Why does is not work for us?

You are not alone. Experts estimate that one in six couples stays childless involuntarily. As a consequence of a changing society, family planning has changed: The preference of a successful career results in an average age of 30 for women having their first child and it is still rising. Yet, from the 30th year of life onwards, women’s fertility declines. Environmental effects and a job add to that effect.

What might be the problem?

Infertility is defined as the failure of conceiving a child after one year of unprotected intercourse. The reasons for that may lie with both partners. For women, the reasons first in line are tubal ligation, hormonal imbalance and endometriosis.

For men, the quality of sperm cells is decisive for successful conception.

At times, there are no identifiable causes for infertility with either the man or the woman. This phenomenon is called idiopathic infertility.

For men, fertility can be severely limited without the person affected recognizing it.

Especially important:

Men should have their semen quality examined early on. Spermiograms are usually taken by andrologists or urologists. Naturally we can provide a semen analysis as well.

Men should stick to an abstention period of 3-5 days prior to the examination. The sperm is acquired through masturbation and will be examined under a microscope afterwards. This semen analysis will determine the continuation of the therapy.

Quality of sperm cells

When examining sperm quality, three parameters are relevant:

• Concentration of the sperm cells

• Their motility

• Their morphology (their shape)

The World Health Organisation (WHO) has defined reference values for what is considered normal semen quality:

• Concentration: >15 million/ml, total sperm <39 million

• Mobility: >32 percent

• Morphology: >4 percent normal shaped sperm

• Volume: >1,5ml

Falling short of one or more of these values does not make a man infertile. He is considered limitedly fertile.  That can mean that it just takes a little bit longer for the partner to get pregnant. However, the worse the semen quality gets compared to the reference values the less likely a spontaneous pregnancy (with a healthy partner) becomes.

In individual cases, sperm is completely missing from the ejaculate. In cases like these an urologist-andrologist institution has to determine, whether an IVF-treatment may be possible by extracting a small tissue sample from the testicles (MESA/TESE).

Tubal ligation

Pathological germs (ex: chlamydia) can get to the uterus or the fallopian tubes through the vagina.  In most cases the immune system prevents that. But sometimes this defense mechanism is not enough and a rising infection occurs that can result in tubal inflammation. This inflammation can cause an adherence of the tubes, as a result of which the egg cell can no longer reach the uterus. Tubal ligation is the classical indicator for in vitro fertilization, since the puncture of the egg cells and the subsequent transfer of the embryos to the uterus bypasses the passage through the fallopian tubes.

When treating infertility there are different options for different causes that vary in complexity. It does not have to come to the use of egg cell fertilization outside the body right away (In-vitro-fertilization). Methods like sexual intercourse during ovulation or intrauterine insemination can be promising in some circumstances. However, oftentimes an In-vitro-fertilization is necessary. Treatment for women is organized into hormone therapy, retrieval of egg cells and embryo transfer.

Depending on the man’s sperm quality different techniques have to be applied to fertilize the egg cells: Conventional IVF in case of normal or slightly limited sperm quality and ICSI in case of severely limited sperm quality. In case of men that do not have any sperm cells in their ejaculate, ICSI suitable sperm may be acquired through MESA/TESE in some circumstances.