Desire to have children

Nowadays, most couples who wish to have a baby assume that their desire for pregnancy can become a reality quickly and easily. Unfortunately, however, it is often not that easy and an increasing number of couples fail to conceive at first – despite their desire to have children. Nowadays, most couples who wish to have a baby assume that their desire for pregnancy can become a reality quickly and easily. Unfortunately, however, it is often not that easy and an increasing number of couples fail to conceive at first – despite their desire to have children.

Some couples can wait up to a year to get pregnant. So there is no reason to worry if it takes a little longer to finally see that positive pregnancy test. However, if a year of regular, unprotected sexual intercourse without conception has passed, you should assume that medical causes may be the reason for the lack of success in getting pregnant.

Causes

If pregnancy is delayed, fertility disorders in both women and men may be the cause. There are couples in which either the woman or the man is suffering from a fertility disorder, but there are also couples in which both partners are diagnosed with disorders. And there are couples whose cause of infertility remains unknown.

In women, the main reason for infertility is hormonal problems, which cause ovary dysfunctions, leading to an egg maturation failure. Scarring of the cervix or muscle growths (fibroids) in the uterus can also prevent fertilisation and implantation or lead to a miscarriage. Furthermore, partial or complete occlusion of the fallopian tubes makes it difficult or even impossible for the egg to reach the uterus or the sperm to reach the egg. Endometriosis, a gynaecological disease in which the uterine mucosa settles outside the uterus, can also have a negative impact on female fertility.

On the other hand, numerous factors can have an impact on male fertility, with the most common male fertility disorder being the production of inadequately intact or mobile sperm. Some men produce enough sperm, but sperm cannot be transported properly due to the seminal ducts being partially or completely closed or not completely formed, which is why the sperm cannot mix with the seminal fluid. As a result, the semen contains too few or even no intact sperm cells. In addition, there are some men whose semen is not transported outwards through the penis at the point of orgasm, but is released into the bladder and later excreted in the urine.

Furthermore, an untreated chlamydia infection can lead to both male and female infertility. Chlamydia is one of the most frequently sexually transmitted pathogens, which are mainly spread through unprotected sexual intercourse. The good news is that a chlamydia infection can be successfully treated with antibiotics.

Smoking, excessive alcohol consumption, extreme excess weight, drug abuse, competitive sports or above-average stress levels can also have negative effects on male or female fertility.

Diagnosis

If you would like to have children but do not conceive for many months, it is advisable to visit a gynaecologist to clarify possible causes and, if necessary, to have them treated.

Each examination begins with a personal conversation between the couple and their gynaecologist. This is followed by special tests, which are usually pain-free and low-risk, to diagnose the causes of the fertility disorder, in which both men and women are examined.

Men’s fertility tests include:

  • Examination of the semen or a spermiogram
  • Hormone tests to check the hormonal control of testicular function
  • Ultrasound of the testes, examining the tissue structures of each testicle and the epididymis and measuring the testicle size
  • Genetic fertility testing (in the case of a very low sperm count)
  • Taking a tissue sample from the testicles (testicular biopsy) to determine whether the testicles generally produce sperm

Women’s fertility tests include:

  • Physical examination and ultrasound to detect possible inflammation or physical changes
  • Cycle monitoring (as a woman cannot become pregnant naturally without ovulation)
  • Hormone tests, whereby the hormone production itself and the interplay of the hormones is checked in the monthly cycle
  • A special ultrasound examination can be performed to clarify possible changes in the fallopian tubes or the uterus (so-called hystero-salpingo contrast sonography, HyCoSy)
  • A laparoscopy to examine the fallopian tubes, ovaries, uterus and the entire rest of the abdomen
  • Uterine endoscopy (hysteroscopy) to detect malformations, adhesions, fibroids or mucous membrane changes in the uterus

In addition, a postcoital test can be performed, i.e. an examination after sexual intercourse. However, this is based on the premise that the woman has a cycle of ovulation and that the man produces enough sperm to fertilise an egg. This test examines whether sufficient sperm can pass through the cervix towards the uterus and fallopian tubes.

Treatments

If the treating doctor diagnoses a fertility disorder, reproductive medical treatment is possible in many cases. However, as the success of the individual methods cannot be predicted and some of them may put excessive strain on both the body and the mind, it is advisable to thoroughly examine all the advantages and disadvantages, opportunities and risks before starting fertility treatment and to discuss them in detail with your partner and the gynaecologist.

In the event of infertility, the following treatment methods, among others, may be considered:

  • Hormonal treatment and hormonal stimulation for the treatment of female fertility disorders due to hormonal imbalances
  • Insemination, where sperm cells capable of fertilisation are inserted into the woman’s womb
  • In vitro fertilisation (or IVF), i.e. artificial fertilisation (the fertilisation of the egg does not take place in the woman’s body, but “artificially,” i.e. in a laboratory)
  • ICSI (intracytoplasmic sperm injection): this type of artificial insemination (= insemination outside the female body) involves injecting a single sperm cell with a very fine needle directly into an egg that was previously taken from the woman’s ovary.
  • Cryopreservation, i.e. the deep-freezing of egg and sperm cells for use at a later date, as part of IVF or ICSI
  • Conception by means of a sperm donation

Aftercare

The time spent during and after a (unsuccessful) fertility treatment is not easy for many couples and often leads to a rollercoaster of emotions – fear, confidence, hope, disappointment, sadness and anger come in waves and not always at the same time, so that the relationship between the two partners is often put under additional stress. For this reason, doctors usually advise the couples undergoing treatment to deal openly with their unfulfilled desire to have children and the often difficult path associated with this.

During the treatment, both men and women are often confronted with a variety of side effects, which vary from method to method and may still be part of life even after the respective therapy has been completed.

For this reason, it is advisable to stay in close contact with the treating doctor even after fertility treatment has been completed, to attend all follow-up appointments, possibly to plan further treatment together or, if necessary, to seek additional psychological support in order to process the impressions and experiences gained alone or as a couple – in both a positive and a negative sense.

FAQs

What complications may occur as part of fertility treatment?

The most common complications in the course of fertility treatment include ovarian hyperreactions, multiple pregnancies, ectopic pregnancies and miscarriages or possible foetal malformations, although these cannot be ruled out in any pregnancy.

What does the medical term “in vitro fertilisation” mean?

In vitro fertilisation (or IVF) is the fertilisation of the female egg, which is carried out in a test tube (“in vitro” means in glass). For the purposes of IVF, eggs capable of fertilisation are taken from the woman. These are added to a nutrient solution and fertilised with the sperm of the partner.

How many IVF cycles are recommended?

Treatment is usually discontinued after three to four unsuccessful cycles of IVF. This treatment is relatively expensive, which is why some couples cannot afford it. Ultimately, however, this is always a completely personal decision.

What are the causes of unwanted childlessness?

If couples remain childless for a long time despite wanting to have children, this is often due to the fact that the desire to have children is postponed, i.e. the couples want to have children later. Conversely, however, fertility decreases with age. However, certain lifestyles such as smoking or alcohol consumption can also be the cause of infertility. Sometimes there are organic causes that prevent pregnancy – for both men and women.

A basic distinction is made between couples who do not become pregnant naturally at all (primary sterility or infertility) and those who were pregnant at one time but were unable to get pregnant again afterwards (secondary infertility). The term infertility refers to those pregnancies that were repeatedly terminated due to miscarriages, meaning no viable child could be born at any time. 

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