When a woman can’t get pregnant, she usually thinks it’s her problem. But this isn’t necessarily the case, as an unfulfilled desire to have children often involves factors relating to the woman and to the man in equal measure – or a combination of the two. A range of treatment methods often have a positive effect on the likelihood of having a child.
Around 10-15 percent of Swiss couples have difficulties fulfilling their desire to have a child. Experts speak of an unfulfilled wish to have children when a couple has unprotected sexual intercourse over the course of a year and the woman still does not become pregnant.
There are numerous reasons for fertility difficulties, which is why the woman and the man are each examined after a comprehensive consultation. Most cases do not involve complete infertility, but rather a fertility disorder.
In recent years, undesired childlessness has been on the rise. On the one hand, it can be attributed to new lifestyles: many couples put off their plans to have children until later. The likelihood of easily becoming pregnant drops considerably after the age of 35.
In addition to limited ovarian reserves or less permeable fallopian tubes, there are other organic factors in the uterine cavity that can reduce the likelihood of pregnancy.
Endometriosis, or PCOS, as well as myomas can result in infertility.
Myomas
- Myomas are benign tumours in the uterus.
- Approximately 30 to 50% of all women of childbearing age are affected.
- In many cases, there are multiple myomas.
- In extreme cases, they can become the size of a football.
- Myomas are easily found by carrying out a gynaecological exam.
- Permanent treatment for myomas usually requires surgical removal.
PCOS
- Polycystic ovary syndrome, or PCOS, is one of the most common hormonal disorders in women of reproductive age.
- Around one in seven women is affected by the disorder.
- The hormonal disorder leads to an increased concentration of androgens (male hormones) causing the formation of numerous tiny cysts.
- There is basically nothing that can be done about a predisposition for PCOS, but the symptoms and effects are very treatable.
Endometriosis
- Endometriosis occurs when the uterine lining grows outside of the uterus, inside the abdomen.
- The mucosal cells adhere to the peritoneum and grow.
- The typical symptoms are chronic abdominal pain, acute pain during menstruation, during sexual intercourse and during bowel movements.
- After documenting a detailed medical history, an ultrasound or laparoscopy is normally performed.
- Endometriosis can be treated surgically or with medication and, in turn, improve the chances of becoming pregnant.
General methods of examination
- By means of a hormone test and an ultrasound examination, your doctor will ascertain whether or not ovulation is regularly occurring (hormonal and/or functional disorders of the ovaries).
- The extent of possible damages or alterations to the Fallopian tube is examined via screening tests (hysterosalpingo contrast sonography, contrast ultrasound method).
- In the case where fertility disorders have more serious causes, the female reproductive organs can be examined by means of an abdominal endoscopy (laparoscopy) and a uterine endoscopy (hysteroscopy). These procedures are referred to as “microinvasive” surgery.
Methods of treatment
- Hormonal stimulation: The hormone treatment for the woman involves her taking medication (by means of tablets or injections) to develop egg cells and initiate ovulation.
- In vitro fertilisation (IVF): With this form of treatment, fertilisation takes place outside of the womb: egg and sperm cell are brought together in a test tube and returned to the womb using a thin catheter after fertilisation (embryo transfer).
- Freezing of fertilised egg cells (cryoconservation): The remaining egg cells can be frozen and stored for up to 5 years.
Male infertility
In two thirds of cases, the man’s reduced fertility is part of the reason a woman is unable to get pregnant. There are simple, low-stress examinations to help identify and treat many of the causes.
Exactly one percent of the male population is actually infertile. The ejaculate of these men contains no sperm. In all other cases, fertility is slightly to greatly reduced. In many cases, however, lower male fertility can be compensated by good female fertility and vice versa.
Examination procedure
At the beginning of the consultation, the man answers questions about his health status. The goal is to identify potential risk factors. Next, he undergoes a physical examination with a testicular and epididymal ultrasonography. The examination is completed with a blood test to measure hormone levels and a spermiogram (see info box). All of this is completely painless and non-invasive.
Varicoceles: the most common cause
- Varicoceles are the most common reason for reduced fertility in men. The veins along the spermatic cord and epididymis become enlarged, which can lead to a rise in temperature and pressure in the testes. This has a negative effect on sperm quality. Surgical removal or sclerotherapy can be used to treat the affected veins along the spermatic cord.
