Medical Matters: Infertility Affects Millions: Don’t Delay - Early Action Can Make All the Difference

infertility without even knowing it. Our guest on the show this evening is doctor Lusanda Shiman gemss, a fertility specialist and director at med fem Fertility Clinic.

actually struggle to poll pregnant. So there is the textbook definition of below the age of thirty five years twelve of regular sexual intercourse, and then if you don't fall pregnant within those twelve months with regular sexual intercourse, then it's defined as infertility or above the age of thirty

five six months of regular sexual intercourse. So the reason why I personally don't necessarily subscribe to it is that if you tell someone that Okay, fine, go and like I said, going for pregnant, you are above the age of thirty five, you've got six months to fall pregnant. That that's quite a stress and stresses is one of the contributors to infertility. But do not incorrect in saying that if you look it up, that's exactly what they'll give you.

than later. And I'm just really saying this because we're seeing a lot of couples above the age of thirty five, above the age of forty who are coming to us and they want for pregnant. And you know, there's a concept of a variant agent, which really is a non modifiable factor. So it's not to say that look, okay, fine, put yourself within the definition. But I'm just saying, once you know that you want to be a parent, it's imperative.

Or I'd highly suggest that you are in touch with some sort of health practitioner who can at least guide you in the right direction. Should you not feel pregnant, and do I think it needs a year? I don't think so. I think when you're ready, you're ready, And you don't think that a lot of us are walking around and we don't know if we've got something going on or not. And I'm saying, just get assessed sooner

rather than later. A case example is they say someone with polycystic ovarian syndrome, which which is a hormonal imbalance that occurs a woman of reproductive age. If you don't know that, you've already got that and now you are going to go for a whole year to try and fell pregnant and all we have to do is sort that out. Wouldn't it be great if you find that out when you decide to conceive, so that it can actually happen and not take a whole year. Do you know what I mean.

And then more so is it a structural problem? So just I'm expanding further on those different categories. So let's just say if it's a structural problem, you do get some women who are born without utresses, so they don't have a wound, and they may not know that. So that's important that we find that out sooner rather than later. And then you may ask, but how would you know that?

So someone who's not going on the period has never had a period, and has never had a period, and therefore that person needs to be checked out because it's not normal for a woman of reproductive age to not have a period. And then if we go to things like medical disorders, does this person have a thyroid problem that we need to look at, and that is one of the big things that smith is their genetic issue

or lifestyle. What type of lifestyle does this person need, you know, in terms of work, do they have work stresses, they don't exercise, they eat unhealthy, they are smokers, and so forth. And then hormonal problems. One of the big ones is the polycystic of wear in syndrome that I mentioned, So that is just really like the woman. And then it comes to the men, and the men we have to check. First of all, you need sperm to fell pregnant,

So do they have a low sperm count? Do they have abnormal looking sperm, or do they have sperm that does not really move properly in other words, so that it can go through the wounds into the tubes and then fertilize their egg. Or is there a gland problems

such as your thyroid. Is there a structural problem there is obstructions that does not allow the sperm to necessarily go into the women's reproductive tract or are they impotence Do these guys are they getting an erection, you know, or if they do get an erection and they ejaculate,

are they actually producing sperm or not. So there are various factors, and that's why I come back to I think it's you know, when you've decided that you want to have a child, is go and visit your healthcare provider and just you know, you just made it, make it known that you want to have a child. There's a few simple blood tastes that need to be taken and an examination just to see if there is something that needs to be fixed or not.

should look out for a younger couple. So let's just say, I don't know what age people get married these days. I've been married forever, so but let's just let's give or take people get married. I want to without touching any nerves at the age of twenty nine. Okay, So they get married at the age of twenty nine, and then they want to spend a year by themselves, and then the following year they're going to try and for pregnant.

With that couple, we've got more time in order to try and for pregnant, So that definition of a year comes into play. But with that being said, when I think of when we talk about the women, this woman must be having regular mastrol cycles. You know, we can't have someone who's having irregular metroal cycles and then they are trying for a year. Once you have irregular metrol cycles, something is wrong and you need to get seen. So that couple, I would not give an extended period of time.

