January 8, 2025, 3:36 pm | Read time: 9 minutes
Infertility–a topic that is often not openly discussed and can be very distressing for those affected. But when is a woman actually considered infertile, and what treatment options are available? STYLEBOOK provides a comprehensive summary for you.
In Germany, about 15 percent of couples face the emotionally challenging issue of involuntary childlessness–and statistics suggest that the actual number is likely even higher. The impact on individual well-being and the social fabric is significant. Studies suggest that infertility is due to a limitation in the woman’s fertility or the man’s inability to conceive in 40 percent of cases, while in 20 percent of cases, both partners are affected.
Overview
Definition of Infertility
The term “infertility” is used when a woman does not become pregnant after one year of regular unprotected intercourse. Primary infertility refers to the inability to become pregnant at all, while secondary infertility means a woman cannot become pregnant again after previous pregnancies. Additionally, there is the term “infertility,” where a pregnancy cannot be maintained until the birth of a viable child.
How is Infertility Diagnosed?
The question of one’s fertility can be a profound and often emotional journey for women. A conscious understanding of physical signals and symptoms can be key to early detection of fertility disorders and addressing potential challenges.
Abdominal Pain and Menstrual Complaints
Severe abdominal pain during menstruation can be an early sign of fertility disorders, especially if associated with fibroids or endometriosis. Chronic lower abdominal pain and dysmenorrhea (severe menstrual pain) should be taken seriously.
Cycle Disorders and Menstrual Changes
An irregular cycle, spotting, or excessively heavy or light menstruation can indicate fertility problems. Cycle disorders can affect ovulation and thus prevent conception.
Possible Signs of Infertility in Women
- Persistent lower abdominal pain
- Hypermenorrhea (heavy and prolonged menstruation)
- Hypomenorrhea (light menstruation)
- Metrorrhagia (spotting, intermenstrual bleeding)
- Pain during intercourse
- Diagnosed endometriosis or fibroids
- Miscarriages
- Excessive hair growth
When Should a Woman See a Doctor?
Early detection of fertility disorders and collaboration with professionals allow for proactive measures and appropriate treatment options. Visiting a doctor and being willing to discuss these issues are crucial steps toward comprehensive reproductive health.
It is advisable to consult a doctor if no pregnancy occurs after one year of regular unprotected intercourse or if the above signs appear. Women over 35 should seek medical support after six months without success (more on this later in the text).
What to Expect During a Doctor’s Examination
Determining the causes of involuntary childlessness requires a thorough examination by a gynecologist. The following examination methods are often used:
Basal Temperature Measurement and Cycle Monitoring
Preparing for the appointment can be done by recording basal temperature and monitoring the menstrual cycle. This allows the doctor to identify patterns and irregularities that may indicate fertility problems.
Also interesting: Determine fertile days yourself–7 methods
Gynecological Examination
A physical examination by the gynecologist is often the first step in diagnosis. An ultrasound examination can, for example, diagnose abnormalities in the uterus.
Hormone Analysis in Blood
Examining hormone levels in the blood can provide insights into possible hormonal imbalances that could affect fertility.
Imaging Procedures
Imaging procedures such as ultrasound or computed tomography (CT) can reveal structural anomalies in the reproductive organs. MRIs, however, are rarely used, mostly for endometriosis.
Possible Causes of Infertility
Hormonal and Functional Disorders of the Ovaries
The ovaries play a crucial role in conception. Hormonal disorders can lead to disturbances in egg maturation, lack of ovulation, and insufficient corpus luteum formation. Stress, significant overweight or underweight, certain medications, and intense physical activity can promote these disorders.
Damage to the Ovaries and Fallopian Tubes
Inflammations, surgeries, or ectopic pregnancies can lead to adhesions, scarring, or blockages of the fallopian tubes, hindering fertilization.
Disorders of the Uterus and Cervix
Scarring of the cervix can prevent sperm from reaching the fallopian tube. Infections and hormonal disorders can disrupt the cervical mucus liquefaction process, which is important for sperm passage during ovulation. These scars can occur, for example, after surgery on the cervical canal.
Endometriosis
Endometriosis, where uterine lining grows outside the uterus, leads to changes in the reproductive organs and adhesions in the abdominal cavity, impairing fertilization.
Organ Malformations
Congenital malformations of the reproductive organs can hinder reproduction. In the case of a uterine anomaly, the egg can be fertilized, but implantation is not possible.
Abnormal Cervical Mucus and Cervical Weakness
Cervical mucus during ovulation plays a crucial role. In some cases, the mucus can produce antibodies against sperm, leading to their death. Cervical weakness can lead to miscarriages or premature births.
