Every story is heart-wrenching and individual, but there are so many that one has to ask: Why? Why are so many men reluctant to adopt?

This is personal for me – my own husband struggled for years to accept the idea of adopting. His eventual change of heart transformed our lives, but it did not occur until we faced some of his fears and concerns together. More than two years later, we are now doing our best to understand these issues in other families. Of course they vary from person to person but interestingly, many men seem to share the same reasons for not wanting to adopt.

As an aside, some women struggle with exactly the same misgivings, but they don’t seem to be as common or as debilitating as those expressed by men.

The three Fs

The top three concerns seem to be:

• Fear
• Family
• Finance

Reason one: Fear

Some of the most prevalent fears that men communicate are:

• Fear of not being able to love an adopted child as much as a biological child.
• Fear about how his family, friends and colleagues will react, and how he will cope with these responses. Some men find this very difficult to navigate, especially when they come from traditional families, in which it is influential family members (such as parents), who may object most to the adoption.
• Fear of other people’s prejudices. This is particularly true when considering trans-racial adoption. Many men really struggle with the fear that they might not be able to protect their child from harm.
• Fear of the unknown. Even if they haven’t had children, most men believe that they know what to expect from parenting a biological child. Adoption however, is unfamiliar and brings with it a large amount of fear.

Reason two: Family

In many families, family line, name and genetic heritage are fundamentally important. While I was researching this topic, one of the things frequently said by men was: “I would never raise another man’s child.” Be it anxiety about bringing new blood into the family, pride in family characteristics and abilities or a threat to his own masculinity, this seems to be a deep-seated concern for a lot of men.

Reason three: Finances

Raising children, be they biological or adopted, is always costly. However, finance may specifically be a factor in an adoption decision when:

• The couple would probably want to employ a private social worker or to adopt a child from another country (this often applies to white, coloured and Indian families trying to find a same race child).
• They already have children, but one parent would like to add an adopted child to the family.

Both these decisions could bring financial stress and if finance is an issue in a household, this may result in resistance from the male partner.

What can you do?

So, are these issues insurmountable? Well, perhaps. But, there may be things that women can do to discuss, and hopefully overcome their partner’s concerns.

Here are my top 10 tips:

1. Try to understand your partner’s fears and respect his position (whatever you do, don’t belittle or minimise them).
2. Communicate your need – as clearly and unemotionally as you can. If necessary ask for help from a counsellor to do this. Don’t beg, manipulate or give ultimatums. In our case, it was my need which initially made my husband change his mind about adoption. It may not always be enough to sustain the decision, but it is a good first step.
3. Have a plan. Most men love plans and feel empowered when they have one. Do your research and ensure that you can explain important considerations such as the adoption process, costs, what is expected of him and the legalities.
4. Normalise adoption. Make friends with other adoptive families and speak openly with them (in front of your partner) about pros and cons. If you don’t know any adoptive families, join an adoption group on social media and make contact with someone in your area. Lots of moms state that it was familiarity, simple exposure to other adoptive families (especially other adoptive fathers and adopted children), that finally resulted in their husbands making the decision to adopt.
5. Don’t ambush him. This is the caveat to number four. If you do make friends with an adoptive family, it is best to warn him before you visit. In addition, please don’t volunteer him to work at a ‘place of safety’ without his permission, don’t constantly confront him with stories about children in need of adoption and don’t ask social workers, adoptive parents or concerned family members to try to persuade him to change his mind – this may result in him feeling trapped and simply increase his resistance.
6. Don’t oversell adoption. It is not a success-only journey, no parenthood is. Exaggerating the positives of adoption may set you up for failure.
7. Be realistic about the costs. All parenting is expensive and in some instances, the adoption process can be costly too. Once again, do your research and as far as possible, include a financial element to your plan.
8. When he is receptive, talk to him about a strategy for dealing with common adoption-related challenges such as family resistance and prejudice (again, exposure to other adoptive families and talking about their experiences can be very helpful here). Getting your partner to problem-solve may help him to recognise that his fears are not insurmountable.
9. If he is not responsive when you discuss adoption, ask him if he is willing to go away and consider this issue for a set time period (decide on the actual time together – for example, a couple of weeks). Remind him closer to the time that you would like to discuss it again but don’t nag. Set a follow up time to chat about it, either alone or with a counsellor.
10. If you are religious, pray. Our research and own history shows that unexpected changes of heart do happen.

