Prof.Dr. Kaan Aydos | 12 January

The question that confuses most the mind of a couple who intends to have a child is whether this will happen with assisted reproductive technologies (IVF/ICSI) or should they wait for a natural pregnancy. However, there was no IVF until 1976 and even so the world population continued to increase. Today, when we go back from 43-year-olds, everyone was born as a result of natural conception. So having a child in a natural way should not be seen as wasting time. Certainly, there are some situations, no matter how long it is expected, pregnancy will not occur naturally. Here, the important thing is to select these cases and direct them to the IVF. Nevertheless, the average success of the IVF is only 50%, which means that in half of the cases, a desired result cannot be achieved. As a troublesome and costly attempt, the failure of IVF will cause a great disappointment in the couples and breaks their hopes for the future. However, we have very reliable scientific data in deciding whether an IVF is necessary or whether natural pregnancy is possible. I will talk about the male aspect; the situation of spouses should be evaluated separately.

A man who intends to become a father should first evaluate himself for the following factors:

  • Are both testicles in the scrotum, or is there a growth or stiffness in the testis?
  • Are the masculine characteristics like beard, mustache and hair distribution missing?
  • During childhood, did he undergo an operation to bring down his testicles or for a hernia?
  • Did he suffer from mumps during his adolescence, causing signs of inflammation such as swelling and pain in the testicles?
  • Has he ever had radiotherapy or chemotherapy?
  • Is there a sexual problem that would prevent him from having a normal relationship, or is there a significant drop in ejaculate volume?

If there is at least one of these, you should apply to a specialist without waiting and immediately start checkup. If there is no such problem, it can be expected to have a natural pregnancy for 1 year. In this period, 85% of men will be able to conceive their spouse. However, if pregnancy is still not seen, then it is appropriate to investigate sperm health. At this stage, routine sperm analysis alone does not provide enough information. Even if the test results are completely within normal limits, sperm quality may still be inadequate. On the other hand, in the most feared situation, azoospermia, the genetic tests, seminal markers and the hormone levels should be evaluated first to assess the potential of testicles for sperm production. In fact, in some cases when azoospermia is treated appropriately, even natural pregnancy is possible.

In cases other than azoospermia, pregnancy should always be expected as long as the sperm quality is sufficient. Investigation of sperm in terms of oxidative stress, DNA damages, mitochondrial energy capacity and centriole disorders provides very useful information in the evaluation of sperm quality. We are very fortunate now that these tests can be performed today. There are only some rare morphological disorders such as total globozoospermia or pin-head anomalies, where natural pregnancy is not expected. Otherwise, morphological disorder is not a definite criterion to prevent having a child. Similarly, lack of sperm motility does not mean that pregnancy cannot be achieved unless all sperms are immotile. Even if the motility is lower than normal, it can be corrected if the cause is found or pregnancy can be achieved by making some changes in lifestyle.

I would like to emphasize once again that as long as the quality of the sperm is good, it can be expected to have a child by natural way in cases other than azoospermia. What is important here is to make appropriate investigations, to reveal the cause of the problem and to plan a specific treatment. We call it as “personalized treatment.” Now, medicine is developing to use individual treatment principles. If the most likely cause of the problem related with your sperm is found and a targeted treatment is done, you will have the highest chance of having a child by natural conception. Only after passing these stages, in vitro fertilization should be considered.


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Prof.Dr. Kaan Aydos

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