- Other potential causes of infertility:
- Hormonal disorders
- Growths or tumours
- Congenital disorders
- Past occurrences, such as testicular infections
General methods of examination
The spermiogram is an important screening method for testing male fertility. The main purpose of the examination is to determine sperm quality. A spermiogram is conducted in the laboratory in order to determine the composition and motility of the sperm cells and the sperm count in the ejaculated male semen, by testing the following properties:
- pH value
- Sperm count
- Sperm motility (mobility)
- Sperm vitality
- Sperm morphology
Methods of treatment
- Artificial insemination: The semen is processed in the doctor’s surgery in order to filter out the motile and normally formed sperm. These are introduced directly into the womb at the time of ovulation using a thin catheter.
- In vitro fertilisation (IVF): With this form of treatment, fertilisation takes place outside of the womb: egg and sperm cell are brought together in a test tube and returned to the womb using a thin catheter after fertilisation (embryo transfer).
- Intra-cytoplasmic sperm injection (ICSI): ICSI is a further development of in vitro fertilisation. In cases where the man has severely impaired fertility, a single sperm is inserted directly into the egg cell.
- Microsurgical epididymal sperm aspiration (MESA)/Testicular sperm extraction (TESE): MESA involves retrieving sperm from the epididymis. In the case of TESE, a tissue sample is taken from the testicles. Either method can be combined with ICSI.
Artificial insemination
In most cases, the reason for unwanted childlessness is not a complete infertility of the couple, but a fertility disorder. This can be treated by a variety of medical care strategies.
All treatments at Hirslanden are tailored to your individual needs. They range from hormonal treatments, through conservation measures such as Social Egg Freezing and sperm preservation, to IVF treatment with ICSI and pre-implantation diagnostics.
Causes of unwanted childlessness
The causes of unwanted childlessness are manifold and are often due to a combination of several factors:
- Male caused infertility (reduced sperm quality)
- Female caused infertility
- Anatomically conditioned (due to various typical underlying diseases e.g. blocked fallopian tubes after infections, endometriosis, adenomyosis, myomas, polyps, Asherman syndrome etc.)
- Hormonally conditioned (problems with the pituitary gland, PCOS, diabetes mellitus, levels of male hormones too high, prolactin elevation, thyroid diseases etc.)
- Age-related (decreasing female fertility from the age of 35)
Initial consultation and examination
A first consultation provides information about the initial situation and treatment options. Based on the initial discussion, our doctors will estimate realistic chances of success and define the first steps of treatment.
Compulsory basic checks decide on the chances of success of an artificial insemination. Based on the results of the examination and the interviews, a personalized care strategy will be developed for you.
In-Vitro and ICSI
The most common method of infertility treatment is In-vitro fertilization (IVF treatment). In this method, fertilisation of the egg cell does not take place in the woman's body, but "artificially" in the laboratory.
In case of affected sperm quality of the man, the related ICSI method is used, which differs in introducing the sperm into the egg rather than fertilize the egg in a laboratory.
In addition to the best-known fertility methods, alternative methods can also be recommended. Our specialists will be happy to advise you.
Requirements for artificial insemination
In order to be able to carry out IVF or ICSI treatment, the following requirements must be fulfilled:
- Basic data exists (hormone examination of the woman, ultrasound, spermiogram)
- Age of the woman maximum between 43-44 years, age of the man maximum 63-65 years
- Negative HIV, hepatitis B/C, syphilis status of both partners
- Proven immunity to rubella and chickenpox
- Stable partnership (the couple does not have to be married)
The selection of embryos by sex or external characteristics is prohibited by law in Switzerland.
Risks
Artificial insemination does not automatically lead to pregnancy, and an unfulfilled pregnancy can be a psychological burden for the couples concerned. Before any treatment, your doctor will therefore always discuss your fears, worries and expectations and inform you and your partner about the further procedure.
In order to retrieve the egg, a small ambulant procedure under short anesthesia must be performed. With the procedure, the rare risks associated with this must be taken into account.
Detailed information on the most common methods of artificial insemination can be found directly under IVF treatment and ICSI.
The gynaecologists at our fertility centres specialise in reproductive medicine and are dedicated to helping women conceive a child. They hold specialised qualifications and perform surgery to treat diseased reproductive organs, menstrual disorders, ulcers and deformities. They are also experts in a wide range of hormonal disorders. Get in touch with one of our centres to find out more.
