Assisted reproductive technology in South Africa: First results generated from the South African Register of Assisted Reproductive Techniques

Objective. We present the first report from the South African Register of Assisted Reproductive Techniques. Methods. All assisted reproductive technology (ART) centres in South Africa were invited to join the register. Participant centres voluntarily submitted information from 2009 on the number of ART cycles, embryo transfers, clinical pregnancies, age of female partners or egg donors, and use of fertilisation techniques. Data were anonymised, pooled and analysed. Results. The 12 participating units conducted a total of 4 512 oocyte aspirations and 3 872 embryo transfers in 2009, resulting in 1 303 clinical pregnancies. The clinical pregnancy rate (CPR) per aspiration and per embryo transfer was 28.9% and 33.6%, respectively. Fertilisation was achieved by intracytoplasmic sperm injection in two-thirds of cycles. In most cycles, 1 - 2 embryos or blastocysts were transferred. Female age was inversely related to pregnancy rate. Conclusion. The register achieved a high rate of participation. The reported number of ART cycles covers approximately 6% of the estimated ART demand in South Africa. The achieved CPRs compare favourably with those reported for other countries

Strategies to improve artificial insemination by donor

Artificial insemination with donor sperm is a widely accepted form of treatment for severe male factor infertility. The introduction of quarantined, cryopreserved semen and the associated reduction in cycle fecundity when compared to fresh semen necessitated the development of strategies to improve the performance of frozen sperm. A prospective randomised clinical trail was undertaken in the Reproductive Medicine Unit at Groote Schuur Hospital to compare intrauterine insemination with intracervical insemination in a therapeutic donor insemination program with cryopreserved semen. The method of insemination was alternated in successive cycles in each patient after intitial randomised selection. Forty three patients underwent 61 intracervical insemination cycles and 48 intrauterine insemination cycles. Strict cycle control was exercised and the timing and frequency of insemination followed a specific protocol. Eighteen clinical pregnancies occurred following eleven intrauterine insemination cycles (22.9% per cycle) and seven intracervical insemination cycles (11.5% per cycle). Treatment outcome was influenced by patient age, the severity of the male factor and endometriosis. Most pregnancies followed insemination with 15 to 25 million motile sperm. Sperm fecundity differed amongst donors. The findings of our study and the current literature suggest that intrauterine insemination improves cycle fecundity in therapeutic donor insemination cycles with frozen donor sperm

Infertility in the public health care system in South Africa : patients' experiences, reproductive health knowledge and treatment-seeking behaviour

Includes bibliographical references (leaves 231-252).Infertility is a common reproductive health problem in Africa. The experiences of men and women who are unable to conceive, their constructs of infertility, their motives for parenthood, and their health-seeking behaviour are, however, inadequately documented in South Africa. In order to improve our understanding of the patients' perspective of infertility, seven studies were conducted employing both qualitative and quantitative research methodology. Study participants were recruited from the infertility clinic at Groote Schuur Hospital, Cape Town, a tertiary referral centre within the public health care system. The central themes explored in the qualitative studies included reproductive health knowledge, health-seeking behaviour, barriers to health care, experiences related to involuntary childlessness, and the reality of infertility and HIV infection. Data from both men and women were collected through in-depth interviews, and the results were analysed according to the principles of descriptive analysis. In the quantitative studies psychological distress was measured and motives for parenthood were assessed with the use of two standardised instruments ( the Symptom Checklist-90-R for the measurement of acute psychological symptom status and the parenthood motivation list). In addition, participants' attitudes towards reproduction in HIV-infected individuals were evaluated. Standard statistical methods were used to analyse quantitative data. The results of these studies demonstrated that men and women had limited knowledge about fertility, infertility, and biomedical infertility management. Some men and women held traditional beliefs and had accessed traditional healers. Most informants appeared highly motivated to engage in biomedical infertility management. Treatment satisfaction varied and reasons for non-compliance were both service and patient-related. Infertile couples gave many reasons for wanting a child and expressed a strong desire for parenthood. For many men and women the inability to conceive was associated with negative emotions, marital instability, abuse, stigmatisation, and loss of social status. Psychological distress levels were significantly higher in infertile women when compared to women using contraception, and in infertile men when compared to fertile men. Infertile women who reported intimate partner abuse were particularly distressed. The diagnosis of HIV infection did not eliminate the wish for a child in infertile couples, and in the absence of medical assistance many continued to attempt conception. The concomitant experience of infertility and HIV infection was associated with considerable suffering The majority of HIV-negative, infertile men and women opposed reproduction in HlV-positive couples. Collectively, the results of these studies provide new insights into the manner in which men and women who access the public health system in South African construct, experience, and respond to infertility. Understanding those details of the patients' perspective should improve the management of infertility in this patient population

Assisted reproductive technology in South Africa: first results generated from the South African register of assisted reproductive techniques

OBJECTIVE: We present the first report from the South African Register of Assisted Reproductive Techniques. METHODS: All assisted reproductive technology (ART) centres in South Africa were invited to join the register. Participant centres voluntarily submitted information from 2009 on the number of ART cycles, embryo transfers, clinical pregnancies, age of female partners or egg donors, and use of fertilisation techniques. Data were anonymised, pooled and analysed. RESULTS: The 12 participating units conducted a total of 4 512 oocyte aspirations and 3 872 embryo transfers in 2009, resulting in 1 303 clinical pregnancies. The clinical pregnancy rate (CPR) per aspiration and per embryo transfer was 28.9% and 33.6%, respectively. Fertilisation was achieved by intracytoplasmic sperm injection in two-thirds of cycles. In most cycles, 1 - 2 embryos or blastocysts were transferred. Female age was inversely related to pregnancy rate. CONCLUSION: The register achieved a high rate of participation. The reported number of ART cycles covers approximately 6% of the estimated ART demand in South Africa. The achieved CPRs compare favourably with those reported for other countries