June is World Infertility Awareness Month and a great time to talk to your doctor and partner about your fertility health
It is estimated that globally, infertility affects 8–12 % of women who are 20–44 years of age. Physiological causes in men account for 20–30 % of cases of infertility and physiological causes in women for 20–35 %, while 25–40 % are due to issues in both partners. In 10–20 % of cases, no cause is found. Women starting their families at an older age is one of the most common explanations for infertility today. It is vital that those facing infertility issues empower themselves by having the necessary conversation about fertility treatment with their partner and doctor, because there are interventions if treatment is sought sooner rather than later.
What is infertility?
Infertility is defined as failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or due to an impairment of a person’s capacity to reproduce, either as an individual or with his/her partner. If the woman is older than 35, she and her partner should seek an evaluation if they have not been able to conceive after six months.
Causes of infertility
All of the steps during ovulation and fertilisation need to happen correctly in order to get pregnant. Sometimes, issues that cause infertility in couples are present at birth, and sometimes they develop later in life – they can affect one or both partners.
Causes of male infertility may include abnormal sperm production or function, problems with the delivery of sperm, overexposure to certain environmental factors (including cigarette smoking, anabolic steroid use, marijuana, alcohol, and certain medications), and damage related to cancer and its treatment.
Causes of female infertility may include ovulation disorders, uterine or cervical abnormalities, fallopian tube damage or blockage, endometriosis, early menopause, pelvic adhesions (bands of scar tissue from pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery), and cancer and its treatment.
Infertility during the COVID-19 pandemic
The COVID-19 pandemic has resulted in increased distress among many people – particularly those already experiencing major stressors in their lives such as problems associated with fertility.
Dr Sulaiman Heylen, President of the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG), says: “Many women who may have been trying to conceive for 3–4 years and needed fertility treatment, but couldn’t access it because of COVID-19 lockdowns, have experienced higher levels of anxiety during the pandemic due to treatment delays. This, in turn, is associated with more negative emotions, lower expectations of future pregnancy, and greater stress and depressive symptoms.”
Recent studies on perceptions of the COVID-19 pandemic among women with fertility issues, have showed that although women with fertility problems have perceived the pandemic as negative and disruptive, those who have higher optimism may be less affected.
Dr Heylen says: “Empowering yourself through gaining knowledge is a great way to boost that optimism. For those facing infertility issues, this entails having the necessary conversation about fertility treatment with their partner and doctor. Fertility starts a slow decline when women are in their twenties – but about half of the women who come to fertility centres are already over 35 years of age. It is at age 35 that one starts to see a more rapid decline in fertility.”
“Women would be far better served by investigating fertility options and fertility preservation earlier in their lives. Even if they only plan on having a family later, they can make sure that they are aware of steps that they can take, such as freezing their eggs to try to preserve their ability to have a child later on.”
Dr Heylen says that while COVID-19 had a major impact on fertility care through lack of access, the rebound effect is that fertility facilities have never been busier. “Women are feeling more comfortable now to proceed with fertility treatment. Doctors also know more about COVID-19 in terms of impact on pregnancy health and fertility, and that it does not cause abnormalities in pregnancy, nor miscarriage, unless the case of COVID-19 is very severe,” says Dr Heylen.
“We have seen many women who have had COVID-19 in the first trimester, and they have been absolutely fine – which is marvellous news. Women may also be safely vaccinated against COVID-19 during fertility treatment, as the vaccine has been proven to have no impact on fertility,” says Dr Heylen.
Many people may delay fertility treatment because they fear the costs associated with in vitro fertilisation (IVF); however, there are a number of treatment options other than IVF that can improve the chance of conceiving. The treatment that will be recommended depends on factors like the cause of your fertility issues, your age, and your preferences. Options include fertility drugs to stimulate ovulation; surgery to fix a uterine condition, such as endometriosis, fibroids, or blocked fallopian tubes; intrauterine insemination, where sperm is placed directly into your uterus during ovulation; IVF, where sperm and egg are placed together in a lab until they form an embryo which is then implanted into your uterus; and intrafallopian transfer, where the sperm and egg or a fertilised egg is placed into the fallopian tube.
“Women and men should continue with their journey towards parenthood – it is absolutely possible despite COVID-19. Time and age are of the essence when it comes to more positive fertility treatment outcomes, so we always encourage people not to delay. The important thing is to have the necessary conversation with your partner and your doctor – and to empower yourself with knowledge about your situation and the options that are available to you,” says Dr Heylen.
Visit a fertility clinic near you to speak to a doctor about the options available to you and your partner.
For more information, visit www.merckfertilityjourney.co.za
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