Fertility Treatment Specialists, PCOS | Aevitas Fertility Clinic

Having a child is a dream rooted in the very depths of the soul. It’s a desire like no other and one the Aevitas Fertility team is privileged to journey alongside you to fulfil.

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Natural Fertility Narural Fertility

Lifestyle & Fertility Lifestyle and Fertility

Fertility Evaluation

Causes of Infertility

"It's a boy!!! Thank you from the bottom of our hearts... thank you for your endless support, reassurance and love that you have given us through the years and for always listening to my theories."

Aevitas Patient

Natural Fertility

Life is an infinitely powerful force and one the Aevitas Fertility Clinic has seen conquer adverse circumstances again and again.

The following is a guide to natural fertility as a reference point.

Ovulation: Every month a female releases one mature egg from her ovaries. The egg leaves the ovarian follicle and travels to the end of the Fallopian tube. It then begins to move slowly down the Fallopian tube to the uterus (womb). For a pregnancy to occur the egg must be fertilised by male sperm while still in the Fallopian Tube.

Fertilisation can occur during the ‘fertile window’, which is five days before ovulation and the day of ovulation. By approximately 12 – 24 hours after ovulation, fertilisation can no longer take place during that menstrual cycle, as the egg is no longer in the Fallopian tube.

Only the best sperm reaches the Fallopian tube during/after intercourse. While many of these sperm manage to bind to the shell, the sperm needs to break through the egg’s shell to fertilise the egg. If a sperm manages to break through the shell, the sperm -and egg’s genetic material (male- and female pronuclei) move towards the centre of the egg. Embryo development then starts to take place through cell division.

Around day 4 – 6 of cell division, the blastocyst stage occurs (the embryo fills with fluid creating a cavity, outer cells start forming a wall and inner cells start forming a ball). At the blastocyst stage the embryo enters the womb. Over the next few days, it will hatch out of its shell and bury into the womb. It will grow and develop blood vessel connections with the mother. This stage is called implantation. By the stage of implantation, the embryo sends out chemicals into the mother’s blood stream, which will be picked up by a pregnancy test about two weeks after fertilisation. The embryo then continues to grow and develop into a baby.

Lifestyle & Fertility

When planning a pregnancy, good lifestyle decisions are important for both female and male partners. At Aevitas Fertility Clinic we emphasize a balanced lifestyle to support you on your fertility journey. Important lifestyle factors influencing fertility, includes:

Diet and healthy weight

Patients are encouraged to follow a healthy balanced diet rich in fruits, vegetables, and Omega 3. A diet which favours low glycaemic carbohydrates, as well as organic- and free-range products is desirable. This is to ensure that your body receive good nutrients to:

1) support physiological processes

2) maintain a healthy body mass index (BMI). BMI is a measure that uses a person’s weight and height to calculate if their weight is in a healthy range. Having a high BMI can harm fertility by inhibiting normal ovulation. Research has also found that a high BMI increases the risk for unsuccessful IVF.

Supplementing your diet with folic acid, Omega 3 or a combined supplement may also be beneficial and can be discussed during your consultation.

Alcohol

When planning a pregnancy, women are advised to avoid alcohol and men are advised to limit their alcohol intake to a maximum of two units per day.

Nicotine

The use of nicotine products either through smoking cigarettes or vaping affects fertility in both male and female patients.

Caffeine

High levels of caffeine consumption (more than 5 cups of coffee per day) have been associated with decreased fertility.

Drugs

It is especially important to discuss the use of any drug or supplement when consulting with your fertility specialist. This includes: any medication, over the counter herbal/homeopathic medication, supplements, or any other drug you may be taking.

Exercise

Moderate exercise is encouraged as it releases endorphins (happy hormones) and helps to relieve stress.

Sleep

Sleep requirements may vary from person to person. It is recommended that adults get about 7 – 9 hours per night, as sleep is vital in restoring and rejuvenating the body.

Fertility Evaluation

Infertility is classified as a disease and can be defined as the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse or exposure to sperm. Although most couples can conceive naturally within a year, infertility affects one in four couples. Factors contributing to infertility can be attributed as 1/3rd female factors, 1/3rd male factors and 1/3rd unknown or a combination of factors.

When should you seek help if you are struggling to conceive?

