MAY 2009

  • How does a woman in her early forties know if she is experiencing early menopause or merely a hormonal imbalance ?

          The only way a diagnosis of early menopause or ovarian insufficiency can be made in a lady of 40 is by way of a blood test. 

        The FSH (follicle stimulating hormone) levels needs to be tested to determine the current function of the ovaries.  The

        typical symptoms of ovarian insuffiency include menstrual irregularities, hot flushes, vaginal dryness and sometimes

        emotional symptoms.  If the FSH level is normal, there might be other hormonal problems.


  • If one does fertility treatment for eg. 6 consecutive months, does it increase the chance of conception ?

          It is not recommended to do IVF / ICSI cycles back to back.  These are cycles where injections are used to stimulate

        the ovaries to produce eggs that can be aspirated.  At least one month's rest is recommended.  Other fertility

        medication such as oral ovulation induction agents like Clomid can be used back to back.  The longer it is used

        continuously, it can cause cysts and be detrimental to the endometrial lining (inside wall of the uterus).  Therefore

        it is better to work in cycles of 3 months.  Treatment needs to be assessed and according to a stepwise process, a

        plan must be formulated to ultimately achieve pregnancy.


  • Is there a chance that the medical aid will cover more costs associated with fertility treatment ?  They cover

          the cost of an abortion with no complaints ?

          Nearly all medical aids do not cover fertility treatment.  It is unclear if they will start doing so in the future.


  • Are there medical advances in the field of infertility or is ICSI still the best treatment in cases of poor sperm

          count and poor egg quality ?

          ICSI is still the gold standard to achieve fertilization in male factor couples.  Protocols differ from clinic to clinic concerning

        type of medication used.


  • If one falls pregnant for the first time, is it advisable to opt for a natural birth or a caeserian section ?

        This is a hugely controversial question.  My opinion is that a couple should make the decision themselves.  They should be

       aware of the pros and cons of both procedures and make the decision themselves.  Counseling should be extensive.


APRIL 2009

  • What is the function of the thyroid gland and how important is it in fertility ?

        The thyroid gland is very important in a number of metabolic processes in a human body.  Fertility and ovulation is definitely

        also part of these processes.  In the work-up of a sub-fertile couple, a TSH (thyroid stimulating hormone) needs to be done

        on the female.  Hyper (overactive) and hypo (underactive) thyroidism can play a part in female fertility.


  • Is it worth it to remove ovarian cysts because they re-occur so soon after surgical treatment ?

        There are different types of ovarian cysts.  The most common are simple follicular cysts that are usually treatable

        conservatively with hormonal manipulation.  If they are bigger than 6cm, then surgery by way of a laparoscopy is

        sometimes indicated to remove the cyst.  During surgery, the cyst wall needs to be removed.  By just aspirating the

        fluid in the cyst, it will almost always re-occur.  Surgery should be the last option and conservative treatment (tablets)

        should always be tried first.


  • Can menopause affect a woman in her forties ?

        On average, menopause occurs between year 50 and 52.  However, it differs from patient to patient and there is a

        rare condition of premature menopause where it occurs in ladies under 40 years of age.  The main symptoms of

        possible menopause are hot flushes, certain emotional symptoms as well as problems with vaginal dryness.  These

        symptoms together with a blood test can be indicative of menopause.  Menopause does not happen overnight and is

        usually a gradual process that can take a number of years.



  • What is HELLP syndrome and is it safe to enter into a second pregnancy if this condition caused the first pregnancy to be terminated ?

        HELLP syndrome is a complication of a specific pregnancy related condition namely pre-eclampsia.  Pre-eclampsia (PET) is

        caused by the pregnancy and causes high blood pressure.  It can however affect basically all the main organs like the

        kidneys, liver and the brain.  HELLP is short for hemolysis, elevated liver enzymes and low platelets.  If a patient with

        PET develops HELLP, the pregnancy must be terminated because it is a life-threatening condition for both the mother and

        the baby.


        In a 2nd pregnancy you do have an increased chance of developing pre-eclampsia and HELLP syndrome again compared to

        someone who has not had it before.  However you still have a much higher chance of not developing it in a 2nd pregnancy.

