Growing a family - with help

The method means that each round of IVF is far more likely to succeed " sparing couples the agony of repeated attempts at having a child.

The method means that each round of IVF is far more likely to succeed " sparing couples the agony of repeated attempts at having a child.

Published Aug 26, 2013

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Cape Town - Fertility treatment used to be the preserve of the rich, but Tygerberg Hospital has changed the game, making it more affordable for regular couples to control when and how they have children.

According to Western Cape Health Department spokeswoman Faiza Steyn, women can now have their eggs harvested and frozen at the state hospital.

She says the most common reasons for egg donation is for use in women who have had surgical menopause, premature ovarian failure, are born without functional ovaries, are at an advanced maternal age or for stem-cell research.

Steyn says some also store their eggs for later use, and the number of women making use of the procedure is growing.

“It is certainly a growing trend due to involvement of women in the mainstream economy and their own personal development during their reproductive years, therefore postponing having children.”

Harvesting eggs involves medication for ovarian stimulation. The medication will cost the patient between R3 500 and R4 000. A number of eggs are then retrieved, using ultrasound guidance, and frozen. The hospital will charge the patient according to the level of care given. A fee of R760 is charged for the actual freezing of the eggs, and a Cryotop vitrification device is used to store them.

Ovarian hyperstimulation syndrome is one of the risks, but can be avoided if the appropriate amount of drugs is used. Other risks, while uncommon, include bleeding during the retrieval of eggs, and infection after the retrieval.

According to the National Health Act, eggs can be frozen for up to 25 years. However, Steyn says such a long period is not advisable, as the survival and the quality of those eggs during thawing might decline. The best age to freeze eggs, as recommended by the South African Society of Reproductive Medicine and Gynaecological Endoscopy, is between 21 and 35 years old. This is in line with global standards.

 

In vitro fertilisation

Couples who wish to conceive using in vitro fertilisation (IVF) will first be evaluated by the medical team. When the decision is made, the woman has pre-treatment and an antral follicle ultrasound on the first day of her period. If everything is normal, she will start the stimulation process.

The cycle will be monitored using ultrasound until the follicles are ready to be punctured for egg retrieval.

A fresh semen sample is collected from the partner on the day of egg retrieval and the egg is then fertilised. The fertilised embryos will be transferred back into the womb on day two or three, followed by a blood test to determine if the treatment was successful.

When it comes to donor IVF, Tygerberg performs the procedure, but the couple must find themselves a donor. The donor’s eggs are graded according to their quality, and the best egg is selected.

“To get good eggs, you have to choose a good and young donor,” says Steyn.

When using their own eggs, a couple’s treatment fee for medication and laboratory costs is between R6 000 and R7 000.

While the cost of the procedure can run to tens of thousands of rands, treatment at the state hospital is considerably cheaper than in the private sector. If a donor is used, the cost rises to between R8 000 and R9 000. Hospital fees are determined by patients’ income.

 

Embryoscope

Women who are struggling to conceive have several options, thanks to advances in technology. And the industry has made another leap forward, this time in the form of the embryoscope.

An embryoscope is an advanced incubator that allows for minute-by-minute observation of an embryo from the moment it is fertilised to the point when it is transferred into the uterus. The technique increases the chances of pregnancy by more than 20 percent.

South Africa’s first embryoscope was made available for use at fertilityclinic Vitalab in Joburg on June 17.

Dr Merwyn Jacobson, specialist in reproductive medicine and co-founder of the lab, says images of the embryos are captured every 20 minutes and monitored at intervals.

The technique allows the embryo cell division to be viewed on a monitor in real time, capturing moments from the beginning of life, he says.

Information about the growth and condition is gleaned without having to remove the embryos from the incubator.

Daily removal and change in temperature and environment can cause stress to an embryo, he explains.

The embryoscope treatment costs the same as an IVF programme in the private sector – about R42 000, excluding medication and investigation. The treatment, however, depends on the cause of infertility, and will differ for each couple.

