In 30 to 40 percent of couples, one of the partners has a biological disorder. In 20 percent of cases, both partners are only partially fertile. Reasons for this can be:

• The most common reason for infertility in both women and men is an infection with chlamydia, which is transmitted during unprotected sexual intercourse. These bacteria can lead to fallopian tube blockage in women or epididymitis and prostate inflammation in men.
Hormonal problems, for example due to thyroid dysfunction, can also cause fertility problems.Female fertility problems can be caused by organic problems or changes and inflammation of the ovaries and fallopian tubes.Fertility problems in men are mainly due to poor sperm quality. Diseases, harmful substances or an unhealthy lifestyle can lead to insufficient intact and motile sperm cells being produced.

If medical causes can be ruled out, mental and emotional stress can be considered. This is the case in 10 to 15 percent of cases. The worry of not getting pregnant straight away can act as an amplifier. The unconditional desire to have children may lead to sexual dysfunction and can have an indirect impact on fertility.

Exhaustion, stress or an unhealthy lifestyle can also have an impact on fertility. Nicotine, for example, impedes blood flow to the reproductive organs, while alcohol can trigger organic disorders. Cycle disorders can occur in severely underweight or overweight women. Severe obesity in men can lead to reduced semen quality. Extreme physical exertion or physical work can also have a negative impact on the hormone balance and therefore also on reproductive capacity.

If you opt for artificial insemination, there are various methods to choose from. All forms of so-called "assisted reproduction" are usually preceded by hormone treatment for the woman. Here we present the methods of artificial insemination.

Sperm transfer (insemination)

This method is mainly used if the partner has too few or insufficient motile sperm. The sperm cells are then transferred directly into the woman's uterus. The success rate is around 5 to 10 percent per attempt. After several attempts, pregnancy occurs in around 10 to 30 percent of cases.

In vitro fertilization (IVF)

After hormone treatment, eggs are retrieved from the woman's ovaries. In the test tube, the eggs are mixed with the man's sperm. If fertilization takes place and the fertilized eggs continue to develop, an embryo is transferred to the uterus. As the embryo does not always implant in the uterus, two to three embryos are often transferred. This procedure leads to multiple births in around 20 percent of IVF treatments. The success rate is around 25 to 30 percent and the live birth rate is 15 to 20 percent.

Intracytosplasmic sperm injection (ICSI)

The ICSI method is a special form of IVF treatment. It is used if the egg is not fertilized during sperm transfer or IVF treatment due to the quality of the sperm. Eggs are retrieved from the woman after hormone treatment. A single sperm cell is then injected directly into the egg. If normal cell division takes place after fertilization, up to three embryos are transferred to the woman's uterus.

TESE and MESA

If there are no sperm cells in the man's seminal fluid, testicular sperm extraction (TESE) and microsurgical epididymal sperm aspiration (MESA) are used. In some cases, sperm can be extracted directly from the testicles (TESE) or epididymis (MESA) using a surgical procedure. Subsequent artificial insemination is carried out using the ICSI method.

Intratubal gamete transfer (GIFT)

This procedure is a hybrid of sperm transfer (insemination) and in vitro fertilization. In GIFT, eggs are retrieved from the woman in a minor operation. These are brought together with the partner's prepared sperm cells and then injected into one or both fallopian tubes via a catheter. Fertilization then takes place naturally. The fertilized egg should migrate to the uterus and implant there. The success rate is around 20 percent. As the operation under general anaesthetic carries higher risks of complications and there is an increased risk of ectopic pregnancy, intratubal gamete transfer is no longer often practised today.

The following applies to all treatment methods: they cannot guarantee pregnancy, but they can increase the chances.

Reproductive medicine in Germany is regulated by the Embryo Protection Act. In addition, the German Medical Association and the Joint Federal Committee of Physicians and Health Insurance Funds have issued guidelines. The regulations in Germany are very strict. Prohibited are

• the use of foreign egg cells,
• surrogate motherhood,
• embryo cloning,
• sex selection of sperm (except in the case of serious sex-linked hereditary diseases),
• the use of sperm from deceased persons.

If a pregnancy does not occur naturally, the first step is to undergo extensive diagnostics to determine possible causes. The necessary medical examinations are fully covered by both statutory and private health insurance.

If you are covered by statutory health insurance

If fertility treatment is subsequently planned, statutory health insurance will contribute to the treatment costs under certain conditions.

The following conditions must be met:

• Both partners must be at least 25 years old.
• The woman must not be older than 39 years.
• The man must not be older than 49 years.
• The infertility must have been medically diagnosed.
• The prospect of success of the fertility treatment must be certified.
• Only the egg and sperm cells of this couple may be used and medical or psychosocial counseling must have taken place before the treatment.

If these requirements are met, the statutory health insurance fund will grant subsidies for the following treatments

• 8 inseminations without hormonal stimulation of the woman
• 3 inseminations with hormonal stimulation of the woman
• 3 attempts at in vitro fertilization (IVF).vitro fertilization (IVF)
• 3 attempts at intracytoplasmic sperm injection (ICSI) or
• 2 attempts at gamete intratubal transfer (GIFT)

Please note, that treatment can only begin once the treatment and cost plan has been submitted to and approved by the health insurance company.

IF YOU HAVE PRIVATE INSURANCE

As private health insurance policies are generally concluded on an individual basis, the scope of benefits may vary. You should therefore clarify the possibilities of cost coverage with your health insurance provider at an early stage

When the longed-for pregnancy doesn't materialize, many couples are initially under pressure. The search for the cause and the agonizing wait for test results put a heavy emotional strain on the relationship. In many partnerships, the desire to have children quickly becomes the overriding issue. If several fertility treatments remain unsuccessful over time, relationship crises are inevitable. If the emotional strain becomes too great, it can even lead to the relationship breaking down. However, many couples report that getting through the crisis together has strengthened their partnership.

What helps is to talk openly about your own situation. Far too often, people keep quiet about the topic because it is associated with strong feelings of inferiority. In addition to talking to family or friends, professional counseling can be particularly helpful. In counseling, you can talk to experts in confidence. This is where possible causes of infertility are discussed openly, diagnostic measures and methods are explained and the opportunities, risks and costs of artificial insemination are discussed. In particular, counseling can help you to cope well with this time together. You will also receive suggestions for coping with grief and developing new perspectives on life if treatment is unsuccessful.