Remember that if you have a partner, the decision to adopt takes two yeses. Most adoptive children have already been rejected – they deserve better than to be rejected by their new father too. And it is tragic when a marriage fails because one partner makes an adoption decision that the other cannot or will not support.

But does that mean that you have to give up your adoption dream? No, it doesn’t. The challenges may seem overwhelming, and sadly, not all situations end well. But don’t lose hope – my story shows that men can and sometimes do change their minds. After years of resistance to adoption, my husband’s transformation was dramatic. Now, when asked, he tells people that adoption is the best decision that we have ever made. The key word is ‘we’. I’m glad I didn’t make the decision on my own, but I am even more grateful that I persevered. There is no doubt that having our daughter in our lives and our family has made it all worthwhile.

For more information about adoption, overcoming infertility and our story, please visit www.becomingamom.co.za

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“Absolute uterine factor infertility” is the only type of female infertility still considered to be untreatable. This condition is often a consequence of Rokitansky syndrome, which is when a woman is born without a womb. Adoption and surrogacy have so far been the only options for women with absolute uterine factor infertility to acquire motherhood.

However, the news of the first baby to be born from a woman with Rokitansky syndrome who received a womb transplant brings hope to women with forms of absolute uterine factor infertility.

The researchers who performed the transplant – from the University of Gothenburg, Sweden – have been investigating the viability of womb transplantation for over 10 years. Before attempting the procedure in humans, the researchers conducted trials on rodents and non-human primates.

In 2013, the researchers initiated transplants in nine women with absolute uterine factor infertility who had received wombs from live donors. The Swedish woman who recently gave birth was one of these women.

Although two of the women in the trial had to have hysterectomies during the initial months – because of severe infections and thrombosis – the team reported success in the other seven women.

These women began menstruating during the first two to three months after transplant. Although occasional episodes of “mild rejection” were detected in some of the women, the researchers were able to overcome this by prescribing a short course of immunosuppression therapy.

Outside of this trial, only two other womb transplants had been attempted. The first of these required the womb to be removed after three months, due to progressive uterine necrosis.

The second attempt involved a womb from a deceased donor being transplanted into a woman with Rokitansky syndrome. Although this woman became pregnant twice via embryo transfer, both pregnancies resulted in miscarriage before week six.

Eggs were fertilized using IVF prior to mother receiving womb transplant

The Swedish woman who gave birth received her womb from a 61-year-old family friend. As the recipient had intact ovaries, she was able to produce eggs, which were then fertilized using IVF prior to the transplant.

A total of 11 embryos were produced and frozen using this method. One year after the womb transplant, one of these embryos was transferred to the transplanted womb.

Prof. Mats Brännström, who led the team of researchers, says that foetal growth was normal through the first 31 weeks of pregnancy. “We found only one episode of mild rejection during the pregnancy that was successfully treated with corticosteroids,” he says, “and the woman was working full time until the day before delivery.”

As a consequence of preeclampsia, the woman was admitted to hospital at 31 weeks and her baby was delivered by caesarean section 16 hours later.

Although an abnormal foetal heart rate had been detected when the woman was admitted to the hospital, in the days after being born, the baby scored as being in perfect health according to the Apgar rating scale for determining the health of newborns.

The infant was discharged from the neonatal unit after 10 days, and the researchers say that both mom and baby are continuing to do well.

According to Prof. Brännström:

“Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility. What is more, we have demonstrated the feasibility of live-donor uterus transplantation, even from a postmenopausal donor.”

About the Author: For more information, visit the Conceive Plus website or Facebook page https://www.facebook.com/conceiveplusSA.

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Male infertility may be the sole reason that a couple can’t conceive, or it may simply add to the difficulties experienced.

Male infertility occurs due to many different factors including hormonal imbalances, physical problems, psychological or behavioural problems. 

The biggest cause of infertility in men is abnormal sperm, which can be affected by lifestyle factors. Men who live a healthy lifestyle are more likely to produce healthy sperm and less likely to have infertility issues.

Changing certain lifestyle and health behaviours can improve a man’s fertility and increase the chances for a couple that is trying to conceive.

Excessive smoking

Smoking has shown to decrease sperm count significantly. Male smokers have approximately 30% higher odds of infertility. Smoking tobacco increases intake of cadmium, because the tobacco plant absorbs the metal. Cadmium, being chemically similar to zinc, may replace zinc in the DNA polymerase, which plays a critical role in sperm production. Zinc replaced by cadmium in DNA polymerase can be particularly damaging to the testes.

