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What is Fertia knowledge
Fertia knowledge is your point of contact for all information about infertility and pregnancy losses. All content was created by reproductive doctors in understandable language without technical terms, based on the current state of knowledge and taking into account medical guidelines.
We are firmly convinced that comprehensive education is a decisive factor in making the right decisions as a patient.
Fertia Knowledge is much more than just an ordinary knowledge database, because the content is compiled individually for you by topic and prepares you in the best possible way for diagnostics and possible treatment options.
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Ways to use Fertia knowledge
1
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In the knowledge area, you can answer a questionnaire, on the basis of which an individual knowledge journal is compiled for you.
2
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In Fertia Wissen, you can browse for comprehensive knowledge content within the various categories.
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In Fertia Wissen, you can search for various content with specific search words using a free text search.
How does Fertia knowledge work?
Infertility: I won't get pregnant
Here you can find a brief overview of important content. Comprehensive information can be found free of charge in the app in Fertia Knowledge.
Not getting pregnant?
When is further diagnostics recommended?
Under 35 years old: after 12 months
Over 35 years old: after 6 months
Causes, clarification, treatment of...
causes
01
Hormonal causes
cycle disorders
02
Anatomical causes
- Occluded fallopian tubes
- Uterine muscle nodes (fibroids)
- Benign tumours of the uterine lining (polyps)
03
Endometriosis
04
Inflammation of the lining of the uterus
05
Lifestyle & pre-existing conditions
- smoking
- Overweight and underweight
- chronic diseases
06
Genetic causes
Work-up
01
Detailed anamnesis and consultation
02
Blood tests with hormone analyses
03
Gynecological examination
04
ultrasound
05
Depending on the previous history and findings: special tests (e.g. for inflammation)
Therapy
Depending on the cause identified, this may include:
01
medicines for cycle regulation, hormone administration
02
Operative treatment
03
Endometriosis treatment
04
Antibiotic therapy for inflammation
05
Lifestyle-, diet-modification, smoking cessation
causes
01
Sperm count
- reduced number
- limited mobility
- distinctive morphology
02
Impossibility of ejaculation
03
Impaired sperm transport
04
Lifestyle & pre-existing conditions
- smoking
- Overweight
- chronic diseases
05
Genetic causes
Work-up
01
Detailed anamnesis and consultation
02
Urological examination
03
Sperm count
04
Depending on the history of the findings: special investigations
Therapy
Depending on the cause identified, this may include:
01
Hormonal therapy
02
Treatment for inflammation
03
lifestyle, diet, smoking cessation
Pregnancy losses: I won't stay pregnant
Here you can find a brief overview of important content. Comprehensive information can be found free of charge in the app in Fertia Knowledge.
Did you have pregnancy losses?
When is clarification recommended?
After two pregnancy losses, at the latest after three
01
A pregnancy loss is very stressful. For many couples, the news of a pregnancy loss comes completely unexpectedly, often as part of a normal preventive examination. This loss often leads to feelings of helplessness, self-doubt, and deep grief. A stable partnership and an intact social environment are important in order to be absorbed here and to process the grief.
After dealing with this situation, questions often arise about the causes but also, above all, what I can do to avoid a pregnancy loss in another pregnancy.
Whether you've had one or more pregnancy losses makes a significant difference in terms of causes, investigations, and opportunities.
situation
You had one pregnancy loss?
Important to know
You're not to blame and you didn't do anything wrong!
Usually, the cause is an accidental, uncontrollable genetic peculiarity of the embryo.
Review general factors for a successful pregnancy.
In individual cases, certain investigations may be useful.
Your chances of having a baby are usually very good.
Every 5th pair
How common is a pregnancy loss?
In fact, a single pregnancy loss affects many couples, and it is estimated that this affects around 10-20% of all couples.
Around every 5th couple has a pregnancy loss
The question of why and whether you did something wrong is asked by almost all couples who are affected by a pregnancy loss.
situation
You had one pregnancy loss?
It is of paramount importance to us that you understand: You have nothing You did it wrong!
In most cases, a single pregnancy loss is a sporadic event, i.e. an accidental occurrence, especially if it happened before the 12th week of pregnancy. The cause is often a genetic peculiarity of the embryo, which in most cases leads to a pregnancy loss within the first 12 weeks of pregnancy. You had no control over this genetic abnormality! The risk of such genetic changes depends primarily on your age.
