infertility
Infertility (synonyms: fruitlessness , sterility , impotentia generandi , inability to reproduce , formerly also unbearable ) denotes the inability to produce fruit . The word fruit (syn. Yield , proceeds , harvest , yield , field crop , advantage , value and effect ) is used in a broad sense, so that sterility , for example, brings about a lack of or only a small agricultural yield , for not able to reproduce or transferred Meaning also stands for meaningless or useless thoughts, conversations or discussions. The opposite is called fertile or fertility .
In biology, the term infertility describes the inability to conceive or conceive . In technical terms, the terms sterility (for males) or infertility (for females) are used here. In human medicine , a couple is considered sterile if, despite the desire to have children, after at least one year of regular sexual intercourse without contraceptive measures, conception does not occur.
Infertility in the field of human medicine
Infertility is not uncommon. In Central Europe, around every sixth couple struggles to have a child. 10% of the couples need more than two years to have children, 3–4% of the couples remain unintentionally childless over the long term.
About a third of infertility is due to causes in the female individuals , a third is due to causes in the males, and a third of cases are combined or nonexistent. With increasing age, the fertility rate decreases.
Primary sterility in women refers to the failure to conceive after one year of regular sexual intercourse without contraception in a woman who has never conceived . Secondary sterility describes the non-occurrence of pregnancy after one year with regular sexual intercourse without contraception in a woman who has already had at least one pregnancy.
Inability to conceive
Factors that can lead to infertility in women are ovulation difficulties , follicular development disorders , blocked fallopian tubes (broken / sticky / narrowed), hormonal disorders ( hyperprolactinemia , hypothyroidism , hyperandrogenemia ), endometriosis , inability of the fertilized egg cell to implant in the uterus , inability to successfully terminating a pregnancy , genetic defects, pernicious anemia ( vitamin B12 deficiency ), infection through a sexually transmitted disease such as chlamydia or gonorrhea , age ( fertility in women decreases significantly from the age of 35), stress , Overweight and underweight, alcohol and drug abuse , damage caused by treatments for malignant diseases ( chemotherapy , radiation therapy ) and celiac disease . It is also more difficult for the fertilized egg cells to implant in the endometrium in heavy smokers . In one study, half of women who smoked became pregnant, compared to only a third of women who smoked heavily.
Infertility
The main factor in men is the quality of the sperm ; The number and quality ( motility , appearance) of the sperm are essential .
Factors that can influence semen quality are alcohol and other drugs, nicotine , environmental pollutants , age (the number of motile sperm cells continuously decreases with age), occupational exposure to harmful substances, dietary habits (e.g. exposure to estrogen- like substances), abdominal testicles , Varicocele , inguinal testicles , mumps ( mumps orchitis), infections in the area of the draining spermatic tract (e.g. prostatitis , epididymitis ), damage caused by the treatment of malignant diseases ( chemotherapy , radiation therapy ), ionizing radiation ( e.g. during air travel or X-ray examinations) and diseases such as pernicious anemia due to vitamin B12 deficiency . At times, the quality of the sperm can also be impaired by visiting the sauna or hot tub , as the heat can destroy the sperm. However, cells formed after exposure to heat are not affected. Since the optimal temperature for sperm formation is around 2 degrees Celsius below normal body temperature, trousers that are too tight and too frequent sitting are assumed to be the cause of poor sperm quality.
These factors can lead to OAT syndrome or azoospermia . Research shows that semen quality seems to decrease with age . A decrease in semen quality has been a controversial issue around the world for years.
In addition to the factors mentioned above, which predominantly affect the quality of sperm, the factors that influence the transport of semen are important for fertility. It is about the man's ability to bring his sperm into the female uterus in sufficient quantities so that the egg can be fertilized. The most important problem in this regard is erectile dysfunction (known colloquially as "impotence"), i. H. the inability of the male sufficient erection of the penis bring to the copulation perform. There are also other clinical pictures such as retrograde ejaculation , in which the sperm is directed into the urinary bladder instead of the penile opening during ejaculation . A ejaculatory duct obstruction is in 1-5% of cases of male infertility, the underlying cause.
Immunological incompatibility of partners
In a few cases, the vaginal tract can show an immunological reaction against components of the sperm - not against the sperm itself.
It is not a matter of course for the female immune system to tolerate an embryo , half of which consists of foreign genes , in its own body. In extreme cases, prevented immune response the fertilization , in rare cases can immunological incompatibility of the genes cause infertility. Female immune reactions against parts of male sexual secretions can also occur in the run-up to reproduction . Research suggests that the woman's immune tolerance required for fertilization can be built up through frequent sexual intercourse. The key here is how the female immune system gets used to the partner's sperm. According to Koelman and Dekker (1999), oral sex may also contribute to such immunological tolerance development.