This question is partly dependent on the female partner’s age, as age influences fertility. Therefore, it is advised that you seek help from a fertility specialist if you are:

younger than 35 and have been trying to fall pregnant for one year
older than 35 and have been trying to fall pregnant for six months

How can a fertility specialist help you?

A fertility specialist is a gynaecologist with an additional qualification in reproductive endocrinology and infertility. A fertility specialist addresses factors that could influence your fertility. This includes medical or surgical treatment for conditions affecting fertility, such as endometriosis. Furthermore, Assisted Reproductive Techniques (ART), such as invitro fertilisation, can be used to achieve a pregnancy.

What to expect when I see a fertility specialist?

If you are struggling to conceive and you have made an appointment with a fertility specialist, you are taking a step in the right direction by consulting with an expert in the field. You might be wondering what to expect.

An initial consultation with one of the Aevitas fertility specialists can take 30 – 60 min. Females will also undergo a transvaginal ultrasound scan, which forms part of examining the female reproductive organs. Male fertility can be evaluated through semen analysis. Semen analysis assesses sperm count and function. Your fertility specialist will determine which further testing is needed for female and male partners. All this information will assist your fertility specialist to make an accurate diagnosis, to present you with treatment options.

What can you bring?

All related medical records
A list of medications, vitamins, herbs or supplements you are taking
A list of the questions you want to ask your fertility specialist

What is the cost of an initial consultation with an Aevitas' fertility specialist?

The cost for an in-person consultation is R 2700 (2024 pricing) and includes an ultrasound scan.

Should you not be situated close to the clinic you have the option of starting with a teleconsultation, which can be performed telephonically or via platforms such as Zoom. The cost for an initial teleconsultation can range between R 930 - R 1200.

Based on the findings during the consultation, additional diagnostic tests might be requested, which will be a separate cost.

Causes of Infertility

The Aevitas Fertility team continues to be in awe of the human body and its resilience. No matter what fertility background you’ve come from, our team is here to work with you in fulfilling your dream of having a child. For this reason, we believe that the more information you have, the stronger you will be to take the journey towards having the child you long for.

These causes of infertility are treatable and the Aevitas Fertility Specialists have helped thousands of patients over the years to create their family.

Causes of Infertility in men and women Aevitas Clinic

Advanced Age

Fertility declines with age for both men and women. The effect of age is much more pronounced in women.

Women are born with all the eggs they will ever have – over a million. The number of eggs, as well as their quality, will gradually decrease over the years. This decline will accelerate beginning around age 35. Age is one of the best indicators of egg quality. The decreasing quantity of eggs is called loss of ovarian reserve. Medical test can be performed to observe the levels of ovarian reserve. These tests do not indicate if pregnancy is possible but can give valuable information about age-related changes of the ovaries. Women with poor ovarian reserve may have a lower chance of becoming pregnant than women with normal ovarian reserve of the same age.

Semen parameters in men also decline after 35 years of age. However male fertility does not appear to be so severely affected.

Asherman's Syndrome

Asherman’s Syndrome is an acquired uterine condition, characterised by scar tissue inside the uterus and/or cervix. Often the scar tissue can cause the walls of the uterus to stick to one another.

Causes

Asherman’s Syndrome occurs when trauma to the endometrial lining triggers a wound-healing process, causing damaged areas to fuse. This can often occur after a dilation and curettage (a procedure used to remove tissue from the uterus for diagnostic or treatment purposes of uterine conditions).

Signs & Symptoms

Obstructed menstrual flow. Periods can become scanty or absent.
Recurrent miscarriages
Infertility

Diagnosis & Treatment

Asherman’s Syndrome should be treated by a well-experienced hysteroscopic surgeon. Direct visualisation of the uterus through a hysteroscopy (endoscopic surgery) is the most reliable method for diagnosis and treatment. Read more on the surgical treatment of Asherman’s Syndrome.

Endometriosis

Endometriosis affects 1 in 10 of all women in their reproductive age and 50% of women undergoing fertility treatment. Endometriosis is a condition in which tissue resembling the cells lining the uterus cavity (endometrium) is found outside the uterus cavity. Endometriosis most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

Endometriosis acts as endometrial tissue would – it thickens, breaks down and bleeds during the menstrual cycle. AS this tissue has no way to exit the body it becomes trapped and so when endometriosis involves the ovaries, cysts called endometriomas may form. Tissue surrounding endometriosis can also become inflamed and irritated, which will eventually develop into scar tissue and adhesions (abnormal bands of fibrous tissue), which can cause tissue and organs to stick to each other.

