Frequently Asked Questions on Fertility Treatment

The natural rate of conception of a healthy young couple is about 20% per ovulation, which means that only every 4th or 5th ovulation leads to conception - ideal circumstances presumed. The success rate of an IVF-treatment is considered worldwide as the pregnancy rate after an embryo-transfer

By an international comparison, the success rate of all fertility clinics combined averages 25%. Expressed in other words, every 4th or 5th embryo-transfer leads to pregnancy, just like under natural conditions. Increasing the number of attempts to achieve pregnancy in patients, the success rate of treatment respectively rises. After four IVF-treatments, the so-called cumulative pregnancy rate is approximately 60%.

And what are the chances of Intracytoplasmic Sperm Injection (ICSI)? Almost independent of the initial semen analysis, embryo transfer is achieved in over 95% of treatment cycles. The pregnancy rate per embryo transfer is approximately 25 – 30%, sometimes even higher. Even with this procedure, the cumulative pregnancy rate is 60% after four trials.

Under optimal circumstances, after ovarian stimulation and insemination, pregnancy success rates up to 20% can be achieved. Looking at these numbers, it can be understood that conception cannot always be guaranteed.

“The age of the female is often the limiting factor of fertility treatment. Therefore, fertility treatment for females should not be performed after hey have reached 40 years of age.

Exemptions can, however, be made. This can only occur if the female has not exceeded her 45th year of birth, and if her insurance company has given its consent, after hearing the positive prospective chances of fertility, should treatment proceed.” [Richtlinien über ärztliche Maßnahmen zur künstlichen Befruchtung - Der Bundesausschuß der Ärzte und Krankenkassen, Sitzung vom 14th August 1990]. Guidelines from a fertility treatment conference in 1990.

In principle, the costs for the services concerning the diagnosis of unintended childlessness are covered by both statutory health insurance companies (GKV) and private health insurance companies (PKV).

Since the Health Promotion Law (‘Gesundheitsmodernisierungsgesetz’) came into practice on the 1st January 2004, statutory health insurance companies pay for 50% of fertility treatment costs. These may include:

• 8 treatment cycles of insemination without stimulation
• 3 treatment cycles of insemination after hormonal stimulation
• 3 treatment cycles of extracorporeal fertilisation using standard practice (In Vitro Fertilisation - IVF)
• 3 treatment cycles of extracorporeal fertilisation using (Intracytoplasmic Sperm Injection – ICSI).

Before starting treatment, an application for meeting the future costs has to be filed to the insurance company concerned. The applications are prepared by the conducting fertility practices/clinics.

The above-mentioned regulations apply only to female patients between 25 and 40 years of age, and for male patients who haven’t exceeded 50 years of age.

After sterilisation, and in cases of unmarried couples, statutory health insurance companies do not take a share in treatment costs, independent of the patients’ ages.

Multiple Pregnancies
In Germany, only up to three fertilised oocytes are allowed to be transferred; the transfer of two embryos being the most common practice. The likelihood of a twin pregnancy is then about 27%, while a triplet pregnancy can be up to 4%.

Ectopic Pregnancies
Unfortunately, in rare scenarios, the transferred embryos migrate into the Fallopian tubes or into the abdominal cavity. Such complications can be detected early through regular examinations in our clinic, so that proper and effective treatment is able to be started immediately, in order to minimise unwanted complications.

Miscarriage
Every pregnancy bears the risk of miscarriage – approximately 10 – 15% of all pregnancies lead to it. There is no scientific evidence that this rate is increased by embryo-transfer.

Oocyte Puncture (follicular puncture/oocyte retrieval)
The ‘harvest’ of oocytes – oocyte extraction – is a surgical intervention, which is commonly performed under an anaesthetic, with certain risks expected. In very rare cases, complications such as bleeding, infections or perforation of surrounding organs can occur.

Ovarian Hyperstimulation Syndrome (OHSS)
In order to acquire a high proportion of oocytes, the ovaries are stimulated accordingly, which leads to an overproduction and enlargement of them. The anticipated symptoms are explained to patients before the commencement of treatment. In case of occurrence, the required therapeutic actions are initiated.

Procedures which are prohibited by German law (‘Embryonenschutzgesetz’):

• Oocyte donation, which means the transfer of fertilised oocytes from another woman’s uterus to the recipient, in order to achieve pregnancy
• Surrogate motherhood, which means pregnancy and delivery is achieved by a ‘surrogate mother’, while the embryos derive from the oocyte donor, who will adopt the child postpartum

Ensure that you are living a healthy, well-balanced lifestyle. Treat yourself especially well during fertility treatment. Examples of how to achieve this are:

• Eat food with nutritional benefits. A fresh fruit platter; a juicy steak; a bowl of crisp salad – retain your good appetite!
• Regularly allow yourself the amount of sleep you need (8+ hours)
• Engage regularly in moderate-intensity sport and physical activity
• Set aside moments of relaxation throughout the day
• Without hesitancy, seek qualified psychological support, should the treatment be a virtually unbearable psychological burden. We will support you in any way we can
• Reduce tobacco consumption, or rather quit smoking entirely, which is advised for both partners to do. Countless times it’s been scientifically proven that smoking negatively influences treatment results
• Refrain from alcohol consumption following an embryo transfer.

Deliberately-taken treatment breaks (generally one or two months long) are of great importance, because going through one treatment cycle after another places an exhausted strain on your body and soul. Furthermore, this can often lead to a decrease in ovarian responsiveness. Additionally, spontaneous conceptions often occur during these breaks.

Though it may be difficult at times, it is essential to enshrine your spontaneity and enjoyment of life as treatment takes its course. Don’t forget to laugh, and make love not only according to plan, but when you desire to do so.

The days following ovulation induction or embryo transfer will no doubt be a challenging time for couples – you hope; you worry. Despite being difficult for you, it’s important to remain calm and to relax. There is nothing that can help this situation more than doing just that.