Introduction

Not being able to have children is usually a source of great emotional turmoil. Men and women often take it for granted that they will be able to. Many couples who have trouble conceiving start looking for medical help at some point. A number of different treatments are available, depending on the possible causes of infertility.

Problems conceiving a child are considered to be “infertility” if a couple has regularly had sex without contraception for one year and the woman hasn't become pregnant.

At a glance

• Not being able to have children may be a source of great emotional turmoil.
• The causes of infertility include physical problems affecting a man, a woman, or both partners.
• A couple’s age is also a factor.
• There are various treatment options depending on what is causing the problem.

Causes

There are a number of different possible causes of infertility. Those related to women's bodies include the following:

• Hormonal imbalances
• Damage to a fallopian tube or an ovary
• Fibroids or endometriosis

Possible causes related to men's bodies include the following:

• Hormonal imbalances
• Poor sperm quality (e.g. low sperm count, or sperm that can't move well enough or have an abnormal shape)
• Blocked vas deferens tubes, preventing the sperm from leaving the body during ejaculation
• Erectile dysfunction

Fertility can also be affected by certain diseases and infections, as well as genetic, psychological or environmental factors. Any of these causes, either alone or together, may make it difficult to conceive a child. Sometimes no clear cause is found, though.

Age also plays a big role when it comes to fertility: The older a couple is – especially the woman – the more unlikely it is that they will conceive naturally soon after starting to try for a baby.

Prevalence

It is estimated that in Europe about 1 to 2 out of 100 women between the ages of 20 and 44 do not conceive a first child despite having regular unprotected sex for several years. About 10 out of 100 women who have already given birth to at least one child have this problem when trying for a baby.

Diagnosis

Because the cause of infertility can be problems related to the man, the woman or both, it's important that both also see a doctor about it. The appointment will usually involve an in-depth talk with the doctor, a physical examination and a blood test. The hormone levels in the blood are usually measured. Men will also have a sperm test and women will have an ultrasound examination of their womb, ovaries and fallopian tubes.

Treatment

There are a number of different treatments for infertility. The exact kind of treatment will mainly be determined by what sort of problem has been diagnosed in the woman or man. For instance, hormones may be used if the woman has an abnormal menstrual cycle. Surgery may be helpful if she has fibroids. Some causes of infertility in men can also be treated with hormones or surgery.

If not enough sperm is produced or if the sperm cells don't move enough, the sperm can be transferred directly to the woman’s womb. This procedure is called artificial insemination. It is also a treatment option if the couple can't have sex or if the sperm can't pass through the cervical mucus. One alternative is artificial fertilization outside the body (in vitro fertilization, or IVF): In this procedure, eggs are removed from the woman’s ovaries through the vagina using a thin hollow needle, and then combined with sperm from the man. Before the eggs are removed from the woman's ovaries, she has hormone therapy to stimulate her ovaries to release several mature eggs during the course of a single menstrual cycle. This hormone therapy can have very unpleasant side effects.

The actual fertilization takes place outside of the woman's body in a laboratory. In IVF, sperm cells are added to an egg cell, and they then fertilize the egg cell on their own. In intracytoplasmic sperm injection (ICSI), one sperm cell is injected directly into an egg cell using a thin needle.

If the fertilization is a success and the egg cells continue to develop to the next stage (embryo), the doctor implants up to three embryos into the womb after a few days. If more egg cells develop into embryos, the woman can decide to have them frozen (cryopreserved) or destroyed. This also applies to egg cells in a stage of development called the pronuclear stage, in which the chromosome sets (genes) in the sperm and egg cells have not yet fully joined together. Cryopreserved embryos or fertilized egg cells can then be thawed out for use in a later menstrual cycle if the first attempt is not successful.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. You can read about how to find the right doctor in our "Health care in Germany" topic, and our list of questions can help you to prepare for your appointment.

Sources

• Deutsches IVF-Register (DIR). Jahrbuch des Deutschen IVF-Registers 2016. Journal für die Reproduktionsmedizin und Endokrinologie 2017; 14(6): 275–305.
• Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Sperm analysis parameters as an indication for intracytoplasmic sperm injection (ICSI) instead of in vitro fertilization (IVF): Final report; Commission N12-02. 2014.
• Pschyrembel Online. 2022.
• Weyerstahl T, Stauber M. Gynäkologie und Geburtshilfe. Thieme; 2013.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.