Tag: fertility

Polycystic Ovarian Syndrome: A lifestyle-related disease?

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Polycystic Ovarian Syndrome (PCOS) is common in South African women and affects about one in 10 women globally. It is caused by a complex imbalance of hormones in the ovaries.  Charlene Yared West spoke to Life Kingsbury endocrinologist, Dr Jocelyn Hellig and gynaecologist Dr Philip Zinn to find out more about this condition. 

So what is PCOS?

In a woman’s body, the ovaries release eggs each month as part of a healthy menstrual cycle.  However, with PCOS the egg is not released as easily, which leads to irregular ovulation and menstruation and can impact fertility. “The ovaries are described as polycystic because there is an excess of the fluid-filled, egg-containing sacs called follicles, all of a similar size, when seen on an ultrasound image,” says Dr Zinn. “This excess occurs due to disturbance of the growth of follicles – to the size required for ovulation.”

It’s all about the hormones… or is it? 

Dr Hellig explains that the exact cause of PCOS is unknown. “There is no one singular factor which causes PCOS. It is considered to be a complex trait arising from the interaction of genetic and environmental factors, usually first presenting when mature gonadotropin levels (hormones essential for reproduction)are achieved at puberty. It occurs naturally in primates as well as humans,” she says. “The disorder arises clinically by the presence of two out of three criteria: irregular periods or the absence of ovulation, features of high androgen levels (acne or excess hair growth) and a certain appearance of polycystic ovaries on ultrasound,” she says. 

You could be predisposed to PCOS if…

  • You have insulin resistance.
  • You have Type 2 diabetes.
  • You have unhealthy eating habits.
  • You do not exercise regularly.
  • You are overweight or obese.

Trying to fall pregnant?

If you are trying to fall pregnant, but it is proving difficult, PCOS might be the culprit, says Dr Zinn. “Many women are unaware that they even have PCOS until they start trying to have a baby. Once they start treatment and their symptoms are managed, then their chances of conceiving are increased.”

QUIZ: ✓Tick the boxes below to see if you might have symptoms of PCOS

  •  Irregular menstrual cycle 
  • Thinning hair or hair loss on the scalp (male-pattern baldness).
  • Acne on the face, back and chest. 
  • Too much hair on the face or areas where men usually have hair (hirsutism affects up to 70% of women with PCOS). 
  • Weight gain and difficulty losing weight. 
  • Darkening of skin pigmentation, along the neck, groin and under the breasts. 
  • Skin tags in the armpits or neck area. 

How is PCOS diagnosed? 

“If you think you have PCOS, make an appointment with your gynaecologist. There is no single test to diagnose PCOS, but we take your medical history and can conduct a physical exam with a pelvic ultrasound and do some blood tests,” says Dr Zinn.  Dr Hellig adds: “Of utmost importance is that PCOS is a diagnosis of exclusion and it is important for your medical professional to look for other causes of your symptoms before ascribing it to PCOS.”

  • Physical exam: Checks your blood pressure, BMI and waist size. Also checking for extra hair on the body, skin discolouration, hair loss and any other signs of excess testosterone such as an enlarged clitoris. It is important to exclude other health conditions. 
  • Pelvic ultrasound: A sonogram will examine the lining of the uterus and check the ovaries for the polycystic features. 
  • Blood tests: To check your androgen hormone levels, as well as other hormone checks, including your thyroid. 

Can I be cured from PCOS?

8Dr Hellig explains that there is no cure for PCOS, but symptoms can be effectively managed and therefore treated. “We take into account if you want to conceive, your risk of long-term health problems, especially diabetes and cardiovascular disease, and will help formulate an effective treatment plan through lifestyle changes and medication where necessary,” she says. 

What can I do to alleviate my symptoms?

Dr Hellig and Dr Zinn agree on the following steps that women can take to treat PCOS: 

  • Lose weight: This will help to stabilise your blood glucose levels and alleviate insulin resistance. Even a 5 – 10% loss in body weight can improve your chances of conceiving. 
  • Remove hair: Using facial hair removal creams, laser hair removal or electrolysis. Medication is not very effective for permanent hair removal. 
  • Hormonal birth control for women not wanting to conceive: Can help to regulate  menstruation cycles, stabilise weight, improve acne and reduce new hair growth on face and body. 
  • Anti-androgen medicines: Although not safe for pregnancy, can help reduce PCOS symptoms. 
  • Metformin: A drug used to treat type 2 diabetes and may help some women with PCOS symptoms in certain circumstances. 

