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Dossier: Planning a family

Diagnosis: infertile

Couples who’ve been trying to fall pregnant but haven’t had any luck are faced with many questions. Why isn’t it working? Is one of us infertile? There are a number of medical treatments that can help.

In this day and age, we think we have everything under control. Everything can be planned, every problem can be solved. So couples are often devastated when they find it difficult to fall pregnant. Childlessness can become a great emotional burden. This is made worse by the fact that many people feel that childlessness is still a taboo topic. However, one in six couples now has problems falling pregnant naturally1 , with the number of people being treated for medically assisted reproduction almost doubling since 2002.2 One of the reasons for this development is that couples are deciding to wait longer before trying for a baby. According to Swiss Statistics, 50 years ago only 11.3 percent of pregnant women were over 34 years of age. In 2008 there were over twice as many – 28.8 percent.

What causes infertility?

Infertility or sterility is when a couple fails to get pregnant (conceive) despite having regular unprotected sex over a period of one to two years. There are many reasons for this. Stress and psychological problems are one factor. Paradoxically, the desire to have children can itself trigger stress. If the longing for a baby becomes all-consuming, the pressure on the couple builds, and sex degenerates into a matter of planning. Stress isn’t necessarily an obstacle, but it is a possible reason for delay. For example, a survey conducted by Imperial and King’s Colleges in London showed that the wish for a child can be fulfilled in apparently hopeless cases. Of 403 couples who were treated in a fertility clinic, almost every fourth couple had a child naturally within four to six years. Once the pressure was off, they suddenly managed to fall pregnant.

There are many reasons for this. Stress and psychological problems are one factor. Paradoxically, the desire to have children can itself trigger stress.

In addition to psychological problems, other “soft” factors such as smoking and being overweight or underweight can have a negative impact on fertility. This applies to both men and women. The reason for infertility is often sought in women, but in around 40 percent of cases the reason for childlessness lies with men as a result of insufficient sperm quality. For example, sperm samples are often found to have too low a sperm count or insufficient sperm movement. Organic problems in women include missing, blocked or damaged Fallopian tubes, hormonal egg maturation disorders or endometriosis. Endometriosis is a disorder in which tissue that normally lines the inside of your uterus grows in other areas such the Fallopian tubes, ovaries, pelvis or organs.

Treatment options: what can I do? What do I want?

The desire to have a child can often be fulfilled. Thanks to advances in medicine many, although not all, fertility problems can be resolved. If you fail to get pregnant and are unhappy about it, you should certainly seek help from a specialist in reproductive medicine, for example in a fertility clinic. In some cases a clarifying discussion can help. In addition both the man and woman should be examined by a gynaecologist or urologist. The first step is to do basic examinations: Does ovulation take place regularly? Are the Fallopian tubes clear? Is the man’s semen fertile? The doctor measures the woman’s basal temperature curve, analyses her hormonal balance and performs a follicular tracking ultrasound scan. Blocked or fused Fallopian tubes are a common cause of fertility problems. If this is diagnosed in a woman, it can be reversed by means of microsurgery. In the man’s case, a spermiogram (sperm analysis) can provide valuable information on his fertility. Both partners should have a blood test to rule out the possibility that diseases may be preventing pregnancy.

If the woman is not yet pregnant by this stage, hormone therapy is often the first stage of treatment. Hormones are intended to regulate irregular cycles. If this treatment isn’t successful, the next option is to try a sperm injection, which involves inserting the partner’s sperm directly into the cervix, uterus or the Fallopian tubes using a cannula or syringe. Another option is artificial insemination, i.e. fertilising the egg cell in a test tube. If the sperm quality is poor, microinsemination is also possible. In this case a single sperm is injected into the egg. It’s worth considering trying traditional Chinese medicine (TCM) or homoeopathy in conjunction with conventional fertility therapies. Alternative medicine adopts a holistic approach that takes both physical and mental factors into account.

There’s no one-size-fits-all treatment.

The path a couple takes depends on their individual requirements. There’s no one-size-fits-all treatment. That’s why it’s important to explore the different treatment options and get advice from a specialist. The psychological stress that the unfulfilled desire for a child can entail should also be taken into account in the decision. Psychotherapists can help you deal with the situation, reduce stress and process your experiences. Self-help groups provide a platform for speaking to people going through similar experiences. It’s also good to know that there are solutions to many of the problems.


1 European Policy Audit on Fertility (EPAF)

2 Swiss Statistics: 3,467 people sought treatment in 2002 compared with 6,055 in 2015.