Questions and Answers / All Questions

Not all snorers suffer from sleep apnea. However, since most suffers of sleep apnea are also snorers, this can be considered a symptom of sleep apnea. Even if a snorer is not diagnosed with sleep apnea, they should exercise caution as they may be at risk of developing sleep apnea in the future.

The main treatment for allergic rhinitis and nasal polyps is medical. Surgery may be required for nasal blockages that develop in the course of these illnesses. Currently, drugs are used to treat allergies, but surgery may be necessary at certain stages of the illness. However, treatment with drugs should continue even after surgery to prevent the recurrence of the illness.

In adults, nasal blockages may be caused by a deviated septum, enlarged turbinates (concha hypertrophy), conditions causing the nasal mucosa to become enlarged (influenza, allergies), nasal polyps commonly observed with allergies and sinusitis. Whereas swelling in the nasal mucosa may be treated with drugs, other conditions causing nasal blockages may require surgery if they are severe enough to affect quality of life and cause the patient to breathe through their mouths for the majority of the day and night.

Sinusitis usually develops after an upper respiratory tract infection known as ‘influenza’. It occurs due to a bacterial infection in the sinuses known as sinusitis, and is caused by a blockage of drainage passageways for the nasal mucous. Sinusitis may also be caused by bone deformities, allergic rhinitis, polyps caused by nasal mucous, adenoids and enlarged turbinates. The main treatment for sinusitis is the treatment of the illness that is causing the condition. Surgery may be necessary if treatment of the illness does not result in the desired outcome or when the sinus problem becomes chronic.

We prefer to use general anesthetic during nose surgery, provided that a very important condition with the patient does not prevent its use or the patient wishes to use another option. General anesthetic is preferred to ensure comfort and convenience for both the patient and the surgeon.

The most common cause of dizziness is sudden loss of blood pressure resulting from the person rising quickly from a sleeping or sitting position. This is known as orthostatic hypotension. This can generally be prevented by taking care to make such movements more slowly. Another common cause is BPPV, sometimes referred to as the dislodging of ear crystals. This condition involves the microscopic crystals in the inner ear’s balance center being displaced from their usual location, resulting in severe bouts of dizziness. The condition is purely due to mechanics. Diagnosis and treatment can easily and quickly be carried out with a series of maneuvers. While other causes of dizziness are quite rare, they can be diagnosed and treated with ease at our ear, nose, and throat department.

The condition known as otosclerosis is only encountered in humans and is a bone illness that affects the inner ear. Here, the movement of the stapes is impaired and can result in conductive hearing loss. The condition is more common in women and can lead to greater loss in hearing during pregnancy. Surgery is employed to treat the illness. The upper portion of the stapes is taken out by raising the eardrum and a special prosthetic is attached to the hole drilled in the footplate.

The intervention commonly known as bionic ear surgery involves surgery for the placement of a cochlear implant and an auditory brainstem implant.  These surgeries are used when the patient has extensive hearing loss or suffers from an underdeveloped auditory nerve or inner ear. These surgeries are most commonly carried out at the Hacettepe University center.

The most common cause of ringing is loss of hearing due to age. This can be easily diagnosed with a hearing test. The role of subsequent drug treatments is limited. A number of very different treatments for this problem are successfully applied at the audiology unit of the Hacettepe Ear Nose and Throat department.

In such cases a detailed ear examination should be carried out and a medical history obtained before a series of audio tests are conducted. The test should be conducted and interpreted at an experienced audiology center in order not to overlook a possible loss in hearing. A hearing aid should be prescribed to patients that are diagnosed with hearing loss and the problem should be monitored.

No. This is a fluid that builds up in your child’s ear when they suffer from an upper respiratory tract infection. While this may dry up on its own after the infection has abated, it may persist afterwards in some children. The bath water escaping into the ear will be present in the outer ear. The fluid being referred to here is present behind the eardrum.

No. This is a misconception. Tonsils are a defense mechanism of the respiratory system. However, if it leads to chronic illnesses and blockages, they may be doing more harm than good. Removing the tonsils in such cases will not lead to increased infections or more severe symptoms than usual. Our body has numerous defense mechanisms that will be able to fend off illnesses in the absence of tonsils.