Diagnosis
The diagnosis of an unfulfilled desire to have children always belongs in the hands of specialists. Basically, both the man and the woman must be involved, as there can be possible causes (see above) for both.
First of all, a comprehensive anamnesis is taken. The attending physician asks:
- How long have you been planning to have children?
- Have you previously received medical treatment for wanting to have children?
- Do you have your own explanation for your childlessness?
- How much do you both suffer from childlessness?
- What has changed in your life since you became infertile (partnership, job, self-esteem)?
The examination of the man includes palpation and ultrasound examinations , spermiogram , hormone level examination (usually only if the spermiogram shows a small number of sperm cells), genetic examinations ( karyogram ) and testicular biopsy.
To investigate the woman include menstruation history (minimum of three to a maximum of six menstrual cycles accompaniments are long observed and documented. This can be determined if for example, a corpus luteum weakness is present (in a shortened cycle) or whether there is no ovulation takes place (in the absence of menstruation )) Basal temperature curve , hormone level examination , palpation and vaginal ultrasound examination (assessment of the uterus and ovaries), uterineoscopy (detection of adhesions, fibroids or polyps in the uterus and exclusion of malformations), laparoscopy (detection of adhesions or fibroids), chromopertubation and contrast medium ultrasound (synonym Hysterocontrast sonography HKSG, hysterosalpingo sonography HSG to check the patency of the fallopian tubes ).
Finally, there are studies on the compatibility of man's sperm with woman's cervical mucus ( Kremer test )
Treatment options
People have always tried to influence their fertility and treat infertility everywhere. There are different ways to treat infertility for both partners, depending on the cause. A body weight with a BMI of between 18 and 30 should be aimed for, nicotine consumption should be stopped and everyday stress should be reduced as much as possible. Ovulation can be hormonally induced by the drug clomiphene, for example , and male enhancement drugs can also be used as a treatment.
Surgical measures can be considered in cases of blocked fallopian tubes and (possibly in combination with hormonal treatment), for example, in endometriosis . Intracorporeal artificial insemination (in which the woman's partner's prepared sperm is inserted into the cervix) and extracorporeal artificial insemination (in vitro fertilization, IVF - the woman undergoes hyperovulation (the simultaneous maturation of several egg cells) after hormonal treatment ) several mature egg cells removed, fertilized outside the body (in vitro) (maximum of four egg cells) and reinserted into the uterus (embryo transfer, ET)) are available. A fallopian tube- internal germ cell transfer (intratubar gamete transfer: here egg cells and sperm are planted in the fallopian tubes, which enables the fertilization of the egg cell in the woman's body), the transfer of a fertilized egg cell (similar to artificial insemination, only in the fallopian tube) are also less common measures instead of in the uterus) or egg donation from another woman (in combination with artificial insemination). Donor sperm can also be introduced directly into the uterus or an intracytoplasmic sperm injection can be performed (a single sperm is injected directly into an egg and the fertilized egg (s) are then transferred to the uterus). None of the therapies used can guarantee success.
A surrogate mother who carries the child to term is possible. However, since this can lead to significant legal and ethical conflicts and since placement agencies for surrogate motherhoods could be formed, the placement of surrogate mothers has been prohibited in Germany since 1989. Surrogacy itself was also prohibited from 1991 under the Embryo Protection Act. Surrogate motherhood is permitted in the UK, but it is a criminal offense to be involved in the creation and negotiation of surrogate motherhood agreements, including making the necessary contact. The commercial inducement of third parties to take appropriate actions, as well as the search for a surrogate mother or the offering of surrogate motherhood in newspapers etc. are also punishable (for more details: Sec. 2, 3 Surrogacy Arrangements Act 1985).
In recent years, various measures have been established that aim to preserve fertility in the case of cancer and the necessary treatment. In German-speaking countries, these measures are coordinated and published by the Fertiprotekt network .
Other aspects
Morally
There have been and are many moral debates dealing with infertility and its treatment, today with special regard to embryos involved . Some religions disapprove of some or all of the fertility treatments; other religions have no problem with them. A secondary discussion deals with whether the treatment should be financed by statutory health insurance - and if so, how often.
psychology
Mental factors are always involved as a cause and / or consequence of infertility. An unfulfilled desire to have children is experienced by many as a stroke of fate and causes psychological pain and sadness . Infertility and infertility treatment are often associated with stress and a higher risk of post-traumatic stress disorder . Factors that can play a role in unwanted childlessness are the motives for wanting children , the personality structure of both partners, an unconscious fear of a child, the structure of the couple relationship and the doctor-patient relationship in sterility treatment.
