Why am I having trouble getting pregnant?

The causes are 30% each for women, men and couples - 10% have still not yet been explained 

In general, the decision to have children is taken much later these days than it was about 20 years ago. However, as you get older, the chance of getting pregnant decreases, especially for women.

One in four women gets pregnant right away

About one in four women who have unprotected sex during their fertile time become pregnant right away. About 80% of all couples become pregnant within one year. After two years, about 90% of women are pregnant. If pregnancy does not occur during this time despite regular unprotected sexual intercourse, this is referred to as an unfulfilled desire to have children or involuntary childlessness. 

After four years, 5% of women still become pregnant spontaneously 

Half of all couples can expect to have a child within the next three years. This general prognosis can be better in individual cases, but it can also be less favourable - depending on the cause of the childlessness and the individual age. After about four years, the chances of spontaneous pregnancy decrease rapidly: Only just under 5% of all couples still have a child without medical assistance. However, in up to 80% of cases, medicine can help. 

In Germany, about 10 to 15% of marriages remain involuntarily childless. The approximately 130 fertility centres in Germany treat about 100,000 couples every year - with the result that about 3% of all children born (about 30,000) are born after fertility treatment. 

Reasons for childlessness in women


The main causes are hormonal disorders and diseases of the fallopian tubes or uterus.

The causes of involuntary childlessness among women are distributed as follows: 30-40% hormonal causes, 30-40% disorders of the fallopian tubes, 10% disorders of the uterus, 7-10% disorders of the cervix, 1% psychological causes and 10% with no apparent cause. Find out about the following details worth knowing:


1.Hormone disorders

Various disturbances of the hormone balance can lead to a missing or delayed oocyte maturation, to the absence of ovulation and to an insufficient formation of the corpus luteum hormone. Elevated levels of male hormones are often present. Thyroid dysfunction may also be a causal factor. Being underweight or overweight, excessive exercise, medications and stress all affect hormone balance. More rarely, a genetic abnormality or tumour disease is the cause.

2.Damaged fallopian tubes

While disorders in the area of the cervix and uterus are comparatively rarely responsible for an unfulfilled desire to have children, a path problem in the area of the fallopian tubes and their funnel-shaped ends is found more frequently. Closures of the fallopian tubes, restricted motility of the fallopian tubes or damage to the mucous membrane of the fallopian tubes lead to a disturbance in the transport of oocyte and sperm cells. The most common causes of tubal damage are infection, endometriosis, adhesions, previous surgery and ectopic pregnancy.


Endometriosis is one of the most common benign diseases in women. The reasons for the presence of endometrial-like cells outside the uterine cavity are not entirely clear. Common symptoms of endometriosis are abdominal pain, painful bleeding and pain during sexual intercourse. It is also not uncommon for those affected to have problems getting pregnant - organic changes or disturbances in the environment of the abdominal fluid may be responsible. The diagnosis of endometriosis is often only made after a laparoscopy. 

Learn more about symptoms, diagnosis and therapy as well as about the MVZ PAN Institute as a certified clinical endometriosis centre level II.

4.Benign tumours

Uterine fibroids are benign tumours that arise from the smooth muscle of the uterus. Malignant degeneration is rare. Whether such muscle nodes negatively affect fertility depends mainly on their number, size and location.

5.Uterine irregularity

Malformations of the uterus, fallopian tubes or ovaries are rare overall. However, depending on their severity, they can prevent pregnancy or lead to frequent miscarriages.


The treatment options available to date - especially for obesity - are often not very satisfactory and for many women are associated with a long period of suffering: Due to their insulin resistance, the body cells are not supplied with sufficient glucose. Consequently, these cause a constant feeling of hunger as well as excessive food intake - but without ever being truly "satiated". 

For this reason, it has been virtually impossible for these metabolically disturbed patients to counteract their excess pounds and metabolic syndrome. A vicious circle, but one that can now be successfully broken. However, this is only possible if the patient, doctor, nutritionist, exercise therapist and often also a psychologist work together in a coordinated and long-term manner.

7.Genetic disorders

Unfulfilled desire to have children can have various genetic causes in women. One possible cause is changes in the number of chromosomes (aneuplioidies), which often lead to severe fertility problems or sterility. An example of this is Ullrich-Turner Syndrome with the absence of an X chromosome, which occurs once in 2,500 cases. 

Up to 10% of women are affected by structural chromosomal changes, such as translocations. These are pairs of chromosomes with small segments exchanged for each other. Even if the woman is healthy, the formation of the oocyte and the associated chromosome division can lead to incorrect combinations. Such an oocyte can be fertilised, but rarely nests in the uterus. If the pregnancy continues, the baby will not fully develop mentally and physically. 

Premature ovarian failure ("premature menopause" or ovarian dysfunction) is also usually caused by genetic mutations. Adrenogenital syndrome is caused by a specific disturbance in hormone production in the adrenal cortex.

Using blood, metabolic and other tests, we can easily diagnose such genetic disorders. 

Reasons for childlessness in men


Most of the reasons for infertility on the male side come from insufficient sperm quality or blockages in sperm transport.
Even in men, there is no one reason that is responsible for a failure to conceive.  A range of factors can limit male fertility - up to and including complete infertility. The search for the cause is complicated by the fact that the individual processes of sperm maturation, sperm transport to the oocyte and the complex fertilisation process are closely linked and involve a large number of hormonal and enzymatic processes. Sometimes it is not possible to clearly determine at which point the maturation or fertilisation process is disturbed. However, the most common male fertility disorder is not producing enough intact sperm with good motility. Find out the details here:


1.Impaired sperm maturation

Several factors can affect sperm maturation. In addition to a mumps infection in childhood, varicose veins in the testicles (varicocele), undescended testicles, tumours that have been operated on or congenital causes, such as an abnormality in the genetic make-up, can also lead to restrictions in semen quality. Hormonal imbalances, stress and environmental exposure as well as acute infections are other possible causes of reduced sperm quality.

2.Malformed or blocked epididymal ducts

In some men, although a sufficient number of motile sperm are produced, they are unable to leave the body at ejaculation due to a blocked vas deferens. This can be caused by malformed epididymal ducts or ducts that are stuck together, e.g. as a result of inflammation. Diagnosis and therapy are performed by a specialised urologist.

3.Insufficient urinary bladder obstruction

In some men, fertility problems take the form of a dysfunction of the muscle closure of the bladder and prostate. This dysfunction can lead to retrograde ejaculation, where semen enters the bladder and is excreted through the urine. This can be caused by prostate surgery, diabetes mellitus or nerve damage.

4.Antibody formation

Immunological disorders can cause the immune system to regard the patient's own sperm cells as foreign bodies and consequently attack them (immunological sterility). In this attack, the antibodies attach themselves to the sperm cell, hindering its motility and thus preventing the sperm from reaching the oocyte, in particular. However, it is questionable whether this antibody formation on the sperm alone is sufficient for a fertility disorder. If more than 50% of the sperm are affected, a disorder is considered very likely. 

We clarify the causes specifically


If reduced semen quality is detected during the ejaculation examination at the fertility clinic, the possible causes should be specifically clarified. This is done by a urologist who specialises in andrology. In individual cases, human genetic counselling or testing may also be useful. Our gynaecologists use the information obtained to plan the further fertility treatment together with you in a way that makes sense.