Infections in the upper respiratory tract usually result from viral infections. They can generally be treated without having to resort to the use of antibiotics. Antibiotics may be needed if you require a doctor’s assistance during an acute attack. If infections occur frequently, then an examination may need to be conducted by a doctor to check for problems with the immune system. If your child’s illness shows no signs of relief, then taking a break from kindergarten may help improve his condition.

If your child sleeps with their mouth open or snores or complains of breathing difficulties during sleep, this indicates the presence of an enlarged adenoid in the posterior of the nasal cavity that is blocking the nasal passage. In such cases an ear, nose and throat specialist should be consulted. The adenoid may have to be removed through surgery depending on the outcome of the examination.

The buildup of fluid in your child’s ear is due to an infection your child has suffered in their upper respiratory tract. No additional treatment is necessary if the body is able to expel the fluid after a certain time. However, in cases where the presence of the fluid persists, this may lead to loss of hearing in the child and may result in complications requiring ear surgery. The child will need to be closely monitored to avoid this. If the fluid is not depleted after three months, then a surgical intervention involving the placement of a tube inside the ear drum will be required to ventilate the ear.

For tumors that have taken hold in the vocal folds, removing the affected vocal fold by avoiding the tumor during biopsy is generally sufficient for both the diagnosis and the treatment. In the more advanced stages of the illness, a more comprehensive treatment may be employed that includes radiotherapy, chemoradiotherapy, or a partial or complete laryngectomy, depending on the location of the tumor and other factors specific to the patient. Once again, depending on the growth stage of the tumor and its location, these patients may undergo a single or double-sided “neck dissection” that involves the clearing of lymph nodes present in the neck.

With the exception of those that have developed in the vocal folds, symptoms of laryngeal cancer will not present during the early phase of the illness. That is why the great majority of sufferers do not become aware of these symptoms until the advanced stages of the illness. However, tumors that have occurred inside the vocal folds can be detected early on if the patient complains about loss of voice. Other symptoms, in addition to voice loss, include swallowing difficulties and swelling in the neck. Other common symptoms are: extensive bouts of coughing that show no signs of abating, breathing difficulties, fatigue, loss of appetite and weight loss.

After receiving an account of the patient’s medical history their symptoms are evaluated and a detailed physical examination is carried out. This may be supported by a CAT scan and/or an MRI, depending on the findings from the physical examination. A biopsy and a pathological test of the extracted tissue should be carried out to ensure an accurate diagnosis. The biopsy is carried out under a general anesthetic and direct examination. During biopsy, the lesion can be observed by determining the areas to which the tumor has spread. For tumors that have occurred in the vocal folds, the fold in question can be removed, depending on the condition of the lesion, thereby making it possible to both biopsy and treat the illness.

Laryngeal is the most common cancer observed in the head-neck area and is also the most fatal. The greatest risk factor for the illness is the smoking of cigarettes and consumption of other tobacco products. The risk is also greater for those having to spend an extended amount of time in areas where they have to endure second-hand smoke. Other risk factors include alcohol, genetic predisposition and air pollution.

Laryngeal cancer occurs when there is uncontrolled growth of abnormal cells in the throat. The cancer cells may spread inside the throat or to adjacent tissues or to more distant parts of the body. 80-90% of cases of laryngeal cancers are due to smoking. The odds of developing cancer increases with the amount of cigarettes smoked and the length of time the habit continues. After quitting smoking, the chance of developing cancer is gradually reduced, with the risk being half that of smokers after five years. Laryngeal cancer is also a risk for non-smokers who have to endure second-hand smoke for extended periods of time.

For high pregnancy rates in IVF, a patient-specific individualized IVF protocol, a very good IVF laboratory and good clinical practice are required. According to the regulation published by the Ministry of Health of the Republic of Türkiye in March 2010, in the 1st and 2nd IVF cycles under the age of 35 (the woman's age), only 1 embryo can be placed in the uterus, and in the 3rd and subsequent IVF cycles, at most 2 embryos can be placed in the uterus. Over the age of 35, at most 2 embryos can be placed in the uterus. In other words, the number of embryos placed in the uterus has been reduced by law. For this reason, the embryos to be placed in the uterus need to be of very, very high quality, so that despite their small number they can implant in the uterus and a pregnancy can be achieved.