Healing… after miscarriage

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Miscarriage is the most common type of pregnancy loss and according to the American College of Obstetricians and Gynaecologists, 10-25% of all recognised pregnancies end in miscarriage and about 80% of all pregnancy loss occurs in the first trimester. Unrecognised pregnancies, which are also known as ‘chemical pregnancies’ account for 50-75% of all miscarriages, where the pregnancy is lost shortly after implantation, where bleeding occurs around the time of the woman’s expected period. Charlene Yared West unpacked the topic with Dr Francis Maleka from Life Mercantile Hospital. “In short, miscarriage is more common than we think,” he says. 

Why does miscarriage happen?
“Not every miscarriage has a clear cut reason and often the cause isn’t identified. Women will ask themselves why – and often blame themselves, but the truth is, there is very little you can do to prevent a miscarriage,” says Dr Maleka. Reasons include chromosomal abnormality, hormonal problems, infections, maternal health problems, maternal age, maternal trauma, lifestyle (smoking, drugs, malnutrition) and implantation of the egg that does not occur properly. “Things that do not cause miscarriage are sex, working outside of the home and moderate exercise,” he adds. 

Men – the forgotten grievers

Women are the ones who have to cope physically and emotionally after the loss of a baby. Often, the grief men experience goes unacknowledged. According to research carried out in 2014 by Dr Petra Boynton at the University College London, dads said they felt happy, excited, thrilled or delighted about the pregnancy before the miscarriage – and 55% of those men had already picked out a name for the baby. After the loss, many fathers reacted with feelings of sadness (85%), grief (63%) and shock (58%), but nearly a quarter didn’t share their feelings with their partner, usually for fear of upsetting her more or saying the wrong thing. “I encourage couples to talk about what happened and also to see a therapist if they find it difficult to access those emotions,” says Dr Maleka.

Getting pregnant after miscarriage

Deciding to have another baby after miscarriage can cause mixed emotions for both parents. “On one hand they want a baby, but the next time around is often fraught with fear of another loss. We have to pay special attention to the next pregnancy even more carefully,” says Dr Maleka. Parents may choose to delay falling pregnant again due to surgery from the miscarriage, a delay in menstrual cycles, genetic testing and autopsy reports, and emotional issues and readiness. “Seek support from family and friends, as well as your doctor or midwife and professional support groups, to help you heal after miscarriage,” he says. “Remember that you are still grieving the loss of your baby while attempting to get pregnant again. Be gentle on yourself.” 

A case study: “How I moved forward”

We fell pregnant for the first time in 2011 and were so excited. We decided not to wait until the 12 week time period to share our news with friends and family – as for us, a life is a life and we told everybody! I had all the pregnancy symptoms; sore breasts and bouts of nausea. Then I was at work one day and started bleeding heavily. The doctor confirmed the miscarriage and we were distraught. I was so heartbroken and this heaviness weighed down on me for weeks. My husband and I went away on a relationship workshop weekend camp and for me that was the turning point. The camp was situated in a beautiful place in nature, which brought me a lot of comfort. There was also a small chapel there that my husband and I would visit. In the quiet of this tranquil place, I came to the realisation that I had to give her a name as I sensed she was a girl and that I needed to somehow name her. So, we named her Faith and I think just the act of giving her a name gave me such a sense of relief. I was much better afterwards and  fell pregnant soon after… and gave my baby the second name of Faith, so that I would never forget the first little life that came to me. I think a lot of people after miscarriage tend to want to close it off and not talk about it – and try their best to forget about it. I somehow embraced the experience as painful as that was and named her, letting myself to feel the loss that occurred. This is what gave me closure. We have two daughters now, but have never forgotten baby Faith.  

Multiples: A dream come true through IVF

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If you have been trying for a baby for more than a year, but have been unsuccessful, you are one of at least 50-million couples who experience infertility worldwide. The number of children being born in South Africa is also on the decline and according to the Recorded Live Births 2013 to 2015 report, the number of birth registrations decreased by 6.8% from 1.6-million in 2013 to 1.08-million in 2015.  As a result, many couples are turning to infertility treatment to fulfil their hopes of having a baby. If you’re a good candidate for In Vitro Fertilisation, it may be the only way to help you grow your family unit from husband and wife to three… or even four… or more! 

Multiples and IVF

“IVF treatment can result in multiple births because, often, more than one embryo is transferred into the uterus of the mother,” says Dr Henk Burger, gynaecologist and obstetrician at Life Carstenhof in Gauteng. “The chance of having multiple births can be reduced considerably by only putting one embryo back into the womb.” The cost of IVF ranges from R30k to R50k per attempt, which explains why many couples opt for implanting more than one embryo to increase their chances of a successful pregnancy the first time around, explains Dr Burger. He notes that sometimes a termination of one of the embryos is requested after implantation, but this is very difficult and dangerous for the embryo that stays behind. 

Multiples and risk

We all know how adorable twins are – and they make for an instant family unit, but they also come with a certain level of high risk in pregnancy. “Around 30% of multiples are prone to prematurity – and born before their due date. There is also the risk of intrauterine growth retardation, birth defects and miscarriage. The mother is also five times more likely to get pre-eclampsia and six times more likely to have polyhydramnios and antepartum haemorrhage,” says Dr Burger. “Mothers carrying multiples must ensure they attend each and every antenatal consult; every four weeks up to 20 weeks, every two weeks up to 28 weeks and every week up to birth thereafter. The aim is to get the mother to carry her baby to at least 36 weeks, but this is often not the case.” He also advises mothers to eat a  balanced diet, not to smoke and to take antenatal supplements. “Simple things like positioning of the safety belt in the car when driving are also important to remember to reduce risk,” he adds. 

Natural or Caesarean birth for multiples

According to Dr Burger, birth by caesarean section is the safest for multiples, because of the risk, especially for the babies born after the first one. “There is positional risk such as breech or transverse positioning, especially for the second baby. There is also the risk of premature labour, placental abruptia, fetal distress and even early closure of the cervix,” he says. “There was a case reported where the cervix closed after the mother had naturally birthed the first of her twin babies. Her cervix remained closed for 56 days before she birthed the second one! It is the longest reported period between delivery of the two babies.” 

Breastfeeding your babies

Dr Rebecca Makate is a paediatrician at Life Carstenhof and is experienced in helping parents adjust to life with their new babies. “Breastfeeding for any baby offers major health advantages such as less infections and better neurodevelopment. The breast can make enough breastmilk for two or more babies as breastfeeding is based on supply and demand,” she says. “In other words, the more you breastfeed the more milk your breast produces. It is also possible to breastfeed twins at the same time on different breasts. Having said that, having more than two babies can come with huge challenges during feeding time.Even if you breastfeed, occasional supplementing your babies formula will give you some much needed freedom and sleep.”