 

Infertility

Infertility treatment is aimed at couples younger than 35 who have been unable to conceive in one year of regular, monthly, contraceptive-free intercourse, or if they are aged 35 years and older and have not conceived after six months.

Jacobson points to research that shows that 85 percent of women under the age of 35 should be able to fall pregnant within 12 months, and 95 percent within 18 months. Failing that, they should seek treatment for infertility.

Infertility is estimated to affect between 10 and 15 percent of couples of reproductive age.

Jacobson says that in recent years the number of couples seeking treatment for infertility has increased dramatically due to such factors as women delaying having children, the development of newer and more successful techniques for infertility treatment, and increasing awareness of available services.

The reason for the failure to fall pregnant may not have anything to do with the woman.

According to Jacobson, in about 40 percent of cases the problem lies with the man.

In 35 percent of cases, the problem is primarily the woman’s, while in the other cases, the failure to fall pregnant may be due to a combination of factors or inexplicable.

Vitalab performs between 850 and 900 IVF or intracytoplasmic sperm injection cycles a year.

Jacobson notes that not all clinical pregnancies culminate in live births.

 

Statistics

A 2006 study by the World Health Organisation showed that there are 72.4 million fertility patients worldwide. Of these only 40 million seek treatment. A separate study by the WHO also showed that women in Africa are more likely to have a secondary infertility or infertility issues for longer before seeking treatment. There may also be a higher incidence of sexually transmitted disease, which can affect fertility and cause complications with pregnancy.

A New York study broke down the age groups of women seeking treatment:

* 25-30: 7 percent

* 30-35: 23 percent

* 36-40: 25 percent

* 41-43: 25 percent

* 44+: 20 percent

 

Case study: Remember to count your blessings, no matter how you got them

The joy of parenthood is ranked among the greatest natural experiences for couples. But for Mariam, 38, and Dr Hussein Cassim, 40, it took a bit of medical help for them to get there.

In April 2001, Mariam, then 25, and Hussein, then 28, both from Pretoria, had been married for six years and wanted to try for a baby. “We were settled, mature in our marriage and the time felt right,” says Mariam.

Since she was a teenager, Mariam had had irregular periods, menstruating only every three to four months. After she stopped taking the Pill in the April, the couple tried to conceive naturally until August.

“I realised perhaps I would need some help,” says Mariam. She went to a gynaecologist, who, according to Mariam, tried various “old-fashioned” approaches. None of these worked.

Mariam was on an emotional roller-coaster. “I started to understand the blessings that come with just being able to have a baby, which millions of couples take for granted. We felt helpless. There was no clear plan, and you feel like it’s just a lucky packet. It’s a very personal, emotional trial if you are not getting the correct help.”

In December 2001, Mariam and Hussein visited the Vitalab fertility clinic in Joburg.

This is where she was diagnosed with polycystic ovary syndrome, and a clear treatment plan was laid out. The syndrome was treated before they tried to get pregnant again. The couple’s first attempt was in March 2002, using the human chorionic gonadotropin injection, also known as the “trigger shot”.

Then they received a call from the clinic. “The blood result came back positive. We were pregnant. It sounded like a dream,” she says.

Mariam says the first scan was an internal one, but they were so excited that the entire family came along. “That’s the Indian way, because the emotional journey was shared by my entire extended family – they all felt that they were part of ‘making this baby’ and wanted to come see for themselves.”

She has since given birth to three healthy children, all conceived with fertility treatment.

Mariam advises women to go directly to a fertility clinic if they are having trouble conceiving. She warns that “unstructured methods” can drain people emotionally, and affect marriages.

“This may lead to exhaustion, and women may not have energy left to enjoy motherhood if they do conceive. There truly are no words to express what being a mother is, until you are blessed to be one. Each child comes with its own joy. My favourite part of being a mom is coming home to find a house filled with noise and mess and kids all over, knowing they need you and love you unconditionally,” she says. - Cape Argus

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