The expression “dangerous gynecological diseases” may sound frightening at first. However, this term generally covers conditions that directly threaten a woman’s dream of becoming a mother, that is, her fertility, or put the pregnancy process at risk. This may be a life-threatening cancer, or it may be a chocolate cyst or fibroid that makes it difficult to get pregnant. Modern medicine, especially IVF technologies, offers us incredible opportunities to overcome these “dangers”. Even in the most difficult cases, with the right diagnosis and personalized treatment plans, we can now focus on solutions instead of falling into despair. Understanding the effects of these diseases on fertility and the paths we follow to overcome these obstacles is the most important first step in this challenging journey.

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I Have Been Diagnosed With Cancer, Is My Chance of Having Children in the Future in Danger?

A cancer diagnosis is undoubtedly one of the most devastating moments in life. In this process, the priority is always to start life-saving treatment as soon as possible. However, especially for young women who have not yet completed their family, the following question immediately comes to mind: “Will I be able to become a mother after treatment?” This is an extremely justified concern because chemotherapy, radiotherapy (radiation therapy) and surgery, which are the strongest weapons we use to fight cancer, can unfortunately also damage the reproductive organs. At this point, oncology (cancer science) and reproductive medicine come together to form the field of “oncofertility”, that is, “cancer and fertility preservation”.

The main issue is the negative effects of treatment on ovarian reserve and uterine health. Understanding how these effects occur helps us choose the right preservation strategy.

Effect of Chemotherapy: Chemotherapy drugs are designed to destroy rapidly dividing cancer cells. However, there are other rapidly dividing cells in our body, and the egg cells in our ovaries are also affected by these drugs. These drugs directly damage the valuable pool of eggs inside the ovaries and reduce this pool. If you think of your egg reserve as an “egg bank”, you can imagine chemotherapy as “withdrawing eggs” from this bank in an uncontrolled way. The extent of the damage depends on the type of drug used, its dose and, most importantly, the patient’s age during treatment. In older women who start treatment with a lower egg reserve, the risk of early menopause and permanent infertility after treatment is higher. Although young patients may be able to preserve their ovarian functions for a while longer, they may enter menopause much earlier and lose a significant amount of the time they have to have children.

Effect of Radiotherapy: Radiation therapy applied especially to the pelvic region has a double negative effect on fertility. First, just like chemotherapy, it is extremely destructive to the egg cells in the ovaries. Second, it can cause serious and permanent damage to the uterus. Some possible effects of radiation on the uterus are:

Hardening and loss of elasticity in the uterine muscles
Damage to uterine vessels and decreased blood flow
Thinning of the inner lining of the uterus
Increased risk of miscarriage in future pregnancies
Risk of premature birth

This condition reduces the uterus’s capacity to carry and grow a baby for 9 months.

Effect of Surgery: In the surgical treatment of gynecological cancers, sometimes both ovaries (bilateral oophorectomy) or the uterus (hysterectomy) may need to be completely removed. These situations eliminate the possibility of getting pregnant naturally and carrying a pregnancy.

In this difficult equation, time is the most critical factor. While the oncology doctor does not want to delay treatment even by one day depending on the type and speed of the cancer, the reproductive health specialist needs about two weeks for the most effective fertility preservation methods such as egg freezing. At this point, an aggressive and rapidly progressing tumor may give us only a few days. In such emergency situations, methods such as ovarian tissue freezing (OTC), which do not require hormonal stimulation and can be applied immediately, come to the fore. A more slowly progressing, early-stage cancer may give us the valuable time needed to freeze eggs or embryos. Therefore, fertility preservation is not an issue to be considered after treatment, but an urgent process in which oncology and reproductive medicine teams must act together at the time of diagnosis and decide in line with the patient’s medical condition and personal wishes.

How Is Fertility Preserved in Ovarian Cancer?

In some young patients diagnosed with early-stage ovarian cancer limited to only one ovary, fertility-sparing surgery (FSS) may be an option. In this approach, the cancerous ovary is removed while the uterus and the other healthy ovary are left in place. In this way, the woman anatomically preserves her potential to become pregnant in the future. However, despite this successful surgery, the protective chemotherapy that may be applied afterwards can threaten the health of the remaining single ovary and lead to early menopause.

For this reason, counseling before treatment is vitally important. Patients should be informed about all available fertility preservation options before any medical intervention begins. If the uterus has been preserved, an IVF treatment using frozen eggs or embryos after treatment is the primary way to become a mother. Sometimes the urgency of the cancer diagnosis does not allow the approximately two-week ovarian stimulation process required for egg freezing. In such cases, it is necessary to speak honestly about post-treatment options.

