At Medfem Fertility Clinic, our team believes in making world-class fertility treatments available for everyone, delivered with empathy and caring, so you can have a positive outcome to your fertility journey.

To achieve this, a first consultation with a number of tests and investigations of both partners is necessary before any treatment begins, and we ensure your initial consultation with us is as comprehensive as possible, already providing you with many answers and options and in some cases even treatment – at this very first session.

Speaking at a recent IFAASA webinar, Dr Tony Rodrigues – a reproductive medicine specialist and a founder and director of Medfem Fertility Clinic – shared invaluable insights about what couples can expect during their first consultation at Medfem Fertility Clinic.

He highlighted that Medfem’s team focusses on “time to pregnancy”. It means that our team’s intention is to help patients achieve a pregnancy as quickly as possible, so they don’t have to go through long-term infertility management. Some couples, however, will have a longer journey than others, but still the focus remains on the shortest time to pregnancy. This is achieved by ensuring only the right treatments are provided based on an accurate diagnosis.

It all starts with the initial consultation, and here’s what you can expect when you visit our leading fertility clinic in Sandton, Johannesburg in South Africa, where our team of highly qualified and experienced fertility experts; as well as trained, qualified lab specialists and embryologists, nurse practitioners, theatre staff, pharmacists and clinical psychologists work together in our state-of-the-art facilities equipped with advanced technologies to maintain a leading pregnancy success rate.

It’s a team effort

Dr Rod says that it is very important for couples to attend the consultation together. “Fertility treatment is a team effort,” he says. “You need both sperm and eggs to make a baby, so a couple needs to be on this fertility journey together. Despite some reluctance among patients with certain cultural thought processes, in our practice, when we see a couple, we test both partners for known causes of infertility, and that includes testing the sperm.

“From 30 years of experience, we know that it wastes time and money to focus on the female partner, only to discover months later that there is a problem with the male’s sperm, as is the case in increasing numbers of couples receiving fertility treatment.”

During your first consultation, you will meet one of our fertility specialists, who will:

– discuss your medical history;
– conduct a comprehensive infertility work up through various tests and investigations discussed below if these have not already been completed;
– advise you of the options; and
– even start to plan or provide treatment.

Exploring your history

When you see us on your first visit, your Medfem fertility specialist will begin by exploring each partner’s medical history to determine if there were any possible causes for infertility and to understand what has happened before in terms of previous or current infertility management, how and where it was provided, and what the outcome was. This will guide your fertility specialist in determining what tests and investigations are most suitable for you as a couple.

The tests and investigations

Dr Rod says that the first important thing couples visiting Medfem Fertility Clinic must understand is that they have to undergo a series of investigations to establish the exact causes of the infertility, which could exist in either partner (about one third of the time in the female partner and about one third of the time in the male partner), but often in both partners (the last third of the time).

“Most of our patients are professional men and women and they are working couples, and they often present with very specific health issues. We check many known fertility issues, and each test is important. We also like to check all the possibilities right at the beginning, before any diagnosis or treatment is considered. In fact, where possible we prefer to have all the tests done before patients come to see us on their first visit.”

These investigations aren’t that extensive, but every single test and scan is crucial to achieve the ultimate objective, which is a healthy pregnancy that culminates in a healthy baby.

“At Medfem Fertility Clinic, we like to also check both partners for immunological problems, because about 15 to 20% of our patients have one or more immune diseases, such as antibodies against the thyroid and high insulin, which will certainly affect their fertility,” says Dr Rod. “High insulin levels are a very common problem both in men and women facing infertility, because it is a lifestyle problem related to dietary issues, especially excessive carbohydrates in the diet.”

Investigations for female partners

While the most common causes of infertility among women receiving treatment at Medfem Fertility Clinic are polycystic ovaries and endometriosis, there is a very wide range of other potential causes of infertility, from lifestyle choices to cancer treatment.”

“On the female side,” says Dr Rod, “we see a lot of patients with hypothyroidism or underactive thyroid as well as hyperthyroidism, both of which can each negatively impact fertility and can affect not just the ability to become pregnant but also the ability to carry a baby to term.”

As such, for women, the tests conducted include investigating hormonal profiles of hormones such as thyroid, insulin and prolactin. In addition, egg reserve levels are checked by testing anti-mullerian hormone (AMH) levels in the blood. This is a measure of the woman’s egg numbers and, for example, a low AMH indicated low number of eggs. However, it does not reflect on egg quality – the woman’s age and health are the main factors in egg quality.

The other hormones that are closely associated with fertility are also measured, including follicle stimulating hormone (FSH) which regulates the functions of the ovaries and is responsible for the maturation of an egg in the ovary; luteinising hormone (LH) which stimulates the release of the egg; as well as oestrogen and progesterone, involved in maintaining the uterus lining.

