On the way to the child

For one in six couples in Switzerland, the desire to have a child does not come about naturally. A wide range of diagnostics and therapies are available to patients at the University Hospital Zurich. Samia El-Hadad, senior physician at the Fertility Center of the USZ, explains in an interview what makes sense and when.

When should an unfulfilled desire to have children be medically clarified?

In principle, an examination is indicated if pregnancy does not occur after twelve months of regular, unprotected sexual intercourse. In women over the age of 35, an examination is recommended after just six months – because the quality of the eggs decreases and there is an increased risk that the ovarian reserve is already low and treatment is urgently needed.

What can doctors in private practice do in the event of an unfulfilled desire to have children?

An initial assessment always includes both the woman and the man. Experience shows that in around 30 percent of cases the cause lies with the woman, in 30 percent with the man and in 20 percent with both at the same time. This means that a cause can be found in almost 80 percent of couples – in twenty percent of cases this remains unexplained.

Which examinations are part of an initial assessment?

In addition to the general medical history of the woman’s state of health, the hormone status is of central importance. This makes it possible to identify common hormonal disorders such as polycystic ovary syndrome, which can lead to infertility. The initial assessment also includes an ultrasound examination of the ovaries and uterus and a follicle count (antral follicle count). This allows fibroids, polyps or diseases such as endometriosis to be detected.

What does the initial assessment look like for men?

A spermiogram is the central examination here. If there are any abnormalities, the analysis should be repeated after about three months, as sperm quality is subject to natural fluctuations. In addition, it makes sense to have a so-called trial treatment carried out. This tests how suitable the sperm are for fertilization. A spermiogram and a trial preparation are usually arranged by registered doctors via a specialized laboratory or can be carried out directly at the USZ.

What other examinations or treatments can be carried out by a doctor in private practice?

If the woman’s hormone status is unremarkable, cycle monitoring is recommended. It is also important to ensure that you have sufficient iron and vitamin D levels, as this can have a positive effect on fertility. In addition, a so-called monofollicular stimulation treatment can be carried out. This involves specifically supporting the growth of an egg until ovulation, either with tablets or injections. The aim is to promote egg maturation and to optimally coordinate sexual intercourse with ovulation. However, the prerequisite for this is that the man has also been examined beforehand. This is the only way to ensure that the sperm quality allows pregnancy to occur naturally – otherwise the woman would be treated unnecessarily.

What are the next steps for the man if the spermiogram was abnormal?

A blood test can identify infections or low testosterone levels as the cause of low sperm quality. It also includes an examination of the reproductive organs to detect any diseases, for example blocked ducts in the testicles or a high or low testicle. Risk factors such as smoking, sauna or excessive cycling should be addressed during the consultation – all of these can impair sperm quality. Conversely, certain dietary supplements or preparations containing zinc or selenium can support sperm formation.

When should couples be referred to a hospital like the USZ?

A referral is particularly useful if the examinations reveal abnormalities that could make artificial insemination necessary. In women, for example, this is the case if the menstrual cycle is disrupted, the fallopian tubes are blocked or if larger fibroids or polyps change the uterine cavity in such a way that the implantation of the embryo is impaired. In men, very poor sperm quality would be a reason for a referral. In general, we can help with unclear findings, as we have additional diagnostic and treatment options at the USZ.

What are they?

With our water ultrasound (hydrosonography or hydrocontrast sonography) and 3D ultrasound, we can examine the uterus more precisely than with a conventional ultrasound. This also allows us to detect an obstruction of the fallopian tubes. Another advantage of the USZ is that psychological and sex therapy counseling is available in connection with the unfulfilled desire to have children. We also offer special examinations for unfulfilled desire to have children after repeated miscarriages. These include blood tests for coagulation factors, biopsies for chronic endometritis and immunological and genetic tests.

How often can an unfulfilled desire to have children be successfully treated?

If the age of the patient is not too great, treatment is usually feasible and promising. If possible, we tackle the causes, i.e. treat hormonal disorders or improve sperm quality, for example. Depending on the results of the preliminary examinations, we at the USZ also offer treatments such as intrauterine insemination (IUI), in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), if necessary with genetic testing of the embryos. In total, 65-70 percent of couples are able to conceive.

Is the number of couples affected increasing?

Yes, the unfulfilled desire to have children is increasing – especially because couples want to become parents later. The age of the woman in particular is an important limiting factor, another is the declining sperm quality in men. In the latter case, lifestyle factors and presumably certain environmental factors play a role. In addition to smoking, an unhealthy diet and a lot of sitting can also reduce sperm quality. Although psychological stress may exacerbate the problems in both sexes, studies have shown that it is not an independent medical cause of infertility. Obesity, on the other hand, is a clear risk factor for both men and women. It reduces the quality of both the sperm and the eggs. In this respect, a fundamentally healthy lifestyle also helps on the way to a fulfilled desire to have children: a Mediterranean diet, enough exercise and avoiding nicotine and, if possible, alcohol.