Ovulation induction increases the number of eggs released per ovulation cycle. This can be achieved through the means of fertility drugs or Laparoscopic Ovarian Drilling.
Ovulation induction through fertility drugs
Fertility drugs are used to stimulate the follicles in your ovaries, resulting in the production of multiple eggs in one cycle. The treatment is often used in women with polycystic ovarian syndrome (PCOS).
Clomid and Fertomid are two of the most commonly used fertility medicines and is prescribed by Aevitas physicians if indicated. Clomid, is taken daily for five days at the start of a woman’s cycle. After which, intercourse or insemination is subsequently timed to coincide with ovulation.
Other hormone treatment may include FSH injections (e.g. Gonal F, Menopur, Fostimon), in order to stimulate the development of multiple follicles or eggs, during an IVF treatment cycle.
Ovulation induction through laparoscopic ovarian drilling
An alternative method of ovulation induction, in the case that fertility drugs deemed to be unsuccessful, is Laparoscopic Ovarian Drilling. Laparoscopic ovarian drilling is a surgical procedure, which can trigger ovulation in woman who suffer from PCOS. The surgery is usually performed through laparoscopy (a small incision), under general anesthetics.
Endoscopic surgery is performed under general anaesthetic and includes hysteroscopy and laparoscopy.
- Hysteroscopy involves passing a telescope into the uterine cavity through the vagina and the cervix. It is used to inspect the condition of the uterus from within.
- Laparoscopy involves an inspection of the pelvic organs by a telescope passed through a tiny incision at the navel. Separate small incisions at the level of the hip bones are used to introduce probes to manipulate the pelvic organs.
Aevitas Fertility Clinic – gynaecological endoscopic surgery referral centre
Furthermore, one of our Aevitas fertility specialist and gynaecological endoscopic surgeon, Prof Siebert, is pioneering the implementation of an internationally accredited education and training programme on endoscopic surgery, in South Africa. ‘The Winners Programme’, developed by the European Academy of Gynaecological Surgery, is aimed at educating and training endoscopic surgeons. The implementation of ‘The Winners Programme’ allows to set a minimal quality standard for endoscopic surgeons, which aids to improve patient care.
The following factors, which could be contributing to your infertility can be treated through gynaecological endoscopic surgery:
Tubal litigation is the surgery used for female sterilisation and includes several techniques used to close/block the fallopian tubes. However, in the case that a couple decides they would like the procedure reversed, to enable them to conceive, tubal anastamosis and/or reanasatamosis can be performed. In other words, female sterilisation reversal or tubal litigation reversal.
Tubal anastamosis refers to the joining of the fallopian tubes through means of laparoscopy, which will allow for natural conception and pregnancy. Occasionally after anastamosis is performed, the fallopian tubes could heal with a blockage, which would then require a tubal reanastamosis to be performed to remove the blockage.
*When tubal anastamosis and -reanastamosis is performed through gynaecological endoscopic surgery by an experienced surgeon, the procedure can be highly effective at restoring normal fallopian tube anatomy and allowing natural conception.
Aevitas Fertility Clinic – leader in Assisted Reproductive Technology South Africa
Assisted reproductive technology (ART) includes the technology used in fertility treatment to achieve pregnancy.
Assisted reproductive technology includes the following:
- In vitro fertilisation (IVF)
- Intra-uterine insemination (IUI)
- Gamete intra-fallopian transfer (GIFT)
- Intracytoplasmic sperm injection (ICSI), Intracytoplasmic Morphological Sperm Injection (IMSI), Preselective Intracytoplasmic Sperm Injection (PICSI)
- The use of donor sperm during fertility treatment
- The use of donor egg during fertility treatment
What is IVF?
In vitro fertilisation (IVF) is the most commonly used of the assisted reproductive technologies (ART). IVF literally means “fertilisation in glass” (referring to the test tube, which is where the term “test tube baby” comes from).
During IVF, eggs are collected from the ovaries and fertilised in the laboratory with sperm. After a number of days, the fertilised eggs (embryos) are transferred to the female patient’s womb to develop and grow.
Aevitas fertility specialist (Professor Thinus Kruger) research and fertility treatment resulted in the birth of South Africa and Africa’s first “test tube” (IVF) baby in 1984. This event opened a new era in reproductive medicine, not only in South Africa but also on an international front.
When is IVF appropriate?
Originally IVF was prescribed for women with blocked fallopian tubes. Laboratory techniques have improved drastically over recent years. Now IVF is used to treat:
- unexplained infertility
- If other treatments such as intra-uterine insemination (IUI) have been unsuccessful.
- male sub-fertility (ICSI is recommended in more severe cases of male infertility).
What to expect during a typical IVF treatment cycle:
To get started, our team of gynaecologists and specialist nursing sisters will work with you to plan your treatment cycle.
Step 1: Hormone treatment
Hormone treatment is used to boost the development of several follicles containing eggs. With more fertilised eggs, the clinic has a greater selection of embryos that can be used.
Step 2: Ultrasound scan
Your ovaries will be monitored by vaginal ultrasound scan on certain days of your cycle. Blood tests may also be required. Regular ultrasound scans monitor the progress, as well as the response of your ovaries.
Step 3: Hormone injection
You’ll receive a final hormone injection (hCG/ Ovitrelle) about 36 hours before the eggs are retrieved. This injection triggers the final maturation of the eggs.
Step 4: Egg retrieval
The eggs are retrieved from the ovaries under intravenous sedation, administered by an anaesthetist. A special aspiration needle is introduced through the vagina and under ultrasound guidance, the eggs are carefully collected. After the procedure, you’ll be offered a cup of tea and a sandwich and will then be able to go home. It is important to have someone with you to take you home.
