Causes in women

Social developments in recent decades have contributed to many couples starting a family much later. Women under the age of 35 have an 80-85% chance of becoming pregnant spontaneously within 12 months. From the age of 35, a woman's natural fertility decreases noticeably. At the same time, the risk of miscarriage increases. The success of fertility treatment is also significantly influenced by the woman's age. Preimplantation genetic diagnosis (examination of the embryo's genetic material) can help to have a child more quickly, especially in women over 37. If pregnancy has not occurred after 6 months despite regular sexual intercourse, women over the age of 35 should consult a specialist for unfulfilled desire to have children. We would also be happy to provide you with more information in a personal consultation. Make an appointment directly.

Even before a girl is born, her immature eggs migrate to the two ovaries, where they remain in a dormant phase, protected in small follicles, until puberty. During puberty, the ovaries take up their function, namely the production of mature eggs and the two most important sex hormones in women, oestrogen and progesterone. The woman's cycle is controlled by the small pituitary gland (hypophysis). Under the influence of follicle-stimulating hormone (FSH), a dominant follicle (egg follicle) matures in the first phase, the so-called follicular phase, in which an egg cell is located. Triggered by complex hormonal signals, ovulation occurs and the egg cell reaches the fallopian tube, where it is fertilized by a sperm cell. Occasionally, this complex hormonal cycle is disrupted and ovulation occurs rarely or not at all. Typically, the monthly menstrual period is then absent or only occurs irregularly.

The fallopian tubes are the connection between the ovaries and the uterus. During ovulation, the fan-like projections of the fallopian tube extend over the dominant follicle of the ovary and receive the mature egg, which is fertilized by a sperm cell in the fallopian tube. Very fine hairs transport sperm to the ovary and the embryo away from the ovary into the uterine cavity. After successful fertilization, the embryo travels through the fallopian tube for around five days and finally reaches the uterine cavity, where it implants. Infections, adhesions and scars or endometriosis can impair the function and mobility of the fallopian tubes or block them completely.

Endometriosis is a chronic inflammatory disease that occurs when the lining of the uterus is located outside the uterine cavity. If these endometrial nests are located in the muscular uterine wall, this is referred to as adenomyosis. Endometriosis may or may not be painful and the symptoms usually occur during menstruation. Endometriosis can also be a cause of infertility. If the symptoms are severe, endometriosis can be treated with medication or by surgically removing the foci. In vitro fertilization (IVF) has proven to be a successful treatment for endometriosis. We would be happy to provide you with more information in a personal consultation. Make an appointment directly.

These foreign words refer to benign neoplasms in the uterine cavity. Polyps are found quite frequently. They are almost always harmless neoplasms of the uterine lining. However, they can hinder the implantation of the embryo. This is why they are removed during a hysteroscopy. Occasionally, fibroids (benign neoplasms in the uterine wall) are also found. If these protrude into the uterine cavity or lie directly under the mucous membrane, surgical removal (as part of a hysteroscopy) is usually recommended. Adhesions in the uterine cavity can also make it difficult for the embryo to implant or lead to miscarriages. These adhesions are removed during a hysteroscopy.

Miscarriages are common in humans. Around 20% of all pregnancies end in miscarriage very early - before the 12th week of pregnancy. Miscarriages, especially if they occur repeatedly (more than two miscarriages), are very stressful and frustrating.

The woman's age plays an important role in repeated miscarriages, as the probability of a chromosomal abnormality in the embryo and therefore a miscarriage increases with age. By far the most common cause is defective genetic material in the embryo. However, this does not mean that the genetic material of the parents is faulty.

Chronic inflammation of the uterine lining, chronic endometritis, can be accompanied by bleeding disorders and repeated miscarriages. Chronic endometritis is not an infection, but a change in the immunome of the uterine cavity. Chronic endometritis leads to an increase in plasma cells in the uterine lining. Plasma cells are an important component of the acquired immune system, they produce antibodies and, if they are present in too high a concentration, can disrupt the implantation of the embryo as well as the early pregnancy. Chronic endometritis is associated with infertility and repeated miscarriages. The extent to which changes in the genital microbiome are causally involved in the development of chronic endometritis is the subject of current research.

Rare causes of recurrent miscarriages are malformations or adhesions of the uterine cavity, functional disorders of blood clotting, thyroid function, sugar metabolism, autoimmune diseases and changes in the number or composition of chromosomes in one of the partners. Investigations should be carried out after three consecutive miscarriages at the latest.

We recommend an ultrasound and hormone examination after just two miscarriages. We would be happy to inform and advise you about this in a personal consultation. Make an appointment directly.

Despite all efforts and conscientious investigations, 10-20% of couples with an unfulfilled desire to have children are unable to find the cause of their inability to conceive. However, fertility treatment can still be carried out successfully.

Sexual dysfunction is not uncommon. Sexual intercourse can be painful for both men and women or very difficult due to severe cramping of the female pelvic floor muscles. Lack of desire, reduced sexual arousal, a lack of or weak erection and premature or absent ejaculation are among the most common sexual dysfunctions. Some couples have consensual sex only very rarely or not at all. If the couple or one of the partners suffers from sexual dysfunction, treatment is possible.