The causes of being unable to have children can be quite different, which is why an in-depth consultation followed by meticulous diagnostics are most important. In most cases of couples who would like children, but can’t have any, neither are completely infertile, but either the man or the woman has a more or less serious infertility problem.
Modern reproductive medicine offers a wide range of therapeutic options which can be used depending on the underlying causes and matched to the couple’s individual needs:
(1) Simple hormonal support via treatment with insemination
(2) Artificial fertilization outside the mother’s body by in-vitro fertilization (IVF)
(3) Intracytoplasmic sperm injection (ICSI)
(4) Special sperm selection procedures
The treatment of women with multiple miscarriages and counseling on how to retain fertility before chemotherapy also falls within this discipline.
Gynaecological endocrinology is that speciality within gynaecology that diagnoses and treats hormonal imbalance. It diagnoses and treats hormonal disorders in connection with the menstrual cycle, and thus with ovarian function. For example, ovarian dysfunction may result in shortened, prolonged, or irregular menstrual cycles, or even in none at all. Menstrual cycle disorders, i.e. irregular periods or the absence of periods occur most often during the first few years after the menarche (first period) and at the beginning of the menopause. They may also be associated with other complaints such as the formation of ovarian cysts, involuntary weight gain, acne, osteoporosis, unwanted lactation, increased body hair or alopecia, the polycystic ovary syndrome, unwanted childlessness, or with eating disorders such as anorexia. A hormonal imbalance sometimes also causes cyclic headaches, mood swings such as premenstrual syndrome (PMS) or painful periods.
(1) Women take medicines (tablets or injections) that mature the egg cells and trigger ovulation.
(2)The man’s sperm is processed in the laboratory to filter out the motile, normally formed sperm. These are then introduced into the woman’s uterus through a thin tube at the time of ovulation.
(3) Fertilisation occurs outside the mother’s body. The egg and the sperm are mixed in a glass dish and, after fertilisation, the embryo is introduced back into the uterus through a thin tube (embryo transfer).
(4) In cases where the man has a serious fertility disorder, one single sperm is injected directly into the egg cell under a special microscope.
(5) Microsurgical epididymal sperm aspiration (MESA)/testicular sperm extraction (TESE). MESA stands for gathering sperm from the epididymis. In TESE the sperm is taken from the testis. Both methods are then combined with ICSI (see 4).
(6) For example, fertilised cells can be frozen and stored for up to 5 years before introducing them into the woman’s uterus at a later time.