Beginners Guide to Infertility

Article kindly provided by Maritza Prinsloo Botha.

You've been trying month after month, after month, ad infinitum, it seems, to try and get pregnant. It's not working. You've googled the terms "very early pregnancy symptoms" one too many times and have now surrendered to the fact that you never had any of those "very early pregnancy symptoms", and that all of it was in fact, as you dreaded, only your mind. You now know the culprit for these phantom symptoms is the hormone progesterone. You have charted your cycle and temperature and gathered more biological data on your own body than Tiger Woods have completed scorecards. You have experienced blurred vision one too many times after looking up from a pregnancy test. You've been waiting till the cows come home, but nothing! Nada! Zero! Now what?

I get asked fertility related questions quite often. For what reason people ask me questions about making babies, I have no clue whatsoever, it's not like I've got a noisy choir of drooling little soldiers to prove my competence in any matters baby making related (not yet, anyway)! Still, for some reason people confide in us infertile creatures to gaze into the crystal ball of fertility and tell them the truth. Why is it not happening? What am I doing wrong?

Firstly, I'd like to say that I'm very sorry that you are in the unfortunate position to have ended up reading this article, but in the same breath I want to say that there is hope. So don't stop reading.

After daily exchanges with literally hundreds of infertile women some key issues have spontaneously made its way to the surface, key issues that every infertile should be aware of, herewith a short introduction.

When should I seek treatment?

Trust your gut feel. If you are concerned about your fertility, seek medical care as soon as possible. Generally, a couple is only considered to be infertile after one year of unprotected regular intercourse. Remember that age plays a very important role in fertility and seeking treatment earlier, rather than later, will serve you well in the future.

People differ in their approaches to this life crisis, some try every trick in the book before seeking treatment, just to make sure they didn't miss anything. My suggestion would be to add a consultation with a fertility specialist to that list of tricks of yours, and try to put it closer to the top, than to the bottom of the list. If you think it's too soon, but you simply can't ignore that niggly feeling in your gut, please discuss this with your fertility specialist. So, essentially, don't wait longer than a year before seeking consultation, and consult with a specialist, not a gynaecologist, if at all possible.

Where can I find treatment?

You can find a list of South African fertility specialists and clinics on our fertility treatment centres page.

How do I know if my Fertility Specialist is reputable?

The best way to find a reputable clinic is to follow recommendations of people who have been through infertility treatment for several years. The fact that these individuals have not fallen pregnant very quickly, does not mean that they are with the wrong specialist, or clinic, it simply means that they have been around long enough to have heard all the stories of both failure and success and have probably lived through several themselves. They know how to tell apart the good from the bad and the ugly. Be cautious of blindly following the advice of your general practitioner (who will probably refer you to a gynaecologist, instead of a fertility specialist) and guard against any advice sourced from people who have not been through treatment themselves. Advice is often dispensed with good intention, but is equally often not well informed.

What tests should be part of a basic diagnostic fertility workup?

Standard Blood Tests:

A range of test should be performed on day 2 or 3 of your menstrual cycle. These tests are especially meaningful within this important window of your cycle. The meaning of results will change as your cycle progresses, so make sure that tests are performed within this timeframe.

  • 17B Oestradiol
  • LH
  • FSH
  • AMH
  • Thyroid
  • Prolactin
  • Insulin

Standard Procedures:

HSG - Hysterosalpingogram:

An HSG is an X-ray of the uterus, done after injecting a dye solution. The X-ray can reveal several uterine abnormalities, like polyps, uterine septums and blocked or damaged fallopian tubes. It is an essential investigative infertility procedure, when performed by a competent and knowledgeable physician. At many clinics, the HSG does not form part of the standard diagnostic test protocol. It cannot be stressed enough, that you insist on having this procedure performed before commencing any form of fertility treatment. Neglecting this aspect of your treatment may come back later to haunt you in several ways. An HSG is a relatively non intrusive and inexpensive procedure.

Alternative Health vs. Traditional Western Medicine?

Every health practice has its proper place and appropriate application. Several studies, for example, have shown acupuncture to be of benefit for improving IVF success, the exact mechanisms, as yet however remain unclear. Despite the efficacy of some forms of traditional medicine in the treatment on infertility, it is highly recommended that you seek professional medical treatment before embarking on any other course of alternative treatment. Discuss with your physician how you can use complimentary medicine to constructively support your fertility treatment programme, and if you should at all.

Western medicine is evidence based, this means that treatment is designed through rigorous randomised control trials - often referred to as the golden standard. Very few alternative medicine practices can claim scientific soundness and efficacy, and should therefore be considered as complimentary rather than primary treatment option.

Stories of people achieving success after giving up on western medicine abound, many sources claim to have the ultimate secret that will solve your fertility problems, be very cautious of such claims and apply good judgement and common sense. A small percentage (2-3%) of infertility cases resolve spontaneously, why this occurs is not fully understood. One should however bear in mind that most infertility patients have a certain degree of reproductive potential (some better than others), and this potential can come into play after several years of failed treatment (which is often wrongly attributed to the act of giving up on treatment, or 'just relaxing').

What lifestyle adjustments should I make while trying to conceive?

  • Drink less alcohol
  • Stop Smoking
  • Exercise 3 times per week for at least 40mins per session
  • Consult a dietician to make the necessary dietary adjustments suited to your individual profile
  • Take a good multi vitamin (For us South Africans a good combo would be Staminogro and Comegavite)
  • Set time aside to unwind

What can I expect from my Fertility Clinic?

Like in any field of business there are businesses headed with people that are really passionate about what they do, and businesses that exist for the sake of people making a living.

Keep your ears open on the forum and you will soon find out how to tell one from the other.

From a patient's point of view and from personal experience you should:

  • Feel that you are sufficiently informed during each step of treatment
  • Be treated with care and respect by Doctors, Nursing Staff and Receptionists
  • Feel that the concerns that you raise are addressed
  • Feel that your best interests are kept at heart

Should you feel uncomfortable with your treatment at any stage, do not hesitate to seek out alternative options.

Article kindly provided by Maritza Prinsloo Botha.