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Egg Donation
VITALAB 's egg donation program is designed to assist women, who for diverse reasons, are unable to produce their own eggs for conception. This program gives them the opportunity to conceive and carry a pregnancy to delivery.
Our goal is to make the egg donation process as positive and stress free as possible.
Any egg donation program requires a great deal of co-ordination from selecting the egg donor and matching her with a couple, to synchronising and performing the related medical procedures.
VITALAB offers a unique combination of skills and experience that facilitate this process.
www.donorlife.co.za
Pelvic Exam
Certain findings of a pelvic examination can lead your physician to suspect endometriosis. A sign that strongly suggests endometriosis is nodularity along the uterosacral ligament, which the doctor may feel during a combined vaginal and rectal exam. The nodules are often tender to the touch. An enlarged ovary can indicate the disease, especially if the doctor finds that the ovary is fixed in position. Occasionally, endometrial implants may be visible in the vagina or the cervix. A physician may suspect endometriosis based on the history and results of a pelvic exam, but cannot confirm its presence without additional studies.
Laparoscopy
Laparoscopy, a surgical procedure that enables a physician to see inside the pelvis and inspect the reproductive organs, can verify the presence of endometriosis. Most doctors will confirm the diagnosis of endometriosis through laparoscopy before treating the disease. In fact, since endometriosis is often without symptoms, many doctors advise laparoscopy as part of the diagnostic process for all infertile women.
During laparoscopy, a thin, lighted telescope, called a laparoscope, is inserted into the abdominal cavity through a small incision in or near the navel. Looking through the laparoscope, the surgeon can see the surface of the uterus, fallopian tubes, ovaries, and other pelvic organs. The doctor can then visually confirm the presence of endometriosis and gauge its extent. A small piece of tissue can be removed for microscopic examination at this time. This is called a biopsy.
The amount of endometriosis is assigned a numerical score at the time of laparoscopy. The score is based on the amount of superficial or deep disease found in the pelvic lining, the ovaries, and the fallopian tubes, and the amount of adhesive disease present in the pelvis. Assigning a numerical score is called staging the disease that uses a standardized system that divides endometriosis into four stages: minimal, mild, moderate, and severe. For example, a score of 1 - 5 indicates minimal or mild endometriosis, and a score of greater than 15 indicates moderate to severe disease. This system is useful in determining what treatment is needed.
In some cases the physician may decide to treat endometriosis during laparoscopy. If so, he or she may make other small abdominal incisions and insert additional instruments. The surgeon may drain fluid, cut scar tissue, or burn away or vaporize endometriotic tissue with a laser beam. Also during laparoscopy, the openness, or patency, of the fallopian tubes can be checked. This is done by injecting contrast fluid through the cervix into the uterus. If the tubes are open, the dye will travel through the tubes and flow out the ends.
Other Diagnostic Procedures
In special cases, your doctor may use various imaging technologies, such as ultrasound, computerized tomography (CT Scan), or magnetic resonance imaging (MRI) to get more information about the extent of endometriosis. These procedures can identify cysts or fluid within the ovaries and are usually performed in a hospital radiology department, an imaging centre, or in a specially equipped doctor's office.
Blood Tests for Endometriosis
Recent studies indicate that women with endometriosis may have increased amounts of a chemical called CA125 in their blood. Research indicates that the amount of CA125 increases as the severity of the disease increases. Unfortunately this test is not specific to endometriosis and can be positive in a number of other diseases such as fibroids, infections, recent surgery, and cancer. Also, not all women who have endometriosis have a positive CA125 test, especially those women with mild disease. Therefore, it is not generally used to detect endometriosis. Other blood tests are being evaluated to see if they may be more specific to endometriosis and more useful in its diagnosis.
Treatment
Your doctor will consider all the symptoms, physical findings, test results and your goals and concerns before advising therapy. Women with endometriosis who have few or no symptoms may require no treatment. Small endometrial implants often remain stable and may even disappear. Hormone medication, surgery, or both may be prescribed. Doctors frequently advise patients with endometriosis to proceed with their plans to conceive. Many think that pregnancy inhibits the growth of endometriosis and causes it to regress.
Hormone Medication
The goal of hormonal treatment is to stimulate pregnancy or menopause, two natural conditions known to inhibit the disease. With both treatments, the normal endometrium is no longer stimulated to grow and shed with each monthly cycle and menstruation ceases. The growth of misplaced endometrial tissue will usually be suppressed as well.