A blastocyst embryo is the name given to the embryo at day 5 after fertilization, and it has a higher likelihood of implanting in the uterus than day-3 embryos.

The easiest way to obtain sperm from a man is to collect semen by masturbation.

In cases such as absence of sperm in the semen, retrograde ejaculation, or inability to provide a sample, it may be necessary to collect sperm using certain methods.

Micro-TESE (obtaining sperm from the testis by biopsy):
In men with no sperm at all in their semen (affecting 1% of men) (azoospermia), this is the finding of sperm or germ cells by making an incision in the testes under general or local anesthesia. It is performed by a urologist; pieces are taken from the testis under a microscope without damaging the blood vessels and given to the embryologist for examination. The search for sperm can sometimes take 6-7 hours. Micro-TESE has many advantages over conventional TESE. Because it is performed with the vessels visible under the microscope, the damage to the testis is minimal. There is also a large difference in the amount of tissue removed. The chances of finding sperm are similar.

The complete absence of sperm in the semen can be obstructive or non-obstructive. The chance of finding sperm is higher in the obstructive type. The non-obstructive type is divided into 5 types among itself. However, the chance of finding sperm is on average 50%.

PESA (percutaneous epididymal sperm aspiration):
It has a place in obstructive azoospermia. It can also be applied if there is difficulty in providing semen or if ejaculation is backward (retrograde ejaculation). A small needle is inserted into the channels called the epididymis above the testes and fluid is drawn. This fluid is screened for sperm.

MESA (microsurgical epididymal sperm aspiration):
This is the collection of semen from the epididymal channels above the testis by performing microsurgery under a microscope.

TESA (testicular sperm aspiration):
This is a method in which a needle is inserted directly into the testes, without making an incision, and the fluid is aspirated.

Treatment should be directed at the cause. In the presence of pretesticular azoospermia, pulsatile GnRH treatment can be applied. Alternatively, human chorionic gonadotropin (hCG) can be given at 1,000-2,500 IU twice a week. Human menopausal gonadotropin (hMG) 150 IU three times a week can be added to hCG treatment. With one year of treatment, a pregnancy rate of 80% is achieved.

In testicular azoospermia, treatment is IVF with the microinjection method. Sperm can be obtained from the testes by different methods.

In post-testicular azoospermia, IVF can be planned directly, or surgical treatment can also be planned. In retrograde ejaculation, medication can be tried.

Patients with azoospermia must be seen by a urology specialist. Examination of the scrotum and testes and determination of blood testosterone, FSH, LH and inhibin-B values are necessary. Genetic testing must be performed.

Azoospermia is the complete absence of sperm in the semen. It is seen in 1% of men in the general population. It accounts for about 10-15% of the causes of male infertility. Among couples who present with infertility, 5% have azoospermia in the man.

Azoospermia should not be confused with aspermia. In aspermia, there is no semen at all. Sperm normally cannot be seen with the naked eye; they can only be seen on microscopic examination. In azoospermia, semen comes out normally, but it contains no sperm, which cannot be seen with the naked eye anyway.

There are 3 types of azoospermia.
Pretesticular azoospermia
It makes up 2% of azoospermias. Because of problems in the walnut-sized gland in the brain (the pituitary), sperm are not produced in the testes. It can develop due to congenital or acquired problems. It is seen in conditions such as taking medications containing testosterone from outside, hyperprolactinemia, hypopituitarism, Kallmann syndrome and Prader-Willi syndrome. Blood FSH is low. There is no sperm production.

