How fertility treatments have evolved
Posted on 10 February 2017
A clinical technologist in reproductive biology at Mediclinic says that on average one in five women experience fertility-related problems, but men are also susceptible. He explains how fertility treatments have evolved in South Africa and abroad.
Africa currently has the world’s highest fertility rates, with an average of five children born to women in sub-Saharan Africa over their reproductive years. In South Africa, the figure is less than half at 2.4. This can be attributed to a variety of factors, says Dr Derick Hamlett, a clinical technologist in reproductive biology at Mediclinic Bloemfontein’s Pasteur Fertility Centre. The factors include better access to modern contraceptives and women choosing to delay or forgo having children, or being unable to conceive.
He adds that when couples delay starting a family because of career demands, it places them at a higher risk for requiring fertility treatment. ‘This is due to the age factor,’ says Dr Hamlett. He reports that, on average, one in five women have fertility-related problems, but not all of them seek fertility-assisted procedures.
Fertility treatment has progressed through history from folk and medicinal remedies in the 17th century to the first experimentation with artificial insemination in the mid-19th century. In the 1940s, synthetic hormone supplements became available and Harvard physician John Rock reported the first US fertilisation of human eggs with spermatozoa (sperm) in a laboratory dish – in vitro fertilisation, or IVF.
Nowadays patients can undergo highly specialised IVF and intra cytoplasmic sperm injection (ICSI) treatments. The process of fertilisation involves manually combining an egg and sperm in a laboratory dish and then transferring the embryo to the uterus. Embryos can also undergo a pre-implantation biopsy procedure that screens for certain chromosomal or genetic abnormalities that may run in the family.
The near future
‘Research abroad and in South Africa takes place on a continual basis,’ says Dr Hamlett. He explains that this research is focused more on improving treatment or protocols already being followed, including:
- obtaining good-quality eggs
- increasing the quality of the spermatozoa
- evaluation techniques of the embryos
- transferring of the amount of embryos, as well as the quality of the embryos.
Who requires treatment?
Dr Hamlett says infertility problems don’t only occur in women, but men represent 50% of the cause of infertility in couples, and it’s more complex to clear up in men.
He says that couples who seek fertility advice or treatment are normally experiencing one or more of the following:
- anovulation – when the ovaries don’t release an egg during menstruation
- menstrual cycle irregularities
- polycystic ovarian syndrome (PCOS)
- hormonal defects
- low sperm count
- low motility (speed) or poor morphology (form) of the spermatozoa.
Are there prerequisites for treatment?
Any couple can approach a fertility centre for assistance, but various tests are performed prior to treatment. These may include hormonal evaluations for women, and sperm tests for men, other cases could require a laparoscopy or a hysteroscopy, which are more invasive examinations. Some clinics may require a visit to a psychologist. Once the gynaecologist is satisfied, treatment can commence.
‘Patients with a history of breast cancer, for example, can’t get treatment immediately, as some of the hormones used can pose a risk,’ says Dr Hamlett, adding that tests can identify which hormones can safely be administered during treatment.
Infertility treatment is usually only considered when a couple has tried to conceive for 12 months. However, due to the fact that couples often delay pregnancy to a later age, Dr Hamlett says they are welcome to visit a fertility centre sooner for an assessment to rule out any physiological problems.