© Nadezhda Moryak
July 7, 2026
Christine Bürg & Marianne Waldenfels
What are the most common reasons couples struggle to conceive? When is it time to seek medical help? Reproductive medicine specialist Dr. Bernd Lesoine explains fertility treatment, success rates and why men should be evaluated early
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Struggling to conceive can be one of the most distressing experiences a couple faces. Month after month, hope builds — and with every negative pregnancy test, uncertainty often grows. Yet many couples wait a long time before seeking medical help, even though early evaluation can significantly improve their chances of pregnancy. Reproductive medicine specialist Dr. Bernd Lesoine answers the most important questions about fertility, infertility and modern treatment options.
Dr. Lesoine, when would you recommend that couples visit a fertility clinic?
Whenever they are worried and asking themselves why it isn't working. Their first port of call should be their gynecologist, who can assess whether there are any signs of a possible underlying cause. If needed, a referral to a fertility center will follow from there.
As a general rule: if a young woman has not become pregnant after one year of regular unprotected intercourse, the cause should be investigated.
For older women, however, waiting that long is not advisable. The World Health Organization's definition only speaks of infertility after two years — but for a 38-year-old woman, that would mean precious time lost, as fertility declines significantly at that age.
There is one point I particularly want to highlight: we regularly see couples who have been trying to conceive for three or four years — and the man has never been examined. Yet in around 40 percent of cases, the cause lies with the man. A semen analysis is straightforward, quick to perform, and should therefore be done early on.pregnant for three or four years — and the man has never been examined. Yet the cause lies with the man in around 40 percent of cases. A semen analysis is straightforward, quickly done, and should therefore be carried out early on.
What are the most common reasons why a couple fails to conceive?
As I just mentioned, around 40 percent of all cases are attributable to reduced fertility in the man — which is why it is so important to always examine both partners.
In women, there are a variety of causes, but age is the single most important factor. Nationwide, the average age of women who come to us is around 35, and in our practice it is closer to 38. Biologically speaking, this is already relatively late, as fertility declines significantly from the mid-thirties onward. This is also why statutory health insurers only cover costs up to the age of 40.
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Why does age play such a decisive role when it comes to fertility?
Fertility peaks between the ages of 25 and 30 — at this stage, most couples don't need our support at all. Between 30 and 35, the chances are generally still very good as well.
From around the age of 35, however, egg quality begins to decline noticeably with each passing year. This is why a growing number of women in this age group are now opting for so-called social freezing — having their eggs frozen as a precaution while their quality is still good.
What costs should couples expect if they decide to pursue fertility treatment?
That depends first and foremost on which treatment is required. If the couple is married, statutory health insurers will generally cover 50 percent of the costs, provided both partners are at least 25 years old and the woman has not yet turned 40.
Not every treatment is equally involved. Often, a cycle monitoring is sufficient as a first step, during which we observe the cycle and provide targeted support for ovulation. If there are no organic causes, couples often end up paying very little in this process.
If sperm quality is reduced, insemination may be a useful option. In that case, the out-of-pocket costs including medication are typically around 70 to 80 euros per cycle.
More complex is in vitro fertilization (IVF) or — where sperm quality is significantly reduced — ICSI, intracytoplasmic sperm injection. Treatment costs here amount to around 700 euros, with additional costs for medication, anesthesia, and other services. All told, couples should initially budget around 1,500 euros.
In Bavaria, the state additionally contributes around 500 to 700 euros, meaning many couples ultimately pay less than 1,000 euros out of pocket.
What differences are there between statutory and private health insurance?
Statutory health insurers tie their coverage to certain conditions: the couple must be married, and the woman must be between 25 and 40 years of age.
Private health insurers take a different approach. For them, neither age nor marital status is the primary consideration — what matters is the medical cause of the infertility. If there is a realistic prospect of pregnancy, a woman aged 42, 43, or even 44 may therefore still be treated. In many cases, private health insurers cover the costs in full.
Which treatment offers the greatest chances of success in your experience?
We achieve the highest pregnancy rates with in vitro fertilization — IVF — or, where sperm quality is severely reduced, with ICSI, intracytoplasmic sperm injection. The success rates for the two procedures differ very little.
One key advantage is that we can retrieve multiple eggs at the same time. From around the age of 35 in particular, a significant proportion of eggs already carry chromosomal abnormalities. Having multiple eggs available increases the likelihood that healthy ones will be among them.
Fertilization also takes place outside the body, which means we can observe which eggs are successfully fertilized and which embryos develop particularly well. We then transfer the embryo directly into the uterus, bypassing any potential problems in the fallopian tubes and significantly improving the chances of pregnancy.
It is important, however, that such a complex treatment is only undertaken when it is genuinely medically indicated.
How many attempts do couples have if the first one doesn't work?
In principle, couples may undertake as many treatment attempts as they wish. However, statutory health insurers will cover the costs for three complete treatment cycles.
