Fertility treatment: understand your options

Posted on 3 August 2021

For some, falling pregnant can only happen with a little medical intervention.

If you and your partner have been trying for a baby for a year or more – having regular intercourse without any form of birth control – you might need medical intervention to fall pregnant. Your first step is to see a fertility specialist, who will establish the cause of infertility and suggest a course of action. The general age limit for treatment is 41 years.

“The most important step is to make a proper diagnosis and to exclude or address issues

like endometriosis, polycystic ovarian syndrome (PCOS), fibroids, polyps, and uterine abnormalities, as well as doing a full semen analysis,” says Dr Abri de Bruin, Medical Director of the Genesis Reproductive Centre at Mediclinic Kloof. “Other tests include thyroid function tests and testing whether you are immune to German measles, amongst other tests, Dr Abri adds. You can then proceed with attempting conception.” Not all couples will require highly specialised fertility interventions and your treatment is tailored to your specific requirements.

 

OVULATION INDUCTION (OI)

How it works: Your fertility specialist will prescribe medication that stimulates the ovarian follicles to produce, mature and release at least one egg.

“You’ll see your fertility specialist on a regular basis for an ultrasound scan. This is to monitor the progress of the follicles and determine the perfect time for intercourse to maximise the chance of conception,” Dr de Bruin explains. “Ovulation induction (OI) is also used alongside intrauterine sperm injection.”  It is not acceptable to be given ovulation induction drugs without proper evaluation to see if it has the desired effect.

When is it appropriate? This procedure is only recommended if your fallopian tubes aren’t blocked, you don’t have major pelvic disease, and where there is good quality of sperm.

 

INTRAUTERINE SPERM INJECTION (IUI)

How it works: The male produces sperm, which is then prepared in the laboratory using a procedure called sperm washing.

“The embryologist then separates the less active sperm from the better ones, maximising the overall quality of the sample to be used,” Dr de Bruin explains. “The insemination itself is a very delicate and painless procedure. A speculum is inserted and the best sperm from the washing is then inserted into your uterine cavity, bypassing the cervix.  It is a small soft 1mm catheter that is used and it is not painful.”

When is it appropriate? IUI is less effective than in-vitro fertilisation (IVF), but it’s much less invasive and less expensive. After three failed attempts at IUI, you might be advised to switch to IVF.

 

IN-VITRO FERTILISATION (IVF)

How it works: When you’re having IVF, your ovaries are stimulated with medication (injections) to produce a greater quantity of eggs.

“Additional medication helps prevent ovulation from occurring, giving the eggs enough time to mature,” Dr de Bruin says. “Your fertility specialist will then regularly monitor the progress of the follicles via ultrasound.” When the eggs are sufficiently mature, you’ll receive an injection to trigger maturation of the oocytes (eggs). While you’re under conscious sedation, the fertility specialist will then insert a needle into your ovary to retrieve the eggs.

“Once you partner has produced a sample of semen, the embryologist will select the most active sperm to fertilise your eggs,” Dr de Bruin says. “This happens in a culture dish and the resulting embryos (fertilised eggs) are allowed to grow in the laboratory for three to five days.” One or two of the embryos are then transferred into your uterus through the vagina. This procedure is like a PAP-smear, not painful and always done under ultrasound guidance.  There are strict guidelines regarding the number of embryos to be transferred. Roughly speaking, if you are younger than 37, only one embryo will be transferred. If you are over 37, two embryos can be transferred, but other factors play a role that can alter this decision.  “The remaining embryos can be frozen and stored for use in future attempts at conception,” he adds.

When is it appropriate? IVF is usually recommended if your fallopian tubes are severely damaged or blocked, in cases of unexplained infertility where inseminations have been unsuccessful and if sperm quality is poor.

 

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

“The fundamental difference between IVF and ICSI is that in the latter procedure, a single sperm is selected and injected directly into an egg for fertilisation to take place,” says Dr de Bruin.

When is it appropriate? ICSI is the most common and successful treatment when sperm quantity and quality is low (male infertility).

 

FROZEN EMBRYO TRANSFER (FET)

How it works: This is when remaining frozen embryos from an IVF cycle are transferred to your uterine cavity.

“You’ll be prescribed medication to help prepare the uterus for the transfer of the frozen embryo,” Dr de Bruin says. “Your fertility specialist will also perform regular ultrasound scans to monitor the condition of your endometrium.”

When is it appropriate? Frozen embryos remain viable for more than 10 years. You may choose to do an FET cycle following an unsuccessful IVF cycle – or if you’ve already had a successful IVF cycle and want to expand your family.

“Oocyte donation and sperm donation, as well as surrogacy, are other available options, says Dr de Bruin. “Oocyte freezing, especially in younger patients who have to undergo chemotherapy for malignancies,” is also available.

 

For many couples, fertility treatment – conducted in a safe and supportive environment, helps to achieve the ultimate dream of becoming parents.  It is very important to make sure you are treated by a registered fertility specialist in an accredited fertility unit. This information is available on the HPCSA website.