**2. General information**

### **2.1 Infertility**

## *2.1.1 History*

 Reproduction is a concept that has been very important since ancient times. Initially, thinkers who lived in ancient times carried out their efforts to understand the human reproductive system and the dysfunctions in this system, after which the scientists continued their work on this subject. The first texts about infertility date back to 2200–1950 BC. Hippocrates, who lived between 460 and 370 BC, also mentioned infertility [14]. The prescriptions for the early recognition of pregnancy and the prevention of infertility were first used in ancient Egypt [15].

The first artificial fertilization in the world was obtained by Hunter between 1776 and 1799 [14–16]. The first reference to reproductive dates back to antiquity, and one of the first examples is the biblical command, "be productive and multiplicative." According to religious beliefs, God was the source of both fertility and infertility. A woman's ability to raise children is considered as a measure of her femininity; infertility was seen as a punishment of misconduct [14–16].

 Rapid developments in reproductive health in the past 30 years have also increased interest and expectation for the concept of infertility. The definition of infertility was accepted in recent years although the couple in reproductive age has been unprotected, sexually related three to four times a week for at least a year [17–20]. It is suggested that infertility rate in the world affects more than 80 million people in the world, which is seen in different ratios in different countries, and it is stated that the infertility rate varies between 5 and 30%.

 In industrialized societies, it is estimated that 10–15% of couples receive a primary or secondary infertility diagnosis. This ratio increases to 30–50% in African countries [21]. Turkey is also considered a diagnosis of infertility in 10–20% of couples [20, 21]. Increased infertility due to various factors all over the world is seen as a developmental crisis involving individual and spousal relationships rather than a medical situation due to the emotional problems created in individuals and marriage relations.

#### *2.1.2 Reproduction process and infertility*

In order for the breeding period to be successfully completed, the male and female physiology must have the maturation and conditions necessary for reproduction. Firstly, hypothalamus-Pituitary aksis, fallopian tube functions, cervical and endometrial conditions; and hypothalamic-hypophyseal-testicular axis in men, sperm production, and mobility should be normal [22, 23].

## *2.1.3 Incidence of infertility*

Infertility is a question of varying frequency and cause of region to region, involving 15% of men and women in the reproductive age [24]. According to the survey, South Korea (1.3%), Jordan (2.2%), and Syria (2.9%) were the lowest in the 40–49 age group. In contrast, especially in Africa, some tribes and communities have much higher rates of infertility. For example, 65% of women aged 45–49 in Mbelo in Zaire are without children [25]. Health care practitioners in the United States report that the incidence of infertility is 15%, that is, it affects one in every six pairs or 4.8 million women [26].

 According to the results of the 1990 census in our country, the rate of married women aged 15–49 is 23%, which is calculated as 11.3 million women. When the incidence of infertility is accepted as 8.5%, it corresponds to 1.5 million women and consequently it directly affects at least 3 million people. This is a large population that is longing for children. According to the results of the 1993 census, the proportion of women who say that it is not possible to give birth at all is found to be 9.5% [26].
