Unfulfilled desire for children: why am I not getting pregnant?

• Age of the eggs: Female fertility decreases slowly from around the age of 25 and much more rapidly from 35 onwards. The older the eggs, the higher the risk for miscarriage or genetic changes.
• Hormonal imbalance An irregular cycle or lack of ovulation are among the most common reasons why pregnancy does not occur. Causes include polycystic ovary syndrome or a regulatory disorder between the central hormone axis and the ovary. Other reasons may include disorders of the thyroid gland, pituitary gland or adrenal glands. Obesity or being significantly underweight can also affect hormonal balance and, in turn, egg maturation.
• Endometriosis: With endometriosis, tissue similar to the uterine lining settles outside the uterine cavity. These lesions can displace healthy ovarian tissue, cause adhesions and obstruct the transport of the egg cell. 
• Fallopian tube problems and infections: Adhered or damaged fallopian tubes are among the classic causes of female infertility. They are often the result of an untreated chlamydia infection, the most common bacterial sexually transmitted infection in young women.
• Uterine changes: Polyps, fibroids or congenital abnormalities, such as a double uterus, can prevent the fertilized egg from implanting.  
  

• Disturbances in sperm production: Insufficient sperm production can be caused by conditions such as undescended testicles in early childhood, testicular inflammation, exposure to heat, anabolic steroids, radiation or certain medicines. 
• Hormonal causes: Impaired pituitary function or low testosterone levels can affect sperm maturation and count. Obesity and lack of exercise are also an important disruptive factors.
• Transport and ejaculation disorders: Blocked vas deferens or ejaculation disorders – for example after operations or injuries – can prevent enough sperm from reaching the egg cell.
• Age: Male fertility gradually declines from around the age of 40. As men age, the risk of genetic changes in sperm also increases. 
• Environmental factors: Chemicals such as plasticisers or pesticides can have a hormone-like effect and impair sperm quality. Dr Fäh explains: “These substances have a measurable effect, but it is relatively minor compared with smoking, cannabis or obesity.” 
  

• Lifestyle: Unhealthy diet, lack of exercise, smoking, alcohol or being significantly overweight or underweight can affect the fertility of both partners. 
• Mental illness and stress: Emotional tension can disrupt hormonal processes, affect the cycle or inhibit sperm production. Chronic stress, pressure and anxiety can also put a strain on sexuality and disrupt the cycle’s balance.
  

Various hormones are measured in the blood to gain insights into egg maturation and hormonal balance.

These include the follicle-stimulating hormone, which regulates egg maturation, the anti-Müllerian hormone, which provides information about the egg reserve as well as thyroid hormones, prolactin and testosterone. The progesterone level is also monitored to check whether ovulation has occurred.

Certain infections can complicate a pregnancy or make it dangerous. Both partners are therefore tested for hepatitis B and C, HIV and chlamydia.

In women, vaccination protection against rubella and chickenpox is also checked, as these diseases can cause malformations in the early stages of pregnancy.

Various methods are available to determine whether the fallopian tubes are open and the uterine cavity is free of obstructions. The easiest way is a special contrast agent ultrasound examination to check the uterine cavity, the mucous membrane and the fallopian tube passage.

In the case of previous surgery or infections in the abdominal area, a hysteroscopy and laparoscopy are recommended.

The test examines sperm count and concentration, motility and viability, sperm morphology, and the presence of inflammatory cells.

The quality of the semen sample can vary greatly – for example after illness, stress or medication. Therefore, any abnormal findings are usually checked again after three months.

In cases of unexplained infertility or repeat miscarriages, a DNA fragmentation test can be useful. This checks whether there is any damage to the genetic make-up of the sperm.

In this process, a semen sample is purified in the laboratory to remove immotile sperm and bacteria. The result shows whether the sperm are suitable for insemination or in vitro fertilisation.

Hormone treatments control or support ovulation when there are cycle or maturation disorders.

In cases of ovulation disorders, anti-oestrogens are used, for example, to promote follicular maturation and thereby increase the chances of fertilisation. After ovulation, progesterone stabilises the luteal phase and helps prepare the uterine lining.

In the case of PCOS, metformin can also be useful because it has a positive effect on sugar metabolism and can promote cycle regulation.

An elevated prolactin level can be treated with dopamine agonists so that ovulation occurs regularly again. Thyroid disorders should also be treated in a targeted way, as they can affect fertility. 

IUI bypasses part of the sperm’s natural journey: prepared, motile sperm are introduced directly into the uterus shortly before ovulation. Beforehand, it is also checked whether both fallopian tubes are open and sperm quality is sufficient. 

