For many couples, the desire to have their own children is an elementary part of their relationship. Many men and women see their relationship completed only by a child; as a rule, they are also confirmed in this by those around them. Most of them do not think about the fact that they might not be able to realize their wish. But an estimated 15 to 20 percent of all couples in Germany are unable to have children.
Cause of childlessness not always identifiable
The search for the causes of their involuntary childlessness remains unsuccessful for many a couple: while medical science knows numerous reasons for infertility in men and women, no reason can be determined for around one third of all couples. Even if the cause can be determined and treated, couples are often not spared a physically and emotionally exhausting journey from one doctor to the next.
Step-by-step investigation of the cause
Regardless of whether one is talking about sterility (no pregnancy despite regular unprotected intercourse within 2 years) or infertility (any disturbance in the ability to conceive or no pregnancy despite regular unprotected intercourse within 1 year), a kind of step-by-step plan is usually followed for investigation and possible treatment, which successively queries and examines various points. In man:
- External genital organs (testes, epididymis).
- Previous diseases such as urinary tract infections, mumps, prostatitis.
- Operations in the genital and abdominal area
- Varicose veins
- Problems with erection and ejaculation
- Evidence of human genetic factors such as hereditary diseases in one’s family.
- Stress in the workplace
- Family pressure
- Sexual habits
For women:
- Previous contraceptive methods
- Irregularities in the cycle by determining the basal body temperature curve over 2 months.
- Knowledge of the fertile days
- Hormone analysis
- Special examinations of the uterus, ovaries and fallopian tubes.
- Abdominal surgery / diseases
- Suspected pelvic inflammatory disease
- Rubella antibody status
- Previous pregnancies
For both:
- Sexually transmitted diseases
- Psychotherapeutic experiences
- Psychiatric pretreatments
The cause research in involuntary childlessness is exhausting and time-consuming; the outcome uncertain. In addition, infertility in Germany is not considered a family medical task, but men and women are treated separately by the respective specialists (gynecologists, urologists, andrologists). According to a recent study by the University of Göttingen, many couples, especially in cases of involuntary childlessness, would like to have a single medically competent contact person who collects the individual examination results and coordinates the further treatment steps. In the context of the current changes in the health care system, it would be conceivable for family physicians to assume a role as coordinator and mediator.
Psychological care
In any case, targeted psychological care at the earliest possible stage is useful for dealing with involuntary childlessness. Many couples find their childlessness extremely stressful and suffer as a result. Concentrating on the question “Why can’t we have a child?” prevents dealing with possible problems in the relationship. In the vicious circle of tense desires, failed attempts and unfulfilled longing, massive stress arises in some cases. The stress hormones adrenaline and noradrenaline also interfere with the household of sex hormones and additionally reduce fertility. Finally, no one can say which came first: suffering from childlessness or childlessness out of grief. However, tying personal well-being and self-esteem so closely to a child is dangerous. The partnership soon takes a back seat to the child, and other interests can neither be nurtured nor developed.
Counseling is needed
Since 2000, there has been the Beratungsnetzwerk Kinderwunsch Deutschland, in which counselors and advisors have joined forces to assist childless couples. Counseling and discussion opportunities are also available from Pro Familia and the welfare associations, among others.The goal of counseling is to provide support in accepting involuntary childlessness. This acceptance does not mean resignation or giving up. Rather, it should enable a reorientation and make it clear that a life without a child can also be possible and, above all, worth living. Couples who opt for reproductive medicine procedures need psychological support just as much as those who give up their dream of having a child. Those who decide to undergo artificial insemination or in vitro fertilization are informed about the risks and dangers. As a rule, however, the desire to have a child and the success of the treatment are in the foreground. The possibility to have qualified crisis talks during this treatment should be exhausted in any case. These discussions help to cope better with the often intense pressure, especially from family and friends. Opening up to the outside world, actively communicating the desire to have a child and one’s own suffering are an important step in overcoming grief and stress.
Consider alternatives
The role of foster or adoptive parent can also be an alternative and discussed. For numerous couples, it is precisely this reorientation that has led to the decisive inner impetus and lifted all mental blocks: Only a little later, the desired child announced itself.
