Munich - It can drive a couple to despair when their efforts to start a family do not bear fruit. The ache is compounded if many of their friends, relatives and colleagues have children, and at the sight of advertising showing smiling little bundles of joy.
There are many such couples. Some 680,000 babies are born in Germany every year, but experts estimate that about 15 per cent of the country's couples remain childless against their wishes. And the number is growing.
"An unfulfilled desire for children is a tremendous burden for the men and women involved," noted Anke Rohde, director of gynaecological psychosomatics at Bonn University Hospital and a member of the German Society of Psychiatry, Psychotherapy and Neurology (DGPPN).
Rohde said that frustration over the inability to conceive, and the loss of control over planning their lives, could seriously dent couples' self-confidence. So many are quick to consider assisted conception in specialized clinics.
Christian Albring, president of the Munich-based German Association of Gynaecologists, warned against resorting to medical assistance too quickly, however.
"There are several other methods that one can try first," he said.
The first sounds simple but is quite effective. "The woman should take close note of her menstrual cycle to determine, depending on its length, when ovulation occurs," Albring said. "Couples frequently say they've been trying for a long time, but don't take into account that after work they often have no desire for sex and therefore miss the date. In some cases their sexual relations are confined to weekends."
It is crucial for conception that sexual intercourse take place on the days around the woman's ovulation. It is also important that couples not have sex too frequently before then because the man's sperm count returns to optimal levels only after three days.
"At the time in question, couples should have intercourse every other day," advised Albring. If the woman still fails to get pregnant, a gynaecologist can use ultrasound to examine whether she has any ovarian follicles.
"If several attempts meet without success, a gynaecologist can check the permeability of the fallopian tubes, do a hormone analysis of the woman and a spermiogram of the man," Albring said. All these procedures can be done at a gynaecologist's practice.
Should this also fail to solve the problem, a fertility clinic could help. Christian Friedrich Stoll, a doctor at the Berlin Fertility Centre, said, "We try, for example, to stimulate, and thereby optimize, the menstrual cycle with the aid of hormones."
If the man has sperm, but a spermiogram indicates problems with their number, shape or mobility, a fertility clinic can perform an artificial insemination. The best spermatozoa are implanted directly in the uterine cavity by means of a small tube, Stoll explained.
Another method is in vitro fertilization (IVF). It is used, for example, when the woman's fallopian tubes are blocked. "Egg cells are extracted and combined with sperm cells in a laboratory dish," Stoll said.
If the quality of the sperm cells is too low for this, they can be injected directly into the egg cell, a procedure called an intracytoplasmic sperm injection (ICSI).
The attempts at conception are not always successful, as a number of studies have shown. "The chances of becoming pregnant by means of artificial fertilization procedures such as IVF or ICSI are about 30 per cent on average," Albring pointed out. (dpa)