Can Fertility Be Preserved in Uterine or Endometrial Cancer?

The standard treatment for endometrial cancer is the complete removal of the uterus (hysterectomy), and this causes permanent infertility. However, in a carefully selected group of very young patients who strongly desire to have children and whose disease is at the earliest stage (Stage 1A, Grade 1), conservative treatment may be considered. It is important to emphasize that this approach is not a standard treatment and that the patient must be informed in great detail about its potential risks.

Evidence shows that surgically clearing the cancerous tissue with hysteroscopy first and then placing a hormonal intrauterine device increases patients’ chances of becoming pregnant and giving birth later. During this conservative treatment, patients must be followed very closely by taking a sample from inside the uterus (endometrial biopsy) every 3 to 6 months to monitor the condition of the disease. When complete regression of the disease is documented, the patient is encouraged to try to become pregnant without losing time. Considering the underlying fertility problems and the need to achieve pregnancy before the risk of recurrence of the disease, IVF is generally the fastest and most effective way. After the process of having children is completed, complete removal of the uterus and ovaries is generally recommended.

Which Methods Are Used to Preserve Fertility in Cervical Cancer?

For women diagnosed with early-stage cervical cancer, surgical options are available to treat the cancer while preserving the uterus. These fertility-sparing procedures are selected according to the extent of the disease.

Conization
LLETZ (loop excision of part of the cervix)
Radical trachelectomy

Radical trachelectomy is a complex operation performed for more advanced tumors that are still considered early-stage. In this procedure, the surgeon removes the cervix, the upper part of the vagina and the surrounding supporting tissues, but leaves the uterus itself (fundus) in place. A permanent stitch (cerclage) is placed in the remaining part of the uterus to support a future pregnancy. Although this surgery successfully preserves the ability to carry a pregnancy, it increases the risk of second-trimester miscarriage and premature birth. Because of the permanent stitch, delivery must be performed by cesarean section.

If pelvic radiotherapy (radiation therapy) is required as part of the treatment, this poses a direct threat to ovarian functions. In these cases, a procedure called repositioning of the ovaries (ovarian transposition or oophoropexy) can be performed before radiotherapy begins. This is the surgical procedure of moving and fixing the ovaries higher in the abdomen, outside the planned radiation field. In this way, hormonal functions and the viability of the eggs inside can be preserved. After this procedure, IVF treatment is required to become pregnant because the fallopian tubes are no longer in their normal anatomical position to catch the egg. Eggs are collected with a needle under the guidance of a special ultrasound performed through the abdomen.

Why Is Chocolate Cyst (Endometriosis) Preventing Me From Getting Pregnant?

Endometriosis, popularly known as chocolate cyst, is a chronic inflammatory disease dependent on estrogen hormone, characterized by the presence of endometrium tissue lining the inside of the uterus outside the uterus, usually in the ovaries, tubes or other organs in the abdomen. It is one of the leading causes of infertility and affects approximately 30-50% of women experiencing this problem. The mechanisms by which endometriosis impairs fertility are quite complex and include much more than a simple mechanical obstacle:

The main ways endometriosis causes infertility are:

Anatomical Distortion: In advanced stages, the disease can cause serious adhesions and scar tissue in the abdomen. These adhesions can disrupt the normal relationship between the tubes and ovaries, preventing the egg from being captured by the tube. Chocolate cysts (endometriomas) that form in the ovaries can damage healthy ovarian tissue and negatively affect egg development and ovulation.
Inflammatory Environment: Endometriosis creates a continuous inflammatory environment in the abdomen. In the fluid in this region, inflammatory cells and molecules that can be toxic to sperm, egg and embryo are found at high levels:
Hormonal and Immune Problems: The disease can disrupt the hormonal balance between the brain and the ovaries. It also creates a state of resistance to the hormone progesterone in the inner lining of the uterus, making it difficult for the embryo to attach to the uterus (implantation).
Low Egg Quality: Chronic inflammation and oxidative stress can reach the follicular fluid in which the egg develops and reduce the quality and developmental potential of the egg.

IVF treatment is an extremely effective method for infertility due to endometriosis because it is designed to “bypass”, that is, disable many of these pathological obstacles. For example, adhesions in the tubes are no longer a problem because the egg is fertilized in the laboratory and the embryo is placed directly into the uterus. The “freeze-thaw” strategy, that is, freezing all embryos and transferring them to the uterus in a later month in a more natural environment where the body has been cleared of hormone medications, increases the chance of implantation by reducing the negative effects of progesterone resistance and inflammation. Modern IVF technology has shifted the clinical focus from the hostile environment in the abdomen to obtaining a high-quality embryo by overcoming many obstacles created by endometriosis. Therefore, with optimized protocols, live birth rates obtained in women with endometriosis are now quite close to the rates of women who do not have this disease.