<Sidebar> So what is life like with multiples?Despite some challenges and drawbacks, having multiples is a great joy, says Dr Makate. “There is a level of convenience and efficiency in parenting children simultaneously; some of the unpleasant aspects are sleepless nights, feeding times, potty training and teenage troubles which all have to be endured at once. Mostly though, there is a great pleasure and enjoyment in parenting multiples, every moment is multiplied and every simple joy is magnified,” she says. Dr Makate lists the following challenges couples should consider before IVF:-Pregnancy and birth risks when carrying multiples.-Fetal complications and time in the NNICU.-Lack of sleep.-Difficulty bonding.-Economic impact on the family unit.-Relationship with your spouse is put under pressure.-The need for extra help with caring for the babies. 
<Sidebar> What are Monozygotic and Dizygotic multiplesMonozygotic multiples: In monozygotic multiples, the embryo splits and the babies are born identical. In utero, they share one placenta and one amniotic sac. Dizygotic multiples: In dizygotic multiples, there are two separate embryos, each with their own placenta. Monozygotic multiples are higher risk for a few reasons: Placenta abruptia: where the placenta tears away from the uterus during birth and deprives one or more of the babies from it’s life source of oxygen and blood. Cord prolapse: where the umbilical cord of the second baby born prolapses out of the mother’s vagina. Twin-to-twin transfusion syndrome: where the babies share a joint blood circulation through the placenta, which contains abnormal blood vessels, where blood is transfused disproportionately from one twin (the donor) to the other twin (the recipient).
Lindy and Michael’s* story
We fell pregnant after many, many years of trying to conceive – almost ten years. Initially we tried naturally, then Artificial Insemination and then only In vitro Fertilisation. As I am an older mom it was necessary to go this route. It’s a very drawn out process with lots of steps and checks and balances. One needs to eliminate the options that are not viable first and the doctors are all very cautious and considered in how they approach IVF in South Africa. It is a very expensive process, but we were committed to being parents, and I was not willing to give up, so we just kept on trying until we had a positive outcome. We first attended the Cape Fertility Clinic but after no luck there, we moved to Aevitas which is based at Life Vincent Pallotti. Prof Kruger and Prof Siebert from Aevitas were absolutely amazing, as were all the sisters that worked with them in their team. A number of eggs were fertilised and the best quality eggs were implanted and we were very lucky that two fertilised eggs resulted in our gorgeous twins, Jacques and Stella. It was a very long and stressful process. We lost a baby at full term, Ruby Mae, who was stillborn at 41 weeks.  Soon after this loss, we tried again to conceive and with the help of Aevitas got pregnant with the twins who were born on 1 May 2015. It was amazing and unbelievable to find out we were pregnant with twins after losing our previous baby.  We were elated and also scared as twins are a major change in one’s life. On the 13th of January we felt our first big kick after steak strips with Szechuan pepper and salad for dinner, it was wonderful! We made it through to 38 weeks and delivered them with the help of Dr Marie Pienaar and her team and Panorama Mediclinic. We love them to bits and they entertain, inspire and motivate us each day to be better, kinder parents. Its tough with two but the highlights are by far in excess.  It is stressful and one learns how to cope. Support makes all the difference, whether it is grandparents, siblings, night nurses, nannies or friends. Also each baby is so unique and has their own personality and it’s such a joy to experience the gift of twins.*Names have been changed. 
Vanessa and Philipp’s storyWe had been trying to conceive for a long time, but I knew that with my pre-existing conditions of Polycystic ovarian syndrome and Hashimoto’s Thyroiditis, it would not be without some challenges. In 2015 I had a molar pregnancy – very rare – where a non-viable fertilised egg implants in the uterus and grows as abnormal tissue.In that time, we had been in touch with an adoption agency to come ‘kangaroo parents’, which are like safety parents for babies under 3 months old, where we would care for them for up to 90 days until they were transferred to their forever homes. When we started the paperwork, I found out I was pregnant and we felt it might be too much to go through with the adoption agency, but then later that year, I miscarried and this broke me on so many levels. After that I left for Europe and shortly after we received a call from the adoption agency to know if we were perhaps keen to foster twins who were 6.5 months old. We slept on it and the next morning we decided that we would do it and eight days later they arrived. We lost our hearts completely to the babies and decided to start the process of legally adopting them. We still kept our sights on having our own biological child one day, so we kept on trying naturally at first and then decided on IVF at the Aevitas Clinic at Life Vincent Pallotti. On the day of the transfer they implanted two eggs and at the 9 week scan we heard three heartbeats! The two boys shared one placenta, but each had their own sac and the girl had her own placenta and sac. I honestly felt as though I lost the ground under my feet and the world was spinning… we would be parents to five children now, the twins included! My pregnancy was easy until 26 weeks when I started having contractions and had to have bedrest at Life Vincent Pallotti until my caesarean birth on the 24th of April at 30 weeks pregnant with Dr Jacky Searle at Life Vincent Pallotti. My precious babies weighed 1290g, 1220g and 1540g at birth and now we are a beautiful family of seven. I am thankful for blessings in abundance and the good health of all my children. 

Dealing with infertility, when he has the problem

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It’s not just a women’s issue

Struggling to fall pregnant? Usually women are the first to seek help when trying to conceive. However, if the woman has been thoroughly examined and it is not due to her that she is unable to fall pregnant, it falls to the male partner to be tested. According to a study published in 2015, infertility affects about 15 per cent of couples globally, amounting to about 48.5-million couples. The study also found that males are found to be solely responsible for 20-30 per cent of infertility cases and contribute to about 50 per cent of cases overall. Furthermore, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. If a male factor is what’s making it tough for a woman and her partner to conceive, it’s important to understand what may be causing his infertility and what the couple’s options are. Charlene Yared West speaks to the experts to find out more… 

Infertility and feelings of inadequacy and impotence

“Research indicates that the male partner is not willing to seek medical advice about infertility. They feel embarrassment for not being able conceive naturally and suffer guilt, self-blame and shame,” says Dr Liezel Anguelova, Counselling Psychologist at Life Roseacres Hospital. “Many men do not feel comfortable with the testing procedure as it includes the examination of their testicles and penis and the production of a sperm sample. As such, men often associate infertility with impotence, when they are actually unrelated.” Dr Anguelova explains how infertility can be devastating to the man who experiences the failure of his procreative nature, as it is so intrinsically linked to his sexuality. “It is often an assault on the masculinity of the male partner and it is not uncommon for him to develop sexual problems such the loss of sexual desire or erectile dysfunction, which can leave him feeling that he is ‘less of a man’,” she says. 

