Desire to reproduce from A to Z: Get answers to the most common questions

Wanting children is a deeply personal journey, and it can be an overwhelming experience that involves many questions and uncertainties. From the moment you consider starting a family, until you hold your newborn child in your arms, there is a lot to learn and understand.

When should I think about having children?

There is no set rule for when you should start considering having children, as it is a very personal decision. Many factors can influence this choice, including your age, life situation and career. Discuss this with your partner and take your own health and life plan into account. Medically speaking, the ideal time for women to start producing children is usually between the ages of 20 and 35. This is because the woman's fertility is at its highest in this age group. After age 35, fertility gradually begins to decline and the chances of complications during pregnancy increase, including an increased risk of genetic abnormalities such as Down syndrome. Although it is possible to get pregnant later in life, it can be more difficult and may require medical help in the form of assisted reproduction. It is important to note that fertility varies from person to person, and that individual health conditions can affect the timing of family planning. It is recommended to consult a doctor or fertility specialist for personal advice.

Do I have an illness/condition that could make it difficult to have children?

Several diseases and medical conditions can potentially reduce the chances of pregnancy. Here are some of the most common diseases and conditions that can affect fertility:

• Polycystic ovary syndrome (PCOS): PCOS is a common hormonal condition that can lead to irregular menstrual cycles, ovarian cysts and reduced ovulation, making it more difficult to get pregnant.
• Endometriosis: Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus. This can lead to scarring and blockage of the fallopian tubes, which can prevent fertilization.
• Uterine fibroids: Uterine fibroids are benign tumors in the uterus that can affect the implantation of a fertilized egg or block the fallopian tubes.
• Thyroid problems: The thyroid gland plays an important role in the reproductive system, and imbalances in thyroid hormones can affect fertility.
• Hyperprolactinemia: Too high levels of the hormone prolactin can lead to irregular menstrual cycles and reduced ovulation.
• Diabetes: Poorly controlled diabetes can increase the risk of miscarriage and complications during pregnancy.
• Autoimmune diseases: Certain autoimmune diseases, such as lupus or celiac disease, can negatively affect fertility.
• Infections: Serious infections such as chlamydia or gonorrhea, untreated pelvic inflammatory disease or sexually transmitted infections can damage the fallopian tubes and affect fertility.
• Cancer and cancer treatment: Cancer of the reproductive organs or radiation and chemotherapy can significantly affect fertility.

It is important to note that many of these conditions can be treated or managed with proper medical treatment and follow-up. If you have concerns about your own fertility or how a pre-existing condition may affect your chances of conceiving, you should seek advice from a doctor or fertility specialist. Early diagnosis and treatment can often help improve fertility and increase the chances of a successful pregnancy.

Can I check the quality and how many eggs I have?

Yes, there are several ways to check egg reserves and egg quality. Here are some of the most common methods:

• Antimüllerian hormone (AMH) test: This is a blood test that measures the level of AMH in the blood. AMH is a hormone produced by the egg follicles in the ovaries. Higher levels of AMH usually indicate a greater egg reserve. This can give an indication of the quantity of eggs, but not necessarily the quality.
• Transvaginal ultrasound: A transvaginal ultrasound examination can provide information on the number of antral follicles in the ovaries, which can correlate with the egg reserve. However, this is not an accurate measurement of egg quality.
• Age: The woman's age is an important factor when it comes to egg reserve and egg quality. As mentioned earlier, egg quality generally decreases with age, especially after the age of 35.
• IVF (in vitro fertilisation): During the IVF process, doctors can evaluate egg quality by examining the eggs before fertilisation. Although this does not provide a complete guarantee, it can help to select the best eggs for fertilization.
• Genetic testing: For some couples with a history of genetic disorders, genetic testing of embryos (preimplantation genetic diagnosis or PGD) can be a way to assess egg quality before the embryo is implanted in the uterus.

It is important to note that although you can get an estimate of the egg reserve and egg quality, there are no absolute guarantees. Egg quality can vary significantly from egg to egg, even in younger women.

Can I freeze my eggs?

