Around 10 to 15 percent of couples in Switzerland have difficulties conceiving. Experts speak of difficulties to conceive a child when, despite regular unprotected sexual intercourse over the course of a year, a couple still does not become pregnant.
In such cases, women usually think it’s their problem. However, this isn’t necessarily the case, as difficulties conceiving a child often involves factors relating to the woman and to the man in equal measure – or a combination of the two. In this article, you can learn more about the reasons, possible symptoms and how infertility can be diagnosed and treated.
- Reasons for difficulties conceiving
- Female infertility
- Male infertility
- Artificial insemination
- Fertility centers at a glance
- Contact
- FAQ
Reasons for difficulties conceiving
There are many reasons why many people find themselves unable to have children. However, in most cases, it’s not a case of complete infertility, but rather a fertility problem on the part of the woman or the man, which can be treated. The causes of an inability to have children are varied.
Causes that can affect both sexes are:
- Problems with the pituitary gland
- Diabetes mellitus
- Thyroid disorders
- Old age
- Infections, especially sexually transmitted infections
- Environmental factors such as pollutants and chemicals
- Taking certain medications
- Consumption of anabolic steroids
- Chemotherapy
- Persistent stress, psychological strain at work and in everyday life
- A unhealthy diet
- Being overweight or underweight
- Smoking
- Excessive alcohol consumption
- Drug use
In addition to causes that can affect both genders, there are also gender-specific factors that can affect fertility.
In recent years, the number of people who are unable to have children despite wanting to has risen. More and more women are having difficulties conceiving a child. On the one hand, this can be explained by changes in lifestyle: for many couples, the desire to have children has shifted to a later stage in life, while the chances of conceiving naturally decrease significantly after the age of 35. On the other hand, a diminished ovarian reserve, impaired fallopian tube patency or structural changes to the uterus can reduce the likelihood of pregnancy.
Tumours of the ovaries, fallopian tubes or the uterus, hormonal imbalances, cysts, malformations and injuries to the ovaries and fallopian tubes may also be potential causes of infertility. Other reasons for not becoming pregnant may include illnesses such as endometriosis, infections (e.g. chlamydia), adhesions in the uterus, polycystic ovary syndrome (PCOS) or fibroids. Despite the many possible causes, a range of treatment methods can have a positive effect on the likelihood of having a child.
Causes of female infertility
Fibroids
- Fibroids are benign tumours in the uterus.
- Approximately 30–50% of all women of reproductive age are affected.
- It is common for more than one fibroid to develop.
- In extreme cases, fibroids can be as big as a football.
- Fibroids can be detected very easily by means of a gynaecological ultrasound examination.
- In most cases, the only way to treat fibroids permanently is through surgical removal.
Polycystic ovary syndrome (PCOS)
- PCOS (polycystic ovary syndrome) is a hormonal disorder.
- It is the most common hormonal disorder in women of reproductive age,
- with around one in seven women affected.
- This hormonal disorder leads to increased levels of male hormones.
- Numerous small blisters form as a result.
- The predisposition for PCOS cannot itself be cured, but the symptoms and consequences can be managed very effectively.
Endometriosis
- In endometriosis, the womb lining grows outside the uterus in the abdomen.
- The mucous membrane cells attach themselves to the peritoneum and grow.
- Following a detailed medical history, an ultrasound or a laparoscopy is usually carried out.
- Endometriosis can be treated through surgery or medication, thereby increasing the chances of pregnancy
Signs of infertility in women
Although infertility does not cause any symptoms, there are a number of signs that may indicate infertility (also know as sterility). In women, these signs are often non-specific: apart from the absence of pregnancy, it’s difficult to detect symptoms that clearly indicate infertility. Whether the symptoms occurring are in fact signs of infertility can only be determined following a thorough examination by a gynaecologist.
