According to the World Health Organization, infertility is characterized by the absence of pregnancy after twelve months of regular unprotected sexual intercourse.
Causes and treatment of infertility in Switzerland
The causes of infertility are varied and often combine several different factors:
In men – reduced sperm count. The amount of sperm in a man changes over time; the sperm production cycle lasts about three months. Decreased sperm quality will not necessarily affect the couple’s fertility. Lower sperm quality can also be compensated for by a highly fertile woman.
In women, the cause of infertility can be :
- Anatomical factors (due to blockage of the fallopian tubes due to infections, endometriosis, myomas, polyps, etc.)
- Hormonal factors
- Age-related factors
- Lifestyle has a strong influence on the ability to conceive (taking alcohol, smoking), emotional state
- Pollutants such as pesticides or plastics, which are endocrine disruptors, may play a role in decreasing fertility in both women and men
Male and female fertility changes naturally over time. The number of sperm cells in sperm fluctuates on a pendulum principle. Similarly, ovulation can be erratic and does not always occur at the same time of the menstrual cycle.
“There are also some additional methods, such as acupuncture to regulate cycle irregularities.
The cause-and-effect relationship between lower sperm quality and fertility has not yet been proven. However, there is one recommendation that everyone agrees on. Men should avoid the greenhouse effect, especially that created by tight pants and tight boxers. This has a proven effect on sperm production by the testicles.
Stress and moods can affect fertility. But it is difficult to determine whether infertility is the cause or consequence of an altered emotional state.
All infertility treatments in Switzerland are reserved for heterosexual couples.
Surrogacy and ovocyte donation are not permitted in Switzerland (sperm donation is, however, possible).
Fertility treatment in Switzerland by in vitro fertilization is not permitted for same-sex couples or singles.
Swiss law prohibits the selection of embryos based on gender or other physical characteristics.
How does infertility screening and treatment in Switzerland begin?
- Hormonal screening, examination for infections, pelvic ultrasound
- Fallopian tubes and uterus exam
- Spermogram
Based on these examinations and discussions, a fertility treatment strategy will be developed in Switzerland tailored to your individual case.
In-vitro fertilization is the most common fertility treatment option in Switzerland. With this method, the fertilization of eggs does not take place in the woman’s body, but in a laboratory.
If the quality of a man’s sperm is reduced, a similar method called ICSI is used, which differs from IVF only in the way the sperm is inserted into the egg.
Important requirements for treatment
To be eligible for IVF or ICSI infertility treatment in Switzerland the following conditions must be met:
- Hormonal evaluation of the woman, ultrasound, spermogram of the man
- Age limit for the woman is between 43-44 years and between 63-65 years for the man.
- Both partners are free of HIV, hepatitis B/C and syphilis.
- Proven immunity against measles and varicella
- Stability of the couple (the couple may not be formally married but have a stable relationship)
Chances of success with artificial insemination
The success rate of infertility treatment in Switzerland depends on the age of the woman and her individual egg supply. Between 35 and 40 years of age, the chances of success halve.
Three tests are performed at the screening stage to pinpoint the individual oocyte reserve:
- Antimuller’s hormone (AMH) determination
- Follicle stimulating hormone (FSH) determination
- Antral follicle count (AFC)
Based on these results, your doctor can give you a relatively accurate assessment of your chances of success in infertility treatment in Switzerland and the possibility of realizing your dream of becoming a parent.
If the quality of the sperm is good, the success rate of ICSI is comparable to traditional IVF treatment. However, ICSI avoids the oocyte fertilization failures that sometimes occur with traditional IVF, even with normal sperm test results.
If a man’s fertility is limited or if previous insemination or IVF procedures have failed, ICSI is always used to treat infertility in Switzerland.
Infertility treatment in Switzerland
In Vitro Fertilization or Intracytoplasmic Sperm Injection (ICSI)
IVF is currently the most widespread and most effective assisted reproduction and infertility treatment method in Switzerland. It accounts for around half of all infertility treatments.
It is particularly indicated in cases of fallopian tube problems, endometriosis, male infertility (insufficient sperm count and motility) or when other treatment methods have failed. IVF reproduces in the laboratory what happens naturally in the fallopian tubes: fertilization (meeting of the egg and sperm) and the first stages of embryo development. The embryo is then placed in the uterus.
The first stage of IVF is ovarian stimulation. The patient is prescribed hormones to help the ovaries produce multiple eggs: this phase lasts an average of 10 days. When the eggs are ready (according to ultrasound results and hormonal blood parameters), the woman receives another hormone to complete oocyte maturation.
After about 35 hours, the oocytes are retrieved: this second stage is performed in the operating room under local or general anesthesia. During the procedure, the oocytes contained in the follicles are aspirated using a needle inserted transvaginally into the ovary under ultrasound monitoring.
The follicular liquid tube and the oocytes thus collected are then sent to the lab in a container at 37°C. They are placed in an incubator that reproduces conditions similar to those that exist in the fallopian tube. The sperm is collected the same day. The sperms are prepared in order to select the most motile and fertile ones. Then, during classic IVF, several thousand sperm are placed next to each egg in a culture medium. This is all placed back in the incubator, and fertilization occurs by itself.
If sperm quality is insufficient or spontaneous fertilization is at risk, embryologists or technicians use an IVF option called ICSI (intracytoplasmic sperm injection). This involves selecting a motile sperm and injecting it directly into the oocyte using a micropipette.
The embryos remain in the incubator for about five to six days. Embryologists then identify the embryos that have the best chance of pregnancy. One or sometimes two embryos are transferred to the uterus. This is a painless and quick procedure.
Additional embryos that are not used immediately are frozen so that they can be used if needed for another infertility treatment attempt in Switzerland or for the birth of a second child.
Ovulation induction
This method aims to induce ovulation in patients whose ovulation does not occur spontaneously. The woman is prescribed hormones (pills or injections) to stimulate her ovaries, as before IVF.
The goal is to stimulate follicle growth to produce one or two mature oocytes. Sexual intercourse is then scheduled at the time of ovulation.
Insemination with the spouse’s sperm
This method is indicated for sexual dysfunction, a moderate decrease in the number or motility of sperm, and in the absence of an underlying cause of infertility. The doctor determines the time of ovulation in advance with a vaginal ultrasound and blood tests.
On the appointed day, about two hours before insemination, sperm is collected from the spouse (by masturbation). The sperms are then prepared in the lab and the most mobile ones are placed in the uterine cavity of the woman through a flexible tube (catheter) passing through her cervix.
This shortens the sperm’s path and prevents it from passing through the cervical mucus. This painless procedure takes only a few minutes.
Risks
Artificial insemination does not always result in pregnancy, and the unrealized desire to have a child can have psychological consequences for desperate couples. Therefore, before any treatment, the doctor always seeks to discuss fears, concerns, and expectations with the couple.
Infertility examinations at the Health and Prevention Center in Geneva