Brief overview
- Description: Those who are not pregnant after one year despite regular, unprotected sexual intercourse are considered infertile.
- Causes: Causes range from diseases to congenital malformations to injuries (e.g., from surgery or infection).
- Symptoms: Signs are usually nonspecific (e.g., in women: Lower abdominal pain and cycle discomfort, in men: weight gain, swelling of the testicles or pain when urinating).
- Forms: Primary, secondary and idiopathic infertility as well as infertility.
- Diagnosis: Among other things, discussion with the doctor, physical examination, ultrasound, hormone examination, spermiogram.
- Therapy: cycle monitoring, hormone treatment, artificial insemination, healthy lifestyle
- Prognosis: after treatment, about 10 percent have a successful pregnancy
When is one infertile?
The term infertility is often used synonymously. However, the term describes the condition in which an already pregnant woman is unable to carry a viable child to term. This is usually manifested by repeated miscarriages or so-called extrauterine pregnancy, which means that the egg implants outside the uterine cavity.
Frequency of infertility
In Germany, depending on the source, about seven to 15 percent of all couples are considered involuntarily childless – that is, they have not been able to conceive a child within one year despite intensive efforts (sexual intercourse twice a week).
Reasons for infertility
Infertility can have many causes and affects both sexes equally: About 30 percent of the reason lies with men, 30 percent with women. In some cases, the cause of an unfulfilled desire to have a child is common to both or remains unclear (idiopathic infertility).
You can learn more about this topic in our articles on infertility in women and infertility in men.
The following risk factors can make it difficult to get pregnant, regardless of gender:
- Age: In women, fertility decreases from the age of 30; in men, sperm quality deteriorates from the age of 40, erectile dysfunction increases.
- Overweight and underweight: In case of severe underweight, the menstrual cycle or ovulation stops. If overweight, fertility decreases due to estrogen-producing fat cells, sperm quality decreases.
- Medications: Some medications, such as psychotropic drugs, drugs for epilepsy (antiepileptic drugs), or high blood pressure (antihypotensives), can affect fertility.
- Nicotine: Smoking is associated with fewer and slower sperm, lower conception rate and higher miscarriage rate.
- Environmental influences: Pollutants and environmental toxins promote fertility-damaging processes, interfere with hormone balance and alter it.
- Psyche: Mental conflicts, sexual disorders, stress and lack of sleep are also risk factors for infertility.
- Competitive sports: Intense training can lead to hormonal disturbances – ovulation fails to occur, sperm production is throttled.
Signs of infertility
Typical symptoms other than childlessness that indicate infertility are rare. In women, infertility may be indicated by lower abdominal pain and cycle discomfort. In men, the possible symptoms are usually even more non-specific: sometimes weight gain, swelling of the testicles or pain when urinating are possible signs of impending infertility.
Forms of infertility
Primary sterility
In primary sterility, no child has yet been conceived despite unprotected sexual intercourse. Either the woman has never become pregnant or the man has never fathered a child.
Secondary sterility
Secondary infertility affects women or men who have already become parents at least once but fail to do so again. Such secondary infertility may result, for example, from intercurrent infections or surgery.
Idiopathic infertility
If no clear cause for childlessness can be identified, physicians speak of idiopathic infertility. Depending on the source, no triggers for infertility can be identified in up to 30 percent of couples.
Infertility
Another important term in this context is infertility. In this case, conception succeeds, but the pregnancy cannot be carried to viability of the child.
Infertility: finding causes
Diagnostics for suspected infertility may include:
- Intensive discussion about previous diseases, infections, operations, cycle disorders, miscarriages, abortions, life circumstances, partner relationship.
- Woman: gynecological examination, ultrasound, hormone testing, ovulation monitoring (basal body temperature curve, cycle monitoring), hysteroscopy of uterus (hysteroscopy) and laparoscopy (laparoscopy)
- Male: spermiogram, physical examination of reproductive organs (focus on possible testicular malformation, inflammation, varicocele), hair and physique, hormone examination, testicular biopsy
Infertility: Therapy
Physical exercise, a balanced diet, abstinence from alcohol and nicotine as well as relaxation and pleasurable sex have a positive effect on the fertility of both men and women and increase the chances of a successful pregnancy. If it is still not possible to conceive a child, reproductive medicine can help.
- Cycle monitoring
- Hormone treatment
- Artificial insemination (in vitro fertilization, IVF)
- Sperm transfer (insemination)
- Microinjection (intracytoplasmic sperm injection, ICSI)
- Collection of sperm directly from the testicles or epididymis(TESE or MESA)
- Intratubal gamete transfer (“gamete intrafallopian transfer”, GIFT)
- Freezing of eggs or sperm (cryopreservation)
- Surgery (fibroids, varicose veins on the scrotum = varicocele, stuck egg/semen ducts)
Before starting any treatment, a psychotherapeutic discussion is important. It increases the chances of success.
Possible complications
Infertility: Prognosis
Despite modern medical options, the success rate of infertility treatment is between 10 and 20 percent. Only slightly more than 10 percent of sterile couples are actually able to hold a baby in their hands nine months later (the so-called “baby take home” rate). Whether treatment is successful depends on several factors. These include, above all, the age of the woman, the fertility problem in question, and the couple’s emotional state.
Infertility: Emotional stress
If infertility affects only one partner, you should still pull together as a couple. Understanding and open discussions can help to ease the situation. Don’t be afraid to seek professional support. Information about local counseling centers can be found on the information portal Kinderwunsch of the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth.
If you have had several unsuccessful attempts, you should take breaks from treatment. It is not uncommon for couples to succeed in conceiving during these phases.