Infertility

There can be a number of different reasons for infertility. In women, the possible physical causes include:

• Hormonal imbalances
• Damage to a fallopian tube or an ovary
• Fibroids or endometriosis

Possible physical causes in men include:

• Hormonal imbalances
• Poor sperm quality (e.g. low sperm count, or sperm that can't move well enough or have an abnormal shape)
• Blocked vas deferens tubes, preventing the sperm from leaving the body during ejaculation
• Erection problems

Fertility can also be affected by certain diseases and infections (like chlamydia), as well as genetic, psychological or environmental factors. Lifestyle can play a role, too. For example, smoking over a long period of time and drinking a lot of alcohol can impair fertility. Any of these causes, either alone or together, may make it difficult to get pregnant. Sometimes no clear cause is found, though.

Last but not least, age plays a big role when it comes to fertility: The older a couple is (especially the woman), the more unlikely it is that they will conceive naturally when trying for a baby.

In Europe, about 18 out of 100 people are affected by infertility at least once in their lifetime. In other words, the woman does not become pregnant despite having regular unprotected sex with her partner for at least a year.

Because infertility can be due to problems related to the man, the woman or both, it's important that both also see a doctor about it. The appointment will usually involve an in-depth talk with the doctor (anamnesis), physical examinations, and a blood test. The hormone levels in the blood are usually measured. Men will also have a sperm test and women will have an ultrasound examination of their womb (uterus), ovaries and fallopian tubes.

There are a number of different treatment options for infertility. The choice of treatment will mainly be determined by what sort of problem has been diagnosed in the woman or man. For example, if the woman's menstrual cycle is abnormal, she can have hormone therapy. If she has fibroids or endometriosis, surgery may be helpful. Some causes of infertility in men can also be treated with hormones or surgery.

The following types of fertility treatment aim to help the man's sperm and the woman's egg join together (a process known as fertilization):

• Artificial insemination: Here, the sperm is placed directly inside the woman's womb using a small tube that is inserted through her vagina. Once inside the womb, the sperm can fertilize the egg.
• In vitro fertilization (IVF): In this procedure, eggs are taken from the woman using a thin hollow needle that is inserted through her vagina. Then the man's sperm is mixed together with the egg in a laboratory. The sperm fertilize the egg on their own. Before doing this, the woman has hormone therapy to try to make her ovaries release several mature eggs at the same time during a single monthly cycle. Hormone therapy can cause unpleasant side effects such as mood swings or nausea.
• Intracytoplasmic sperm injection (ICSI): This procedure is similar to IVF. The difference: In the laboratory, the sperm is injected directly into the egg cells using a fine needle.

If the IVF or ICSI procedure is successful and the fertilized egg cells continue to develop to the next stage (embryo), the doctor places up to three embryos inside the womb after a few days. If more than three egg cells develop into embryos, the woman can decide to have them frozen (cryopreserved) or destroyed. This also applies to egg cells in a stage of development called the pronuclear stage, where the sperm and egg cell have not yet fully joined together. Cryopreserved embryos or fertilized egg cells can be thawed out for use in a later menstrual cycle if the first attempt is not successful.

These forms of fertility treatment are not always possible, or are sometimes very unlikely to work – for example, if the woman's womb has a certain type of abnormal shape.

When people are ill or need medical advice, they usually go to see their family doctor first. If you are having trouble conceiving a baby, you can go to a gynecologist or urologist. There are also special fertility clinics. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

People who live in Germany can visit informationsportal-kinderwunsch.de for information on the diagnosis and treatment of fertility issues, as well as where to get advice and financial assistance. This website is provided by the German Ministry of Education, Family Affairs, Senior Citizens, Women and Youth.

The website familienplanung.de, operated by the German Institute of Public Health (BIÖG), provides information on trying for a baby, fertility issues and the treatment options.