Involuntarily childless: What could be the reason?? quarks.en / Health / Medicine / Involuntarily childless: What could be the reason??
Infertility
We want a child – nothing seems so simple. But the fact is: many couples remain unintentionally childless.
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Article section: How many couples have no children?
How many couples have no children?
Not having children is a mass phenomenon in our society. Along with Switzerland, Finland and Italy, Germany is one of the top countries in Europe when it comes to childlessness. At the same time, the rate of childlessness over the past 40 years has increased almost doubled: In women born in 1937, the rate was 11 percent. Among women born in 1976, 22 percent are childless at the onset of menopause.
In the age group between 30 and 50, a good 7.02 million Germans do not have a child. There are many reasons for this: too little money, too little time, not the right partner. Or it simply does not want to work.
About one quarter of all childless women and men between 20 and 50 is, according to a survey for the Federal Ministry for Family Affairs unintentionally without offspring – that would be more than one million couples whose desire to have children has not yet been fulfilled.
Article section: What are the reasons for infertility??
What are the reasons for infertility??
Normally, a couple with a desire to have children up to the age of about 35 years achieves pregnancy within one year in 85 percent of cases. The remaining 15 percent have a fertility problem that needs to be clarified.
If pregnancy fails to occur despite regular, unprotected sexual intercourse over a period of twelve months, doctors refer to this as sterility or infertility.
In industrialized countries, large studies of unintentionally childless couples have investigated which partner was responsible for the failure to conceive. In the vast majority of cases, the reasons lay with the woman (37 percent) or both partners (35 percent). In 8 percent of cases, only the man was infertile, while the woman was normally ready to conceive. Depending on the study, in 10 to 20 percent of the cases no clear cause for the failure to conceive was found.
There are many reasons – for men and women
While in men it is mainly changes in the sperm that play a role, in women a wide variety of causes can make pregnancy impossible, including:
Cycle disorders The female cycle is controlled by different hormones. First, follicle-stimulating hormone (FSH) from the pituitary gland is responsible for the maturation of the follicles from which the egg emerges. The follicles in the ovary secrete the hormone estrogen, which is responsible for building up the uterine lining.
The so-called luteinizing hormone (LH) from the pituitary gland triggers ovulation. At the site where the egg cell has jumped, the so-called corpus luteum is formed, which secretes the hormone progesterone. Progesterone prepares the uterine lining for implantation of the fertilized egg.
If it stays off, the corpus luteum regresses. Due to the sudden lack of progesterone, the arteries of the uterus contract, the blood supply to the mucous membrane decreases and a localized oxygen deficiency occurs. Within a few hours, the upper layer of the mucous membrane dies off. Menstrual bleeding begins. The cycle starts all over again.
Pregnancy is only possible through these finely tuned processes. Disorders in the menstrual cycle can have the most diverse causes: For example, the formation of hormones may be disturbed or the stimulation of the ovary by the pituitary gland fails to occur.
However, the disorders can also be triggered by a condition known as endometriosis. Tie similar to the lining of the uterus grows in places other than the uterus, such as the ovaries, intestines or peritoneum.
Disorders of ovulation Hormonal imbalances can also prevent ovulation. However, it is not only the female sex hormones that are responsible for this; other hormones can also cause ovulation to fail to occur. For example, prolactin, which normally stimulates the production of milk. The prolactin level can be increased, for example, by a tumor in the pituitary gland. Hormonal imbalances in the thyroid gland can also be the cause of ovulation failure.
In polycystic ovary syndrome (PCO syndrome), ovulation occurs only irregularly. If the egg does not pop, a cyst develops in the ovary – a fluid-filled blister after which the syndrome is named. PCO syndrome usually goes hand in hand with obesity. Is accompanied by excessive production of male sex hormones. It affects about 5 to 10 percent of women. Is a common cause of infertility.
Obstruction of the fallopian tubes Fertilization of the egg takes place in the fallopian tube. If the fallopian tubes are blocked, sperm cannot reach the egg and consequently cannot fertilize it. These adhesions usually occur after inflammations and infections. The main causes are chlamydia or gonococci.
Infectious diseases Various infectious diseases can reduce the likelihood of getting pregnant – especially, of course, sexually transmitted diseases.
The classic among these diseases is an infection with gonococci. In common parlance, the resulting condition is also called "Gonorrhea " called. Gonococci are bacteria and highly contagious. Mostly they cause only little dramatic symptoms at first: some increased discharge, slight itching or an inflammation of the bladder. However, they can also affect the uterus or fallopian tubes. The result: bleeding irregularities and infertility.