Possible signs include:
- Chronic lower abdominal pain
- Pain during sex
- Pain during bowel movements
- Menstrual disorders such as severe period pain (dysmenorrhoea)
- Irregular periods
- Heavy periods (hypermenorrhoea)
- Light periods (hypomenorrhoea)
- Intermenstrual bleeding (metrorrhagia)
- Malformations of the sexual organs (e.g. due to endometriosis, fibroids)
- Miscarriages
- Excessive hair growth (may indicate an excess of male hormones)
- Skin problems such as acne as a sign of hormonal disorders
- Fluid discharge from breast (galactorrhoea)
Male infertility
In two out of three cases, the man is partly responsible for couple’s difficulties to conceive due to reduced fertility. Many causes can be identified and treated through simple and minimally invasive investigations.
The number of men who are actually infertile is around one percent. In these men, the ejaculate does not contain any sperm. In all other cases, fertility is described as being reduced to varying degrees, from mild to severe. Often, however, a man’s reduced fertility can be compensated by a woman’s increased fertility and vice versa.
Reasons for male infertility
Varicoceles: the most common cause
- Varicoceles is the most common cause of reduced fertility in men.
- Varicose veins (varicoceles) form along the spermatic cord, which can lead to increased temperature and pressure in the testicles.
- Increased temperature and pressure have a negative effect on sperm quality.
- Affected veins in the spermatic cord can be surgically removed or sclerosed.
Blocked seminal ducts or epididymal ducts
- Even if there are enough viable sperm, there is still a possibility that they may not reach the ejaculate.
- There are many reasons for this: sexually transmitted infections are a possible cause, as well as cystic fibrosis, injuries, inflammation, surgery (e.g. due to a hernia) or other congenital malformations.
Immunological reactions
- Injury or inflammation may result in the formation of antibodies (anti-sperm antibodies) against the body’s own sperm.
Genetic illnesses
- Klinefelter syndrome: genetic illnesses such as Klinefelter syndrome can lead to an inability to conceive. Men with Klinefelter syndrome have an additional female X chromosome.
- Defects in the Y chromosome: such defects are the second most common genetic cause of male infertility after Klinefelter syndrome.
- Cystic fibrosis: this autosomal recessive hereditary disease can also be a cause of infertility.
- Primary ciliary dyskinesia (Kartagener syndrome): this congenital form of primary ciliary dyskinesia mainly affects the respiratory tract, but can also be associated with reduced fertility and even infertility.
Signs of male infertility
The same applies to men: infertility itself does not cause any symptoms, but there are signs that may indicate possible infertility.
The following may indicate male infertility:
- Testicular pain
- Pain when passing water
- Discharge from the penis
- Erection problems, ejaculation problems
- Changes in the shape of the penis
- Unexplained swelling of the testicles, changes in size and consistency of the testicles
Artificial insemination treatments
For many people, the desire to have a biological child of their own is closely linked to their vision for the future. If pregnancy does not occur despite trying to conceive, this can be extremely stressful. If natural conception is difficult or not possible, artificial insemination offers a medical option to help achieve pregnancy.
Artificial insemination is a process in which egg and sperm cells are brought together with medical assistance. This type of treatment is tailored to your individual needs and ranges from hormonal treatments to fertility preservation measures such as social egg freezing and sperm preservation, to in vitro fertilisation and ICSI.
Treatment options
In vitro fertilisation (IVF)
In vitro fertilisation is the most common method of infertility treatment. Insemination takes place outside the woman’s body: eggs and sperm are brought together in the laboratory, whereby the sperm enter the egg independently. After insemination, the fertilised eggs are then placed into the woman’s uterus.
This procedure is mainly used in cases of blocked fallopian tubes, endometriosis or inability to conceive for unknown reasons. It requires viable eggs and sperm with sufficient motility.
The chances of success depend in particular on the age of the woman and the cause of infertility. The risks include side effects of hormone therapy, the risk of multiple pregnancies and, in rare cases, overstimulation of the ovaries.
