In our clinic it is protocol to perform a swim up and morphology before starting an IVF/ICSI attempt. This is seen as a mock run in order to have no surprises on the day of egg retrieval. It measures the count, morphology, motility and survival. If the need arises it can be combined with a MAR.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

The Birth Control pill helps to create a steady state in the ovaries, preventing the inherent hormonal imbalances associated with PCOS. Should a PCOS patient take the Birth Control Pill from puberty, her hormonal state will be on par with her non-PCOS counterpart. The birth control pill plays an important role in the management of associated illnesses within the syndrome, such as heart disease, androgen excess and ovarian cysts. It is therefore advisable that PCOS patients not seeking to conceive make use of the benefits of using the BCP. The BCP however is not a cure all, and special precaution in the form of dietary and exercise intervention still need to be taken to manage other associated diseases within the syndrome that pose possible future healthrisks, such as insulin resistance and diabetes.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

The answer to this question is threefold:

1)Learn as much about your problem as possible by reading up or visiting credible sites on the internet. By doing this, you will be able to ask him or her direct questions and comparing the answers with what you have read.

2)Reproductive medicine is a registered sub speciality with the Health Professional’s Council of South Africa.

3)Ideally, the practise you are attending should devote all their time and effort only doing infertility.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

There is no evidence to support this notion.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

Treating infertility or sub fertility without a proper workup does not make sense, as one needs to make a firm diagnosis in order to know what the further management should be. Without a firm diagnosis one can not formulate a plan of action. One should keep in mind that there are various reasons for not being able to conceive that the universal subscribing of clomiphene will not solve .

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

The definition of infertility (whether primary or secondary) is the inability to conceive after 1 year of regular unprotected intercourse in patients 34 years and younger and only 6 months in patients 35 years and older. This definition, however only applies to patients with REGULAR menstrual cycles. When a patient has persistent irregular, long cycles, this definition falls by the wayside and investigation and management should be sooner rather than later. It would therefore be advisable to seek assistance sooner rather than later.The definition of infertility (whether primary or secondary) is the inability to conceive after 1 year of regular unprotected intercourse in patients 34 years and younger and only 6 months in patients 35 years and older. This definition, however only applies to patients with REGULAR menstrual cycles. When a patient has persistent irregular, long cycles, this definition falls by the wayside and investigation and management should be sooner rather than later. It would therefore be advisable to seek assistance sooner rather than later.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

Endometriosis on the cervix is relatively uncommon. Cauterizing it is the right way of managing these lesions and recurrence is always a possibility. The timeframe is however not clear. Theoretically, these lesions can lead to spotting during a cycle as well as after intercourse.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

Changing the trigger from one agent to another is highly unlikely to influence the number and quality of the oocytes as all these agents have been scrutinised by doing randomised control trials before releasing the drugs for commercial use on the market.  See attachment from the Cochrane Review.

Recombinant versus urinary human chorionic gonadotrophin for ovulation induction in assisted conception
Al-Inany HG, Aboulghar M, Mansour R, Proctor M
Urinary human chorionic gonadotrophin was used for several years to trigger ovulation. Similar man-made drugs, recombinant human chorionic gonadotrophin and recombinant luteinizing hormone, have been developed. This review found there was no difference in pregnancy rates or adverse effects between urinary and recombinant human chorionic gonadotrophins. High dose recombinant LH was associated with lower pregnancy rate and the pharmaceutical company manufacturing the product has withdrawn it for clinical use.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

Having some empty follicles during oocyte retrieval must be clearly differentiated from the so called “empty follicle syndrome” The latter is a very rare and sometimes very controversial topic. From the point of view of having 25 follicles on ultrasound and only harvesting 4 oocytes, the reasons are generally one of 4:

1)The ovary is dysfunctional and therefore only 4 of the 25 follicles could actually  yield viable mature oocytes. (sometimes seen in severe PCOS patients)
2)Coasting took place to diminish the risk of ovarian hyperstimulation syndrome, during which time many of the follicles were lost.
3)Triggering took place before most of the follicles were mature and ready for harvesting
4)Ovulation had already taken place or was in the process of taking place at the time of oocyte harvesting.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

Vesicular endometriosis is not classified as a specific stage or type of endometriosis. The terminology is purely based on the appearance of the lesion to the naked eye – almost blister like in appearance – hence the name vesicular. Regardless of the lesions appearance, it has to be confirmed as being endometriosis by a pathologists report.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -