Please click on each question to collapse the answer.
For Future Parents
There are many causes of infertility. Infertility is not confined to just women it can be found in both women and men. Research has shown that about:
- 30% the cause of infertility is found to be the woman
- 30% the cause of infertility is found to the man
- 30 the cause of infertility is found to be both male and female
- The final 10 % is believed that the underlying cause could not be determined by diagnostic methods used today
To determine the cause of infertility you would need to undergo tests to find the underlying causes of the problem. Many problems can be rectified which could increase your chances of being successful in conceiving a child.
This should not affect your chances of falling pregnant unless there were other problems unrelated to the lack of a single ovary.
The cervix has what is called cervical mucus which is a jelly-like substance; this jelly substance is produced by minute glands in the cervical canal. Its consistency changes with the menstrual cycle. Prior to ovulation the hormone estrogen causes it to become watery to allow the sperm to easily swim through. When ovulation is completed progesterone causes the mucus to become thick and sticky, when this happens the sperm can’t penetrate through the mucus.
When cervical mucus hostility happens the sperm cannot penetrate the cervical mucus, it causes no symptoms, but is accepted as a cause for lack of pregnancy.
What can be done?
There are a few treatment options available for patients that have cervical mucus hostility; these include estrogen tablets, antibiotics, IVF or IUI.
The estrogen tablets will make the cervical mucus more watery to allow sperm to penetrate
Antibiotics is prescribed if there is an infection
IVF and IUI (intrauterine insemination) if it is found that there are anti sperm antibodies present, some specialists might recommend steroids to prevent the antibodies from developing. High doses are required to be effective often over a long period of time. It should be noted that steroids can have significant side effects and are not always guaranteed to work.
Taking fertility drugs will increase the chance of a multiple pregnancy. However, most people who have taken fertility drugs only have a singleton pregnancy. Today the risk of a multiple pregnancy is reduced with ultrasound scans, testing of the blood, and very careful monitoring. Unless you specifically want a multiple pregnancy, it can be controlled.
Male fertility and male virility are not correlated. You need to understand that the testes have a dual function, one component that produces the sperm and the other produces male hormone. The male hormone continues to function even if the component that produces sperm is diminished or absent.
There are various treatment options available each person is different and may require individual treatment. Here are the different treatments:
Drugs: Usage of drugs allows endometriosis in the healing process to ‘dry up”. There are several drugs that can be used and each drug has its own advantage and disadvantage, its best to discuss this with your doctor, the treatment can be lengthy, six months or more.
Surgery: Mild endometriosis can be treated with surgery with a reasonable success rate. For more serious conditions surgery can improve the situation so that access for egg collection or IVF will improves the chance of pregnancy. The procedure is carried out under general anesthesia, often done by laparoscopy, or in some cases by laparotomy. This procedure destroys the endometriotic nodules, it will also divide adhesions, and this is done by burning them. A laser or fine metal electrode is use for this purpose. On completion of surgery a woman can try for a baby after two to three weeks. This is a better option for women who are older.
IUI (intrauterine insemination): This technique is ideal for young women who have healthy fallopian tubes. They must also ovulate regularly. The endometriosis must be mild. Six cycles of treatment may be offered as this will increase the chance of pregnancy.
IVF: The technique is usually effective for all stages of endometriosis and this is often a choice of treatment that women who have moderate or severe endometriosis. It is also a choice if there is fallopian tube damage or male factor infertility.
For Egg Donors
Women whose ovaries have been surgically removed for one reason or another, or those who have undergone chemotherapy and find their ovaries aren’t functioning correctly.
Some women go through early menopause or have poor ovarian reserves.
Women who fail to fall pregnant after repeated IVF treatments or do not respond to the drugs used in IVF treatment
On your 1st visit to a clinic, you will see a Psychologist. You will also see a Doctor for a scan and a blood test. You will be screened for STD’s, HIV and some genetic diseases namely: Tay-Sach’s disease, Sickle Cell disease, Thalassemia, and Cystic Fibrosis
The pros are that you will now know if you are a carrier of a genetic disease. There are no cons. The testing is done using one blood sample.
No.The egg donation cycle is done at no cost to the donor.
Extremely unlikely. In fact, donors are cautioned to take measures against falling pregnant whilst on a donation cycle, as you will be extremely fertile whilst you are on the medications.
No. By law, the egg donation process in South Africa is anonymous. As such only childhood photos are seen by the couples looking for a donor.
There are about 3-4 visits to monitor the response with vaginal ultrasounds and blood tests. These visits take between 15-30 minutes and are done between 8:00 and 17:00. On the day of the egg retrieval you will be required to be at the clinic for about an hour.
Once the ultrasound shows that the eggs are mature, the retrieval is scheduled. This procedure is done under General Anaesthetic (GA). The eggs are retrieved through the upper vagina using a needle guided by ultrasound. The procedure itself takes about 10 minutes.
R5000 for each completed cycle.
Egg donors use the same medication as fertility patients undergoing IVF. The sequence, dosage and schedule of administration of the drugs for each egg donor is carefully planned by the nurse coordinator in consultation with the fertility specialist.
All donors are required to undergo controlled ovarian stimulation, in which medications are used to stimulate the ovary and produce multiple eggs. Donors are instructed how to take daily injections as part of the treatment cycle. The timing of the treatment cycle is based on the menstrual cycle. Medications begin at the start of the menstrual cycle and continue for approximately two weeks.
Every month a woman’s ovaries will produce between 4-13 oocytes (eggs), by the time ovulation comes, only one egg (the healthiest egg) is released in the hopes of being fertilised by a sperm. If fertilisation does not happen, about 2 weeks later the woman will have a menstrual period and all 4-13 eggs are lost. All the medication does is to ensure that all the eggs that are available for that month are allowed to grow to their fullest and healthiest state. Those are the eggs that the Doctor retrieves.
Yes. The average female is born with +- 500 000 eggs. The body only makes about 4-13 eggs available each month.
Some women get symptoms typical of Pre Menstrual Syndrome (PMS)
The most commonest medication used is GonalF , a pure recombinant preparation of human FSH (Follicle Stimulating Hormone)made from specially genetically engineered cells. Other HMG preparations used are Menopur and Menogon which are obtained from the urine of menopausal women. GonalF comes in prefilled pens for subcutaneous use and are easily self administered. The other HMG preparations have usually to be administered by a second person as they are for intramuscular application. These injections are usually started on day 2 or 3 of the cycle and given daily in doses specified by your doctor for about 8 – 9 days. This medication is needed to achieve follicular growth, meaning the maturing of eggs. Follicular growth has to be checked regularly by ultrasound examinations of the ovaries usually starting on day 8 of the cycle and then repeated at least every 2nd day until a follicular size of about 18-20 mm is reached.
Side effects: Ovarian Hyperstimulation (OHSS)Symptoms are ovarian distention, abdominal fluid collection and occasionally fluid accumulation in the lung when OHSS is severe. Severe OHSS may require hospitalization to monitor kidney and respiratory function. The syndrome is self limiting, has no long term effects and usually only lasts for a few days. With conservative application of HMG and triggering of ovulation with GnRH the syndrome is an absolute rarity.
2. Human Chorionic Gonadotropin
Human Chorionic Gonadotropin (HCG) is a polypeptide Hormone produced by the human placenta and is derived from human pregnancy urine.
Reconstituted HCG should be kept refrigerated
The action of HCG is virtually identical to the ovulation hormone LR. It stimulates the production of steroid hormones by stimulating the corpus luteum (follicle after ovulation) to produce progesterone, a vital hormone to maintain pregnancy. 36 hours after administration ovulation usually occurs and egg retrieval is timed to be 34 – 36 hours after the injection is given. Timing is extremely important. RCG secreted by placental cells of an implanting embryo will ensure continued production of estrogen and Progesterone to prevent menstruation and pregnancy loss.
Side effects ( extremely rare!) : headache, nausea, irritability, fatigue and pain at the side of injection.
3. Leuprolide Acetate
Leuprolide Acetate (Lucrin) is a so called Gonadotropin releasing hormone. It has similar activity to the natural Gonadotropin releasing hormone released by the hypothalamus. Given as a daily dose it will cause initial stimulation and then suppression of the ovaries and will suppress ovulation. Given in single dose it will cause release of LR and trigger ovulation. If used as a trigger for ovulation in IVF it has the main advantage that Ovarian Ryperstimulation does not occur, which only seems to be a problem after triggering with RCG.
Side effects are extremely rare as used in an IVF program. Long term administration will cause menopausal symptoms like hot flushes, vaginal dryness, mood swings and changes in bone density but this does not apply to IVF.
4. GnRH Antagonist (Cetrotide)
Cetrotide inhibits the effects of a natural hormone called Luteinising releasing hormone ( LHRH). LHRH regulates the function of another hormone called luteinising hormone (LH), which induces ovulation during a normal menstrual cycle. Cetrotide inhibits premature ovulation which is undesirable during hormone treatment for ovarian stimulation, as only mature eggs are suitable for fertilisation. Side effects are rare and include nausea and headaches as well as local reactions to the injection.