What is female infertility?

There are no obvious symptoms indicating infertility, however women who have ovulation problems could have irregular, painful, or even absent menstrual cycles. The main indication of infertility is struggling to fall pregnant after having unprotected intercourse for 12 months. .

It is recommended to seek assistance from a reproductive specialist if pregnancy is not achieved within 12 months and earlier if the below scenarios are valid: Infrequent menstrual periods, females of 35 years and older, history of pelvic infections or sexually transmitted diseases, known uterine fibroids or endometrial polyps.

You are also at greater risk of experiencing difficulties conceiving if fertility issues run in your family, if you are very under- or overweight, or if you are struggling with other medical conditions such as an autoimmune disorder.

There are several causes for fertility problems in females. These can include the following:

Polycystic ovarian syndrome (PCOS)
PCOS is a hormone imbalance problem which can interfere with normal ovulation. PCOS is a common cause of female infertility, with up to 40% of female infertility cases in South Africa linked with the disorder.

It’s frequently associated with insulin resistance and weight gain, and can result in symptoms ranging from acne and excess body and facial hair, to depression and anxiety. Watch Wijnland’s Dr Candice Morrison explain PCOS in detail here.

There’s no absolute cure for PolyCystic Ovarian Syndrome, but our female fertility specialists have extensive experience helping women manage their symptoms through healthy lifestyle changes – and get pregnant! IVF (In Vitro Fertilisation) and IUI (IntraUterine Insemination) are both effective fertility treatments for women with PCOS.

Uterine abnormalities
These include uterine fibroids and/or polyps, which are clumps of tissue and muscle in the uterus, prohibiting the fertilized egg from implanting. Uterine abnormalities can unfortunately also increase your chances of having a miscarriage. However, most cases can be successfully treated through minimally invasive techniques such as laparoscopy or hysteroscopy.

Fallopian tube damage or blockage
Fallopian tube abnormalities can be caused by inflammation from sexually transmitted diseases, endometriosis, adhesions or surgery due to an ectopic pregnancy. This may lead to the inability of the fallopian tube to catch the ovulated egg and guide the egg to the uterus. In many cases, keyhole surgery can correct these abnormalities.

Endometriosis
This is another common cause, which occurs when endometrial tissue grows on the outside of the uterine cavity, affecting the function of the ovaries, uterus as well as the fallopian tubes. Find out more about endometriosis.

Primary Ovarian Insufficiency
This is better known as early menopause. Here the ovaries stop functioning and menstruation ceases before the age of 40 years.

Cancer patients
Cancer treatment is known to affect our gametes when undergoing both radiation and chemotherapy. Particularly cancers that target the reproductive organs. Patients are advised to freeze their gametes prior to having therapy and might require IVF treatment after they have undergone cancer treatment.

Find out more about how we can help with cancer patient fertility preservation

Women will have a general gynaecological examination, which includes an ultrasound scan and a pap smear. The doctor will also take a full medical history and a few standard tests will be performed, which include blood tests and a semen analysis (if applicable to a male partner).

Depending on the outcome of the evaluation by the doctor, he or she will request specific tests. These include hormonal tests such as Estradiol (E2), FSH, TSH, prolactin and AMH to determine whether a woman is ovulating and what her egg reserve status is. All patients will need to go for sexual transmitted disease (STD) screening before starting their fertility treatment.

Additional tests may be requested, depending on the evaluation by the fertility specialist and their recommendations.

Hysterosalpingography
This is a test to determine whether the fallopian tubes are open and functioning properly. Fluid is injected into the woman’s uterus and X-rays are taken to determine whether the fluid travels properly out of the uterus and through the fallopian tubes.

Laparoscopy
A thin, flexible tube with a camera at the end of it is inserted into the abdomen and pelvis, allowing a doctor to look at the fallopian tubes, uterus, and ovaries. This can reveal signs of endometriosis, scarring, blockages, and some irregularities of the uterus and fallopian tubes.

Hysteroscopy
Hysteroscopy is the evaluation of the uterine cavity by endoscopy (using a camera) with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention.

We understand that some of these tests and procedures may sound a little alarming, but rest assured that all our female fertility doctors are vastly experienced, and know how to put your mind at ease.

Truthfully, the uncertainty around fertility issues is often far more stressful than any of the physical interventions which might be needed to detect or treat the underlying issue! All these services, as well as expert counselling, are available at our female fertility clinic in Stellenbosch, near Cape Town.

If you are over the age of 37, have been diagnosed with any of the conditions discussed above, or simply haven’t been able to conceive naturally after trying to fall pregnant for more than 12 months, Wijnland offers the following fertility and assisted conception treatments for women:

Ovulation Induction
Timing is everything when trying to conceive naturally, but ovulation isn’t always easy to predict! Conditions such as Polycystic Ovarian Syndrome, a low ovarian reserve, hyperthyroidism, hormonal imbalances, or even unmanaged stress can all cause irregular ovulation, or no ovulation at all.

By carefully monitoring your cycle and inducing ovulation at the right time through medication, our aim with this service is to help you fall pregnant at home. Depending on your age and whether there are any other fertility factors to be considered, we will generally try this approach for a few months before exploring other options.
Find out more about ovulation induction here.

Artificial Insemination (AI) and Intrauterine Insemination (IUI)
AI and IUI can be helpful in a number of scenarios, including cases of mild endometriosis, unexplained infertility, or when there is a known male factor such as a low sperm count which is making conceiving naturally difficult.

