IVF AND FERTILITY TREATMENTS
Having a baby is one of the most exciting times in a couple's life, but for couples coping with infertility conceiving a baby can be trying.
Procreation is one of the most insatiable human needs. This strong natural urge exerts tremendous pressure on couples unable to have a baby, and the pressure to reproduce becomes increasingly acute as couples grow older.
If not properly managed, the physical, emotional and financial stress of infertility can hurt the relationship.
causes of subfertility
The term 'subfertility' may be preferable to infertility, as many of the bars to conception are relative rather than absolute and in about 25% of cases no cause is found.
Infertility may be due to problems with one or both partners. Natural female fertility declines with age and increasing maternal age is also associated with increased obstetric risks and risk of miscarriage. This should be noted by women who choose to delay their family.
A variety of options are widely available in South Africa, and various popular techniques offer a considerably higher success rate for people experiencing conception issues.
Which technique is advised in the patient's specific case will depend largely on the cause of the infertility, and as a medical travel facilitator we will put you in contact with the best available doctors to be in the position of making the best-informed decision.
Browse below for an overview of the most popular fertility treatments.
Intrauterine Insemination (IUI)
During normal intercourse, only a small amount of sperm makes it to the woman’s uterus and into the fallopian tubes where fertilisation takes place.
Intrauterine Insemination (IUI) inserts large amounts of the best performing sperm directly into a woman’s uterus, thus increasing the chance of fertilisation.
The whole IUI procedure in South Africa can be completed in one week, it is painless and it's done without anesthetics.
HOW IS IUI PERFORMED?
➥ The procedure of IUI might start with an ovarian stimulation cycle, to make sure that the body of the mother produces an higher number of eggs
➥ A sample of the father’s sperm will be collected and washed, selecting the healthiest and best performing
➥ The sperm will be placed into the uterus with a thin flexible plastic tube which is passed through the cervix
The procedure is usually painless and requires only a few minutes.
A few women will experience temporary menstrual-like cramping. All normal activities can be resumed after the procedure.
when is IUI indicated?
IUI is a common treatment for male infertility, and can be considered as an option in the following groups:
➥ People who are unable to have intercourse
➥ People with specific conditions that require consideration in relation to conception, for example sperm washing where the father is HIV-positive
➥ People in same-sex relationships, making use of donor sperm
WHICH SPERM CAN BE USED?
Sperm can be provided by the woman’s partner or a donor.
While under South African law it is compulsory that the sperm donor remains anonymous, donors are screened for sexually transmittable agents (including HIV) and genetically inherited diseases, and generalities such as age, race, occupation, medical history, are collected and made available so that the hopeful mother can select a donor of her choice.
COST OF INTRAUTERINE INSEMINATION
The cost of Intrauterine Insemination is of R 7,500 (USD 500) per cycle, which is about half of the cost of the procedure in the USA or Europe.
That makes it the cheapest assisted reproductive technology available, but the real value should be read in conjunction with the success rate of the procedure.
The fertility clinic might prescribe 3 to 4 cycles to have a significant chance of getting pregnant, so you will have to budget at least USD 2,000 to achieve a statistical chance comparable to IVF.
While IUI can be a good first step toward fertility treatments, International patients might not find IUI to be the most economically viable solution, as the cost of repeated return flights into the country will have a significant impact on the total cost.
INTRAUTERINE INSEMINATION SUCCESS RATE
Statistically, during normal intercourse, the couple has a 5% possibility of generating a pregnancy. IUI success rate is considerably higher, between 10% and 15% per cycle.
For this reason doctors may try three to four cycles, to achieve a cumulative success rate of 40% to 60%.
If the attempts do not trigger a pregnancy, the fertility doctor will most probably recommend more advanced methods that offer higher success rate, such as in vitro fertilisation (IVF).
In vitro fertilization (IVF)
In vitro fertilization is the most widely performed embryo transfer procedure, particularly due to the high success rate compared to other fertility procedures.
It might be considered for couples that have been trying to conceive without success for two years, and that might have been diagnosed with one of the following:
➥ Damaged or blocked Fallopian tubes
➥ Severe endometriosis
➥ Male infertility
➥ Advanced reproductive age
➥ Unexplained infertility
WHICH ARE THE STEPS OF IVF?
The IVF treatment process starts with a hormonal pharmacological treatment to induce the ovaries to produce more eggs than usual.
When the eggs have formed they are harvested with a small operation performed under partial anesthetic (egg retrieval). Each egg is then mixed with sperm by the embryologist in a lab, to facilitate the fertilization.