Genetics, an uncontrollable factor!
As you certainly know, age plays an important role when it comes to wanting to have children. With increasing age, not only do the chances of getting pregnant decrease, but unfortunately also of staying pregnant. This is because with every year of life, the probability of genetic abnormalities in your eggs and thus also in the embryo increases. Men's fertility is also affected by age. Regardless of age, diagnostics can be useful to identify and understand your individual risk of pregnancy loss and successfully treat potential risk factors.
Should I do special diagnostics after a pregnancy loss?
It is important to understand that a one-time pregnancy loss is usually a random event, which is often associated with an uncontrollable genetic peculiarity of the embryo. For this reason, no special pregnancy loss diagnostics are usually recommende. If you have had a late pregnancy loss, i.e. later than the 12th week of pregnancy, we recommend individual advice from your gynaecologist.
However, this in no way means that general risk factors should not be checked even after an early initial pregnancy loss. Quite the contrary, we strongly recommend that you pause for a moment and think: Is there perhaps something that has been overlooked so far and can be adjusted?
Are there any tests that I should do?
Even though, as explained, no specific pregnancy loss diagnostics are recommended after a pregnancy loss (i.e. if it was your first pregnancy loss), certain tests may still be useful in individual cases.
Your menstrual cycle
Cycle length can vary greatly from person to person and can be influenced by many factors, including stress and diet. Some women have a very regular cycle with always the same number of days, while for others, the cycle may fluctuate by a few days from month to month. Such fluctuations may be normal and are usually no cause for concern.
A cycle length of 25-35 days is considered normal and inconspicuous. This is calculated from the number of days that elapse from the first day of your period to the first day of your next period. However, if you notice significant deviations in your cycle, we recommend that you discuss this with your gynecologist. Various causes may be responsible for this, including spotting and a possible shortening of the cycle, which could indicate so-called luteal insufficiency. This can usually be treated with the hormone progesterone.
Thyroid
The thyroid gland is an important organ that uses hormones to control many bodily functions. If there are problems with your thyroid function, this can increase the risk of a pregnancy loss. If you suffer from constant tiredness, feel weak and exhausted, your weight has gained, you have noticed sensitivity to cold, notice rather dry skin and hair, increases hair loss and you have frequent constipation, we recommend that you have your thyroid function checked by taking a blood sample. In particular, hypothyroidism, which often occurs in women, may play a role as a risk factor for pregnancy loss.
Sugar metabolism
Disorders in sugar metabolism, such as insulin resistance, can reduce your chances of a successful pregnancy and increase the risk of pregnancy loss. When you are insulin resistant, your cells no longer respond to insulin as effectively as they should. If you notice that your cycles are irregular and longer than 35 days and that you are also overweight, it could be useful to check the so-called HOMA index. This index is determined by measuring your fasting blood sugar and insulin levels in the blood. Many women with an elevated HOMA index have difficulty losing weight, but there are support options available to help you.
situation
What else can I do? Factors for a successful pregnancy
vaccination status
Before you implement your desire to have children, it is important to...
Factors for a successful pregnancy
vaccination status
Before you implement your desire to have children, it is important to check your vaccination status. Current vaccination protection can protect not only you, but also your baby from potential risks. Your vaccination status should be checked by your gynaecologist using your vaccination book (vaccination certificate). If you don't have a vaccination book, one should be created for you.
folic
Folic acid is a crucial vitamin when it comes to...
Factors for a successful pregnancy
folic
Folic acid is a crucial vitamin when it comes to the desire to have children. It supports your baby's development in the womb and reduces the risk of certain abnormalities. If you want to become pregnant, you should start taking folic acid daily (once a day, orally, dose 400 ug*) at least 4 weeks before becoming pregnant.
*400 ug is the standard dose, a higher dose may be necessary if you have had childhood abnormalities in a previous pregnancy, but also if you have certain illnesses. It is best to discuss this again with your supervising gynaecologist.
Nutrition & vitamins
Whether a particular diet is your...
