Desire to have children and fertility treatment

Once you have a baby, completely new questions will arise in your life, and suddenly you'll be 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 that you will surely make the right decisions for yourself and your little explorer. But also that it doesn't hurt to occasionally seek advice from people who deal with these questions daily 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 all of us have on our minds.

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 the definition of the term infertility, in order to relativize the pressure of "must get pregnant at all costs": A partnership is only considered sterile if, after more than two years of regular unprotected intercourse, no pregnancy has occurred. If the woman has a regular cycle and no fertility-restricting disease 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 to conceive 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. Also, the physical combination and the reaction of both partners to each other can be the reason why pregnancy does not occur. A detailed medical history is therefore the first important step. During the consultation, it will be determined together whether there are obvious reasons that impair the desire to have children.

The most common problems on female side are hormonally caused, so it is important to find out: Is the woman's cycle regular, can she even 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 ), indicate insufficient luteal phase after ovulation or premature exhaustion of ovarian reserve. Additionally, they can organic problems of women The reason why she is not getting pregnant. A very heavy period can, for example, indicate Polyps or myomas (good-taste nodules on the uterus) indicate, which hinder the implantation of the egg. Increasing abdominal pain, especially during the period or pain during intercourse, can be a sign of acute or previous infections or Endometriosis (indicative of a benign tissue deposit outside the uterus) also Diseases of the blood clotting system the woman can repeatedly Miscarriages lead to or hinder the occurrence of pregnancy. In cases of recurrent miscarriages, also Immunological disorders between the partners are to be examined.

From the man's side can the Sperm quality the reason for unwanted childlessness. Also here, the medical history is important: are there known Pre-existing conditions, how Mumps or other infections or Inflammations the testicle or prostate, or also preoperative procedures that could affect sperm quality?

Since many couples today only start planning children after the age of 30 or 35, the age and the associated already diminished or limited egg/sperm quality naturally play an increasingly important role in 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 nowadays we have many options for detailed diagnostics and targeted therapy to fulfill the desire to have children. Many analyses and treatments can be carried out in gynecological practice; treatment or artificial insemination at a fertility center is not always necessarily required.

Fertility treatment for women

The treatment naturally depends on the diagnosis. In some cases, small measures already help: Through a healthy lifestyle with regular exercise, abstaining from 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. The activity of the ovaries can also be easily stimulated with certain medications. If there are anatomical changes to the internal female reproductive organs (such as
Polyps, myomas, or malformations of the uterus) are diagnosed, then an operative
Diagnostics via hysteroscopy or laparoscopy may be considered, as obstructive anatomical changes might already be removable.

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

Finally, in cases of repeated miscarriages in an early week 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. Additionally, a human genetic evaluation is recommended.

Fertility treatment for men

Alongside the investigation of the causes in women, there is also a urological examination the man with medical history, 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 then exists
for example, the possibility of insemination or a 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 the 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 the 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?

Actually, most couples are afraid of simply not getting pregnant – and this fear can occur after just a few months. Therefore, it is necessary to first reassure the couple: it is not uncommon for it to take some time to conceive, and especially after hormonal contraception, the female cycle must first readjust itself. Couples are often surprised that even with unrestricted fertility of both partners and timely 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. Therefore, medical professionals should not quickly resort to 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 much less often about possible side effects or potential follow-up problems – often, the desire to become pregnant is so great 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. Perhaps it would help you to talk about your experiences with friends, family, or even in a support group. You are not alone on your journey!