Infertility – When To Get Treatment and What It Entails


During an insightful interview on Iono.fm, Dr Sulaiman Heylen – a reproductive medicine specialist and director of Cape Fertility in Cape Town – explained when it becomes necessary to seek medical assistance for infertility and what the process entails.

In this article, we summarise reasons why there are increasing numbers of infertile couples today, and find out when you should see a fertility specialist and what happens when you do.

In South Africa, infertility occurs in 15% to 20% of the population. That means one in every six couples struggle to conceive. There are many driving factors behind the increase in the number of couples facing fertility challenges.

One that stands out is the clear decrease in male fertility over the last 40 to 50 years, confirmed by research. Although the cause has not been established, it is likely that something in the environment is causing the decline in sperm counts. This could be pollution or it what is called ‘estrogen-like’ factors in the environment. Estrogen is the female hormone. Certain plastics can act like estrogen and have an effect on sperm quality.

In women, egg quality is also affected by pollutants and by outside factors. Certain lifestyle choices like smoking, an unhealthy diet, excessive alcohol consumption and being overweight are all proven to have an effect on egg quality. And poor egg quality will certainly reduce the chance of conceiving.

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.

Polycystic ovarian syndrome or PCOS is also a chronic disease of the ovary, which leads to a poor ovulation. Because PCOS is also associated with high blood pressure and diabetes, women with PCOS not only have a reduced chance of conceiving, they also have a greater risk of having pregnancy complications, like diabetes and hypertension in pregnancy.

When Should You See A Fertility Specialist?

‘Infertility’ is a term that is used when a couple has been trying to conceive, but have not been successful after one year of trying.

If a couple has been trying to conceive for two or three months without success, it is generally still considered normal because the natural chances of conceiving in any given month is not very high. However, if there is no conception after one year, the medical terms ‘infertility’ or ‘subfertility’ may be used to indicate a reduced chance of conceiving.

The exception here is for women over the age of 35. This is because after the age of 35, a woman’s chance of conceiving becomes lower and lower every year. So, for women over the age of 35, the definition of infertility is no conception after six months of trying.

However, if you have any reason to be concerned about your fertility, you should not delay seeking medical assistance.

What Happens When You Get Fertility Treatment?

All couples and individuals who want to have a child is very welcome at Cape Fertility.

When you come to Cape Fertility, the first thing our team will do is a comprehensive assessment or a full fertility workup to determine what is the cause of the infertility.

This is important, because infertility can only be treated successfully if the real cause – and often several causes – has been identified. Once the cause of the fertility problem has been established, the right treatment can be provided.

We normally start with the basic tests.

The basic tests are a general examination, as well as a medical history, so you and your partner will be asked about your health, operations, hospitalisations, medications and so on. We also do a medical assessment of the uterus and the ovaries through an ultrasound.

We do additional blood tests on both partners. For the male partner, we do a ‘sperm count’ which is a microscopical examination of the sperm to determine the quality and the quantity of the sperm.

These baseline tests – in the majority of cases – reveals the cause or causes of the fertility problem. Where the cause of the fertility challenge has not been found, some additional tests and more complex testing can also be done.

Once the cause of the problem has been found, the right treatment can be recommended. The first line of treatment is always to fix or address the cause of the fertility problem.

For example, if there are fibroids in the uterus, the first line of treatment will involve fixing this cause by, for example, removing the fibroids. Or, if the cause of the infertility is blocked fallopian tubes, the treatment may, for example, involve opening the fallopian tubes.

So, the first line of treatment is to fix the cause. But, sometimes it is not possible to fix the cause – for example, if the ovaries have been removed. However, there are other treatments that can help a couple to have a baby without fixing the cause of the infertility.

Fortunately, there are many different types of fertility treatments currently available.

These treatments are called assisted reproduction therapies (ART) and the most well-known ART is in vitro fertilisation or IVF. During IVF treatment, eggs are fertilised in the lab and the embryos are nurtured in the lab for a few days before they are transferred back into the womb.

Many ARTs are very successful, and are often used where the cause of the infertility cannot be fixed.

Where To Get Infertility Treatment

If you have been trying unsuccessfully to achieve a pregnancy or if you are concerned about your fertility for any reason, we would like to invite you to come and meet one of our specialists by clicking here

Our four reproductive specialists all have impressive qualifications and extensive experience and enjoy the qualified support of a team of associated specialists, embryologists, IVF co-ordinators, theatre staff and an administration team.

At Cape Fertility, we value each individual patient and we look forward to providing you with individualised and personalised care, affordable quality fertility treatment, and higher success rates at our purpose-built premises, where we achieve some of the best success rates in the world, yet always strive for higher success rates to ensure even more of our patients can experience the joy of have their own baby.