Unfulfilled desire to have children

In 30 to 40 percent of couples, a biological disorder is present in one of the partners. In 20 percent of cases, both partners have limited fertility. Reasons for this can be:

• The most common reason for infertility in both women and men is infection with chlamydia, which is transmitted during unprotected sexual intercourse. These bacteria can lead to tubal occlusion in women or epididymitis and prostatitis in men.
• Hormonal problems, such as those caused by thyroid dysfunction, can also trigger fertility problems.
• Female fertility problems can be caused by organic problems or changes and inflammation of the ovaries and fallopian tubes.
• Fertility disorders in men are overwhelmingly due to poor sperm quality. Diseases, pollutants or even an unhealthy lifestyle can lead to the fact that not enough intact and mobile sperm cells are produced.

If medical causes can be ruled out, mental and emotional stresses come into consideration. This is the case in 10 to 15 percent of cases. The worry, if it does not work out with the pregnancy immediately, can work as an intensifier. The unconditional desire to have children possibly leads to sexual disorders and can have an indirect influence on fertility.

Exhaustion, stress or an unhealthy lifestyle can also affect fertility. Nicotine, for example, hinders blood flow to the reproductive organs, and alcohol can trigger organic disorders. Severely underweight or overweight women may experience cycle disorders. Severe obesity in men can lead to restrictions in semen quality. A negative influence on the hormonal balance and thus at the same time on the reproductive capacity also have extreme sporting efforts or physical work.

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

Sperm transfer (insemination)

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

In-vitro fertilization (IVF)

After hormone treatment, eggs are removed from the woman's ovary. In the test tube, the eggs are mixed with the sperm of the man. If fertilization occurs and the fertilized eggs continue to develop, an embryo is transferred to the uterus. Since the embryo does not always implant in the uterus, two to three embryos are often transferred. This procedure results in multiple births in about 20 percent of IVF treatments. The success rate is about 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 when fertilization of the egg does not occur due to sperm quality during sperm transfer or IVF treatment. For this purpose, eggs are retrieved from the woman after hormone treatment. Then a single sperm cell is injected directly into the egg. If normal cell division takes place after fertilization, up to three embryos are transferred into the uterus of the woman.

TESE and MESA

If there are no sperm cells in the man's seminal fluid, the so-called testicular sperm extraction (TESE) and microsurgical epididymal sperm aspiration (MESA) are used. With surgical intervention, sperm can be obtained directly from the testicles (TESE) or epididymis (MESA) in some cases. The subsequent artificial insemination is carried out according to the ICSI method.

Intratubal gamete transfer (GIFT)

This procedure is a hybrid of sperm transfer (insemination) and in vitro fertilization. In GIFT, eggs are removed from the woman in a small operation. These are combined with the partner's prepared sperm and then injected via a catheter into one or both fallopian tubes. Fertilization then occurs naturally. The fertilized egg is supposed to travel to the uterus and implant there. The success rate is about 20 percent. Since the operation under general anesthesia brings higher risks of complications and there is an increased risk of ectopic pregnancy, the intratubal gamete transfer is no longer often practiced today.

For all treatment methods, they can not guarantee pregnancy, but increase the chances.

In Germany, reproductive medicine is regulated by the Embryo Protection Act. In addition, the German Medical Association and the Joint Federal Committee of Physicians and Health Insurers have issued guidelines for action. In Germany, the regulations are very strict. Prohibited are

• the use of foreign oocytes,
.
• the surrogacy,
• the cloning of embryos,
• the sex selection of sperm (except in cases of serious sex-linked hereditary diseases)
.
• the use of semen from deceased persons.

If a pregnancy fails to occur naturally, the first step is a detailed diagnostic examination to determine possible causes. The necessary medical examinations are fully covered by both statutory and private health insurance.

If YOU ARE LEGALLY INSURED FOR SICKNESS

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

The following conditions must be met:

• Both partners are 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 attested.
• Only the eggs and sperm of this couple may be used and medical or psychosocial counseling must have taken place prior to treatment.

If these conditions are met, the statutory health insurance provides subsidies for the following treatments

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

Please note that treatment cannot begin until the treatment and cost plan has been submitted to and approved by the health insurance company.

IF YOU ARE PRIVATELY INSURED

Since in the private health insurance are basically individual contracts, the scope of benefits may vary. Therefore, clarify the possibilities of cost coverage early with your health insurance.

In addition, there is state support for involuntarily childless couples. In family-friendly North Rhine-Westphalia, promising fertility treatment should not fail because of money. Since 2019, the state of North Rhine-Westphalia has been funding fertility treatments together with the federal government as part of its own state support program.

Here it goes to the online application

Please note: Financial support for fertility treatment must be applied for before treatment begins. Which requirements and individual steps for the financial support are to be observed, explains the infographic in the download area.

Which documents you must submit in addition to the application form, please refer to the checklist in the download area.

When the longed-for pregnancy does not materialize, many couples are first under pressure. The cause research and the agonizing wait for examination results put a heavy emotional strain on the relationship. In many partnerships, the desire to have children quickly becomes the overriding issue. If, in the course of time, several infertility treatments remain unsuccessful, relationship crises are inevitable. If the emotional strain becomes too great, it can even lead to a relationship breakdown. However, many couples report that getting through the crisis together has strengthened their partnership.

What helps is to talk openly about their own situation. Far too often is outwardly silent about the subject, because it is associated with strong feelings of inferiority. In addition to talking to family or friends, professional counseling can be especially helpful. In counseling, you can talk to experts in confidence. Here, possible causes of infertility are discussed openly, diagnostic measures and methods are explained, and the chances, risks and costs of artificial insemination are discussed. In particular, counseling can help you to cope well with the time together. You will also receive suggestions for coping with grief and developing new life perspectives, should the treatment remain unsuccessful.