Drugs

Prolonged use drugsmay temporarily reduce the number and quality of your sperm.

Alcohol abuse

Chronic alcohol abuse can lower testosterone levels, cause erectile dysfunction and decrease sperm production and testosterone levels. Liver disease caused by excessive drinking also may lead to fertility problems.

Heat

Heatcan be the cause of infertility. Working in a hot environment has been linked to raised testicle temperature. This may affect sperm’s ability to mature, leading to poorer sperm quality and a temporary drop in sperm production.

Tight underwear increases scrotal temperature which results in decreased sperm production.

Stress

Excessive stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.

Don’t forget about medications

Medications that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironolactone; as well as medication that decrease sperm motility such as sulfasalazine and nitrofurantoin, should be avoided.

Anabolic steroid use causes testicular shrinkage and sperm production to decrease.

Obesity

Obesity can cause hormone changes that reduce male fertility. Being overweight may lower the quality and quantity of your sperm. The effect is greater in men who have a BMI of 30 or higher.

Prolonged bicycling

Prolonged bicycling is another possible cause of reduced fertility due to overheating the testicles. Men who are serious cyclists may have lowered sperm counts, poorer sperm quality and less mobile sperm. In some cases, bicycle seat pressure on the area behind the testicles can cause numbness in the penis and erectile dysfunction.

About the Author: Prelox® is a patented blend of Pycnogenol and L-arginine designed to actively treat male infertility. For further information visit www.2tostartafamily.co.za or email [email protected]

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Our social worker advised us that it is vital that your child knows right from the start about the adoption. If it is kept a secret and told later on, the child may assume that if it was a secret, it must be a bad or shameful thing. She told us to use the word ADOPTION freely in happy conversations, not to make a big deal out of it, but make sure that it is “out there”.

We were advised to not force the topic but to answer questions honestly in an age-appropriate way. Children will ask many questions but they often don’t listen to the answer. They process information at their own pace and when they need more information, they will ask.

We have always spoken openly to our friends in front of our child about adoption. As he has gotten older, he has asked me a few questions about adoption but never with any huge interest or emotion.

We have lots of friends with adopted children and through my counselling work, I meet lots of adoptive parents. I always love hearing the stories people tell their children so I thought I would share a few.

These are some of the sweet stories I have heard:

• Mommies have hooks in their tummies where they hang their babies. My hooks are broken so another lady hung you on her hooks until you grew into a big enough baby and then she gave you back to me.
• We knew we wanted you so badly that we chose you. We asked a lady who knew lots of babies to look for you and we told her exactly what you would be like. She went and searched all over for you and when she found you, she called us and said we could take you home with us.
• Most babies are born from their moms’ tummies but you are special because you were born from my heart.
• Mommy and daddy could not have a baby of their own because they have a problem that the doctor could not fix. We adopted you because your tummy mummy could not look after you and she was so kind and loved you so much that she trusted us to look after you and make you our son or  daughter.

There are lots of books that explain adoption to small children. The one I wrote is called The Greatest Gift and it is about animals rather than humans. I chose animals because they can represent any type of human –  all ages, all colours, all sexual orientations. It is a story that can be used by all adoptive families and interpreted as their story. Whichever way you chose to do it, just make sure that you do it from the start if possible.

Article by: Terri Lailvaux – Adoptmom, Counsellor – Dip C (Inst NH)

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I used to have them often when I was in my early thirties and trying desperately to fall pregnant. It felt like all my friends, colleagues and acquaintances were popping babies out left, right and centre. I often screamed internally “WHY ME?”

Looking back now I realise that there is so much truth in that saying by Morris Kline: “The most fertile source of insight is hindsight.” [MORRIS KLINE, Mathematics: The Loss of Certainty]

Because of my infertility, I have been fortunate enough to embark on the most beautiful and treasured journey with my son. I have built a family, changed my career, engaged with, helped and inspired many people, written a book, been invited to speak to large gatherings of people and I have no regrets.

Instead of: “Why me?” I now say: “Lucky me!”

After five years of fertility treatment, I finally took a friend’s advice and looked into adoption but it was a minefield of American websites and rumours and I could not find anything very helpful. I procrastinated for another year and eventually I got in touch with the social worker who would walk me gently through the entire process. We encouraged early on in the process to understand that there were no white babies available for adoption in South Africa and it did not matter to us. We wanted a baby and we did not care much about the shade of the skin.