Symptoms

Depending on the severity of the condition it can be associated with the following symptoms:

infertility
dysmenorrhoea (abdominal pain during menstruation)
pain during sexual intercourse

Diagnosis

A medical history is taken, and a physical assessment is performed. Furthermore, an ultrasound, MRI or CT-scan can further assist with the diagnostic process.

Treatment

Treatment can be addressed through:

pain medication (to control symptoms),
hormonal therapy (to slow endometrial tissue growth and prevent new implants of endometrial tissue)
gynaecological endoscopic surgery (to remove the endometriosis and preserve the uterus and ovaries).

If a woman has been diagnosed with endometriosis, it is important that she is treated by a physician with knowledge and treatment expertise on endometriosis. Often extensive complicated surgery for severe endometriosis need to be addressed by a team of dedicated and experienced surgeons. The extent of endometriosis needs to be diagnosed and planned for as accurately as possible prior to surgery, to avoid unnecessary repetitive surgeries.

The treatment approach chosen by yourself and your physician, will depend on the severity of your signs and symptoms and whether you wish to become pregnant.

Fibroids

Fibroids are the most frequently seen tumours of the female reproductive system. These tumours consist of smooth muscle cells and connective tissue, which develops in the uterus and multiplies due to the influence of oestrogen. In most cases they are benign (non-cancerous).

Symptoms

Heavy or prolonged menstrual periods
Abnormal bleeding between menstrual periods
Pelvic pain (caused by the tumour pressing on pelvic organs)
Frequent urination
Low back pain
Pain during intercourse
A pelvic mass/growth

Diagnosis

These tumours can be found through routine pelvic examination and diagnosis can usually be confirmed by ultrasound.

Treatment

Management depends on the symptoms, location and size, as well as the patients desire to conceive. However, these tumours usually do not interfere with getting pregnant, it is possible that it — especially if located in the uterus cavity — could cause infertility or pregnancy loss. These tumours may also raise the risk of certain pregnancy complications, such as:

miscarriages
foetal growth restriction
preterm delivery

*These tumours can be managed by means of gynaecological endoscopic surgery . It has been established through research, that gynaecological endoscopic surgery is the best treatment option for symptomatic women with uterine fibroids, who wish to preserve their fertility.

Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a common endocrinopathy (disease of an endocrine gland resulting in hormonal problems) among infertile women and it affects approximately 6% of the general female population.

Symptoms

No/irregular ovulation. Therefore, fertility is affected.
Abnormal hair growth (male patterns of facial hair growth e.g. moustache, beard)
Follicles/cysts form on the ovaries. This can be seen through ultrasound examination.
Insulin resistance and overweight. Insulin resistance can cause long term health problems.

Diagnosis

Polycystic ovaries can usually be diagnosed by ultrasound (sonar), physical examination and hormonal tests.

Treatment

1. Weight loss and lifestyle factors (e.g. exercise) as long-term management

Many women with PCOS are overweight, which can negatively impact ovulation and be linked to insulin resistant Type 2 Diabetes. Once a healthy body max index is achieved, ovulation often starts spontaneously, and pregnancy can occur naturally. Furthermore, through ensuring a healthy body mass index, metabolic disease such as Type 2 Diabetes can be prevented.

2. Treating insulin resistance

A study has proven medication has not assisted in improving fertility. However, weight loss and lifestyle factors can decrease insulin resistance and assist fertility.

3. Treating anovulation

Primarily the first answer is weight loss and lifestyle factors. However, medication can be given to assist ovulation, if required.

Recurrent Implantation Failure

Recurrent implantation failure (RIF) can be defined as the failure to achieve a pregnancy after the transfer of four embryos in three or more IVF cycles, for woman under the age of 40 years. Implantation of the embryos is very dependent upon a well-developing embryo and a healthy endometrium.

Causes

Maternal- and paternal factors could include chromosomal impairment, which can be evaluated through genetic analysis of the foetus.

