What is IVF?

History of IVF

The in vitro fertilization procedure was pioneered in the UK in 1978 by Sir Robert Edwards, along with his colleagues – embryologist Jean Purdy and gynaecologist Patrick Steptoe.

As early as 1958, Sir Robert realised that fertilisation outside of the body could be used to help treat infertility. He and his collaborators faced significant challenges, including criticism from religious leaders, ethicists and the medical establishment.

Although at times coming close to giving up, the team was encouraged by the letters received from many couples struggling to conceive. After 20 years of work and dedication, on 25 July 1978, Louise Brown – the world’s first IVF baby – was born to parents Lesley and John Brown.

Since then, an estimated eight million babies have been born thanks to IVF treatment.

Despite the initial criticism of his work, Sir Robert was awarded the 2010 Nobel Prize in Physiology or Medicine for the development of in vitro fertilization treatment. He was delighted with the recognition of his team’s research work over many years to help millions of couples throughout the world overcome the burden of infertility. A year later, in 2011, Sir Robert was also knighted for his contribution and services to human reproductive biology.

What does IVF entail?

In vitro fertilization – or IVF as it is often called – is a type of assisted reproductive technology (ART) that is used to treat fertility or genetic problems to help couples to conceive a child.

Infertility Awareness Month: Safe, Successful Treatments Change Millions of Lives

Infertility is not uncommon

Around one in every four couples in developing countries is affected by infertility, while one in six couples worldwide experience some form of infertility problem at least once during their reproductive lifetime. Infertility doesn’t discriminate either, and can be an issue regardless of gender, race, religion or economic status.

In fact, the prevalence of infertility lasting for at least 12 months is estimated to affect between eight to 12 per cent off women aged 20 to 44 worldwide.

In recent years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing in women. It is a medical fact that a woman’s fertility begins to decline in her 20’s and significantly deteriorates after age 35. The chance of conception for a woman older than 43 is very low. As increasing numbers of women postpone starting families until after 35, many require reproductive assistance.

Other factors that have increased the incidence of infertility include lifestyle factors and treatment of diseases such as cancer.

However, in many cases, infertility is a medical condition that requires an accurate diagnosis and the right treatment.

Infertility is a medical condition

“Infertility” is the term used when a couple cannot get or stay pregnant after trying for at least a year, and the female partner is younger than 35, according to the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy.

COVID-19: The Impact on Fertility Patients

In managing the impact that COVID-19 is having on fertility patients here in South Africa, local fertility clinics are guided in by SASREG – the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy. The society represents specialists – ranging from gynaecologists, embryologists and scientists to fertility and theatre nursing sisters, allied practitioners, psychologists and social workers in the field of Gynaecological Endoscopy and reproductive medicine – and serves to protect the interests of patients undergoing fertility treatment.

Cape Fertility is very proud to be a SASREG-accredited fertility clinic. In addition, one of our fertility specialists, Dr Sulaiman Heylen is currently the President of SASREG. Along with Dr Nomathamsaqa Matebese, also a fertility specialist at Cape Fertility, Dr Heylen was part of the team that created the COVID-19 best practice guidelines for fertility clinics in South Africa.

Health Risks

Fertility patients were particularly concerned about the health risks that COVID-19 could pose to themselves and their partners, how it could affect their ability to conceive and to what risks it would expose a fetus – and later a baby.

Cape Fertility’s fertility specialists believe that most fertility patients can safely proceed with fertility treatments, provided that the right safety procedures are in place, as they are at Cape Fertility.

Fertility Treatments at Cape Fertility during Covid-19

During the initial lockdown locally, based on senior legal opinion, fertility clinics were entitled to continue with essential services for patients of advanced age; patients with a diminished ovarian reserve; patients with poor prognosis for whom time is essential and for oncofertility patients.

This meant fertility clinics could continue to care for patients who are currently in a treatment cycle, while considering freezing of all eggs or embryos for patients who are in a treatment cycle. It also meant fertility clinics could continue care and initiate cycles for patients who require urgent stimulation and cryopreservation for oncology or other urgent indications.

While fertility clinics could continue to care for patients who required emergency surgery, such as ectopic pregnancy, retained products of conception, acute abdomen, acute very severe pain and certain oncological procedures, all elective and semi-elective surgery was suspended.

It also meant no initiation of new treatment cycles, including ovulation induction, intrauterine inseminations, in vitro fertilisation including egg retrievals and frozen embryo transfers, as well as elective gamete cryopreservation. Fertility clinics were also strongly advised to consider cancellation of all embryo transfers, fresh or frozen.

Since the beginning of May, when South Africa went into Lockdown Level 4, all fertility treatments are now allowed under strict safety regulations, but it is not quite business as usual.

How to Find The Best Fertility Clinic in Cape Town

The Best City for Fertility Treatment – Cape Town

The beautiful city of Cape Town is certainly one of the most inspiring and exciting places in the world to undergo fertility treatment and to conceive your baby.

Nestled at the foot of the iconic Table Mountain – one of the New7Wonders of Nature and a Unesco World Heritage Site – Cape Town is a destination to experience! For the seventh year in a row in 2020, 39 000 travellers surveyed by the UK’s “The Telegraph” for its “Telegraph Travel Awards” have voted Cape Town as the greatest city in the world.

Cape Town also holds a host of other accolades – like Condé Nast’s Reader’s Choice Number One Food City in the World; Luxury City Destination of the Year; One of the Top 10 cities in the world for travellers according to the Lonely Planet’s annual Best in Travel campaign; and World Design Capital for its colourful neighbourhoods, modern architecture, art galleries and great museums.