Factors for a successful pregnancy
Nutrition & vitamins
Whether a particular diet increases your fertility is not scientifically proven. However, a balanced diet with a high proportion of vegetables, fruit, whole grains and fiber, as well as moderate fish and little meat, is recommended. There is evidence that such a diet can also have a positive effect on sperm quality.
weight
A healthy BMI (body mass index) can reduce the risk of miscarriage...
Factors for a successful pregnancy
weight
A healthy BMI (body mass index) can reduce the risk of miscarriage. Being overweight and underweight increases the risk of pregnancy complications. The BMI represents the ratio of body weight to height and is calculated as follows:
BMI = body weight in kilograms/ (height in meters)2
Many factors influence BMI, such as diet, physical activity, stress and genetic predisposition. If you have an unhealthy BMI, switching to a healthy lifestyle that includes a balanced diet and regular physical activity is an important step. In addition, hormonal disorders such as thyroid disorders and disorders in sugar metabolism such as insulin resistance may play a role and should therefore be investigated.
sports
Regular physical activity has a positive effect on...
Factors for a successful pregnancy
sports
Regular physical activity has a positive effect on your desire to have children. It not only helps you achieve or maintain a healthy weight, which regulates hormone levels, but also helps to reduce stress.
smoking
Smoking during pregnancy increases the risk of...
Factors for a successful pregnancy
smoking
Smoking during pregnancy increases the risk of miscarriage and significantly harms your unborn baby.
When you smoke, your baby also smokes.
If you are unable to give up smoking, we recommend that you seek advice before you become pregnant.
liquor
Drinking alcohol during pregnancy can lead to...
Factors for a successful pregnancy
liquor
Drinking alcohol during pregnancy can cause serious damage to your unborn baby. It is therefore extremely important to completely abstain from alcohol during pregnancy.
There is no safe amount of alcohol during pregnancy, so alcohol should be avoided completely during this time.
If you find it difficult to abstain from alcohol, we recommend that you discuss this with your gynaecologist before you become pregnant.
caffeine
Whether caffeine is a risk factor for miscarriage is not...
Factors for a successful pregnancy
caffeine
Whether caffeine is a risk factor for miscarriages has not been conclusively proven. Excessive intake should therefore be avoided at all costs. It is usually recommended to limit caffeine consumption to a maximum of around 200 milligrams per day during pregnancy. It is important to know that not only coffee, but also tea and chocolate can contain caffeine. Even though the caffeine content in different drinks varies, this calculator can help you estimate your caffeine consumption: https://www.tommys.org/pregnancy-information/calculators-tools-resources/check-your-caffeine-intake-pregnancy
stress
There is no clear evidence that psychological factors such as...
lifestyle factors
stress
There is no clear evidence that psychological factors such as stress alone are the causes of miscarriages. However, stress and psychological stress can lead to behaviours that have a negative effect on the desire to have children and thus indirectly increase the risk of a miscarriage. This includes smoking, consumption of alcoholic beverages, but also an unhealthy diet. We advise you to reduce stress as much as possible. This is often not easy to implement in hectic everyday life with its numerous challenges. Still, it's important to find ways to consciously manage stress and find out what relaxes you.
What are my chances after one pregnancy loss to a successful pregnancy?
If it was your first pregnancy loss, your chances of a successful pregnancy are still very good and, in particular, depend on your age.
Your chances of having a baby are still very good!
The risk of another pregnancy loss increases due to one previous pregnancy loss is minimal, if at all. You notice that we emphasize that the number of pregnancy losses you have has a major impact on the risk of recurrence. We address this again in the chapter on recurrent pregnancy loss.
Likelihood of a successful pregnancy after one pregnancy loss:
Here you can calculate the chance of a successful pregnancy. Even though this does not take your individual situation into account, it can still serve as a guide.
situation
You had several pregnancy losses?
Importnat to know
Recurrent pregnancy losses can be very stressful; allowing individual grief is important.
A distinction is made between influenceable and non-influenceable risk factors.
Seek help from specialists. A detailed workup for recurrent pregnancy los is recommended after 2 or at the latest 3 pregnancy losses.
There are effective therapies that reduce the risk of miscarriage.
Depending on your individual situation, your chances of having a baby are usually still good.
How many couples are affected by recurrent pregnancy loss?