When evaluating maternal factors contributing to RIF, maternal age plays a big role. Furthermore, various forms of anatomical impairment could be the cause of RIF. Therefore, ovarian function should be assessed, and uterine pathology should be excluded through ultrasound and hysteroscopy. Typical uterine pathology could include:

*Surrogacy may be an alternative option if there is no success with further IVF attempts.

Recurrent Miscarriages

Recurrent miscarriages, also known as Recurrent Pregnancy loss (RPL) is defined as three or more consecutive failed clinical pregnancies. Having a miscarriage is surprisingly common, as miscarriages occurs in 15 – 25% of all pregnancies. 1% of women may experience three or more consecutive miscarriages and in up to 50% of cases a clear cause cannot be found.

5% of women will experience two consecutive pregnancy losses and investigations for a possible cause is recommend at this stage. The main cause of loss before 10 weeks gestational age is random chromosome abnormalities, such as trisomy 13, 18 or 21. The incidence of these abnormalities rises with the increase in age of the woman.

Diagnosis

In order to evaluate the reason for your recurrent miscarriages, an Aevitas fertility specialist may decide to do certain tests, including:

Chromosome analysis (karyotyping) of the parents.
Blood tests on the mother for antiphospholipid syndrome, as well as some hormonal conditions (such as undiagnosed Diabetes Mellitus, and untreated thyroid disease). Increased clotting risk (“thrombophilia”) is also found in some women.
Hysteroscopy (looking inside the cavity of the uterus, under anaesthesia) in order to exclude and treat anatomical abnormalities, such as adhesions or the presence of a congenital septum (abnormal shape of the cavity of the uterus) and/or Hysterosalpingogram (an X-ray test).

Immunological factors, such as the presence of “Natural Killer Cells” are unproven as a cause of pregnancy loss and most experts advise against such tests due to extra costs. Research in this field, is an ongoing process.

Lifestyle Factors

The following lifestyle factors could be linked to an increased risk of pregnancy loss:

Cigarette smoking
Obesity
Alcohol consumption
Increased caffeine consumption
Recreational drug use

Learn more about how lifestyle factors can influence fertility.

Support

We encourage couples to make use of psychological counselling and support during these trying times!

*There is hope in knowing that even after three consecutive miscarriages, most women will not experience a miscarriage again.

Male Infertility

Research in the field of male infertility is a big focus point for the Aevitas team as there are many unanswered questions and male infertility is often overlooked. Aevitas team’s biggest scientific contribution to male infertility has been in the field of sperm morphology (shape) which causes male infertility. The criteria created by this unit are used worldwide and recognised by the World Health Organisation (WHO) as an international standard.

Signs & Symptoms

The main, sometimes only sign, of male infertility is the inability to conceive a child. In other cases, an underlying problem such as, an inherited hormonal imbalance or a condition that blocks the passage of sperm, may cause signs and symptoms. Signs & symptoms associated with male infertility, may include:

Problems with sexual function. E.g. difficulty reaching orgasm (delayed ejaculation), premature ejaculation, or difficulty maintaining an erection (erectile dysfunction).
Pain, swelling or a lump in the testicle area.
Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality.

Diagnosis

Male infertility can be evaluated through semen analysis. Semen analysis can assess whether low sperm count, or sperm dysfunction is the reason behind male infertility. The process of semen analysis includes evaluating the following factors:

Motility. Percentage of sperm that are moving. Normal: more than 30%.
Forward progression. Speed at which the sperm are moving forward. Normal: more than “2”.
Concentration. Number of sperm per millilitre of semen. Normal: more than 15 million per millilitre.
Normal morphology. The percentage of sperm cells with normal forms. Normal: more than 4%.
Anti-sperm antibodies (“MAR”). Factors that bind to sperm resulting in the agglutination (sperm-sperm binding) and immobilisation of sperm. Normal: less than 60%.
Presence of infection. Indicated by white blood cells or a positive pathogen culture.

A fertility diagnosis is made by comparing the values obtained for the male partner’s sperm, with standard fertility values. A small percentage of men may have no sperm in their ejaculate, and this is called Azoospermia.

Azoospermia is often referred to as ‘no sperm count . Testis biopsy can be performed to retrieve sperm for IVF/ ICSI.