Where infertility is caused by a hormonal imbalance of the woman hormone therapy (also called fertility drugs) is generally the first step in fertility treatment. There are a number of medications available that are to regulate irregular periods and trigger ovulation.
Where a man is unable to father a child, the doctor will in some cases initially also recommend treatment with medication. They can help, for instance to improve sperm quality or treat hormonal imbalance.
In vitro fertilization (IVF)
Louise Brown, the world’s first baby to be conceived through IVF (in vitro fertilisation), was born a healthy baby in 1978. Now, each year thousands of children are conceived by IVF. With IVF, the egg is fertilised outside of the body. IVF is usually used, where the egg cannot reach the uterus, because the fallopian tubes have become blocked due to inflammation. IVF can help to conceive, if the woman has uterine fibroids (myoma) or develops antibodies against the sperm, or with insufficient sperm quality, or where the doctor has found no cause for infertility.
In-vitro maturation (IVM)
In-vitro maturation (IVM) is a new technique, which is not yet a standard option and only offered by a few fertility centres. In IVM, the doctor removes immature eggs from the ovaries of the woman. The eggs then mature in a test tube while exposed to hormones. The further procedure is as with IVF or ICSI.
An operation can help with getting pregnant, if the fallopian tubes are blocked or abdominal adhesions prevent conception. Where the vas deferens has become blocked during hernia surgery, surgeons are sometimes able to unblock it surgically.
Artificial insemination (or intrauterine insemination, IUI)
With insemination, the doctor uses a catheter to place washed and concentrate sperm in the uterus, the vagina, the cervix or the fallopian tubes. Insemination is used where sperm quality is fair or where the cervix has been scarred by an infection or inflammation, and where the cervical scar tissue makes it very difficult for the sperm to reach the uterus. Sometimes, it is necessary to use hormones to stimulate the ovaries before insemination.
Intracytoplasmic sperm injection (ICSI)
With intracytoplasmic sperm injection (ICSI), the doctor injects the sperm directly into the egg. ICSI is used where the sperm cannot fertilise the egg in the woman’s body nor in the test tube and where the women cannot get pregnant despite IVF treatment.
Surgical sperm retrieval
Sperm retrieval from the epididymis (microsurgical epididymal sperm aspiration, MESA) can help if the vas deferens has become blocked and where it is not possible to surgically unblock it, or where the sperm in the semen sample are immotile (i.e. they cannot move). It can also be used if the male partner cannot ejaculate, for example because he is paraplegic or has had surgery for cancer. Where MESA cannot be performed, some doctors recommend TESE (testicular sperm extraction), Here, the doctor takes sperm from the testicles. MESA and TESE are always performed in conjunction with ICSI.