Mopani Pharmacy visited Surgi Clinic embryologist, Dr Cornelia van Zyl, to discuss invitro fertilisation (IVF). This refers to the process whereby a female egg is harvested, fertilised with a sperm, cultured and reintroduced to the womb as an embryo, in cases where couples struggle to fall pregnant.
How prevalent and successful is IVF?
“Infertility affects about 15% of the population. IVF treatment is the last resort. It is expensive, and there are no guarantees. Women typically try to fall pregnant for a year or two before they come to see us. The fertility expert gynaecologist will perform a couple of tests on both partners, to rule out possible causes of subfertility. We will usually try artificial insemination first for three to six months provided that the couple has a good sperm count and that the fallopian tubes are patent (not blocked). If that fails, or the couple is nearing their late thirties or the man has a low sperm count, then we will look at IVF.”
“The couples who opt for IVF are therefore usually older or have had procedures done such as a tubal ligation or a vasectomy. With age, a man’s sperm count, and sperm quality lowers; and a woman’s eggs harden on the outside. This makes it harder for older couples to conceive, because even if you have a strong sperm and a healthy egg, the sperm cannot get through the outer layer. Even if it does, the fertilised egg cannot break through its own ‘shell’ to attach to the womb.”
“We have ways around all of this, but our success is not guaranteed. We understand that out of every 10 procedures, three to four will result in a successful pregnancy. Since our clinic opened in February 2020, three babies have been born.”
How does it work?
“There are a few steps to this process.”
- Step one
The fertility journey always starts by making an appointment with the fertility expert gynaecologist who will make the final fertility treatment diagnosis. Once pregnant, the couple can always return to their referring gynaecologist for pregnancy follow-ups.
“If mom or dad can’t provide eggs or sperm, we might need donors. For the sake of this explanation, say we are not using donors.”
“For IVF Mom comes in and we put her under sedation. Her eggs are then harvested, as many as possible detected from the number of follicles on the sonar. Sometimes we get one good egg, sometimes many more. She won’t feel anything while it happens, but she will be uncomfortable afterwards, as if she is menstruating.”
“After the gynaecologist harvested the eggs, I then screen the follicular fluid under a microscope to locate the eggs and to put them into culture ready for fertilisation later thatday.”
“Dad either provides a sperm sample, or we extract sperm from the testes in extreme cases where there are no sperm present in the ejaculate. I view them under a microscope to see which ones are healthy. Important criteria in sperm selection are to find those that have normal shapes in terms of head, neck and tail; ones that are swimming forward in a clear line rather than circling aimlessly.
- Step two - Let’s make a baby
“This is where the miracle happens. The egg is stabilised under the microscope by means of the holding pipette, and a single sperm is injected into the centre of the egg. Now the sperm will not have to work so hard to get inside the egg, but still needs to deposit its DNA into the egg for fertilisation to take place. I will repeat this process with as many eggs as possible. The fertilised eggs are then placed into an incubator that keeps the temperature and pH steady, at the same level it would be in a mother’s womb. After three days, we will be able to see how many embryos have developed, and are healthy enough to be either transferred to Mommy and/or be frozen stored for later transfer. I enjoy sending the parents updates, photos of each step, so they can experience the ‘conception’ and daily development of their baby as well.”
- Step three – Last minute prep-work before embryo transfer
“As mentioned before, some eggs are somewhat hardened on the outside. Just like a baby chick, an embryo needs to get out of the shell so it can attach to the womb. In earlier days, I had to wash these eggs in an acidic solution to soften the outer layer. This was a huge challenge, as you only had a moment or two to do it before the solution damages the egg.”
“Today, we are so incredibly blessed to have this laser application attached to the ICSI microscope. It is meticulous in its precision. I can easily zap an opening into the outer layer of an embryo. This allows for the embryo to have a weak-spot in its ‘shell’, to break out of and attach to the womb, much easier.”
The process is called Laser Assisted Hatching.
- Step four – “Placing the bun in the oven”
“The gynaecologist usually transfers the 2 best embryos back into mom-to-be. His assistant will use the sonar to give him a clear view of where he will place the embryo. Using an incredibly special tiny catheter he will want to place it as close to the uterine wall as possible where it can then attach.”
- Step five – The rest of the embryos
“We freeze the rest of the embryos cryogenically in a liquid nitrogen container, provided that they are just as good as the ones that were replaced. This halts the metabolic activity and keeps it viable for a future transfer attempt. If the first attempt was unsuccessful, or they would like a sibling, they have the option of trying again without having to start the process all over. We don’t recommend them waiting longer than five years.”
“Parents have the last say, of what happens to the embryos. They can either come back for them, or have them destroyed or donate their embryos to science and research. Some parents donate their embryos to adoptive parents, those mothers will then have the babies themselves.”
- Step six – the pregnancy test
“About a week or so after the embryo was placed inside the womb, mom’s body will have started releasing human growth hormones. This is the hormone that pregnancy tests will pick up on. We do blood tests, as a home-kit is not as accurate. The pregnancy test is done 14 days after the eggs were retrieved from Mommy. This is really when we will know if our efforts were successful.”
Can you determine the sex of a sperm?
“Men theoretically have equal amounts of male and female sperm cells. Microscopically, male sperm cells are typically slightly smaller and move quicker. Female sperm cells are slightly heavier and thus move a bit slower.”
“Because male sperm swims faster, it burns through its energy quicker. Female sperm tend to last a bit longer.”
“If we insert a sample into a certain solution, the lighter, faster ones will raise to the top. The heavier, slower ones will move to the bottom. This means we could, select from the top to increase the chance of a boy, and from the bottom for a girl. However, this is not a guarantee of the sex, it’s only an increased likelihood. As we know, by the time couples get to us, the sperm count is already low. We are not focused on the sex of the sperm, but rather on its health. We can ‘try’, but most of the time we only have one shot at creating healthy embryos, so it is not our priority to choose according to sex.”
How well is the Surgi Clinic equipped to provide added services?
“The surgical team consists of four gynaecologists, two plastic- and reconstructive surgeons and a full-time embryologist. The team is well assisted by our highly trained nursing staff.”
“Surgi Clinic is a niche hospital, specialising in femina-type surgery and treatment. It is a modern, fully licenced, high-tech hospital equipped to perform most gynaecological procedures as well as plastic and reconstructive procedures.”
“Surgi Clinic has six beds inside the main building, and an added six beds in three bedrooms outside. It is geared to alleviate strain on hospitals. Doctors can perform elective surgeries and treatment here. The bedrooms outside are geared with oxygen and all the gadgets of a regular hospital room; but they are kitted with private bathrooms and small kitchenette areas. Patients who are mobile and care for themselves but still need some time to heal, stay there. The garden area outside is designed to promote a quiet and tranquil space for healing.”
“Sometimes, our patients travel from Mozambique or far-away. Between harvesting and implanting, traveling costs seems wasteful. We often let them stay in our rooms, at no extra cost. It’s all included in the package.”
“This property used to be a guest house. We kept most of the original infrastructure and made adjustments to accommodate the hospital facility. Our mission is to help patients feel more comfortable. We keep the lights dimmed and curtains drawn in the ward. Our staff are all quiet and calm, always. Resting well and a positive experience is especially important.”
The Surgi Clinic is based at 15 Hendrik Potgieter Street, Nelspruit. You can phone the clinic for queries and appointments on 013 752 6688.
Read more: When conceiving is difficult
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