Am I infertile? And when do you speak of it?

The desire to have our own child is part of our humanity, and if it doesn’t „work out“, we need one thing above all: helpful information and education. And secondly: good solutions.

We speak of infertility when pregnancy does not occur even after a year of regular efforts by a couple. This view is also shared by the WHO (World Health Organisation), which thus takes into account the changed living conditions in western industrial nations, e.g. the greater mobility of partners. The causes of infertility are manifold in both men and women; 20%-30% are in the woman, 50% in the man and a further 20% in both the man and the woman. In 10%-15% of all couples, the cause of infertility remains unexplained. Infertility treatment is therefore always a couple therapy.

A woman’s highest natural fertility is between the ages of 22 and 27 and gradually decreases thereafter. Natural fertility ends with the onset of the menopause. The natural fertility of men decreases slowly from the age of 40; however, in individual cases it can remain until old age.

Above-average success rates at the Fertility Center Berlin

The success of fertility treatment depends primarily on the experience of the treating doctors and the laboratory. The Fertility Center Berlin team has been working together in the same constellation since 1999. The doctors have known each other since 1991 and have already carried out infertility treatment at the University Women’s Clinic of the FU Berlin (Pulsstraße location) and at the DRK Kliniken Westend.

Risks associated with fertility treatment

No successful treatment is without risks – this is also the case with fertility treatment. The risks are mainly due to the hormone stimulation and its consequences. Hormone stimulation is usually necessary for successful fertility treatment. This leads to follicle growth and can, in rare cases, lead to overstimulation. Overstimulation is accompanied by enlarged ovaries, fluid formation in the abdomen and more or less pronounced lower abdominal discomfort. In rare cases, it can also lead to shortness of breath or thrombosis. Overstimulation is very rare in the field of conventional sterility therapy (pure hormone stimulation or sperm transfer). It occurs most frequently with stimulation for in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). If you experience overstimulation, a gynaecologist should always be consulted for an assessment.

Another risk of treatment is the development of a multiple pregnancy. A higher-grade multiple pregnancy (triplets or higher) is very rare and occurs in <1% of all cases after conventional fertility treatment. After in vitro fertilisation (IVF), this has also become rarer in recent years, as only 1-2 embryos are usually transferred in women under 40. In women over 40, the individual probability that all of the maximum 3 embryos used will implant is even less likely, so that 3 embryos can be transferred more often here. A carried-out triplet pregnancy in a woman over 40 has not occurred in the Fertility Center Berlin in the last 7 years. Other risks such as the formation of abscesses or the development of bleeding after procedures such as vaginal follicle puncture are very rare and occur with a frequency of about 1:500.

In children born after the ICSI method, the probability of malformation is 9%. The German ICSI follow-up study compared 2800 children born after ICSI with 2800 children conceived spontaneously. In the ICSI group, the probability of a malformation was 9%, in the spontaneously conceived group the probability was 7.2%. Thus, a slightly increased risk of malformation after ICSI can be assumed. However, we think that this risk is only increased to a very limited extent and does not represent a contraindication against fertility treatment.

An unfulfilled desire to have children: Is it the woman?

Only 30% of the causes of an unfulfilled desire to have children lie with the woman alone. In 50% of cases the man is the sole cause, in another 20% there is a common cause. The Fertility Center Berlin supports you in clarifying the causes in your personal case. We discreetly discuss all questions together, carry out an exact diagnosis and, if necessary, develop a treatment plan for you – in close cooperation with specialists or the doctor you trust.

Possible causes in women:

    • Blockage of the fallopian tubes (tubal sterility)
    • Carriage of uterine mucosa into the free abdominal cavity (endometriosis)
    • Hormone disorders with too much male hormone and lack of ovulation (PCO syndrome)
    • Premature aging of the ovaries
    • non-functioning of the pituitary gland with lack of stimulation of the ovaries
    • and many other causes.

     

    In our experience, a high proportion of the causes lie in premature exhaustion of the ovaries, which in individual cases can occur at an early age. However, in many women from the age of 38, this exhaustion of the ovarian reserve is increasing. This can be measured using the anti-mullerian hormone (AMH), which can tell us directly to what extent the ovaries are still functional and how good the chances of fertility treatment are.

What is the anti-Müllerian hormone (AMH)?

Anti-Müllerian hormone is secreted by the ovary or testis. It directly measures the number of small follicles in the ovary and thus directly measures the ovarian reserve. In menopausal women, the anti-Müllerian hormone is below the detection limit. In women with excessive ovarian production (such as in polycystic ovary syndrome / PCO syndrome) the value is elevated. The AMH is the earliest marker with which an early depletion of the ovarian reserve can be detected.

An unfulfilled desire to have children: Is it the man?

More than 50% of the causes of an unfulfilled desire to have children lie with the man – that is undisputed. But in any case it is good to use the possibilities of the Fertility Center Berlin: We talk about the possible causes with you, carry out an exact diagnosis and then research the causes – and develop your treatment plan in cooperation with specialists.

Possible causes in men:

    The most common cause of infertility in men is reduced sperm quality. There can be many reasons for this, including the following:

    • Hormone imbalances
    • Varicose veins in the testicles
    • Positional anomaly of the testicle
    • Mumps disease in childhood
    • Diabetes
    • Operated tumours
    • Genetic causes
    • Stress
    • Infections
    • Drug and alcohol abuse

Limited sperm quality

There are different forms of impaired sperm quality: oligozoospermia, asthenozoospermia, teratozoospermia, cryptozoospermia and azoospermia. These can occur individually or in combination with each other.

    • Oligozoospermia: The number of sperm in the ejaculate is too low (norm: > 20 mill. sperm/ml).
    • Asthenozoospermia: The motility of the sperm is reduced (norm: > 32% motile sperm).
    • Teratozoospermia: There are too few normally shaped sperm in the ejaculate (norm: >4% normally shaped sperm).
    • Cryptozoospermia: Only isolated sperm are present in the ejaculate.
    • Azoospermia: The ejaculate contains no sperm at all.

If the examination of the ejaculate does not reveal any abnormalities and all values are within the normal range, we speak of normozoospermia.
After a precise diagnosis in our centre (spermiogram and blood sample), the cause is investigated and treatment is planned in close cooperation with appropriate specialists (human geneticists and urologists), if this appears necessary.