Written by Lizanne van Waart
Director & Founder of Wijnland Fertility Clinic / ART Counselling
MA. (Psychology) University of Stellenbosch
We dedicated to Couples & to help them Build their Family Future.
To do this we need building blocks!
“To build is to construct or make something. When you build a house, you start at the very bottom, with the foundation, and work your way up.
You build a birdhouse using scraps of wood, a hammer, and nails, or you can build a career as a poet by writing daily and submitting poems to literary magazines. In both examples, you’re constructing something yourself using materials and hard work. Another meaning is to make stronger: “I have to build my endurance if I’m going to finish that marathon.” The Old English root of build, “byldan,” specifically means “build a house,” from bold, “house.”
Infertility Treatment can be expensive, it can be an emotional burden and it can also be a medical challenge. That is why it so important to build blocks to go through treatment.
Let us look at the medical treatment to your future.
Fertility Treatment Options
1. Timed Intercourse Ovulation
induction with timed intercourse is the first step in the management of infertility. Ovulation induction cycles are followed by a hCG injection to induce ovulation. The couple is then advised to have intercourse. Indications for timed intercourse/ovulation induction:
- Patients who have not been trying for too long to fall pregnant.
- Patients who are younger and with no male factor
- If the female partner does not ovulate.
2. Artificial Insemination
The IUI is also known as an artificial insemination (AI) and consists of ovulation induction and inserting sperm into the uterus at the time of ovulation. At least one fallopian tube leading from the uterus to the ovary should function normally for the sperm to reach an ovulating egg. A semen sample from the husband/partner or sperm donor is used and needs to be washed and prepared for the insemination procedure to select the most fertile sperm population. This increases the chances of falling pregnant by three compared to trying at home with timed intercourse, and the average pregnancy rate is 5% to 15%, depending on the diagnosis and female age. After three to four IUIs have failed, in vitro fertilisation is usually the next step to consider.
Indications for an IUI:
| Female factors: | Male factors: |
| Unexplained infertility | Normal or good sperm parameters |
| Mild endometriosissadsa | Frozen sperm (if husband is away during ovulation time) |
| Failure to ovulate (anovulation) | Sexual dysfunction or retrograde ejaculation |
| Same-sex female couples | Traditional surrogacy (same-sex male couples) |
| Irregular menstrual cycles | Donor sperm |
| Single women | |
| Traditional surrogacy (uterine pregnancy problems) |
3. IN VITRO FERTILISATION (IVF), including Intra-cytoplasmic Sperm Injection (ICSI)
In vitro fertilisation means that fertilisation of the egg(s) by the sperm takes place outside the body in a special IVF culture laboratory that mimics the environment of the fallopian tubes and uterus as closely as possible.
In short, IVF entails initial stimulation to achieve ‘super’ ovulation (stimulation of the ovaries to grow more than one egg), followed by retrieval of the eggs (called an aspiration procedure) one to two hours before ovulation. The semen of the husband (or partner or donor) is prepared to select the most motile sperm. The sperm is added to the eggs and incubated in the IVF laboratory overnight to allow fertilisation. The resulting developing embryos are then returned (called an embryo transfer procedure) to the uterus five days after fertilisation.
Indications for an IUI:
| Female factors: | Male factors: |
| Failed intra-uterine insemination cycles | Sexual dysfunction (e.g. Premature ejaculation) |
| Endometriosis | Mild male factor |
| Egg donor and/or surrogate | |
| Irregular menstrual cycles | |
| Blocked tubes (one or both) | |
| Polycystic ovarian syndrome | |
| Anovulation |
Indications for ICSI (Intra-cytoplasmic Sperm Injection):
| Female factors: | Male factors: |
| Failed IVF fertilisation | Male factor, incl. low count, testicular
sperm |
| High female age | High male age |
With IVF, the prepared sperm will be placed with the eggs and be left together overnight in the incubator. The sperm can then penetrate and fertilise the eggs in the same way as would happen normally in the fallopian tubes. The fertilisation rate (how many of the eggs fertilise) cannot be predicted. Sometimes some of the eggs do not fertilise and, very rarely, none of the eggs may fertilise. Reasons for fertilisation failure cannot always be established, but in these cases ICSI would usually besuggested as the insemination option to follow in the next treatment.
The next method is called ICSI (Intra-cytoplasmic Sperm Injection) and is a very specialised laboratory technique. With ICSI, a single sperm is injected with a micro-needle directly into the egg. The ICSI method does not guarantee fertilisation of the egg – the sperm must still perform the necessary biological processes to fertilise the egg successfully.
The decision on which method to be used will be discussed with you before treatment starts and will depend on several factors, like diagnosis, history, and other specific indications. It can also be decided by the embryologist and/or the doctor on the day of the aspiration to change the insemination method if there are indications to do so (e.g. number of eggs, egg quality and sperm sample quality). This will be discussed with you.
Let’s look at the emotional blocks you need for treatment.
Look after your Mental Health and Sexual Health during Treatment
According to American Psychology Association latest article: Stress won’t go Away? Maybe you are suffering from chronic stress. I want to highlight the following:
Remember Infertility is a chronicdisease, and all patients may experience this as a chronic stressful situation.
“Some stress is positive. It causes our bodies to release adrenaline, which helps us to accomplish assignments and projects, and can even enhance our performance and problem-solving ability. But chronic stress, which is constant and persists over an extended period of time, can be debilitating and overwhelming. Chronic stress can affect both our physical and psychological well-being by causing a variety of problems including anxiety, insomnia, muscle pain, high blood pressure, and a weakened immune system. Research shows that stress can contribute to the development of major illnesses.”
With higher adrenaline release, higher risks for cortisol levels exist and this mean higher risks for infertility. Beware, take care of yourself during these times.
According to this article you can address chronic stress!
- Set limits. List all the projects and commitments that are making you feel overwhelmed. Identify those tasks you feel you absolutely must do to survive and cut back on anything nonessential. Refrain from accepting any more commitments until you feel your stress is under control. Setting limits on nonessential obligations is important to mitigating chronic stress.
- Tap into your support system. Reach out to a friend and/or relative with whom you’ve enjoyed a close relationship over the years. Let them know you are having a tough time and welcome their support and guidance.
- Make one health-related commitment. Do what is possible to bolster your health so that you can have the energy and strength to tackle the challenges you are facing. One small step, like cutting back on your caffeine consumption, can have a positive effect.
- Enhance your sleep quality. People who are chronically stressed often suffer from lack of adequate sleep and, in some cases, stress-induced insomnia. It is important to take steps to increase the quality of your sleep. Experts recommend going to bed at a regular time each night, striving for at least 7–8 hours of sleep.
- Strive for a positive outlook. Looking at situations more positively, seeing problems as opportunities, and refuting negative thoughts are all important aspects of staying positive and trying to minimize your stress.
- Seek additional help. If you continue to feel overwhelmed, are feeling hopeless or are having trouble getting through your daily routine, seek consultation with a licensed mental health professional such as a psychologist.
Heart Maps serve as a visual reminder of the things we love and care about. Create one for yourself or alongside friends and family!
How to create a Heart Map:
- Draw a large heart on paper.
- Visualize and draw the chambers of your heart.
- Fill in each chamber with colours, drawings, and or images of the things you love, value, or define your personal strengths.
- Label the mapped sections of your heart!