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My Fallopian tubes are blocked, is there something that can help me?

14 Jul, 2016

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My Fallopian tubes are blocked, is there something that can help me?

Question: I have been trying to get pregnant for the past four to 6 years now..two years ago the gynae told me i have blocked Fallopian tubes when I did HSG examination, they told me they can unblock my tubes through surgery or I can conceive through IVF.. I DON’T HAVE SO MUCH money for those procedures, question: Can I use Clomid in the mean time I’m saving money?? My gynae said I have healthy eggs.

Answer: Unfortunately the only way for your eggs to reach your uterus is through the Fallopian Tubes, the egg is also fertilized while in the Fallopian tubes, from there the fertilized egg moves down into your uterus to embed into the lining. Using Clomid would not make a difference at all. Having your tubes unblocked through surgery isn’t always successful. Fallopian tubes are very sensitive and damage to them is often irreversible. Your best option would be IVF, if your eggs are healthy that will give you a very good chance at success with IVF. ** Please note the medical disclaimer at the bottom of the page

Additional Information: Female reproductive organs What are Fallopian Tubes?: It is a pair of tubes that connects the ovaries to the uterus.

What causes my Fallopian tubes to be blocked: There are a few causes, one of them is infection, if at any stage in your life you had a pelvic infection of Pelvic Inflammatory Disease or PID, you could be at risk for blocked Fallopian tubes. Other causes are: – Current or historical STD (Sexually transmitted disease) especially Chlamydia or Gonorrhea – Previous ectopic pregnancy – Ruptured appendix – History of abdominal surgery – Infection caused by abortion or previous miscarriages

Why can’t I fall pregnant when both my tubes are blocked? When you ovulate, an egg is released from your ovaries directly into one of your Fallopian tubes, while there it awaits the arrival of sperm to fertilize it. If the egg is not fertilized, it moves down to your uterus and gets expelled when you menstruate. If it is successfully fertilized the fertilized egg will move down your Fallopian tube into your uterus where it embeds into your endometrial lining and the baby grows. If your tubes are blocked, the egg cannot be fertilized by sperm and it cannot move down into your uterus. Sometimes your tubes can be partially blocked, and this can be a very big risk for an ectopic pregnancy, which is life threatening and can cause massive internal bleeding. If at any stage during the early stages of pregnancy you feel extreme abdominal pain, with or without shoulder pain you need to seek medical care immediately.

How are blocked Fallopian tubes diagnosed? Your doctor will most probably send you for a HSG X-ray or Hysterosalpingogram is a radiologic procedure. It entails the injection of a dye into your uterus through your cervix. X-rays are then taken to see the shape of your uterus and the state of your Fallopian tubes. The procedure can be very painful but it will be over in seconds. You may want to take a couple of pain tablets an hour before the procedure if you’re nervous about the pain and you will need a sanitary towel afterwards as there will probably be some bleeding afterwards. Your doctor will most probably also prescribe an antibiotic to take afterwards to prevent any risk of infection.

What are my options? One of the most difficult parts of answering emails relating to blocked Fallopian tubes is breaking the news as gently as I possibly can that your options are limited. You have some choices, but depending on your financial situation it might not be ideal.

1. Surgical repair. This should ideally be done by a Fertility Specialist or an excellent Gynecologist. Unfortunately the repair is not covered by Medical Aid and you will have to foot the whole bill, including hospital stay, theater fees and anesthetist among other things.  The other drawback is that depending on the damage to your Fallopian tubes, the operation might not be successful. The cost for repair is roughly the same as one IVF attempt. If there are no other fertility issues, your eggs are healthy and there is no male infertility factors then you could be successful with one IVF attempt. But as with anything and everything conception related there are no guarantees. Most clinics will state that it can take up to 3 IVF attempts to conceive. I’ve known a few women who’ve done 10 or more. But those are the exception.

2. IVF. or In Vitro Fertilisation, is a good option. Unfortunately it is extremely expensive and cost prohibitive for the majority of couples in South Africa. I have written an article on cost effective treatments here, but not all of them will help with blocked tubes. In this case you may only be able to go through one of the State hospitals on the list, and even then, there will be costs involved, but not as much as private clinics.

3. Adoption. If all else fails you might consider adopting a baby. Adoption has brought many families together, but it’s also not for everyone. You may want to research this option thoroughly and read books written by adoptees and birth mothers. Being armed with all the necessary information regarding adoption will go a long way in helping you understand and assisting your adopted child as he or she navigates through life.

4. Living Child Free: I will be honest, when I first struggled to conceive and especially after my 1st miscarriage I would have died thinking I was going to go through life child free, it simply wasn’t an option. The only reason I’m putting this as an option is to let you know, you are not alone, you will not die and there might be light at the end of the tunnel. I struggled with this choice, I really did, but I’d made a promise to myself that if I’m not pregnant by 39, that I will completely stop trying. My husband and I spoke about adoption at length, and we have seen many of our friends adopt and all of them had happy outcomes, but we just felt it wasn’t the way for us. So set out coming to terms with living child free. It’s been 5 years now, and I still struggle with our decision. It wasn’t an easy road. I just kept repeating to myself and anyone within earshot or who asked whether we have children or not, that we are OK, I repeatedly said we have accepted it, that we are enjoying life, we are enjoying the silence and the freedom, that I am over my infertility trauma, we have moved on. Not because I was lying but that I was affirming what I knew would eventually be true. It didn’t necessarily feel true, but in the logical sense it was true. Slowly but surely we established ourselves as a childless couple, we enjoyed the freedom and the quietness. We enjoyed each other and our relationship has blossomed. For the most part we are REALLY enjoying ourselves, sleeping in, going out to dinner at the drop of a hat, saving money and going on holiday without the need for a trailer ;) but there are moments, and there will always be moments of extreme sadness, loss and missing out on the fun things, the achievements, the milestones.

So, if you’re reading this and you’re grappling with the decision of staying childless, or opting for adoption or even for saving up for your 1st IVF, I hope this has in some small way helped you to come to terms with your decision.

What to expect from Fertility Doctors

19 Nov, 2015

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What to expect from Fertility Doctors

Deciding to see a Fertility Specialist can be daunting. You might be unsure what to expect, you might be unsure of the charges, you might even be unsure whether you really need to go. I felt foolish when I went the first time, I really thought that I will get pregnant eventually and I thought the Doctor would think I was overreacting. I had just been trying for 9 months, and my Mom however was very worried, she must have had a gut feeling about my fertility as she got me the details of my first Fertility Specialist. She was right to worry, what I didn’t know then was that I was never going to bare my own children. So, really, just go on your gut feel, if you think you’ve got a problem, just go. Close your eyes, drag your partner with and make the appointment.

What is a Fertility Specialist?