The most common sexually transmitted infection is the Chlamydia infection . Chlamydia are bacteria that can infect the cervix, the inner mucous membranes of the uterus and also the fallopian tubes. The resulting inflammation can cause the fallopian tubes to stick together. The problem: In over 80 percent of women, the infection with chlamydia goes completely unnoticed. A major factor in cycle disorders. Thus also infertility) is the body weight. Both severe obesity and severe underweight can affect fertility.
If you eat too few calories over a long period of time, the body shuts down the organism to an "emergency program". This is to reduce the burning of nutrients for functions that are not essential for survival – and that includes reproduction. Disruption of the menstrual cycle can occur after just a few weeks without solid food.
Obesity also upsets the cycle. Because fat cells can release the female sex hormone estrogen. This excess of estrogen can also limit fertility.
Article section: How crucial is age?
How crucial is age?
Very crucial. If you ask childless women under 30, only about 10 percent say that they do not want to have children in the future either. The far larger part sees itself sooner or later as a mother.
This is exactly where the problem may lie: Many underestimate the time window in which pregnancy is possible without problems. Because the chance of pregnancy decreases with age – rapidly.
While a healthy young woman in her 20s only has to wait an average of two and a half months to conceive successfully, the time for women in their 40s is extended to about two years. Or, to put it another way, at 35 a woman is only half as ready to conceive as she was at 25, and at 40 her body is only half as ready to conceive as it was at 35.
Women today are in the middle of life when their fertile years end. The majority occur between the age of 45. and 50. Most women in industrialized countries have their last menstrual period between the ages of 50 and 50. and 52. Birthday. After that, conception is no longer possible by natural means.
The menopause in women is something unique: Hardly any animal loses its fertility so early. Great apes, for example, become increasingly infertile after the age of 40, but they do not lose the ability to reproduce completely, as do their human relatives.
Menopause in women is by no means pointless
The older the mother, the greater the risk of certain malformations in the child or genetic anomalies, such as trisomy 21. In women, all the eggs are already laid before birth, and as they get older, errors can occur in the maturation of the eggs.
As age increases, so does the mother's risk of dying in childbirth. If she dies, her youngest children used to have little chance of survival.
By the way: Fertility also decreases in men with age. A 45-year-old not only produces fewer sperm than an 18-year-old – sperm motility also decreases with age. And it is precisely this that is important for fertilization.
Article Section: Is infertility on the rise?
Increases in infertility?
Whether the sperm quality of men as a whole is declining has been the subject of debate for years. The fact is: too few or not enough motile sperm can make fertilization impossible.
However, whether men's sperm counts actually decline to levels that threaten fertilization has not yet been conclusively determined. Especially since different studies come to different conclusions. The problem: sperm density is highly dependent on the man's sexual quiescence period before sperm retrieval -. This waiting period is not even documented in many studies. Possible causes for a decrease in sperm quality have also not yet been clearly proven: It is often said that the sperm quality of men whose mothers smoked during pregnancy is poorer. However, studies found no change in sperm quality over 20 years, although the number of smoking mothers had decreased significantly.
Significantly fewer children – but no more medical reasons
According to researchers, there is also no significant increase in the medical causes of infertility in women. Nevertheless, far fewer children are born today than in the baby boomer years – although the number has now stabilized.
The researchers believe that the fact that birth rates are so low despite the fact that male fertility is likely to remain the same is more likely to be due to the fact that women are getting pregnant later and later in life.
And at a certain age, this is no longer so easy. Women actually have their first child later and later in life. On average, mothers were 30.1 years old at first birth in 2019. Ten years ago, the average age at the birth of the first child was 28.8 years. The age of men is not recorded.
At some point, having children is no longer so easy
Many women initially delay pregnancy. First the career – then the child. Thus, childlessness that is still wanted at a young age can later become involuntary childlessness due to old age. Because not even normal fertility guarantees pregnancy.
If normally fertile couples make love on the day of ovulation, the likelihood of pregnancy is also only about 35 percent. That is why it is anything but self-evident that if you only want it to work out. Producing children is not so easy after all.
Article Section: What to do if it doesn't work out?
What to do if it doesn't work out?
The female cycle is dependent on the general health of the body. In addition to body weight, stress, anxiety and lack of sleep can also affect hormone balance. Therefore, the "classic" advice such as a balanced diet, physical activity and adequate sleep increase the chance of pregnancy.
Also stress-reducing measures such as yoga or massage Have had an effect on fertility in studies – although it is not yet clear exactly how they promote conception.