Intracytoplasmic sperm injection (ICSI)
Under a specialised microscope, a single sperm is injected directly into the egg. This method is mainly used when the quality or number of sperm is severely limited or when conventional IVF has not been successful. It requires viable eggs and sperm.
The chances of success depend primarily on the age of the woman and the egg quality and are comparable to those of IVF. The risks here also include in particular the side effects of hormone treatment and egg removal. Additional risks from the injection itself are low.
Social egg freezing (cryopreservation)
Eggs can be frozen and stored for up to five years. This method makes it possible to preserve fertility for a later date, whether for personal or for medical reasons. This requires hormonal stimulation and the retrieval of a sufficiently number of mature eggs.
The chances of success in this case also depend in particular on the age of the woman at the time of freezing and on the number of frozen eggs. The risks include the side effects of hormone treatment and egg removal.
Hormone therapy
In hormone treatment for women, medication (tablets or injections) is used that mature the egg cells and trigger ovulation. It is particularly used to treat hormonally-induced menstrual cycle disorders or a failure to ovulate. This requires a thorough gynaecological assessment and regular medical check-ups.
The chances of success are good if the cause of infertility is hormonal. The risks include side effects such as mood swings or headaches and, in rare cases, overstimulation of the ovaries or multiple pregnancies.
Intrauterine insemination (IUI)
The semen is processed at the doctor’s practice to filter out the motile, normally formed sperm. These are then introduced into the uterus through a thin tube at the time of ovulation. Insemination then takes place naturally in the woman’s body.
The method is used in particular in cases of slightly reduced sperm quality, when a couple is unable to conceive for unknown reasons or when donor sperm is used. This requires at least one unblocked fallopian tube and sufficiently motile sperm.
The chances of success particularly depend on the age of the woman, the sperm quality and the cause of infertility. The risks include, in particular, side effects of concomitant hormone treatment and an increased risk of multiple pregnancies.
Microsurgical epididymal sperm aspiration (MESA)/testicular sperm extraction (TESE)
In MESA, sperm is retrieved from the epididymis, while in TESE, a tissue sample is taken from the testicle, from which sperm is then isolated. Both methods are usually combined with ICSI.
The methods are used in particular in cases of obstruction of the semen ducts or where sperm production in the ejaculate is severely reduced or absent. This requires the presence of viable sperm in the epididymis or testicular tissue.
The chances of success depend primarily on the cause of male infertility, the available sperm quality as well as the age and egg quality of the woman. The risks include, in particular, bruising or infections as well as possible injury to the testicular tissue in the case of TESE.
Requirements for artificial insemination
In order to be able to carry out IVF or ICSI treatment, the following conditions must be met:
- Basic data is available (woman’s hormonal examination, ultrasound, semen analysis)
- Maximum age of the woman 43–44 years, maximum age of the man 63–65 years
- Negative HIV, hepatitis B/C and syphilis status of both partners
- Proven immunity to rubella and chickenpox
- Stable partnership (the couple does not have to be married)
Selecting embryos according to sex or external characteristics is prohibited by law in Switzerland.
Risks
Artificial insemination does not automatically lead to pregnancy, and not being able to conceive can be a source of emotional distress for affected couples. Your doctor will therefore always seek to talk to you and your partner before any potential treatment, to discuss any fears, concerns and expectations, and to explain the next steps.
To retrieve the egg, a minor outpatient intervention must be performed under short-acting anaesthesia. The rare risks associated with egg retrieval and short-acting anaesthesia must be taken into account.
You can find detailed information on the most common methods of artificial insemination and their chances of success under In vitro and ICSI.
Initial consultation and examination for those having difficulty conceiving
What happens during the initial consultation?
An initial consultation provides patients with information about their current situation and treatment options. During the initial consultation, patients are asked about their state of health. The aim is to identify potential risk factors. Mandatory preliminary checks ultimately determine the chances of success for artificial insemination.
