Longing for a child can cloud your head like a rainy day. When you can't get pregnant, every second woman seems to be pregnant or pushing a pram.
Pregnant friends become hesitant – should or shouldn't they share their good news with you?
Men also struggle with infertility and can feel insecure and inadequate. You may be thinking about IVF (in-vitro or artificial fertilisation) but what are the risks, how much will it cost, how will you cope if the treatments are unsuccessful – and what will happen if you end up with triplets?
Leading fertility specialist Dr Merwyn Jacobson, at the Sandton Vitalab fertility clinic in Johannesburg, gives his advice on what you need to know about IVF.
Who can have IVF?
"IVF treatment is available to couples or women who are having difficulty conceiving."
What are the risks?
"As with all medical procedures, there are risks that patients need to be made aware of – the most widely noted risk of IVF treatment is multiple pregnancies."
"Other less common risks associated with undergoing an IVF treatment could be ovarian hyperstimulation syndrome (OHSS) and complications at egg retrieval, such as bleeding or infection."
How much does it cost?
"IVF treatment varies in cost due to the technology, treatment and medication used within a cycle of treatment. This means that it's individualised for each patient."
"Typically, an IVF cycle will range from R55 000 to R80 000 in private practice, which may be more than it costs in academic practice."
Do medical aids cover even a percentage of these costs?
"Unfortunately, the medical aid companies in South Africa currently do not cover fertility treatments such as IVF, except for Camaf (Chartered Accountants Medical Aid Fund), which contributes."
Discovery also changed their policy in this regard and under certain conditions treatment may be covered.
Do state hospitals (academic training hospitals) provide this service?
"Yes, there are some state/academic hospitals currently in South Africa that do provide this treatment. There is a low-cost IVF programme at Tygerberg Hospital in Cape Town."
How can a woman prepare her body for IVF?
"All preparation that is needed for an IVF treatment cycle will be explained to a patient and managed by the medical professional with the appropriate medications. A balanced and healthy lifestyle is always recommended."
Where can women go for IVF?
"The Southern African Society for Reproductive Medicine and Gynaecological Endoscopy (Sasreg) has a list of accredited clinics within South Africa who offer various fertility treatments such as IVF. Go to Sasreg.co.za."
What about birth defects?
"When babies are conceived naturally, they have the advantage of having imperfect sperm sifted out by the cervix – but this doesn't exclude genetic abnormalities. The mother's age is the primary risk factor. Some countries recommend the cut-off age to be 43."
"More research needs to be done to find out whether babies conceived using IVF may have a bigger risk of certain birth defects. On the other hand, some experts believe that using IVF does not increase the risk of birth defects."
What lifestyle changes do you need to make if you want to improve your chances of successful fertility treatment?
1. Quit smoking.
Women who smoke risk having fewer eggs retrieved during IVF and may have a higher risk of miscarrying. Smoking can also lower her chances of having a successful IVF.
2. Lose weight.
Obesity can decrease a woman's chances of getting pregnant and having a healthy pregnancy. It's best to cut out all non-nutritional carbs, sugar, cakes, fast-foods and carbonated cooldrinks and to eat more fruit and vegetables every day.
Improves overall health. Walking is the best. Use the stairs, walk during your lunch hour and walk every day before or after work.
Cut-out alcohol, recreational drugs and excessive caffeine. Speak to your doctor about any medications you may be taking that could interfere with your fertility.
Types of Fertility Treatment
1. IVF In-vitro fertilisation – fertilising the egg outside the body. This means having hormonal treatment to stimulate the ripening of more than one egg. Eggs and sperm are left in a dish at body temperature and are allowed to fertilise over the next five to six days. Embryos are then transferred into the womb.
2. ICSI Intracytoplasmic sperm injection is used when the sperm count is very low. The sperm is microscopically injected into the egg. These are left to incubate for five to six days before being transferred into the womb.
3. GIFT Gamete intra-fallopian transfer – eggs and sperm are artificially placed into the Fallopian tube where fertilisation happens naturally.
4. ZIFT Zygote intra-fallopian transfer is when a one-day embryo (called a zygote) is transferred into the Fallopian tube. Depending on your age, cause of infertility and risks, your specialist will advise which treatment would be best.
Some infertility facilities offer PGS or pre-implantation genetic screening that checks tens of thousands of genetic markers to ensure a normal, healthy embryo and a healthy full-term pregnancy. PGD (pre-implantation genetic diagnosis) can detect some inherited genetic diseases.
IVF from the personal perspective
'I had IVF, and it worked'
"I believe my treatment was quite standard. I had to inject myself daily for about 10 days with hormones to ensure that multiple eggs developed for retrieval. Then I had several stimulation injections to help my ovaries develop more than one egg."
"Once the eggs were ready for collection, I took a trigger injection to mature those eggs. Once my eggs reached a certain maturity level/size, I was booked in for the egg retrieval process."
"Here, doctors gave me medication that made sure that although I was technically awake, I didn't remember much, and it numbed the discomfort."
"It still wasn't a very pleasant procedure. My husband had to provide a sperm sample on the same day to fertilise the eggs. A few days later we went back in for the implantation, which was a simple and painless procedure."
"Two weeks after that I went in for a pregnancy test. We were ecstatic at discovering we were pregnant! We had been trying for a few years and had three rounds of IUI (artificial insemination) before this IVF attempt."
"I also felt very cautious though, and couldn't quite believe it for the first few months – I was nervous to celebrate too soon as I had never been pregnant before and feared a miscarriage or complications."
"Once we passed the three-month mark, I allowed myself to take a deep breath and to enjoy the pregnancy and be excited about what was coming." – Anonymous
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