Infertility and assisted reproduction


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Million people worldwide dream of offspring, but ever more often their desire for children is not fulfilled. The reasons for unsuccessful conception can lay with the man, the woman or both partners. Here you can find answers to the most often causes of infertility and information for the multiple treatment methods, which reproduction medicine offers.

If a pregnancy is not reached after a longer time period, this can have different causes. Advanced age, various (chronic) diseases, hormonal disorders, as well as unhealthy lifestyle habits (smoking, being under or overweight, excessive alcohol consumption, drug use etc.) can all influence fertility. Often there is not a single cause for unwanted childlessness, but a complexity of factors responsible. 

What is infertility?

We talk about infertility or primary sterility when despite unprotected sexual intercourse a pregnancy does not occur. Another form of infertility is the so-called secondary sterility when after one pregnancy a couple cannot conceive a second child. When the causes for infertility are not identified it is idiopathic sterility. For up to 30% the causes for the infertility remain unclear. According WHO (World Health Organization) infertility can be assumed only after one year of regular sexual intercourse without pregnancy.

What is the difference between sterility and infertility?

Sterility means the inability to conceive, whereas infertility signifies a successful conception which ends with abortion or miscarriage.

Infertility affects both men and women equally.

 

What are the main causes of infertility?

Childlessness is associated with a combination of causes - in more than 50 percent of the cases men are involved, with suboptimal spermiograms usually being due to testicular inflammation during childhood and, for example, to undescended testis or pendulum testicles, but also could indicate a worse sperm quality.

In the case of young women, however, disturbances in the hormone balance are primarily responsible for the sterility. In older women apart from advanced age organic factors such as fibroids (myoma), changes in the uterus, endometriosis, fallopian tube dysfunction after tubal inflammation, etc. come into play. 

 

Main causes in men:

 

  • Suboptimal sperm production: causes may be undescended testicles or varicose veins of the testicle (varicocele), a testicular inflammation after mumps, but also medical therapies such as chemo or radiation;
  • Decreased semen quality: In the meantime, various studies indicate that in the last twenty years sperm quality has declined by 50% in industrialized countries due to numerous factors such as various illnesses, medication intake, stress, etc.;
  • Impaired testicular function: different testicular infections may lead to testicular dysfunction, but also excessive consumption of alcohol or nicotine, medication, etc. may have a negative impact;
  • Ejaculatory duct obstruction: in which the sperm cells can not be transported through the ducts;
  • Hormonal disorders: a disturbed testosterone production, but also a prolactin disorder can affect the production of semen;
  • Erectile disorders (erectile dysfunction);
  • Chlamydia infection: transmitted through unprotected sexual intercourse, and others. can cause prostate inflammation (prostatitis)
  • Immunological sterility: producing antibodies that attack sperm cells;
  • Psychological causes indirectly causing sterility;
  • Lifestyle factors: smoking, excessive alcohol consumption, drug use, environmental factors can affect male fertility.

 

Main causes in women:

 

  • Hormonal disorders: Primarily thyroid dysfunction, impaired insulin metabolism, polycystic ovarian syndrome (PCO), lack of ovulation, premature menopause, increased levels of the hormone prolactin, a lack of the hormones FSH and LH, which are directly responsible for oocyte maturation and disturbances in the formation of the corpus luteum hormone, which is important for the implantation of an embryo in the uterus, may affect fertility;
  • Chlamydia infection: one of the most common sexually transmitted infections among women. can cause blockage of the fallopian tubes;
  • Existing endometriosis: infertility may occur especially in more severe forms of this common gynecological gynecological disease;
  • Fallopian tube or ovarian inflammation, ovarian cysts, adhesions of the fallopian tubes: the connection between the ovary and the uterus is blocked by various infections or diseases, due to which the transport of the egg in the uterine cavity is not possible;
  • Malformations of the uterus, fallopian tubes or ovaries: Doctors differentiate between congenital uterine tumors that grow genetically and later on occurring disorders such as myomas or polyps, the probability of malformations increases significantly with age;
  • Myomas: benign muscle tumors that often form in the uterus or cervix; these can lead to blockages in the fallopian tubes and prevent implantation of the embryo;
  • Advanced age: The age of the woman is an important factor and indicator of her fertility. Once a woman is 30-35 years old, her fertility begins to decline;
  • Immunological causes: Building of anti-bodies against the sperm cells;
  • Psychological factors: directly influence the chances of pregnancy;
  • Unhealthy lifestyle: Exhaustion and stress, nicotine consumption, beign overweight and underweight , excessive sport can all negatively influence;

Diagnosing infertility: am I infertile?