Step 5: Fertilisation
The eggs are mixed with the sperm, and placed in an incubator so that fertilisation can occur overnight. The procedure is performed by an embryologist (scientist) in our IVF laboratory.
Step 6: Record fertilisation
The embryologist monitors the eggs daily to record fertilisation as well as embryo development.
Step 7: Embryo transfer
Embryo transfer into the uterus is usually done on the third to fifth day after the eggs have been retrieved. The optimum day for embryo transfer is determined according to the number and quality of the embryos. One or more embryos are transferred into the female partner’s womb. No sedation is needed for this procedure, which is very similar to IUI or to having a cervical smear taken. A fine catheter is gently threaded into the cervix and the embryo is placed in the cavity of the uterus. Ultrasound is often used to confirm the placement of the catheter.
Step 8: Pregnancy test
A blood pregnancy test is done on the 10th day after embryo transfer to confirm the outcome.
Number of visits to clinic: 5 – 7 per cycle.
On the same day that the eggs are collected, you will be asked to produce a fresh sample of sperm using one of our private facilities. The sperm is then washed, the healthiest and most active sperm are selected.
What is Intra-uterine insemination (IUI)?
Intra-uterine insemination (IUI) is most commonly known as artificial insemination (AI). Leading up to ovulation, the partner’s best sperm is concentrated through a laboratory procedure. This sperm is introduced into the woman’s uterus through a soft plastic catheter.
What is the difference between In vitro fertilisation (IVF) and Intra-uterine insemination (IUI)?
Intrauterine insemination (IUI) and in-vitro fertilization (IVF) are two commonly used methods for fertility treatment. With the assistance of fertility treatment, couples can increase their chances of conceiving.
When is Intra-uterine Insemination (IUI)/Artificial Insemination (AI) appropriate?
IUI/AI is often recommended if:
- mild sperm disorders
- poor quality of the female’a cervical mucus
- impotence or premature ejaculation (sperm cannot be introduced through sexual intercourse)
- unexplained infertility
What is GIFT?
Gamete intra-fallopian transfer (GIFT) is a form of assisted reproduction technique, however not such a common treatment procedure, it involves the same first, second and third steps as IVF.
The three steps of IVF include:
1. Boosting the development of eggs
2. Monitoring the growth of the eggs using ultrasound and administering medication to ensure that the eggs mature.
3. A laparoscopy is performed and after the eggs have been collected, they are placed together with the sperm sample in a catheter (tube).
*The eggs and sperm are injected into the fallopian tube through this catheter, within 24 hours. Fertilisation may then take place in the body and not in the laboratory as with IVF.
When is GIFT appropriate?
The procedure has been successful with couples that have:
- unexplained infertility
- a low sperm count
- IVF treatment has failed.
Requirements for success with GIFT
- At least 1 million sperm per milliliter after preparation.
- At least 1 normal and open Fallopian tube.
Aevitas Fertilic Clinic – responsible for the 1st ICSI baby in South Africa (1995).
ICSI (Intra-cytoplasmic sperm injection) is a form of fertility treatment that involves the selection and injection of a single sperm directly into an egg in order to fertilise it. This does not guarantee fertilisation, but the chances are significantly higher. The rest of the procedure is similar to IVF and the fertilised egg can then be transferred to the female partner’s womb.
Recent laboratory techniques include IMSI (intra-cytoplasmic morphologically-selected sperm injection) and PICSI (Preselective intra-cytoplasmic sperm injection).
During IMSI, a very high magnification microscope is used to improve sperm selection. PICSI, is a laboratory technique by which mature sperm are selected for ICSI by binding to a substance called hyaluronan. This technique aims to select the optimal sperm, in turn increasing the pregnancy rate and decreasing the miscarriage rate.
When is ICSI appropriate?
ICSI is used when:
- The male partner has a very low sperm count, if the sperm are not very active (low sperm motility) or a low percentage of sperm have a normal shape (low morphology).
- The male partner does not produce sperm and sperm has been collected from the testicles (testis biopsy).
- Previous IVF cycles have failed.
Various reasons could exist why people use surrogacy
Often the intended mother has no uterus or she has an abnormal uterus preventing her from carrying a baby of her own. During gestational surrogacy, an embryo created from the biological mother’s egg and father’s sperm is transferred into the uterus of the gestational carrier, who then carries and delivers the baby.
Surrogacy must adhere to certain legal and medical criteria:
- The surrogate
The surrogate must have a living child of their own and be in good physical-, emotional- and mental health.
- Surrogacy agreement
Surrogacy agreement between the surrogate and commissioning parents will have to be confirmed and authorised by the high court before any treatment commences. Chapter 19 of the Children’s Act, which relates to surrogacy, came into effect 1 April 2010. As a result prospective parents and surrogates are required to bring an application to the High Court for an order confirming the surrogacy agreement and ordering that the child/children born of the agreement and artificial fertilization process, are those of the intended parents and not that of the surrogate. This alleviates the need to undergo an adoption process. The application, collated by attorneys include:
1. An affidavit
2. A surrogacy agreement between the surrogate and commissioning parents
3. A medical, psychological- and social worker report of the surrogate and commissioning parents
The surrogate will be compensated for expenses related directly to the surrogacy and may claim for reasonable and appropriate loss of earnings that result from the surrogacy, pregnancy and birth, but she may not use this as a source of income. Furthermore, the surrogate and commissioning parents can have as much contact as they choose to, however the surrogate will have no rights to the child after birth and the commissioning parent’s names will be entered directly onto the birth certificate after birth.
*As you may imagine, there are but a few women medically, emotionally and psychologically willing and able to carry a baby for someone else. Many couples try to find someone close to them to carry their baby for them (a sister, cousin or friend). However, finding someone is not easy and Aevitas Fertility Clinic, can guide you through this process. Follow the link to read about one of our success stories.