For many unintentionally childless couples, reproductive medical treatment is an anchor of hope. Since the first baby conceived in a test tube was born in Germany in 1982, around 340,000 children (up to 2019) have seen the light of day in Germany following artificial insemination.
This figure was published by the German IVF Register in its Yearbook 2020.. The abbreviation IVF stands for in vitro fertilisation. Translated, this means fertilisation in (test tube) glass - i.e. outside the female body. However, even if the egg and sperm are specifically brought together using this medical method, they still have to fuse and develop on their own. In this context, doctors also speak of "assisted reproduction".
The legal framework
In Germany, only doctors are permitted to carry out artificial fertilisation. The legal basis for this is provided by the Embryo Protection Act and the Transplantation Act as well as certain guidelines. These regulate the permitted treatment methods, which include in vitro fertilisation and sperm donation, for example. In Germany forbidden Methods include surrogacy and egg donation.
The methods for the desire to have children with medical help
There are different ways in which fertilisation can take place with medical assistance in the laboratory. The doctor will advise the couple on which procedure offers the best chances of success in each individual case. This depends above all on the causes that have been identified for the childlessness.
The optimum time is important for the treatment steps. It is the top priority, even if it often causes couples to have difficulties with appointments, for example if it results in (repeated) absences from work. Many people also don't want to tell their superiors and colleagues why they want to take time off (again) now of all times.
Preparation
Before the egg is actually fertilised, examinations and treatments are carried out in advance to increase the chances of pregnancy. This includes the Cycle monitoring. This means that the maturation of the egg cells is checked by means of an ultrasound examination via the vagina and determination of the hormone levels in the woman's blood. In this way, an egg cell ready for fertilisation can be identified. This moment occurs when the follicle, i.e. the vesicle in which the egg cell grows, is around 2 centimetres in size. The optimum time for fertilisation via sexual intercourse or sperm transfer (insemination) is determined with the help of a doctor.
If necessary, ovulation is also triggered by injecting the HCG hormone (human chorionic gonadotropin). This then takes place as part of a parallel hormonal stimulation. Hormones or hormone combinations are administered in tablet form or as an injection. This depends on the results of the hormone status test. This procedure is used to rebalance hormonal irregularities. Hormonal disorders are one of the Most common causes for an unfulfilled desire to have children. This procedure is also intended to stimulate the ovaries to mature more than one egg at a time so that they can be retrieved for fertilisation in a test tube.
Different fertilisation methods
The actual merging of egg and sperm cells can take place using the following procedures:
Homologous insemination (HI): For this purpose, the man's sperm is specially prepared and inserted directly into the woman's uterine cavity through a thin catheter. This also Intrauterine insemination The doctor performs the procedure at the time of ovulation. The success rate per treatment - i.e. the development of a pregnancy - is 10 to 15 per cent. Even though this procedure is relatively simple, it should not be used more than four to six times. After that, the chances of success drop significantly.
Reasons for HI include reduced sperm quality and irregularities in the cervix.
Donor insemination (DI): The procedure is the same as for HI - but with one important difference: the transferred sperm does not come from the woman's partner, but from an anonymous sperm donor. This also Heterologous insemination This fertilisation option is chosen if the partner is unable to conceive or if there is a so-called genetic indication. This is the case if the partner's sperm carries a high genetic risk of miscarriage or is very likely to produce children who are severely damaged or not viable at birth.
In vitro fertilisation (IVF): After hormonal stimulation, several fertilisable eggs are retrieved from the follicles in the woman's ovary 36 hours after ovulation has been triggered (known as follicular puncture). This is done regularly through the vagina using a thin needle and is monitored by ultrasound on a screen. The eggs are then brought together in a test tube (hence the term "in vitro") in a nutrient solution with the partner's sperm. His sperm is obtained by masturbation or has already been frozen (cryopreserved). In either case, the sperm cells are prepared accordingly before use in order to optimise their fertilisation capacity.
The test tube with the eggs and sperm is then placed in an incubator where the two types of cells are supposed to fuse. The initial stage of fertilisation can be observed under the microscope on two so-called Pre-coring can be recognised: Once the sperm cell has penetrated the egg cell, a so-called pronucleus forms from each of the two germ cells after around four hours. Each contains half the maternal and half the paternal chromosome set.
After a few days, the doctor inserts a maximum of three fertilised eggs or embryos into the uterus. The law prohibits placing any more fertilised eggs there. Surplus fertilised eggs are destroyed or kept frozen for possible later use. The latter is called cryopreservation. The Embryo Protection Act only permits this under very specific conditions and only at this very early stage of fertilisation, i.e. the pronuclear stage.
If an embryo has successfully implanted, the HCG hormone in the woman's blood indicates pregnancy after around two weeks. After a further two weeks, the embryo is then recognisable on the ultrasound image.
According to the IVF register, the Pregnancy rate per cycle of the treatment process described is currently 31.9 per cent. The birth rate, also Baby Take Home Rate is 23.5 per cent. The chance of pregnancy increases to 70 per cent after at least four treatment cycles.
The IVF method is used, for example, in cases of reduced sperm quality or irregularities in the fallopian tubes.
