Every seventh couple has difficulty getting pregnant without medical help. This emerges from the statistics of the Federal Ministry of Family Affairs for artificial insemination.
Infertility treatment experts confirm the situation. Situation is the same or similar in different countries, in Russia as well as in the Middle East countries. These patients often come to Germany or Austria for artificial insemination and infertility treatment.
Sometimes it can help if the couple changes it’s living conditions, for example healthier food, or refusal of alcohol and cigarettes. And of course the whole thing should be as stress-free as possible, but of course that is difficult.
The experts here in Germany are of the opinion that if a couple sleeps together twice a week and after two years there is still no child, then medical help should be sought. Couple can contact one of the approximately 140 fertility centres in Germany. The hormone status of women is usually checked there first. "If there are problems, sometimes medication is enough," says Prof. Sabine Kliesch at the University Hospital in Münster.
In any case, she also advises men to do all necessary examination. Because in around 30 percent of cases it is up to them if their desire to have children is not fulfilled, for example because they have too little semen. If women cannot get pregnant, the fallopian tubes are often not permeable enough. And in every tenth case, the doctors do not find out why pregnancy does not work.
Most couples remain childless
"Every fifth couple goes home after a treatment cycle with ICSI or with the conventional IVF method with a baby," says Sabine Kliesch. A number that gives hope. Nevertheless, one should not forget that the majority of couples remain childless even with the help of modern reproductive medicine.
The treatments are often torture for couples - physically and mentally. Hormone stimulation poses some health risks and waiting and worrying after artificial insemination is a major psychological burden.
Desire to have children - Great gap between desire and reality
All over Europe, people would like to have more children than they actually have. The Germans recently had a very low need to reproduce: they wanted only 1.7 children on average in 2001. According to the 2006 Eurobarometer, their ideal is now 2.1 children, while the actual birth rate during this period was between 1, 33 and 1.38 children commuted per woman. No other of the 15 "old" EU countries has seen such a large change in the number of children desired (Eurostat 2006).
In Europe, most women remain without offspring: 22 percent of women born in 1955, who have therefore had their fertile years, are childless. 23 percent of men in Germany and 15 percent of women consciously choose not to have a family.
This was the result of an international comparative population survey in 2005 (Generations and Gender Survey). The survey also provided some information as to why the desire to have children in Germany is so strikingly low. Around half of the 20- to 49-year-olds surveyed, men and women, thought that a full life was conceivable even without children. The value for childless people was as high as 55 percent, which is less surprising than the finding that it was still very high at 42 percent for those who were already parents. Children are just one value among many that make sense and bring happiness.
This is not only a perception problem, it also has tangible material reasons: The vast majority of childless people said in the survey that children meant a high financial burden, worsened the professional opportunities, especially for women, and also restricted their own freedom.
Many wishes for children remain unfulfilled
At the same time, there are often high expectations: A stable partnership and a stable job are also widely accepted as minimum requirements for starting a family, even for people who want children. According to a survey conducted by the Institute for Demoscopy Allensbach on behalf of the Berlin Institute for Population and Development in autumn 2006, over half of childless adults between the ages of 25 and 59 have the desire to have children. Of these, however, almost half state that the "right" partner is missing. Around a quarter of the childless with a current desire to have children stated professional or financial reasons, while 13 percent stated that it did not work out when they became pregnant. Even for parents who want to enlarge their family, the additional desire to have children remains at least provisionally unfulfilled for financial (35 percent) or professional (18 percent) reasons, while 19 percent state that the partner does not want another child.
In Germany, the hurdles for starting a family are high - even for those who actually would like to have children or would like to expand the existing family. They deny themselves this wish altogether, or postpone it until it may be too late because fertility decreases with increasing age. According to the survey by the Berlin Institute, a total of 12.8 million 25- to 59-year-olds could not or did not fulfil their desire to have children, for different reason, including around two million who, despite "trying", failed to get pregnant.
To facilitate the decision-making regarding the birth of children in the family, measures on family policy have long been required. And recently, some of them have been implemented: the introduction of parental benefits is just one example.. However, families still suffer from excessive tax burdens, and childcare under the age of three is not guaranteed across the board. But for family policy measures to take effect, a society also needs a feeling of reliability. French politics has been working on it for almost a century, regardless of who is governing. It has created a climate in which having children is considered normal.
