Female Infertility Treatments and Procedures
If you are looking into female infertility treatments, you may be surprised to discover how many highly advanced treatments, proven procedures and alternative options are available to address any infertility challenge you may face.
The term ‘infertility’ means that the ability to become pregnant is diminished or absent. It is generally used if a couple has not conceived after 12 months of regular unprotected intercourse or after six months for women aged over 35.
Please note that infertility does not mean that you are unable to have children, but rather that you may require treatment or assistance to achieve a pregnancy.
About one-third of infertility cases are due to the female partner; one-third are due to the male partner; and the remaining one-third are due to a combination of male and female factor issues.
Some of the most common causes of female infertility are listed below.
Common Causes of Female Infertility
* Abnormal Thyroid
* Advanced Maternal Age
* Blocked Fallopian Tubes
* Cervical Factor
* Diminished Ovarian Reserve
* Polycystic Ovarian Syndrome
* Uterine Factor
Which female infertility treatment is right for you?
Fortunately, scientific advances over the past three decades have helped millions of women overcome these and other problems with infertility. Female infertility treatments ranging from medications to assisted reproductive technologies (ART) – including in vitro fertilisation (IVF) – are achieving unprecedented success.
Given the many options are available, you are likely to wonder how you will know which treatments, procedures and options are right for you? The answer is simple: an initial consultation with a fertility specialist.
The first step in any infertility treatment
A 30 – 60 minute initial consultation is your first step in any female infertility treatment plan, regardless of which specific treatments you may require.
During your initial consultation at Medfem Fertility Clinic, a highly qualified and experienced fertility specialist will:
* do an extensive review of your medical history
* perform a comprehensive infertility physical exam and blood tests
* provide in-depth explanations and answers to all your questions
* detail a broad range of female infertility treatment options
* develop with you a personalised fertility treatment plan that fits you best.
Female Infertility Evaluation
Following your initial consultation, a basic fertility evaluation may be required, targeting ovarian function, tubal and uterine anatomy, ability of the sperm to reach the fallopian tube and male factor. A female infertility evaluation may include the following:
* Ovarian reserve testing
* Ultrasound to document the time of ovulation
* Post coital test to see if sperm can penetrate the cervical mucous
* Mid-luteal phase progesterone level
* Laparoscopy (if there is suspected endometriosis or tubal disease)
* Prolactin, Thyroid stimulating hormone (TSH) and HIV
Ovarian reserve testing
The results of FSH tests provide a rough idea of the number of eggs in your ovaries at a given time. It helps predict how well you might respond to the fertility medications used in superovulation, IVF, and ICSI. We also use other estimates of ovarian or egg reserve such as an antral follicle count – a vaginal ultrasound examination.
A hysterosalpingogram (HSG) is an X-ray test that looks at the inside of your uterus and fallopian tubes to evaluate the inside of uterine cavity and patency of the fallopian tubes and uncover uterine abnormalities.
The proper development of the follicle, which contains the egg, as well as the timing of its release is critical to the evaluation of infertility. An ultrasound is a safe, painless and non-invasive way of evaluating this factor and timing subsequent tests.
Post coital test
Once the timing of ovulation is determined accurately, the next step is to assess if the sperm can penetrate the cervical mucus. Early morning intercourse is followed by an appointment at the clinic, at which time a microscopic examination of the cervical mucus will show if there is adequate penetration of the sperm.
Mid-luteal phase progesterone
Some women ovulate but fail to produce adequate quantities of progesterone (luteal phase deficiency) following ovulation. The clinical tests for ovulation (e.g. temperature chart, positive ovulation predictor kit) are not sufficient to diagnose luteal phase deficiency. We recommend obtaining a progesterone level approximately 8 days after detection of the LH surge.
A hysteroscopy is a procedure where the doctor passes a hysteroscope-a narrow, telescope-like instrument with a camera on the end-through your vagina and cervix and into the uterus to directly examine the interior of your uterus. This procedure is used to determine if you have any fibroid tumours, polyps, scar tissue, or other obstructions that could be affecting your fertility. If the doctor finds anything abnormal, he or she may remove a small sample for further examination. You don’t need to have an incision with a hysteroscopy, and most women recover within an hour or two.
A laparoscopy is a surgical procedure that involves looking directly into your abdomen and pelvis using a small camera that is placed through an incision in your umbilicus. This allows us to evaluate and potentially treat gynaecological problems such as scar tissue (adhesions), endometriosis, and ovarian cysts that may affect fertility. For this operation you will require a general anaesthetic (you will be asleep), but in most cases you will go home the same day.