        One would suggest that a woman undergo certain blood tests between pregnancies. There are some haematological

        conditions associated with increased tendency for bloodclotting that might cause Pre-eclampsia.  There are also some

        medication like Ecotrin(aspirin) and calcium that you will need to take in a 2nd pregnancy to decrease the chances of

        developing pre-eclampsia again.  Extensive monitoring during your second pregnancy is vital to pick up any problems early.

        In conclusion a 2nd pregnancy will be emotionally quite taxing due to the stress of the 1st one, however, with good

        monitoring and some medication there is no reason why you could not have a good, healthy full-term pregnancy.


  • Does the practice of Dr Joubert have a surrogacy and donor egg program and how does each program work ?

          No, patients usually provide their own surrogate or donor.  The counseling in such a case is quite extensive and there are

        certain legal aspects that needs to be addressed first.


  • What is the difference between a myoma and a fibroid ?

           A myoma and a fibroid are the same thing.  It is a benign tumor of the muscle layer (myometrium) of the uterus.  It causes

         symptoms including pain, severe bleeding, infertility.  Myomas are usually genetic.


  • What vitamins should a man take if his sperm count is low ?

          The only multivitamin that has proven to have a positive effect on the male sperm count is Staminogro.  The usual

        dose is 4 tablets daily.  It is also a very good multivitamin.


  • I don't have a menstrual cycle for 3-4 months.  Someone told me that it is quite normal for some women.  Is that

          true and can I still fall pregnant naturally ?

          It is not normal to skip your cycles.  The reason is probably that you did not ovulate.  This can be caused by stress,

        medication etc.  There is no reason to think that you will not be able to fall pregnant naturally.



  • If a woman has medically related problems, what alternatives can she try before her womb is removed ?  My husband feels that it is so permanent to remove one's womb.

        Other alternatives for a hysterectomy is firstly an endometrial ablation where the whole inside lining (endometrium) of the

        uterus is destroyed with a specific instrument.  This is also permanent and cannot be reversed.  It is a lesser invasive

        procedure than a hysterectomy with a quicker recovery time.  Only a certain percentage of patients achieve total loss

        of menstruation and 1 in 5 patients end up eventually with a hysterectomy.


        Secondly, a Mirena intra-uterine device (IUD) can be considered.  It is placed inside the uterus usually as a consulting room

        procedure.  This IUD releases a hormone that keeps the inside lining thin so that menstruation decreases or completely

        goes away.  This is not permanent and when the device is removed the lady can fall pregnant again.  It can stay in for 5

        years.  30% of patients achieve total loss of menstruation and 70% menstruate much lesser.  Every patient should be

        evaluated individually to find the best solution for her specific problem.


  • Is endometriosis a hereditary condition ?

          There is increasing evidence that genetic factors are implicated in endometriosis.  Endometriosis occurs 6-9 times

        more commonly in first-degree relatives of affected women.  This also seems to be more pronounced in women

        with severe disease.  This has also been confirmed in extensive animal studies.


  • What are the symptoms one can observe early on if a teenager has endometriosis ?

          Teenagers can definitely have endometriosis.  It is difficult to diagnose endometriosis only on the patients symptoms,

        especially in teenagers.  The reason for this is the poor correlation between symptoms and the severity of the

        endometriosis.  Patients can have severe symptoms with no endometriosis and the other way around as well. 

        Dysmenorrhoea (pain during menstruation) is basically the only symptom helpful in teenagers.  If the pain does not

        improve on oral contraceptives a laparoscopy is indicated for possible endometriosis.  The endometriosis needs to be

        removed during laparoscopy for future fertility benefit.



  • I am from Nigeria.  My husband has testicular cancer.  We are trying for some time to have our own children.  Can good sperm be frozen to use again the following month after fertility treatment ?  I would like to try fertility treatment in your country and do not want to waste the good sperm from one attempt at fertility treatment.

          Yes, sperm can be frozen and re-used.  However, fresh sperm yields the best results and one would prefer to use fresh

        sperm as often as possible.


