What is the market size for the treatment of infertility

Infertility and the desire to have children : "Five people were present when my daughter was conceived"

When my worst nightmare came true, I was just 28 years old. At this point in time, I had known for about 14 years that I wanted to be a mother one day, and had been taking the pill for almost as long, because of course the conditions for starting a family should be right: education, job, partner and a bit of life beforehand. So now the time had come, after all this time I finally got off the pill and it happened - nothing.

The period did not materialize. First a few days, then a week. Ultimately months. What I would have wished for when I was in my early twenties - a life without menstruation - has now become a curse. Because no period means no ovulation either. And how can you get pregnant without ovulation? But I'm getting ahead.

At first I didn't think much about it, even secretly hoping that it could have worked out with a pregnancy in the first month. After all, that happened all the time around me, my family was legendarily fertile. That I could seriously have a problem fathering a child was unthinkable. A few years earlier I had even secretly mocked an acquaintance who had worked so desperately on her desire to have children that there was no other subject for her than fertility monitors, temperature curves and baby names. I never wanted to end like this, I confided to my best friend at the time. Since then I have often thought of those acquaintances and internally apologized.

Because the pregnancy test stayed clean, no matter how long I waited, how much I hypnotized this stupid open field. Every time I had to get a new test in the drugstore, it triggered a whole series of emotions in me: shame, fear, hope, despair. Of course, I was impatient, after all, I'd been waiting for over a decade to finally get started. But I also knew that after so many years of external control by the pill, the cycle could get messed up. So i waited. And waited. And got me an app to determine my cycle so that at least I always knew how long I was overdue. I started doing research on fertility and the cycle on the internet and learned that a medical problem is only accepted after three months without a menstrual period. I also learned that there are herbal supplements in the pharmacy that you can take to help with the cycle. This is how my personal path through infertility began.

Every happy news was a blow to the pit of my stomach

At first I took it calmly and was optimistic that a solution would be found for my problem. I was highly motivated to drive this forward and also willing to go to some doctor several times a week for it. But over time it got grueling and I began to doubt myself more and more, after all I was apparently unable to do the most natural thing in the world: reproduce. Fortunately, my partner was an important support during these difficult times. He patiently went to the doctor when I sent him and consoled me when it didn't work out again or when I racked my brain about various things.

The time of fertility treatment was also emotionally a rollercoaster ride. Questions from relatives (“When is it finally time for you?”), Stupid comments (“You still have so much time”) or precocious remarks (“Then maybe it shouldn't be”) just got annoying at some point exerted unintentional pressure on me, even if no one meant it badly. Worst of all, however, was the stress I put on myself every time someone "just got pregnant" again.

As much as I was happy for my friends, every happy news hit me in the pit of my stomach and the little envy monster whispered nasty things in my ear. What helped, on the other hand, was: fade out and distract, preferably with something you can't do with a baby, like a wellness weekend in a chic hotel, a great trip or just a boozy evening with alcohol. Just don't despair or embitter, I made up my mind, in an emergency I would have got psychological help.

I keep the next steps on my way short, even if they seemed infinitely tough and slow in reality: my gynecologist determined some hormone levels to rule out typical diseases. The result was sobering because it wasn't particularly sensational: I was hormonally and physically at the level of cycle day 3 or 4, only that it didn't go on; I called that ovaries in hibernation. The only thing I noticed was my thyroid level. So I went to the nuclear medicine doctor for an underactive treatment. When my period continued to fail, my doctor referred me to the endocrinologist, who was supposed to help me - or rather my cycle - hormonally on the jumps.

Money is earned with the insecurity of those affected

I was in treatment with her for about a year, first taking a tablet that is supposed to support ovulation, later I injected hormones to simulate a normal cycle. My partner and I actually had to have calendar sex during that time. In the first half of the cycle, every few days an ultrasound was used to check whether an egg cell was maturing in my ovaries, and thus an estimate of when ovulation would occur. In all honesty, having sex according to plan isn't fun. The pressure increases, the spontaneity is lost, it feels like work. But if I wanted to have children, I was ready to take it upon myself.

When, after almost two years, even the hormone treatment was unsuccessful, the endocrinologist advised us to go to the fertility center and do further tests. I was now 30 years old and ready for the next step, even if I had been reluctant to do so until then. I had reservations, yes, prejudices against these practices: fertility treatment is something for women who are ten years older than me, and it's all terribly expensive anyway, I thought. But after all the time in which there was no progress and I felt more helpless every day, the fertility clinic was suddenly a valid option - and above all a reason for hope. My fallopian tubes were supposed to be examined here, and my husband also had to submit a sperm sample. After all, as one doctor put it, you can also have lice “and” fleas, in which case that would mean that in addition to my infertility, my husband could also have restricted sperm cells. Incidentally, the fact that there is a problem with both partners is the case with around a third of all those affected, otherwise it is roughly equally down to the woman or the man if a couple cannot father children.