Fertility Specialists in Cape Town

Dr Nomathamsanqa (Tamtam) Matebese – Fertility Specialist

Dr Paul Le Roux – Fertility Specialist

Dr Lizle Oosthuizen – Fertility Specialist

Dr Sulaiman Heylen – Fertility Specialist

A Team of Fertility Experts

These four top fertility specialists are part of the extensive team of fertility experts at Cape Fertility. A unified team, guided by the highest ethical standards, we provide our patients with the best quality, individualised, compassionate fertility care.

Our six-member team of specialist IVF co-ordinators, all registered nurses with a 4-year degree or equivalent qualification, guide our patients through the various steps of the IVF or Egg Donation cycle, planning the treatment dates and synchronising the donor and the recipient.

Our team of experts in embryology are key to our reputation as one of South Africa’s best IVF labs. Our eight embryologists work as a team who draw on and combine their individual experiences and talents to define and establish the finest IVF practices in all areas including oocyte vitrification, frozen embryo transfer, ICSI and PGS/PGD.

We also have a wonderful theatre staff of four who have the crucial role to ensure each patient has a compassionate and dignified experience.

Advanced Sperm Functional Testing

High rates of sperm DNA fragmentation and pregnancy potential

• Normal, healthy pregnancies do occur in couples where the male partner has high percentage of sperm with fragmented DNA, although the chances are significantly reduced, as the percentage of sperm bearing low levels of DNA fragmentation is much lower
• Embryos derived from sperm with highly fragmented DNA have poor prognosis
• DNA fragmentation could result in initiation of apoptosis (natural cellular death) and mutations resulting in blastocyst arrest, miscarriage and abnormalities in the offspring
• Spermatozoa with high DNA fragmentation fertilising younger oocytes than older oocytes carry a better prognosis of successful pregnancy, as the are much more efficient at DNA repair of defective sperm

Causes of Sperm DNA Fragmentation

In men, the major contributing factor for sperm DNA fragmentation is oxidative stress, which can be associated with one or more of the following:

• Infection
• Pyrexia
• Elevated testicular temperature
• Recreational drugs
• Smoking
• Alcohol
• Stress
• Diet
• Environmental and occupational pollutants
• Advanced chronological age
• Varicocoele

Indications for men who may benefit from sperm functional testing

• Unexplained infertility
• Arrested embryo development
• Poor blastocyst development
• Multiple failed IVF/ICSI treatments
• Recurrent miscarriage
• Advanced chronological age
• Varicocoele
• Poor semen parameters
• Exposure to harmful substances

Treatment of abnormal sperm functional testing

It depends essentially on the cause. If the damage is caused by free radicals, a change in lifestyle and diet designed to protect against oxidative stress may help reduce the levels of DNA fragmentation. Other treatment options include:

• Antibiotics in the co-existence of an infection

In Vitro Fertilisation (IVF) – What Happens in the Laboratory Day 0 to Day 6

By Embryologists – Gloria Raidani and Hughlene Baker

Herewith a detailed explanation as to what happens in the laboratory from Day 0 up till Day 6.

Environment and Infertility

Definition

Xenoestrogens are substances in the environment that mimic the action of estrogen. Xeno comes form the Greek word Xeno what means foreign and estrogen is one of the two female hormones. The other female hormone is progesterone. So Xenoestrogens are substances that have the same effect on the human body as one of the female hormones. Some examples are BPA, Dioxine and Pyrethoids.

There has been a great concern that Xenoestrogens have a significant effect on infertility specifically in endometriosis and male infertility.

BPA

One of the most common Xenoestrogens is BPA (Bisphenol A). BPA is used in plastic to make it stronger. It is used mainly in plastic bottles, trays, on the inside of cans, and is also found on receipts and other rolled paper therefore everyone is exposed.

We can avoid exposure to BPA by not using plastic bottles and cans. Using glass, porcelain, and stainless steel are better options and are BPA free. Heating plastics releases more BPA or BPA substitutes so if you are storing food or drinks in plastic containers, put it on a glass or porcelain plate before microwaving or adding boiling water. Don’t leave reusable water bottles in the car in the summer where it gets baked.

Dioxin

Polycystic ovarian syndrome (PCOS) is a very common reason of infertility. Together with sperm problems, fallopian tube problems and endometriosis PCOS is one of the most important reasons why women visit the fertility clinic. PCOS is by far the most common reason for ovulation problems. It is however more than just a fertility problem. PCOS can be the cause of significant health problems and if not properly managed, it can lead to additional health problems later in life.

The most common symptoms in women with PCOS are:

1. Irregular menstruation or no menstruation at all. Some women may also experience other bleeding problems such as very prolonged and heavy menstruation.
2. Problems with the male hormones. This presents as unwanted and abnormal hair growth, acne and oily skin.
3. Decreased fertility and recurrent miscarriages.
4. Weight problems: being overweight, rapid weight gain and difficulty to lose weight.
   Associated health problems, especially problems with the sugar metabolism, and high blood pressure.

Women with Polycystic ovarian syndrome have a chronic medical condition. It is an endocrine disease of the ovaries. There are no cysts on the ovary, and it can be compared to other chronic medical problems such as asthma or diabetes. There is no known definite cure for PCOS. However like asthma and diabetes it can be very well managed. PCOS is a genetic disease and runs in families.