In studies, however, measures such as Acupuncture, Ayurveda, traditional Chinese or herbal medicine the results have been very mixed. Often the studies do not meet the scientific standards and it could not be conclusively proven or disproven whether a possible effect is actually due to the measure.
Artificial insemination is well documented The situation is clearer with the classic conventional medical measures. The interventions of the so-called assisted reproductive medicine have been well investigated in studies – i.e. methods of artificial insemination.
A distinction is made between methods in which fertilization can inside the body and those in which the egg and sperm are combined with in a test tube brought together – the so-called In-Vitro-Fertilization (IVF).
Methods without fertilization in the test tube One can use drugs Stimulate the ovaries to ovulate. This can sometimes be enough, but it is also done in the run-up to IVF. hormone preparations are given that promote the maturation of the follicle and at the same time inhibit the normal menstrual cycle. Ultrasound is used to monitor the maturation of the follicles and to determine the best time for fertilization, sexual intercourse or egg retrieval.
With the Insemination Sperm are injected directly into the uterus – ideally, this should be about two to five days before ovulation occurs. However, insemination can only be performed if there are no serious causes of infertility. This means that the fallopian tubes and uterine lining must be functional and there must be sufficient sperm that are also normally mobile.
Otherwise, insemination can also be carried out with foreign sperm (e.g. from a sperm donor). Insemination is also an option for couples who cannot have unprotected intercourse, for example, if one of them is infected with HIV. GIFT. Oocytes are retrieved after hormonal stimulation. Flushed into one of the fallopian tubes together with the sperm cells. eggs are collected after hormonal stimulation. Flushed into one of the fallopian tubes along with the sperm. The egg and sperm cells are separated from each other. The actual fertilization takes place in the fallopian tube. Since the chances of pregnancy are no higher with this method than with IVF, it is hardly used any more.
Methods with fertilization in a test tube During In vitro fertilization the egg and sperm are brought together in the Petri dish. The sperm then penetrates the egg in the Petri dish and fertilizes it.
In the intracytoplasmic Sperm injection (ICSI) involves injecting sperm into the egg with a thin needle.
In most cases, several eggs are fertilized in this way, which are then transferred to the uterus in a procedure known as embryo transfer. These methods are therefore also suitable for couples in which the motility of the sperm is greatly reduced or the fallopian tubes are stuck together. If the number of sperm in the man is very low, they can also be obtained directly from the testicle or epididymis of the man.
The first IVF took place in Great Britain in 1977. On 25. July 1978, Louise Brown became the first "test-tube baby" to be born. In 1982, the first German IVF child was born at Erlangen University Hospital – in 2019, more than 100 children were born in Germany, according to the IVF registry.000 treatment cycles documented. However, only one in three women achieved a pregnancy -. Only one in four actually gives birth to a child after embryo transfer.
Chances of success decrease with age The chances of success with IVF are also strongly dependent on age. While the pregnancy rate after IVF for a 30-year-old is still 40 percent, it drops by the age of 41. Under 19 percent per embryo transfer at age 19.
Pregnancies after the age of 45. Birthday are extremely rare. In only 2.5 percent of cases does embryo transfer in this age group result in pregnancy – often with a sad outcome: 80 percent of these pregnancies resulted in miscarriage. Overall, in 2018, there is only one documented birth where the woman being treated was over 45.
In general, the risk of miscarriage after IVF is on average 20 percent higher than after natural conception with 15 percent. And again, the older the woman, the higher the risk. According to the IVF registry, six out of 10 pregnancies in a 44-year-old patient end in miscarriage, and eight out of ten in patients over the age of 45.
Costs: This is how much health insurance covers
If all reproductive medicine measures are taken together, pregnancy occurs in 60 percent of couples who undergo treatment. And for many, it is also the only way to have "their own" child. It should not be forgotten that the treatment period can be emotionally draining. With each failed attempt the disappointment increases.
And the financial burden is also increasing. This is because health insurers usually only cover three treatment cycles – and even then only half of them and under certain conditions. One treatment cycle costs about 3500 €.
Artificial insemination is no longer a rarity. Since 1997, according to the IVF Registry, almost 320.000 children have been born after artificial insemination – which is roughly equivalent to the population of a medium-sized city like Munster or Bonn.
Nevertheless, couples should realize that infertility treatment should also take place as early as possible and that one should not wait too long to realize one's wish.
Physician and science journalist for TV, Internet and radio. Curious, thirsty for knowledge, easy to inspire. Favorite topic: the miraculous human being from the first cry to the silent end.