A Fertility Specialist is someone who’s qualified as a Medical Doctor and specialises in Obstetrics and Gynecology, with further studies in Reproductive Health.

Why not just see my GP or Gynecologist?

While most GP’s have a fair knowledge of reproduction, they don’t really have the facilities to do regular scans and they have not specialized in Gynecology and Reproductive health. Fertility Specialists know when to to send you for tests, they know that some hormones needs to be tested at different times in your cycles. They know what signs to look out for on the ultra sound scanner, and they know exactly how to diagnose and treat fertility related issues. They really are the best place to go to if you find yourself unable to conceive. Your very first step could be a gynecologist, but just keep in mind that if you’re not pregnant withing 6 months to a year that it’s time to see a specialist.

GP’s cannot diagnose blocked tubes, endometriosis, uterine polyps and many more, they should refer you to a specialist if you’ve been under their care for a while and you have not conceived. If they don’t refer you, ask them to refer you, especially if you’d like to be treated by one of the state hospitals listed here: http://www.getpregnant.co.za/if-you-cant-afford-fertility-treatment-youd-want-to-read-this/

When do I need to see a specialist?

  • If you’re younger than 35 years and you’ve been trying for 12 months, or if you’re older than 35 and you’ve been trying for 6 months, it might be time to seek a specialist.
  • If, for some or other reason you think or believe that you need helps sooner, make that appointment as soon as you can.
  • If you have any known issues or suspected risk factors you should see a Fertility Specialist as soon as you start trying for a family.

Is it compulsory for my partner to go with me?

Most doctors prefer to see the couple as a whole, you would both need to go for investigative testing. If your partner is adamant that he is not the problem and refuses to go for a sperm test, just ask him to accompany you to the consultation. You do need his support anyway. The doctor will most probably be able to explain in a  clear way why he needs to be tested and most men are happy to comply with doctors order. It really is just to make sure that all your bases are covered. If he refuses to go to the consultation, you can go without him and and the doctor will start the investigative process without him. But he will eventually have to go in if they can’t find a problem with you or you’re just not falling pregnant. He definitely needs to show up for IUI or IVF unless you’re using donor sperm. But it really is advisable that you go through this as a couple. I also went alone mostly on the first appointment at the first two clinics I attended. Mostly because hubby had pressing work commitments, and also because when I’m unsure I prefer doing things alone. At my third clinic hubby was with me at every consult or test.

What can I expect from my first consultation?

You will be asked a lot of questions, on your history, your cycles your family history etc. Fertility Doctors are quite thorough and they know exactly what needs to be done. I’ve found most fertility doctors to be gentle and kind and patient. Some have a more matter of fact bedside manner, but it most certainly does not detract from their expertise.

If this is your first visit to a fertility clinic, you will most probably be sent for basic a hormone profile and chromosome tests and your partner will be asked for a thorough sperm analysis. You will also be scanned on your first visit.

You might also be asked to come in for a scan on day 2 or 3 of your cycle. Don’t worry about this, I know you’re probably recoiling at the idea that you have to be scanned while you’ve got your period, this is normal, they do this all the time. If it falls on a weekend, they have this covered too! You will be given the opportunity to go to the toilet to remove your tampon if you’re wearing one before the scan. If you’re bleeding heavily just put a sanitary pad between your legs while you wait for the doc to do the scan. Most fertility doctors always has a nurse or female assistant with them while they do the scan. You will get used to the scanning while you have your period as it will most likely happen every time you go in for a treatment cycle.

And in case you wondered, the scan is not the abdominal scan you see in movies, it’s a probe they insert into your vagina, it looks something like a thin vibrator, so if your partner is with you, please brief him on this beforehand so he doesn’t give the doc a left hook ;)

Remember to ask any burning questions that you have, and if necessary take some notes as you will be given a lot of information.

What tests can I expect?

Here is a list of tests you might do, depending of course on your history and symptoms

Basic fertility profile. You will be asked to go in at a specific time in your cycle. The following tests will most likely be tested: AMH, FSH, LH, Prolactin, Estrogen, Progeserone. You will also be tested for autoimmune diseases like Lupus, Antiphospholipd anti bodies, rheumatoid factor, thrombophilia, thyroid and hepatitis.

HIV test

Rubella immunity

Pap Smear: Some clinics will do a pap smear, other clinics will refer you back to your gynecologist for a pap smear.

Day 21 Progesterone test. You will be asked to go in on day 21 of your cycle to test your progesterone, this will give an indication on whether or not you ovulate

Chromosone tests: Some clinics prefer to send their couples for chromosome tests

HSG Xray: This will be preformed if they suspect blocked tubes or other uterine abnormalities. If you are sent for an HSG X ray, please pack a sanitary pad as you will be bleeding, some ladies find this extremely painful, while other ladies sail through this. If you want to you can take 2 anti inflammatory pain pills an hour before the procedure. You will be asked to lie on a table, they will insert a speculum into your vagina, then a tiny catheter will be inserted through your cervix, a dye will then be pushed through the catheter into your uterine cavity. The whole procedure will be filmed so they can examine the fluid movement through your tubes and they will also be able to pick up if you have an abnormally shaped uterus, polyps and scar tissue. I’ve found that as the dye hit my tubes and uterus that it felt like a really bad menstrual cramp. In any case it’s over as fast as it started. You will be given an antibiotic just to make sure that no infections will develop. The procedure does not cause damage to your tubes or uterus in any way.

Laparoscopy: This will be performed if they suspect endometriosis or adenonyosis among other things.

HLA studies: This is an extremely expensive test, ours cost R12 000.00 in 2008. They do this if you have recurrent miscarriages, it tests to see if you and your partner might have similar genetic markers that could be causing the miscarriages.

Post Coital test: If they suspect you might have a hostile cervical environment you will be asked to do this test. You and your partner will be instructed to have intercourse on the morning of the test then go through to the clinic within one or two hours. You would not be able to shower afterwards, so make sure you shower before. A swab will be taken and the sample examined under a microscope. If there are a lot of dead or slow sperm (granted your partner has gone for a sperm test and they know more or less what to expect) it might show that you have a hostile cervical environment for sperm.

Sperm test: Your partner will be asked to do a sperm test. They will test the count, motility and morphology of the sperm. They might even test for DNA damage, and other factors like antibodies, infection etc. Some clinics have facilities for the sperm sample, safe private rooms with some reading material if needed. Some don’t, so ask first, if they don’t have facilities and you live close enough, he can do the sample at home, remember to pick up the empty sample bottle before the test date. You must make an appointment for the test as they have to allocate a specific time and date to do the sperm test as sperm starts dying very quickly after the deposit. You would need to deliver the sample within and hour of the deposit and it needs to be kept at body temperature, so maybe tucked into your bra while you drive over there.

It is very common for men to freeze up and not be able to perform during this time, the pressure is immense! If they have facilities at the clinic the reading material might be helpful, if he’s doing it at home or some place private near the clinic, you might be able to sweet talk him. If it’s not happening at all, cancel the appointment and make it another time and try again.

What type of fertility treatments can I expect?

This is by no means a complete list of all the tests and procedures, I’m sure there will be changes in protocols and drugs etc. as time goes on. This is just to give you an overview of what to more or less expect when you see a Fertility Specialist. Of course this all depends on your diagnoses, but here are treatment options you would most often find:

Medicated cycle: You will be scanned on day 2 or 3 of your cycle to check for cysts before you are given an ovulation inducing drug, you will most likely receive Clomid, Fertomid or Femara, unless you’re a poor responder, in which case they will give you injectable drugs to administer at home. You can either do it yourself, or ask your partner to help you. Once you get over the initial reaction of horror at injecting yourself it will become easier. Luckily for me both hubby and I had been on diets where we needed daily injections so we were quite comfortable with this. It feels more or less like a little pin prick, Nothing to worry about. Hopefully you get pregnant before you get to this point!

You will then be scanned at various times closer to ovulation as they need to see how your follicles are developing. If you’ve produced too many follicles your cycle will be cancelled and you will be requested to abstain from intercourse as a pregnancy at this point will be life threatening.

If you’ve produced no follicles your cycle will also be cancelled and you will have to start again with your next cycle and they will tweak your ovulation inducing drugs.

When they see that your follicle will ripen soon you will either be given an injection like Ovidril to control the release of the egg and you will be given instructions on when to have intercourse. Or they will skip the injection and just give you instructions on time and frequency of intercourse. You may or may not need to do the injection yourself, it all depends on your follicle size, but don’t worry, their instructions will be clear. You will then be instructed on when to go in for your pregnancy test. Just as a side note, Ovidril or a similar drug is the hCG hormone, so don’t do any pregnancy tests for at least 10-13 days after the injection as you will receive a false positive on a pregnancy test. Rather wait to do the blood test at the lab.

IUI: Or Intrauterine Insemination. You will follow the same route as the medicated cycle, but your ovulation will definitely be induced by Ovidril so they know exactly when to do the insemination. Your partner will be requested to give a sperm sample one hour more or less before the scheduled insemination, the sperm will be washed, and counted and prepared for insemination.

In case you were wondering whether you can do the insemination yourself at home, you can’t. Unwashed sperm that enter the uterus is extremely dangerous. The seminal fluid contains prostaglandins that will cause extreme cramps, you could even lose your uterus. This is life threatening. You would have noticed that you always have some sperm leakage when you have intercourse at home, that is the seminal fluid that your cervical mucous ejects from your body as it cannot allow it to enter the uterus. Sperm washing removes all the seminal fluid and other impurities before you can be inseminated.

You will then be told when to come in for a pregnancy test.

IUD: Intrauterine Donor Insemination: If you have major male factor fertility issues you could consider using donor sperm. Donor sperm should always be discussed with your partner, always consider his feelings first. Many men aren’t comfortable with using someone elses sperm, but many couples have gone on to have happy families after considering donor sperm.

The procedure for IUD will be much the same as IUI except you will receive a thawed out straw of donor sperm instead of your partner having to give the sample.

IVF: Invitro Fertilization: This is what I call getting out the big guns. You will have to undergo IVF if you have blocked tubes, major male factor infertility, unexplained infertility, if you’re not ovulating or you’ve had recurrent pregnancy losses. Your scanning regime will be much the same as the previous two procedure, but you will receive a lot more drugs and the protocols will be very different. I’m not very familiar with IVF as I’ve never had it myself but your clinic will guide you through every step. There are differences in IVF protocols, you get long protocol and short protocol, but your doctor will know exactly which one is best for you. You may or may not be given birth control pills before hand. They use birth control pills to prior to a stimulation protocol which may help the ovaries respond better and it gives them better flexibility in planning your cycles.

A typical IVF Cycle may look like this

1. Initial Contraceptive: To help the ovaries respond better with stimulation and give better flexibility of your cycle.

2. GnRH Analog (Lupron) Administration: This is to prevent premature release of the eggs from the ovaries prior to egg retrieval. These are  injections which you have to administer yourself.

3. Baseline Ultrasound: You will have an ultra sound at the start of your period to check your ovaries and to check for cysts. You will also have your estradiol levels tested. If your estrogen is to too high or you have a cyst you may be asked to continue with the Lupron until your levels have stabilised or to allow your cyst to resolve itself.

4. Ovarian Stimulation: This is started after your period starts if your estrogen levels were favourable and you don’t have any cysts. The dosage and type of drug used will depend on your ovarian reserve, how you’ve typically responded to to stimulation in the past etc. Typically the injections are given between daily between 8 and 12 days. The typical quantity of eggs they are looking for is between 8 and 15 eggs on egg retrieval day. It is the quality of eggs they are looking for not the quantity. If you’ve produces less eggs, they may still continue with the cycle depending on how they develop through out your cycle. If you’ve produced more eggs you might suffer from ovarian hyperstimulation syndrome, This can be life threatening and if you have any symptoms that are worrisome and painful you have to contact your clinic immediately. To see the symptoms for Ovarian Hyperstimulation Syndrome click here.

5. Monitoring of Follicles and Estradiol levels: You will be monitored with ultrasound and blood tests throughout your IVF cycle to make sure you respond correctly and the correct doses of drugs are given to you.

6. Final maturation and hCG administration: Drugs like Ovidril which contains hCG will be given to you to stimulate the final maturation of your eggs.

7. Egg retrieval: Egg retrieval is typically done under sedation as it is quite painful. They will use ultrasound to guide them, a thin needle is inserted into your vagina to just behind your uterus where your ovaries are located. They then retrieve the eggs. At the same time or just before, your partner will be asked to produce sperm, which will be washed and prepared as they do for IUI.

8. Insemination of eggs: The sperm and eggs will be placed together to fertilise the egg, in some cases the embryologist will find a healthy sperm and inject it directly in to the egg to fertilise it.

9. Embryo transfer: Your clinic will decide whether to transfer the fertilised eggs after 3 or 5 days. It all depends on how your babies grow and develop, but your clinic will guide you through every step. The embryos will be transferred by inserting a speculum into your vagina, the embryos will be loaded into a small catheter and with the help of an ultrasound scan they will deposit it into your uterus. You will probably be asked to remain lying down for an hour after the procedure and you might even be asked to remain at rest for at least 24 hours after the transfer.

10. Progesterone supplementation: You will take progesterone injections from the evening of your embryo transfer until your pregnancy tests. If you are pregnant you will most probably continue with the injections for another 10 weeks or so.

 

 

 

 

 

 

If you can’t afford Fertility Treatment you’d want to read this

9 Nov, 2015

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If you can’t afford Fertility Treatment you’d want to read this

Struggling with infertility is hard! It hurts more than anyone will ever know. I would know because we struggled for 8 years to fall pregnant. In the end we gave up. We gave up due to a few reasons, but that is a post for another day. If you would like to read more about me, please click on this link: http://www.getpregnant.co.za/about-2/

But I don’t want anyone else to go through what we did, I will do anything to help someone else, just so that they can experience the happy and not so happy days of bringing up children. Children are a blessing, they are wonderful and you will experience unconditional love that you’ve never felt before. So I set out to research the options. And there aren’t many. Fertility treatment is expensive, prohibitively expensive if you don’t have the means to save up enough money for treatment, here are some alternatives.

State Hospitals:

There are a few state hospitals that treats infertile couples, I’m not sure what the requirements are but I’m pretty sure you need a referral letter from your doctor. Just call them and find out for yourself. Their costs are a lot lower than Private Fertility Clinics, but you would still need to pay for the services.

Pretoria:

Steve Biko Academic Hospital Reproductive and Endocrine Unit
Tel: (012) 354 6045
Address: Steved Biko Academic Hospital, Lelel J8, Room 82290, Pretoria
Website: www.pah.org.za/departments/endocrine.html

Free State:

University of Free State, Dept of Obstetrics, IVF
Tel: (051) 405 3385
Doctors: Dr Strydom
Address: Universtitas Hospital, 1 Logeman St
Bloemfontein

Western Cape:

Groote Schuur Fertility Unit
Tel: (021) 404 6027
Doctors: Dr Dyer, Dr Matebse (consulting) & Dr Matjila (consulting)
Address: Groote Schuur Hospital, Andrology Department, Maternity Centre
F Floor, Anzio Rd
Observatory

Alternative Medicines:

LIFE centre Johannesburg is run by Dr Leanne Scott who is a qualified Homeopathic doctor who specialised in reproductive health, she and a colleague developed a post graduate course at University of Johannesburg focusing on Reproductive Health. The clinic focuses on hormone imbalances, egg quality and sperm quality. They treat the underlying causes of hormonal imbalances and often work concurrently with Fertility Clinics while their patients are undergoing treatments like IVF. They treat PCOS and Endometriosis. At your first assessment it will be decided if it is possible to treat your infertility. You will be sent for blood tests if you have not had them done yet. If you’ve been for Fertility Testing at another clinic or Doctor they will request those files so you don’t have to redo the tests. If blocked Fallopian tubes or other uterine anomalies are suspected you will be sent for an HSG xRay. Men will have to undergo a sperm analysis. They make use of Homeopathic and Herbal medicines, as well as light therapy to treat hormonal imbalances. They do have an Ultrasound scanner on the premises. They also offer timed cycles, where you are scanned and assessed throughout your cycle to see when you ovulate and you will be advised when the best time will be for intercourse.

Costs: It depends on your case and outcome of your tests but generally in the region of R4000-R6000 per cycle.

Medication ranges from R330 to R800 per month.

LIFE centre Johannesburg
Tel: (011) 807 1202
Doctors: Dr Leanne Scott
Address:  101A, 1St Floor, Bram Fischer Centre, 95 Bram Fischer Dr, Ferndale
Randburg
Website: www.lifecentre.co.za

Butterfly Wings: I teach women how to chart their menstrual cycle so that we can use the chart as a diagnostic tool which enables us to get so much information out of it which actually even amazes the gynaes. I don’t have to send you for hundreds of Rands of tests as the chart gives us information such as:
If and when you are ovulating,

  • How long your post ovulatory phase is,
  • What are your hormones doing
  • Are your adrenal glands stressed
  • Is your thyroid working
  • Are you eating food you are intolerant to
  • The list goes on

I work with couples because conceiving requires both the man and the women. I look at man’s semen analysis to make sure they are healthy too. I help couples change their diet (where necessary) and their lifestyles so that they can prepare their bodies and their lives to incorporate a baby into their life.

Costs:
Consultation fees I have 3 options for fees:
The package deal (which includes the Intro session of 2 hours + 3 x 60 min follow up appointments + All the material to start charting) and is a once off payment of R2 400
If you would like to pay in two separate payments then:
The Introduction session (2 hours + All the material to start charting) = R1300
Pay for 3 follow up sessions in one go = R1250 (works out each session at R416.66)
3. You pay per consultation which is the most expensive:

a. The Introduction session (2 hours + All the material to start charting) = R1 300

b. Each 1 hour follow up is R450

Procedures:
I work with the charts as the charts give me all the information. Only in cases where I am picking up adrenal stress or thyroid stress will I require further tests if the client is happy to go for them.

If patients can’t fall pregnant within a certain amount of time do you refer them to someone?
It all depends on the clients history and their current lifestyle. It can take up to 1-3years for a client to start living in a way that enables their body to start functioning properly. I always work with speciality doctors if there is something that really needs medical attention but charting your cycle and preparing your body for a baby takes time.
I work on a consultation basis and my hours are Monday – Thursday mornings, Friday and Saturday afternoons.
The program I offer consists of :
The introduction session which is a 2 hour consultation where I go through medical history, and I teach you the method of charting
The follow up sessions are 1 hour in duration: I require 3 follow up sessions (Sometimes more depending on the reason I am seeing you). In these sessions I add to what you have learnt in the training session. As charting is a new method that requires time to learn I answer all your questions and make sure you are understanding all the rules of the method. I also look into your daily habits, diet and lifestyle choices so that you are educated to make the correct and healthy choice for you and your body.

Butterfly Wings
Tel: 082 596 3147
Email: claudia@butterflywings.co.za
Website: www.butterflywings.co.za

Finance:

If alternative medicines isn’t your thing, or you’ve done the tests and you know that the only people who can help you are Fertility Specialists, then you might want to look into financing your treatment. I have found two financial companies who offer flexible medical finance

Depending on who you contact, here are the general requirements to finance your treatment:

  • Minimum Monthly Salary: R8500 – R10000
  • Proof of Income
  • 3 months bank statements
  • Proof of residence
  • ID
  • You can pay the loan off in 6-36 months
  • Maximum loan amount dependent on your income, but no more than R60 000 to R150 000

First Health Finance
Tel: 0800 212 537
Address: 14th Floor No 1 Thibault Square, Long Street,
Foreshore, Cape Town
Website: www.fhf.co.za

Incred
Finance available for IVF and IUI
Tel: 0860 INCRED (462 733) or (011) 262 2385
Fax: 0865 201 513
Address: PO Box 1277, Gallo Manor, 2052
Website: www.incred.co.za

Jewish Couples:

If you’re Jewish and you cannot afford fertility treatments then Malka Ella Fertility Fund might be able to assist. You can contact them through their webiste: www.malkaella.co.za

Fertility Treatment Costs:

Now, lets look at what Fertility Treatment actually costs. Please bear in mind that each clinic charges differently and you would have to phone around to get the best prices. For a list of clinics please click hereThese costs are for Private Fertility Clinics, you’d have to contact the government clinics to find out what their costs are.

  • Initial Consultation: R1000.00 – Includes Ultra Sound scans, excludes Blood Tests
  • Blood Tests: R2800 – R4000 – If you’re on medical aid then your medical aid should cover most of this. If you’re not on medical aid you’d have to pay the lab upfront.
  • IUI (Intra Uterine Insemination): R 3500 to R8000 – the cost of Donor sperm is excluded if you’re using donor sperm.
  • IVF (In vitro Fertilization): R35 000 to R60 000, this depends on your stimulation requirements, the cost will be lower for low dose and obviously higher for high doses of fertility drugs.
  • Medicated Cycles: R2000 – R4000 – a medicated cycle is when you get ovulation stimulating drugs and you’re monitored throughout your cycle until the doctor gives you the green light for intercourse.

There are other costs involved in your treatment, but that all depends on how you respond to initial treatment. Your clinic will guide you through everything.

Adoption:

If you’ve reached the end of tether and you’ve exhausted all your options, or you simply don’t want to continue with ART then you may want to consider adoption. The adoption process is stressful and time consuming, and you may wait a few years, but you will be blessed with a little soul who will be entrusted to you. There are a lot of resources on adoption, please visit this page to find a social worker close to you who’d be able to help: http://www.adoption.org.za/

and lastly,

Counselling:

Going through Infertility and miscarriages can be a very lonely path, friends, family and colleagues will often tell you things like “Don’t stress about it”, “It will happen, just have to have faith” or “It’s not meant to be” etc. Without really understanding exactly what you are going through. Being told it’s not meant to be is as painful as being physically stabbed with a knife. If you are struggling to come to terms with not being able to have children, I would urge you to find someone who will listen to you and give you some much needed perspective, after all a burden shared is a burden halved. There are a few infertility support forums out there, join one of them and start chatting to the ladies. You will soon find out that you are not alone, the worse thing about infertility is when everyone around you is falling pregnant, and it feels like you’re standing on the sidelines being left behind. It is frustrating, heartbreaking and stressful, especially if your partner is putting you under immense pressure to fall pregnant. See a psychologist, talk to someone, there are so many out there and I promise you, you will feel so much better. Many of the Fertility Clinics have psychologists that work closely with them, find a clinic close to you and ask them if they can recommend someone for you to talk to.

If you’re suicidal, have suicidal thoughts or suffer greatly from Depression and anxiety, reach out ASAP, here is a list of organisations  to call if you find you just cannot continue anymore:

http://www.mobieg.co.za/

http://www.sadag.org/

http://lifelinesa.co.za/

While the lists if clinics and consultants who might be able to help you conceive seems very small, and it all seems hopeless to you, just remember that if a problem seems too big, i.e you don’t have the finances or the resources, just start small. Start with the initial consult, explain your situation to the doctor. It might take you a bit longer than most to have all the tests and treatments done, but by just putting one foot in front of the other, little step by little step you will get there in the end.

In my opinion, from what I’ve seen over the last 10 years is that most people, with a little patience and perseverance eventually end up holding a little bundle of joy, don’t give up.

How to get pregnant

23 Oct, 2015

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How to get pregnant

It would be impossible to count the many many emails I receive on almost a daily basis asking me to help someone fall pregnant. The reasons are just as varied, some ladies are being put under immense pressure by their partners to fall pregnant fast or they risk losing their partners. Other’s have been trying and failing for anywhere between a couple of months and  many years and looking for answers. This article will only cover the basics for ladies who are just starting out and have no idea where to start and need a little advice. I will post more in-depth articles about infertility and what to do about it soon.

Firstly the reasons for not falling pregnant are vast. There are so many reasons that women fail to conceive, here is a list of some of the causes of infertility: http://www.getpregnant.co.za/infertility/

But lets start with the basics, and lets assume you’ve just started trying or you’ve not yet seen your doctor and you need a little direction:

1. Define your cycle length.

Start with the first day you see bright red blood and you need more than a pantyliner to get you through the day, this will be the 1st day of your cycle or CD1 (Cycle Day 1) then count the days until the day just before your next Cycle Day 1, for most ladies this is around 25 to 40 days.  The most common cycle length is 28 days. Any amount of days between 26 and 40 is normal as long as it is consistent, if you consistently have cycles that are 25 days (more or less) or 40 days then you are normal, it just means that you ovulate earlier or later than most women. You can also have variations of a few days, this is all normal, for instance if one month your cycle is 25 days and the next month it is 28 days, this is still considered normal. It’s when you have wildly different cycle lengths, or cycles longer than 40 days that you should be concerned.

2. Find out when you ovulate.

How to fall pregnant, I need to fall pregnant, fall pregnant fast

  • There are a number of ways to do this. The easiest and quickest way is to use Ovulation Test Strips or Ovulation Midstream Tests. You start using this them on cycle day 10 and as soon as you have a strong positive result on the test you know that you will ovulate in 48-36 hours, so you’ll have intercourse every day or every other day during this this for at least 4-5 days.
  • You can use an Ovulation Calculator like this one: http://www.getpregnant.co.za/ovulation-calculator/
  • You can chart your Basal Body Temperature using a BBT thermometer and a charting mobile app like www.fertilityfriend.com. This could take a couple of months to get the hang of, but you will know for sure exactly when you’ve ovulated and when to expect your period. This is best used in conjunction with Ovulation Test Strips and charting of your cervical mucous to help speed things up.
  • Or you can simply count back 14 days from your last cycle day (if your cycles are the same each month) and then start trying 2 or 3 days before that day.

 

 

 

However, counting the days and using an ovulation calculator might be helpful, but if your luteal phase is longer or shorter than the norm you will miss your most fertile time. In this case using ovulation tests for a couple of months will really help you to narrow down your most fertile time.  PS. Your Luteal phase is the one constant of your cycle. It will be same every month as soon as ovulation has occurred. When you see on your BBT chart that you have ovulated you can count 14 days ahead and predict when your period will start. Some women have shorter luteal phases like 10 days, and for these women using a calendar to predict ovulation will often fail and they will miss out on their most fertile time.

3. Know your Cervical Mucous.

A women naturally has vaginal discharge, it should be clear with no colour and no strong fragrance, if you see any changes to this you might have an infection or thrush and you should see a doctor straight away as untreated infections can cause infertility.

Also, as you progress through your menstrual cycle your body will go through different hormonal changes. At first you will get your period, then you will have a dry, tacky discharge, this is when your are not fertile, but as you near ovulation your discharge will become plentiful and slippery, this is call the Egg White Cervical Mucous or EWCM, because it closely resembles the texture of egg whites. This is when you are most fertile. Your fertile cervical mucous is so well designed that it actually helps the sperm swim through the cervix and it also nourishes the sperm. When you notice this you will know to start intercourse. As soon as you have ovulated, your body starts producing increased levels of Progesterone to prevent your ovaries from releasing another egg, and it’s this increased Progesterone that triggers your body to stop producing the fertile mucous, and your discharge will be dry and sticky again until you either start your period in 14 days or by that time you will hopefully get your positive pregnancy test.

4. Time your intercourse

Loving coupleWhen you’ve established when you ovulate and when your most fertile time is you can time your intercourse over this period. It can be incredibly challenging when you start having intercourse straight after your period and you or your partner will inevitably run out of steam and you can miss the most important time to increase your chances of falling pregnant.

Most people when they start out are very eager and they will have intercourse every day until a few days after ovulation. This is OK, but just bear in mind that if falling pregnant takes longer than you anticipated you might have intimacy issues later on in your relationship as men has the tendency to feel like a ‘sperm bank’ or simply an object used for making babies. In my opinion from personal experience and having chatted to many many ladies trying to conceive over the years, I’ve come to this conclusion; most partners don’t like it when intercourse feels like work, they like to feel wanted and having to have to try regularly will soon get old and they will come up with excuses when you need them the most, so be gentle, don’t force things. Sometimes our drive for having babies can completely overshadow our husband’s desire to feel wanted and this can cause feelings of rejection and resentment.

If your partner has sperm issues, like low sperm count it is advisable that you try every other day instead of everyday.

5. Eat Healthy

Eat Healthy Preparing to have a baby is the best time to change your lifestyle for the better. There has been a lot of evidence that sugar and refined carbs as detrimental to your health and your fertility. Cut back on sugar (honey and maple syrup is also considered sugar) refined baking products like bread, pies, cakes and biscuits. Eat whole, fresh food, healthy meats, fats, and drink lots of water. Also note that being well hydrated will help you produce that all important Fertile Mucous.

6. Be patient.

A women only has a 25% chance at falling pregnant every month, so it could take you a while to fall pregnant. You ovulate once a month, and that egg only stays alive for 24-48 hours before it dies. The sperm has to go through an inordinate amount of work to reach the egg and circumstances aren’t always ideal, so they can miss the mark. Don’t worry if it doesn’t happen immediately, in most women you should fall pregnant within 12 months. Stressing about it will only make your situation worse.

If you’re not pregnant within 12 months, then you need to see a Fertility Specialist or at the very least a Gynecologist. I will have more in-depth posts about infertility in the future.

7. What about fertility supplements?

It would be so wonderful to make promises of success with the supplements available on our website, but the truth is; when it comes to conception there are no guarantees. Supplements like Fertipil Plus and FertilAid for Women might help you, and they have helped many women to conceive naturally, but no one can guarantee success. If you’ve been trying for a couple of months or if you just started trying, by all means, start taking a fertility supplement and it might just help you conceive. I have had good responses with both the supplements I’ve mentioned, but I know from personal experience, it doesn’t guarantee a baby, and anyone who tell you so is lying.

If you have any undiagnosed fertility issues, like blocked tubes, because blocked tubes present with no symptoms at all, and you will not know your tubes are blocked until a surgeon or Fertility Specialist tests specifically for this, then no Fertility Supplement will help you fall pregnant. There are many reasons why you won’t be able to fall pregnant easily, but you’ll never know unless you’ve seen a good doctor that will diagnose you. If you have any concerns about your fertility rather find our sooner rather than later, so see your doctor if you think you might have an issue. Choosing a supplement for your needs will be a lot easier if you know why you’re not falling pregnant, for example you have hormonal imbalances, your cervical mucous is hostile, you have PCOS or your partner has a low sperm count, then you will know exactly what your needs are and you can choose one accordingly.

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Preparing for the emotional journey that is IVF

8 Jun, 2015

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by Lizanne van der Waart, Psychologist and co-owner of Wijnland Fertility Clinic, Cape Town

The decision to undergo IVF often comes when you have already wandered down a challenging emotional road. Many women – and their partners – take it for granted that there will be children in their future and when this doesn’t happen naturally, a difficult journey of self-discovery begins.

The World Health Organisation has defined infertility as a disease, the emotional effects of which are second only to cancer. My husband and I had personally experienced IVF before we opened our Wijnland Fertility Clinic in Cape Town. We felt that there was a psychological need in the treatment of infertility that included a focus on the emotional well being of patients. Today our patient-centered approach is central to everything we do – and we also like to think it contributes to our success rates. I have worked with countless couples through their experiences of infertility and I have found that whether or not they end up with a baby in their arms, there is an opportunity to grow and learn through the process.

Control is a key issue for a lot of would-be parents and with infertility control is taken away. Added to this, the escalation of hormones in the body and the feeling of loss and disappointment can often evolve into blame and judgement within the relationship. To a large extent the emotional fallout is very similar to that experienced in grief. The intensity of the emotional roller-coaster varies from person to person but you may experience anything from the inability to concentrate to numbness, to guilt, deep sadness and isolation.

Your relationship with yourself is central to ensuring that IVF doesn’t derail your relationship. It’s important to look into what your motivation is for wanting a baby and to plan for all the possible outcomes rather than being focused on success alone. Cultivating coping mechanisms that take your mind off of the ‘goal’ will help you manage the experience. Nurture the things you can control and make sure you spend time in your day enjoying simple, easy pleasures that make you feel good about yourself and that aren’t related to your desire to fall pregnant. Talk to your partner about your feelings and share your feelings about all the possible outcomes. This will deepen the trust between you.

I have seen many couples experience something very meaningful when faced with the challenges that IVF treatment can bring and I am positive that with guidance and honesty it can be a transitional moment.

 

The Power of Charting

8 Jun, 2015

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Charting your menstrual cycle is the process of learning what your body is telling you every single day of the year. The process of charting is taught to women who want:

• A natural method of birth control that does not disrupt the natural rhythms of the body.
• To conceive and therefore learn when is the optimum time to fall pregnant.
• Eradicate painful and irregular menstrual cycles as the charts provide a diagnostic tool and picture which indicates what is going on in their body.

As a Holistic Reproductive Health Practitioner who has worked with many women with all very different cycles – it is the power of charting that continues to amaze me. When a women walks into my practice she has a specific goal for the method (birth control, falling pregnant or reproductive health). However, her journey that she will embark on is far greater than the intended aim she came to see me about. What do I mean by this?