For this operation you will require a general anaesthetic (you will be asleep), but in most cases you will go home the same day. Most patients are able to resume normal activities within a few days to one week.
Prolactin, Thyroid Stimulating Hormone (TSH) and HIV
At Medfem Fertility Clinic we routinely test all patients for Prolactin, Thyroid Stimulating Hormone (TSH), and HIV. A positive result for any of these tests will require intervention.
A Broad Range of Fertility Treatments, Procedures and Options
Your initial consultation and the basic fertility evaluation will reveal which treatments are required to assist you in falling pregnant.
These are the female infertility treatments proudly offered at Medfem Fertility Clinic and which may be included in your treatment plan, depending on your unique circumstances.
* Artificial / Intrauterine Insemination (AI / IUI)
* Assisted Hatching
* Blastocyst Culture
* Congenital Uterine Anomalies
* Egg Donation
* Egg Freezing and Storage
* Embryo Freezing
* Embryo Testing
* Fertility Preservation
* Fibroid Surgery
* Frozen Embryo Transfer
* In Vitro Fertilisation (IVF)
* Infertility Stress Test
* Low Dose IVF
* Ovulation Induction
* Pregnancy Scanning
Artificial Insemination (AI) / Intrauterine Insemination (IUI)
This is the technique of placing sperm from a male partner or from a sperm donor directly into the uterus. IUI has become the most commonly used fertility treatment for lesbian and single women. It is also sometimes used in cases where the male partner has a mild sperm abnormality or anti-sperm antibodies. The procedure is usually painless and requires only a few minutes.
One of the most common reasons for an in-vitro fertilisation (IVF) cycle to fail is because the embryo/s have failed to implant into the lining of the uterus. For this to happen, an embryo must hatch out of its shell. In assisted hatching a small break is made in the shell. In specific cases this results in increased implantation and increased pregnancy rates. At Medfem we employ assisted hatching in cases such as advanced reproductive age, elevated FSH, decreased ovarian reserve, thickened zona and prior implantation failure.
Pregnancy rates are greatly improved if embryos are left in the incubator to develop to their blastocyst stage, which is usually by five days old. As a blastocyst has many more cells than an embryo and, because of its longer development, it provides the optimal chance of pregnancy. Embryo monitoring and assessment allows our embryologists to determine whether a three-day old embryo transfer or a five-day old blastocyst transfer is more suitable.
Congenital Uterine Anomalies Treatment
Both congenital and acquired uterine abnormalities are significant causes of infertility, recurrent pregnancy loss and can create difficulties in carrying a pregnancy to term. The doctors at Medfem Fertility Clinic are experts in the diagnosis and treatment of uterine anomalies, using advanced imaging techniques.
There are no non-surgical treatments for congenital uterine anomalies. Recommendations for surgical treatment of congenital uterine anomalies depend on the particular anomaly and your reproductive history. Pregnancy can generally be attempted roughly three months after surgery, and the prognosis for a successful pregnancy is excellent.
Egg Donation (Oocyte Donation)
Some couples face difficulties conceiving because of an egg factor, for example the female patient’s eggs cannot be used to create healthy embryos or in the case of male couples, an egg is required for surrogacy.
At Medfem Fertility, our egg donation program is dedicated to the ultimate goal of a healthy child. Our egg donation team of professionals strives to make the process confidential, safe and effective. We carefully screen each donor with a comprehensive health questionnaire, physical, psychological, genetic, and ultrasound examinations to ensure a safe pregnancy.
Egg donation in South Africa is anonymous – egg donor and recipient parents’ details are strictly confidential. Egg donation is managed with strict guidelines and protocol procedures contained in the Southern African Society of Reproductive Medicine and Gynecological Endoscopy Regulations (SASREG).
Egg Freezing and Storage
Egg freezing is a breakthrough technology that allows women to freeze and store their eggs until a pregnancy is desired, at which time the eggs are thawed, fertilised and transferred to the uterus as embryos.
It is a known fact that women experience a decline in reproductive capacity with increasing age as their egg number and quality diminishes, yet many would like to postpone childbearing. Vitrification, a new freezing technique, has made egg freezing and storage a much more realistic option for those wishing to preserve their fertility.