I would want them to get seen sooner rather than later. Or if let's just say she was mestruating at some point and then stopped menstruating, that person, I'd like to see sooner rather than later. Or if they's now they're starting to go a beard which they never had, or they had been having a beard that they've been shaving off, that person, i'd want to see sooner rather than later. And then in terms of the guys, if they're having

premature ejaculation, obviously they're having pre mature ejaculation. By the time there's penetration, you've already ejaculated, so you are going

to find it a bit difficult to for pregnant. So I think where I would really come in is to say, if you feel something is wrong or you feel you need to consult, there's nothing wrong with having that first consultation, having investigations done, getting assessed, and then you know where your baseline is or where your standpoint is rather than no, let's just wait, let's just wait because a lot of couples actually put it off for it's longer they're necessary,

and then by the time you know, by the time they come and see us, it's either now the old or the egg reserve is low, or the sperm count has been abnormal all this time and now we're only discovering it. So I think once you think about it, so if there are couples out there and they feel sure, we've been at this for I don't know, six months, they will take rather just go and see someone. Go and see your Guyanese so that you know, you can at least have the conversation, so you understand because I

only say people, it's actually quite difficult. We see a lot of babies running around and so forth, but it's not it's actually hard to feel pregnant, and it's even harder when there is an issue. Sure.

regardless of what it is. And I think it's not necessarily that it's becoming you look that you can say it's becoming more prevalent because lifestyle has changed, you know, and and the job market has changed. Women are coming up corporate ladders. You know, they're putting all falling pregnant till they're much older. And that's where I'm like, okay, guys, now, let's start social freezing. Then freeze your age when you're younger so that you've got options later on in life.

So in terms of prevalency is different factors. You know, now women are working in the minds and there's there's a concept called endocrime disruptors, so environmental factors that can affect your fertility so there is different reasons why women may becoming fertile. But I also think there is a subset of women who are actually happy to speak about it.

I mean, when I think about our fertility clinic, it's been around for thirty years, you know, so it's been a long time since people have been struggling to fell pregnant.

there's a concept of ovarian aging. This is a non modifiable factor. You're are forty five, or your eggs are thirty and so forth. So where would you start? And it starts with the first point of contact with any health care provider, and that's where we are really, that's where the gap is. So even if you like, I don't know, just random, you're going to see your dentist, you know, for your six month check up, but you

don't see any other doctor. The only person you see is your dentists because you're so you know, intentional about having dental health and it's for that dentist to say, listen, actually i've been doing your teeth for quite a while. What is happening with you in terms of you know, fertility and so forth. Do you want to be a parent And you're like, yes, actually I do, but not

right now. Maybe and I'm a bit older, and it's that well, you know, there is maybe you should go and see a guy, and you're going to see a fertility specialist in terms of guest seeing what your options are if you're going to put or falling pregnant, And that's where the conversation begins. And we're not having those conversations.

We really just have them at dinner parties. If someone just happens to mention that they say they went to and made same fertility clinic, and they froze the eggs and then everyone gets excited like, oh my gosh, so what does it entail? What did you do? You know? And I want us to start having all those conversations because then I think it will sat out a lot. It just gives you options. So it's not to say when you're older you will struggle. You know, you won't

feel pregnant. It just means that in the events that you do struggle, you've got these thirty year old eggs which are sitting there waiting to be used.

consider freezing your eggs. Okay, so what does that entail. Well, you'll need to go to a fertility specialist and basically we do explain that to to to the patient. And mind you, it's not just about freezing eggs. You can free sperm as well, So the conversation really starts there.

And then in terms of what it entails, basically is injections that we give which we basically we want to get as many eggs as possible, so we grow the follicles up to a certain size, and then after that, once we track them via ultrasound, and we'll give you other medication to stop you from augulating so that you don't lose the eggs. And when we ready, then we

do what we call a trigger. So to always explain it to my patients where I'm like, think of an egg, like you know, a chicken egg that we make for breakfast. So we want that egg to grow, and then at a certain size, we give you an injection so that we can go and so that we can soften the egg shell so we can go and take out the egg white and hopefully that egg white will find an egg yolk and that's what we freeze. So it's quite a simple process which takes around to give or take

two weeks. So it's something and a lot of women are doing it. A lot of women are actually waking up to the fact that, look, I'm not in a relationship. I don't know what my prospects are. But what I really love about social freezing of eggs is that it gives the woman reproductive freedom. It says, I'm not waiting for mister Wright to come, because what happens if mister Wright comes at forty five?

All right, So doctor, you spoke about lifestyle changes. How important is diet when one is trying to feel pregnant?

cooked it, and so forth. And I think that's why, you know, long time ago, women were really just having It was not abnormal to say, you know, we hear my grandmother had nine kids, you know, because they really actually had an organic diet, they ate what they planted. And now we are in a fast culture where it's just a matter of just putting something in the microwave and you know, and eating it, or in the a fryer and eating it and we're not cooking our food anymore.