Freezing eggs, also known as oocyte freezing, is a process that allows women to preserve their eggs for future use, either for medical reasons or personal choice. Here's how the process works:

• Pre-stimulation medications: The process usually begins with the use of hormonal medications that stimulate the ovaries to produce more eggs than are normally released in a single menstrual cycle. This is done through daily injections for several days.
• Follicle growth and monitoring: During the stimulation period, the ovaries are closely monitored using ultrasound and blood tests to assess follicle growth and hormone levels. This enables doctors to determine the right time for egg retrieval.
• Egg retrieval (egg collection): When the follicles are sufficiently mature, the eggs are removed through a short surgical procedure called egg retrieval. This is usually done under sedation, and an ultrasound-guided needle is passed through the vagina to aspirate the eggs from the ovaries.
• Egg freezing: After egg retrieval, the eggs are immediately cooled and then frozen using a process called vitrification. This involves lowering the temperature quickly to around -196 degrees Celsius using liquid nitrogen. The eggs are placed in small containers and sealed for storage.
• Storage: The frozen eggs are stored in a specialized storage container that is kept in a fertility clinic or laboratory. The eggs can potentially be stored for several years.

When a woman is ready to use her eggs, they are thawed and fertilized with her partner's or a donor's sperm through in vitro fertilization (IVF). The fertilized eggs are then transferred to the uterus to attempt to achieve pregnancy.

When should I investigate if something is wrong?

When trying to conceive, it may be wise to be patient as it often takes time to achieve pregnancy even for couples without any underlying problems. If you've been trying to get pregnant for over a year without success (or for six months if you're over 35), you should consider consulting a fertility specialist. You should also seek help earlier if you have known fertility problems or medical conditions.

Are my uterus/fallopian tubes normal?

A gynecological examination and possibly additional tests, such as a hysterosalpingogram (HSG), can provide information about the condition of your uterus and fallopian tubes.

Why do I miscarry?

Miscarriage, also known as abortion, is the natural rejection of a pregnancy embryo or fetus before it reaches a viable age. It is important to understand that miscarriages are relatively common, especially early in pregnancy, and they can happen for various reasons. Here are some of the most common causes of miscarriage:

• Genetic abnormalities: Miscarriages are often caused by genetic abnormalities in the embryo that make it non-viable. This may be a natural way the body prevents the birth of a child with serious genetic defects.
• Chromosome abnormalities: Chromosome defects in the embryo can cause it not to develop normally, and this can result in a miscarriage.
• Hormonal problems: Hormonal imbalances, such as low levels of progesterone needed to maintain a pregnancy, can lead to a miscarriage.
• Anatomical problems: Physical problems with the uterus or fallopian tubes can affect the ability to maintain a pregnancy.
• Age: The woman's age plays a role, as the risk of miscarriage increases with age, especially after the age of 35.
• Infections: Certain infections, such as cytomegalovirus (CMV) or listeriosis, can cause miscarriage if they affect the embryo.
• Autoimmune diseases: Autoimmune diseases can cause the body to attack the embryo as a foreign invader.
• Medicines or drugs: Some drugs or drugs can increase the risk of miscarriage.
• Lifestyle factors: Smoking, excessive alcohol consumption and unhealthy diet can also increase the risk of miscarriage.
• Stress: Severe stress can affect hormone levels and have a negative impact on pregnancy.

It is important to note that in many cases miscarriage is a natural process that cannot be prevented or stopped. Most women who experience a miscarriage can later achieve a healthy pregnancy. However, if you experience recurrent miscarriages, it is important to seek advice from a gynecologist or fertility specialist to rule out any underlying causes and to get advice on how to improve your chances of a successful pregnancy.

When should I consider IVF?

In vitro fertilization (IVF) can be a solution for couples who have difficulty conceiving naturally. This can be assessed after a thorough investigation and discussion with a fertility specialist. There are many steps before IVF is necessary for many women.

When should I consider donating?

Egg or sperm donation may be considered if there are serious fertility problems or genetic challenges that affect the possibility of pregnancy. Talk to a specialist about your situation, and get a recommendation on which options you should consider.

When should I be examined for habitual abortion?

Habitual abortion, or repeated miscarriages, should be investigated if you have experienced three or more miscarriages in a row.

What tests should be taken to check fertility?

Fertility assessment can include blood tests for hormone measurements, ultrasound examinations, sperm analysis for the partner, and more advanced tests such as laparoscopy or endometrial biopsy. Start with a dialogue with a gynecologist about your concerns so that you can receive guidance that is adapted to you and your body.

Is there supportive treatment that can help me have children?

Yes, there are various treatment options, including hormone therapy, intrauterine insemination (IUI), IVF and other assisted reproductive techniques.