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Desire to have children

You have wanted a child for many months. The conditions seem perfect, but you still won't get pregnant. The desired child is a long time coming and this can have various causes. There may be organic reasons, hormonal disorders or problems in the psychological area. It is estimated that one in seven marriages involuntarily remains childless, but advanced medical methods often help to fulfill the desire to have children these days. We will clarify with you what is in the way of pregnancy and try to help you.

First of all, couples also need patience, because sexual intercourse during a woman's fertile days does not necessarily lead to pregnancy. Typically, the likelihood of pregnancy in each menstrual cycle is 15–25 percent. Half of the couples who want to have children do it during the first 3 months. Two thirds of women get pregnant within a year. An irregular menstrual cycle takes longer on average to become pregnant. If you have a regular cycle, you and your partner should take a year before consulting a doctor.

The best conditions for conception

Every month the female body prepares itself for conception. But before a pregnancy can occur, many factors have to interact. Only around ovulation, i.e. in the middle of the cycle, can fertilization occur at all. The female egg can be fertilized for a maximum of 24 hours. After ovulation, the sperm must either quickly travel through the uterus into the fallopian tubes or wait there for the egg cell if sexual intercourse has taken place beforehand. Because sperm are viable in the woman's body for up to 72 hours. The highest fertility is 72 hours before ovulation until about 12 hours afterwards. However, a successful fusion of egg and sperm cell does not guarantee pregnancy. Only about one in three germs develop and lodge in the uterus.

In addition to the right time, a healthy diet is particularly important. Unfortunately, many nutrients are insufficiently contained in the daily diet. You should consume at least 0.3-0.8 milligrams of folic acid and 200 milligrams of iodine before you become pregnant. You should also quit smoking and drink no more than three cups of coffee a day, as both of these reduce fertility and increase the risk of miscarriages and stillbirths. You should also avoid raw meat now to avoid infection with toxoplasmosis, which can damage your fetus.

Rubella infection during pregnancy is very dangerous for the fetus. You should therefore have your immune status checked before a planned pregnancy.


The causes of childlessness

Around 15 percent of all couples wait in vain for a child. The reasons for this lie in roughly equal parts (40 percent each) in men and women. In many cases there are disorders in both. And in about 20 percent of those affected, no reason at all can be determined.


The medical options

As is well known, it takes two to have children. Therefore, the search for the causes of the infertility and the subsequent treatments are a partner's affair. Everything becomes a lot easier when you can rely on mutual encouragement and support in your partnership.

We are at your side in all further steps. We advise you and also coordinate the joint treatment with your partner's andrologist (andrology means men's medicine).
In the last few years, a specialty area for unwanted childless couples has developed in medicine: reproductive medicine. Reproductive medicine work in specialist practices and clinical departments. If all of our diagnostic and therapeutic options are unsuccessful, we will refer you to these specialists.


The first investigations

After an intensive preliminary talk in which we determine your personal expectations and requirements, the first examination will take place as precisely as possible in the middle of the cycle. We analyze the mucus in the cervical canal. We use ultrasound to check whether the follicles have developed in a timely manner. In the event of irregularities in your cycle, we will take a blood sample to check the hormone level. It enables further information about the state of the egg maturation.


The hormone therapy

The interplay between the hormones that trigger ovulation and prepare the lining of the uterus for a fertilized egg to implant is extremely complicated. If this system is disturbed, hormone therapy can help. The hormone doses have to be selected correctly and dosed carefully. During treatment, the cycle is closely monitored by ultrasound and hormone controls. If it is found that too many eggs are maturing, the treatment that is supposed to trigger ovulation will not be continued. Unprotected intercourse should not take place during this month, as there is a risk of multiple pregnancies.


The semen analysis

A sperm analysis provides information about the nature of the male sperm cells. The laboratory uses the semen sample to make what is known as a spermiogram: the sperm cells are counted under the microscope and their shape and mobility are assessed. If disorders are found here, a hormone analysis can often help. This examination takes place at a urologist.


Treatment options for men

If the results of the semen analysis are unsatisfactory, your partner should first of all avoid harmful influences such as smoking and excessive stress. But medicine also has several options for improving the "quality" of semen. If the cause of the malfunction z. B. If there is a varicose vein in the testicle area, it can be surgically removed.
If the seed threads do not mature properly, there is also the option of hormone treatment for men. Successful hormone therapy then requires a lot of patience. It takes at least 12 weeks for the hormonal regimen to kick in and the results of the semen analysis to get better.
If the number of sperm cells is reduced or if no motile sperm cells have been observed in the cervical secretion several times, semen transfer (insemination) can be used. To do this, the sperm is introduced with a soft catheter through the vagina into the uterine cavity or even into the fallopian tubes. In this way the semen is brought directly to the place of fertilization. The semen must be prepared in the laboratory before treatment.


In vitro fertilization

For many childless married couples, in vitro fertilization is a good chance of having their own child after all. With this method, egg and sperm cells are brought together outside the body (extracorporeal). ICSI (intracytoplasmic sperm injection) is a laboratory technique used in IVF in which the individual sperm is microinjected directly into the egg cell.

In-vitro fertilization can, however, be associated with physical and psychological stress and should therefore be carefully considered, because treatment is also a test of patience and a test of strength for the couple.

Conception in a test tube can be used if the fallopian tubes are so closed or overgrown that microsurgical operation has little chance of success, but also if there are no clearly diagnosable causes for the unfulfilled desire to have children.

How it is carried out: A hormone treatment is carried out so that several egg cells mature. The egg cells are suctioned off and brought together with the semen in a test tube ("in vitro"). Egg and sperm cells should then fuse together in the incubator. This first stage of fertilization succeeds in about half of the germ cells. When the fertilized egg cells have divided after around 28 to 48 hours, the resulting embryos are returned to the uterus. The chances that egg and sperm cells will implant and that a stable pregnancy will result are around 20 to 35 percent per transmission.


Multiple births and risks

Modern reproductive medicine often achieves more than expected. Sometimes she helps couples not only have the desired child, but also two or three. However, only one out of every hundred women treated has more than two children at a time. In order to keep the risk of multiple births as low as possible, regular check-ups should take place during hormone treatment.

However, we can take away one fear from the outset: fertility treatment has no effect on your child's health. Long-awaited children are as healthy as anyone else.


The psyche

The physical causes of involuntary childlessness are one side. On the other hand is the psyche. It also has a significant role in the fertility of a couple. In any case, body and psyche are closely interrelated and should always be viewed together.

Psychological factors that can prevent conception include: E.g. stressful situations for men and women, existential worries, fear of responsibility or indecision between motherhood and work.

On the one hand, advancing medicine gives childless couples new hopes, but they can also be disappointed again and again. Your self-esteem may become weaker rather than stronger.

In such situations, the fertility counseling service offers help. Here couples can find out in a conversation whether they can still cope psychologically with the stresses of the therapy.

Sometimes not having a child can also be an opportunity to experience life together in a new way. Unwanted childlessness does not have to mean an unfulfilled life for two. Quite the opposite, maybe just not having a child will open up completely new perspectives for your relationship.



Information about other methods such as ICSI, TESE and MESA can be found on the websites of the fertility centers. In North Rhine-Westphalia you can z. B. contact the following special practices: