In this article you will learn the following
FATIGUE CLINIC – NOTHING SO NORMAL LIKE THIS
When couples can't have children, something is wrong. That's the consensus. Many factors have to fit together. Unfortunately, there is no guarantee.
Nevertheless, many factors can be optimized with medical help. The way to the fertility clinics is often difficult, but just as often helpful.
If getting pregnant doesn't work out, many doctors have the right reason ready. Stress. It must be stress, maybe age too. But definitely stressful. If the woman with an unfulfilled desire to have children is over 35 years old and possibly still working full-time, it is clear that it must be stress, which is why it does not work out. Too much time stress, too much pressure. It doesn't matter whether she puts pressure on herself or whether it is imposed on her from outside. Pressure, doctors quickly learn, is a barrier to pregnancy.
And here's the well-intentioned advice: „Don't think about it, leave it alone and it will work out.“
The friendly specialist often ignores the fact that this did not help in the slightest for a year or even several years. Then it says that in their old age they have to be patient. Even the fact that women over 35 in their circle of acquaintances become pregnant unexpectedly, quickly and spontaneously does not prevent some gynecologists from sticking to their stress theory and not taking a closer look.
Of course, a woman's fertility decreases rapidly from the age of 35 and the chance of becoming pregnant in one cycle is only about 10 percent. And of course it can take some time before the body takes the ten percent chance and fertilizes an egg. But if that is not the case, after six months, after a year, then the doctor treating you should take a closer look and investigate the causes.
This often happens not to a sufficient extent. The local gynecologists are not always well trained in matters of unfulfilled desire to have children and rarely show you the package insert from the fertility center without being asked. They often like to dismiss the unfulfilled desire to have children as an undesirable banality or that women are too impatient.
On the one hand, this can waste valuable time, and on the other hand, the patient feels misunderstood and not taken seriously, which means that those affected do not like to talk about it even in their normal environment and the topic continues to be taboo.
40 is the new 30 – one would think
There are around 120 fertility clinics in Germany. In addition, there are of course countless practices that also specialize in fertility therapy – without immediately resorting to the last resort. Because artificial insemination is not always necessary.
In metropolitan areas such as North Rhine-Westphalia alone, there are 23 fertility clinics that cannot complain about a lack of patients.< /p>
With 2 million couples in Germany it doesn't work at all, with 6 million it takes a very long time. And yet many of those affected find it difficult to talk about it because the social pressure is too great. The performance-oriented society we live in seems incapable of accepting a dysfunctional nature. We can control everything else and have it in our own hands how we want our life to go. But when it comes to having children, we have to – maybe as one of the last things in the world – trust that nature is kind to us. Our society cannot simply accept that.
First in the media and then in our heads it resonates that today's modern woman has all the time in the world to to have children. Making a career first, concentrating on your job and then starting to think about family planning in your late thirties is no longer considered „late“ but normal.
But when nature doesn't cooperate and refuses to serve a couple trying to have children, it is perceived as an unwanted exception, an anomaly of the body that is associated with shame.
But actually it is the paradox of our time. Women should work longer and have children later, this is fully accepted by society. But if having children doesn't work or only works with difficulty, which is in the nature of things, it is viewed with suspicion and is no longer socially acceptable, no longer corresponds to our new social norm. Outside pressure on childless couples trying to conceive is increasing and intense.
Quite a few women and couples who, for whatever reason, are unable to have children experience this on top of their own sense of failure. They receive suggestions from outside as to when the right time would be for a child. And be it through the constant question: „When is that time for you?“
Hardly a couple dares to give the honest answer: „We would like to, but it just doesn't work. That is private and has a lot to do with shame. Of course it has. But wouldn't the societal pressures feel a little less onerous if more women and men, despite all the demands placed on them, were talking about the fact that it just doesn't work?
When we talk about it, we often find out that other people feel the same way or that it took a long time and that we were helped. Because there are more couples than you might think who don't just get pregnant spontaneously. For various reasons: age, physical limitations, increasing environmental influences, increasing pressure in the meritocracy, to name just a few possible causes.
And so many couples secretly sneak into the fertility clinic because they have not received any support from other doctors. Because they are tired of waiting, hoping and worrying. And because somehow word gets around that there are good fertility clinics. And not so few.
The first step into the fertility clinic
Getting there is not always easy. Opening the door of a mostly very large practice or clinic for the first time, immediately feeling the friendly smile of the receptionist as encouraging and knowing, meeting other couples in the waiting room, feeling their nervousness. None of this is easy.
And yet the oversized poster for the fertility clinic practically praises the fact that their desire to have children is a promise. That gives hope. And rightly so.
It is recommended to take the first step after about a year of unsuccessful attempts. Women over the age of 35 are often advised to see a specialist in a fertility clinic after just six months because they have fewer fertile years on average.
Which is often underestimated , is the woman's age. It's hard to believe that nature is the „40-is-the-new-30 trend“ participates and has adapted to it.
From the age of 35, the fertility of women decreases significantly. Even if prominent women in the media show us how easy it is to get pregnant over 40. It often isn't. And the fact that this can involve long and expensive treatment in a fertility clinic is often concealed. It's not talked about.
Of course, at the beginning of every treatment in a fertility clinic, there is a research into the causes. This is no different in fertility clinics than in gynecological practices that specialize in the unfulfilled desire to have children. One should not expect clairvoyant abilities. Often there is simply no apparent reason why it hasn't worked so far.
Further diagnostics then includes a complete hormone level of the man and woman, which is determined by a blood sample can be examined and broken down.
In addition to the thyroid hormone, many doctors in fertility clinics value the anti-Mullerian hormone (AMH). In older studies, a correlation of the value with the success of a pregnancy was found. Put simply, the anti-Müllerian hormone is a marker for how many fertilizable egg cells mature in the woman's ovaries in a cycle. Some doctors conclude from this how many egg cells capable of being fertilized will generally mature in the woman. If the value is below 1, many fertility doctors sound the alarm and predict the rapid onset of menopause. The desirable value of AMH is 2.5. Since many fertility clinics only have this value determined in the laboratory, there are also many doctors who do not consider it important for the diagnosis and completely neglect it. It is important for many fertility clinics when artificial insemination, i. H. in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
Because the goal is to get as many oocytes as possible from the ovary in one cycle in order to be able to select the oocyte with the best quality and ultimately the chances of a successful one increase fertilization.
Treatments in the fertility clinic
Depending on the causes of the unfulfilled desire to have children, it is sometimes sufficient to simply give your fertility a boost, i.e. to correct some thyroid values with medication or to adjust certain hormone values.
A second examination, which precedes everything, is the man's spermiogram. In the spermiogram, the sperm are examined after 3 to 5 days of abstinence for certain criteria such as quantity and mobility.
Unfortunately, there are different definitions of the normal range. According to the latest WHO (World Health Organization) definition, there should be at least 15 million sperm per milliliter of ejaculate and a forward mobility of at least 32%.
If the man's spermiogram is unremarkable, cycle monitoring is often initiated. This is nothing more than the observation of the female cycle with the help of an ultrasound examination. When does an egg hatch and how many eggs mature in a follicle. With the help of blood analyzes and ultrasound, the expected ovulation can be calculated well and sexual intercourse can be „prescribed“ at the right time. Sometimes ovulation is also triggered by the administration of hormones.
However, if one of the reasons for the lack of success is the amount, quality or motility of the man's sperm cells, an „insemination“ tries. This means that the man's sperm cells are processed and, in the best case, are introduced into the uterus with a small catheter in front of the fallopian tubes as easily mobile sperm cells.
Another method that may involve the greatest effort for women is in vitro fertilization (IVF), i.e. fertilization in a test tube. In many fertility clinics, in-vitro fertilization is used when the main reason for the infertility lies with the woman (e.g. blocked fallopian tubes, endometriosis).
After weeks of hormonal stimulation, the egg cells are removed under short-term anesthesia. After appropriate preparation, the egg cells and sperm are placed in a nutrient medium for about 20 hours. During this time, fertilization takes place. Ideally, up to 3 embryos can then be placed in the uterus.
If the sperm cells are very immobile, they can also be introduced directly into the previously removed egg cell with an intracytoplasmic sperm injection (ICSI) with a small syringe. In this way it is possible to fertilize the egg cells directly without the sperm having to travel any further.
If the treatment is longer or women of younger age simply want to save their good quality eggs for a later date, the „Social Freezing“ in the fertility center. Social Freezing“ gives patients the opportunity to have an „oocyte reserve“ to create. After hormonal stimulation, the egg cells are removed under a short anesthetic and frozen using a special procedure (vitrification). If necessary, the oocytes can later be thawed, fertilized and used as embryos.
But let's be honest, all these options don't sound very tempting at first, because they often involve lengthy hormone treatments so that the doctors can even get to the woman's eggs. For each artificial insemination, the specialist in the fertility clinic needs more than one, in the best case even 20 follicles, which mature into an egg cell in the ovary in order to make successful fertilization likely.
The fertility clinic's chances of success
Miracles are not always to be expected. And the chances of success depend heavily on personal circumstances – for example on the nature of the fertility problem, the duration of the infertility or the age of the woman and man. Psychological aspects and the question of how many treatments one is willing to undergo also play a role in success.
Exorbitant chances are unfortunately not to be expected. Anyone who expects a success rate of 50 percent is wrong. The average success rate of all fertility clinics and all possible treatments is no more than 20 percent.
Many treatment methods only achieve a rate of 10-15 percent.
Nevertheless, for many couples, these numbers mean a 20 percent increased chance of having a child, which they would not have had without the fertility clinic.
Although success cannot be guaranteed, it is always worth a try. However, couples and women should take one step at a time, weigh up treatments, and most importantly, listen to your gut and trust your body. Not every hormone drug is good for you, not every pain or altered feeling is normal and requires no further action.
Maybe it takes some getting used to not all specialists in the fertility clinic seem to be psychologically trained and do not always treat their patients as sensitively, or you have to change fertility clinics. However, you should always feel that you are in good hands. Because in this emotionally difficult phase of fertility treatment, it can be an additional burden not to feel optimally cared for. But that's what you need for successful treatment in the fertility clinic.
Trust, a good feeling and courage. But it's worth it.