Having Trouble Conceiving
Although most (fertile) couples become pregnant within one year (rate approx. 30% per cycle), it happens again and again that despite unprotected sexual intercourse, pregnancy does not occur. Taking into account the above-mentioned pregnancy rate per cycle, the desire for a child is usually medically described as "unfulfilled" after one year of regular unprotected sexual intercourse without a successful pregnancy1.
There are many different factors which alone or in combination can be responsible for the difficulty in getting pregnant. The positive aspect is that most (untreated) couples achieve a birth rate of 55% within 36 months! During this time, Daysy can be a good strategy to support you on your way to conception.
It is well known that the reproductive behavior of the western world has changed dramatically over the last 25 years. Today, parenthood is planned and implemented specifically with the personal education and career goals of both partners in mind. The current situation in the labor market plays a very important role in this context. For example, women with academic degrees are on average 32 years old when giving birth for the first time2. This means it is not unusual that 20 years of contraception use precede the desire for children. Conversely, this means that less than 25% of the fertile years are used for the desire to have children - and these 25% are biologically the least fertile years. With this background knowledge, it may indeed well be that a planned desire to have children does not occur immediately.
What are the first steps?
Important to know in advance: if you do not get pregnant for more than a year, please always seek the advice of your doctor. If you are over 35 years old, a consultation is advisable after six months.
Daysy and your personal temperature curve are the ideal basis when consulting your doctor. The length of your menstrual cycle or abnormalities within the temperature curve can give you a first helpful indication of whether you are ovulating regularly or, for example, whether your thyroid gland is underactive. Based on the discussion with your doctor, he/she will make a diagnosis and suggest a suitable therapy (if necessary).
In the first step, a so-called cycle monitoring is carried out in most cases to obtain meaningful values for diagnostics.
In most cases the cycle monitoring includes three appointments during your menstrual cycle:
- 1st appointment: on the 3rd - 5th day of the cycle for taking blood samples to determine hormone levels
- 2nd appointment: on the 10th-12th day of the cycle for ultrasound examination and determination of blood values
- 3rd appointment: 5-8 days after ovulation for blood sampling
Ideally, you can use Daysy and your temperature curve to customize the described appointments with your treating physician and provide the ideal basis for his/her diagnosis.
If the cycle monitoring shows that there is no or insufficient follicle maturation, the next step is usually hormone stimulation with Clomiphene3.
What is clomiphene and how does it work?
Clomiphene has been used for ovarian stimulation therapy since the 1960s. Despite its use over many years, the complete understanding of its mechanism of action is still missing. It is believed that clomiphene inhibits the estrogen receptors and leads to the release of the hormones FSH (follicle stimulating hormone) and LH (lutarisizing hormone). The released hormones stimulate follicle maturation and lead to ovulation.
When using clomiphene, Daysy can help you to take the medication at the right time and after consultation with your doctor, observe whether ovulation has occurred. For women with ovulation problems, there is a 70-80% chance of success in achieving ovulation. About 10-13% of these ovulations lead to pregnancy.
How effective is a treatment?
If the fertility is disturbed more permanently, IVF (in-vitro fertilization) or ICSI (intracytoplasmic sperm injection) treatment must be considered. The chances of success here are 20-30% per treatment attempt. About 60-80% of couples become pregnant after several treatments.
The male should have his sperm checked
A man’s infertility can also be the cause of an unfulfilled desire to have children - just as often as a woman’s infertility is the cause. In most cases, the testicles are the main part of the root cause analysis.
An unhealthy lifestyle (obesity, nicotine, drugs, alcohol, stress) and harmful environmental influences (pollutants, pesticides) damages the fertility of both men and women. However, there are gender differences in the physical causes.
An infertile man usually does not produce enough healthy, mobile sperm. This is revealed by a semen examination in which a spermiogram is made: normally, each milliliter of sperm fluid (ejaculate) contains at least 15 million sperm - one of the prerequisites for procreating. But the quantity alone is not decisive: at least 58% of the sperm must be alive, at least 32% with good mobility and at least 4% normally shaped.
The infertility diagnosis puts a strain on a couple’s relationship. Regardless of the cause of infertility - both partners should be in agreement when deciding on infertility treatment in order to walk this path together. Understanding, patience and honest communication are crucial during this time!
The male’s sperm quality plays a major role.
Infertility in men is just as often a factor in the unfulfilled desire to have children as infertility in women. Harmful environmental influences, for example pollutants and pesticides, as well as an unhealthy lifestyle, being overweight or underweight, stress and nicotine/drug/alcohol consumption affect the fertility of men and women equally.
However, gender differences are found in the physical causes: When an infertile man has a (spermiogram, it is often diagnosed that too few healthy, well-moving sperm are produced.
Normally, each milliliter of sperm fluid (ejaculate) contains at least 15 million sperm. This is one of the prerequisites for making babies. It is not only the quantity of sperm that is important, but also the quality: at least 58% of the sperm must be alive, at least 32% must be well motile, and at least 4% must be normal in shape.
Infertility is a difficult diagnosis and a strain on the relationship, whether it lies with the male or the female. When deciding to undergo fertility treatment, both partners should be in agreement and willing to walk the path together. Understanding, patience, and honest communication are crucial during this time.
Daysy - Your personal fertility tracker (incl. app DaysyDay)
Daysy is an intelligent fertility tracker that lets you get to know your very own menstrual cycle.
1) Zegers-Hochschild, F. et al. The International Glossary on Infertility and Fertility Care, 2017. Hum. Reprod. Oxf. Engl. , 1786–1801 (2017).
2) Ärzteblatt, D. Ä. G., Redaktion Deutsches. Trend zur späten Geburt: Mütter bei erstem Kind immer älter. Deutsches Ärzteblatt
3) Kinderwunschbehandlung in der gynäkologischen Praxis - Thieme.de - Thieme Webshop - Christoph Keck. Thieme Webshop