Difficulty conceiving

Difficulty conceiving occurs when there is no pregnancy despite unprotected sexual intercourse for more than one year. About every tenth couple in Germany is involuntarily childless. The cause for the difficulty can be due to fertility issues occurring in the man or the woman. A comprehensive urological examination is part of the assessment of the male partner. Male infertility can have hormonal, infectious, genetic, or anatomical causes. The sperm quality can be assessed with the help of a spermiogram, or sperm examination.

Questions about the diagnosis and treatment if the couple has difficulty conceiving

About 15% of couples have difficulty conceiving due to fertility issues. Such issues are as likely to occur in men as they are in women.

In most couples, the woman becomes pregnant within one year of regular (meaning twice a week) unprotected sexual intercourse. If pregnancy does not occur within one year, a medical examination of both partners is recommended. Pregnancy can be achieved in most cases with medical help, as absolute infertility only occurs in very few cases. Most of the time, the issue is limited fertility (subfertility).

Both partners should be examined by a specialist. The male partner should be examined by a urologist, and the female partner by a gynaecologist. If there are any abnormalities detected, further diagnostics and treated are carried out by the respective specialists and, if necessary, by a fertility centre. Examinations by a geneticist are sometimes necessary to exclude hereditary causes.

Difficulty conceiving relates to many different areas of medicine. A fertility centre acts as a coordinator and counsels the couple. If pregnancy cannot be achieved naturally and artificial insemination becomes necessary, a fertility centre carries out this procedure. For this purpose, we work closely with the Kinderwunschzentrum H.- J. Graeber & Kollegen.

The treatment always depends on the cause of infertility. Hormones or antibiotics in the form of medication are available. Surgical treatment can sometimes be necessary depending on the situation and cause.

If a varicocele in the testicle is causing the limited fertility, it can be surgically removed. If the ejaculate does not contain sperm cells, these can be obtained directly by extracting them from the testicle (testicular sperm extraction – TESE). These can then be used to artificially inseminate the egg (intracytoplasmic sperm injection, or ICSI) in a fertility centre.

Men can favourably influence their fertility through their lifestyle. Smoking reduces natural fertility by about 20%. Other factors such as alcohol consumption or obesity can also play a role. These factors also apply to female fertility to a similar extent. However, the greatest influence on female fertility is age. A woman’s probability of becoming pregnant decreases significantly long before menopause. Age is not as decisive in men, but it is a factor that should be considered.

About this page:


Prof. Dr. med. Sven Lahme
Urology specialist

Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.

Member in Scientific Societies and Reviewer of scientific journals.

Creation Date: 08.03.2020Modification date: 08.03.2020