We started to prepare our families and very close friends for the arrival of our new baby. We bought a few things and we got the room ready. We had been advised that the wait could be around nine to 12 months so we were mentally prepared for the best part of a year to pass. Six weeks later, we got the call. “Your son has been born. Can you be at the hospital in two hours?” We were overwhelmed, excited, elated, terrified and instantly parentally protective of our new baby.

We arrived at the hospital to be presented with the smallest little human. He had been born prematurely weighing 1.6kg and he was on a ventilator. (As it turned out, our son is white)

In the following weeks, we became dab hands at caring for a premature baby (with the help of the NICU staff) and finally one month after he was born, we were able to take him home weighing a whopping 1.9 kg.

Our beautiful adventure had started.

Our son is about to turn 10 in October and is the love and light of my life. I cannot imagine it any other way. I now spend a great deal of time in my counselling practice helping people cope with the emotions around infertility and getting started with the adoption process. I am still overwhelmed with joy whenever I get a call from a client to say that they are getting their baby.

Article by: Terri Lailvaux – Adoptmom, Counsellor – Dip C (Inst NH)

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According to the Children’s Act (Act 38 of 2005), a child may be adopted;

• Jointly by a husband and wife, partners in a permanent domestic life-partnership, or other persons sharing a common household and forming a permanent family unit
• By a widower, widow, divorced or unmarried person
• By a married person whose spouse is the parent of the child
• By the biological father of a child born out of wedlock
• By the foster parent of the child.

The screening process

All prospective parents go through a screening process, which can take up to six months, and normally involves;

•  Orientation meetings
• Interviews with a social worker
• Full medicals
• Marriage and psychological assessments
• Home visits
• Police clearance
• References.

After that, there is a legal process carried out through the Children’s Court. This screening process can be tough and can take time, but for good reason, as the interest of the child is of utmost importance.

Valuable resources during and after adoption

During the process and after the adoption, it helps to know where to access valuable resources.

After I adopted my son in 2004, I battled to find a good children’s story book about adoption so I wrote called The Greatest Gift.

Through this book, I met a lot of people who needed emotional support as well as good, correct information on adoption. I studied to qualify as a counsellor and I started my practice, called Adoptmom which offers assistance to people considering adoption.

For me, the decision to adopt was easy. I wanted a baby and my body would not respond so I adopted and my wish came true. Once the application process is done and you have your child in your arms, the adoption seems secondary. You are a parent just like anyone else and you are overwhelmed with love and terror just like all new parents. I must emphasise the importance of seeking counselling to work through any grief that infertility may bring and to understand adoption entirely.

Useful resources:

You can find lots and lots of adoption books on Amazon.com. To make it easy, I have grouped them all together on my website.

For counselling and general advice, you will find these pages useful:

www.adoptmom.co.za

www.adoption.org.za

https://www.facebook.com/groups/272818456237019/

Article by: Terri Lailvaux – Adoptmom, Counsellor – Dip C (Inst NH)

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Reducing ovarian hyperstimulation

According to researchers, the naturally occurring hormone kisspeptin is safer than hCG (human chorionic gonadotropin) for it greatly reduces the occurrence of ovarian hyperstimulation syndrome (OHSS), the consequences of which can be life-threatening.

“Our study has shown that kisspeptin can be used as a physiological trigger for egg maturation in IVF therapy,” said Professor Waljit Dhillo, from the Department of Medicine at Imperial College London, who led the study. “It’s been a joy to see 12 healthy babies born using this approach. We will now be doing more studies to test whether kisspeptin reduces the risk of OHSS in women who are most prone to developing it, with a view to improving the safety of IVF therapy.”

In the study, researchers gave a single injection of kisspeptin to 53 healthy volunteers between the ages of 18 and 34 at Hammersmith Hospital in London and 51 of them developed mature eggs as a result.

In what researchers say is a good outcome compared to conventional in vitro fertilization treatment using hCG, 49 of the women had embryos implanted in the uterus and 12 became pregnant for a success rate of just over 22 percent.

IVF success rates

In the US, the Centers for Disease Control and Prevention reported that in 2012, 40.5 percent of the IVF cycles performed on women under age 35 resulted in live births, while the UK’s National Institute of Health say that women under age 35 can count on an IVF success rate of between 41 and 43 percent.

