© Magnific
August 27, 2026
Christine Bürg & Marianne Waldenfels
When pregnancy doesn’t happen, the uncertainty can take a heavy toll on couples. Reproductive medicine specialist Dr. Bernd Lesoine explains why age matters, when to seek medical advice, and which treatments offer the best chances of success.
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When a pregnancy takes a long time to happen, many couples find themselves under enormous stress. But how long should you actually try to conceive naturally? What role does age play, and why should not only the woman but also the man be evaluated early on? Reproductive medicine specialist Dr. Bernd Lesoine explains what can lie behind an unfulfilled desire to have children, what treatment options are available, and how much of a psychological toll the situation can take.
Dr. Lesoine, the number of artificial inseminations has doubled since 2006. What is behind this?
I should first offer a small correction: we are now roughly back to the levels seen in 2003. After that there was a sharp decline, and since 2006 the number has indeed doubled again. One reason is that the stigma surrounding infertility is no longer as strong. Couples no longer simply accept remaining childless.
On top of that, we again have a larger number of younger people who want to start a family. And reproductive medicine has remained comparatively affordable in Germany. Salaries have risen while the cost of treatment has stayed largely the same, and the state also partly covers the costs. This has made fertility treatment a realistic option for more couples.
When would you advise a couple to seek medical help?
The moment a couple starts to worry and asks themselves: why isn't it working? — I would first suggest visiting a gynaecologist. They can check whether everything is fundamentally in order and refer the couple to a specialist if needed.
As a general rule: if a young woman hasn't conceived after one year, it's worth taking a closer look, because she is inherently at peak fertility. For a patient who is 38, on the other hand, waiting two years could be devastating. By that point, her chances will have deteriorated significantly. That's why I always tailor my advice to the patient's age and individual situation.
Why should the man also be examined at an early stage?
We regularly see couples who have been trying to conceive for three or four years, and the man has never been examined. I firmly believe that when a couple shares the desire to have children, the man should be evaluated at least once.
After all, in around 40 percent of couples, male fertility is impaired. A semen analysis is painless, inexpensive, and quick. Before subjecting the woman to more elaborate diagnostic procedures, I want to know what the sperm quality looks like.
What would be the ideal age for a pregnancy from a medical point of view?
The ideal age is somewhere between 25 and 30. At that point, couples generally don't need us at all. Between 30 and 35, fertility is still good as well. This is also the age at which more and more women are opting for social freezing — having their eggs frozen — because they know the quality is still quite good. From around 35 onwards, it declines noticeably year by year and the chances decrease.
Which treatment holds the most promise?
In vitro fertilisation, in fact, regardless of whether it is performed with or without sperm injection. Pregnancy rates do not differ significantly between the two.
The advantage is that we can retrieve several eggs at once. In a 35-year-old patient, a significant proportion of eggs are already chromosomally abnormal. If we retrieve ten eggs through stimulation, the chances are good that some of them will be viable.
Furthermore, the sperm do not have to reach the fallopian tube on their own. Eggs and sperm are brought together in the laboratory. The following day, we can see how fertilisation went, and after that, how the embryos are developing. We can wait and observe which embryo develops best, then transfer it directly into the uterus. This gives the highest chances of success. That said, this complex therapy should only be undertaken when there is a clear indication for it.
Many women are afraid of hormone treatment. Is this concern justified?
You often hear that women are being "pumped full" of hormones. That's not quite accurate. What we actually do is stimulate the woman to produce her own hormones. Oestrogen, progesterone, and other hormones are produced by the follicles, and we stimulate those follicles.
Women generally feel well during stimulation. At some point they become aware of their ovaries, but this is usually not experienced as particularly burdensome. A great deal of it comes down to mindset, because the notion that one is being pumped full of hormones persists. That is simply not the case.
How likely is it that a fertility treatment will actually work?
We are talking about average success rates of around 30 percent per attempt. From our perspective that is quite significant, but it also means a 70 percent chance that it won't work.
