Celebrity couples and their broods have made assisted conception a hot topic of conversation.
Elton John and David Furnish are proud parents of a son born to a surrogate mother.
Nicole Kidman and Keith Urban’s newest baby came into the world via a “gestational carrier”.
Brooke Shields, Marcia Cross and others are reported to have had children thanks to in-vitro fertilisation (IVF).
Nobody is saying that assisted conception is a breeze. It is stressful and can be expensive. But the rewards are immeasurable.
One in six couples experiences infertility problems and in many, the diagnosis is simple and the treatment effective. Others are not so lucky.
According to Dr Anil Ramdeo, who heads the Centre for Assisted Reproduction and Endocrinology Clinic (Care) in Westville, nearly 80 percent of couples who try to conceive will do so within 12 months of trying. Couples who are under 35 and have been trying for 12 months and those over 35 who have been trying for six months should seek professional help, he says.
“There are many treatment modalities available,” says Ramdeo. “Intra cytoplasmic sperm injection (ICSI), IVF, IVM, ovum donation, sperm donation and surrogacy are all available.”
But sadly, even medical science cannot guarantee a baby. At Ramdeo’s clinic, pregnancy success rates per embryo transfer for IVF and ICSI are 44 percent (under 35 years), 40 percent (35 to 39 years) and 29 percent (40 to 45 years).
There are many causes of infertility and one or both partners may be implicated. When no apparent cause is found, it is called unexplained infertility. Treatment varies from simple hormonal treatment to more complex investigations and treatment.
Female factors include Polycystic Ovarian Syndrome, ovulatory problems, early menopause, low hormone levels, damaged or blocked tubes, endometriosis and immunological problems.
Male factors include sperm dysfunction, poor sperm motility, low sperm count and antibodies that may destroy or damage the sperm.
Lifestyle factors include:
* Age: Many couples are now waiting too long to start a family, says Ramdeo. As you get older, your egg reserves fall, quality decreases and eggs are more difficult to fertilise. From one million eggs at birth to 250 000 at puberty, a woman is left with a reserve of 13 percent at the age of 30.
* Smoking: There is evidence that men and women who smoke are more likely to have problems falling pregnant and suffer miscarriages than people who don’t smoke. Men who smoke are more likely to have reduced sperm motility and increased numbers of abnormal sperm than non-smokers.
* Alcohol: Alcohol can affect sperm quality, erection and ejaculation. It also increases the chance of miscarriages.
l Weight: Very underweight women do not ovulate every month and this decreases the chance of falling pregnant because they have an imbalance of hormones that increases the risk of infertility. Obesity may also affect fertility negatively.
* Infection: Any infection can affect the fertility of the male or female.
* Chlamydia: This sexually transmitted disease can damage the female and male reproductive systems resulting in infertility. It can be treated once identified.
Technical talk is all very well, but the real toll is the psychological one, and for many couples the inability to conceive equals heartbreak.
Dealing with the condition is a struggle that can make a couple feel out of control of their lives. They may become the perfect patient, follow all the rules, fill out all the forms and willingly submit to all the tests, but they cannot control the outcome. In fact, this might be the first time in their lives that they have been unable to control or achieve their goals.
Bernice Lits, a counsellor at the Vitalab Fertility Clinic in Johannesburg, explains: “Most people take their childbearing for granted. We tend to scheme on how not to have children, rather than how to have them. Being told that you have a fertility problem, generates feelings of shock, anger and disbelief, just as with the diagnosis of any other serious medical condition.
“For a couple, infertility encapsulates the worst conflict elements of any relationship. Having a baby now becomes a ‘job’, something that has to be monitored. Couples may experience a sense of failure in the relationship, rather than a sense of achievement.”
Cultural factors make it even more difficult.
Dr Merwyn Jacobson of the Vitalab Clinic says that in many cultures, the woman is blamed for failing to produce children. Yet, in about 40 percent of cases, the problem lies with the man, in only 35 percent of cases the problem is female orientated. The remaining cases may result from combined factors or be inexplicable.
The clinic’s senior programme co-ordinator, Veli Maseko, says that African culture disapproves of the concept of male infertility. Bearing children is the purpose of marriage, and a woman who never gives birth is often ridiculed and shunned.
