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Abstract

Unfulfilled desire for a child

Infertility is defined as the absence of pregnancy for a period of 12 months or more while having regular unprotected sexual intercourse. Over the past years, the number of couples who remain involuntarily childless has increased. The first step when investigating sterility is the patient?s history, the clinical examination and the woman?s menstrual cycle. In men, sperm analysis is the most important diagnostic tool in the context of couples trying to conceive.

When monitoring a woman?s menstrual cycle, the course of the cycle is evaluated. Hormone stimulation of any kind requires cycle monitoring to determine the time of ovulation. In addition, it allows for the tracking of follicular growth and may thus avoid an increased risk for multiples.

In intrauterine insemination (IUI), the sperm is injected into the uterus via a catheter, either within a spontaneous cycle or in a hormone-stimulated cycle. In vitro fertilization (IVF) is an assisted reproductive technology (ART). After hormonal stimulation, the woman?s oocyte is removed by transvaginal oocyte retrieval (TVOR) under ultrasound guidance. In a laboratory culture, the sperm then fertilizes the egg. In contrast to conventional IVF, intracytoplasmic sperm injection (ICSI) is a method in which a single sperm is directly injected into the oocyte with a micromaniputalor. ICSI is the therapy of choice for men with severe subfertility. The pregnancy rates with ICSI are generally comparable with conventional IVF. In Germany, the pregnancy rates for ICSI is 30% for every embryo transfer. 22% of all ICSI induced pregnancies are twins and 1% are triplets (Deutsches IVF-Register, Jahrbuch 2013). Ulla Schmidt, our former health minister enacted a law forcing patients in infertility treatment to contribute 50% of the costs. This resulted in a massive drop in IVF/ICSI cycle numbers of more than 50%. The German Ministry of Family Affairs is now trying to compensate for the damage. In addition, some public health insurance companies voluntarily pay more than 50% of the cost for artificial insemination, which is the payment required by law.

CME Prakt Fortbild Gynakol Geburtsmed Gynakol Endokrinol 2015; 11(2): 96–107

Keywords
Kinderwunschdiagnostik, Kinderwunschtherapie, künstliche Befruchtung, IVF/ICSI, Kosten

Andreas Jantke
Kinderwunschzentrum FERA, Berlin-Tempelhof
Reviewer: Jakob Keilbach, Stuttgart,
und Jutta Sidor, Berlin

Jantke A. Unerfüllter ... Gynakol Geburtsmed Gynakol Endokrinol 2015; 11(2): 96–107 publiziert 31.07.2015 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2015 ISSN 1614-8533