In about 85% of couples who want children and have regular intercourse a pregnancy occurs within one year. If you belong with the remaining cases, chances are there is a problem and you should see a specialist to investigate the causes. When infertility is probable it is important to find out the underlying causes. The right contact person is a gynecologist who, after a medical examination, can propose various methods to help with conception.

 

If a woman wants to get pregnant but does can not after a prolonged period of time, the following steps are to be taken after a first consultation:

 

  • Body check-up (Scan of the reproductive organs);
  • Gynecological ultrasound check to monitor uterus health and, if necessary, monitor changes in the endometrium;
  • Check Fallopian tubes patency: the methods used include Hysterosalpingography (HSG), Hysterosalpingo-contrast-sonography (usually shortened to (HyCoSy) or laproscopy;
  • Hysteroscopy to detect changes in the uterus;
  • Cycle monitoring: determine the ovulation date (check if and when it takes place);
  • Assess hormone status to determine if hormonal imbalance is the cause of infertility;
     Female health

To examine the fertility of men, after a general medical history different methods of fertility diagnostics could be used:

 

  • Body check-up: Palpation of the external genitals and inguinal region connecting pelvis and thighs;
  • Urologic ultrasound check: Sonography of the kidneys, bladder and testicles;
  • Seminogram: microscopic and chemical examination of semen sample to determine the number and quality of the sperm cells;
  • Chormone diagnostics: Determination of sex hormones after taking blood to check whether or not there is a hormonal disorder.
Seminogram
A seminogram (semen analysis) is the main test for infertility in men.

 

Unwanted childlessness: when to go to doctor?

How often should I have sex?
Regular sex raises chances for a pregnancy

If there is no pregnancy within one year despite unprotected, regular intercourse (at least twice a week), both partners should in any case proceed to investigate the causes starting with a consultation discussion with a specialist in reproductive medicine. Accurate and rapid diagnosis of fertility disorders is the basis for targeted fertility treatment. Most research to find out the causes of a fertility disorder is low-risk, yet it is advisable to familiarize yourself with the various diagnostic procedures that are available before initiating any investigations and the risks of each method. Counseling couples should first and foremost feel supported personally and medically.

I can’t get pregnant: what can I do?

A reproductive therapy could provide a good chance for pregnancy. There are a number of different treatment options available - which method is suitable in the individual cases, must be first clarified through fertility diagnostics.

 

The most common therapeutic methods of reproductive medicine are:

 

