Fertility related problems and treatment

What kind of fertility related problems are there? How are they diagnosed and treated? Read more about it here.

What if it does not work to become pregnant?

If you have been trying to conceive for a year (with regular sexual intercourse) and have not been successful, it's a good idea to make an appointment with your general practitioner, gynecologist, or fertility specialist together with your partner. You're certainly not alone if you're experiencing difficulty getting pregnant. About 10% of couples face fertility problems. Seek help if you're having trouble with intercourse or experiencing pain during sex. It's also possible that you were able to conceive easily before but are facing difficulties this time. In such cases, it's referred to as secondary infertility.

Discuss with your partner how important your desire for a child is, which investigations you may wish to undergo, and which treatments are feasible for both of you. Fertility treatments can be emotionally challenging, and psychological support during the process can be beneficial for many couples.

It's important for both partners to take steps if pregnancy is not occurring, as fertility is not solely a "female issue." About 30% of fertility problems are attributed to issues with the woman, around 30% to the man, another 30% have their origin in shared problems (both male and female), and the remaining 10% of fertility problems are due to unknown origins.

The treatment depends on the cause of infertility. If ovulation is not occurring, hormone therapy (pills or injections) can help. If the quality of sperm cells is poor, artificial insemination can be a solution: the partner's sperm is processed, and the most motile sperm cells are introduced through a painless procedure via the vagina using a catheter. This method can also involve using donor sperm for artificial insemination. In cases of less accessible fallopian tubes, in vitro fertilization (IVF) is used. The woman's ovaries are first stimulated to release additional eggs within a single menstrual cycle, and the follicular fluid is then aspirated using a fine needle. Simultaneously, the male partner provides a sperm sample, and in the laboratory, eggs and sperm are brought together so that fertilization can take place there. In ICSI (Intracytoplasmic Sperm Injection), a selected sperm cell is further injected directly into the egg using a fine needle. This technique is employed when there are few high-quality sperm cells. Both in IVF and ICSI, the development of the fertilized egg is evaluated in the lab for a few days. If development proceeds normally and a high-quality embryo is obtained after about 5 days, it is transferred back into the uterus through the vagina. Since the woman was previously stimulated to mature multiple eggs, multiple embryos can be available simultaneously. Typically, only one embryo is transferred per cycle. If there are still good-quality embryos available, they can be frozen and used for a subsequent cycle. Depending on the woman's age, the number of IVF attempts, and the quality of the embryos, sometimes it may be decided to transfer two embryos. This can increase the chances of pregnancy, but it also increases the chance of a twin pregnancy. To minimize twin pregnancies, the reasons for transferring multiple embryos are regulated by law.

A fertility journey is often experienced as very challenging by most individuals: it demands a lot physically and, especially, can be mentally taxing. Many patients experience feelings of failure, anxiety, uncertainty, and shame. Psychological support is available at fertility centers.

Useful links and material on fertility

useful links useful links

What if something goes wrong with the pregnancy?

It's difficult to measure the exact percentage of pregnancies that end in spontaneous miscarriage, but it's estimated to affect around 10 to 15% of pregnancies. Approximately 1.4% of women experience this in two or more consecutive pregnancies. The loss of two consecutive pregnancies could be due to chance, or there might be an underlying issue. Consult your gynecologist for further investigation.

Pregnancy loss is a deeply impactful event for most women/couples. The loss of the baby is accompanied by the loss of the future plans that you were already envisioning. Given that many women/couples have gone through this process before, talking about it with others can be helpful. If you find it challenging to cope with this loss over an extended period, it might be advisable to seek support from a psychologist.

Disclaimer

The words "woman" and "man" are increasingly ambiguous concepts and should be avoided where possible. For ease of communication on this platform, we use the terms "woman" and "man" when providing information about biological processes. In this context, the term "woman" refers to a person with "female" sex characteristics (e.g., vulva, uterus, ovaries, etc.), and the term "man" refers to a person with "male" sex characteristics (e.g., penis, testes), although we are aware that:

1) There are many intersex individuals or individuals with variations in sex characteristics;

2) There are many people for whom gender identity does not fully correspond to or align with sex characteristics.

When providing information about relational aspects, however, the term "woman" does not refer to biological characteristics, but rather to gender. This also includes trans women (individuals who were legally registered as male at birth based on sex characteristics but have a female gender identity) and intersex individuals (born with variations in sex characteristics) who identify as women. Similarly, the term "man" refers to gender in this context, including trans men and intersex individuals who identify as men.