Fertility facilities and services

Fertility services

For couples trying to start a family but not having any success even after a prolonged period, the possibility that one or both partners are infertile is something that they will have to consider. Emotionally, this realisation could be highly distressing. However, today, thanks to ongoing advances in diagnostic technology and in the discipline of fertility, the cause or causes of their inability to conceive can be diagnosed much more accurately and treatment can be targeted specifically to help address these causes and assist couples on their journey to parenthood.

What is infertility?

Infertility refers to the failure to conceive after regular unprotected sexual intercourse for two years in the absence of any known reproductive pathology. Primary female infertility implies that a woman has never conceived and secondary female infertility indicates that a woman has had at least one previous conception.

Netcare fertility centres and services

There are dedicated, specialised fertility centres at the following Netcare hospitals. For more information on the fertility treatments offered at a specific centre, please contact the fertility specialist(s) at that hospital.

Fertility specialists

Gauteng

Netcare Femina Hospital

Dr NJ Biko
Dr GC Dempers
Dr TGM Deo
Dr ND Gumata

Netcare Park Lane Hospital

Dr B Bothner

Netcare Pretoria East Hospital

Dr M Trouw

KwaZulu-Natal

Netcare St Augustine’s Hospital

Prof JS Bagratee
Dr M Bhana
Dr S Naidu

Western Cape

Netcare Blaauwberg Hospital

Dr Femi Olarogun

Causes of female infertility

Female infertility can be caused by a number of factors, including the following:

Damage to the fallopian tubes (which carry the eggs from the ovaries to the uterus). This can prevent contact between the egg and the sperm. Pelvic infection, endometriosis and pelvic surgery may lead to scar formation and fallopian tube damage.
Hormonal causes. Some women have problems with ovulation in that synchronised hormonal changes leading to the release of an egg from the ovary and the thickening of the endometrium (lining of the uterus) in preparation for the fertilised egg do not occur. These problems may be detected using basal body temperature charts, ovulation predictor kits and blood tests to detect hormone levels.
Cervical causes. A small group of women may have a cervical condition in which the sperm cannot pass through the cervical canal. This could be due to abnormal mucus production or a prior cervical surgical procedure, in which case it could be treated with intra-uterine inseminations.
Uterine causes. This could include an abnormal anatomy of the uterus, or the presence of polyps and fibroids.
Unexplained infertility. In approximately 20% of couples, the cause of infertility cannot be determined through the methods of investigation that are currently available.

Diagnosing the cause of infertility

Fertility couple work-up involves a specialist taking a relevant and thorough history of both partners (female and male). The emphasis of the history would include aspects such as the following:

Age
Previous conception
Menstrual cycle
Contraceptive use
Infections
Breast problems (development)
Skin abnormalities (acne)
Weight
Previous surgical interventions
Current medication

If male infertility is suspected, a semen analysis is performed. This test will evaluate the health of a man’s sperm. A blood test can also be performed to check his level of testosterone and other male hormones.

If female infertility is suspected, your doctor may order several tests, including:

a blood test to check hormone levels; and
an endometrial biopsy to check the lining of the uterus.

Two other diagnostic tests that may be helpful in detecting scar tissue and tubal obstruction are hysterosalpingography and laparoscopy.

Hysterosalpingography (HSG). This procedure involves either ultrasound or x-rays taken of the reproductive organs. Either dye or saline and air are injected into the cervix and up through the fallopian tubes. This enables the ultrasound or x-ray to reveal whether the fallopian tubes are open or blocked.
Laparoscopy. In this procedure, a laparoscope (a slender tube fitted with a fibre optic camera) is inserted into the abdomen through a small incision near the belly button. The laparoscope enables the doctor to view the outside of the uterus, ovaries and fallopian tubes to detect abnormal growths, as in endometriosis. The doctor can also check at the same time to see whether or not the fallopian tubes are open.

Treatment of female infertility

Female infertility can be treated in several ways, including:

Laparoscopy. Women who have been diagnosed with tubal or pelvic disease can either undergo surgery to reconstruct the reproductive organs or try to conceive through in vitro fertilisation (IVF). Using a laparoscope inserted through a cut near the belly button, scar tissue or ovarian cysts can be removed, endometriosis treated, and blocked tubes opened.
Hysteroscopy. A hysteroscope placed into the uterus through the cervix can be used to remove polyps and fibroid tumours, divide scar tissue, and open blocked tubes.
Medical therapy. Ovulation problems can be treated with prescribed medication, which can lead to ovulation. These drugs also can enhance fertility by causing multiple eggs to ovulate during the cycle whereas only one egg is released each month under normal circumstances. There is also medication that may restore or normalise ovulation in women who have insulin resistance and/or polycystic ovarian syndrome (PCOS). A specific therapy can also be offered in cases of unexplained infertility and for other factors that may have caused infertility but which have been corrected without resulting in pregnancy.
Intrauterine insemination. During this procedure semen is collected, rinsed with a special solution, and then placed into the uterus at the time of ovulation. The sperm are deposited into the uterus through a slender catheter that is inserted through the cervix. This procedure can be done in combination with the previously listed medications that stimulate ovulation.
In vitro fertilisation (IVF). This refers to a procedure in which the woman’s eggs are fertilised in a culture dish and then placed into the uterus. The woman takes medication to stimulate multiple egg development. When monitoring indicates that the eggs are mature, they are collected using a vaginal ultrasound probe with a needle guide. Sperm are collected, washed, and added to the eggs in a culture dish. Several days later, embryos (or fertilised eggs) are returned to the uterus using an intrauterine insemination catheter. Any extra embryos can be frozen for later use, upon the consent of the couple.
Intracytoplasmic sperm injection (ICSI). This technique is used in the case of sperm-related infertility. The sperm are injected directly into the egg in a culture dish and then placed into the woman’s uterus.
Gamete intrafallopian tube transfer (GIFT) and zygote intrafallopian transfer (ZIFT). Like IVF, these procedures involve retrieving an egg from the woman, combining it with sperm in a laboratory and then transferring it back to her body. In ZIFT, the fertilised eggs (at this stage called zygotes) are placed in the fallopian tubes within 24 hours. In GIFT, the sperm and eggs are mixed together before being inserted.
Egg donation. Egg donation helps women who do not have normally functioning ovaries (but who have a normal uterus) to achieve pregnancy. Egg donation involves the removal of eggs (also called oocytes) from the ovary of a donor who has undergone ovarian stimulation with the use of fertility drugs. The donor's eggs are then placed together with the sperm from the recipient's partner for in vitro fertilisation. The resulting fertilised eggs are transferred to the recipient's uterus.

Medical therapy and in vitro fertilisation.