The fertilized embryo is then grown in a protected environment for multiple days before being transferred into the woman's uterus, and are grown for three or five days.
Some of the embryos which have formed are then placed into the woman's womb using a fine plastic tube passed through the cervix.
The remaining embryos can be frozen for further attempts at IVF at a later date.
IVF SUCCESS RATE
IVF success rate is considered to be quite high, usually between 40% and 50%, depending on the age of the hopeful mother.
Every woman is different, but fertility shows to decline once reached the age of 38.
Older women might still consider IVF as solution for infertility, but they must be aware that the chances of success will not be as good as for a younger woman.
COST OF IVF
IVF carries a high price tag worldwide, which makes it a procedure not for everyone’s pockets.
Luckily the cost of IVF in South Africa is very affordable compared to other first class IVF destinations, like the US or Europe.
Every IVF is different from the other, as the patient is followed very closely and the prescribed medications can vary considerably daily.
That kept in mind, IVF in South Africa can cost anything from R 40,000 to R 80,000 (USD 2,900 to USD 5,800) - also depending on which clinic you will choose.
In local terms the procedure is very expensive, but the devaluation of the local currency makes the procedure quite affordable for international patients.
We usually recommend our clients to budget for at least USD 6,500 including accommodation.
You might want to consider 2 round of IVF, as the second round, with frozen embryos, can be performed at a much lower cost (USD 1,500) and having to spend only one week in the country.
IVF AND TWINS
A lot of clients ask us about the possibility of having twins with IVF.
Statistically, traditional conception carries a 2% possibility of twin birth.
With IVF at least two good grade embryos are transferred to the womb; combined with the fact that good grade embryos are linked to an increased possibility of twin birth, the statistical possibility of having twins with IVF is 20%.
IS IVF PAINFUL?
If properly performed, IVF is not a painful procedure. The mother might experience cramping, nausea or some dizziness symptoms during the stimulation process, and a light pain in the womb the day after egg retrieval.
We have heard horror stories about IVF in some third world countries, but they were more related to medical malpractice rather than the IVF procedure itself.
South African doctors are very concerned with the patient experience, and suitable medications are prescribed in order to avoid any pain or discomfort as much as reasonably possible.
IS IVF SAFE?
Absolutely. Taken into consideration that every woman and every pregnancy is unique, no matter how the baby is conceived, an IVF pregnancy is under all aspects just a "regular" pregnancy and therefore carries the normal risk associated with it.
When clients contact us, we still hear terms as ivf baby, test tube baby and in vitro baby. There is simply not such a thing! These terms are now archaic and associated to a poor understanding of the IVF process: IVF is just the mean through which a couple can achieve pregnancy, which will develop and progress - hopefully until conception - as any other pregnancy.
The first person conceived with IVF was born in England in 1978, and since over 5 million people were born thanks to IVF. In 2017 an estimated 500,000 healthy babies were conceived through IVF, and the number keeps on growing. There are now enough information to say that IVF, if properly performed, does not represent a health risk neither for the mother nor for the child.
WHAT IS THE MAXIMUM AGE FOR IVF?
In South Africa fertility clinics are more relaxed about the age of the mother than in other first world countries.
While the cutoff mother’s age for the most reputable clinics is 49, we recommend not to wait too long as female fertility statistically declines starting from the age of 38.
If you are at an advanced age you might want to consider egg donor, as women in their late 40s do not usually produce many good quality embryos, thus precluding the possibility of embryo freezing and the consequent opportunity of a second round of IVF at a fraction of the cost.
Intracytoplasmic sperm injection (ICSI)
Intracytoplasmic Sperm Injection (ICSI) is the process through which a single sperm is injected directly into the egg.
ICSI can be the best remedy for couples where the male partner has been previously considered as infertile, as a very few good sperm are required for a successful fertilization.
The procedure should be considered for those with deficits in semen quality, where a previous IVF cycle failed due to the poor quality of the fertilized embryo.
how is ICSI performed?
ICSI is a precision procedure, that is performed with the following steps:
➥ The collected sperm is washed in the laboratory by the embryologist
➥ The best well performing and healthiest sperm is retrieved with a very thin hollow needle
➥ The needle is then carefully inserted through the shell of the egg and placed into the cytoplasm
➥ The sperm is injected into the cytoplasm, and the needle is carefully removed
At every ICSI a number of eggs are fertilized, and the best grade embryos are monitored closely for transfer.