Embryo freezing – also known as embryo cryopreservation or blastocyst vitrification – allows for the storage of unused embryos for an indefinite amount of time. In vitro fertilisation and egg donation cycles often result in more embryos than are needed. The remaining suitable embryos can be cryopreserved and can be transferred at a future time in a simple short procedure.
Medfem Fertility Clinic has extensive experience in embryo freezing. With modern freezing techniques and greater experience, results from the transfer of frozen/thawed embryos are now almost as good as those with fresh embryos, so a store of frozen embryos can significantly add to the likelihood of pregnancy.
With fewer embryos being replaced in each transfer cycle of IVF, embryo selection has become more important than ever. Studies have shown that as many as 50% of embryos are chromosomally abnormal. Embryos have traditionally been chosen according to their appearance under the microscope, but high-tech methods now allow us to perform embryo screening for genetic and chromosomal information. This allows us to select high grade embryos for transfer thus reducing the risk of pregnancy failure and improving the chances of having a healthy baby.
These advanced techniques of genetic analysis make it possible to screen eggs and embryos for specific abnormalities. The most common embryo testing techniques are preimplantation genetic diagnosis (PGD) and preimplantation genetic screening (PGS).
Endometriosis is a common and sometimes painful condition of the reproductive system which can affect up to one in ten women. Roughly 30% of women with infertility problems have endometriosis.
It occurs when the tissue that normally lines the inside of the uterus grows in other parts of your body where it does not belong, such as on the ovaries, fallopian tubes or outside surface of the uterus. Endometrial tissue may lead to an inflammatory reaction which has been shown to affect the reproductive process.
While endometriosis is a known cause of infertility, it is possible to become pregnant when you have endometriosis. The medications and procedures available to assist you in falling pregnant are well established and effective.
Treatment can either be surgical or medical (by means of medication). Some patients need a combination. The usual approach is to treat endometriosis surgically at the time of the diagnostic laparoscopy. Deposits of endometriosis can be removed or destroyed laparoscopically and scar tissue can be excised.
At Medfem Fertility Clinic endometriosis patients suffering from infertility are treated with specific stimulation protocols which have superior success rates. Every effort is made to avoid surgical resection of endometriomas to prevent deterioration of ovarian reserve and damage to healthy ovarian tissue.
Medfem Fertility Clinic offers fertility preservation for women. If you think you may have trouble conceiving in the future or wish to delay having children for personal reasons, fertility preservation may be an option for you to consider.
Many factors could impact your future ability to conceive, including advancing age, planned surgery to remove the ovaries, chemotherapy or radiation or medication that can damage eggs, or genetic causes of rapidly decreasing egg numbers.
Uterine fibroids are very common and benign (non-cancerous) growths that grow underneath the uterine lining, inside the uterine wall or outside the uterus, and often appear during childbearing years. Surgery for uterine tumours can involve removing the entire uterus – known as a hysterectomy – or a myomectomy, in which only the fibroids are removed, not your uterus.
Myomectomy or hysterectomy can be done through one or more small incisions using laparoscopy, through the vagina, or through a larger abdominal cut (incision). The method depends on your condition, including where, how big, and what type of fibroid is growing in the uterus and whether you hope to become pregnant.
Frozen Embryo Transfer (FET)
Frozen Embryo Transfer (FET) is the transfer of frozen embryos. Following IVF treatment, many couples choose to freeze their spare embryos for use at a later stage. The technique of freezing embryos allows couples to use these embryos should their first attempt at achieving pregnancy from IVF fail, or if they would like to have more children in the future.
Natural cycle: A frozen embryo transfer can be performed in either stimulated or unstimulated cycles. During an unstimulated natural cycle, the embryo(s) are replaced when implantation is most likely. With a stimulated cycle, you will need to take medication to go through the process of down-regulation. The embryo transfer is similar to a smear test. It may cause some minimal discomfort.
Intracytoplasmic Sperm Injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) is a procedure in which sperm are directly injected into the egg. ICSI is usually offered to couples who have had poor or no fertilisation during standard IVF, or when fertilisation is less likely to occur with routine IVF. To date, tens of thousands of children have been born around the world as the result of ICSI.
In Vitro Fertilisation (IVF)
IVF treatment was originally developed for women with damaged or missing Fallopian tubes and has been the standard treatment for infertility since 1983. Since then, more than 5 million babies have been born worldwide as a result of IVF treatment. In fact, IVF treatment success rates are now comparable – and even superior – to those of nature.