Dangers of ovarian hyperstimulation

Success statistics aside, the safety aspect of kisspeptin is of great importance in the field of infertility, and women prone to OHSS, which can cause kidney damage in its mildest forms, should take note.

“OHSS is a major medical problem,” says Dhillo. “It can be fatal in severe cases and it occurs in women undergoing IVF treatment who are otherwise very healthy. We really need more effective natural triggers for egg maturation during IVF treatment, and the results of this trial are very promising.”

Women with PCOS prone to ovarian hyperstimulation

Dhillo and his team are set to conduct another study, this time on women with polycystic ovary syndrome, which makes them particularly prone to OHSS.

Kisspeptin is a hormone whose other functions include inducing puberty. Unlike hCG, which lingers in the bloodstream long after injection, kisspeptin reduces chances for overstimulation because it is absorbed rapidly for efficient effects.

The study was published in the Journal of Clinical Investigation

(AFP Relaxnews)

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Causes of infertility

The causes of infertility include retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from STDs or decreased sperm count (in males). In women, blocked fallopian tubes, endometriosis, ovulation dysfunction or fibroids are common causes, according to the Infertility Awareness Association of SA (http://www.ifaasa.co.za/infertility-facts-statistics/).

Lubricants have a negative effect

Research indicates that most popular lubricants also have a negative effect on sperm motility, the fertilization process and the chances of conception. Treatments for infertility include surgery on fallopian tubes, hormone treatment, sperm insemination and in vitro fertilization (IVF)¹.

New sperm friendly lubricant

Now, a new, sperm friendly lubricant has been approved by the US Food and Drug Administration (FDA) as a lubricant for couples trying to conceive naturally and is available in SA. Conceive Plus® is the only lubricant to contain both calcium and magnesium ions, essential for cell viability and fertilization².

The gentle formulation of Conceive Plus® also matches fertile cervical fluid and semen to create a conception-friendly environment. Conceive Plus® is compatible with sperm, oocytes (immature female reproductive cells) and embryos. It is isotonic and has a pH range compatible with human sperm survival and migration. The lubricant helps enhance the ease and comfort of intimate sexual activity and supplement the body’s natural lubrication.

According to widely quoted US physician on women’s health issues, Dr Sharon Orrange from the USC/Keck School of Medicine in Southern California, most common lubricants can limit sperm motility and sperm integrity “so we advise women who are trying to get pregnant to stay away from them. Conceive Plus will be the first lubricant that does not harm the process of fertilization.”

About the Author: Conceive Plus is distributed by Litha Pharma and available at local pharmacies and online at www.getpregnant.co.za. Visit: http://www.conceiveplus.co.za/ or find us on Facebook here: https://www.facebook.com/conceiveplusSA.

References:

¹Anderson L., Lewis S. & McClure N, The effects of coital lubricants on sperm motility in vitro, Human Reproduction

1998; Volume 13, no. 12.pp. 3351-3356, 1998.

² Kurtz J, Willmer E, Nikolic B, Gupta V. Development of a Novel, Physiologically Important Ca2+ and Mg2+ ion

Containing Non-Spermicidal Vaginal Lubricant. Fertility and Sterility, Volume 92, Issue 3, Supplement 1,

September 2009, pages S212-S213.

LP 698 05/2014

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The privilege of living in the age of IVF was brought home to me recently while watching a television drama set in the 1950s. One of the characters was diagnosed as infertile and her despair was profound. It made me realise that until recently, being “barren”’ was often a life sentence.

It could have been me. My husband had had a vasectomy during his first marriage and by the time we married it was too late to reverse it. We would not have been able to conceive without IVF. The procedure gave us hope and then the greatest gift imaginable, a son.

So if I am singing its praises, why do I describe myself as an “IVF survivor” and why was undergoing IVF the hardest thing that I have ever done?

The answer is simple—because it is hard.

We did have one positive IVF, but it was followed by four failures. And successful or not, navigating the process is always challenging.

Understanding how difficult IVF is and preparing to manage it, are two of the most important strategies for making it through.

With that in mind, here are my top tips for coping with IVF:

1. Get help from an expert (as soon as possible)

Infertility is defined as: “a failure to achieve pregnancy after 12 months or more of regular unprotected intercourse in women under the age of 35, or 6 months if you are over 35.”