We don't know what's actually going into our food, so we have to look at you know, inflammation does play a big part, and what are those inflammatory foods? You know, so when you know your process, cover hydrates your process and your processed foods and so forth. So diet does play a big part. But it's not to say you have an unhealthy diet. You can't fall pregnant, because someone can easily phone now and say, look, I've been eating McDonald's all my life, or I've been eating fast food

all my life and I've got four kids. That those people are outliers. But for someone who really is struggling to for pregnant, I will always gauge the diet aspect, like what do you actually eat, you know, and how

is it affecting your body. But with that being said, I think in general we all need to check ourselves in terms of our lifestyles and what we're doing, because ultimately, let's just say you do for pregnant with this unhealthy lifestyle, you bring a child into the world, you really want to die young and leave this child without a parent.

And that the part that we actually don't think about you know, we've all got bragging rights about how it felt pregnant, drinking every day and I've been smoking since our sixteen and eating false food. But then what does your lifespan look like and what happens to that child? So definitely, lifestyle diet definitely does play.

a couple things. It's not either all. So if one is going to be on a healthy lifestyle chain, both of you must be on that train.

you're uncomfortable with being here, and I get it. I get it in that you know, the ones that you've probably succeeded in everything that you've done in your life, and the one thing that it's just supposed to happen naturally is not happening, and you may be struggling to, you know, to deal with this. So we refer, we do refer to a psychologist who will unpack everything. By the time people come into the facility, clinics. They've conceded to the fact that we are struggling and we need help.

And you know, once you step into that door, then it's one of those where okay, guys, now we're going to be open with each other and we are going to work together in all this. Very rarely you will get people who will say, I really don't want to be here. My wife has forced me to be here, you know. I think way it becomes a bit of a challenge is once you get to a fertility clinic, you know, by virtue of what we do, you know, with assisting couples, and it's a lot to say they

can't for pregnant spontaneously. But is when there's an insistent that, yes, we want your help, but we don't want iva for anything like that. We want for pregnant spontaneously. That's really where the challenge comes because it limits us in terms of what we can actually do as fertility specialists. But once they walk in, they've decided that okay, we need help and we are here.

We've got doctor Shermange here to help us make sense of your questions and give you the answers that you may need to please get in touch in touch with us, and our callers have the tendency of calling towards the end of the hour and they're not getting the answers that they require. You'll find people calling at fifty five, at fifty three, or you know, seven minutes to the hour. So I want to encourage you to call now if you have a question so that we can address it

with doctor Shimangem. Maybe my next question that doctor Missander is, I mean, how much of a bearing does the psychological aspect have on fertility issues? You know, you often hear people saying you're overthinking it, You're overthinking the whole thing.

is wrong? So I was so I was ready to go and see a fertility spacialist by man five. You know, not because of anything, but I'm like, but because it was just that expectation that is going to happen. And then when I stopped, you know, because this is exact and so forth, and you know, sat down with my husband and I was like, oh my gosh, you know, we get pregnant. Now you know what's going to happen with exams and all that, so maybe we should just like shelve it for now and we'll start it going.

So we literally just like stopped overthinking, and then we felt pregnant, you know. So there isn't because it does get technical. It really does be technical, because now you'll have a woman's like, no, no, no, we can't have sex now because I'm not ovulating, you know, I'll there, you know. And then the poor guy's straight now he's supposed to perform, and then he has performance anxiety. So there is an

element of that. But what I really want to stress upon is the mental part or the psychological part, which is really the silent cost to infertility, were either a couple can't talk about the challenges that they have so they're basically suffering in silence, or the couple can't go and talk to someone and they don't know what to do. And and almost like there's a shame in that we are struggling to feel pregnant, you know, and and and and that is the part which I really wish we

could just get over that. It's okay, it's okay if you're struggling to fell pregnant, because you can actually get help. So there is there is that one part where a couple start overthinking it and then you've got all the apps and you've got all the ovulations and you're just you're doing a lot, and you know, then you're not even lovers anymore.

enjoy being with each other, you know. And I think that is so important because it's I think it's just kind of like as an element of it doesn't have to be a job, you know, it does not have to be a job. And I think it and it happens without you even realizing that. It's just that you know, we can I mean, jeez, you can. You can definitely depict it, you know, from the consultation. So there is

definitely a psychological aspect to it. But there's also the other side, because couples do break up trying to feel pregnant and it doesn't happen, you know, couples do get depressed and do get anxious. So that is the one part that we really always need to address. And I always ask, like, you know, so how are you doing? You know, how are actually how are you dealing with this? And especially when you know the guys sometimes struggle to

open up. Eventually they do because they realize, look, there is no judgment here. We just want to help you.

