas deferens]. Contracept Fertil Sex, 1996; 24(6); 495-500.
