Putting the spotlight on reproductive health

With an estimated one in every six South African couples experiencing infertility, this dream is not always readily realised. As a result, reproductive health is a subject that can no longer go ignored.

Contrary to common belief, the cause of infertility does not rest solely with the woman. According to specialist in reproductive medicine Dr Merwyn Jacobson, in about 40% of cases, the problem in fact lies with the man, while, in 35% of cases, the problem is primarily female. The remaining cases may result from combined factors or be inexplicable. While Dr Jacobson says there is no reason to panic that you may be infertile, he also warns against being too blasé.

If there are problems, seek advice

"The issue is not knowing if you are infertile, but recognising the fact that there may be a problem with fertility," he explains. "A couple is generally considered infertile when there has been no conception after a year of unprotected sex. If there have been problems such as irregular, painful or abnormal periods, pelvic infections, surgery, or pain during intercourse, or you are over the age of 35 and have been trying to conceive for more than six months, it is strongly advised that you seek help by visiting a fertility clinic. If the male partner has a history of mumps in puberty, injury to his testicles, or surgery to the groin or genitalia, a semen analysis would also be of value and can be assessed at a fertility clinic."

Sadly, Dr Jacobson says, too many couples visit a fertility clinic only after many unsuccessful experiences; the sooner a childless couple visits a fertility clinic, the sooner they can get started on their fertility journey. "Dealing with the challenge of infertility is emotionally challenging, but a holistic fertility clinic like the Vitalab Centre for Assisted Conception can prepare, nurture and support infertile couples to help them better cope emotionally and physically during this roller coaster of a journey," he says.

Three primary areas to be considered

When determining the cause of infertility, there are three primary areas that need to be considered: the process of ovulation, the quality of the sperm and the pathway along which the egg and the sperm have to travel. Any factors which impact on these functions may affect fertility to varying degrees. For women, common causes of infertility include blocked fallopian tubes due to pelvic inflammatory disease; endometriosis; surgery for an ectopic pregnancy or ruptured appendix; or physical problems with the uterus and/or uterine fibroids (non-cancerous clumps of tissue and muscle on the walls of the uterus). In men, undescended or injured testicles and previous genital area surgery may adversely affect sperm quality or could cause blockage in the testicular tubes. Post-pubertal mumps may lead to sterility while impotence also reduces fertility potential.

There is good news

The good news is that technological breakthroughs in infertility treatment mean that couples struggling to conceive do have a good chance of having children. There are currently two types of fertility therapy: natural methods, and assisted reproductive techniques such as artificial insemination, in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT). For women with standard indications for IVF (e.g. blocked or diseased fallopian tubes), the pregnancy rates per treatment cycle have improved significantly over the past three decades.

Huge improvements in dealing with reduced sperm mobility have also revolutionised therapy for male infertility. For example, the direct injection of sperm into eggs obtained enhances the likelihood of pregnancy in even the most difficult of male infertility cases, including sperm abnormalities before or after vasectomy reversals. Called intra cytoplasmic sperm injection (ICSI), this is a major programme at Vitalab. Vitalab accomplished its first ICSI pregnancy in 1984 with the help of Dr. Simon Fishel of Care Nottingham, UK, one of the pioneers of this technology. "We have a very large experience with this powerful technology, and have established numerous pregnancies," explains Dr Jacobson. "Patients come to Vitalab from throughout Africa and other foreign countries for this treatment. Other treatments offered include electro-ejaculation for patients with spinal cord injuries, epididymal sperm aspiration for men with absent or blocked ducts, and hormone replacement for individuals with pituitary deficiencies."

Chances of conceiving have been enhanced

High-tech breakthrough techniques have further improved childless couples' chances of conceiving. A new technique called array comparative genomic hybridisation (CGH), for example, means the way the eggs work and the quality of the embryos can be established in an IVF cycle to help further improve birth rates and minimise the incidence of miscarriage and birth defects. This is a significant breakthrough as one of the main reasons IVF doesn't work is chromosomal abnormality; up to half of eggs in younger women, and up to 75% in older women are not functionally normal. Jacobson adds that having poor quality eggs, or no eggs at all is a major infertility factor: "Many women are unable to produce eggs from their own ovaries. The early onset of menopause leaves a woman with no hormones, and no eggs. Some women's ovaries fail to ovulate, while exposure to auto immune diseases and cancer treatments can harm or destroy eggs. In these cases using egg donors and surrogates may be options. In South Africa, neither surrogacy nor the use of egg donors is common and is an issue we are trying to address."

Watch your diet - and exercise

While it is great that there are these medical interventions to treat the causes, Dr Jacobson reminds us that there are many ways to help improve fertility naturally, particularly when first starting to think about creating a family: "Diet, exercise and overall health have a huge impact on fertility. A balanced diet, for example, not only helps to maintain a healthy weight, but it also helps to regulate hormones and nourish your reproductive system. Caffeine has been shown to reduce both male and female fertility levels, while alcohol can reduce fertility levels by up to 50%. Exercise can also be a good natural fertility treatment when done in moderation: exercise can help maintain a healthy BMI, aid in circulation and help remove toxins from your system."

Fortunately, South Africa has a number of leading edge fertility clinics which can help couples who think they may be infertile and this, combined with the significant strides being made in dealing with infertility, offers great hope for today's childless couples to realise their dream of having children.