Approximately 7 to 15 percent of all couples in Germany are involuntarily childless. After a long period of not conceiving naturally, or if other circumstances indicate that natural conception is unlikely, many consider medical assistance to fulfill their desire to have children. The options are diverse and range from cycle monitoring and hormone therapy to artificial insemination. In this article, you will find an overview of the most common options for artificial insemination and who they are suitable for.
If you are interested in more details about causes, diagnostics, and further treatment options for infertility, you will find more information in the article “Infertility and Fertility Treatment” by LILLYDOO gynecologist Christian.
What are the possible causes that a pregnancy does not occur naturally?
The reasons for the absence of pregnancy can lie on both the female and male sides. The most common causes of female fertility disorders are hormone-related, but organic problems such as malformations of the fallopian tubes or the uterus can also be responsible. Additionally, acute or past infections can make pregnancy more difficult, as can blood clotting disorders and immunological disturbances between partners. On the male side, impaired sperm quality can be the reason for infertility. Genetic mutations (genetic changes) can, of course, be present in both men and women and can also cause fertility issues.
Even with regular, unprotected intercourse, it is completely normal for pregnancy to occur only after one or even two years. Therefore, LILLYDOO gynecologist Christian recommends that, as long as the woman has a regular cycle and no fertility-reducing illness is known in the man, medical diagnostics or treatment should begin no earlier than after one year.
The diagnosis by the gynecologist/urologist is then decisive for the further course of treatment. Consultation at a fertility clinic is advisable only when the treatments available in the gynecological practice show no effect or the diagnosis requires it.
What options for artificial insemination are available?
There are various methods of artificial insemination, also known as assisted reproductive technology ( ART) . The goal of medical treatments is always to help the egg and sperm find each other more easily and successfully merge. Which form of artificial insemination is suitable for you always depends on the diagnosis and is decided together with your doctor. Here you will find an overview of the most common methods:
Intrauterine Insemination ( IUI)
This is the most common method of assisted reproduction, in which sperm is placed directly into the uterus or immediately in front of it, in the cervix or cervical canal. Since IUI brings the egg and sperm together but their fusion occurs naturally, the method is suitable only if there are no serious causes for the absence of pregnancy.
For IUI , the cycle and ovulation are closely monitored to determine the woman's fertile days. In the case of an irregular cycle or repeated absence of ovulation, additional hormone treatment may be administered before insemination to increase the likelihood of successful fertilization. The insemination itself can then be performed with fresh or cryopreserved semen from the partner or donor semen. To optimize quality, the sperm cells are first purified and selected in the laboratory based on their quality. Subsequently, they are introduced into the vagina near the cervix or directly into the cervical canal through the cervix, using a syringe and a catheter, as close to or immediately after ovulation.
In-vitro fertilisation ( IVF )
When people casually talk about artificial insemination, they usually mean in-vitro fertilization—the oldest method of assisted reproduction. In this process, egg and sperm cells are combined in the laboratory and then transferred into the uterus. Since fertilization occurs outside the body, IVF, for example, is suitable if the woman has a fallopian tube blockage or endometriosis, has antibodies against her partner's sperm (usually in combination with a special immunotherapy), or if his semen quality is poor. The treatment involves various phases that take place over several weeks.
1. Hormonelle Stimulation und Follikelpunktion:
Hormones are initially used to stimulate the ovaries for egg maturation. After about 14 days, ovulation is then deliberately triggered, and ideally five to ten mature eggs are collected under anesthesia from the ovary using a fine needle through the vagina ( Follicle aspiration ).
2. Künstliche Befruchtung im Labor
In a special nutrient medium, the eggs are then combined with the partner's sperm or a donor's sperm, which has been previously cleaned and centrifuged in the laboratory to minimize the risk of possible rejection reactions with the female egg. The egg and sperm cells are then placed in the warm incubator. After just one day, it can be examined under a microscope whether fertilization was successful and, if necessary, fertilized eggs can be selected for transfer.
3. Eizellentransfer
If fertilization was successful, a maximum of two fertilized eggs can be transferred into the uterine cavity using a catheter two to five days after retrieval. Ideally, one or both will implant, often supported by the administration of various hormones or, depending on the fertility issue, medication. Whether implantation was successful and resulted in pregnancy can be determined after about two weeks.