Hidden in this definition are two important principles. Firstly, the time frame for establishing infertility is relatively short—unfortunately, our fertile years have a limited duration. Secondly, there is a call to action: seek help if you have not achieved a pregnancy in that time.

My advice (from personal experience) is that the moment you realise you are struggling to conceive, you should consult a fertility expert—the best one that you can afford. Why? Because infertility is a specialised field,because the waiting rooms at fertility clinics are full of women who have spent their most fertile years implementing bad strategies, resulting from well-meaning but often inaccurate advice and, because your problem might be relatively easy for an expert to fix.

Remember that as a rule of thumb, the older you are, the more the quality of your eggs will become a factor (in addition to any other problems that you might be experiencing).

If possible, don’t wait too long to get help.

2. Slow down and manage your stress

Telling you to slow down may seem odd given my warning about the age of your eggs and the danger of decreasing fertility. But, psychologists have established a specific personality type that is often linked to infertility—a time urgent, perfectionistic personality.

If this is you, your high stress approach towards life may be a factor in your struggle to conceive so it is worth taking this stress test to find out.

After my second laparoscopy (a procedure to identify and remove endometriosis), I woke up in the recovery room and heard another patient in the bed next to me—who had just had the same operation—commanding the nurse to tell her when she could start IVF. I sincerely hope that the doctors slowed her down—after all, they had seen it all before. Without help though, she was a perfect candidate for an IVF failure.

But, even if you don’t have this personality type, IVF is incredibly stressful.

Be sure to get support during the process, find ways to manage your stress, and do your best to clear other stressors from your life.

3. Try less invasive fertility strategies before you start IVF

We knew from the start that our only option for conceiving was IVF. But, if that isn’t the case for you, IVF shouldn’t be your first strategy for having a baby.

Good fertility specialists use proper diagnostic tools to identify all of the factors involved in your infertility and treat them systematically.

It may be with medication, counselling, operations or other interventions, but the goal is always for you to fall pregnant naturally.

Only if those strategies fail, will your clinic suggest IVF. If your doctor bypasses the diagnostics and the treatments and tries to rush you into IVF, it may be best to look for another specialist.

IVF shouldn’t be your first strategy for having a baby

4. Ensure that you and your partner are in agreement

Bottom line, this is something that you have to do together.

Your partner will also have to undergo a medical assessment to establish if his fertility is a factor. And, if you do undergo IVF, he will need to produce sperm (usually on the day) for the clinic to fertilise your eggs.

You cannot do this without him, which is good thing because IVF is hard and expensive and you both need to be committed to have the best chance of success.

You cannot do IVF without your partner

5. Seek emotional and psychological support

Infertility and IVF can be a lonely journey.

People who haven’t been through it are often clumsy and embarrassed (at best), or judgemental and dismissive (at worst) when you tell them about it.

In addition, your hormones are in turmoil (think of it as PMS on steroids). It is therefore really important to get emotional support during the process to help you manage your feelings and fears.

There are plenty of options including seeing a psychologist or religious counsellor, chatting to empathetic friends or family members, or a support group. So, if one solution isn’t working, there are many others you can try.

Manage your feelings by getting emotional support

6. Think about the moral issues before you begin

In South Africa, a lot of these moral issues are governed by legislation and clinic policy.

Controversial strategies like gender selection are currently not legal and we will never have a South African “octomom” because for each course of IVF, clinics are only permitted to transfer two embryos to a young woman or three, at most, to an older one. And, even this is subject to the doctor’s judgement.

I was in my late thirties when I had my final IVF and for the first time, we made three viable embryos. I pleaded with our doctor to transfer all of them. But, believing that my frame was too small to support a triplet pregnancy, he transferred two and froze the third.

Some decisions will be up to you though. For example, will you freeze embryos and if so, what will you do with the frozen embryos you don’t “need”? And, are you open to using donor eggs or donor sperm if necessary?

Try to make decisions together before the hormones and emotions kick in and rational thought has gone out the window.

7. Develop a communication strategy

This may sound odd but knowing what to say, and to whom, is one of the hardest parts of IVF. Before you begin you should decide what you are going to say to the following groups of people: close friends and family; acquaintances; your workplace (and his) and any existing children.