Intracytoplasmic sperm injection (ICSI): With this also known as Microinjection method, a sperm cell is injected directly into a female egg cell. The rest of the procedure is similar to IVF. The sperm is obtained from the ejaculate or surgically removed from the (epididymis) testicles.
The ICSI method is used, for example, if the number and quality of sperm are significantly reduced.
Gamete intratubular transfer (GIFT): In this procedure, eggs are retrieved from the woman by means of a laparoscopy. Together with the prepared sperm, these eggs are then injected into her fallopian tubes. The aim of this method is to ensure that fertilisation occurs naturally.
As the woman requires a general anaesthetic for the laparoscopy, the risk of complications is higher. The risk of an ectopic pregnancy is also higher. However, as the success rate of GIFT is no better than that of IVF, this procedure is hardly practised any more.
The costs
If a couple has not conceived naturally after one or two years, medical examinations can provide information about the possible causes Causes . Your statutory or private health insurance will cover the full cost of these examinations.
If the couple then decides to undergo fertility treatment, statutory health insurance will pay a subsidy towards the treatment costs under certain conditions. This is usually 50 per cent of the costs, but the co-payment can also be higher, as some health insurance companies voluntarily pay more.
The requirements for partial assumption of costs are regulated in § 27a SGB V and stipulate, among other things:
- The couple must heterosexual and married to each other be.
- Both spouses may use a certain Age limit must not be exceeded.
- The likelihood of success of the treatment must be certified.
In addition, only a certain number of fertilisation attempts are subsidised - in the case of in vitro fertilisation, for example, this is three attempts. If the treatment was successful and the couple wish to have a second child, the statutory health insurance will also cover a proportion of the costs if all the necessary conditions are met.
The extent to which and the conditions under which private health insurance companies cover treatment costs depend on the respective insurance contract.
In addition, heterosexual couples can apply for state financial support towards the costs of fertility treatment from the relevant authorising authority. This applies equally to married and unmarried couples and also to the desire for a second child. This service is financed by the federal and state governments. There are currently 12 federal states participating in this funding programme. The amount of the co-payment varies depending on the federal state, but for married couples it is usually up to 25 per cent of the couple's own contribution. The exact conditions and amount of the co-payment are not standardised. You can also find out more about state subsidies here read more.
The cost of an IVF treatment cycle is around 3,000 euros, although it can be a few hundred euros more or less. ICSI treatment is even more expensive. In any case, there is also the cost of the necessary medication, which can be between 700 and 1,600 euros.
A treatment cycle means treatment during a woman's monthly cycle. However, in most cases, a single cycle is not enough to eventually hold a baby in your arms. The cost of several treatment cycles increases accordingly.
The risks The desire to have children with medical help
Even if the treatment cycles run perfectly, it can happen that success does not materialise and the desire to have a child is not fulfilled. Then at some point it is time to say goodbye to carrying a child yourself. If you are currently at this point in your life, please read here continue.
Ongoing fertility treatments are also usually a great strain on the soul. Couples often experience a rollercoaster of emotions: fears, confidence and hope, disappointment and sadness alternate. For many, the wait after treatment is a particularly difficult time. The question of whether a pregnancy will finally occur or whether it won't happen again tugs at the nerves. It remains a challenge not to blame oneself for a failure that then occurs and to come to terms with it. This also includes the question: Do I, do we want to try again and endure all the physical strain?
I can only advise every couple to seek professional advice and support in all phases of this entire process!
Let us now look at the physical risks. As with any other medical procedure, there are also risks associated with artificial insemination. A side effect of hormonal stimulation used to be the frequent occurrence of Ovarian hyperstimulation syndrome (OHSS). This means that the greatly increased hormone levels cause the ovaries to enlarge and produce a particularly large number of follicles, which produce a correspondingly large amount of hormones. As a result, the woman could suffer from nausea or vomiting, severe abdominal pain, fluid retention in the abdomen or even kidney failure. However, this overstimulation syndrome now only occurs in 0.3 to 2 per cent of such treatments.
Regardless of how a pregnancy came about, there is the possibility of a Miscarriage. From the time the embryo is visible on ultrasound, the risk is around 15 per cent. In more than 50 per cent of cases, the reason for miscarriages is genetic malformations in the embryo.
Studies have now shown that babies conceived through fertility treatment have a significantly higher risk of Malformations wear. However, this is not necessarily due to the treatment itself. Rather, doctors explain this realisation by the fact that most couples who undergo fertility treatment are already older: Most women, for example, are between the ages of 35 and 39. However, with increasing age, especially for women, the general risk of foetal malformations increases anyway. And the risk of a premature birth or a baby born with health problems also increases.
In the case of conception by IVF or ICSI, there is also an increased risk of Multiple pregnancy by 20 to 30 per cent. This not only harbours an increased health risk for the children, but also for the mother. Not to mention the fact that a multiple birth turns the parents' lives upside down in all areas even more than a single baby can.
For these reasons, the woman may only have a maximum of three fertilised eggs per fertility treatment. After all, even after transfer to the uterus, it is still possible for further cell division to lead to more children. According to the IVF register, the trend is now to transfer only one fertilised egg (single embryo transfer).
One Response