What Is Adenomyosis and How Does It Affect IVF?

Adenomyosis is a condition characterized by the growth of the tissues that form the inner lining of the uterus (endometrial glands and stroma) into the muscle layer of the uterus (myometrium). This disease, which was less known in the past, is now considered an important cause of infertility, recurrent pregnancy losses and IVF failures.

Adenomyosis affects fertility mainly by disrupting the uterine environment and the function of the inner lining of the uterus. It disrupts the normal structure of the uterine muscle layer and leads to abnormal, irregular contractions. These involuntary contractions can both make it difficult for sperm to move toward the uterus and prevent the embryo from attaching firmly to the uterus. In addition, the local inflammatory condition it creates in the uterine wall disrupts the structure of the genes and proteins necessary for embryo implantation, making the inside of the uterus “unwelcoming”.

Studies show that women with adenomyosis have lower pregnancy, lower implantation and lower live birth rates in IVF treatments compared to women without it. At the same time, the risk of miscarriage is also significantly higher. Therefore, because of this profound negative effect of adenomyosis on the uterine environment, pretreatment is recommended before embryo transfer. The most effective approach is the use of injections called GnRH agonists for 2 to 6 months before frozen embryo transfer. This treatment temporarily puts the body into a menopause-like state, suppresses adenomyosis foci, reduces inflammation and stops abnormal contractions. This “uterine resting” treatment creates a much more favorable environment for embryo implantation and significantly increases the chance of pregnancy.

What Should I Do If I Have Fibroids and Cannot Get Pregnant?

Fibroids (leiomyomas) are benign smooth muscle tumors of the uterus and are the most common pelvic tumors in women. Although most fibroids do not cause symptoms, their effects on fertility depend on their number, size and, most importantly, their location in the uterus.

The mechanisms by which fibroids prevent pregnancy are:

Mechanical Obstacle: Fibroids growing toward the uterine cavity can distort the shape of the uterus and physically prevent embryo implantation or disrupt an early pregnancy.
Blood Flow and Contraction Problems: Large fibroids within the uterine wall can affect normal uterine contractions and disrupt blood flow to the uterine lining over them and to the developing embryo, increasing the risk of implantation failure or miscarriage.
Inflammatory Effect: The presence of fibroids can cause chronic inflammation in the uterus, making it difficult for the embryo to attach.

In the context of infertility, the treatment of fibroids is determined entirely according to their location. Therefore, it is important to know the types of fibroids.

Submucosal Fibroids: These are fibroids that originate from the area closest to the inner lining of the uterus and grow toward the uterine cavity. It has been definitively proven that they reduce pregnancy rates and implantation and increase miscarriage rates. Before starting IVF treatment, removing them with a closed surgery called hysteroscopic myomectomy is a standard approach and has been shown to improve reproductive outcomes.
Intramural Fibroids: These are fibroids located inside the muscle wall of the uterus. If they are large enough to distort the shape of the uterine cavity, they have a negative effect like submucosal fibroids and must be removed. The situation of those that do not distort the cavity is more controversial. However, especially those larger than 4-5 cm are thought to reduce fertility by disrupting blood flow and contractions, and their surgical removal may be considered.
Subserosal Fibroids: These are fibroids that grow on the outer surface of the uterus. Since they do not press on the uterine cavity, they are considered to have no significant effect on fertility or IVF outcomes. Therefore, surgical removal solely to increase fertility is generally not recommended.

In such structural uterine problems, advanced imaging methods such as 3D ultrasound or MRI not only make the diagnosis but are also critical tools that determine our roadmap before IVF. According to imaging results, the patient is directed to one of three paths: (1) start IVF treatment directly, (2) have surgery first, then proceed to IVF treatment, or (3) receive hormone-suppressing treatment first, then proceed to IVF treatment.

Is It Possible for Me to Get Pregnant If My Tubes Are Blocked?

Infertility due to tubal factor accounts for approximately 25-35% of all female infertility cases and includes a series of problems that impair or block the function of the fallopian tubes. In this situation, IVF treatment is not only a treatment option but a definitive technological solution that completely bypasses the damaged or dysfunctional anatomy.

The condition that most commonly damages the tubes is usually Pelvic Inflammatory Disease (PID), caused by sexually transmitted infections. The inflammatory response given by the body against the infection causes permanent damage to the tubes. This damage causes the tube to become completely blocked and, more importantly, the delicate hair-like structures (cilia) that catch the egg and carry it to the uterus to disappear. One of the most serious consequences of PID is the formation of hydrosalpinx. In this condition, the end of the tube becomes blocked and fills with sterile, inflammatory fluid and swells.

