Unfulfilled desire to have children – what couples can do – SWR2

Balanced ratio of the causes of childlessness

In general, the polluter-pays principle for childlessness is relatively balanced for men and women. The exact breakdown is: 30 percent is the woman’s fault, 30 percent the man’s fault, and 20 percent of the affected couples have a common cause. And in 20 percent of cases, the doctors cannot find a cause.

Ramona Das is a specialist in gynecology, obstetrics and reproductive medicine at the University Women’s Clinic in Cologne. She has been working in this field for almost twenty years and has repeatedly experienced that many couples seek specialists very late.

More and more lesbian couples or single women are coming to the fertility clinics. It is clear that artificial insemination with sperm donation is usually the only way to have your own child. That’s why lesbian couples are often more relaxed about treatment, says Ramona Das.

Artificial insemination: only for heterosexual couples

Lesbian women are not treated everywhere. Because a directive of the German Medical Association allows “assisted reproduction”, artificial insemination, only in heterosexual, married couples. If the cause of the unfulfilled desire to have children is found in these cases, the next treatment steps are at stake. And the Embryo Protection Act provides the options.

End of a myth: “Psychogenic infertility” has been scientifically refuted

Tewes Wischmann is familiar with the feelings that couples go through with an unfulfilled desire to have children. The psychologist heads the “Gynaecological Psychology” department and the fertility clinic at the University of Heidelberg.

Typical questions from the affected couples:

• Are you putting too much pressure on yourself?
• Is it the stress?
• Is there a “mental blockage?

On behalf of the Federal Ministry of Research, Tewes Wischmann researched whether couples who use reproductive medicine have mental health problems. The result: Not one study was able to prove a connection between the psyche, stress and an unfulfilled desire to have children. The so-called “psychogenic infertility” has been scientifically refuted.

Couples sometimes ask: “Yes, but I have so much stress at work.” Then Wischmann says:

However, what has a negative impact on fertility:

• excessive sport
• underweight
• overweight

Mental problems: possible consequence of childlessness, not its cause

The diagnosis of infertility catches many couples completely unprepared, says Tewes Wischmann. Men often suffer more than women because they associate the finding with their sexuality, their masculinity. Over time, couples also become more discouraged, the waiting wears them down, and there is always shame, a stigma – because unwanted childlessness is not talked about. Psychological problems can therefore be a consequence of childlessness, they are not a cause.

Very few say how difficult the path to fertility treatment really was. However, singer Celine Dion has been open about it. She had her first child with the help of artificial insemination and then – after several miscarriages and with the sixth artificial insemination – gave birth to twins again. Michelle Obama also had her daughters using in vitro fertilization. In her autobiography she also reports on a miscarriage.

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The birth rate for artificial insemination is almost 20 percent

For Ramona Das, a specialist in reproductive medicine, it goes without saying that couples are honestly informed about obstacles and opportunities. Depending on the age of the woman and the available findings, the chances of becoming pregnant within a treatment period are 30 to 40 percent. This rate does not describe that a woman actually gives birth to a child. According to the German in vitro fertilization register, the birth rate per treatment is almost 20 percent, the rest are miscarriages.

Couples planning to have children should consider alternatives

Health insurance pays for three artificial inseminations for married couples. After that, you have to bear the costs yourself. The chances of success: After three attempts, 50 percent of the couples have a child, after four attempts 60 percent and after six attempts a third of the couples. Across all age groups and internationally comparable.

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For many couples, a limit is reached after three attempts, says Tewes Wischmann. However, he also advises those affected to set a kind of “emotional limit”, a personal timetable for the respective couple. The psychologist advises that this roadmap should also include a plan B, C or D right from the start. Couples should discuss:

• Would adoption be an alternative?
• Could children be included through co-parenting?
• What could a fulfilling life without children look like?

Criticism of the ban on egg cell donation in Germany is increasing

In contrast to sperm donation, egg cell donation is prohibited in this country. This is regulated by the Embryo Protection Act, explains the medical lawyer Jochen Taupitz. He is Director of the Institute for Medical Law, Health Law and Bioethics at the Universities of Heidelberg and Mannheim and was a member of the German Ethics Council for many years. However, since the law is already 30 years old and there are medical developments and new findings, experts are calling for a new reproductive medicine law.

In this context, the voices that want to legalize egg cell donation in Germany are increasing. The proponents argue, among other things, with equality. If a man can donate sperm, a woman should also be able to donate eggs. Further arguments are less reproductive tourism abroad and more rights for the children born. Jochen Taupitz is also in favor of legalization for these reasons.

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Surrogacy and Co-Parenting

Surrogacy is the most controversial method in the field of reproductive medicine – and is also prohibited in Germany. There have been isolated reports of gay couples using surrogate mothers abroad, particularly in the United States. Starting a family is complicated for gay couples. They can now adopt children or fulfill their desire to have children through family models such as co-parenting. For example, a gay and a lesbian couple form a relationship of purpose in order to start a family.

For medical lawyer Jochen Taupitz, however, it is clear that all methods permitted in Germany must not only be open to heterosexual couples, but also to same-sex couples. Since marriage is for all and adoption is for all, it would be utterly absurd to say that these couples should not have children and thereby deny them reproductive health options.

SWR 2020

manuscript for the broadcast

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