Wanting to have children

Have you been trying for more than a year to get pregnant in vain? Are you older than 35 and worried because you still haven't gotten pregnant? Are you already undergoing treatment and want to get a second opinion? Have you had complications during pregnancy or have you repeatedly suffered miscarriages?

About one in ten couples in Switzerland is unfortunately unintentionally childless. In around 20-30% of cases, the cause is found in either the woman or the man and in around 40% it is a combination of both   partners. The most common reasons are disorders in the production or function of male sperm cells (sperm), the age of the woman, polyps and fibroids in the uterine cavity, occluded fallopian tubes, absence of ovulation,endometriosis and sexual dysfunction. Obesity, smoking and stress can also contribute to involuntary childlessness. In around 20% of cases, no cause for the unfulfilled desire to have children can be found despite careful investigation. This is referred to as unexplained infertility (infertility). Involuntary childlessness can severely affect a couple's physical and mental health and is therefore recognized as a disease by the WHO (World Health Organization).

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Care concept

Your medical advisor will conduct all consultations (initial consultation, second consultation, follow-up consultation) with you and will accompany and support you during all phases of treatment. Necessary examinations as part of the clarifications and fertility treatments are carried out by all members of the medical team. This procedure is efficient and has proved very successful. Please let us know if you have any special requests.

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Causes

In order to find the cause(s) of involuntary childlessness, both men and women need to be examined. Even if the cause appears to be clear (e.g. blocked fallopian tubes), both partners still need to be examined in order to choose the optimal, tailored treatment method.

Possible causes of involuntary childlessness:

• The age of the woman
• Failure to ovulate (anovulation)
• Closed fallopian tubes
• Endometriosis
• Polyps and fibroids
• Recurrent miscarriages
• Unexplained infertility
• Disorders in the formation and function of sperm cells
• Disorders of sexual function

 

Examinations

A confidential consultation with your doctor is one of the most important steps in the investigation of involuntary childlessness.  This will cover your personal medical history, couple sexuality and the question of hereditary diseases. We attach great importance to finding the cause of the unfulfilled desire to have children and the right treatment. Examinations are necessary for this purpose.

In women, we usually carry out cycle monitoring. The investigations in men include a blood sample (e.g. to examine certain sex hormones), an examination of the sperm cells and a physical examination of the testicles with an ultrasound scan. In certain cases, it is necessary to carry out a genetic examination. These examinations are all painless and help in the search for the causes of involuntary childlessness.

Our team is committed to carrying out the diagnostics efficiently and keeping you informed of the results.

 

Treatments

We always try to listen to your needs and find the best treatment to give you the best chance of getting pregnant. However, the exact clarification of the cause of the unfulfilled desire to have children is the basis of the treatment. As there can sometimes be a combination of causes, both partners must always be examined. Sometimes a change in lifestyle (e.g. losing weight, abstaining from regular alcohol consumption and nicotine) is enough to achieve pregnancy naturally. In other cases, surgery is sufficient, e.g. in the case of blocked or fused fallopian tubes, endometriosis or polyps and fibroids in the uterine cavity. If ovulation does not occur, it can usually be induced with medication. Insemination (injection of sperm into the uterine cavity) is usually carried out at the time of ovulation. If there are serious or unexplained causes, in vitro fertilization (IVF) with or without microinjection (ICSI) may be necessary. Fertility treatments are only ever carried out with the written consent of the couple after informing them of possible side effects and complications and in strict compliance with legal guidelines.

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Women's medicine

As the name suggests, our medical services are aimed at women of all ages. The need for medical advice and treatment changes over the course of a woman's life. For very young women, the focus is on the safe prevention of unwanted pregnancies and the clarification of irregular or painful bleeding. Women of reproductive age can experience cycle and bleeding disorders at any time, which can severely impair their quality of life and must be taken seriously. Before and after the menopause, health care and maintenance play an important role. In addition, symptoms such as hot flushes and sleep disorders can occur during the menopause. We care for and treat women of all ages and try to help you in every way possible.

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Contraception

Preventing unwanted pregnancies is an important area of women's medicine. Contraception should be efficient, safe, cheap and practical and have few side effects and risks. Today, there is a wide range of different safe methods for all age groups. We will be happy to help you choose the best contraceptive method for you!

