Once you have a baby, completely new questions arise in your life, and suddenly you’re thinking about topics you never would have considered before. It’s a wonderful, exciting time, but we also understand if your head starts to spin at some point!

At LILLYDOO, we believe you will make the right decisions for yourself and your little explorer. Still, it can be helpful to seek advice now and then from people who deal with these questions every day and are experts in their field. That’s why, in this series of articles, we want to ask experts the questions about pregnancy, birth, and parenthood that are on all our minds.

An unfulfilled desire to have children is a significant and sensitive topic. LILLYDOO gynecologist Christian considers it particularly important to explain to the couples who come to him what the term infertility means, in order to ease the pressure of “must get pregnant at all costs”: A partnership is only considered infertile if, after more than two years of regular unprotected intercourse, no pregnancy has occurred. If the woman has a regular cycle and no fertility-limiting condition is known in the man, medical steps should therefore be started no earlier than after one year. In the following article, Christian explains what reasons there may be for a couple not conceiving naturally and what treatment options are available.

What could be the reasons that a pregnancy does not occur naturally?

The reasons can lie on both the male and female side. The physical combination of both partners—and how their bodies react to each other—can also be the reason a pregnancy does not occur. A detailed medical history is therefore the first important step. During the consultation, you will determine together whether there are obvious reasons that may be affecting the desire to have children.

The most common problems on the female side are hormone-related, so it is important to clarify: Is the woman’s cycle regular, and can she feel her ovulation? A very irregular cycle or the absence of menstruation can be due to hormonal causes such as Thyroid Disorders , increased male hormone production (polycystic ovarian syndrome, PCOS ), an insufficient luteal phase after ovulation, or premature depletion of the ovarian reserve. In addition, organic problems in women can be the reason pregnancy does not occur. A very heavy period can, for example, indicate Polyps or myomas (benign nodules on the uterus), which can hinder implantation of the egg. Increasing abdominal pain, especially during your period, or pain during intercourse can be a sign of acute or previous infections or Endometriosis (a benign tissue deposit outside the uterus). Diseases of the blood clotting system can also lead to repeated Miscarriages or hinder a pregnancy from occurring. In cases of recurrent miscarriages, immunological disorders between the partners should also be examined.

On the man’s side, sperm quality can be the reason for unwanted childlessness. Here, too, the medical history is important: Are there known pre-existing conditions such as Mumps or other infections or inflammations of the testicles or prostate, or previous surgical procedures that could affect sperm quality?

Since many couples today only start planning children after the age of 30 or 35, age—and the associated decline in egg and sperm quality—naturally plays an increasingly important role in an unfulfilled desire to have children.

What is the next step, and what are the most common treatment options for infertility?

As mentioned, there can be various reasons why a couple has remained childless so far—but it is important to know that today we have many options for detailed diagnostics and targeted therapy to help fulfill the desire to have children. Many analyses and treatments can be carried out in a gynecological practice; treatment or artificial insemination at a fertility center is not always necessary.

Fertility treatment for women

The treatment naturally depends on the diagnosis. In some cases, small measures can already help: Through a healthy lifestyle with regular exercise, avoiding smoking or other drugs, moderate alcohol consumption, a balanced diet, and weight loss in cases of overweight, a stable cycle with regular ovulation can often be restored naturally. Certain thyroid disorders or severe forms of PCOS, on the other hand, usually require hormonal treatment to induce regular ovulation. Ovarian activity can also be stimulated relatively easily with certain medications. If anatomical changes to the internal female reproductive organs (such as
polyps, myomas, or malformations of the uterus) are diagnosed, then operative
diagnostics via hysteroscopy or laparoscopy may be considered, as obstructive anatomical changes may already be removable.

Unfortunately, it is not always that simple: the diagnosis of endometriosis, which is often behind an unfulfilled desire to have children, frequently requires fertility treatment through a fertility center even after surgery.

Finally, in cases of repeated miscarriages in the early weeks of pregnancy, an examination of the immune reactions between maternal and paternal cells and an assessment of the woman’s blood clotting system should be conducted. In addition, a human genetic evaluation is recommended.

Fertility treatment for men

Alongside investigating the causes in women, there is also a urological examination of the man, including medical history, physical examination, and sperm analysis. He is also generally advised to adopt a healthy lifestyle—nicotine, excessive alcohol, or drug use can significantly impair sperm quality. The chances of a spontaneous pregnancy depend on the precise diagnosis, but in cases of impaired sperm quality, consultation and treatment at a fertility center are usually necessary. Depending on the diagnosis, there is then
for example, the possibility of insemination or special sperm selection in IVF or ICSI procedures. You can find out more in the article " Infertility treatment and artificial insemination ".

What about the costs—are they covered by health insurance?

The costs for diagnostics, whether hormonal or surgical, are covered by health insurance companies. Stimulating treatments in gynecological practices using oral medications are also supported by insurance companies. The situation is different with fertility treatments in specialized centers. Here, treatment costs are only reimbursed for married couples—and usually only half of the costs for the first three treatment attempts. However, there are also health insurance providers that cover 100 percent of the costs or reimburse costs for additional treatments beyond the third attempt.

What is the most common question you receive about fertility treatment?

Most couples are simply afraid they won’t get pregnant—and this fear can arise after just a few months. That’s why it’s important to reassure the couple first: it is not uncommon for conception to take some time, and especially after hormonal contraception, the female cycle needs time to readjust. Couples are often surprised to learn that even with unrestricted fertility in both partners and well-timed unprotected intercourse, the probability of becoming pregnant spontaneously within a cycle is only about 30 percent; in some cases, it is even said to be only 15 to 20 percent. For this reason, medical professionals should not rush into artificial procedures, extensive diagnostics, or surgical therapies.

However, if treatment is unavoidable, the question I am asked most frequently is: "How likely am I to become pregnant through this or that treatment option?" Interestingly, patients ask far less often about possible side effects or potential long-term issues—often, the desire to become pregnant is so strong that side effects are accepted. Nevertheless, thorough counseling about risks is, of course, necessary. How likely it is to become pregnant through a specific procedure cannot ultimately be answered reliably, as too many individual factors play a role. Therefore, even with an artificial procedure, it is not uncommon for multiple attempts to be necessary to achieve a successful pregnancy.

For many couples, involuntary childlessness is a sensitive and painful topic. It may help you to talk about your experiences with friends, family, or even in a support group. You are not alone on your journey!