The process involves stimulating the growth of more than one egg (superovulation) through medication, along with insemination of a specially prepared sperm sample from the male partner or sperm donor. This procedure is performed at the Wijnland female fertility doctors’ rooms, and is similar to a normal gynaecological examination or Pap smear.
Find out more about AI and IUI here.

In Vitro Fertilisation (IVF)
In Vitro Fertilisation takes place in three stages – egg retrieval, fertilisation and incubation of the eggs in the lab, and finally transfer of one developing embryo directly into the uterus. If several high quality embryos result, these can potentially be frozen for later use, or for donation to another couple.

Wijnland’s advanced EmbryoScope™ allows us to closely monitor the developing embryos without removing them from the protective space of the incubator, which is one of the factors which contributes to our high IVF success rates. Find out more about IVF here.

Intra Cytoplasmic Sperm Injection (ICSI)
This procedure is advised in cases of severe male-factor infertility. The process is the same as with IVF, except that it also involves the injection of a single sperm into the egg in a highly specialised laboratory procedure. Find out more about ICSI here.

Intracytoplasmic Morphologically-selected Sperm Injection (IMSI)
IMSI takes ICSI one step further, as it involves the selection of a special ‘hero’ sperm under strong magnification, which is then injected into the egg cell. Find out more about IMSI here.

Egg and Sperm donors
In some instances, patients require egg or sperm donors. Donor eggs are needed for patients who either cannot produce eggs or who have a genetic disease. This is also applicable to social infertility, such as same-sex couples, or single parents. Our clinic offers our own in-house egg and donor bank, ready to assist our patients throughout the process.

Please visit the Wijnland egg bank and sperm bank for more information on this option.

Surrogacy
This option is available to patients who are not medically fit to carry a baby due to having no uterus, serious health problems or same-sex male couples. The couple will use their own or donor gametes (or a combination thereof) to create the embryo, which is transferred into the surrogate’s uterus. This involves a willing surrogate who carries the baby to full term for the couple, without being genetically related to the child. This process is regulated by strict legal and ethical policies.

Unfortunately, the single biggest factor affecting a woman’s fertility is her age. This is because females are born with all the eggs they will ever have. In effect, her eggs age as she does, decreasing in both quality and quantity over time. And while every woman is different, the odds that she will have trouble conceiving increase as she approaches and enters her 40s.

As societal norms and lifestyles change, many women are faced with a difficult decision if they want to have children. Do they choose to do so naturally when they are still young, likely impacting their careers, or do they risk potentially running into fertility problems later if they decide to postpone starting their family?

One solution which is becoming increasingly popular is egg freezing. Ideally, we aim to extract about 20 eggs before the patient turns 35, and those eggs can then be stored through cryopreservation until she’s ready to use them.

Aside from helping women preserve their fertility for longer, egg freezing can also be useful in other scenarios, such as if the patient has been diagnosed with cancer or another serious disease which requires urgent treatment which may negatively impact her fertility.

We cover a range of healthy lifestyle changes to increase fertility for both men and women on our Improving Fertility page.

For women specifically, these tips may be helpful:

• Avoid excessive exercise: While exercise can be extremely helpful in reducing your stress levels and weight to help you conceive, overdoing it can have the opposite effect. This is especially important if you are already slightly underweight, or have irregular periods.
• Get checked for STI’s: Untreated sexually transmitted infections such as chlamydia and gonorrhea can lead to pelvic inflammatory disease, causing infertility.
• Watch your intake of Folic Acid, Vitamin B12, Iron and Omega-3 fatty acids: A prenatal supplement can be helpful, as well as increasing your consumption of dark green leafy vegetables (iron, Omega-3’s and folates all in one!)
• Relax: While the science behind stress and infertility is still a little murky, most female fertility specialists agree there’s a definite, most likely hormonal, link. Experiment with yoga or meditation, take up some light regular exercise, find things that make you laugh, and deliberately set time aside just for you.
• Make sure you’re getting adequate sleep: Staying up late every night can impact hormone production, which may hinder your chances of getting pregnant.

Q Is infertility just a woman’s problem?
No, infertility is not only due to female factors. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by female factors. Another one third of infertility problems are due to male factors. The other cases are caused by a combination of male and female factors or by unexplained problems.

Q What factors increase a woman’s risk of infertility?

• Female age – we know that after the age of 35, the chances of falling pregnant naturally start to decline exponentially and egg quality decreases substantially. Smoking and excessive alcohol use can have a negative impact by damaging the egg quality.
• Lifestyle factors such as stress, poor diet and excessive athletic training can increase the chances of infertility.
• Being overweight or underweight, as this will affect ovulation.

Q How does age affect a woman’s ability to have children?
Due to many women waiting until their 30s and 40s to have children today, we are seeing an increased number of patients who require assistance to fall pregnant. Science has well established that aging decreases a woman’s chances of having a baby due to the following reasons:

• Egg quality decreases with age (at age 40, 3 in every 4 eggs will be abnormal, despite regularovulation).
• Egg reserve gets less with age.
• Miscarriages are more likely due to increased DNA damage, leading to abnormal eggs.

Finally, remember that there is expert help at hand. The staff at the Wijnland female fertility clinic have seen it all, heard it all, and understand exactly where you’re coming from!

Whatever your concerns around your or your partner’s fertility, we’d love to get to know you and help you start your family. Reach out today.