I have seen women who come to me because they are battling to conceive and through the process of charting everyday they have realised that it’s not their body failing them but rather their situation they find themselves in. An example is where clients realise that it’s the relationship that is not conducive to bringing another life into this world and they have realised this simply by monitoring their female bodily changes every day. It is this process that goes far beyond a theoretical method but rather one that enables one to open up to what is really going on and what your body is trying to tell you which makes us STOP and listen to what our body, mind and soul is telling us.

I have seen clients who have battled for years going from doctor to doctor in search of answers, spending thousands of Rands on finding an answer to their menstrual and health related problems. Through charting women see that the changes are lifestyle changes that are required and very few doctors will suggest this. Lifestyle, diet and stress are huge factors affecting our modern lifestyle more than we would like to admit but it is this we find so hard to change.

Charting is a physical process of observing, and writing down what your body is physiologically doing on a daily basis. However, it can have huge effects on our emotional state as we see how we are abusing our body in our current lifestyle choices. It is also emotional when we have had pasts that we haven’t dealt with and continue to hide under the carpet. It is the physical process of charting that helps alleviate the hurt of the past so that one can move on and make amends so the body can heal.

Therefore, charting is far more than a method for me – it is life changing and affects the physical, mental and emotional side of women and therefore enabling a women to be entirely complete (mind, body and soul.)

Written by Claudia Slattery of Butterfly Wings www.butterflywings.co.za

Taking control of your life, what not falling pregnant teaches you – Guest post by Claudia Slattery

22 Apr, 2015

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In an age where convenience is key, we get what we want, when we feel we want it and when we think we need it. As life gets faster, we look for short cuts to keep up with the pace – some work others don’t. When we don’t get what we want we question why, we head to medical specialists asking questions (often not getting the answers we want), we blame ourselves, our partners, our mothers and we search for solutions or we give up.

This applies so much to falling pregnant. We spend so many years not wanting to fall pregnant, using artificial hormones to stop our natural bodies from working, we abuse our body (most of the time not even realising we are doing this as the latest magazine article said its okay to only eat one meal a day), we as women have become highly career orientated, which is wonderful but comes with its own stresses which again puts strain on the body and all of this happens year upon year. So suddenly you realise the biological clock is ticking and you are not getting any younger and now you want, need and have to have a baby. So you start trying.

You think this has to be easy – you go off your hormonal birth control which you have been on for 10 years, your husband loves the fact that you now want sex, and you have sex everyday thinking that this baby making thing has to be easy – come on how many teenage girls and women have unplanned pregnancies, how many of your friends have families of their own? However, month upon month nothing happens, you start to dread that period. With every period you get you hate it even more, because now it reflects not only the physical pain and the frustration of wearing a tampon, sanitary pad or a Mooncup and the fact that you can’t wear that white sexy dress to that business function because the last thing you feel is sexy!  But now that menstrual bleed resembles failure, your failure, your body’s failure and you question why this is so easy for so many people? You let a tear out, allow just 10 minutes to weep but life carries on. So while you are battling with this the world outside just doesn’t seem to care.

Eventually you make the appointment with the specialist, in some cases you are prodded, poked and questioned. Sometimes they will tell you: you have blocked fallopian tubes, your eggs are insufficient, and the list goes on. Most of the time the specialists are insincere and really all they want is your money. Some women (more each year) will be convinced that IVF is the only way to go others simply do not have the finances so they do not even let themselves think about this.

But while all this is happening have you ever taken time to think: How did I get to this point? Where there warning signs before? The truth is if you are not falling pregnant there is a reason. Often it is the reason that something in the body is not working right, some system is out of balance, some part of you is not ready to fall pregnant.

Think about it: you spent so many years trying not to fall pregnant and then one day the switch changes but when this switch changed did you look at your lifestyle? What are you eating, what are you doing to your body and how is a baby going to fit into your life? Well living on Woolworths readymade meals, drinking excessively over weekends, loving the sweet flavour of 2 sugars in your coffee each morning to kick start your day, your work hours that keep you up to the wee hours of the morning and the stresses of making everything happen. Now you look at your life, your body and you really question what have I done to support my body so that it can do this amazing task of creating another human being. What have you done? What have you changed?

Not falling pregnant tells you that there is something wrong with the bigger picture (emotional, psychological and or physical) and its giving you the opportunity to change it. It is the biggest sign of all signs that say: The way you are currently living is not supporting your health. You can treat the symptom (IVF,etc.) or you can look at it holistically. Find out why and what is out of balance. Babies come when they feel they can survive, when they feel that you are really ready for them and when you truly love your body. Until then, this is the time to help you, your body and your mind.

Written by Claudia Slattery

Butterfly Wings: Holistic Reproductive Health Practitioner, M.A. (Human Movement Science) (PTA)
Training through the Justisse Method of Fertility Awareness
Cell: +27 82 596 3147
Email: claudia@butterflywings.co.za
Web Address :www.butterflywings.co.za

Falling pregnant…..Naturally – Guest post by Claudia Slattery of Butterfly Wings

13 Apr, 2015

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Some women fall pregnant without even batting an eyelid, others plan it to the tea and others try for years. We are all on our own journey and what’s difficult for some come naturally to others. That’s why whether you are the in the group of planning to a tea or battling to fall pregnant charting your cycle is one of the most effective, eye opening, life changing things you can do.

Firstly, something most women do not know is that if you are even considering falling pregnant you should be off all hormonal contraception for at least a) 1 whole year or b) three HEALTHY menstrual cycles – whichever comes first. The reason being is the synthetic hormones in hormonal contraceptives could have a potential effect on your developing foetuses reproductive system. Yes that’s true, the hormones you take could affect your baby’s chances of conceiving later on in life. So many women do not know this and it is such important information they often are not given.

For those women trying to fall pregnant – you need to understand if you are not falling pregnant there is a reason for it. As women, we are designed to fall pregnant and if we can’t it is our body SCREAMING at us saying PLEASE HELP ME! So many women want the quick fix, the drugs, the answers but they do not realise that there is a lot that they can do before they even hit the medical world for answers.

If you are one of the many woman:

  • Considering falling pregnant and you want to be educated about your body

Or

  • You are one of the many battling month in and month out, frustrated with your body and yourself you need to understand that there are many factors that are at play and all contribute to this amazing journey.

It is about looking at your current life and seeing what is not currently working for you physiologically, emotionally and in your relationship.

These 3 points (physiological, emotionally and relationship) all have many factors that make them up. Have you ever considered that within the physiological group the following can affect you and your partner’s fertility:

  • What you eat
  • What you drink
  • What supplements you are taking, if any
  • What your menstrual cycle is ACTUALLY doing
  • When you ovulate
  • If you are producing mucus
  • How long the phase from ovulation to your next period is.

So many aspects to consider and you can address all of this and so much more when charting your cycle……the price……learning your body, understanding why you are not falling pregnant, ability to take control of the problem and finding a solution the end product education and the ability to grow as a women, a couple and into future parents.

