Influencing factors explaining why the desired pregnancy is not achieved

Even if it’s not true statistically: 50% of the reasons why a woman is not getting pregnant are caused by the woman, 50% are caused by the man and 50% are caused by both. In most cases, infertility is the reason why a desired pregnancy is not achieved, the influencing factors for this, however, are different, like for example lifestyle, age, or diseases. Unfortunately, "infertility" is still an absolute taboo topic, causing fears of failures, stress and shame to the people affected. Another problem is that infertility is often detected very late and may stand in the way of fulfilling your wish for a child.

But when is a man actually infertile? 

The sterility of most "infertile" men is caused by the quality of their sperms. The cause is in particular based on changes in the quality of the semen. When we refer to the quality of the semen, we distinguish three potential changes. Either the number of sperm cells is reduced, or their motility is restricted, or the appearance of the sperm cells is noticeable.

Deformed or immobile sperms can only advance the egg with difficulty or not at all. The number of sperms produced also plays a role for this. Normally, one millilitre of sperm fluid approx. corresponds to 20 million sperms. If less than 30 percent are formed normally and 50 percent or more are immobile, the man is considered infertile.

What are the reasons for a poor sperm quality?

A poor sperm quality in most cases has hormonal reasons. Further reasons can be an injury of the testicles, congenital malformation, infections or diseases such as mumps and diabetes, varicose veins, drug consumption or environmental influences and detrimental influencing factors such as excessive smoking, excessive alcohol consumption, environmental toxins such as heavy metals or plant protection agents and permanent overheating or hypothermia of the testicles.

As the man grows older, the natural number of his sperms and their motility is reduced. Recent studies confirm that 20% of the men between the age of 18 and 25 are provided with an unnaturally low number of sperms, which is mainly attributed to an unhealthy lifestyle. The average proportion of sperm cells of a healthy man is currently 60 m/ml.

 

What can the female partner do?

Apart from a healthy lifestyle and the frequent visit at your gynaecologist, you should not postpone your desire to get pregnant not too far to the future. If you’re uncertain, a fertility test can give you the certainty and even tell you with high precision how long you’ll still be fertile. If a pregnancy is not achieved, we strongly recommend clarification. But the question is:

 

When is one actually considered as “not getting pregnant”?

The basic rule is: a woman is “not getting pregnant” if she has not been doing birth control for 1 year and a pregnancy has not been achieved. However, this only applies to patients to the age of 35. After that, it is already considered noticeable if the woman has not got pregnant after 6 months without birth control. What’s fascinating is that there is a mathematical incongruity in the reasons why a pregnancy is not achieved.

 

An earlier use of hormonal contraceptives can also temporarily reduce female fertility. A condition following miscarriage and pregnancies outside the uterus, i.e. ectopic pregnancies, also means that it’s recommendable to seek professional assistance. For approx. 1% of the women, early menopause, i.e. menopause before the age of 35, is the reason. In this case, an egg donation may be the remedy. 

 

Why does female fertility decrease?

The reserve of egg cells in the female ovaries is already established at the embryonic stage. Every woman is born with approx. 400,000 immature egg cells, which only become active with sexual maturity. Every month, some eggs mature, from which, however, in most cases only one ovulates, is then fertilised and can thus produce pregnancy. Eggs are the few body cells which are not continuously renewed after birth. By the advanced age, damage may form on the DNA, which can then cause fertilisation issues or embryonic abnormalities. Increasing age, in addition to infertility issues, also increases the probability of having a child suffering from trisomy.

 

What are the greatest risk factors causing fertility issues? 

From the age of 32, female fertility declines at an increasing speed. Therefore, age is the greatest risk factor when it comes to desired, though unachieved pregnancy. Egg cells are approximately 8 months older than the woman herself, since they are already created in the embryonic stage of the woman in the fourth week of pregnancy in the yolk sac from which they mature later on. In the process of polar body diagnosis, the genetic functional capability of the eggs with increasing age is measured.

  • At the age of 20, approx. 90% of the egg cells are fertile
  • At the age of 30, only approx. 50% of the egg cells are fertile
  • and at the age of 40, this only applies to approx. 10%

Additionally, numerous factors concerning the lifestyle play a major role: smoking, alcohol and stress reduce the fertility as well as severe obesity and underweight. Certain diseases can also have a negative impact on the fertility or sometimes even cause infertility.

Which diseases have an impact on the fertility

Possible reasons why pregnancy is not achieved are for example a disruption of the follicles and their growth, blocked fallopian tubes, or mechanical obstacles in the uterus.

Endometriosis: These are a benign growth of the endometrium, outside of the uterus. Most frequently, the focus of these diseases is in the lower abdomen, on the ovaries and the fallopian tubes. Since this tissue is also subject to the cycle, bleeding at regular intervals occurs there, which can be accompanied by intense pain, the formation of cysts, inflammations and adhesions.

PCOS: The polycystic ovary syndrome is a hormonal disorder which produces an increased testosterone level, the male sex hormone, and therefore brings about cycle disorders and fertility issues. PCOS patients suffer from an enlargement of the ovaries by the formation of cysts. The reason for this is that although the egg cells mature, however, there is no ovulation and the egg cells remain in the follicles in the ovaries. This disorder is also referred to as the PCO syndrome or Stein-Leventhal syndrome, hyperandrogenic chronic anovulation or functional ovarian hyperandrogenism.

Blockage of the fallopian tube due to inflammations: Rising abdominal inflammations may cause a blockage of the fallopian tubes. A laparoscopy provides certainty about a potential blockage of the fallopian tubes.