During this first visit, the woman will also have a vaginal scan, which an important tool. Transvaginal scans do a great deal of the work: it is accurate in providing a visual of the uterus, so abnormalities of the uterus can be detected. It can also be determined if the hormones are acting properly on the uterine lining. In addition, the scan also enables your fertility specialist to look at the size of your ovaries and to make sure that there are no diseases of the ovaries that could also lead to infertility.

For example, polycystic ovarian disease is called so because – when using the ultrasound – the ovary looks like it is full of small cysts. The scan shows whether the ovaries are normal or whether they are what is called polycystic ovaries. In severe cases of polycystic ovaries, women actually don’t have any periods whatsoever and therefore can’t fall pregnant.

“At Medfem Fertility Clinic we might also do a laparoscopy – which is minimally invasive surgery – for example, when there is reason to investigate and diagnose endometriosis. This is because endometriosis is a known cause of infertility and, in fact, it is one of the top two causes of infertility we see among women who visit our clinic,” explains Dr Rod. “This technology allows us to simultaneously check the fallopian tubes. From the scan we did first, we will also know whether there are any things like fibroids or polyps or any other growths in the uterus and we can treat it at the same time as doing the laparoscopy by removing these growths. In the same session, we will then also manage the endometriosis by removing the endometriosis tissue.”

Depending on the results, further tests may be conducted. For example, at Medfem Fertility Clinic testing includes investigating the mucus produced. On the day of ovulation, or just pre ovulation, the couple will have intercourse early morning and when the scan is done at the clinic later in the day, a sample is taken from the cervix to check that the sperm is alive.

A cycle assessment may also be necessary – during this assessment, the ovulatory processes and the physiology around the uterus are checked for any problems.

Investigations for male partners

Dr Rod says that although there are many possible causes of infertility among men, the most common fertility problem is a low number of normal sperm.

Nevertheless, male partners undergo similar testing as the women through blood tests that check insulin, prolactin and thyroid levels for hormone imbalances, all of which will affect fertility. In addition, FSH levels in the blood are also tested, as this result could indicate if there is a sperm problem. Produced by the pituitary gland, FSH regulates the functions of the testes and a lack or low levels of it can cause infertility in men as it does in women.

But the most important test for men is a semen analysis. It consists of producing a sample by masturbation and that sample is then assessed in the our state-of-the-art lab by specialists for a range of factors.

A semen analysis measures the volume of semen and takes a sperm count to determine how much sperm is present in one ejaculation. A semen analysis also determines sperm morphology, which is the percentage of sperm that have a normal shape, and measures sperm motility, which refers to the percentage of sperm that can move forward normally. The analysis further reveals the acidity (low pH) or alkalinity (high pH) of the semen, the level of sugar called fructose in the semen that provides energy for the sperm, and the presence of white blood cells, which are not normally present in semen.

At Medfem Fertility Clinic, the ability of the sperm to bind to an egg is also investigated as a primary test. This is because everything might be fine with the sperm count and motility and how the sperm looks in terms of normality, but it might not have the ability to bind to an egg, which makes it impossible to fertilise an egg.

Depending on the results, further tests may be conducted, and this might include an ultrasound or a testicular biopsy. An ultrasound examination of the testes and prostate provide a picture of the testes and epididymis, and is also useful for diagnosing testicular cancer and varicocele. A testicular biopsy involves the removal of a small sample of the tissue from a testicle to enable direct inspection of the sperm-making tissue.

Excellent progress in a single visit

By the end of your initial consultation with your Medfem Fertility Clinic fertility specialist, you will have made excellent progress on your fertility journey:
– having completed a range of pertinent investigations and tests for both partners;
– in many cases having a good chance of already receiving a primary diagnosis based on the results and the fertility challenges uncovered; and
– often, even leaving with treatment recommended or already provided, as in the case of a laparoscopy that allows specialists to investigate, diagnose and treat issues such as endometriosis, fibroids or polyps in the first consultation.

“Not only do thorough, relevant tests and investigations enable us to make an accurate diagnosis, but it also ensures that only the right treatments are provided to both partners. This reduces both time to pregnancy and the costs of fertility treatment, because only the necessary treatments are provided,” explains Dr Rod. “Importantly, in our experience, if you identify and correct all the underlying fertility issues that are playing a role in a couple’s fertility journey, it is often not even necessary for advanced and costly Assisted Reproductive Technologies (ARTs) such as IVF (in vitro fertilisation) and ICSI (intracytoplasmic sperm injection). In fact, only small percentage of fertility patients have no option but IVF treatment.”

Schedule your initial consultation now!

Medfem Fertility Clinic’s team are committed and understanding team of medical professionals, who have the experience, knowledge and desire to provide you with the best chance of a successful outcome at the end of your treatment.

Since the 1980’s, Medfem Fertility Clinic’s team has assisted couples struggling with infertility to experience the joy of parenthood, helping to bring more than 18,000 babies into the world.

If you would like to meet one of our fertility specialists, simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

Our Fertility Specialists can also meet with You During a Virtual Consultation Via Zoom or Skype. Click here to book a virtual consultation now.

We look forward to meeting you!