In Germany, on the other hand, where, among other things, the issue of birth promotion is historically negative, the parties are still arguing over the right line. According to a survey conducted in the spring of 2007, 80 percent of French consider their country to be child-friendly, while only 25 percent of Germans think the same of their homeland. Women in Germany tend to feel compelled to give up their careers and look after the children themselves, otherwise they are considered "raven mothers" - a term for which there is no equivalent in French. Even if things have got going in recent years, it will take a long time for potential parents to get the impression that they will not be left alone when they start a family.
Assisted reproductive technologies for infertility treatment
Assisted reproduction implies the wide scope of innovative medical methods, which manipulate the germ cells (sperms or eggs) with the aim of achieving healthy pregnancy. The most efficient methods of assisted reproduction are:
- Supporting techniques (all kinds of gentle hormonal stimulations before and after the blastocyst transfer).
- Artificial insemination
- Fertilization (IVF)
- Intracytoplasmic sperm injection (ICSI)
The type of fertility treatment depends primarily on an underlying fertility problem. Due to innovative diagnostic technologies, cutting-edge treatment methods, the latest medical equipment and medicines of new generation more and more patients suffering from childlessness solve the infertility problem. According to EU statistics, every second IVF and every third insemination procedure ends up in pregnancy.
The medical causes of infertility are evenly distributed across both genders
Contrary to the still widespread prejudice that infertility affects women only, the physical causes are distributed roughly equally between men and women, 30 to 40 percent each. In about 15 to 30 percent of cases, there are combined causes in both partners. The reason of male infertility is mainly due to poor sperm quality: there is a low count of sperm cells in the effusion, these are malformed or not sufficiently motile. In less common cases, the testicles may not function properly, e.g. due to a mumps infection during puberty, or the vas deferens may be blocked.
Female infertility most often stems from blocked or stuck fallopian tubes. Often, however, there is also a hormone disorder, which can affect the monthly cycle, the maturation of egg or ovulation. Another common cause are so-called endometriosis, which are growths of endometrial tissue in the abdomen.
Insemination and artificial insemination
Insemination is the method by which doctors interfere least with natural processes. The processed sperm is injected directly into the woman's uterus. If the woman receives hormone treatment to stimulate ovulation beforehand, there is a ten percent chance that she will get pregnant.
The chance of having a baby is greater if the semen and egg are brought together outside the body. The reproductive doctors then speak of in-vitro fertilization (IVF). With this method, the woman first gets hormones so that several egg cells mature. Later, also by hormones, ovulation is triggered.
Then the doctors take one or more egg cells and bring them together with the man's sperm. It all happens in the laboratory. The actual fertilization takes place in the test tube, but without the intervention of the doctors. Only when it is certain that the semen and egg cell have been found is the egg cell inserted into the uterus.
Good success rate with ICSI
In the meantime, however, doctors are taking on this job more and more. They choose the sperm that should fertilize the egg. In three quarters of all artificial inseminations, the semen is injected directly into the egg. This treatment is usually preceded by hormone treatment for weeks. Experts particularly recommend an intracytoplasmic sperm injection (ICSI) if the fertility of the man is very limited or if it is not clear why the pregnancy does not work.
Insemination: a gentle way to boost your fertility!
If a woman does not get pregnant after a medical or surgical infertility treatment, a more sophisticated procedure may be needed to restore fertility. One of the modern methods is the computer-aided insemination procedure, which in 25% ends up in pregnancy. In case of homologous insemination, a specialist brings the sperm of a man into the body of a female partner. A child conceived with the help of homologous insemination is the biological child of both partners. The main advantage of this procedure is that the sperm reaches the egg faster than during a natural intercourse.
The European specialists distinguish among the following methods of insemination:
- Intracervical insemination (ICI): The physician injects the sperm into the cervix;
- Intrauterine insemination (IUI): Sperm injection into the uterus;
- Intratubal insemination (ITI): Sperm introduction directly into the fallopian tubes.
An individual stimulation of ovulation in women is an essential part of every insemination procedure. To have your body prepared for the treatment, it is advisable to come to the clinic in at least two weeks before the duly insemination. In some cases, however, you can start stimulation at home, which is especially favored by the international patients.
The cost of insemination (including the laboratory services and ovarian stimulation) makes up about 1 500 – 3 000euro. If no pregnancy is diagnosed after 3 insemination attempts, it is advisable to move on to other assisted reproductive methods (IVF or ICSI).
