Infertility affects a growing number of individuals and couples in South Africa. More so than ever, people are postponing pregnancy in favour of developing their careers during their most fertile years, only to find that they may have difficulty conceiving further on down the line. But when is the best time to consider seeking help and when is it too late?
According to Dr Antonio Rodrigues, a fertility specialist at Medfem Clinic, the best starting point is to formulate a Fertility Plan, outlining the steps that you are prepared to take, and possible solutions depending on the success or failure of each step. If you have been unable to conceive within the first six months to a year, it may be best to consider seeing a specialist.
“One of the biggest problems is that many couples put-off pregnancy for a long time, thinking that they will be fertile forever,” he says. “Age is a very important factor to consider. Medical assistance should be considered in couples under the age of 35 who have been trying to conceive for over a year without success, or after six months in women over the age of 35.”
Some signs to look for
He explains that in most cases infertility may be diagnosed by a gynecologist, but many patients go directly to a fertility clinic. “If you have a feeling that you need to be checked, then you should get checked,” he says. “Symptoms like irregular cycles, abdominal pain or a poor lifestyle should prompt individuals and couples to seek help even sooner – there is little point in waiting a whole year.”
Comprehensive fertility testing is essential to determine the causes of fertility problems and a possible course for fertility treatment. Doctors will typically begin with the simplest and least invasive fertility testing. If the causes of conception difficulties are not identified, more involved tests may be scheduled.
Initial tests: what to expect
To begin with a fertility specialist will conduct a primary investigation, which includes examining the female patient properly and doing hormonal blood tests, as well as an ultrasound to ensure that she is ovulating. “We would also check the fluid in the cervix to ensure that it is allowing the sperm through,” says Dr Rodrigues. “The male patients would initially undergo a sperm analysis and blood tests,” he adds.
According to Mandy Rodrigues, a clinical psychologist, specialising in fertility treatment and stress management, there are many fallacies when it comes to a Fertility Plan. “I think many people have this misconception that if you visit a fertility treatment centre, you have to go straight to invasive treatment immediately. But it's really just about getting those basics checked out,” she says. “It's not going to do any harm to come in for an appointment and complete a cycle assessment,” she adds.
“By the end of the first cycle, we will be able to determine if the female patient should undergo further examination in terms of a laparoscopy to check for Endometriosis or Polycystic Ovarian Syndrome (PCOS),” explains Dr Antonio Rodrigues.
Infertility: some causes
According to Dr Rodrigues, infertility affects approximately 20% of the population, or one in five South Africans. In South Africa, infertility is quite often linked to lifestyle and high levels of stress, but there are also other contributing factors such as PCOS and Endometriosis. However the biggest cause of Infertility worldwide seems to be something known as Tubal Disease where the female patient’s fallopian tubes are blocked or damaged. For men infertility is often caused by damage to the sperm which can be a result of sexually transmitted diseases.
Age doesn’t play a factor in determining who may have fertility treatment or not, neither does sexual orientation, nor marital status. However there may be certain limitations in achieving success in fertility treatment.
“By the time you reach menopause it is too late to begin fertility treatment using your own ovaries,” says Mandy Rodrigues. “But by definition, premature menopause is before the age of 35, and after 35, menopause is defined as normal. A woman's fertility rate starts dropping off after 28, and the amount of normal eggs will begin to reduce. But generally as long as a woman is still having her period, she still may have good ovaries and therefore still has a chance of becoming pregnant.”
How much is enough?
She says that making the decision to end fertility treatment, after unsuccessfully trying to conceive, is a very personal one, which really depends on the individual or couple involved. “For some couples one course of treatment is enough, but many people need closure, even when they have been told that there is a less than 1% chance of them being able to conceive,” she says. “It’s important that fertility specialists sit down with poor prognosis couples, and discuss further options such as donor sperm and donor eggs, and even adoption - before they go through the treatment process.”
The most important factor to consider before undergoing the fertility treatment process is to have a strong support system. If a couple is trying to conceive they need to be very supportive of each other as well because this process can put a relationship under a lot of pressure. “A fertility counselor can also play a very important role in helping individuals and couples deal with the emotional and psychological impact of fertility treatment,” concluded Mandy Rodrigues.
(Mandy Rodrigues, clinical psychologist, Medfem Clinic, 2010)
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