Testicular azoospermia (non-obstructive azoospermia)
In this type of azoospermia, the problem is in the testes. The testes may be absent, smaller than normal, or of normal size. It is the most common type of azoospermia. 49-93% of azoospermias are of this type. The blood FSH level is increased. There is no sperm production.
Causes
• Congenital chromosomal abnormalities
• Klinefelter syndrome (seen in 15-30% of non-obstructive cases)
• Y microdeletion (seen in 10-20% of non-obstructive cases). It has 3 types: A, B and C. Type B is the worst, and the chance of finding sperm is almost nonexistent. Type C is the best.
• Undescended testis
• Sertoli cell-only syndrome
• Having had testicular inflammation in adulthood
• Exposure to trauma
• Exposure to radiotherapy
• Exposure to chemotherapy
• Testicular torsion

Post-testicular azoospermia (obstructive azoospermia)
In this type, although sperm are produced, they cannot pass into the semen. It makes up 7-53% of azoospermias.
Causes
• Congenital absence of the vas deferens (associated with cystic fibrosis)
• Obstruction due to infections
• Retrograde ejaculation or absence of ejaculation altogether

The pregnancy rate of what is known as drug-free IVF (IVM, in vitro maturation) is lower than that of classical IVF.
Stem cell transplantation in men without sperm or women without ovaries is still at the research stage, and positive results have been obtained in mouse experiments. Its entry into routine clinical practice will happen sooner or later, but it is not available yet. For this reason, ask your doctor from time to time whether this method has started to be used.
The preferred form of freezing is embryo freezing. However, sperm and egg freezing are also performed successfully in single patients. In patients for whom cancer treatment (chemotherapy or radiation therapy) is planned, an evaluation must be made before treatment.

Poor ovarian response can be predicted before IVF (anti-Müllerian hormone, FSH and E2 on day 3 of the period, determining the antral follicle count during the menstrual period). An anti-Müllerian hormone level below 0.5 ng/ml indicates poor ovarian response with 85% accuracy. Also, having fewer than 5 antral follicles in both ovaries during the menstrual period, or, if there was a previous IVF cycle, having had fewer than 5 eggs collected from both ovaries, indicates poor ovarian response.
Having had ovarian surgery before, having had an ovary removed before, heavy smoking, the presence of advanced-stage endometriosis, and having received chemotherapy or radiation therapy before are risks for poor ovarian response.

Painkillers should not be taken during IVF treatment.
The use of aspirin does not increase IVF success.
Ovulation-inducing drugs do not cause ovarian cancer.

• If you have had a pregnancy before, in whatever form, your chance of becoming pregnant with IVF is greater than if you have never been pregnant.
• Advanced female age is the most important factor affecting the pregnancy rate in IVF. Over the age of 40, pregnancy rates fall very significantly. For women at these ages, months matter. IVF should be started without losing time, as soon as possible.
• Removing fibroids and polyps located in the area of the uterus where the embryo will be placed, by hysteroscopy, increases pregnancy rates.
• If there is a uterine septum, cutting it hysteroscopically increases pregnancy rates and reduces the risk of miscarriage.
• In repeated IVF failures, examining the inside of the uterus by hysteroscopy and treating any problem found may increase the pregnancy rate.
• Techniques said among the public to increase the pregnancy rate, such as the "screwing" method, the "gluing" method, co-culture and lymphocyte immunization, have no definitively proven benefit.
• Although studies have been published suggesting that the use of acupuncture in IVF treatment increases the pregnancy rate, more evidence is needed before it can enter clinical practice.
• Determining the genetics of the embryo (PGD) before placing it in the uterus is beneficial if there is a genetic disorder in the family; when the mother and father are normal, performing PGD does not increase the pregnancy rate but rather decreases it. Taking a piece from a healthy-developing embryo for genetic analysis usually harms the embryo.

This is a really difficult decision for patients. Today, many IVF centers use all sorts of improper methods to attract patients out of commercial concerns. With promises that are not based on truth, such as "we use new techniques" and "our pregnancy rates are very high," they exploit patients' desire to have a baby. Unfortunately, some television programs are also used for this. For good centers:
• How long has the center been in operation?
• Is it authorized to issue reports?
• Is it audited by international organizations?
• Is there an embryo, sperm and egg freezing program?
• What percentage of the frozen embryos survive?
• What are the pregnancy rates from frozen embryo transfer?
• What is the take-home baby rate?
• Does it have the infrastructure to treat you if a problem arises (for example, when the ovaries are overstimulated)?
Good centers should meet these conditions.

During IVF treatment, your expectation of pregnancy should be in line with the pregnancy rate your doctor has given you. A negative pregnancy result after excessive expectations can affect you, and therefore your family, negatively. If you feel tense before IVF treatment, you can receive psychological support with your doctor's approval.