Infertility of the soil
Soil science speaks of infertility when its properties (mineralogical, physical, chemical and biological) are poor or unsuitable for the growth of plants.
Infertility in literature and film
Infertility in the human medical sense has occasionally been treated in works of literature and film, for example in the German feature film Frucht ohne Liebe (1956) directed by Ulrich Erfurth .
See also
literature
- M. Crausaz, J. Vargas, R. Parapanov, Y. Chollet, M. Wissard, E. Stettler, A. Senn, M. Germond: First Evaluation of Human Sperm Quality in Various Geographic Regions in Switzerland. In: Chimia. 62, 2008, pp. 395-400. doi: 10.2533 / chimia.2008.395
Individual evidence
- ↑ sterile . dwds.de
- ↑ sterile . Canoonet
- ↑ wortschatz.uni-leipzig.de
- ↑ D. Manski: Infertility . In: Online textbook of urology.
- ↑ The Brockhaus multimedia 2006 premium. Bibliographisches Institut & FA Brockhaus, Mannheim 2006.
- ↑ P. Martinelli include: Celiac disease and unfavorable outcome of pregnancy. In: Gut 2000, 46 (3), pp. 332-335, PMID 1727862 .
- ^ Online edition of Human Reproduction . Quoted from: Direct damage. In: Süddeutsche Zeitung. January 4, 2007, p. 18.
- ↑ Decline in sperm quality in Germany and Europe. (PDF; 208 kB) WWF, November 1999, archived from the original on February 1, 2012 ; Retrieved February 3, 2010 .
- ^ Warren G. Sanger, Patrick C. Friman: Fit of underwear and male spermatogenesis: A pilot investigation star. In: Reproductive Toxicology , 1990, Vol. 4, pp. 229-232, doi: 10.1016 / 0890-6238 (90) 90063-2 .
- ↑ Niels Henrik I. Hjøllund, Jens Peter Bonde E., Tina Kold Jensen, Jørn Olsen: Diurnal scrotal skin temperature and semen quality. In: International Journal of Andrology. 2001, 23 (5), pp. 309-318, doi: 10.1046 / j.1365-2605.2000.00245.x
- ↑ A. Gies et al.: Hormonally acting chemicals and development of the semen quality in humans . In: Umweltmed Forsch Prax. 6 (1), 2001, pp. 31–32, technical discussion
- ^ Declining sperm counts (Editorial). In: BMJ. 1996, 312, pp. 457-458.
- ^ Henry Pryor: Ejaculatory duct obstruction in subfertile males: analysis of 87 patients. In: Fertil Steril . 56, 1991, p. 725.
- ↑ netzeitung.de ( Memento from March 25, 2004 in the Internet Archive )
- ↑ theaustralian.com.au
- ^ CA Koelman, AB Coumans, HW Nijman, II Doxiadis, GA Dekker, FH Claas: Correlation between oral sex and a low incidence of preeclampsia: a role for soluble HLA in seminal fluid ?. In: Journal of reproductive immunology. 46 (2), (2000), pp. 155-166.
- ↑ Hysteroscopy with septal dissection, Unifrauenklinik-Kiel: Desire for children
- ↑ Chromopertubation in the film
- ^ Henry de László, Paul S. Henshaw: Plant materials used by primitive peoples to affect fertility. In: Science. Volume 119, 1954, pp. 626-631.
- ↑ Josef Löffler: The disorders of the sexual property in the literature of the authoritative theology of the Middle Ages (= treatises of the Academy of Sciences and Literature. Humanities and social science class. Born 1958, Volume 6).
- ^ A b V. Frick-Bruder: Care of the infertile couple, taking into account psychosomatic and psychodynamic aspects. In: C. Schirren , F. Leidenberger, V. Frick-Bruder, GE Hirsch, K. Rudolf, B. Schütte: Unfulfilled desire for children. Deutscher Ärzteverlag, Cologne 1995, ISBN 3-7691-0299-1 .
- ↑ Barbara Bartlik et al: Examining PTSD as a Complication of Infertility. Medscape General Medicine, May 3, 1997, accessed June 13, 2008 .
Web links
- Risk factors for fertility Federal Center for Health Education (BZgA)