My tips are:

• Choose a few people who you will tell everything to, but for the rest, share only what you are comfortable with sharing or what is necessary.
• Acquaintances really don’t need to know.
• What you share with your children should depend on their age. You should share enough so that they aren’t afraid (why is mommy having an operation?) but don’t develop unrealistic expectations. Please don’t tell them that you are having IVF so you can give them a sibling. If it goes wrong, it will result in huge disappointment and they may even blame themselves for mommy being sad (she did it for me). If in doubt, consult an expert on this one.

8. Clear your diary

The schedule for IVF is an immovable object—missing important milestones like your egg aspiration may result in you having to start all over again. So, don’t begin IVF in a month when you are starting a new project, travelling for work, moving house or doing anything else that is demanding of your time or emotional energy.

Given how challenging and expensive IVF is, it is best to clear your diary as much as possible for its duration.

9. Stick to your plan

There are two dimensions to this. The first is; to take your meds and adhere to the plan that the clinic has given you. This may be very hard if your plan involves giving up smoking, controlling your weight or cutting down on caffeine or alcohol. To get through it, think about your end-goal and remember that the clinic is doing this for you, not to you.

In addition, you need to schedule well so that you take your meds on time and are present for all of your procedures. There are many tools available to help – anything from old school wall charts to high tech diary planners. However, if you aren’t good at sticking to a plan, ask an organised friend or family member to help. Do take this seriously but do not panic if you make a mistake, just be sure to contact your clinic and ask for advice.

10. Know when to quit

No one wants to start something – especially something as hopeful as having a child – with the possibility of failure in mind.

But, it is a real factor in IVF and unfortunately, many people continue long after doctors have recommended that they stop. It is the reason that many of us have met people whose multiple failed IVFs have harmed their marriage or cost them their life savings.

IVF can become like gambling—there may come a point at which you feel that you have “too much on the table” to walk away and that if you quit now, you will “miss the jackpot”. But, sadly, this is probably the moment to stop. Trust your doctor and listen to your partner. Walking away from the possibility of a baby is tragic but not as tragic as losing everything too.

IVF can become like gambling. Know when to walk away.

I wish I could tell you that it will all be ok, and easy, but IVF often isn’t. And, preparing properly won’t necessarily give you the child you are so desperate for. But, it will ensure that you give this process your best shot. And, equally important, it will give you the peace of mind to know that you did absolutely everything to make the baby you so desperately want.

About the Author: Robyn is a writer, survivor of IVF and a passionate adoption advocate.  She is mom to a biological son (7), an adoptive daughter (2) and two step-daughters in their twenties. For more information about infertility and adoption, or to read her story, visit: http://becomingamom.co.za/

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IVF is a medical technique used for couples experiencing a variety of infertility problems—in particular, male factor problems, endometriosis, advanced maternal age or blocked or damaged fallopian tubes.

Here is an explanation of the process:

Before you begin

Before you start, the doctor will complete a thorough diagnostic and treat you and your partner for any conditions that might compromise your fertility (including medical conditions like auto-immune problems or elevated sugar levels, lifestyle issues like a high BMI, smoking or excessive alcohol intake, and emotional conditions like stress).

If the doctor diagnoses IVF as a solution for your fertility problems, you and your partner will need to assess the cost and emotional challenges of the process and decide if it is right for you to go ahead.

The IVF process

If you choose to begin IVF, the doctor will determine which programme is best for you (either short course or long course IVF—these differ in duration but contain many of the same elements).

The clinic staff will then create a detailed, patient-specific programme for you which usually includes the following stages:

1. First Scan

IVF begins with a scan to establish the state of the lining of your uterus.

2. Hormone injections

If the doctor is happy with the results of the scan, you will begin hormone injections.

These can be self-administered but if the thought of injecting yourself is stressful, ask your partner for help or visit your clinic or pharmacy daily and request that the nurse does them for you.

Typically, there are two sets of injections and the timing of administering them depends on your programme. They are:

• A GnRH Antagonist which is given subcutaneously. This injection is designed to take control of your cycle, suppress the release of the body’s hormones and prevent premature ovulation.There are very few related side effects but some women do report headaches and hot flushes.

• A FSH or FSH/LH injection, given subcutaneously or intramuscularly. This is designed to hyperstimulate the follicles in the ovaries to produce as many eggs as possible. You may feel bloated and uncomfortable so try to drink lots of water.

3. Follicle scan

After five days of the FSH or FSH/LH injections, the clinic will scan you to determine the number and size of the egg follicles.