The problem is that women often blame themselves when it doesn't. Eggs were retrieved, embryos are transferred back, and still nothing happens. They think it must be their fault. This is enormously psychologically distressing and a profound blow to one's self-esteem — you feel inadequate.
We constantly have to support our patients and help them understand that getting pregnant is simply not that easy. If the woman is not too old, our experience shows that a great many women do eventually have a child, as long as they don't give up. Sometimes it takes a fourth or fifth attempt.
There are studies in which women and couples were asked before their consultation how high they estimated their own chances to be. On average, the estimates were around 70 to 80 percent. They were then given the realistic probability of around 30 percent, and immediately afterwards were asked again. Remarkably, many still believed their chances were around 70 percent. I think this is also a matter of self-preservation: you believe that you will be among the 30 percent for whom it works.
How great is the psychological burden during fertility treatment?
Enormous. Nobody comes to us willingly. It's not like visiting a GP for a cold — it is a truly difficult step. Patients are already under enormous psychological strain simply by being here.
And how do men experience this situation?
For men, too, it can be an enormous burden, particularly when the fertility problem lies with them. They watch their partner go through the entire treatment process, while they themselves only need to provide sperm once per cycle. The man is not the one being treated, yet he suffers alongside her. Empathy is therefore very important in this situation.
What role does stress play in the success of fertility treatment?
The mind certainly has an enormous influence. The problem is that we cannot measure it. There are all manner of studies on the psyche's influence on outcomes, but this is incredibly difficult to assess because there are so many stressors involved.
A competitive athlete, for example, faces high oxidative stress, as does a smoker, and psychological stress also takes a physical toll. We cannot measure the influence precisely, but I have absolutely no doubt that stress plays a role.
What are the risks of artificial insemination?
The greatest risk is actually multiple pregnancy. By law, up to three embryos may be transferred, but in Bavaria we have not done this for many years. We occasionally transfer two embryos, particularly in older patients, and we naturally accept the risk of twins in doing so.
A twin pregnancy carries greater risks. There are more frequent premature births, longer hospital stays, and more frequent adjustment difficulties in the children after birth.
Another risk from earlier times was what is known as ovarian hyperstimulation syndrome. In trying to retrieve as many eggs as possible, there was a concern that women might be severely overstimulated. Today, we can largely prevent this problem through different treatment approaches.
As for medium- or long-term risks such as cancer, there are very robust studies available. These show no increased cancer rate and no increased cancer incidence as a result of the treatment.
Reproductive medicine was long a subject of intense societal controversy. Has that changed?
Enormously. Particularly in the 1970s and 1980s, reproductive medicine specialists were sometimes seen almost as "Frankensteins". We were accused of turning women into breeding machines or of interfering with God's work.
There were even active women's rights groups that carried out attacks on laboratories well into the 1990s. As a result, many reproductive medicine facilities operated very discreetly at the time. In some cases there were no signs or directions; patients had to be collected and escorted to the premises.
This is also why we imposed very strict rules and controls on ourselves from an early stage. Women were followed up over decades, and to our reassurance we see no medium- or long-term health consequences from the treatment.
Are there treatments that are not permitted in Germany?
Yes. Egg donation is prohibited in Germany, whereas sperm donation is permitted. Surrogacy is also not permitted. In addition, embryos may only be genetically tested prior to transfer in very limited exceptional cases.
I deeply regret this. We now have the means to examine embryos before transfer. In Germany, however, this is only permissible in a few exceptional cases, such as when a serious genetic condition is present.
Do you believe this legal situation will change?
I very much hope it will. What troubles me is that such an examination is repeatedly referred to as selection. We see it as prevention. As a doctor, one wants to avoid and prevent illness wherever possible.
What would you like to say to couples who have been trying for a long time without success?
I believe that the desire to have children is something you should never stop fighting for. There is always some kind of solution. Sometimes we may not be able to provide that solution ourselves, but we know where solutions can be found and are always glad to help.
When pregnancy doesn’t happen, the uncertainty can take a heavy toll on couples. Reproductive medicine specialist Dr. Bernd Lesoine explains why age matters, when to seek medical advice, and which treatments offer the best chances of success.
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