Based on the initial consultation, realistic chances of success are assessed and the first steps of the treatment defined. Based on the results of the examinations and consultations, we will draw up a treatment plan that is specifically tailored to your needs.
Male examination
The initial consultation is followed by a physical examination and an ultrasound of the testicles and epididymis. The assessment is concluded with a blood test to check hormone levels and a semen analysis (spermogram).
The spermogram is considered an important screening test to assessing male fertility. The focus of the examination is on the quality of the sperm. A spermogram is carried out in a laboratory to determine the quality, count and mobility (motility) of the sperm in the male ejaculate. Amongst other things, the pH level, sperm count, sperm motility, vitality and morphology are checked.
Female examination
The attending doctor uses a hormone test and an ultrasound examination to determine whether ovulation is occurring regularly.
Potentially damaged or abnormal fallopian tubes are examined using imaging techniques (hysterosalpingography or contrast-enhanced ultrasound) to determine whether they are open.
If the causes of fertility are more serious, the female reproductive organs can be examined using laparoscopy and hysteroscopy. These are minimally invasive interventions.
At our fertility clinics, gynaecologists specialised in reproductive medicine are dedicated to helping you fulfil your wish of having a child. They provide empathetic and personalised support on your journey to having a child, have specialist expertise, and perform surgery for conditions affecting the sexual organs, menstrual disorders, ulcers and malformations. They also specialise in hormonal disorders. Please feel free to get in touch with our fertility clinics or specialists.
How long is it normal to have difficulty conceiving?
Struggling to conceive is not in itself a cause for concern. Experts define this as a situation where pregnancy has not occurred after 12 months of regular, unprotected sexual intercourse. For women aged 35 and over, or those with known pre-existing medical conditions, it is advisable to seek advice at a fertility clinic at an earlier stage in order to improve the chances of becoming pregnant.
What percentage of women have difficulty conceiving?
Around 10 to 15 percent of couples in Switzerland have difficulties conceiving. The cause is roughly equally likely to be either or both partners. As both female and male infertility can play a role, both partners should always be examined.
What can you do if you’re having difficulties conceiving?
In the event of difficulties conceiving, there are various options for clarification and treatment. After a comprehensive consultation, the causes are investigated and a personalised fertility treatment plan is recommended. Depending on the findings, hormone treatment, hormonal stimulation, intrauterine insemination (IUI) or IVF/CSI may be considered to help you achieve your wish of having a child.
What is the most common cause of difficulties conceiving a child?
The causes of difficulties conceiving are varied and often cannot be attributed to a single factor. In women, factors such as advancing age, hormonal disorders, endometriosis or PCO syndrome can affect fertility. In men, poor sperm quality and varicose veins around the testicles (varicoceles) are amongst the most common causes. It is not uncommon for both partners to be affected by several factors at the same time.
What are the first steps in if you’re struggling to conceive?
The first step is a detailed consultation with a specialist, for example, at a fertility clinic. This is followed by targeted examinations for both partners, such as hormone tests, ultrasound scans and a semen analysis (spermogram). On this basis, an personal treatment plan or fertility treatment will be recommended that is tailored to your individual situation.
What costs does health insurance cover for fertility treatment?
In Switzerland, the coverage of costs for fertility treatment depends on the treatment itself and your individual circumstances. Some medical investigations are covered by your health insurance. However, treatments such as IUI, IVF/ICSI or other artificial insemination procedures are often only partially covered or not covered at all. You should therefore seek advice at an early stage and obtain the relevant information directly from your health insurance provider.
What role does the menstrual cycle play when trying to conceive?
A regular cycle is an important indicator of ovulation and thus also of fertility. An irregular cycle or the absence of a cycle may indicate hormonal imbalances and reduce the chances of getting pregnant. As part of fertility treatment, the cycle is therefore carefully monitored and, where necessary, specifically supported.