Unfortunately, the tests did not bring anything new. Even at the fertility center, no one could tell me why my cycle didn't want to get going. But since everything was okay with my husband, we were advised to do in vitro fertilization. The woman injects herself with high doses of hormones in order to allow ten to 15 egg cells to mature immediately. These are then surgically removed at the time of ovulation and combined with the man's sperm in a test tube. In the best case, sperm and egg cells fertilize each other, so that after a few days one or two embryos can be transferred directly into the woman's uterus. Or, to put it another way: when my daughter was conceived, five people were present: my husband and I, our fertility doctor and two assistants.

We were lucky. The first attempt was successful, I became pregnant and gave birth to a healthy daughter nine months later. Even if nobody can tell me for sure, I am convinced that it was due to my young age. I was only 30 years old and had a 35 to 40 percent chance of getting pregnant because I had two embryos inserted. For comparison, a healthy middle-aged woman has about a 20 percent chance of it working out on a normal cycle. The older a woman gets, the smaller this number gets. In general, it is said that, statistically speaking, couples who actively want to have children will get pregnant within six to twelve months. If nothing has happened after a year, it is worth seeking medical advice.

Only every fifth couple uses professional help

In any case, this is one of the most important lessons for me from my odyssey to my dream child: don't hesitate too long, don't let too much time pass and look proactively for solutions. Through my personal story and the research on my book, I got to know a lot of those affected and repeatedly found that many wait too long before they get help - out of fear of high costs or social stigma or simply because they are no better knowledge. It is estimated that only one in five affected couples actually goes to the fertility center; the others resign themselves to being unable to have children or hope for a miracle.

The reservations are often unfounded. The health insurance companies pay much more than assumed (examinations, hormone therapy) and are even legally obliged to cover half the costs for up to three attempts under certain conditions. Some health insurers even reimburse 100 percent of the costs - they want to retain young customers. In addition, there are state grants in some federal states. The condition is always that the partners are married and do not exceed certain age limits. It is also precisely regulated which measures are taken.

All of these details seem terribly complicated and put a lot of people off looking at them. During the fertility treatment, I also mostly felt insecure and at the mercy of the doctors. I didn't know where I stood, how far my way was and whether I would get there. The various additional examinations and treatment methods confused and overwhelmed me. What if the 200 euros for the special incubator make the difference? Will the dietary supplement improve my egg quality? I have often wished for a compass that would tell me where to go.

In the end I came out unscathed at the other end of the fertility jungle, even if I felt lost several times in between. Unfortunately, that's part of it, as well as bruises from the syringes and the fact that you literally reveal your innermost being to all sorts of doctors. It helped me to exchange ideas with others and to talk about my fears and worries. I made no secret of my infertility and received a lot of encouragement for it. Above all, I found out that a surprising number of people feel the same way as me.

However, some have to come to terms with the fact that, unfortunately, it doesn't work even with medical help. When the legal possibilities in Germany are exhausted, the woman goes through menopause or not a single sperm cell can be found in the man, at some point you have to accept that it will at least not work with your own children.

Psychologists then try to focus on the beauty of life without children and make it clear to those affected that they can be that happy too. Very rarely does a miracle happen and the woman suddenly becomes pregnant in a very natural way; at least you hear that over and over again. In fact, that's rarely the case. I'm glad I never got to this point. But if the worst came to the worst, we could also have foster parenting or adoption. I always knew that one day I would be a mother. That helped me to stay calm.

There are enough offers for women in my situation. Whether medically or alternatively, whether with dietary supplements, fertility yoga or medication - in the end everyone has to find their way to stay relaxed and not be driven crazy. In my experience, “less” is often “more” because you quickly get the impression that you want to earn money with the insecurity of those affected. But that's no reason to bury your head in the sand. In 2015, 20,949 children were born in Germany after artificial insemination. One of them was my daughter.

Melanie Croyé is a freelance journalist in Berlin and author of the guidebook “If the stork doesn't come by itself - relaxed through fertility treatment” (Beltz-Verlag, 19.95 euros). She has two daughters whom she could only have with the help of reproductive medicine.

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