The emotional component of falling pregnant is also so important and often neglected. You need to be in the right head space, where there are no obstacles that are unconsciously preventing you from moving forward and in a place that there is actually a want to have a baby. So many of us forget how important the emotional component of falling pregnant is. Our emotions have a very powerful effect over our body

Finally the relationship component. Our relationship and wanting to have sex because we love our partner and not just because we want a baby. Bringing the love, fun and excitement back into sex and the bedroom is so often the key to building on the relationship and making your 2 into a 3.

So if you are thinking of falling pregnant or you are battling. Remember you have the ability to find the answers and take control. If this is something you want to do  contact me and we can chat further.

Written by Claudia Slattery

Butterfly Wings: Holistic Reproductive Health Practitioner, M.A. (Human Movement Science) (PTA)
Training through the Justisse Method of Fertility Awareness
Cell: +27 82 596 3147
Email: claudia@butterflywings.co.za
Web Address :www.butterflywings.co.za

HIV and Fertility Q & A with Dr Matabese

30 Nov, 2012

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I had the awesome opportunity of having a Q&A session with Dr Matabese of the Cape Fertility Clinic who has a state of the art HIV lab to help couples who are HIV positive realising their goal of having babies of their own. I have learnt a lot about this issue and I can only thank Dr Matebese for her information. I’m sure many HIV patients will be helped with this information.

GET PREGNANT Q&A with Dr Nomathamsanqa (Tamtam) Matebese, Specialist in Reproductive Medicine at the Cape Fertility Clinic

 

TOPIC – Assisted conception for HIV positive patients

aids-awareness-ribbon

1. I often get emails from HIV positive couples who are scared to call just any fertility clinic for help, for fear of being rejected or judged. Do you know which clinics are able to help?

We are definitely able to help at the Cape Fertility Clinic, as we have a dedicated lab for the treatment of fertility in HIV positive patients.

2. What would you tell an HIV positive couple to reassure them?

Modern technology allows HIV positive patients to realise their dream of having HIV negative children. While the thought of receiving treatment may seem very daunting, by seeking consultation with a reputable fertility clinic, that specialises in treating HIV positive patients, couples can rest assured that their treatment is in the hands of an expert doctor.

3. Are all fertility clinics required to help?

According to international guidelines, a clinic must have a dedicated HIV lab in order to offer assisted reproduction to couples who are HIV positive. This means that a separate set of equipment is used for patients with infectious diseases like HIV/AIDS. The equipment is very expensive and this might be a deciding factor for some clinics, as to whether or not they offer such treatments.

HIV positive patients who are not able to receive treatment from some clinics should not think that they’re being rejected because of their status. The reality is that many clinics to not have the equipment needed to help them, and this would probably apply to most of the public hospitals.

4. Is it possible for a HIV positive couple to conceive and give birth to a HIV negative baby?

Absolutely! If the mother is on antiretroviral drugs during the pregnancy then the risk of transmission to the baby is very low.

5. Is there a guarantee that the baby will be HIV negative?

Unfortunately there are no guarantees. However, if the mother is on ARV’s and her viral load is non-detectable, she has a 98% chance of delivering a HIV negative baby.

6. What procedure is used when the male partner is HIV positive?

It’s important to know that it’s not the sperm that carries the virus, but rather the semen in which the sperm survives. A procedure of sperm washing is therefore done to remove the HIV virus from the sperm. The sample then undergoes viral testing to determine whether or not the virus has been successfully removed. If the sample is negative, the sperm is then inseminated directly into the woman’s uterus.

Another option is for the couple to use donor sperm. With this option, the risk of the female partner getting HIV is eliminated completely.

A third option is IVF/ICSI. With ICIS (an intracytoplasmic sperm injection), the sperm is washed and then injected directly into the egg. This reduces the chance of transmission to the partner.

7. What procedure is used when the female partner is HIV positive?

We can inseminate the HIV negative sperm directly into the woman’s uterus so that there is no risk of unprotected intercourse for the male partner. The couple can also consider the option of surrogacy.

8. What procedure is used when both partners are HIV postive?

The couple can choose to have artificial insemination or IVF depending on other clinical criteria such as the age of the female partner and whether or not her he fallopian tubes are blocked.

Blocked fallopian tubes are quite common in patients who are HIV positive as they are prone to pelvic infection. If the fallopian tubes are blocked, then artificial insemination will not work. IVF and preferably ICSI (mentioned above) will reduce the risk of transmission.

9. How would a HIV positive mother give birth, without infecting the baby?

There is enough medical evidence to show that if a HIV positive mother is on antiretroviral treatment with a non-detectable viral load, she has a 98% chance of delivering a HIV negative baby. Under these circumstances there is no longer enough medical evidence to show that an elective caesarean section is necessary. Certain precautions are however necessary. The mother’s membrane, for example, must not be ruptured until she’s close to delivering the baby. In other words, the mothers’ waters must not be artificially broken. If her waters break spontaneously and it is estimated that she will NOT deliver the baby within 4 hours, then she will require a caesarean section. During natural childbirth, cutting of the perenium should be avoided. The use of forceps and vacuum should also be avoided. All procedures that put the baby at risk of coming into contact with the mother’s blood should be avoided.

10. What happened after the birth? Are there any ARV’s the baby has to take?

Yes, the baby is given antiretroviral medication in a syrup form for the first 6 weeks. In most cases exclusive bottle feeding is advised.

11. Are there special precautions to make sure the baby remains HIV negative?

Exclusive bottle feeding is the best. However, if no safe clean water is available or the couple cannot afford the formula then exclusive breastfeeding for six weeks has been shown to reduce the chances of the baby getting HIV from breast milk.

12. Will baby have to go for regular blood tests?

The baby will have an HIV-PCR test at six weeks and if test comes back negative, then it confirms that the baby is HIV negative.

13. Many people would wonder if both parents are HIV positive and they give birth to a HIV negative baby and by some unfortunate circumstances they both die an early death and the baby is left orphaned. What would you say to those people?

If someone is HIV positive, takes their ARV medication properly, has a healthy immune system on blood tests and has a good HIV physician looking after them, they can expect to live a long normal healthy life. It is really the same as living with any other long term well controlled illness e.g. Diabetes or asthma. There is no reason why they should not consider having children as well.

14. Can ARV therapy affect fertility?

There is no definite scientific evidence for this. There are a few papers however, which show that some antiretroviral drugs have a negative effect on the sperm.

15. Are ARV’s safe to use during pregnancy?

Most ARV’s are safe in pregnancy. Only Efavirenz is contra-indicated in pregnancy due to the increased chance of getting abnormalities in the baby if on this drug during pregnancy.

16. Would mommy be able to breastfeed?

Exclusive bottle feeding is the best.