From there on the steps followed are the same as IVF.
WHAT IS THE DIFFERENCE BETWEEN ICSI AND IVF?
The difference between IVF and ICSI is that while with the first the egg and the sperm are left in a controlled environment overnight for fertilization to happens, while with ICSI fertilization is guided by selecting the best sperm of the sample collected.
The end result is that ICSI offers augmented chances of a pregnancy as the accurate selection of the sperm used can generate a better quality embryo.
COST OF ICSI
In South Africa, the average cost for an IVF cycle is between R 40,000 and R 80,000, which in US dollars translates into $2,900 - $5,800.
This amount varies, depending on the hormonal stimulation dosage that you will require and on the clinic that you will choose.
For ICSI you can add about $600 to the total.
SUCCESS RATE OF ICSI
Statistically 70% to 85% of the eggs injected with the ICSI method result in fertilized embryos.
That said, the eventual pregnancy rate will be the same as an IVF cycle. ICSI can help you bypass sperm quality or quantity problems, and the fertility doctor will inform you when ICSI is necessary
Despite advanced fertility treatments available today, some couples may still face difficulties conceiving because of an egg factor.
In such cases, the female patient's eggs cannot be used to create healthy embryos, and egg donation (oocyte donation) is undertaken.
Additionally, egg donation, combined with gestational surrogacy, is a wonderful option for family building for gay men and couples who wish to have a biological child.
There are many reasons why a woman may not be able to use her own eggs to conceive a child. In some cases the woman may not have any eggs at all: her ovaries may have been removed from a previous operation, her ovaries may have been damaged during cancer therapy, or she may have experienced early menopause or have diminished ovarian reserve.
In other cases, a woman may simply not have enough eggs or they may be of poor quality, or she may be a carrier of a specific genetic disorder.
Whatever the reason, egg donation can be an effective fertility treatment for women who are unable to conceive using their own eggs.
how is egg donation performed?
In egg donation, embryos are conceived using eggs obtained from a young egg donor and sperm.
In order to maximise success rates for the intended parents, the donor undergoes ovarian stimulation with injectable medications and multiple eggs are produced.
Simultaneously, the intended mother's uterus is prepared for implantation.
As in a standard in vitro fertilisation cycle, the eggs are then harvested from the donor and fertilised with the intended father's sperm in the laboratory.
The embryos are next transferred into the recipient's uterus so that she may carry the pregnancy.
when is egg donation indicated?
Some reasons for using donor eggs include:
➥ Repeated unsuccessful IVF cycles involving poor egg or embryo quality
➥ A risk of transmitting a chromosomal or genetic disorder
➥ Poor response or diminished ovarian reserve
➥ Early menopause
➥ Removal of the ovaries
Privacy of egg donation
Egg donation in South Africa is anonymous and strictly confidential.
The egg donor and recipient parents never meet, nor are names or details exchanged.
There is no central donor registry available for public view.
Egg donation is managed with strict guidelines and protocol procedures contained in the Southern African Society of Reproductive Medicine and Gynecological Endoscopy Regulations (SASREG)
Egg and Embryo freezing
Embryo and egg freezing are a very routine part of the IVF and ICSI process. Freezing of excess good quality embryos allows for the transfer of fewer embryos in the stimulated cycle.
The process provides patients with a "back-up" should the initial fresh embryo transfer not result in a pregnancy, at a much lower cost than starting IVF all over again and often with minimal medications.
Frozen embryo transfers have allowed many of the parents-to-be that we assisted to achieve a pregnancy out of a single ovarian stimulation, and in certain cases to achieve more than one pregnancy from the same stimulated cycle.
how is embryo freezing done?
Embryos can be frozen at any stage of development during the assisted fertilization process.
Eggs that are fertilized can be frozen as early as 1 day after an egg retrieval procedure, but it is more common to allow embryos to develop for a number of days before freezing them so that only the best embryos can be selected.
Embryos tolerate freezing very well and a very high percentage is expected to survive the process.
cost of egg freezing
Egg and embryo freezing costs in South Africa can vary greately, depending on the fertility clinic that you will choose.
Depending also on the number of straws that you will decide to freeze, the cost could start from $300 initiation fee plus $20 per month.
Success rate of embryo freezing
Pregnancy rates with frozen/thawed embryos are as good as pregnancy rates for embryos that were transferred fresh without ever being frozen.
Egg freezing can also be convenient for performing a second IVF cycle or a second pregnancy without the male partner having to travel several times.