Kinderwunschzentrum
Berlin
Ihre Spezialisten bei unerfüllter Kinderlosigkeit und Kinderwunsch für Berlin und Brandenburg

Dr. med. Reinhard Hannen

Dr. med. Christian Stoll

Landgrafenstr. 14
10787 Berlin/ Tiergarten

Web: www.kinderwunschzentrum.de
eMail: info@kinderwunschzentrum.de

Tel.: +49.(0)30.263 983 - 0
Fax: +49.(0)30.263 983 - 99
Praxiszeiten:
Montag, Mittwoch, Freitag: 8.00-12.00, 14.00-18.00 Uhr
Dienstag, Donnerstag: 8.00-12.00 Uhr

Wir bitten Sie nach Möglichkeit um eine Terminvereinbarung.


Kinderwunsch Zentrum Kinderwunschzentrum Berlin und Brandenburg bei unerflltem Kinderwunsch
 
 

Causes of Undesired Childlessness

 

When love does not yield results - possible causes of undesired childlessness.

There are diverse causes of undesired childlessness and these rarely arise from real illnesses such as diabetes or other metabolic illnesses. Of course, personal circumstances such as stress, smoking or obesity can influence the chances of becoming pregnant. In 80% of cases, both partners are factors which compound the difficulty of conceiving.

 

As a result, a lot of small problems can sometimes lead to one big problem….

Examination of the woman:

Female cycle

In order to help you to better understand the complicated processes which are necessary in the lead up to implantation in the endometrium, we will now give you an overview of the natural course of the female cycle.

 

weiblicher Zyklus Kinderwunsch Kinderwunschzentrum Berlin(enlarge)

The female menstrual cycle normally lasts 28 days, beginning on the first day of menstrual bleeding (period) and ending on the day before the start of the following period. A dominant egg follicle begins to grow in one of the ovaries during the woman’s period, which can last between 3 and 7 days.

A single follicle grows throughout the monthly cycle through the minutely synchronized interaction between the ovary and the pituitary gland (hypophysis)

An ultrasound scan in the vagina can provide a detailed image of the ovary and the number of follicles present can be counted. Based on this number of follicles, the doctor can estimate how well the ovaries will react to possible future hormone stimulation.

The follicles generally contain one egg cell. As a result of the release of hormones through the pituitary gland (hypothalamus), just one follicle containing a fertile egg cell matures monthly. This one follicle can open at the right moment (ovulation) and release its contents along with follicle fluid and egg (oocyte).

 

Embryo Kinderwunsch Zentrum Berlin unerfüllter Kinderwunsch(enlarge)

 

Ovulation may not occur if the follicle has not reached the required size. In terms of reproductive medicine, this is often the case in older women. Conversely, ovulation often does not occur in young women because the pituitary gland is not yet capable of supporting the maturing of the follicle to the extent needed.

 

After ovulation, the follicle becomes a so-called corpus luteum. The function of this corpus luteum is to influence the implantation conditions in the womb so that pregnancy can occur.

In healthy women, the lifespan and function of the corpus luteum is aligned to support the beginning of the pregnancy in the first twelve days. Should the lifespan of the corpus luteum be shortened (less than ten days) as a result of unhealthy circumstances or if the function of the corpus luteum is reduced to the extent that the endometrium can not be sufficiently prepared for the implantation of an embryo, then this is referred to as corpus luteum weakness or luteal insufficiency.

 

Hormones:

Hormones are signals which are sent out by one of the body´s organs to have an effect on another organ. The following hormones play a role in assessing the menstrual cycle:

 

Hormones

Oestradiol is the main female sex hormone. It is produced in growing follicles and released into the blood. The larger the follicle grows during its development, the more this hormone is distributed through the blood. If several follicles mature in both ovaries (for example through hormonal stimulation of the ovaries) then the concentration of oestradiol is higher in relation to this.

 

Examination of the womb and the fallopian tubes

Ultrasound:

Should an ultrasound examination reveal irregularities in the endometrium, then this could signal a benign change in the membrane. Such a so-called polyp can alone be a factor which prevents the implantation of the embryo. A further examination is necessary in order to confirm this diagnosis and to establish the size, number and position of the polyps. This second examination involves viewing the womb cavity with the aid of sterile cooking salt.