It is often possible to retrieve multiple eggs in a single treatment cycle. If embryos are created that are not transferred immediately, they can be frozen and used at a later stage — which further increases the cumulative pregnancy rate considerably.
How long does it take on average for a woman to become pregnant with the help of fertility treatment?
That naturally depends on the individual course of treatment. For patients who opt for IVF or ICSI, it takes on average around six months until a pregnancy is achieved.
We generally allow some time to pass between individual treatments. Some women become pregnant on the first attempt, while others require four or five. It is therefore not possible to give a universally applicable answer.
Fertility treatment is emotionally very demanding for many couples. What role does mental health play?
The psychological burden is immense. Nobody comes to a fertility center by choice. For many couples, even the first appointment is a major step, because it means acknowledging to themselves that things haven't worked naturally so far.
On top of that, the chances of success per treatment attempt average around 30 percent. From a medical perspective, this is a good figure — but it also means that in around 70 percent of treatments, a pregnancy does not result initially.
Many women then blame themselves. They think: There's something wrong with me. Many experience this as a personal failing. That is why it is such an important part of our work to support couples consistently throughout treatment and to help them understand that pregnancy is not a given even under optimal conditions.
At the same time, we are able to give most couples genuine encouragement. If the woman is not yet too old and treatment is consistently continued, around 95 percent of women will ultimately have a child — as long as they don't give up. Some become pregnant after the first attempt; others need four or five treatments.
It is also worth noting that many couples significantly overestimate their chances of success. Studies show that women often put their probability of success before treatment at 70 to 80 percent.
Even after we have explained at length that the chance per attempt is around 30 percent, many still believe shortly afterward that their probability of success is around 70 percent. This hope is probably part of a self-protective mechanism.
Does fertility treatment also put a strain on the relationship?
Absolutely. The situation is particularly difficult when the cause lies with the man — which is the case in around 40 percent of all couples.
Many men find it hard to watch their partner go through all the examinations and treatments while they themselves usually only need to provide a sperm sample once per cycle. A lot of men struggle with that.
That is precisely why it is so important for both partners to carry the treatment together. A man needs to show a great deal of empathy toward his partner during this time. Fertility treatment affects both people — even when the medical procedures are carried out predominantly on the woman.
Many women are afraid of hormone treatment. Is this concern justified?
We encounter this concern very frequently. Many women feel as though they are being "pumped full of hormones" during fertility treatment. This does not, however, reflect what actually happens.
We do not administer female hormones such as estrogen or progesterone. Instead, we stimulate the ovaries using so-called gonadotropins — messenger substances that are naturally produced every day by all people, both men and women. They simply prompt the follicles to produce their own hormones.
Most women actually feel very well during this phase. It is only when the ovaries become larger that some women notice a sense of pressure. Overall, the physical burden is usually far less than many expect. The greatest burden is often a mental one — brought on by worry, hope, and uncertainty.
Are there procedures available abroad that are not permitted in Germany?
Dr. Bernd Lesoine: Yes. Egg donation is prohibited in Germany, while sperm donation is permitted. Surrogacy is also not allowed here.
What I personally find particularly regrettable is that we are only permitted to genetically examine embryos before transfer in a very small number of exceptional cases — even though we know that the risk of chromosomal abnormalities increases with the woman's age.
In many European countries, embryos can be examined before transfer. This makes it possible not only to identify genetic diseases but also, in some circumstances, to avoid distressing pregnancies. In Germany, this is only permitted for a small number of serious genetic conditions.
Do you believe the legal situation will change in the future?
I very much hope so. From my perspective, this is not about selection, as is so often claimed — it is about prevention.
Our goal as doctors is to prevent illness wherever possible. Yet we are repeatedly accused of selecting embryos. I consider this debate to be outdated, and I would welcome a more objective discussion about the possibilities of modern reproductive medicine.
What risks are associated with fertility treatment?
The most significant risk today is multiple pregnancy. While the law permits the transfer of up to three embryos, in Bavaria we have not followed this practice for many years. We occasionally transfer two embryos, particularly in older patients — but this does increase the risk of a twin pregnancy, which is more frequently associated with premature births and other complications.
A risk that was once greatly feared was ovarian hyperstimulation syndrome. Today, we are able to avoid this in the vast majority of cases through modern treatment protocols.
Patients also regularly ask whether treatment increases the long-term risk of cancer. There is now very robust scientific data on this question, and it shows that fertility treatment does not increase either the cancer rate or cancer incidence.
In the past, reproductive medicine was viewed very critically. There were significant social reservations and, at times, even attacks on fertility centers. As a result, patients were monitored with particular scientific rigor for decades. It is precisely these long-term observations that give us the confidence today to say that no medium- or long-term health risks have been demonstrated.
What would you like to say in closing to couples who want to have children but haven't yet succeeded?
I believe that the desire to have a child is something very special — and that's why one shouldn't give up on that wish too quickly.
There are many options available today to help couples. We can't always provide the answer ourselves, but we often know which paths are still open. The most important thing is to seek advice early and not to lose hope.
