Why do you need fertility treatment

Fertility treatment: methods, opportunities and risks

Fertility treatment is often seen as the last hope for a baby. Many couples go this way - with success, but there is no guarantee of success. We present various methods of fertility treatment and fertility treatment, and explain the risks and costs.

Father, mother and child. A nice triad. But about every seventh couple in Germany hopes in vain for offspring. Unintentionally they remain childless, they are sterile. The World Health Organization (WHO) has defined what is called sterile: "A couple is considered sterile if the woman has not become pregnant within a year of regularly having unprotected sexual intercourse." In Germany, however, many doctors only speak of infertility after two years. There are several reasons for infertility and they are equally shared by men and women.

Absolutely underestimated and yet the number one pleasure and fertility killer is stress. The good thing about it: It is up to you to do something about it. But often the causes are physical and couples need medical help if they want to have children. There is now even a whole range of fertility treatments or fertility treatments. For example, with the help of methods such as insemination or in-vitro fertilization, it is increasingly possible to father children in a test tube when this is not (or no longer) possible naturally. But these methods do not have to be absolutely necessary. For example, in 30 to 40 percent of women affected, the unfulfilled desire to have children can be traced back to a hormonal disorder that can be treated with medication. Therapy must therefore be tailored precisely to the causes of the infertility after it has been determined whether the impairment is in the woman, in the man or in both.

Fertility treatment in women

Hormonal disorders are not uncommon in women. Therefore, hormone therapy is often the first step in fertility treatment. This should regulate the cycle again and stimulate the ovaries. Doctors call this ovarian or hormonal stimulation. One hormone that is often used in the first step in fertility treatment is clomiphene. It is taken in the form of tablets - this is how it works:

Follicle-stimulating hormone (FSH) or human menopausal gonadotropin (HMG) can also be administered to support egg maturation. However, they must be injected. So that the ovulation of the carefully nursed egg cells takes place at the right time, the treatment is often supplemented by other hormones that prevent premature ovulation or trigger a planned ovulation.

How successful the fertility treatment with hormones is, of course, also depends on the severity of the hormone disorder. Nevertheless, on average, about 30 percent of women become pregnant naturally, without additional artificial insemination, after the treatment.

Further fertility treatments

The cause of infertility determines fertility treatment. If the preliminary examinations have shown that both partners have no organic or hormonal disorders, then poor sperm quality and / or a hostile vaginal environment can be the reason for the unfulfilled desire to have children. In this case, an insemination (semen transfer) is done. With this method, the fittest sperm are sorted out from the man's ejaculate and introduced into the uterus with the help of a syringe or indirectly via a plastic tube (catheter). In this way, the germ cells of both partners receive a jump start so that they can find each other more easily. Insemination also takes place when donor sperm has to be used.

What sounds so simple, however, has only a limited success rate: together with hormonal stimulation, it is often only 15 percent. A 40 percent chance of success can be achieved over several cycles. *

Artificial fertilization

If several attempts at insemination have already failed, the doctors go one step further and relocate the fertilization of the egg "outside" - it then takes place in the test tube. The woman receives hormones in order to allow several follicles to mature within one cycle. These are sucked off through the vagina and mixed in the test tube with the father's "presorted" sperm. The successful sperm must penetrate the egg by itself. After three days, a maximum of three fertilized egg cells are implanted in the uterus. This method is called in vitro fertilization (IVF). But it is also often referred to as artificial insemination. In Germany, IVF is currently only allowed to be performed on married couples. The Embryo Protection Act applies to treatment.

If the preliminary examinations found that the sperm quality is very poor and the germ cells would not be able to penetrate the egg by themselves, the ICSI method (Intracytoplasmic Sperm Injection) is used for fertility treatment. The principle is the same as that of the IVF method. The key difference is that only a single sperm is injected directly into the egg using a pipette. A maximum of three fertilized egg cells are then introduced into the uterus.

Depending on the age of the woman, the success rate with IVF and ICSI is 15 to 20 percent. *

With all fertility treatments mentioned above, the woman has to treat her body with sometimes strong hormone preparations so that the egg cells are strong enough for removal and fertilization in the test tube or so that several corpuscles mature in one cycle. A more gentle fertility treatment for women can therefore be the IVM method (In-Vitro-Maturation). The immature germ cells can be taken directly from the ovary. Therefore, a significantly smaller amount of hormones is required or the hormones are administered over a shorter period of time. The egg cells only mature in the test tube under the influence of hormones. They are then fertilized either by IVF or ICSI. An IVM can be a great option for women with polycystic ovarian syndrome (PCO syndrome). Depending on which study you read, the success rates are between 3-27 percent. *

Some couples also have the problem that the man cannot ejaculate or that his spermatic ducts are blocked. Then the sperm must be obtained through surgery for further fertility treatment. This procedure is called MESA (sperm extraction from the epididymis) or TESE (sperm from testicles). TESE and MESA are always combined with an ICSI.

Assumption of costs for artificial insemination

"Every man and woman has a human right to have a family," says the WHO and defines childlessness as a disease. The German health insurance companies see it differently. They argue that one can live happily without offspring. That's probably true. But only if you choose to do so of your own free will. Otherwise, involuntary childlessness is one of the most stressful experiences a person can have, comparable to the loss of a partner, as American studies show.