How to get pregnant with blocked fallopian tubes?
Such a question cannot be responded in a generalized way. The obstruction of the tubes is always the result of a pathological process (i.e. endometriosis, inflammation, adhesions). To understand, whether the fallopian tubes are obstructed or not, special tests should be performed. Among the most efficient diagnostic procedures, widely applied by the German physicians, is a hysterosalpinography (HSG). During this test, the special marking substance is inserted into the endometrial cavity. This dying liquid highlights the problem area or proceeds freely into the abdomen. Sometimes the same diagnostics is carried out with аir flow, controlled by the sonography devices. If the diagnosis is confirmed, i.e. patient’s tubes are blocked, the European specialists recommend a light surgical intervention, helping to correct the problem.
Now when the blocked tube is opened, the egg can pass from the ovary to the uterus, which makes natural fertilization possible. Successful conception after such a procedure is reported in 70% of all cases of fallopian infertility. If the laparoscopic operations don’t bring the expected results, one should think about in-vitro fertilization, which excludes the functionality of tubes from the fertilization process.
In-vitro fertilization: Modern ways to beat infertility
The IVF an effective and safe method of artificial conception. This procedure is performed in Germany, Switzerland and Austria in compliance with the modern rules of reproductive medicine. The IVF involves the following main steps:
- hormonal stimulation (to prepare your body for the egg retrieval)
- blood tests and ultrasound
- follicular punction
- fertilization of the egg cell with the sperms of your partner
- cultivation of t embryos up to the blastocyst stage (3-4 days)
- blastocyst transfer
The cost of IVF treatment accounts in Germany for 5,000 – 7,000 euro. We understand that for most couples who want to solve the infertility problem, the IVF method is the last hope and resort. For this reason we advise performing in-vitro-fertilization at the well-equipped reproductive centres, which can guarantee the high hygiene standards and absolute security. Our website showcases information about the leading infertility clinics in Switzerland, Germany and Austria. The best European centres, specializing in infertility treatment see it as their highest concern to offer the personally tailored medical services in order to meet the therapeutic needs of each patient.
Intracytoplasmic sperm injection (ICSI)
ICSI is a modern reproduction technique is implemented in case of poor sperm characteristics in a male partner. The medical concept is simple. Under guidance of a special microscope a sperm is absorbed into a thin injection syringe and moved directly into the egg. Through this “marriage” of an egg and a sperm, the successful fertilization can be achieved, even if sperms are almost motionless.
In some cases the IVF procedure may involve the donor eggs or sperms. This method is indicated if one or both partners cannot produce healthy reproduction material (in case of genetic diseases). In the EU there are 34 donor sperm banks which closely cooperate with the biggest fertility centres.
Pregnancy rates and course of pregnancy depending on the age of the woman
Age is a key factor in the success of treatment. While the pregnancy rate for women under 30 years is over 40% per embryo transfer, the probability of pregnancy continuously decreases from the age of 34. Patients aged 43 years and older have only 15% chance of pregnancy.
At the same time, the frequency of miscarriage increases significantly, making the probability of having a child from 43 years is below 8%. The age-related success of fertility treatment should always be taken into account. Especially when for effective fertility treatment age plays a crucial role.
While patients up to the age of 35 can wait to start treatment, effective therapies should be considered if they are 36 or older without any further delay. In this case, for the first time, it is possible to reach high pregnancy rates after several cycles.
For this purpose, all patients were evaluated who had 1-5 transfer cycle between 2014 and 2016.
These results are important for advising couples: While 30% are pregnant after one cycle, this probability increases to 49% after two, to 61% after three and 68% after four embryo transfers.
After more than four transfer cycles, almost 79% of all patients are pregnant. It is also interesting that the cumulative probability from 2014 has increased to 2016 to almost 82%. The rate of pregnancy per individual embryo transfer is often limited, but there are more chances to reach a pregnancy after multiple embryo transfers.
Improper diet, smoking and aging reduce the chances of parenting
About five to ten percent of all infertility cases are due to faulty processes in the development or maturation of the male sperm or the egg cells in the woman, without a cause being found. Maybe previous illnesses play a role, maybe hereditary factors or environmental influences.
However, it can be clearly demonstrated that lifestyle affects fertility: For example, excessive overweight or underweight in women can upset the hormonal balance. Smoking greatly reduces the chances of conception, both for men and women.
