The Desire to have Children
For most couples, the desire to have children is fulfilled almost naturally. About 15% of all marriages, however, are unintentionally childless. 45% of these infertility problems are caused by feminine issues while another 40% are attributable to male factor infertility. In 10% of infertility cases, interfering factors may be found in both partners. In about 5% of sterile couples, no cause for the infertility can be found even after thorough examination of both partners (this is referred to as idiopathic sterility). The bedrock of any fertility treatment has to be a sound partnership. The dignity of the desired child is of utmost importance when it comes to making a couple's dream of having a child come true by means of recognized medical techniques.
An oocyte grows inside a follicle in a woman's ovary within two weeks after menstrual bleeding. Mechanisms of hormonal regulation then trigger ovulation. The mature oocyte which is then capable of being fertilized is released from the ovary and caught by the fallopian tube, from where it is transported to the uterine cavity. During sexual intercourse, sperm is deposited in the vagina and travels through the cervix and uterine cavity into the fallopian tubes, where only one of those sperm cells will fertilize the oocyte. The fertilized oocyte - now called embryo - begins dividing as it travels through the fallopian tube. It usually takes four to five days after ovulation for the embryo to reach the uterine cavity. Implantation of the embryo into the uterine wall typically occurs about five to six days after fertilization.
Causes for Infertility
Even before implantation in the uterus has occurred, the early embryo may die as a result of either congenital disorders or spontaneously acquired damages. It may also happen that the inner lining of the uterus is not sufficiently prepared for the embryo to implant. Additional cases have been identified where the mother's immune system recognized the embryo as a foreign body and rejected it. When no apparent medical reason can be found in the man or the woman to explain the couple's undesired childlessness, this is referred to as so-called idiopathic sterility. These unexplained fertility problems should be thoroughly investigated with particular attention being paid to psychosomatic aspects. Emotional stress may very well have a marked influence on our bodily functions. In such cases, psychotherapeutic diagnosis is recommended to ensure that adequate steps can be taken (see also: psychological counselling) in order to achieve a successful outcome.
Even though an oocyte has matured properly and there is a sufficient number of motile sperm, there are still many factors that may prevent the fusion of egg and sperm. Problems with the fallopian tubes are one of the most frequently encountered conditions that may inhibit the fusion of the gametes. The function of the fallopian tubes can be compromised by the presence of adhesions following an infection or adhesion formation between fallopian tube and ovary. The absence of the fallopian tubes after their surgical removal or tubal blockage after tubal ligation makes it impossible for egg and sperm to come together in a natural way. In rare cases, sperm may become immobile inside the cervical canal due to immunological processes.
Unwanted childlessness can be due to the fact that either no oocytes or an insufficient number of spermatozoa reach maturity. If a woman is not able to produce oocytes, this is often due to a disturbance of the endocrine system made up of glands that produce essential hormones (e.g. pituitary gland, ovaries, thyroid gland, adrenal cortex etc.). Such cases require hormone assays to be performed in order to identify the disorder and subsequently treat it in a targeted way. The presence of spermatozoa in the seminal fluid can be investigated by means of microscopic examination. It is recommended to abstain from ejaculation 3 to 5 days before the examination takes place. It takes millions of motile sperm to fertilize an oocyte. Only a small part of them actually reach the fallopian tubes. Inside the fallopian tube, the ovum must be surrounded by several hundred motile sperm cells, so that one single sperm may finally succeed in fertilizing it.
Fertilization fails to occur
Thus, if there are not enough motile sperm, fertilization cannot occur. A low sperm count can rarely be traced back to purely hormonal causes but is frequently due to testicular disorders which are not easy to treat, in comparison, for example, with egg maturation problems in a woman. The diagnosis requires special examinations. In some cases it may prove beneficial to try to increase the number and quality of motile sperm by administering drugs or hormone preparations. Currently, the available treatment options for conditions which are solely due to disorders of the testis are, however, extremely limited.
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A pleasant atmosphere, empathy, medical knowledge and expertise are especially important when it comes to fulfilling your desire to have children. We hope that our "striving for excellence" will also gain your trust, and we are looking forward to welcome you in Salzburg.