Unfulfilled wish to have children

Approximately 15% of couples have an unfulfilled wish to have children. The cause lies just as often with the man as with the woman.

In most couples, the woman becomes pregnant after one year of regular (i.e. twice a week) unprotected sexual intercourse. If no pregnancy occurs, it is generally advisable for both partners to see a doctor after one year. With medical help, a pregnancy can be achieved in most cases, as absolute infertility is only present in very few cases. In this context, reference is also made to reduced fertility (subfertility).

Both the man and the woman should be examined by a specialist. The man sees a urologist and the woman sees a gynaecologist. If abnormalities are found, further diagnostics and treatment are carried out by the respective specialists and, if necessary, by a fertility centre. Occasionally, examinations by a human geneticist are also necessary to rule out hereditary causes.

The wish to have children is a topic that affects many areas of medicine. A fertility centre has an advisory and coordinating role. If a pregnancy cannot be achieved naturally and "artificial insemination" of the egg cell is necessary, this is carried out by a fertility centre. For this purpose, we work closely with the Kinderwunschzentrum H.- J. Graeber & Kollegen.

The causes of subfertility or infertility are very varied and can be hormonal, infectious or genetic, among other things. Anatomical causes such as an inguinal testicle or a varicocele of the testicle can also be considered.

In addition to a detailed consultation, a physical examination and a basic laboratory test, the examination of the ejaculate (semen analysis) is the most important examination in fertility diagnostics. With a normal semen analysis, the ability to father children is usually also present. If abnormalities are found, further examinations follow.

Treatment always depends on the cause of the infertility. Hormones or antibiotics are used as medication. Occasionally, surgical therapies are also necessary.

If a varicocele of the testicle is the cause of the reduced fertility, it can be removed surgically. If no sperm cells at all can be detected in the ejaculate, they can be obtained directly by extraction from the testicle (testicular sperm extraction – TESE). These can then be used for artificial insemination of the egg cell (ICSI) in a fertility centre.

Men can have a favourable influence on their fertility simply through their lifestyle. For example, it is known that smoking reduces natural fertility by around 20%. However, other factors such as alcohol consumption or obesity can also play a role. Incidentally, these points also apply to women to a similar extent. Age probably has the greatest influence on female fertility. A woman's probability of becoming pregnant decreases significantly long before the menopause. In men, age is not decisive to the same extent, but it is also a factor that should not be neglected.