Cycle Disorders
Cycle disorders, such as oligomenorrhea, polymenorrhea, or amenorrhea, can be caused by ovarian dysfunction, hormonal diseases, or eating disorders.
Hormonal Disorders
Hormonal disorders, including a lack of progesterone or overproduction of prolactin, can negatively affect egg maturation and the cycle. PCO syndrome, a hormonal disorder, can also lead to infertility as too many male hormones are produced.
Premature Menopause
The menopause, the end of the reproductive phase, can occur prematurely and deplete egg reserves, affecting fertility.
Surgeries and Infections
Surgical interventions and untreated infections can lead to scarring and adhesions that impair fertility.
The exact cause of infertility cannot be identified in about 10 percent of cases. Fertility can be influenced by various factors, including:
- Smoking
- Excessive coffee and alcohol consumption
- Environmental factors
- Psychological factors
- Poor diet
- Overweight and underweight
- Medications
- Stress
- Metabolic disorders
- Lack of sleep
A detailed understanding of these causes is crucial to developing appropriate diagnostic and treatment strategies and helping couples with involuntary childlessness.
Is a Woman’s Age a Decisive Factor?
According to the Federal Statistical Office, the average age of a woman in Germany at the birth of her first child was 30.2 years. Ten years earlier, the average age was 29.0 years. Of the 360,000 firstborns in 2020, 0.8 percent of the mothers were under 18 years old, and 2.9 percent were 40 years or older at the time of delivery. Yet, women in their late 20s constantly hear that the “biological clock is ticking” and that it’s too late for a baby after 40. But is that really true?
“As women age, their eggs also age, their quality decreases, and the separation of chromosome pairs no longer functions properly. This can lead to an increased occurrence of genetic defects and miscarriages,” reports Dr. med. Heidi Gößlinghoff in a STYLEBOOK interview.
She continues: “There is therefore a higher risk of a chromosomal anomaly, particularly trisomy 21. Statistical surveys show that the likelihood of having a child with trisomy 21 increases with age. At age 25, it is less than 0.1 percent, at age 35 it is 0.3 percent, at age 40 it is one percent, and at age 48 it is nine percent. The risk of developmental disorders of the embryo and miscarriages and premature births also increases. The cesarean section rate is also higher.” Generally, mothers over 35 are considered high-risk pregnancies. However, the gynecologist adds: “This simply means that they are monitored more closely during their pregnancy.”
Dr. med. Heidi Gößlinghoff advises women who are 35 or older not to lose hope or give up on their desire. “Although it is often more difficult, I advise women to remain as calm as possible. It makes no sense to stress. However, early clarification is advisable.”
Endometriosis and the Desire for Children: What Those Affected Should Know
Early Menopause: When the Body Takes a Break Sooner Than Expected
Female sterilization – procedure, costs, side effects
Possible Treatments–A Holistic Approach
Fertility problems require not only medical interventions but also a conscious adjustment of lifestyle habits. Women facing possible signs of infertility can actively contribute to improving their reproductive health by considering certain factors and tips.
Psychotherapeutic Support
As mentioned earlier, the unfulfilled desire for children can be an emotional burden, both for the woman and the relationship. Psychotherapy offers help in coping with worries, fears, and dealing with the thought that the desire for children may not be fulfilled. Open communication about the challenges can contribute to relief and promote calmness.
Reviewing Lifestyle Habits
Stress management also plays a central role: Professional and private stress should be reduced through relaxation methods such as autogenic training, progressive muscle relaxation, yoga, and mindfulness. A healthy, balanced diet with adequate vitamins and minerals is also essential. Avoiding indulgences such as alcohol, cigarettes, and drugs improves the chances of a healthy pregnancy. A normal body weight, neither overweight nor underweight, should be aimed for. Excessive exercise and strenuous physical activity should be avoided. The fertile window should be kept in mind, and regular intercourse on fertile days is advisable. In the case of necessary chemotherapy or radiation therapy, it is possible to freeze eggs for later fertilization.
Medication Therapy
Hormone preparations in the form of tablets or injections can treat hormonal imbalances and increase the chances of pregnancy. In the case of a chlamydia infection, treatment is usually with antibiotics, and the sexual partner should also be treated to avoid reinfection.
Surgical Interventions
Surgical measures are considered when structural problems such as scarring, adhesions, endometriosis foci, fibroids, cysts, tumors, or polyps hinder pregnancy. Minor procedures can be performed on an outpatient basis, such as the removal of fibroids or the treatment of endometriosis foci using laparoscopy.
Assisted Reproductive Technologies (ART)
Intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) are techniques used for certain causes of infertility. Hormonal stimulation is often required before artificial insemination and can lead to side effects such as hot flashes, headaches, and breast pain.