Advanced Age
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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.
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Asherman's Syndrome
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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.
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Endometriosis
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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.
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Fibroids
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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.
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Polycystic Ovarian Syndrome (PCOS)
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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
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.
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Recurrent Implantation Failure
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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.
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Recurrent Miscarriages
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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.
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Male Infertility
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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.
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