  • My husband's sperm is fine but I do not ovulate.  If I use an egg donor, what is the procedure that the gynae will follow ?  I live outside Pretoria and would need to budget for accommodation and travel as well.

          Anovulation (not ovulating) can have several causes.  Only when the diagnosis of ovarian failure has been made should

        one start contemplating using an egg donor.  Egg donors are not easy to come by.  The whole procedure from start

        till the pregnancy test is done takes 1 month.  The egg donor uses daily injections to stimulate her ovaries to produce

        eggs.  The recipient uses medication orally to thicken the endometrial lining (area where the embryo will be implanting).


  • My family has a history of Downe's Syndrome.  I am 43 years old and still trying to fall pregnant.  What are the chances that my baby will also have Downe's Syndrome ?

          The older one becomes, the greater risk is to have a baby with chromosome abnormality.  However, it also becomes

        extremely difficult to fall pregnant  at the age of 43.  My suggestion would be not to wait too long and to consider

        seeing a fertility specialist for possible treatment.  If you do fall pregnant, there are several tests that can determine

        the specific chance that you have to have a chromosome abnormal fetus.  The only way to know 100% wgere a

        chromosome abnormality is present is to undergo an amniosinteses.


  • Are there any damaging side effects to the fertility medication that is used during any fertility treatment eg. ICSI especially if a person is doing the treatment many times ?

          The main complication with fertility treatment is the condition of hyperstimulation that can occur specifically with

        IVF or ICSI cycles.  Hyperstimulation can be severe with life-threatening consequences.  It is rare and can be avoided

        with strict monitoring and definite treatment principles.  There does not seem to be a link between premature ovarian failure

        and repeated IVF/ICSI cycles.  The emotional impact of going through many unsuccessful cycles can however be quite






  • Why are some women so much more prone to cysts than others ?

There are a vast number of reasons for ovarian cysts of which polycystic ovarian disease / syndrome is the most common. 

Other reasons include tumors, adhesions, medication, ovarian insufficiency, bleeding, anovulation etc.  Each patient with a

cyst needs to be individually evaluated and examined to determine the cause and what sort of treatment to offer the

specific cyst.


  • What is the difference between a normal quantity of sperm vs a normal quality of sperm ?

    According to the criteria of the World Health Organization, normal quantity of sperm is the count per ml – more than 

   20million per ml.  Normal quality of sperm refers to percentage normal morphology (head, neck, tail) - in other words, the

   percentage sperm in a specimen that will be able to fertilize a normal oocyte (egg).  The normal value is above 14%.


  • Can an illness affect sperm count ?

   The sperm count will only be affected if the disease affects the testis tissue which leads to decreased sperm count, mobility

   and morphology.  An example of such a disease is orchiditis of which mumps is a common cause.  Commons colds and flu will

   not affect the sperm count.


  • Is it best to have sex only on the day of ovulation and not the day before and after ?

   Sperm can stay alive inside the body for up to 72 hours and an oocyte can stay fertilizable for up to 24 hours after

   ovulation.  Few women can tell exactly the moment they do ovulate.  You do increase your chances of conceiving if you are

   intimate everyday from 2 days before ovulation till 2 days after ovulation.


  • How does age affect ovulation ?

   Unfortunately, the older that ladies are, the more difficult it becomes to fall pregnant.  If is difficult to say what age is the

   critical age for a woman but from 38 years of age the pregnancy rate declines rapidly.  Ovulation still occurs deep into a

   woman’s forties but the quality of oocytes/eggs rapidly decreases when the lady reaches 40 years of age.  It is definitely

   still possible to fall pregnant but it does become difficult.


  • I am not pregnant but I have not had a period for six months.  Why ?

   Not menstruating / amenorrhea can have different causes.  By far the most common cause is anovulation / not releasing an

   egg.  Polycystic ovarian disease is the most common reason for this.  Each patient needs to be individually evaluated to

   determine a cause.  Other reasons include thyroid problems, ovarian insufficiency, anorexia, excessive exercise and tumors.