Contraception in high-risk situations
There are many conditions for which advice from a specialist is advisable in order to avoid health risks when using contraception. Some examples are a tendency to thrombosis, migraine, breast cancer, diabetes, high blood pressure, etc. There are many ways to efficiently avoid pregnancy without taking a health risk.

Cycle and bleeding disorders

If your period is absent, too frequent or too infrequent (menstrual irregularities), very heavy or painful (bleeding disorders), it is advisable to undergo tests to rule out serious causes and to treat the symptoms correctly and to your satisfaction. Bleeding that occurs  after the menopause should always be clarified.

PCOS

Women with PCO syndrome (polycystic ovary syndrome) often have irregular cycles and are prone to increased hair growth and skin blemishes. This is due to excessive production of male sex hormones (androgens), which can be treated. Sometimes there is also obesity and an increased risk of having or developing diabetes, high blood pressure and other so-called diseases of affluence. Women with PCO syndrome need good medical care and must pay particular attention to their health.

Hirsutism and acne

Hirsutism is excessive hair growth, similar to that of a man, which is due to excessive production of male sex hormones (androgens). Acne can also be caused or worsened by an increased production of androgens. This is disturbing and distressing for most people affected and should therefore be treated.

Obesity

The number of overweight people is steadily increasing worldwide, including in Switzerland. Obesity and lack of exercise can have serious health consequences and are important risk factors for the development of diabetes or cardiovascular disease. In young women, being overweight can lead to unwanted childlessness, increased miscarriages and complications during pregnancy. Losing weight permanently is difficult and requires a profound change in lifestyle. Thanks to professional advice, friendly support and motivation from your doctors, we can help you lose weight.

Adolescent gynecology

Young women are sometimes reluctant to visit a gynecologist, even though they have urgent questions or problems, fears and doubts. Effective pregnancy prevention is particularly important for women who are still in education. We will be happy to advise you and help you in an uncomplicated and confidential consultation.

Endometriosis

Endometriosis is a chronic inflammatory disease that occurs when the lining of the uterus is located outside the uterine cavity. Endometriosis may or may not be painful and the symptoms usually occur during menstruation. Endometriosis can also be a possible cause of infertility. In most cases, a lot of time passes before endometriosis is recognized as such, which can be very frustrating for those affected. Endometriosis can be treated surgically and/or hormonally. Great caution and restraint is required when surgically removing endometriosis, especially in women who still wish to have children. Repeated operations on the ovaries in particular can severely impair their function and lead to a premature menopause. The course of endometriosis can usually be favorably influenced by hormonal treatment.

The menopause

The last menstrual period (menopause) occurs on average at around 51 years of age and most women do not regret this. However, the hormonal changes that occur before and after the menopause can lead to a disturbing reduction in quality of life. There are various treatments that can alleviate the symptoms. Due to the many and sometimes contradictory media reports, many women are unsure and have questions that we will be happy to answer. We will try to find the best solution together with you.

Premature menopause

If the menopause occurs before the age of 40, it is referred to as premature. Affected women are often overwhelmed by this diagnosis and have many worries and questions. The cause of premature menopause can rarely be determined. Young women with premature menopause should receive hormone treatment to prevent osteoporosis (bone loss) and cardiovascular disease and to restore their quality of life. We will be happy to advise you on your questions and wishes.

Osteoporosis

Bone formation and structure in men and women depend to a certain extent on sex hormones. Being underweight, lifestyle, osteoporosis in close relatives or a premature menopause can promote the occurrence of osteoporosis (bone loss). We will be happy to advise you in collaboration with bone disease specialists.

Laboratory

Our laboratories comply with all regulations and are equipped with the highest quality equipment. Our employees are highly trained and motivated. In the andrology laboratory, ejaculate analyses are prepared and sperm are processed for treatments, among other things. IVF and ICSI treatments take place in our clean room laboratory. This is where the egg cells are prepared for fertilization and injected. The embryos that are to be transferred into the uterine cavity are cultivated in special incubators. Fertilized eggs that are not yet to be transferred are deep-frozen using the vitrification process.