Depending on the definition used, it is estimated that around 2-5% of all couples who want to have children are affected by repeated pregnancy losses. Some medical guidelines define recurrent pregnancy loss as 2 or more pregnancy losses, others as 3 or more pregnancy losses. In absolute terms, this therefore affects a great many couples. It is important to know that you are not alone.
workmanship
Grief, processing, and mental health after multiple pregnancy losses
A pregnancy loss can trigger deep grief. It is advisable to allow your individual grieving process. Sensitive communication with familiar people, a supportive partnership and an intact social environment can help you do this. But here too, it may be advisable to talk to an outsider or your doctor.
When grief turns into excruciating guilt, sleep disorders, and social withdrawal, it is wise to consider professional help. Scientific studies have clearly shown that recurrent pregnancy loss can cause mental health risks such as depression, anxiety disorders, and post-traumatic stress disorder in both women and their partners. If you or your partner needs support, we strongly recommend that you discuss this with your gynaecologist to connect with specialist professionals.
What is the cause of recurrent pregnancy losses?
The causes of recurrent pregnancy loss are described as multifactorial. This means that many factors can play a causal role. When it comes to risk factors, a distinction is made between influenceable and uninfluenceable factors.
Uncontrollable risk factors
Your age:
Your age also plays a major role here. The older you are, the higher is the probability that the embryo has a genetic characteristic. This is because the probability of genetic abnormalities in your egg increases with each year of life. The effects of age on men's fertility and sperm quality have not yet been as well researched, but there is evidence that age may also play a role here.
Number of pregnancy losses:
With every pregnancy loss, the risk of another pregnancy loss in the subsequent pregnancy increases. This is because an increasing number of pregnancy losses makes you more likely to have underlying risk factors.
Influenceable risk factors
Various risk factors from the following areas play a role here:
lifestyle factors:
overweight and underweight, smoking, alcohol consumption.
anatomy:
These include congenital deviations in the shape of the uterus, such as a partition (septum), but also acquired abnormalities such as muscle knots (fibroids) and adhesions (adhesions, synechia).
Genetics:
Variations in the number and structure of chromosomes, which are carriers of hereditary information.
Hormones:
These are disorders of thyroid function, corpus luteum and sugar metabolism.
blood coagulation:
These include antiphospholipid antibodies (a group of autoimmune antibodies) and other coagulation disorders.
immunology:
Various autoimmune diseases play a role here, such as thyroid antibodies, celiac disease, chronic inflammation of the uterine mucosa and abnormalities in other immunological markers.
When should I have a special recurrent pregnancy loss work-up?
This is where the recommendations differ in the various guidelines. Some guidelines recommend a specific recurrent pregnancy loss workup after two, while others recommend after three pregnancy losses. There is also no uniform opinion in the recommendations as to whether the pregnancy losses must follow one another or whether they can also be interrupted by a successful pregnancy.
A recurrent pregnancy loss workup can be carried out after two or three pregnancy losses.
The type of pregnancy loss may also play a role in this decision. After two late miscarriages, for example, we strongly recommend a detailed work-up.
In the end, it is always an individual decision. However, we believe that an informed decision can only be made when the various options are known. That is why it is so important for us to provide you with detailed information so that you can make well-informed decisions.
Explanation of procedure
How does a special recurrent pregnancy loss work-up happen?
Special diagnosis of recurrent pregnancy loss comprises three main areas:
1
Recording your individual history in a detailed doctor's consultation
This step is about collecting as accurate information as possible about your history and the exact course of your pregnancies. This is known as anamnesis. This is very important so that we can record and understand your situation as precisely as possible. We are aware that discussing recurrent pregnancy loss in particular can be stressful, which is why an empathetic approach is so important.
2
Diagnostics
As part of the doctor's consultation, we will discuss with you which tests are necessary in your individual case to determine the causes of the miscarriages. These investigations may cover various areas, including:
Anatomy: Uterine examination, ultrasound and/or hysteroscopy
Genetics: Chromosome analysis, blood sampling
Hormones: Analysis of various hormones, such as thyroid hormones and cycle hormones, as well as sugar metabolism, blood collection
Blood coagulation: examination of antiphospholipid antibodies and possibly other blood coagulation parameters
Immunology: Analysis of various immunological markers in the lining of the uterus and in the blood, endometrial biopsy and/or blood collection
3
Discussion of findings and treatment planning in a detailed medical consultation
The results of the various tests will be discussed in detail with you and it will be explained what they mean for you and your desire to have children. You will receive information about treatment options that can help reduce the risk of another pregnancy loss. Please note that the path to fertility is not painted in black and white, so a potential treatment plan is always based on your individual history and situation.
therapy
What treatment options are available?
