June is World Infertility Awareness Month, a time dedicated to heightening awareness about infertility – a medical condition often not widely spoken about yet something which affects a surprisingly large number of couples around the world.1a
“Infertility is when you cannot get or stay pregnant after trying for at least a year and you are under the age of 35, or if you are over the age of 35 and are unable to get or stay pregnant for six months,” says Dr Sulaiman Heylen, President of the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG).”
In the past few years, the number of couples seeking treatment for infertility has dramatically increased due to factors such as postponement of childbearing in women, and lifestyle factors such as stress, smoking and body weight.1b However, an additional recent stumbling block has been the fear of contracting COVID-19 which has had an impact on delaying people’s fertility journeys.
For those already undergoing fertility treatment, when COVID-19 hit, there was a suspension of treatment worldwide and the subsequent delay of fertility treatments has resulted in much psychological distress for many patients.2a The month of June therefore aims to highlight why it’s so important not to let the pandemic ruin one’s fertility plans.
“In addition to psychological issues, there are the physiological ones too,” says Dr Heylen. “Delaying fertility treatment due to fear of COVID-19 can further reduce your chances of successful treatment outcomes, with studies showing a reduction in live birth rates in patients who have postponed treatment.”
“Treatment was suspended during the hard lockdown, but clinics are open once again, and particularly ‘high risk’ patients whose chances of falling pregnant would be further reduced by delaying treatment are encouraged to seek assistance,” says Dr Heylen.
Dr Heylen says that infertility is a disease as defined by the WHO that can lead to disability (loss of function). “Section 27 of the constitution entrenches the fundamental right to access healthcare services and specifically includes reproductive health. SASREG feels that fertility services are an essential service and should therefore not be withdrawn for patients for whom delay in treatment would affect their prognosis.”
“It’s very important to stress that assisted reproductive technology (ART) clinics are safe and have taken precautions to ensure the health and safety of patients and staff, while we await the availability of the vaccines,” says Dr Heylen. “There is minimal risk of exposure to the virus at these clinics and there is therefore no need to wait for a vaccine to reach out to receive fertility treatment.”
Dr Heylen also notes that there has been much misinformation circulating online about the potential negative impact the COVID-19 vaccine might have on fertility, which has been causing patients to delay treatment while deliberating whether to have the COVID-19 vaccine or not.2b
With COVID-19 vaccines now available globally, the British Medical Journal (BMJ) has stated that there is “absolutely no evidence” that these vaccines can affect the fertility of women or men.3a
“Patients undergoing fertility treatment should be encouraged to receive a COVID-19 vaccine when it becomes available to all South Africans,” says Dr Heylen. “There’s no evidence that vaccination before or during fertility treatment will impact the outcome of treatment in any way. As the vaccine does not contain any actual virus, there is also no reason to delay pregnancy attempts after vaccination.”
People undergoing fertility treatment (in vitro fertilisation (IVF), frozen embryo transfer, egg freezing, ovulation induction, intrauterine insemination, or using donated gametes) can be vaccinated during treatment but may wish to consider the timing given the potential side effects in the few days after vaccination.3c
People may start their fertility treatment immediately after being vaccinated, unless they wish to have a second dose before pregnancy.3d Those who are donating their eggs or sperm for the use of others can also still have a COVID-19 vaccine.3e
Don’t delay fertility treatment
One in every four couples in developing countries is affected by infertility4a, while one in six couples worldwide experience some form of infertility problem at least once during their reproductive lifetime.1a The current prevalence of infertility lasting for at least 12 months is estimated to affect between 8 to 12% worldwide for women aged 20 to 44.1a
“More than 50% of patients who visit a fertility centre are 35 or older,” says Dr Heylen. “It is very important for people not to wait too long when they consider having children. Young women need to be aware that there is a slow decline in fertility from their 20s until the age of 35, after which it starts to decrease rapidly until the age of 45. About half of infertility cases can be linked to the male. It’s therefore extremely important to investigate your fertility options and fertility preservation earlier in life, rather than leaving it too late. A woman who is not ready to have a child can choose to freeze her eggs to try to preserve her ability to have a child later on should she wish to.”
It is now estimated that more than 9 million babies have been born worldwide since the first IVF baby was born in the last 70s.1c The most common fertilisation treatment is intracytoplasmic sperm injection (ICSI)1e. This accounts for around three quarters of all treatments globally while conventional IVF accounts for around one quarter.1e Success rates from frozen embryo transfer are increasing too.1e
“The good news is that over the last decade the advances that have been made in the field of assisted reproduction are massive and there is hope for those who might be suffering from some form of infertility,” says Dr Heylen. “You are not alone and there are many options available to help you realise your dream of having children.”
Visit a fertility clinic near you to speak to a doctor about the options available to you and your partner.