Michelle Obama has published her memoirs, including a miscarriage and how she felt about it. "I felt that I had failed because I did not know how common miscarriages are, and nobody talks about it," the former First Lady said in a companion interview to the book.

Obviously Obama has a concern to break the taboo. That may also be because little has changed since their experience 20 years ago. Many women only experience abortions when they are themselves affected - and then feel alone with them.

In the book, Obama also writes that her two daughters were conceived by artificial insemination. This too is a topic that only a few couples publicly speak about. We have summarized the most important questions and answers about miscarriage and artificial insemination.

What is a miscarriage and how common is it?

A miscarriage is the loss of a baby weighing no more than 500 grams. From a higher weight is the talk of a stillbirth. Stillbirths are extremely rare in Germany. Of a thousand children, on average, four dead are born - that is, 0.4 percent.

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In comparison, miscarriages are much more common. Particularly high is the risk in the first twelve weeks of pregnancy, which is why most couples make pregnancy known only then.

According to an overview study from 2012, in each of these first twelve weeks on average two out of every hundred pregnant women lose their embryo. Together, this so-called early abortion affects about one in four pregnant women.

After the 12th week of pregnancy the miscarriage rate decreases - the speech is then from the late abortion. In their data analysis, the researchers found in the 14th Week still miscarriage among a hundred pregnant women until the 20th week, the rate continued to fall. "Taken together, the risk of miscarriage between the fifth and 20th week of gestation is 11 to 22 percent," the researchers write.

What causes are there?

The reasons for a miscarriage are manifold, at the same time, the cause can often not be clarified. Sometimes it is the malformation of the embryo, but alcohol consumption by the mother and mental stress can also contribute to a miscarriage.

In addition, malformations in the abdomen may be the cause. Even with the age of the woman increases the risk of miscarriage.

What does a miscarriage mean to a woman?

Obama writes in her book that she felt like a failure after the miscarriage and felt very lonely. So she probably speaks to many affected women from the soul.

"It is often a profound experience, but it is not perceived by society because miscarriages are a taboo subject," says psychologist Rayna Markin of Villanova University in a May 2018 report from the American Psychological Association. Even doctors often become affected women not sufficiently caring, but they felt this intense emotional pain and despair.

VIDEO: Obama in an interview

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The parting from the embryo or fetus is sometimes complicated by the fact that there are no socially accepted rituals for it - no ceremony, no funeral, no room to mourn. In Germany, for example, a miscarriage is not notifiable; the child will never have existed in official books.

It is typical that many women - as Obama describes it - question themselves after a miscarriage. "Miscarriage is a traumatic loss, not just of pregnancy, but of the woman's self-perception, her hopes and dreams for the future," said psychiatrist Emma Robertson Blackmore of the University of Rochester in another post by the American Psychological Association in 2012.

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The extent of mourning is independent of how far the pregnancy has progressed, the researchers report. Women who lost their unborn baby at the eleventh week may suffer as much as women who miscarried in the twentieth week.

How many children are born after artificial insemination?

Their experiences with artificial insemination also share the Obama with many other couples. Over the past 40 years, more than eight million babies have been born worldwide after a fertility treatment. This is the result of an evaluation of the data collection ICMART presented at the annual congress of the European Society of Reproductive Medicine and Embryology in Barcelona.

Michelle Obama became aware at the age of 34 that the biological clock was real and the number of her ovulation limited. "We had to do IVF," she said in a television interview with ABC. After IVF (In Vitro Fertilization), her daughters Malia and Sasha were born.

In Germany, almost 21,000 children were born after artificial insemination in 2015 - that was three percent of the children born alive in those years. In a large school class, statistically speaking, in 2022 a child will be sitting who owes his life to artificial insemination.

What are the causes of unwanted childlessness?

In Germany, almost every tenth couple between the ages of 26 and 59 is unintentionally childless. According to experts, the reasons are roughly the same for the woman as for the man. With each fifth pair both partners are only partially reproductive.

For women , the main causes are:

  • decreasing function of the ovaries with increasing age
  • genetic changes of oocytes
  • disturbed function of the fallopian tubes or ovaries
  • Endometriosis (benign growth of the endometrium)
  • disturbed hormone balance

The most important causes in men are:

  • Disturbed sperm production and maturation: Nicotine, alcohol, medication, obesity or extreme endurance training can increase the risk of producing too few, too slow, motionless or malformed sperm
  • Mumps disease as a teenager
  • blocked vas deferens
  • stress

How do fertility treatments work?

In Germany, different methods are used to help couples who are unintentionally childless. These include sperm injection into the uterus when sperm motility is restricted. Artificial insemination includes IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection), which is more commonly used.

How successful are artificial inseminations?

The chances of a child after an artificial insemination depend strongly on the age of the mother. For a 35-year-old woman, according to doctors, they were 27 percent per treatment, a 40-year-old 15 percent and a 44-year-old only about three percent. Although the chance of pregnancy increases when two or even three embryos are transferred to the uterus. At the same time, however, the risk of a multiple pregnancy increases, which often causes complications. In addition, every hormone treatment means great hardships for the women.

Also, the success rate depends on whether freshly-derived eggs are used for fertilization outside the body or frozen ones. According to the German IVF register, the pregnancy rate in 2016 was 32 percent per transfer in fresh cycles, and 27 percent in cryogenic cycles - that is, with frozen eggs. In four out of five cases, the pregnancy ended with the birth of a child. The so-called baby take home rate was therefore 23 percent per fertilization in the fresh cycle and 20 percent per fertilization in the cryocycle.