infertility

Nicole Wendler holds a PhD in biology in the field of oncology and immunology. As a medical editor, author and proofreader, she works for various publishers, for whom she presents complex and extensive medical issues in a simple, concise and logical manner.

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The diagnosis of infertility (sterility) comes as a shock to most couples. It can be down to the woman as well as the man if it does not work out to have children. Sometimes, but not always, sterility treatment helps. Read here about the causes of infertility and how they can possibly be remedied.

Pregnancy: a complex process

Have you stopped contraception, had sex regularly and still not pregnant? Infertility should not always be considered immediately, because getting pregnant is a complex process:

First an egg cell has to mature and then meet a fertile sperm cell. If the two successfully fuse, the fertilized egg (zygote) migrates through the fallopian tube to the uterus (uterus) and normally develops into a blastocyst in this way, in order to finally establish itself firmly in the uterine mucous membrane (endometrium). However, all these steps are only successful if the right hormones are released at the right time, the fertilized egg cell is healthy, and anatomically everything works for both partners.

Since a sperm cell survives in the woman's body for a maximum of five days, and the egg cell itself is only capable of fertilization for 24 hours, the couple only have a few days per month for their attempt. Knowing the fertile days is therefore very helpful if you want to get pregnant.

Infertility could only exist if it does not work out with the child witness despite regular sexual intercourse without contraception within a year. Medical examinations can clarify the suspicion.

Frequency of sterility

In Germany, depending on the source, around seven to 15 percent of all couples are considered to be involuntarily childless - that is, they were unable to father a child within a year despite intensive efforts (twice a week sexual intercourse). However, it is rarely spoken about openly. Shame, guilt, and social pressure mean that infertility is still a taboo subject. It can therefore be assumed that in reality far more couples are affected.

Forms of infertility

Not all infertility is the same. In the case of a fertility disorder, medical professionals first differentiate between primary and secondary sterility. There is also the Idiopatchic sterility. The term infertility also appears again and again in the context of involuntary childlessness. It is important to understand the various terms correctly.

Primary sterility

In the case of primary sterility, no child has so far emerged despite unprotected sexual intercourse. Either the woman has never become pregnant or the man has never conceived a child. But there is a clear reason for the childlessness to be identified.

Secondary sterility

Secondary sterility affects women or men who have already become parents but cannot make it again. Such a secondary sterility can result, for example, from infections or operations in the meantime.

Idiopathic sterility

If no clear cause of childlessness can be identified, doctors speak of idiopathic sterility. Depending on the source, no triggers for infertility can be found in up to 30 percent of couples.

Infertility

Another important term in this context is infertility. Here the conception succeeds, but the pregnancy always ends with a miscarriage or an abortion.

Causes of Infertility

A fertility disorder can have many causes and affects both sexes equally: around 30 percent of the cause lies in men, 30 percent in women and another 30 percent in both. In the case of the remaining ten percent, the doctors find no cause for the "sterile partnership".

Basically, infertility can have anatomical reasons that result from diseases (e.g. infections, hereditary diseases), congenital malformations, injuries or operations. These manifest themselves differently in men and women.

Infertility in women

You can find out what exactly can lead to an unfulfilled desire for children in a woman in the article Infertility in women.

Infertility in men

Various factors can ensure that "man" cannot father children. You can read more about this in the article Infertility in Men.

Infertility Risk Factors

The following risk factors that make getting pregnant more difficult affect both sexes:

• Age: In women, fertility decreases after the age of 30; in men, the quality of the sperm deteriorates from the age of 40 and erectile dysfunction increases.
• Overweight and underweight: If you are severely underweight, the menstrual cycle or ovulation stops. If you are overweight, fertility decreases due to estrogen-producing fat cells, and the quality of sperm decreases.
• Medicines: Psychotropic drugs, anti-epileptic drugs (anti-epileptic drugs) or high blood pressure (antihypotensive drugs) impair fertility.
• Nicotine: Smoking is associated with fewer and slower sperm, lower conception rate and higher miscarriage rate.
• Alcohol and drugs: They can cause menstrual disorders, impotence, and impaired sperm production and mobility.
• Environmental influences: Pollutants and environmental toxins promote fertility-damaging processes, intervene in the hormonal balance and change it.
• Mental health: Mental conflicts, sexual disorders, stress and lack of sleep are also risk factors for infertility.
• Competitive sport: Intensive training can lead to hormonal disorders - ovulation does not occur and sperm production is reduced.

