HAPPY FAMILIES
In Reproductive Health Month, Lindsay Ord speaks to two couples who have had babies thanks to fertility treatment

CELEBRITY couples and their broods have made assisted conception a hot topic of conversation. Elton John and David Furnish are proud parents of a son born to a surrogate mother: Nicole Kidman and Keith Urban's newest baby came into the world via a "gestational carrier". Brooke Shields, Marcia Cross and others are reported to have had children thanks to in-vitro fertilisation (IVF).

Nobody is saying that assisted conception is a breeze. It is stressful and can be expensive. But the rewards are immeasurable.

One in six couples experiences infertility probleeatmentn many, the diagnosis is simple and the treatment effective. Others are not so lucky.

According to Dr Anil Ramdeo, who head the Centre for Assisted Reproduction and Endocrinology Clinic (Care) in Westville, nearly 80% of couples who try to conceive will do so within 12 months and those over 35 who have been trying for six months should seek professional help, he says.

"There are many treatment modalities available," says Ramdeo. "Intra cytoplasmic sperm injection (ICSI), IVF, IVM, ovum donation, sperm donation and surrogacy are all available."

But sadly, even medical sceince cannot guarantee a baby. At Ramdeo's clinic, pregnancy success rates per embryo transfer for IVF and ICSI are 44% (under 35 years), 40% (35 - 39 years) and 29% (40 - 45 years).

There are many causes of infertility and one or both partners may be implicated. When no apparent cause is found, it is called unexplained infertility. Treatment varies from simple hormonal treatment to more complex investigations and treatment.

Female factors include Polycystic Ovarian Syndrome, ovulatory problems, early menopause, low hormone levels, damaged or blocked tubes, endometriosis and immunological problems.

Male factors include sperm dysfunction, poor sperm motility, low sperm count and antibodies that may destry or damage the sperm.

Lifestyle factors include:

• Age: Many couples are now waiting too long to start a family, says Ramdeo. As you get older, your egg reserves fall, quality decreases and eggs are more difficult to fertilise. From one million eggs at birth to 250 000 at puberty, a woman is left with a reserve of 13 percent at the age of 30.
• Smoking: There is evidence that men and women who smoke are more likely to have problems falling pregnant and suffer miscarriages than people who don't smoke. Men who smoke are more likely to have reduced sperm motility and increased numbers of abnormal sperm than non-smokers.
• Alcohol: Alcohol can affect sperm quality, erection and ejaculation. It also increases the chance of miscarriages.
• Weight: Very underweight women do not ovulate every month and this decreases the chance of fallying pregnant because they have an imbalance of hormones that increases the risk of infertility. Obesity may also affect fertility negatively.
• Infection: Any infection can affect the fertility of the male or female.
• Chlamydia: This sexually transmitted disease can damage the female and male reproductive systems resulting in infertility. It can be treated once identified.

Technical talk is all very well, but the real toll is the psychological one, and for many couples the inability to conceive equals heartbreak.

Dealing with the condition is a struggle that can make a couple feel out of control of their lives. They may become the perfect patient, follow all the rules, fill out all the forms and willingly submit to all the tests, but they cannot control the outcome. In fact, this might be the first ti me in their lives that they have been unable to control or achieve their goals.