Usually the follicles are small at the first scan. If so, you will continue hormone injections and scans until the biggest follicle reaches 18mm or more in size.

4. Ovulation injection

This injection(which can again be self-administered) is usually given at a specific time in the evening.

Egg retrieval will then take place 38 hours after the ovulation injection—about eight hours before the egg is due to be released from the ovary.

5. Aspiration

The clinic will tell you what time to check into the clinic for the egg retrieval.

The procedure is only about 15 to 20 minutes but takes place under strong sedation, so plan to take the day off work.

The doctor will retrieve the eggs and your partner will produce a sperm sample to fertilise the eggs. When I woke up from the procedure, the number of our eggs was written on my hand (clinics know that women need details and their partners are often bad at remembering or communicating them).

This can be an emotional day because your hopes and expectations are linked to the number of eggs and how mature they are.

Ask your partner to drive you home and be available to support you if the news is bad.

6. Embryo fertilisation (naturally or through ICSI)

Once the eggs are retrieved, the laboratory scientist will place them in a dish along with the sperm. The dish is put in an incubator where fertilisation occurs.

If necessary (usually when there is male infertility or when fertilisation has failed to occur or has occurred abnormally in the past), the lab will use ICSI (intracytoplasmic sperm injection) to fertilise the eggs. During ICSI, the lab will select and then inject a single sperm into a single mature egg.

7. Embryo development (the waiting period)

The clinic will decide when to do the embryo transfer (either on day three or five after aspiration). In the period between aspiration and transfer you will phone the clinic every day to get an update on the growth of your embryos.

This can be a very stressful time, especially if the embryos are poor quality. Remember that stress at this point can no longer affect your embryo quality but it can impact negatively on your experience of IVF as well as your emotional preparedness for the embryo transfer and early pregnancy.

If you are feeling overwhelmed, it is best to seek some help.

8. Embryo transfer

The clinic will schedule a time for the embryo transfer. This is a minor procedure, not requiring an anaesthetic.

Before transfer, the clinic will talk about the number and quality of embryos and give you a more accurate estimate of the likely success of the procedure.

Depending on the quality of the embryos, this may be an emotional and challenging day but do try to stay hopeful.

9. Waiting stage

Following the transfer, you will be given medication to maintain a healthy uterine lining which will result in heightened emotions and symptoms that resemble pregnancy.

Symptoms can include; tender breasts, bloating and frequent urination. This is a period of high stress where emotions can vacillate wildly from hope and optimism to despair.

Try to keep busy and not attempt anything too physically or emotionally strenuous during this time.

10. Pregnancy test

This takes place 11 days after the transfer. The clinic will perform a blood test and then communicate the results.

If the test is positive (and I sincerely hope it will be), you will continue on your medicine and return to the clinic for regular scans. Many clinics will continue to care for you through the first trimester following which you can see an obstetrician.

A negative result can be devastating though. It is common to go through all of the stages of grieving: shock, disbelief, numbness, anger, depression and lots of “why” questions. This is normal but friends and family may not understand so it may be a good time to seek external help (especially if you find that you cannot move on).

Hard as it is, it is also important to speak to your doctor about factors that may have contributed to the failure,as well as next steps.

Having a plan can make the difference between depression and continued hope.

Top tips

1. Cost

IVF is expensive – leading clinics quote between R35 000 and R50 000 per IVF cycle depending on the procedures used (this excludes medication).

Although semi-government hospitals offering IVF may be cheaper, you will still need to budget for it or obtain IVF-specific finance (speak to your clinic about options).

South African medical aids don’t fund IVF but pressure groups continue to lobby them so watch this space.

2. Your emotions

IVF is very stressful. Be sure to set up a good support structure and if necessary seek professional help to cope with it successfully.

3. Readying yourself

Prepare well. Infertility experts understand that a large number of factors contribute to a couple’s success with IVF. Try to make any necessary health, psychological and lifestyle-related changes prior to the treatment to maximise your chances of success.

About the Author: Robyn is a writer, survivor of IVF and a passionate adoption advocate.  She is mom to a biological son (7), an adoptive daughter (2) and two step-daughters in their twenties. For more information about infertility and adoption, or to read her story, visit http://becomingamom.co.za/

Acknowledgements: Medical content derived from Medfem clinic and Vitalab. With grateful thanks to Mandy Rodrigues for the content about how you will feel.

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