In the simplest terms, IVF treatment is a process of assisted reproduction where the egg and sperm are fertilised outside of the body to form an embryo, which is then transferred to the uterus to hopefully implant and become a pregnancy.
‘Vitro’ is derived from the Latin ‘vitrum’, which means glass. In vitro fertilisation (IVF) literally means ‘fertilised in glass’, which is why children resulting from this treatment are often referred to as ‘test tube babies’.
However, IVF treatment is not a single event, but rather a series of procedures that are completed over five stages to complete a treatment cycle. These are:
Stage 1: Ovarian Stimulation and Monitoring
Stage 2: Egg Retrieval
Stage 3: Fertilisation and Embryo Development
Stage 4: Embryo Transfer
Stage 5: Luteal Phase Support
Low Dose IVF
Low Dose IVF, a minimal stimulation IVF, is a relatively new and advanced reproductive technology (ART) that offers a gentle alternative of ovarian stimulation to traditional in vitro fertilisation (IVF). In Low Dose IVF the ovaries of a woman are minimally stimulated, using oral ovulation induction agents and/or low doses of hormones to induce the growth of a small number of eggs.
The process is identical to traditional IVF, except that the goal is to create only a few but high quality embryos for transfer. Low Dose IVF answers two major concerns for both patient and doctor – cost and overmedication. Recent trends in the fertility field prefer an ovulation induction that uses fewer medications and produces fewer but better quality embryos than an ovulation induction that uses significantly higher doses of medications. In other words, Low Dose IVF is a useful method that can be used to help women get pregnant with minimal risks and low cost.
Ovulation induction is a treatment protocol designed to increase the number of eggs that a woman ovulates in a cycle. Whereas ovarian stimulation for IVF and ICSI aims to produce many eggs for collection (in women who are usually ovulating), ovulation induction aims to stimulate just a couple of eggs in women who are not ovulating normally. The treatment is most often used in women with polycystic ovarian syndrome (PCOS), a condition characterised by multiple ovarian cysts, irregular or absent periods, and high levels of male (androgen) hormones.
The treatment is a course of fertility hormones to stimulate the ovaries to produce a mature follicle, and then timed intercourse or Artificial Insemination (AI) / Intrauterine Insemination (IUI) to coincide with ovulation. Ovulation induction may be performed using orally ingested medications or injectable medications, and is normally combined with intrauterine insemination (IUI).
All clients are routinely monitored at Medfem Fertility Clinic until 12 weeks of pregnancy. The first pregnancy scan generally occurs at six weeks of pregnancy. Thereafter scans are conducted every two weeks. Internal scans are carried out until the baby is big enough to be viewed by external scan, usually by 12 weeks of pregnancy.
During your first scan at six weeks you can expect to see the pregnancy sac containing the early developing baby along with your baby’s heartbeat.
Surrogacy is an arrangement in which a woman carries and delivers a child for another (commissioning) couple or person.
Traditional surrogacy is when a woman (called a surrogate mother) carries and delivers a pregnancy conceived with her eggs for a couple. After the birth she gives the child to the intended parents with whom she has a contract.
Gestational carrier surrogacy is when a woman (called a gestational carrier) becomes pregnant after an embryo is transferred into her uterus. The embryo was created from another woman’s eggs, and so the gestational carrier is not genetically related to the child. After birth, she gives the child to the biological mother and/or father.
Surrogacy arrangements can be complex undertakings for both the commissioning couple and the surrogate. Therefore, it is important that patients are well informed about the steps involved.
At Medfem Fertility Clinic, our fertility specialists have been helping couples have children through surrogacy for over a decade.
The first step in any infertility treatment
The first step in any infertility treatment – contacting a fertility clinic to set up your initial consultation – is never easy.
However, you could view this as a progressive and positive step in uncovering what your infertility problems might be, receiving professional treatment, and ultimately falling pregnant with your much desired baby.
Also remember that you are not alone – infertility affects one in six couples of reproductive age. So, whether you are recently concerned about your fertility or looking for guidance, we will do our best to help you find the right path.
A first consultation is necessary before any treatment begins. You will meet one of our four specialists, who will discuss your medical history, conduct a comprehensive infertility work up, advise you of your options, and start to plan your treatments.
Simply click here or contact us on +27 (11) 463 2244 to book your initial consultation and take your first step to parenthood.