big thing. Age is a non modifiable factor, and I would have done all the investigations. But I'll also ask why are we freezing? Why aren't we having a baby? So I would want to know the reasons for that, and would also talk about the quality of the eggs, you know, to say, do you want to freeze eggs? Obviously there will be investigations that will be laid with, but ultimately the quality of the eggs would be a big thing in this situation as to let's just say

we go and we freeze your eggs. We are not going to freeze twenty eggs. We may be lucky if we freeze one or two eggs, and then once we freeze those eggs, they still need to be fertilized by sperm at some point, and when they get fertilized, they need to get to what we call a blastocyst stage, so a day five. So we need to actually create a baby with these eggs, you know, And this right now the success rate is actually quite low. So it's a matter of you've got this information, what do you need?

What do you want to do? A lot of our patients over the age of forty so forty three forty two actually end up using donut eggs, which are younger eggs, which has a better chance of success. So to answer her question, should she freeze eggs at forty three, I'm saying at forty three, please have a baby? Can we help you have a baby at forty three, not help you freeze eggs?

There's a point of departure in terms of cost with freezing eggs. And let me just say we are freezing and not necessarily going to fertilize, just really keeping them there. There is a cost permans. It differs from clinic to clinic, and I'll be lying if I give you absolute values, but rough estimate it's about two thousand rand per month to keep them frozen. But for the actual process we're looking at about plus minners. I want to say about

sixty to seventy k but I'm speaking under corrections. But you're welcome to phone our clinic and they will definitely give you the correct values, the correct amounts, all.

for a month. So now that i'm telling for the two years, for the four three, what must I do to boot both my eggs is to try for the last time because in the pri in the government hospital, they told me that I must look for it now, so of course is my age anymore?

and I know you're coaching in the government hospital. They say you must use a donut, but in the private space as well, and it goes back to the first caller, should she freeze the eggs at forty three? Can I

use your eggs at fourty four. I'm not saying that you can't, but knowing what you know, the prognosis is not that great, you know, because we know that there is a decline in terms of your life births the older you get, and it starts going down at the age of thirty five, whereas with the donor eggs, and which is not a bad option, your chances actually remain high. So to answer your question is what should you do?

I think you need to get hold of, you know, get in touch with a faculty specialist and just really see what your options are because there's also be blood work involved. But from a cost effective point of view, I would recommend donor eggs. But like I said, we do get patients, so like, look, I just want to try my eggs and if that doesn't work, then I'll go to donor. You know, but at the age of forty four most definitely me and you are the same age mates.

sperm is processed and then it's frozen. So you can see, it does not require any form of medication unless there is something clinically wrong with the male who is freezing sperm, who may need medication but definitely.

And you just get those people who are just they're for pregnant easy. You know, they're made to full pregnant So to answer the question about alcohol, definitely it does play a part. It is a toxin at the end of the day, and you don't know how your body is going to react to it. You know, you don't know if it's going to have an adverse effect or not. So for me, for anyone trying to fall pregnant, I'll

definitely lean towards a more healthy lifestyle. And when I say that, I mean if you have a glass of wine every now and then, then you know it is what it is. But also, don't stop living because you're just trying to fell pregnant. There's life at the end of the day, you know. And I think that it's very important that I say that, because you can't spend your whole life living a certain way because you are trying to fall pregnant and then it doesn't and then

it comes it has other ripple effects. So alcohol, yes, does play It does play a certain role, especially because of equality. You know, everything goes back to equality, s film quality at the end of the day, you know, So it does. But I also say, don't stop living. Don't stop living. Just rather, I'd rather had someone to come and see me then to stop alcohol and try and fall pregnant for five years.

in a relationship? Is she doing this by herself? And if she's in a relationship, is to assess the guy as well, and then for her to just basically assess the medications that she's got and to have a physical examination with an ultrasound scanned and then from there then we can have the conversation about okay, call, you can go and you know you can try and for pregnant, but we and we need to take agent. I know,

I'll always keep going back into age. How does she want for pregnant, that you want to be assisted, that you want to susue the own and so there's a lot of evaluations that really and I think a lot of people are going to call to say what should they do? And ultimately is you actually need to see someone so that you can you can have a full comprehensive examination, consultation, worth investigations to really know where you

are sitting because it's easy for me. So of course you can feel pregnant at the age of forty one and next thing you've got block tubes. Yeah, then it completely nullifies everything.