Intracytoplasmic Sperm Injection ( ICSI )
ICSI goes a step further to support fertilization. In this form of assisted reproductive technology, a single sperm is injected directly into a previously retrieved egg under a microscope using a fine pipette. Since this method theoretically requires only one fertilizable egg and one sperm cell each, it is suitable for couples where the man's fertility is limited, if both partners have fertility issues, or if the cause of the absence of pregnancy is unclear. ICSI involves several steps and begins, like in-vitro fertilization, with the maturation and retrieval of eggs:
1. Hormonelle Stimulation und Follikelpunktion:
With the help of hormones, the maturation of eggs in the ovaries is stimulated. After about 14 days, ovulation is triggered, and as many mature eggs as possible are collected through follicle aspiration.
2. Samenprobe und künstliche Befruchtung
When the eggs are retrieved, fresh or processed, cryopreserved sperm (from the partner or from a sperm donor) must be available. From this sample, the doctor selects a suitable, as mature as possible, microscopically normal sperm for fertilization. Using a fine pipette, the sperm cell is injected directly into the interior of the egg under the microscope. The fertilized egg is then placed in the incubator. It is also possible to fertilize multiple eggs at once in this way—however, only a maximum of two embryos will be transferred in the next step. The remaining eggs can be cryopreserved (that is, preserved with liquid nitrogen) and stored.
3. Eizellentransfer
After two to three days, it becomes clear whether the procedure was successful. If the fertilized egg continues to develop, it is inserted into the uterine cavity using a catheter through the vagina, where it can ideally implant. Overall, the entire process of ICSI takes up to 20 days.
Testicular Sperm Extraction/Microsurgical Epididymal Sperm Aspiration ( TEST/TABLE )
These two surgical procedures for sperm retrieval are used when the male spermogram is significantly impaired, for example, when the semen contains too few sperm. In about half of all seemingly infertile men, active sperm can still be found with these medical treatments. In the MESA , one or both testicles, where the sperm mature, are punctured under general anesthesia with a fine needle. The extracted fluid is then examined under a microscope for active, mature sperm. In the TESE , tissue is taken from a small incision under local or general anesthesia and immediately examined in the laboratory. If the collected fluid or tissue contains motile sperm, the sample is frozen and stored using cryopreservation. The
collected sperm can be thawed and prepared again for ICSI
to be used.
What should be considered during fertility treatment?
Medicine today offers numerous options for fulfilling an unfulfilled desire to have children. As with all medical treatments, artificial insemination procedures can also involve side effects and complications—both physical and psychological. Gynecologist Christian emphasizes that it is not possible to give a definitive answer to how likely pregnancy is with a specific procedure. Many individual factors play a role, and it is not uncommon for multiple attempts to be necessary before a successful pregnancy occurs. Unfortunately, a one hundred percent success rate is not achievable, even with repeated tries. The wait for the desired pregnancy can become a test of patience, and the treatment(s) themselves, which usually involve numerous examinations and medications, are perceived by some patients as a significant burden. That is why not only thorough counseling at the beginning of treatment, but also support throughout the process, is so important. More information about treatments, counseling, and financial support can be found, for example, on the or at the .
Despite all its possibilities, reproductive medicine is also subject to strict
rules. In Germany, it is regulated by the Embryo Protection Act, the German Medical Association, and the Federal Joint Committee of Physicians and
health insurance companies also establish additional guidelines. In Austria and Switzerland, the respective reproductive medicine laws regulate the framework of reproductive medicine.
For many people, artificial insemination offers the chance to make their desire for pregnancy come true after all. If you are interested in medical treatment or want to learn about the different options, a thorough and professional consultation is the first step. Your gynecologist is usually your most important contact person. But not only medical support is crucial in fertility treatment: if you feel that the topic is affecting you psychologically, share your feelings with your partner so you can support each other. Additionally, you can access numerous counseling services, participate in therapy, or join a self-help group if you wish.
Whatever it looks like: We hope you find the right path for you and wish you all the best!