“Sadly, if a wife can’t bear children she is no longer a valued member of society, while the man moves on to the next wife,” he says.
Culture will also dictate what reproductive treatment options a couple can pursue. Many cultures and religions believe that assisted reproductive techniques are unnatural, because they remove the spiritual nature of conception.
Many people would also rather consult a sangoma or a spiritual counsellor than seek medical assistance when trying to conceive.
* See: www.careclinic.co.za and www.vitalab.co.za
Lindsay Ord speaks to two couples who have had babies thanks to fertility treatments
Life is sweet for Mariam Tayob Cassim and her husband, Hussein.
The couple, a chartered accountant and a dentist, who gave up their professions to start a sweet factory, Richester Foods, could not be happier.
After suffering the heartbreak of infertility, they now have two beautiful children - and they’re talking about trying for a third.
“We had been married for a few years and decided to delay starting a family until we had finished studying,” says Mariam. “After trying to conceive for four months, we consulted my gynaecologist, who prescribed a fertility drug to stimulate ovulation. I am a strong person but it made me so emotional I decided to stop. We then decided to consult Dr Merwyn Jacobson at the Vitalab Clinic.”
Jacobson diagnosed Polycystic Ovarian Syndrome in Mariam, a condition that can lead to impaired fertility but one that is very treatable. Mariam underwent a laparoscopy to examine the condition of her ovaries and to remove scar tissue.
Injections were given to stimulate egg production and she went for daily scans to monitor the state of her follicles and to determine when she would be most fertile. After four months, she fell pregnant.
Iman, now eight, was delivered after a trouble-free pregnancy and the couple underwent similar procedures to have Zia, now six.
“Because of the stress and the treatments, I was nervous in both pregnancies and especially at the scans.
“My advice to people who are having fertility treatment is to be positive, accept the fact that you might need to be patient and be grateful for what medical science can do.”
Mariam and Hussein are talking about a third baby.
“We have parents and a large extended family so although we have busy working lives, we also have a wonderful support system. And that is a blessing.”
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) affects one in 8-10 women. It is caused by a hormonal dysfunction of excessive androgen (male hormone) production in the ovaries resulting in enlarged ovaries with multiple small cysts.
Patients suffering from PCOS often have difficulty conceiving because of irregular ovulation. The hormonal imbalance of PCOS also contributes to a slightly increased risk of a miscarriage.
Good short- and long-term medical care can address and alleviate most of the implications of PCOS.
Trace’Lee and Brad Turner have been together for 10 years and married for five. As a couple in love, they faced a future without children owing to a medical condition that led to Trace’Lee having her fallopian tubes removed in her 20s.
Today they are parents of a beautiful brood of four children. How did it happen?
“We tried IVF (in-vitro fertilisation) twice - when I was 26 and 28 - but it failed,” says Trace’Lee.
The Turners then decided to adopt and heard of a baby through a friend. Through a private adoption agency, they met the biological mother and were present at the birth of Joshua, now five.
Three years later, the biological mother contacted the Turners and asked if they would take her daughter, Shianne, four at that time.
Her partner and father to the children had died in an accident and she said she could not raise the child.
So Trace’Lee and Brad adopted Joshua’s sister.
“We wanted to try fertility treatment again but waited 18 months to let Shianne settle down,” says Trace’Lee. “We approached Dr Anil Ramdeo of the Care Clinic in Westville and went ahead with ICSI (intra cytoplasmic sperm injection). Eight weeks later we had a positive pregnancy result.”
In mid-January last year, they heard they were expecting twins. When her blood pressure shot up at 34 weeks, Trace’Lee was admitted to Westville Hospital and the babies were delivered by Caesarean section, weighing 1.3kg and 1.5kg.
Today, seven-month-old Hannah and Grace complete this family.
INTRA CYTOPLASMIC SPERM INJECTION (ICSI)
ICSI is the injection of a single sperm into the centre of the egg. It is used to assist fertilisation for couples who are not suitable for IVF. Couples who have not achieved fertilisation during IVF may also be considered for treatment. A similar programme of treatment is carried out for ICSI and IVF patients. The actual process of ICSI is carried out by an embryologist in a laboratory. It requires special treatment of the semen to select the best sperm. Mature eggs are identified and a single sperm is injected into each egg using a fine glass needle. - Daily News