The experience of recurrent pregnancy loss can diminish the hope of a successful pregnancy for many couples. It is therefore all the more important to know that there are effective treatments that reduce the risk of a pregnancy loss. The respective treatment options are usually individually adapted to your situation, so we can only give you general options here.
lifestyle factors
Make sure you maintain a healthy body weight, improve your eating habits, and incorporate regular exercise into your daily routine...
Read on
Therapy options
lifestyle factors
Make sure you maintain a healthy body weight, improve your eating habits, and incorporate regular exercise into your daily routine. Dietary advice can be helpful, and in some cases, medication options can also be supportive. You should definitely stop smoking and reduce alcohol consumption before pregnancy. With a positive pregnancy test at the latest, you should completely refrain from drinking alcoholic beverages.
Smoking and alcohol consumption during pregnancy should be strictly avoided!
anatomy
There are surgical treatment options here, for example, muscle knots, a partition and adhesions can be surgically removed,...
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Therapy options
anatomy
There are surgical treatment options here, for example, muscle knots, a partition and adhesions can be surgically removed.
Comprehensive expertise in surgical procedures is essential, as injuries to the uterus must be avoided at all costs.
genetics
We cannot change the genetic information, but there are possible treatment options as part of a...
Read on
Therapy options
genetics
We cannot change the genetic information, but there are possible treatment options as part of artificial therapy (IVF/ICSI therapy), which should be discussed with you individually.
hormones
If your thyroid function is impaired, we can treat it with medication. The hormone progesterone can be used in...
Read on
Factors for a successful pregnancy
hormones
Hormones: If your thyroid function is impaired, we can treat this with medication. The hormone progesterone can help with corpus luteum weakness, but also if bleeding occurs early in pregnancy or no causes have been found for the repeated miscarriages. Medication as well as changes in your diet and exercise are available to normalize sugar metabolism.
Progesterone can be used as a medication, especially if bleeding occurs during pregnancy!
blood coagulation
If you have antiphospholipid antibodies twice, we recommend therapy with acetylsalicylic acid (ASA, aspirin)...
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Therapy options
blood coagulation
If you have antiphospholipid antibodies twice, we recommend treatment with acetylsalicylic acid (ASA, aspirin) in combination with an injection of low molecular weight heparin under the skin.
Heparins do not reduce the risk of miscarriage unless there is an antiphospholipid syndrome!
immunology
If you have thyroid antibodies, we pay particular attention to the proper function of your thyroid gland. With celiac disease,...
Read on
Therapy options
immunology
If you have thyroid antibodies, we pay particular attention to the proper function of your thyroid gland. A gluten-free diet can help with celiac disease. Chronic inflammation of the lining of the uterus can be successfully treated with antibiotics. If there are other immunological abnormalities, we can consider individual treatment options such as prednisolone or lipid-containing infusions.
The immune system plays an important role in a successful pregnancy!
What are the chances of a successful pregnancy after several pregnancy losses?
The chances of a successful pregnancy after several pregnancy losses depend on various factors and cannot be converted into an absolute probability. We understand that you're looking for a clear assessment, but the reality is complex.
Whether we were able to identify a treatable risk factor in the detailed recurrent pregnancy loss workup plays an important role. Your age and number of previous pregnancy losses are also important factors that influence your chances.
To give you a rough idea: For example, if you are 30 years old and have already had 3 pregnancy losses, the probability of a successful pregnancy is around 73%. But if you've already had 5 pregnancy losses, the probability drops to around 56%. At 45 years of age and after 3 pregnancy losses, the probability is only 23%.
Here you can calculate the chance of a successful pregnancy. Even though this does not take your individual situation into account, it can still serve as a guide.
For this reason, we recommend that you carry out a comprehensive assessment of the risk factors after 3 miscarriages at the latest.
We're here to guide you on this journey and offer the best possible support.