It is also clear that fertility decreases with the age of potential parents. A woman is most fertile in her third decade. At the age of 35, a woman has half the chance of becoming pregnant and having a healthy baby than at 25. Men generally remain fertile, but testosterone level and sperm quality decrease over time.
Delaying the desire to have children can lead to unwanted childlessness
The average age at which women give birth to their first child has been rising for years. In the 1960s it was almost 25 years. In 2003 it had risen to 29.4 years in Germany and now it is around 30 years old. It is obvious that this also increases infertility.
So it happens that couples who actually postponed childbearing are increasingly looking for help in reproductive medicine - together with those who, for medical reasons, cannot reproduce naturally. The spectrum of the so-called fertility treatment ranges from hormone therapy to insemination (introducing processed sperm directly into the uterus) or fertilization outside the body, scientifically in vitro fertilization.
Ultimately, the success of fertility treatment depends on the same factors as natural conception. With increasing age, the chances decrease.
In Germany, the probability that a couple will have a baby using IVF or ICSI is around 18 percent per treatment started. Around every hundredth newborn in Germany owes its existence to fertilization outside the body. In view of the already declining birth rate, this is a proportion that should not be underestimated. The statistics of German reproductive medicine show a significant drop in the number of IVF treatments in 2004, as well as in the number of newborns produced with IVF. Since the health care reform came into force in early 2004, statutory health insurers have only covered 50 percent of the costs for a maximum of three treatment cycles instead of fully reimbursing four treatments as before. The connection is obvious: in countries that support fertility treatment more generously, such as Sweden, Finland and Denmark, the proportion of children born out of body after fertilization is higher in the total number of newborns.
Actual prices for infertility diagnosis and treatment
How much does fertility treatment (IVF) cost? This question is really important for those who want to undergo treatment abroad. Due to the transparent price policy of the German fertility clinics, you will get the estimate cost of treatment in advance. The costs for treatment will definitely be minor compared to the advantages you enjoy.
If you have previous medical history, it is a good idea to take the medical documentation with you, so that the specialist could estimate your condition and draft a personal step-by-step diagnostic plan. It helps to avoid the called “overdiagnosing” and to spare your time and money.
HIV and Children's Desire
Around 56,000 to 60,000 people are currently infected with HIV in Germany, which affects approximately 11,000 women. Thanks to improved treatment options, HIV patients have an almost normal life expectancy. This results in the possibility of long-term life planning with regard to work and family planning. Some studies have shown that the desire to have children is just as important in HIV patients as in non-sufferers.
HIV and Fertility Treatment
Fertility treatment for HIV patients is possible in some of our centres. A necessary prerequisite for treatment is antiretroviral therapy by the patient with close checks by the doctor (HIV outpatient clinic). The viral load must have been below the detection limit for at least 6 months, i.e. <40 virus copies/ml (HIV outpatient clinic). In addition, there must be no other infections with sexually transmitted pathogens, such as e.g. Syphilis or genital herpes. Whether an insemination or IVF / ICSI is carried out is decided after a detailed consultation and depending on other findings.
Chances and risks
HIV does not lead to a worsening of the mother's state of health in pregnancy, nor is there any evidence of an increased risk of malformation under antiretroviral therapy.
Of course, some peculiarities must be taken into account, and close care must be given to the mother.
In the choice of medication, as well as in the treatment, there are no differences between HIV-positive patients and unaffected patients.
In HIV-positive men, a semen sample is cleaned, frozen and used for therapy only after the viral load in the ejaculate has been determined. So you can be sure that sperm that are used in IVF or ICSI are not infected with the HI virus.
The best European experts in infertility treatment
Being an international patient in Germany, Switzerland or Austria you can expect infertility treatment, performed by the chief physicians. Our database of infertility specialists includes the most renowned and experienced professors and doctors of sciences, who have at least 20 years of practical experience. All experts perform infertility treatment based on the latest therapeutic methods and scientific concepts. The close cooperation of specialists (biologists, embryologists, medical technical assistants, laboratory staff and senior medical specialists) will make sure that you achieve the therapeutic aim and fulfil your dream to have a baby.
We endeavour to find the optimal solutions for everyone who requests medical help. Don’t hesitate to call us for further information about infertility treatment in Germany, Austria or Switzerland. We will be glad to answer your questions.
Tel: + 49 (7221) 39-65-785 E-mail: ips german-medicalgroup (dot) com Skype: German-medicalgroup