Ovulation disorders: Ovulatory disorders are examined under 3 headings. Hipogonadotrophic hipogonadism results from defects in the pituitary gland. Treatment consists of replacement of defective hormons by injections. A cranial MRI and serum prolactin level assessment are required in these patients. Hipergonadotrophic hipogonadism results form ovarian failure. In such patients pregnancy can be achieved only via oocyte donation.

Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder among women.
It is of unknown etiology. It is characterized by numerour immature follicles located at the periphery and hypertrophy of the ovarian stroma which secretes androgens. It typically appears at adolescence. Obesity, hirsutism, acne vulgaris are common symptoms. There is no definite cure for the disease. Symptoms are treated. First step in the treatment is weight loss.

Skin findings are common in PCOS. Hair loss and acne vulgaris are common findings. Antiandrogens are used for these symptoms. Other findings of PCOS are oligomenorrhea and infertility.For couples who do not desire fertility, oral contraceptives can be used to achieve regular cycles. Ovulation induction agents are preferred for those couples who desire fertility.

PCOS is associated with several long time health hazards. One of them is coronary artery disease resulting from hyperlipidemia which is strongly associated to PCOS. Breast cancer and endometrial cancer are other risk factors. PCOS patients may face gestational hypertension and diabetes mellitus if they get pregnant. Weight loss and appropriate nutrition can decrease all these health hazards.

Tubal disorders: Tubal patency is usually disturbed secondary to infections. Almost all of these infections are sexually transmitted. Most common are chlamydia and gonorrhea. Tuberculosis is also an important infection for our country. Surgery may also have a negative impact on tubal patency. Tubal patency is evaluated by HSG. Microsurgery to restore tubal patency requires experience and is difficult to perform. IVF is preferred in these situations. Presence of hydrosalpinx requires laparoscopic treatment. If hydrosalpinx is not treated, IVF success is decreased.


Endometriosis: It is overgrowth of endometrial tissue in locations other than the endometrium. It is usually seen among women older than 35 and is of unknown etiology. Most commonly accepted theory is retrograde menstruation. Endometriosis most commonly involves peritoneum and ovaries. Rectovaginal septum may also be involved and this may lead to severe pain. Disease is usually progressive and can be diagnosed only by laparoscopy. Symptoms are pain, mass and infertility.

Endometriosis involving ovaries is known as endometrioma. If endometriomas are associated with infertility, they should be removed surgically. Half of patients get pregnant spontaneously after removal of endometriomas within 6 months. If the patient is over 35, time should not be wasted. For patients with advanced endometriosis, anatomy may be severely distorted and IVF is preferred for these patients.

Treatment of peritoneal endometriosis involves laparoscopic cotherization. Similarly, presence of rectovaginal septum involvement requires laparoscopic removal. Endometriosis is a relapsing disorder and it may relapse after surgical treatment.

Other infertility factors: Among other factors are myoma uteri and congenital malformations of the uterus.