Reproductive medicine specialist Dr. Löbbecke answers the most important questions about fertility.

How long can I get pregnant? What is a high-risk pregnancy? And how does artificial insemination actually work? Gynecological endocrinologist and reproductive medicine specialist Dr. Kay Löbbecke has been working at the Hamburg FCH fertility clinic for 11 years. In this interview, he answers the most important questions about fertility and the desire to have children .

How long is a woman fertile?

This depends on the individual ovarian reserve . A woman is born with approximately 1-2 million eggs. This reserve decreases over the course of her life. A gynecologist can check whether there are still enough follicles present by measuring the concentration of anti-Müllerian hormone (AMH) in the blood and using ultrasound at the beginning of the menstrual cycle.

The term "decline in fertility" is often used in this context. This is based on the assumption that fertility declines rapidly after the age of 35. Studies show that this decline is not as steep as previously thought. Becoming pregnant at 35 is generally not a problem; however, the statistical probability of miscarriage and complications during pregnancy and childbirth increases with age.

When is fertility at its highest?

Women are particularly fertile in their early to mid-twenties. From then on, the probability of pregnancy gradually decreases with advancing age and depletion of egg reserves.

When is a pregnancy considered high-risk? And what does high-risk pregnancy mean?

A high-risk pregnancy means that there are risk factors present during the pregnancy, which arise from the mother's medical history (for example, conditions such as high blood pressure or a previous miscarriage) or have been identified through examination findings (such as gestational diabetes or a fetal disorder). All of this is recorded in the maternity record.

For first-time mothers under 18 and over 35, age is also a risk factor. This doesn't mean that complications will inevitably arise during pregnancy or childbirth, but rather that the statistical probability is higher. The medical risk increases with the mother's age; after 40, the likelihood of miscarriage is elevated, and genetic defects are also more common in children of older mothers. Therefore, this risk is given increased attention as a precautionary measure. 

Is it still possible to get pregnant at 45?

It depends on the woman's individual egg reserve. Generally, at this age, the body prepares for the onset of menopause, and cycles without ovulation become more frequent. Therefore, pregnancy at 45 is not impossible, but less likely than at 25 – and associated with risks. Six to eight percent of all pregnant women in Germany develop high blood pressure during pregnancy, which in the worst case can lead to dangerous preeclampsia. In reproductive medicine, such risks become more prominent with increasing maternal age.

Can the pill slow down the biological clock?

Contrary to popular belief, taking hormonal contraceptives that prevent ovulation only slightly slows down the depletion of egg reserves. A healthy lifestyle with low stress and, above all, no smoking, on the other hand, has a positive effect on fertility.

Does smoking reduce fertility?

Studies show that female smokers have fewer eggs on average and therefore often wait longer or unsuccessfully for a pregnancy. Various components of cigarettes negatively affect ovarian function and egg maturation. The success rates of fertility treatments are also significantly lower for smokers. 

Does an abortion affect fertility?

As long as the abortion is performed according to certain standards and without complications, fertility is not affected.

What factors make it difficult to get pregnant?

There are medical and psychological causes, as well as external factors, that can make it difficult to conceive. Besides age, hormonal imbalances such as thyroid dysfunction, sexually transmitted infections like chlamydia, and conditions like endometriosis, lifestyle can also be a reason for an unfulfilled desire to have children. Negative influencing factors include smoking, excessive alcohol consumption, being overweight or underweight, and severe physical or emotional stress, for example, from extreme physical exertion or a chronically elevated stress level.

What happens during fertility treatment?

In reproductive medicine, we use different procedures depending on the problem to support patients in their desire to have children:

• Hormonal stimulation in the form of injections or tablets can be used to enable ovulation.
• If the problem lies more in the number or motility of the sperm, these can be injected into the uterus via insemination .
• In in-vitro fertilization (IVF), the egg cells are combined with the partner's sperm in a test tube outside the body to achieve fertilization.
• If fertilization still does not work, the sperm cells can also be injected directly into the egg cell using intracytoplasmic sperm injection (ICSI) . 

When does fertility treatment become an option?

Women who have been trying unsuccessfully to conceive for about a year should seek advice from a fertility clinic and have the underlying causes investigated by a reproductive medicine specialist. Women over 35 should have their reproductive health checked after six months of trying unsuccessfully to conceive. 

How exactly does artificial insemination work?

A common method of assisted reproduction is intrauterine insemination (IUI). In this procedure, the man's sperm is inserted into the uterus via a catheter. The treatment is usually accompanied by hormonal stimulation of the woman's ovaries to promote egg maturation and to allow for targeted sperm transfer on the day of ovulation.

Another method of artificial insemination is in-vitro fertilization (IVF). In this procedure, the fertilization of the eggs takes place outside the body in a laboratory. Through hormone treatment, several eggs mature; these are then retrieved transvaginally and fertilized in the laboratory with the sperm of the man or a sperm donor. A few days later, one or two embryos are transferred to the uterus via a catheter inserted through the vagina.

Men can donate sperm, but is egg donation also possible?

Egg donation is prohibited in Germany by the Embryo Protection Act of 1990. At that time, there were concerns that split motherhood could occur if a genetically determined egg cell did not remain with the biological mother, and that the resulting child might later experience identity problems. Back then, egg donation was a highly invasive procedure with significant side effects. With today's technology, the procedure is still not without risk, but considerably simpler: The donor is hormonally stimulated so that several follicles mature, which can then be retrieved transvaginally under anesthesia and donated. This treatment is currently only available abroad.

Is it worth freezing eggs? If so, when?

For women diagnosed with cancer, egg retrieval is often the only way to become pregnant after chemotherapy. This involves retrieving eggs or ovarian tissue before cancer treatment begins (medical freezing). However, this does not guarantee successful fertilization later on. The procedure and cryopreservation are relatively expensive, but fortunately, these costs will be covered by health insurance companies starting early next year.

When is the perfect time to have a child?

There is never really a "perfect time." However, certain personal and medical circumstances can speak for or against it. In any case, it is advisable to seek advice from a gynecologist or reproductive medicine specialist in good time when considering these factors.

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