• If the tubes are swollen (hydrosalpinx), the swollen tube or tubes must be removed laparoscopically before IVF. If they cannot be removed, their connection to the uterus must again be cut laparoscopically. Removing swollen tubes increases the pregnancy rate and decreases the ectopic pregnancy rate.
• If there is an endometrioma (chocolate cyst) larger than 4 cm in the ovaries before IVF, it must be removed laparoscopically. If it is smaller than 4 cm, there is no need to remove it.
• If there is an endometrioma smaller than 4 cm before IVF, aspirating it with a needle before the procedure is not recommended because it increases the infection rate.
• Aspirating non-functional cysts larger than 1 cm (estradiol below 60 pg/ml, endometrial thickness below 5 mm) with a needle before the procedure is recommended before IVF.
• The presence of polycystic ovary disease is not negative for IVF; on the contrary, it is positive. In a study we conducted, we found that the IVF pregnancy rate in women with polycystic ovary disease was higher than in the control group. We presented this study to the world in 2005 in "Fertility and Sterility," one of the most respected infertility journals in the world. This study can be found among my academic publications.

After IVF treatment has started, if there is not an adequate ovarian response or if your blood estradiol values drop suddenly, egg stimulation may be cancelled by your doctor. The treatment may be cancelled if no sperm can be found from your partner (azoospermia patients), if no eggs or no eggs suitable for fertilization are obtained at egg retrieval, or if fertilization has not occurred. Also, if your ovaries are overstimulated, the fertilized embryos may be frozen and the treatment may be cancelled.

If you smoke before IVF treatment, quit and do not drink alcohol.
If your partner smokes before IVF, he needs to quit 70 days beforehand.
Excess weight negatively affects the pregnancy rate in IVF treatment. Therefore, if possible, lose weight before IVF treatment.
Coffee should not be consumed during IVF treatment.

You do not need to be hospitalized at any stage.

IVF treatment generally lasts between 15 and 20 days, although it varies according to the ovarian stimulation protocol applied to you. During this treatment you need to come to the IVF center at various intervals. It is enough for the man to come for only 1 day (he comes to provide a sperm sample on the morning the eggs are collected).

Government support can be obtained for IVF by getting a health report (with 3 signatures). It is sufficient to apply to the centers authorized to issue this report. Your doctor must determine that IVF is necessary in order for the report to be issued. In addition, to receive government support:

• The woman's age must be between 23 and 39. If she is even one day over 40, the report cannot be issued.
• Even if the report is issued by obstetrics and gynecology specialists, the man may need to be seen by a urologist.
• If the report is to be issued for unexplained infertility, 3 years of official marriage must have been completed. For other causes, the 3-year marriage period is not required.
• There must be no healthy child registered in the woman's or the man's civil registry.
• For those covered by the Retirement Fund, BAĞ-KUR and SSK (SGK), it is necessary to have paid premiums for at least 5 years (intermittent payment is also accepted) and to have paid premiums for more than 900 days in total.
• You must have been working for the last 90 days.
• There is no time restriction for Green Card holders.
• At present the government pays for IVF twice.
Documents required to obtain the report
• 1 copy of a civil registry record with history showing that there are no children registered to the woman and the man (separately for the woman and the man). It can be obtained from population directorates.
• 1 photocopy of the identity card (the woman's)
• 1 photocopy of the marriage certificate
• 1 photograph (the woman's)
• For SSK and Bağkur, a document showing the number of premium days (can be obtained from the relevant institutions)
• For Retirement Fund patients, a service record (can be obtained from the relevant institutions)

When the ovaries are overstimulated, fluid leaks from the ovaries into the abdominal cavity, and conditions such as abdominal bloating, nausea and vomiting, inability to eat, difficulty breathing, excessive weight gain and inability to urinate may develop. In this case, be sure to contact your doctor. Hospitalization may be necessary in some cases. In some cases, fluid may need to be drained from the abdominal cavity.

The blood pregnancy test is done 12 days after embryo transfer.

After embryo transfer, progesterone treatment is given until the pregnancy test. Vaginally administered progesterone (Crinone 8% gel) is more effective than other methods.