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Infertility is defined as not having become pregnant after 1 year of having regular sexual intercourse without the use of birth control. Dr Deon van Zyl provides infertility evaluations and treatment to identify the underlying cause and correct the issue.
Infertility can be caused by several factors. Both male and female factors can contribute to infertility. Female factors may involve problems with ovulation, the reproductive organs, or hormones. Male factors often involve problems with the amount or health of sperm.
Age: A woman begins life with a fixed number of eggs, which gradually decreases as she grows older. For healthy, young couples, the chance that a woman will become pregnant is about 20%, but this starts to decline in a woman's early 30s. Then, after 37, it declines more rapidly.
Lifestyle: For women, being underweight, overweight, or excessive exercise may be associated with infertility. In addition, drinking alcohol at moderate or heavy levels and smoking may make it difficult for a woman to get pregnant. For men, smoking, heavy drinking, marijuana use, and anabolic steroid use can reduce sperm count and movement. Smoking also can lead to erectile dysfunction.
You should consider having an infertility evaluation if any of the following apply to you:
Your first visit with Dr van Zyl involves going through your medical history and having a physical exam. During the medical history, Dr van Zyl will ask about your menstrual period, pelvic pain, abnormal bleeding or discharge and disorders that can affect reproduction.
If you have a male partner, both of you will be asked about the following health issues:
You and your partner will also be asked questions about your sexual history:
When testing for infertility, we do a range of procedures, including laboratory and imaging tests, to assess your overall reproductive health.
Laboratory tests include:
Different imaging tests and procedures are used to look at your reproductive organs. They check whether your fallopian tubes are healthy and whether there are problems in your uterus. The procedures used depend on your symptoms and the results of other tests and procedures. Imaging tests and procedures include:
You may not have all of these tests and procedures. Some are done based on the results of previous tests and procedures.
The testing for a man often involves a semen analysis (sperm count). If the result of the semen analysis is abnormal or areas of concern are found in the man's history, other tests may be considered. For example, an ultrasound exam may be done to find problems in the ducts and tubes that the semen moves through. Ultrasound also may be used to find problems in the scrotum that may be causing infertility.
Treatment options depend on the cause of your infertility. Lifestyle changes, medication, surgery, or assisted reproductive technology (ART) may be recommended. Several different treatments may be combined to improve results. Infertility can often be successfully treated even if no cause is found.
Lifestyle changes: If lifestyle factors are identified, you may need to lose or gain weight or do more or less exercise. You or your male partner may need to reduce your intake of alcohol, quit smoking, or stop using illegal drugs.
Surgery: In women, surgery may be able to repair blocked or damaged fallopian tubes. Surgery is used to treat endometriosis, which is commonly associated with infertility. In men, surgery can be used to treat some infertility problems. A common problem that leads to male infertility, varicocele, can sometimes be treated with surgery.
Hormonal problems: Abnormal levels of hormones can cause irregular ovulation or lack of ovulation. For example, polycystic ovary syndrome is a condition in which the levels of certain hormones are abnormal and menstrual periods are irregular or absent. It is a common cause of infertility. This condition often is treated with lifestyle changes or medication. Progesterone may be used to treat some ovulation problems. Other hormonal conditions that affect fertility in women, such as thyroid disease, should be ruled out.
Ovulation induction is the use of drugs to induce a woman's ovaries to release an egg. This treatment is used when ovulation is irregular or does not occur and other causes have been ruled out.
The drug most commonly used for ovulation induction is clomiphene citrate. About 40% of women achieve pregnancy with this drug within six menstrual cycles. Side effects are usually mild and include hot flashes, breast tenderness, nausea, and mood swings.
If clomiphene citrate is not successful, drugs called gonadotropins might be tried to induce ovulation. Gonadotropins also are used when many eggs are needed for ART or other infertility treatments. This is called superovulation.
Gonadotropins are given in a series of shots early in the menstrual cycle. Blood tests and ultrasound exams are used to track the maturation of the follicles (tiny sacs in which eggs develop). When test results show that the follicles have reached a certain size, another drug called human chorionic gonadotropin (hCG) may be given. This drug triggers ovulation.
In intrauterine insemination, a large amount of healthy sperm is placed in the uterus as close to the time of ovulation as possible. It often is used with ovulation induction. The woman's partner or a donor may provide the sperm. Sperm that has been retrieved earlier and frozen also can be used.
If ovulation drugs are used with intrauterine insemination, multiple pregnancies can occur. If too many eggs are developing at the time of insemination, the insemination may be cancelled.
Assistive reproductive technology (ART) is a general term for fertility treatments in which eggs and sperm are used separately. ART usually involves in vitro fertilisation (IVF), whereby the sperm is combined with the egg in a lab, and the embryo is transferred to the uterus.
IVF is often used in cases such as:
Success rates are also listed on the Society for Assisted Reproductive Technology (SART) (www.sart.org).
IVF is done in cycles, and it can take more than one cycle to succeed. The sperm may come from your partner or a donor. Sperm can be retrieved and then frozen for later use in IVF. Ovulation usually is induced with gonadotropins so that many eggs are produced. The egg also may come from a donor. Eggs that have been previously frozen can be used.
Eggs are removed from the ovaries when they are mature. Healthy sperm are then added to the eggs in the lab. The eggs are checked the following day to see if they have been fertilised. A few days later, one or more embryos are placed in your uterus. The embryo may come from a donor. Healthy embryos that are not transferred can be frozen and stored for later use.
Sometimes, a single sperm may be injected into each egg. This is called intracytoplasmic sperm injection. This procedure may be recommended if there is a problem with your partner's sperm. In ICSI, only a single healthy sperm is needed for each egg. A few days later, one or more embryos are placed in the uterus.
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