Our reproductive medicine specialist Dr. Mann shared insights in the Welt interview and explained what reproductive medicine actually achieves. We would also like to share with you here where the opportunities and limitations lie and what we experience in the daily work of the fertility center.
- What exactly is reproductive medicine?
- What do reproductive medicine specialists do?
- Methods of reproductive medicine
- How do you become a reproductive medicine specialist?
- What makes good fertility specialists?
- Open questions in reproductive medicine
What Exactly Is Reproductive Medicine?
Reproductive medicine is also called “fertility medicine” and deals with the diagnosis and treatment of infertility. Couples who are involuntarily childless learn why they have not yet conceived. They then receive an individualized treatment plan to help them fulfill their desire to have children. “The best thing is when it works out for couples who have almost no hope left. One couple tried for six years to get pregnant. They are now coming back for their second child,” says Dr. Mann.
Reproductive medicine treatments are not limited to artificial insemination. Sometimes no therapy is necessary and it is sufficient to monitor the cycle or to flush the sperm into the uterus with a little assistance at the right time.
“Reproductive medicine fascinated me early on because, in addition to medicine, it raises many psychological, ethical, and social questions,” says Dr. Mann. This makes it clear: the field encompasses much more than just reproductive medicine techniques that bring egg and sperm together.
What Do Reproductive Medicine Specialists Do?
We place great importance on understanding the exact history of the couples. Once I had a couple in their early 30s who had been wishing for a child for years. Only during the conversation did it become clear that they had never actually had proper intercourse because the woman suffers from vaginismus, a condition in which the entire pelvic floor muscles cramp up. To talk about something so intimate requires trust. Once we knew, we were able to flush the man’s sperm into the uterus, and on the second attempt she became pregnant,” says Dr. Mann.
Reproductive medicine deals with sensitive topics that require openness from the couples on one hand, and a great deal of empathy and sensitivity from the physicians on the other. When both come together, it is often possible to end involuntary childlessness with the appropriate therapy.
Overview: Methods of Reproductive Medicine
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Cycle Monitoring
When the cycle is monitored, women can better utilize their fertile days to conceive a child with their partner.
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Hormonal Stimulation
Hormones dosed as low as possible trigger ovulation so that the couple can conceive the child naturally.
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Insemination
Here the sperm cells are flushed into the uterus at the right time using a thin, soft catheter.
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IVF/ICSI
Egg and sperm are brought together in a test tube. With ICSI, the most promising sperm is also selected.
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Sperm donation
In cases of complete male infertility, lesbian couples, or single women, sperm donation can provide offspring.
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Social Freezing
Women who wish to have a child later can have their eggs frozen as a precaution. This procedure makes it possible to preserve fertility.
Family Planning in Transition
Society is changing—women live more self-determined lives and want to plan their families accordingly. Sperm donation and social freezing in particular are increasingly in demand.
Dr. Mann on this: “Women are having children later and later, but biology has remained the same. I myself have four children and know how difficult it sometimes is to balance career and family. Many women also lack the right partner. More and more single women want anonymous sperm donation. And social freezing is increasing. Especially women who are successful in their careers find it difficult to accept that nature is only partially in their control.”
How Do You Become a Reproductive Medicine Specialist?
First, a medical degree of approximately six years is required, followed by a five-year specialist training in gynecology and obstetrics. This is followed by a three-year full-time training in “gynecological endocrinology and reproductive medicine.” In total, it takes 14 years for specialists to build up enough expertise in the field of reproductive medicine to work as a “reproductive physician.”
What Makes Good Fertility Specialists?
This question is naturally difficult to answer, also because the answers are likely to be subjective. There is therefore no single “best reproductive medicine” or one “best fertility center” in Germany.
What we consider important and implement accordingly in our private center ‘Die Kinderwunschärztin’:
- personal care by the same physician
- time for conversations in a calm atmosphere
- good accessibility through flexible appointment scheduling
- offering all treatment options in reproductive medicine
- continuous education, adherence to scientific standards, and integration of new findings into the daily work of the fertility center
In addition, there are of course many other criteria that can play a role. In the end, however, it is also important that patients have a good feeling and feel well cared for.
Open Questions in Reproductive Medicine
A look at history shows: reproductive medicine began with the birth of Louise Brown in 1978, the first child conceived through artificial insemination. Then as now, there are some open questions surrounding assisted reproductive medicine.
“I find it terrible how much the laws in Germany lag behind. According to the Embryo Protection Act, we are only allowed to genetically examine embryos during artificial insemination in certain cases and only after an approval process by an ethics committee before they are implanted. This early examination could prevent many miscarriages and abortions and spare women a great deal of suffering,” explains Dr. Mann. But it is not only in the context of preimplantation genetic diagnosis that pros and cons are hotly debated. In reproductive medicine, there are several other questions that concern ethics and require clarification.
Another issue is the treatment of lesbian couples. Not every fertility clinic accepts them. It would certainly be desirable if it were made easier for lesbian couples to have children as well. The guidelines that currently exist are neither clear nor uniform. They only apply at the state level—some allow lesbian couples to receive fertility treatment, others do not comment on it, or even prohibit it. And this in the 21st century. Our fertility center, in any case, is open to lesbian couples.