 

During this examination, a narrow tube is inserted through the cervical canal and into the womb cavity. Then the sterile water is injected into the womb cavity whilst being viewed through the ultrasound. In this way, the shape of the womb cavity as well as possible irregularities in the endometrium can be assessed. This examination is almost always painless. Polyps in the endometrium are found in around 5% of women who are childless for unknown reasons.

 

 

Hysterosalpingo-contrast sonography (echovist):

In a similar examination, a possible blockage of one or both fallopian tubes is tested through the use of a sugar-based contrast substance.
In such cases, the possibility of opening a blocked fallopian tube through an operation or of carrying out test-tube fertilisation from the outset exists. It is particularly important to weigh up the risks here because the fallopian tube can be opened through an operation but the price is an increased danger of ectopic pregnancy.

Echovist Kinderwunsch Zentrum Berlin unerfüllter Kinderwunsch(enlarge)

 

Laparoscopy:

A detailed examination of the fallopian tube function is possible through laparoscopy. An optic with a camera is inserted through the navel into the abdominal cavity after this cavity has been filled with carbon dioxide using a needle. This operation, which can only take place under full anesthetic, allows a direct examination of the abdominal area including the fallopian tubes. In addition, this method provides the opportunity of carrying out operative measures simultaneously. In this way, blockages of the fallopian tubes, which restrict their mobility and thus prevent the collection of the egg cell during ovulation, can be overcome. Abnormal changes such as endometriosis can in some cases be diagnosed and removed.

 

Transvaginal endoscopy (laparoscopy):

This operation method (endoscopy) does not involve making a hole in the navel. In this case, the surgeon inserts the optic through a tiny opening in the vagina and can thus examine the fallopian tubes and the womb. It is an uncomplicated process. Nevertheless, one must be aware of the limitations of this method, as complex removal of concretions in the abdominal cavity and other large operative measures remain beyond the scope of the classic laparoscopy.

 

Examination of the man:

Certain factors which prevent pregnancy occurring can just as often be attributed to the man as to the woman. The examination of male fertility takes place through a spermiogram (ejaculate analysis). Here, the number, movement and shape of the semen cells (sperm) in the seminal discharge are assessed. The diagnosis of factors leading to male infertility is not only drawn from the analysis of the spermiogram but also from the further examination of the male genital organs.

 

Male genital organs::

The assessment of the male genital organs with the aid of ultrasound plays an important role here, although the volume of the testicles is also examined (amongst other factors). In addition, the possibility of the existence of a tumour can in this way be eliminated. Furthermore, the vascular consistency of the testicles and penis can be examined through the Doppler method. The physical examination, which is undertaken by an urologist, pays particular attention to the following:

 

Testicle volume and consistency (firm or soft), the presence of varicose veins next to the left testicle, the shape of the penis (particularly the position of the urethra) and possible cysts in the scrotum or in the epididymis. The results of this clinical examination can validate and enhance the interpretation of the spermiogram and can be compared to the results of the laboratory tests and thus better assessed. The spermiogram only reflects the current state of the man`s fertility. As a result of this, it is worthwhile to repeat the spermiogram analysis after a reasonable time period.

 

Spremiogramm unerfüllter Kinderwunsch Zinderwunschzentrum Berlin(enlarge)

 

Sperm sample, spermiogram:

The analysis of your semen sample in the laboratory comprises the assessment of a diversity of elements, which are considered as a whole in order to evaluate the quality of the semen. The three most important factors here are:

  1. the concentration of sperm (the number of sperm per ml of seminal discharge)
  2. the movement of the sperm in the liquid semen
  3. the shape of the sperm

As well as these three factors, a large amount of additional data is measured as part of the seminal discharge. This data allows us to assess the quality of sperm in detail and thus to also recognize rare forms of male infertility.

 

Explanation of terms related to sperm analyses

The following terms are often used in the assessment of male infertility and are therefore explained here:

Sperm analysis

2. Asthenozoospermia: The movement of the sperm is impaired: less than half the sperm move forwards in the ejaculation fluid

 

Hormone Test:

A hormone test is done in addition to consultation with the doctor, the physical examination and the microscopic examination of the sperm quality. For this, we take a blood sample, in which the concentration of a number of hormones which are important for the assessment of your fertility is analysed: e.g. LH, FSH and testosterone. LH, FSH and Testosterone.

 

Examination of the woman:

Examination of the man:

 

 

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