For women with blocked or damaged tubes, IVF treatment is the cornerstone of treatment. Because all stages such as capturing the egg, fertilizing it with sperm and the embryo’s journey to the uterus, which normally take place in the tubes, are performed in the laboratory environment. The obtained embryo is placed directly into the uterus, completely bypassing the blocked tubes.

However, the presence of hydrosalpinx is a serious obstacle to IVF success. It has been proven that this fluid accumulated inside the tube is toxic to the embryo (embryotoxic) and prevents the embryo from attaching by leaking back into the uterus. This fluid can also mechanically “wash” the transferred embryo out of the uterus. Therefore, in the presence of a hydrosalpinx visible on ultrasound, surgically solving this problem before embryo transfer is a definite standard. The preferred procedure is the complete removal of the damaged tube by laparoscopic (closed) surgery (salpingectomy). This is a vital first step that must be taken for technologically advanced IVF treatment to be successful.

Is IVF a Solution If I Cannot Get Pregnant Due to Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome (PCOS) is the most common cause of ovulation disorders and is a complex hormonal problem. The main features of this syndrome are:

Irregular or absent ovulation
High levels of male hormones (androgens) in the blood or related symptoms (hair growth, acne)
Seeing many small egg sacs (follicles) on ultrasound

Women with PCOS constitute a special group in IVF treatment. Because there are many follicles in their ovaries, they have a very high risk of over-responding to ovarian-stimulating hormone drugs and developing a dangerous condition called Ovarian Hyperstimulation Syndrome (OHSS). OHSS is a complication caused by treatment that can lead to serious problems such as fluid accumulation in the abdomen, shortness of breath and blood clotting.

Therefore, using safety-focused special protocols in patients with PCOS is not a preference but a necessity. Today, the standard approach that almost completely eliminates this risk is the GnRH antagonist protocol together with the agonist (such as Lupron) trigger method. In this protocol, the last injection used to mature the eggs (“trigger injection”) is done with a GnRH agonist instead of standard hCG. This drug causes a short and physiological increase in the body’s own LH hormone. This increase is sufficient to mature the eggs, but because its effect passes very quickly, it does not start the chain reaction that causes OHSS. This approach is generally combined with the “freeze-thaw” strategy, making IVF treatment extremely safe and successful in patients with PCOS. Since these patients generally produce many eggs, live birth rates are quite high when they are treated with the right protocols.

What Could Be the Cause of My Recurrent Miscarriages and Can IVF Help?

The condition in which two or more pregnancies result in miscarriage is defined as recurrent pregnancy loss (RPL). This is an extremely exhausting process for couples. Although some causes can be revealed through standard tests, no clear cause can be found in about half of the cases. In a significant portion of these “unexplained” cases, the underlying cause is genetic abnormalities in the embryos.

Human reproduction is inherently an inefficient process, and the cause of more than half of miscarriages in the first three months is an incorrect number of chromosomes in the embryo (aneuploidy). Although this is usually a random error, some couples have a tendency to continuously produce genetically abnormal embryos. Advanced maternal age in particular is the most important risk factor for this condition.

In a small proportion of couples experiencing recurrent miscarriage (2-5%), one of the parents has a chromosomal rearrangement called a balanced translocation. The carrier person is healthy because the amount of genetic material is correct, only its location is different. However, during sperm or egg production, they are highly likely to form reproductive cells with unbalanced chromosome sets. Embryos formed with these cells inevitably result in miscarriage.

IVF treatment combined with Preimplantation Genetic Diagnosis (PGT) offers both a diagnostic and treatment tool for genetic causes of recurrent miscarriages. This technology allows embryos to be genetically analyzed before they are transferred to the uterus.

PGT-A (Preimplantation Genetic Testing for Aneuploidy) checks whether the number of chromosomes in embryos is correct (46,XX or 46,XY). For couples with unexplained recurrent miscarriages and in whom the underlying cause is suspected to be continuous production of abnormal embryos, PGT-A changes the rules of the game. By ensuring that only genetically normal (euploid) embryos are transferred, it dramatically reduces the miscarriage rate and significantly increases the live birth rate per transfer. PGT-A is no longer positioned as a last resort for this difficult condition, but as an evidence-based primary intervention that directly targets the most likely cause. While this method provides an answer to the question “why do I keep having miscarriages?”, it also offers the most reliable way to achieve a healthy pregnancy.