During IVF, eggs are fertilised outside the body. First, the ovaries are stimulated so that multiple eggs mature. Egg retrieval is performed on an outpatient basis shortly before natural ovulation.

In the laboratory, the eggs are then combined with sperm; the fertilised eggs mature into embryos over two to five days. An embryo is then transferred into the uterus.

At some fertility centres in Switzerland, IVF is also offered in the natural cycle without hormonal stimulation. This is suitable for women who are not allowed or do not want to use hormone therapy.

IVF is particularly useful in cases of fallopian tube damage, unsuccessful IUI or long-standing desire for children. Success rates decrease with age, while the risk of miscarriage increases. 

ICSI is an IVF variant used if there is male-factor infertility. A single sperm is injected directly into the egg cell using a micropipette. The process is the same as IVF; the difference lies in how the egg is fertilised.

ICSI is useful, for example, in cases of severely reduced number or mobility of sperm, if IVF has not worked or in cases of ejaculation or transport disorders.

The pregnancy rate is age-dependent. According to BAG statistics, the success rate for women below the age of 35 is just under 50%, and lower for women over 35. As with IVF, the miscarriage rate also increases with age, especially the woman’s age.

Surgical intervention can remove mechanical barriers or correct unfavourable anatomy.

Fibroids and polyps are removed from the uterine cavity using a hysteroscopy to improve implantation. Adhesions can be treated with a laparoscopy. Blocked fallopian tubes can be surgically reconstructed.

For men, operations such as a vasovasostomy may be an option. 

With PID, a few cells of the embryo are taken and examined for the number of chromosomes or for specific genetic changes. In Switzerland, the PID is strictly regulated and reviewed individually.

The aim is, among other things, to avoid the most severe hereditary diseases, reduce the risk of miscarriage and optimise the chances of successful transfer.

Dr Fäh explains: “PID can be especially useful for women over 38. I often advise younger women against it, because good embryos can be lost that way.”

With IVF and ICSI, surplus embryos or blastocysts can be frozen to enable additional transfers later. Social freezing describes the precautionary freezing of unfertilised eggs to prevent age-related fertility loss.

It makes sense before the age of 35 because egg cell quality and chromosome stability are best then. In Switzerland, egg cells/embryos may be stored for up to ten years.

A balanced diet supports metabolism and hormonal balance.

Folic acid is important even before pregnancy; vitamin D and omega-3 may also be beneficial. However, there is no direct scientific evidence proving that supplements lead to more pregnancies.

For women with PCOS, taking (myo-) inositol is recommended. For men, zinc, selenium, vitamins C and E as well as folic acid are considered useful, but here, too, the evidence for improving pregnancy rates is limited. 

A normal body mass index is ideal for increasing the chances of pregnancy. Being overweight and underweight, on the other hand, can impair the cycle, egg maturation and sperm quality.

Regular exercise also stabilises insulin and stress regulation, promotes sleep and mood – all relevant factors when it comes to fertility.

Chronic stress can disrupt the cycle and spermatogenesis and put sexuality under pressure. Mindfulness, breathing and relaxation exercises, and spending time as a couple can help reduce stress.

Planning a family should not dominate your daily life – moments of relaxation, routines and good sleep habits help stabilise your system.

Sex every two to three days reliably covers the fertile phase. The highest chance of conceiving is 36 to 48 hours before ovulation. Those who want to time more precisely can use a cycle app or tracker.

In men, regular ejaculation every two to four days improves sperm quality. “Abstaining until ovulation, however, is counterproductive”, says expert Fäh. 

Acupuncture and acupressure can help stabilise an irregular cycle. This, in turn, can increase the chance of conceiving. 

Many couples underestimate how much the psychological burden changes everyday life and their relationship. Treatment requires patience, trust and mutual consideration, and it also puts a couple’s love life to the test.

When sex becomes a project and the timing of intercourse is medically prescribed, spontaneity can be lost. It often helps to consciously schedule phases of relaxation or breaks to allow closeness and intimacy beyond the desire for children.

It’s normal to feel disappointed after a failed attempt, and you should allow yourself room for that. Many women feel exhausted, angry or ashamed.

What matters is understanding that this is not a personal failure, but part of a longer process. Conversations with the doctor, psychological support or even a break between two cycles can help you regain strength.

Open communication is crucial in this phase. Sharing your concerns instead of keeping them to yourself prevents misunderstandings or blame from taking hold. Fäh advises: “Talk to each other and also to the people around you. Openness relieves pressure. Often, it is only then that you realise many other couples experience similar things.”

Self-help groups or counselling centres, where those affected can exchange experiences, can also be helpful. Knowing that you're not alone can be a source of comfort and open up new perspectives.