Infertility: symptoms

Typical symptoms other than childlessness, which indicate sterility, are rather rare. In women, infertility can manifest itself through pelvic pain and menstrual cycle problems. It is usually even more severe in men: sometimes weight gain, swelling of the testicles, or pain when urinating are possible signs of impending infertility.

Infertility: Finding Causes

Before you can prematurely suspect sterility, you must have tried unprotected sex for a while without success. If you then suspect infertility, contact a gynecologist or a urologist or andrologist (specialist in men's medicine). After a detailed examination, he or she can refer you to a reproductive medicine center if necessary.

Diagnosis of suspected infertility can include:

• Intensive discussion about previous illnesses, infections, operations, menstrual disorders, miscarriages, abortions, living conditions, partner relationships
• Woman: Gynecological examination, ultrasound, hormone examination, ovulation control (basal temperature curve, cycle monitoring), uterine examination (hysteroscopy) and laparoscopy (laparoscopy)
• Man: Spermiogram, physical examination of the genital organs (focus on possible testicular malformation, inflammation, varicocele), hair and physique, hormone examination, testicular biopsy

Infertility: Therapy

Physical exercise, a balanced diet, avoidance of alcohol and nicotine as well as relaxation and pleasurable sex have a positive effect on the fertility of men and women and increase the chances of success of a pregnancy. If it is still not possible to father a child, reproductive medicine measures can help.

Depending on the cause of the infertility, the following sterility treatments are possible:

• Cycle monitoring
• Hormone treatment
• Artificial insemination (in vitro fertilization, IVF)
• Semen transfer (insemination)
• Microinjection (intracytoplasmic sperm injection, ICSI)
• Obtaining sperm directly from the testicles or epididymis (TESE or MESA)
• Gamete intrafallopian transfer (GIFT)
• Freezing eggs or sperm (cryopreservation)
• Operation (fibroids, varicose veins on the scrotum = varicocele, sticky egg / sperm ducts)

Before starting any treatment, it is important to have a psychotherapeutic discussion. It increases the chances of success.

Infertility: prognosis

Despite modern medical possibilities, not every sterility treatment brings the desired success. Only around 10 percent of sterile couples can actually hold a baby nine months later.

Infertility Complications

Various problems can arise in the context of sterility treatment. In particular, the hormonal stimulation of the woman, which is necessary for the treatment, is extremely physically demanding and carries the risk of a life-threatening overstimulation syndrome. Miscarriages or premature births, fallopian tubes or multiple pregnancies are also not uncommon. Furthermore, complications can arise with every surgical procedure. For example, an infection or injury to surrounding vessels or other organs is possible as a result of egg retrieval.

Infertility: Emotional Stress

In addition to the physical strain caused by numerous examinations or lengthy sterility treatment, the emotional tension in both men and women is great. If a couple involuntarily remains childless, every relationship is severely tested. Each cycle quickly consists only of hope and fear, and each further failed attempt increases the pressure to succeed. Sexuality is increasingly being instrumentalized and only serves the purpose of procreation, so that a carefree exchange of caresses is often hardly possible. In particular, if no physical causes can be determined, the pressure increases. Shame, feelings of guilt or guilt, impaired self-esteem, social isolation or even depression are often the result.

If infertility only affects one partner, you should still pull together as a couple. Understanding and open conversation can help ease the situation. Don't be afraid to seek professional support. The information portal Kinderwunsch of the Federal Ministry for Families, Seniors, Women and Youth provides information about on-site advice centers.

If you have tried several unsuccessful attempts, you should treat yourself to breaks in treatment. It is not uncommon for couples to succeed in procreation in these phases.

Infertility: Are There Any Alternatives?

After the diagnosis of infertility, most couples first exhaust all therapeutic options. However, if pregnancy does not occur despite numerous efforts and intensive sterility treatment, you as a couple should consider whether you can lead a happy and livable life together without children. If the desire for a family is great despite infertility, it can be just as fulfilling to adopt a child or take in a foster child and give him a new home.

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