What causes male infertility?According to Dr Sulaiman Heylen, Specialist in reproductive medicine at Life Kingsbury Hospital, male infertility is diagnosed by an abnormal semen analysis. “We always start at the beginning of the fertility testing with the semen analysis. We don’t want to do a lot of testing on the female without knowing what the male factor is. Semen analysis is very easy and inexpensive.”
There are three parameters important in the semen analysis according to 2010 WHO criteria:
1. sperm count: must be over 15 million sperm per milliliter.
2. sperm motility (how they move): 50% of sperms cells must be motile.
3. sperm morphology (their shape): at least 4% of the sperm cells must have a normal morphology.
“If one of these parameters is abnormal we speak of male infertility in combination with an inability to conceive,” he explains. Dr Heylen lists the following as possible causes of male infertility;Varicocele: These are varicose veins of the testis, they can contribute to up to 30% of all cases of male infertility. Trauma of the testicles; related to accidents or sports injuries.Sexual transmitted disease which can lead to infections of the testis and blockage of the epididymis (tubes of the testis)Mumps of the testis.Pollution and environmental factors (estrogen like factors in the environment): These are called xenoestrogens. Estrogen is the normal female hormone. Xenoestrogens are chemical compounds that mimic estrogen. There is more and more evidences that pollution and environmental factors can contribute to male infertility.Unhealthy lifestyle: Obesity, excessive alcohol, smoking and drugs. Anabolic drugs are well known to cause low sperm counts. Antibodies that attack sperm: Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to destroy them.Undescended testes: During fetal development one or both testicles sometimes fail to descend from the abdomen into the scrotum. Genetic: there are genetic defects in the chromosomes or small defects of the Y-chromosome. Unknown: We not always can identify the cause of the low sperm count. 

How is male infertility uncovered?

Urologist, Dr Dap Louw from Life Beacon Bay Hospital explains how the physical examination entails a general exam, evaluation of the testes ( volume, masses, varicocele, infections, etc) and a prostate exam if needed. “The basis of the evaluation starts with taking  a thorough medical history. We normally do a pelvic and scrotal ultrasound as well, to evaluate the testicular tissue and to look for signs of sperm transport blockage. Other more invasive diagnostic methods can be used especially when there is little or no sperm seen in the ejaculate. This would then be aimed at distinguishing between abnormal sperm production or blockage of sperm transport,” he says. 

What treatment is available? 

Dr Louw explains that treatment is aimed at the underlying problem whether it is advice on a healthier lifestyle, surgical correction of a testicular abnormality or medically treating an underlying infection, sexual dysfunction or hormonal abnormality. “When there is no urological correctable contributing cause to the infertility, I then like take a multidisciplinary approach and get the infertility specialists and/or gynaecologists involved,” says Dr Louw. “Together we can then decide on further optimal treatment, according to their hormonal levels, semen analysis and then also female factors. These can then vary from medical treatment, sperm washing with artificial insemination, IVF (in-vitro fertilization) or ICSI (intracytoplasmic sperm injection).” Dr Louw always emphasises to his patients that 20-30% of sub-fertile couples end up falling pregnant without any further help, which is positive – as nature is on their side! “Anxiety about infertility also plays a significant role and it is important to explain the normal conceiving time of 6-12 ovulatory cycles,” he says. “It does unfortunately happen where our patient is not able to have children and the couple would need to discuss alternate options like sperm donation or adoption.” 

Can a couple survive infertility treatment?Infertility can be a relationship maker or breaker depending on how it is managed says Dr Anguelova. “It will put your relationship to the test, but if you focus on the importance of your relationship, it could be used as a opportunity to make your relationship stronger.” She shares some tips for surviving infertility;Stay in the moment, because it can be very overwhelming.  Wait for each doctor’s visit to gather information on the process before making decisions and planning ahead.  Communicate openly and honestly to address unmet expectations, fears, frustrations and  stress. Find professional assistance and counselling if you are not communicating effectively.  Do not get caught in a blame game of resentment, but rather become committed as a team. Remain positive about yourself and your partner.Keep your sexual relationship spontaneous and full of fun and nurture intimacy by touching, hugging and kissing outside of a sexual connotation.Do not let your entire life be merged into the fertility treatment process. Continue with other hobbies and keep other dreams alive.Build a support system. Support each other and include friends and family in the process.

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