TOPIC: FLUOXETINE/CIPRAMIL
Q	I know that Fluoxetine has been passed as a safe antidepressant to be on for IVF and pregnancy. However I am on Cipramil. Should I change to fluoxetine? Is it safe for my hubby to be Cipramil as well?
A	Cipramil, like Fluoxetine is a SSRI. Current literature supports the fact that SSRIs in early pregnancy does not seem to be a major risk factor for infant malformations. I would therefore suggest that you stay on the Cipramil if you are satisfied with it. The same goes for your husband.
	TOPIC: ACCUPUNCTURE/IVF
Q	A German study showed an increased rate of clinical pregnancies when combining acupuncture with IVF. Do you think it is better for patients to go for acupuncture before treatments to prepare the body or for the patient to jump right in just before or while busy with IVF treatment?
A	The jury is out with regards to the fact that acupuncture ON the day of embryo transfer and on the day FOLLOWING embryo transfer seem to be beneficial from a pregnancy rate point of view. It is however not clear as to what the benefit might be during the period leading up to IVF or for how long.
	TOPIC: HOMEOPATHY/CONVENTIONAL WESTERN MEDICINE
Q	What is your response to individuals claiming that homeopathy is a superior treatment method for infertility, especially in cases where western medicine has failed them?
A	As a reproductive specialist and scientist, I practice evidence based medicine, meaning medicine that has been shown to be beneficial through rigorous randomised controlled trials. As homeopathy is not my speciality, I am therefore not qualified to volunteer an opinion as to the benefit.
	TOPIC: RECOMMENDED ALTERNATIVE TREATMENTS
Q	There are many forms of alternative practices (i.e. acupuncture, reflexology, full body massage etc.) Which ones of these do you believe have real efficacy? And if you had to recommend one, which would you recommend, and at which stages of treatment?
A	Acupuncture is for now the only alternative method of treatment that has been evaluated by using randomised trials and shown to be beneficial around the time of embryo transfer( the day of and after ET). Therefore it is what I can recommend at this stage in time.
	TOPIC: STAGE 2/3 ENDO LAP FREQUENCY
Q	If you have stage 2/3 endo how soon after having a lap would you do another while on infertility treatment?
A	Stage 1 and 2 endometriosis qualifies as mild to minimal. In cases where surgical excision has been complete, the recurrence rate is about 20% over a 5 year period. Stage 3 and 4 is severe and the recurrence rate is 75% over a 5 year period. It would therefore be wise to repeat the surgery as soon as the symptoms re-appear in the case of previous stage 3-4 endometriosis.
	TOPIC: RETROVERTED UTERUS
Q	I have a retroverted uterus, how does this affect conception, pregnancy & labour?
A	A retroverted uterus is a normal finding in 20% of the general reproductive population and therefore has no significance to conception, pregnancy or labour. The only issue is to probably turn onto the stomach for 20 minutes following intercourse instead of lying on the back. This however is also a point of controversy. But as a whole – no significance.
	TOPIC: LIGHT BLEEDING/PINK DISCHARGE MID-LUTEAL INTERCOURSE
Q	I have experienced light bleeding/pink discharge a few times after intercourse. Especially midway through the luteal phase, and especially during stimulated cycles. What is the cause of this? Does it indicate good endometrial development? Possible implantation bleeding? Anything else?
A	If your gynaecologist has excluded a local cervical reason for the post coital bleeding, then it is probably due to the mild drop in the estrogen level post ovulation. This might lead to sloughing of the top cell layers of the endometrium leading to the slight bleeding.It has been suggested that should the patient be symptomatic, that endometriosis should be excluded.
	TOPIC: TENSION HEADACHES MEDICATION/OVULATION
Q	I get a lot of tension headaches, and the only thing that helps for this is Adco-dol (Adcock Ingram Ltd). How much does it affect your fertility treatment, for eg during a IVF cycle. Also, during normal cycles, when not on treatment, and you drink it over ovulation time, could it prevent you from falling pregnant?
A	Adco-dol contains a substance known as doxyamine . The safety of this substance is questionable during pregnancy and therefore one should explore alternate medications or interventions for the tension headaches during early pregnancy. Leading up to IVF, before embryo transfer, theoretically it should not have an influence.
	TOPIC: ESSENTIAL FATTY ACIDS/ PCOS
Q	Is there a place for EFA (Essential Fatty Acids) supplementation for PCOS, and why is it recommended?
A	EFAs are a very important part of a PCO’s daily requirements and the potential advantages numerous. It reduces all of the following: Inflammation, heart disease, high blood pressure, high levels of triglycerides,the risk for developing diabetes, depression and stress. All of these are very relevant for the PCO patient. The best form are cod liver oil or EFAs in capsule form. Wild, cold water ocean fish are especially rich in EFAs, for e.g. herring, salmon, sardines, anchovies and tuna.
	TOPIC: ANTI-THYROGLOBULIN AND ANTI-THYROPEROXIDASE
Q	I have noticed two tests ordered on my bloods, anti-thyroglobulin and anti-thyroperoxidase. What are these tests for and on what level do they indicate a possible threat to fertility/conception?
A	Studies have shown that very high levels of anti thyroid antibodies might be detrimental to implantation. The other reason for requesting these antibodies is to establish a diagnosis as to why the thyroid might be underactive.