In any case: the procedures in reproductive medicine are complex - and therefore also expensive. For in vitro fertilization (IVF), fertility centers charge an average of € 3,000 per cycle. Intracytoplasmic sperm injection (ICSI) is even more expensive at around € 3,600. Added to this are the costs for hormone treatment for women and general doctor and consultation costs. Most couples need about three attempts before artificial insemination is successful. If “only” one insemination is necessary, the cost per treatment is € 200. However, most women also take hormones beforehand. If you add up the costs of the hormone treatment, this is also just under € 1,000 per insemination attempt. Fertility treatment means an immense financial burden for couples.

The good news: the couples do not bear the cost of fertility treatment alone. For example, the examination costs for determining infertility are completely covered by health insurance companies. The same applies to the first consultation in a fertility clinic. The health insurers also contribute to the costs of a subsequent fertility treatment. Hormone therapy for women that is not aimed at insemination or artificial insemination is 100% reimbursed. In all other fertility treatment methods, the health insurers usually contribute 50 percent - albeit with restrictions.

Half of the costs are reimbursed for:

  • max. 3 artificial inseminations - whether IVF or ICSI
  • max. 3 inseminations with accompanying hormone therapy for the woman
  • max. 8 inseminations if there is no hormonal stimulation of the ovaries

But in order for the health insurances to contribute to the costs of an artificial insemination, couples have to meet some strict criteria:

  • The couple must be married
  • The woman must be between 25 and 40 years old, the man between 25 and 50 years
  • The couple must submit a detailed treatment plan to the health fund (medical diagnosis, planned fertility treatment, duration and costs)

What do private health insurance companies pay?

These criteria are somewhat relaxed for privately insured couples. You do not have to be married to be reimbursed for part of the treatment costs or all treatment costs. The insurers also usually take on more than three IVF or ICSI cycles, at least as long as there are sufficient prospects of success.

Artificial insemination with donor sperm is not covered by private or statutory health insurances. In this case, the couple must bear the costs themselves. However, in this case you should still ask the health insurance company whether at least the costs for the preliminary examinations or the consultation costs can be reimbursed.

The federal government supports unmarried couples

Since 2012, couples have also been able to apply for financial help for fertility treatments from the federal initiative "Help and support in the event of unwanted childlessness". For a long time, a marriage certificate was a mandatory requirement. This regulation no longer applies since the beginning of 2016. From now on, unmarried couples (but only heterosexual couples) will receive financial support from the federal government.

Fertility treatment: stress on psyche and relationship

Fertility treatment is a wonderful chance for a baby - and its successes have increased significantly in recent years. But what you should consider beforehand: A fertility treatment is a mental roller coaster ride. And unfortunately there is no guarantee that the treatment will be successful. "Most couples literally ignore the fact that, realistically speaking, the probability that the treatment will lead to the child in the end is not very great. But perhaps this suppression at the beginning is also a sensible strategy to maintain enough strength and optimism, the matter at all to begin, "explains Maren Weidner, doctor and consultant at Pro Familia.

The procedures, some of which take years, push some couples to their limits: an average of 100 syringes, dozen blood tests and multiple anesthesia. Someone who has not experienced it themselves can hardly imagine the stress. Again and again the anxious wait to see if it worked this time. "Of course the burden increases with every failed attempt. To deal with such a big disappointment over and over again is an act of mental strength," says Weidner.

No guarantee of success: Baby take home rate 2013

In fact, the success rate, the so-called baby take home rate, as reproductive medicine specialists call it, is far lower than most people think: In Germany, it is around 15 to 20 percent per IVF or ICSI attempt. The current figures (2013) of the German IVF register show that the rate is, however, shifting further upwards. For example, 26 percent of all couples who received treatment in 2013 were able to take a baby home with them - that's around 1,400 couples.

But how successful a fertility treatment really is also depends to a large extent on the respective couple. Of course, how badly fertility is affected is crucial. But the woman's age and weight also have an influence on the treatment, as do harmful habits such as smoking or regular alcohol consumption.

Risks of fertility treatment

Of course, the risks of fertility treatment should not go unmentioned. Strong hormone preparations intervene massively in the female body. It is clear that this also involves risks. Doctors undertake to inform themselves about this, but you should definitely address this during the consultation. The possible risks include:

  • Even if the woman's hormone treatment is closely monitored, the so-called overstimulation syndrome can still occur. Then the ovaries produce too many and too large follicles, the vaginal environment can change and prevent sperm from penetrating or the egg cells from implanting. Shortness of breath and blood clotting disorders can also occur.
  • If egg cells have to be removed in the case of artificial insemination, complications can also arise during the surgical interventions. For example, there is a risk of bacterial inflammation of the ovaries.
  • The likelihood of multiple pregnancy increases.
  • Fertility treatment is a great strain on the relationship. Everyday and working life must be subordinate to fertility treatment. And "the mere fact that a couple does not get pregnant naturally represents a crisis that has to be overcome," says Wedner.

* Source: Familienplanung.de/ Bundeszantrale for health education