GIFT            ZIFT             EIFT           IVF & ET              DONOR SPERM          ASSISTED HATCHING

BLASTOMERE ISOLATION         OOCYTE DONATION        SURROGASY           CRYOPRESERVATION

Between 10 - 15% of couples have infertility problems.  Infertility is the inability to conceive after one year of unprotected intercourse.  The deep seated longing for children in these couples can lead to total desperation that overshadows their lives.

Infertility can be caused by various factors.  About 40% of the problems lie with the wife, 40% with the husband/male partner, 10 % are combined problems and 10 % unexplained.  The good news is that infertility can be treated.    In addition to the surgical and pharmaceutical methods there are also highly advanced technological assisted reproduction techniques available

With the development of assisted reproduction techniques (ART) like In Vitro Fertilization and Embryo transfer (IVF + ET), gamete intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), intra-cytoplasmic sperm injection (ICSI), embryo and sperm cryopreservation as well as embryonic sex selection (embryo biopsy) for medical reasons, numerous infertile couples can enjoy parenthood.

Infertility treatment is not always successful and the treatment is physically and emotionally straining as well as time consuming.  The success of the treatment is not only dependant on the infertility team but also on the co-operation and enthusiasm of the patient.

It is thus obvious that the couple plays a major roll in the treatment program and the male partner is encouraged to accompany his partner to all the examinations and relevant procedures   

HISTORY OF OUR UNIT:

1987  -   Our first Gift procedure was done

1988  -   The first triplets were born from a GIFT procedure that was done at our unit at Garden City Clinic

1989  -   The unit started doing In Vitro Fertilization procedures.

1990  -   Micromanipulation techniques were introduced into the unit.

1992  -   The first baby conceived with micromanipulation in Africa was born at this unit.

1997  -   The laboratory facilities moved to Wilgeheuwel Hospital, Honeydew, Roodepoort.   Clinical  procedures, IVF work-ups and inseminations are done at Garden City Clinic and Wilgeheuwel Hospital, but IVF's ICSI's, GIFT's etc are only done at our laboratory at Wilgeheuwel Hospital.

MALE INFERTILITY

It is important to establish to what degree the male infertility plays a role in the infertility problem presenting itself. Different treatments are then suggested to try and counteract the problem. Referral to an Urologist may be indicated.

OVULATION INDUCTION (O/I)

This entails inducing ovulation hormonally followed by intercourse.  Sonar synchronization will also be done to establish the exact time of ovulation..

ARTIFICIAL INSEMINATION (AIH)

For the artificial insemination (AI) the ovulation is also hormonally induced but this also includes preparation of the partners semen sample and transfer thereof into the uterus at the time of ovulation.  Ovulation time will again established with sonar examination..

SEX SELECTION / GENDER SELECTION

The protocol is the same as for AIH except that the sperm is washed differently to select for a boy or girl.  The timing of insemination (before or after ovulation) is also important for success.  This gives you a favourable chance to have the desired gender.

GAMETE INTRA-FALLOPIAN TRANSFER (GIFT)

The patients receive a hyperstimulation protocol, which would ensure the production of more than one mature egg.  These eggs are then removed, a semen sample is prepared and together the eggs and semen are transferred into the fallopian tube.  The transfer is done trans-vaginally and therefore a laparoscopy is no longer indicated when doing a GIFT procedure.

ZYGOTE INTRA-FALLOPIAN TRANSFER (ZIFT)

This procedure resembles the GIFT procedure except that the eggs and sperm are incubated for 24 hours before transfer into the fallopian tube.  In other words fertilization is first established before the transfer takes place..

EMBRYO INTRA-FALLOPIAN TRANSFER (EIFT)

This procedure is done as for the ZIFT but the incubation time is extended to at least 48 hours to ensure the development of embryos before transferring them into the fallopian tube.

IN VITRO FERTILIZATION AND EMBRYO TRANSFER (IVF + ET)

Once again a hyperstimulation protocol is used to produce more than one mature egg.  When they are mature enough, they are collected with trans-vaginal aspiration, inseminated and incubated until fertilization can be confirmed.  After this the zygotes are incubated  to divide and become embryos.  The embryos are then incubated until blastocyst stage at which time they will be transferred into the uterus..

INTRA-CYTOPLASMIC SPERM INJECTION (ICSI)

This micromanipulation procedure is used in severe male infertility cases.  The general procedure is the same as for the IVF + ET, but insemination is done by micromanipulating a single spermcell  into the egg.  Again embryos will be transferred once they have reached the blastocyst stage.

ASSISTED HATCHING

During an IVF + ET procedure or an ICSI procedure the embryos that are transferred into the uterus are manipulated to facilitate implantation.  A small break is made in the zona (outer layer of the embryo) to help with the implantation process.

BLASTOMERE ISOLATION (GENETIC SCREENING AND PRE-IMPLANTATION DIAGNOSTICS)

This procedure is done where there is a sex linked genetically transferred disease in the family.  It includes IVF and then the removal of one Blastomere (cell) from the embryo for genetic testing. Only unaffected embryos will then be transferred.

DONOR SPERM (AID)

In instances where there is a problem with the partners sperm, (genetically, azoospermia, congenital absence of the vas deference etc.) it is possible to use donor sperm from a sperm bank in all the procedures with the consent of both partners involved.

OOCYTE DONATION

Oocytes can be donated to couples by a third person in such cases where the woman does not produce any eggs of her own.

SURROGASY

This is a procedure, which will be considered where the woman has an underlying medical conditioned a pregnancy may therefore be life threatening or where she does not have a womb (had a hysterectomy or was born without a womb).  Because of the complexity of surrogasy, selection for this procedure will depend on psychological evaluation as well as legal consultation.

CRYOPRESERVATION

The use of cryopreservation is employed where there are more than the required number of healthy embryos for transfer.  The remaining embryos, after transfer, can be frozen and stored.  These embryos can then be thawed at a later stage and transferred in a normal cycle.

TRANS-VAGINAL VERSUS LAPAROSCOPIC ASPIRATION:

There are two ways of doing IVF + ET, GIFT, ZIFT, EIFT and ICSI.  First all the oocyte (egg) retrievals and GIFT/ZIFT/EIFT transfers can be done through laparoscopy, under full anaesthetics in theater.  The second method is done trans-vaginaly and is a lot less traumatic and invasive.

The majority of our cases will be done trans-vaginaly.

RECURRENT MISCARRIAGES

This is something that is also looked at and endeavored to treat.  Treatment includes treatment of causes like anti-phospholipids, hormonal problems and many other such causes.