  • Menstruation monitoring: the ideal time for fertilization is determined by the treating gynecologist by means of ultrasound monitoring and examination of the hormones in the blood;
  • Hormone therapy: If hormonal disorders are responsible for infertility, it is possible to normalize the hormone balance by hormone therapy (hormonal stimulation), which should support the menstruation cycle (egg production, egg maturation, ovulation). Hormone therapy for infertility works by administering fertility-promoting hormone medications such as clomiphene, Follicle-stimulating hormone (FSH) or human menopausal gonadotropin (hMG or menotropin) under the supervision of a doctor in the form of tablets or injections. Most hormone treatment begins on the third day of the menstruation cycle. The hormonal stimulation is accompanied by a regular medical examination by ultrasound and blood tests to control the therapeutic success. Often therapy will continue for a few menstruation cycles to reach the goal. After about four to six unsuccessful treatments, the next option would be artificial insemination to achieve pregnancy. Men may also be affected by hormonal imbalances - usually treated with drugs containing testosterone;
  • IUI (Intrauterine Insemination): For insemination sperm is taken by the male partner at the time of the hormonally induced ovulation. In the laboratory, sperm is put through a special filter system, centrifuged and washed. Thus, only the active and intact sperm cells are isolated and weak cells and other components are discarded. With a syringe and a catheter, the prepared spermatozoa are introduced directly into the uterine cavity over the cervix and immediately swim alone towards the fallopian tube. The aim is to shorten the path to the fertilizable egg for as many powerful sperm as possible. These selected sperm cells are faster the sperm heads are already prepared for fertilization;
  • IVF (In-vitro-Fertilisation): In this method, the ovaries are first stimulated with hormones so that they form multiple follicles, which should increase the chances of a pregnancy. Even before ovulation, stimulated by the administration of another hormone, the puncture of the follicles takes place under anesthesia. The oocytes thus obtained are pooled in the laboratory with previously purified and concentrated sperm in the test tube i.e. fertilization takes place outside the body. In the process, one sperm cell of many will find their way into the egg cell. When this is done, a matured embryo is transferred through a catheter into the uterine cavity, where it is to implant itself in the uterine lining. However, IVF is a complex and expensive method that can put a lot of physical and mental strain on the patient. The embryo does not attach to the uterus in every attempt - statistically, the chance of getting pregnant with IVF treatment is around 30 percent, but the pregnancy rate may vary depending on factors such as the couple's age, existing chronic conditions, and Lifestyle habits depend significantly;
  • ICSI (Intracytoplasmic sperm injection): In this method of assisted reproduction, the ovaries are first stimulated hormonally to ripen several ovarian follicles and the oocytes are removed afterwards. This is done under general anesthesia as part of a short outpatient procedure. Subsequently, a single sperm cell is introduced directly into the oocyte by means of a microscopical injection needle and fertilized with it. In this procedure too, fertilization takes place outside the body, but it differs from IVF in that the sperm cell is introduced directly into the oocyte. If fertilization is successful, a maximum of three embryos are introduced into the uterus of the woman to enter the uterine lining like a natural pregnancy. An indication for the ICSI is, if the sperm quality is clearly limited, that is, if there is any doubt that the seed can reach or penetrate the egg shell;
  • Egg donorship: Another option is egg donorship and fertility therapy with donor eggs. Egg donation is considered a possible solution when a reduced oocyte reserve is the cause of infertility; if multiple IVF attempts failed; after surgical removal of the ovaries, after chemotherapy; and / or hereditary diseases that can be transmitted from the mother to the baby.

The methods of assisted reproduction can offer a couple the chance to have a healthy baby. Eine Beratung und gründliche Untersuchung sind Voraussetzung, um die für die individuelle Situation erfolgsversprechende Behandlung festlegen zu können. Da die natürliche Fruchtbarkeit der Frau bereits ab dem 30. Lebensjahr abnimmt, sollten Paare mit unerfülltem Kinderwunsch nicht zögern, sich kompetenten ärztlichen Rat einzuholen, um die Chance auf eine Schwangerschaft nicht zu verpassen.

 

What to do if corpus luteum or the yellow body function is weak?

If a pregnancy does not happen often the reason is luteal phase defect (LPD). A yellow body weakness is present too little progesterone is produced. The sex hormone progesterone (luteal hormone) is produced by the yellow body (corpus luteum) formed in one of the ovaries after ovulation. This corpus luteum helps the implantation of the fertilized egg in the uterine lining.

Usually, the yellow body weakness can be treated well hormonally during a fertility therapy. Hormonal medicament such as clomiphene, the human chorionic gonadotropin (hCG), Dydrogesterone, Progesterone etc. are used to bring the hormonal structure back into balance. Medicinal plants such as chaste tree can supplement the hormone treatment - the ingestion must take place in any case after consultation with the attending physician.

Why is folic acid recommended when trying to conceive?

Meanwhile, several studies have shown that folic acid protects unborn babies from malformations, reduces the risk of premature birth and can improve fertility. Therefore women who want to become pregnant are recommended diet rich in folic acid (including spinach, green salad, broccoli, kale, legumes, nuts, wheat germ and whole grains, egg yolk, liver, etc.) and in addition to take folic acid supplements before the onset of pregnancy and prepare the body to conceive a healthy baby. However, you should seek medical advice about the additional intake of folic acid.

Folic acid in brocolli
 Broccoli is a good source of folic acid.

 

What role does age play in conceiving?

