Female Fertility After Forty

At Cape Fertility, we support women empowerment. It is a woman’s right to be allowed to decide when to start a family. Women must empower themselves with financial independence, because one of the main reasons gender-based violence exists is that women are financially dependent on their male partners.

Women who want to further their careers before starting a family can fully count on Cape Fertility’s support. We believe women deserve the same reproductive freedom as men.

However, when making this decision, women should also be fully aware of the impact of their age on their fertility, their pregnancy, labour and birth, as well as the treatment options that are available.

Age-related infertility

The reality is that women have a prime fertility window that extends to around age 35. One of the barriers to falling pregnant naturally in your 40s is infertility.

With increasing age, a woman’s fertility decreases. This is due to the fact that from the age of 35 onwards, women not only produce fewer eggs than at a younger age, but these few eggs produced are also of lower quality.

Of course, some women have no issues getting pregnant well into their 40s, and most healthy women who get pregnant after age 35 and even into their 40s have healthy babies.

But, statistically speaking, a woman is less likely to get pregnant and more likely to need fertility treatments the older she is when trying to conceive.

Technology Advances In Fertility Treatment

Very simply stated, during in vitro fertilization, the female partner’s eggs (or eggs from a donor) are collected and fertilized with sperm in a laboratory. The resulting embryo is then implanted into the mother-to-be’s uterus.

Several technology advancements have enhanced the success rate of IVF and other fertility treatments. These include automatic sperm analysis, ICSI, laser biopsy, time lapse technology, Pre-Implantation Genetic Screening (PSG) and Pre-Implantation Genetic Diagnosis (PGD), all of which are very exciting developments that have improved IVF pregnancy rates.

Automated sperm analysis

A significant innovation in terms of the treatment of male infertility is automated sperm analysis. Traditionally, sperm samples would be analysed under a microscope, based on visual information. Today, thanks to automated sperm analysis, sperm samples are now checked and automatically analysed by a computer.

Since 2017, Cape Fertility has provided our patients with access to a Sperm Class Analyzer CASA System. The computer analysis is more accurate than an analysis done by a person, and this improves the chances of a pregnancy.

ICSI

Intra Cytoplasmic Sperm Injection or ICSI revolutionised male infertility treatment. Before ICSI, it was very difficult to treat male infertility. But now, nearly every man can have his own biological child, as long as there is sperm.

Top Four Common Causes of Female Infertility

Endometriosis

Endometriosis is a benign condition in which the lining of the uterus is growing where it is not supposed to be – outside of the uterus, often at the back of uterus or around the ovaries or on other organs.

Endometriosis is a very common disease and it can start at any age. Up to 10% of all women have this disease.

There are different stages of the disease, ranging from minimal to severe. Most women have minimal or mild endometriosis, characterised by superficial implants and mild adhesions. Moderate and severe endometriosis is characterised by chocolate cysts and more severe adhesions.

A very common symptom of endometriosis is infertility – endometriosis affects between 25 and 40% of women facing fertility challenges.

This is because endometriosis can cause inflammation and scar tissue. Endometriosis is an inflammatory disease, and the inflammation it causes can interfere with a woman’s ovulation.

Endometriosis can also cause anatomical abnormalities such as scarring that can reduce the chances of conceiving. For example, endometriosis adhesions may prevent the fallopian tubes from picking up the egg from the ovary during ovulation.

Endometriosis can also grow on the surface of the ovary as implants or invade the ovary and develop a blood-filled cyst called an endometrioma, or a “chocolate cyst” (so called because over time the blood they contain darken to a deep reddish-brown colour). These cysts may be as small as a pea or grow larger than a grapefruit.

Infertility – When To Get Treatment and What It Entails

There is currently an epidemic of obesity in South Africa. Fertility treatment is also less successful in women that are overweight than among women with a normal body mass index.
Chronic diseases also affect couples’ chances of conceiving.

In men, the testes are the most sensitive organ in the body. So, any serious chronic health disorder will have an effect on sperm cell production and on sperm quality, including hypertension and diabetes.

While chronic diseases like diabetes, hypertension, asthma or heart disease, do not always have an effect on a woman’s ability to conceive, it can come into play during pregnancy, when there may be more complications.

Certain common pelvic diseases can also influence fertility. Fibroids of uterus is one common example in South Africa. This is a disease of the uterus, with abnormal growth of the muscle of uterus, that is known to cause infertility in women.

Another chronic condition of the pelvis, called endometriosis, refers to the lining of uterus growing outside uterus on the fallopian tubes or ovaries, on the bowel or on the bladder. It can lead to pain, but is also a very common cause of infertility.

Common Causes of Ovulation Problems

The Most Common Causes of Ovulation Problems

There are different causes of ovulation problems.

The most common cause of ovulation problems is polycystic ovarian syndrome. However, there are also other causes of ovulation problems, such as early menopause, thyroid problems, a dysfunction of the pituitary gland, and even certain medications.

In this article, we describe the most common causes and treatments.

Polycystic Ovarian Syndrome

By far the most common cause of ovulation problems is polycystic ovarian syndrome or PCOS. In fact, PCOS is responsible for ovulation problems in about 80% of cases.

Women with PCOS have irregular periods and very often also experience weight gain as well as skin problems, most commonly excessive hair growth and acne. In addition, PCOS is also associated with two major health problems: diabetes and high blood pressure. Women with polycystic ovarian syndrome are at an increased risk of having these two diseases.