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Ejaculate analysis

The seminal fluid (ejaculate) solidifies quickly after discharge and is therefore heated at 37°C for half an hour so that the ejaculate liquefies again and can be analyzed. On the one hand, the volume released, the pH value and the concentration of sperm are measured. Secondly, tests are carried out to check whether autoantibodies against the sperm are present, whether the survival (vitality) of the sperm is restricted and whether there is a bacterial infestation. For the preparation of the sperm, one milliliter of liquefied ejaculate is placed in a tube and washed with culture medium to remove the seminal plasma. Through centrifugation (very rapid circling), the sperm collect in the lower part of the tube and must swim to the surface on their own. Only the sperm that manage to float to the surface are then removed and tested for various parameters such as concentration, speed and maturation capacity (capacitation).

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Testicular biopsy (TESE)

If no or only very few sperm can be detected in the ejaculate, sperm can be obtained for artificial  fertilization with the help of a testicular biopsy. A small amount of tissue is removed from the testicles using a fine needle (TESE = testicular sperm extraction). These tiny pieces of tissue are searched for living sperm under a microscope in the laboratory. It is not always possible to find living sperm in the biopsies. In special cases, the testicular tissue can be removed under a microscope (micro TESE).

IVF therapy

After the cumulus complexes (egg cells with the surrounding nutrient cells) have been aspirated from the follicles, they are placed in a drop of culture medium coated with oil. In IVF therapy, the prepared sperm are added to the untreated cumulus complexes and left there overnight to fertilize the eggs. This means that it is not known at this stage what stage of maturity the eggs are in. However, fertilization can only take place if the eggs are at the right stage of maturity. The next day, the sperm are separated from the eggs. The eggs are examined closely under a microscope. Successfully fertilized eggs remain in the so-called embryo culture until they can either be frozen or transferred into the uterine cavity.

IVF therapy

After the cumulus complexes (egg cells with the surrounding nutrient cells) have been aspirated from the follicles, they are placed in a drop of culture medium coated with oil. In IVF therapy, the prepared sperm are added to the untreated cumulus complexes and left there overnight to fertilize the eggs. This means that it is not known at this stage what stage of maturity the eggs are in. However, fertilization can only take place if the eggs are at the right stage of maturity. The next day, the sperm are separated from the eggs. The eggs are examined closely under a microscope. Successfully fertilized eggs remain in the so-called embryo culture until they can either be frozen or transferred to the uterine cavity.

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Cryopreservation

Cryopreservation means "preserving through cold". Oocytes, sperm cells and fertilized eggs can be frozen using modern methods such as vitrification and thawed at a later date. This makes it possible, for example, to freeze eggs and sperm before chemotherapy in order to fulfill the desire to have children after recovery. If several fertilized eggs have been produced after fertility treatment, some of them can be frozen and used later for another pregnancy.

Male medicine

Men's specific health problems are often emotionally stressful and can have a variety of causes. These include disorders of fertility, sexual function or androgen balance (androgens = male sex hormones). The field of andrology is an interdisciplinary specialty with content from urology, endocrinology, general medicine, sexual medicine and reproductive medicine. Our andrologist has been treating men with andrological issues since 2004 and is also happy to help you with investigations and possible treatment.

Male sex hormones

Androgens and testosterone in particular are not only responsible for the development of sexual characteristics, the desire for sex (libido) and erectile function in both young and older men, but can also play an important role in psycho-emotional factors (performance, fatigue, depression, etc.). Male sex hormones are important for physical functions such as muscle development, bone health, red blood cell formation and fat distribution. A lack of sex hormones can therefore lead to corresponding disorders.

Sexual function

Sexual dysfunctions such as erectile dysfunction, problems with premature or delayed ejaculation, problems with internet sexuality, etc. are an enormous burden for many men and their partnerships. The causes of sexual dysfunction can be purely physical or purely emotional. Very often there is a combination of causes behind it. Trustworthy and specialized care often leads to a solution to the problem or to a better way of dealing with one's own sexuality. A wide range of therapy options are available for this purpose.

Unfulfilled desire to have children

The assessment of both partners is very important, as in around half of couples with an unfulfilled desire to have children, relevant causes are also found on the male side. In addition to a confidential discussion with the doctor and a physical examination, a good assessment of the man also includes optimally performed laboratory tests of ejaculation and certain blood values

Our doctors

• Dr. Rebecca Moffat

• Dr. Anna Raggi

• PD Dr. Gideon Sartorius

• Dr. Giuseppina De Napoli

• Dr. Oliver Sterthaus
  (embryologist / biologist)

• Dr. med. Sjanneke Beutler

 

 

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