Female age plays a crucial role in the reproduction. The natural fertility of the woman is remarkably stable over a long period (from puberty to the late 30s), but this begins to slowly decrease from the age of 30 and above 40 years the fertility after artificial insemination is also reduced. Not only the number, but also the quality of the eggs decreases from about the age of 37 massively, which greatly reduces the chances of pregnancy. In addition, aging increases the likelihood of chromosomal abnormalities, miscarriages, and pregnancy complications.

The age of the male partner plays a minor role in the desire to have a baby, since sperm cells are constantly being re-produced - the ability to procreate remains with the man until about the age of 60, then decreases rapidly. However, the sperm quality and the number of sperm in men decreases significantly from the age of 40 years on.

Pregnancy age
Age plays a big role for pregnancy. Despite this, pregnancy is still possible even for older couples.

 

Although fertility in women and men decreases with advancing age, this is a very individual development, which is affected by individual lifestyle (smoking, stress, physical inactivity, obesity, etc.) as well as by various diseases (e.g., cardiovascular, metabolic, or cancer). In any case, couples should consider this fact when choosing the right time for a child.

Why go to dentist if I want to get pregnant?

It might come as a surprise but mouth and teeth problems, as well as breathing area, can influence fertility. Especially Periodontitis (gum inflammation) can complicate matters seriously. Various studies about the effect of gum inflammations on female fertility and conceiving show that the risk for premature birth or underweight baby is clearly higher for women with periodontitis. Therefore, it is advisable for the couple to visit a dentist as well. Even when a pregnancy is a fact, women should regularly check for problems with their dentists.

Periodontitis and pregnancy
Inflammation in mouth, especially periodontitis can hinder attempts to get pregnant.

 

When to quit smoking if trying to conceive?

Smoking and conceiving do not go well together. Cigarette smoke contains around 4000 different ingredients, including nicotine, nitrogen oxides, sulfur dioxide, and carbon monoxide. Poisons in tobacco smoke are responsible for long-term damage.

Quit smoking before pregnancy
 Couples who want children should quit smoking approx. 1 year before conception.

 

The harmful substances can interfere with hormone production (mostly of the female hormones estrogen and progesterone) which controls the female cycle and moreover the fertilization and implantation of an egg. Fertility of men is also affected by smoking. Blood flow to testicles is reduced, which can worsen sperm quality, production and especially velocity. In general, the chances for a successful infertility treatment of smokers decrease considerably.

When a couple plans a child, both partners should should quit smoking  no later than a year before conceiving, to detoxify their bodies and not endanger the fetus in the womb.

Trying to conceive? What else do I need to know?

Most couples only find they are having problems when they first try to have children. Unwanted childlessness is a sensitive topic, which is still a taboo in society and can represent a serious psychological burden over the couple. Often childless couples find it hard to talk about their problem. Very important is the psychological and emotional support, which can help dealing with the unknown and strengthen the inner self.

Infertility can be psychological burden for the couple.
Unwanted childlessness can be a serious psychological burden for the couple.

 

Especially treatments with reproduction medicine treatments can be very emotional challenge for both men and women. When the therapy does not shortly lead to pregnancy is the stress high and emotional and psychological support would be helpful to prolong the treatment, increase quality of life, avoid partner conflicts and enjoy the time of wait.

Mental and stress management trainings reduce tension, help relaxation and give internal strength to continue the path of treatment. Feeling happy will not get you pregnant but the burden of the diagnosis can be excruciating, and a responsible doctor should be part of the psychological coaching to relieve the stress. Childless couples should seek professional psychological help with someone, who has experience with such cases.

Diets for pregnancy
The chances to conceive could be improved by a balanced nutritional diet.

 

Normal bodyweight is another important factor when trying to get pregnant– different studies have proved, that women with normal weight get pregnant more often than women who are under or overweight. In this most important role is played by nutrition and diet. There isn’t a unique I-want-a-kid-diet, but balanced eating is very important. It has been scientifically proven that certain vitamins, especially microelements and among others folic acid, which can be obtained, for example, via legumes or cereals, but also in addition to folic acid preparations, can improve the chances of pregnancy. In addition, too little or too intense sport as well as smoking could be at fault for childlessness- a positive change in the way of life is always a good idea on the way to the desired offspring.