Reproductive medicine: the number of fertility treatments is increasing

Status: 11/20/2022 7:51 am

Every sixth couple in Germany has difficulties in fulfilling their desire to have children, and the trend is rising. Could this be due to the decreasing number of sperm in men?

By Anja Braun, Leila Boucheligua and Antonia Weise, SWR

In Germany, more and more fertility treatments are being used. This is from the recently published Yearbook of the German IVF Register (DIR) out. In 1997, more than 6,500 children were born after fertility treatment; in 2020, there will already be over 22,200. What are the most common methods of infertility treatment? What is allowed in Germany, what is forbidden? And what are the supposed causes of the unfulfilled desire to have children?

From hormone preparations to in-vitro solutions

Unwanted childlessness can have different causes. In men, infertility is mostly due to the fact that not enough functional and motile sperm are produced. In women, hormonal disorders, changes in the fallopian tubes or the uterus can be the cause. However, the widespread disease endometriosis can also impair fertility in women. This causes cysts in the abdomen, the tissue of which is similar to that of the lining of the uterus, as well as inflammation, for example in the ovaries.

Depending on the cause, there are a number of different treatment methods. One possibility is the administration of hormone preparations to stimulate egg cell maturation and ovulation in the woman.

Another method is to use a thin tube to deliver sperm directly into the uterus. Donor sperm can also be used. So-called in-vitro fertilization goes one step further. Egg cells are taken from the woman and combined with the partner’s sperm in the laboratory. The fertilized eggs are then transferred to the uterus.

Increase in children by in vitro methods

The number of children born outside the body as a result of fertility treatment is growing steadily. According to the German in vitro fertilization register, a total of 363,940 children have been born after in vitro fertilization cycles, i.e. “procreation in a test tube”, since 1997. In Germany, the first baby conceived in this way was born in 1982.

Even if an embryo transfer in fertility treatment is successful today at around 93 percent, the average pregnancy rate is 33 percent. The birth rate, also known as the “baby take home” rate, is even lower at 23 percent.

Sperm count has dropped in recent years

What exactly is the reason for the increasing number of fertility treatments is still unclear. However, according to a recent study from Israel, the sperm concentration in men has fallen by more than half in the past 50 years. The researchers looked at data from 1973 to 2018 from more than 57,000 men worldwide.

While the researchers noticed a significant drop in sperm counts in men in Western countries as early as 2017, the current study shows that the trend is also affecting men from South America, Africa and Asia.

According to this, the concentration of sperm per milliliter of semen should have dropped from 101 million to 49 million on average. Since the year 2000, the average sperm count has been declining even faster than before – currently by more than 2.5 percent annually.

No conclusions about fertility

The quality of the sperm was not examined in the study, so that no conclusions can be drawn about the fertility of men. For Professor Christian Gratzke, medical director of urology at the University Hospital Freiburg, the results are no cause for concern. According to Gratzke, only the sperm count was examined in the study, while the vitality and mobility of the sperm are more important for men’s fertility.

However, the Israeli researchers warn that low sperm concentration can be a risk factor for testicular cancer. According to the authors, the causes that the study does not indicate should be investigated further.

Egg donation and surrogacy banned in Germany

If couples are unable to have children because the man is infertile, there is a solution: sperm donation. But when the woman is the reason, it becomes more difficult. Because egg cell donations are prohibited under the Embryo Protection Act in Germany. Couples who are childless due to infertile egg cells have no chance of becoming pregnant. In a statement published in 2019, the Leopoldina considers this to be unjustifiable gender inequality.

Surrogacy, which is prohibited in Germany, also raises ethical and legal questions. Here, a surrogate mother carries the child on behalf of a couple or single people. Doctors and mediators for surrogacy are liable to prosecution, but the “intended parents” are not. Some countries abroad allow surrogacy.

Multiple pregnancies are risky

Reproductive medicine wants to get away from the often risky multiple pregnancies and premature births. Therefore, if the prognosis is good, only one embryo is used. Although this reduces the probability of becoming pregnant by around four percent, the more embryos a woman uses, the higher the chances of a multiple pregnancy with considerable risks for mother and children. Preterm birth occurs in the majority of cases.

Women up to the age of 32 have the best chance of becoming pregnant through fertility treatment. From the age of 33, the pregnancy rate falls continuously until it is below 20 percent from the age of 40. This is even clearer when looking at the birth rate. It is 30 percent up to the age of 33 and falls below 20 percent from the age of 39. The older the women and couples are, the lower the chance of pregnancy and childbirth. This means that fertility treatment should not be delayed for too long.

Freezing of egg cells possible

Today, reproductive medicine specialists are increasingly recommending the freezing of egg cells. This works with both unfertilized and fertilized egg cells. The so-called cryopreservation already accounts for 31 percent of the total treatment cycles – and the trend is rising. Many couples use this option to freeze embryos left over from treatment for future pregnancies. The success rates with previously frozen embryos are almost as good as with fresh ones. They differ by just 1.2 percent.

Statutory health insurance companies have been covering cryopreservation since July 1, 2021 – but only before therapies that could damage the germ cells, i.e. sperm or egg cells. This should make it possible for cancer patients, for example, to fulfill their desire to have children after undergoing germ cell-damaging therapy through artificial insemination. Women over 40 and men over 50 are not entitled to have the costs covered.

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