Fortunately, polycystic ovarian syndrome is easy to treat. For women with PCOS who are trying to fall pregnant, the treatment involves restoring ovulation. There are also other approaches for women who are not trying to conceive.

The starting point is always weight loss. Every kilogram lost helps and even just losing two or three kilograms will make a difference.

Don’t let COVID-19 delay your fertility treatment!

COVID’s Effect On Fertility

Understandably, one of the main concerns among couples struggling to conceive is the effect of COVID-19 on their already-compromised fertility. However, SASREG allays these fears, saying there are no scientific reports that suggest COVID-19 could affect fertility.

There has also been a great deal of misinformation circulating online about negative impacts of the COVID-19 vaccine.

Firstly, it is important to understand that it is impossible to get COVID from the vaccine, because it is an mRNA vaccine, and it does not contain live SARS COV2 virus. The vaccine will also not impact existing medical conditions. However, underlying medical conditions entail a higher risk of having severe complications from COVID-19. Getting the vaccine will lower your overall risk of illness.

Despite a great deal of incorrect information in the media, there is also no evidence that the vaccine affects fertility.

According to the American Society of Reproductive Medicine (ASRM), the available data indicate that COVID-19 vaccines do not cause infertility in women or men, citing a randomized blinded Pfizer-BioNTech trial in which a similar number of women conceived after receiving the vaccine as those who received a placebo. It also confirms that because COVID-19 mRNA vaccines are not composed of live virus, they are not thought to cause an increased risk of infertility, first or second trimester loss, stillbirth, or congenital anomalies.

A Patient-Centred Approach To Treating Endometriosis

Another problematic approach is only considering surgery to treat endometriosis. Fortunately open surgery is no longer necessary and instead laparoscopy is an option. Laparoscopy is a minimally invasive surgery during which a small incision in the navel allows medical specialists to look inside the abdomen and the pelvis, to inspect the uterus, the ovaries and the fallopian tubes, and to detect and treat any endometriosis at the same time.

A further problematic approach is simply focussing on one symptom of endometriosis, such as infertility, and treating endometriosis with ART to the exclusion of surgery.

All these approaches are problematic because the treatment of endometriosis should not be based on the classification or even the severity of the disease. It should also not be based on a medical specialists’ preference for medical treatment, or for surgical treatment.

The treatment of endometriosis should be based on the symptoms of the patient and should therefore entail a combination of medical treatment, surgical treatment and assisted reproduction based on the patient’s situation. Because endometriosis is a benign disease, the disease itself does not require treatment.

Understanding Endometriosis

What Is Endometriosis?

It is very important to understand that endometriosis is not a cancer. Endometriosis is a benign condition in which the lining of the uterus is growing where it is not supposed to be – outside of the uterus.

Medically, endometriosis is defined as: “a benign condition in which endometrial glands and stroma are present outside the uterine cavity and walls.”

One could say endometriosis is uterine lining growing in the wrong place: often at the back of uterus or around the ovaries or on other organs.

There are also different stages of the disease and the ASRM (American Society for Reproductive Medicine) classification is used to determine the stage of endometriosis in a patient.

Depending on the location, extent and depth of the endometriosis implants; the presence and severity of adhesions; and the presence and size of ovarian endometriomas, endometriosis is classified as:

Stage I = minimal

Stage II = mild

Stage III = moderate, and

Stage IV = severe.

Most women have minimal or mild endometriosis, which is characterised by superficial implants and mild adhesions. Moderate and severe endometriosis is characterised by chocolate cysts and more severe adhesions.

Male Fertility Clinic In Cape Town

Here at Cape Fertility, we can also confirm that male infertility is far more common than many people realise. In around 30% to 40% of the infertility cases that we work with, there is a male infertility factor involved – meaning that the cause of a couple’s infertility is due to, or partly due to, a medical problem experienced by the male partner.

The possible causes of male infertility

There are many factors that can cause male infertility.

These range from obvious reasons such as a vasectomy or a spinal cord injury to medical conditions or even medications that are affecting sexual performance and fertility.

A range of lifestyle factors and the use of steroids or testosterone are also common causes and male fertility levels can also decline due to, for example:

* age
* stress
* a compromised immune system
* environmental factors like working with chemicals and heat.

However, a top cause of infertility in men is problems with sperm production or the quality of the sperm. In fact, male fertility is defined by the “sperm quality”, which refers to semen volume, sperm count, sperm motility (movement) and sperm morphology (shape).

IVF and ICSI Costs In South Africa

What IVF treatment entails

IVF is a type of assisted reproductive technology (ART) that has been practiced for more than three decades across the world. It is a safe and trusted medical treatment, and its success rate is impressive.

Very simply stated, during in vitro fertilization the female partner’s eggs are collected and fertilized with sperm in a laboratory. The embryo is then implanted into the uterus.

While this sounds relatively simple, it is important to understand that IVF is not a single medical procedure or event, but a series of procedures completed over several weeks. From the first day of the cycle to the pregnancy test completed 14 days after the egg retrieval, the entire IVF process spans around 28 days, as briefly explained below.

Treatment usually commences on the Day 1, 2 or 3 of the female partner’s cycle. The first step is taking medications to stimulate the growth of the eggs, and to suppress ovulation. Patients are carefully monitored using blood tests and ultrasound scans, usually starting on Day 8 of the cycle.

The next step in the process is the egg collection. It begins with an HCG injection 36 hours prior to the egg collection procedure, which takes about two hours and is performed under sedation.