Oral Contraceptives
To stimulate the hormonal environment of pregnancy, your doctor may prescribe birth control pills to be taken in a pattern quite different from that used for contraception. One of the more effective regimens for endometriosis is to take the pills continuously, without placebos for withdrawal bleeding. If breakthrough bleeding occurs, the dose may be increased to two or three pills per day. Side effects associated with these higher dosages include nausea, water retention, and irregular vaginal bleeding. More serious complications, such as stroke, vascular problems, and heart disease are rare but have been reported in susceptible women.
As a contraceptive, birth control pills are administered one per day for three weeks each month, followed by a week of hormone-free (placebo) pills to permit menstrual flow. Many doctors feel that birth control pills taken in this manner may prevent progression of endometriosis, but although appealing, the theory has not been proven.
Gynaecological Endoscopy
Gynaecological endoscopy is a procedure where a thin telescope is used to visualise the pelvic and other abdominal organs (laparoscopy). Visualisation of the inside of the womb through a very thin optic lens has also been developed (hysteroscopy). Technological advances have enabled projection of superior imaging of these organs, on to a video monitor.
In spite of extensive investigations, many gynaecological conditions (endometriosis, chronic pelvic pain, infertility, etc.) remain elusive. Diagnostic laparoscopy performed under general anaesthesia entails two small incisions in the abdominal wall to introduce a 10mm lens and a 5mm instrument to visualise and manipulate the pelvic organs for the diligent inspection of all the structures. Proper diagnosis of these conditions can be made and the patient can be discharged from hospital on the same day.
Diagnostic hysteroscopy entails the introduction of an 8mm-lens transvaginally into the cavity of the womb. Suspicious areas of the womb can then be sampled. This procedure has replaced the traditional D+C, which was merely a blind sampling of the cavity of the womb.
Improved optics and imaging on the video monitor has opened the avenue for endoscopic surgery. Well-trained and skilled gynaecologists can now perform many operations endoscopically. The advantages to the patient are manifold. Previously these operations required major surgery with high pain levels, higher complication rates, long hospitalisation and slow return to normal working activities. With laparoscopic surgery, pain levels are much lower, enabling early discharge from hospital and speedy return to normal activities. When skilled operators perform these procedures, complication rates are lower than with traditionally open surgery.
Endoscopy performed by skilled gynaecologists can improve the diagnosis and management of many gynaecological conditions without impacting unnecessarily on daily activities.
Gynaecology
VITALAB offers a fully integrated medical, scientific and counselling facility dedicated to the diagnosis and treatment of couples experiencing fertility problems or other aspects of reproductive failure. These facilities include infertility evaluation, hormonal assessment and endoscopic procedures. The full range of assisted reproduction technologies is also available.
In Vitro Fertilisation
Originally developed to help women with irreparable damage to their fallopian tubes, IVF (In Vitro Fertilisation) is now used for many other disorders including endometriosis and low or poor sperm quality. The technique involves removing several eggs from the ovary, fertilising them in the laboratory with sperm from the male partner, and transferring the resulting embryos to the womb for implantation and pregnancy. 
GIFT (Gamete IntraFallopian Transfer) is also available for specific fertility problems. It differs from IVF because the eggs collected from the ovary are transferred back to the fallopian tube almost immediately after collection together with a small sample of sperm. The technique requires a general anaesthetic and a laparoscopy.
The techniques of Intracytoplasmic Sperm Injection (ICSI) have revolutionised the treatment of the most difficult cases of male infertility. It makes use of sophisticated microscopes and 'micromanipulators'. A human egg is injected with a single sperm using a very fine needle (which is fourteen times finer than a human hair). The technique can be successfully used to treat men who have very low sperm counts or sperm of such poor quality that the chances of spontaneous conception or fertilisation at the time of IVF are not realistic. The technique has been further refined to treat men who not only produce poor quality sperm, but also those who do not ejaculate sperm due to a blockage, or other testicular disorder where the testes produce sperm in such small numbers that they do not appear in the ejaculate. These sperm may be retrieved from the testis by needle aspiration or biopsy.
VITALAB specialises in the latest technologies surrounding embryo cryopreservation and micromanipulation utilising Intra Cytoplasmic Sperm Injection. Sperm recovery techniques for the most severe forms of male infertility and electrostimulation for ejaculatory failure are also available.
See our Services for Men for more information
VITALAB also offers the following
Availability of Medical Staff, Programme Co-ordinators and Embryologists seven days a week.
Transvaginal ultrasound equipment.
You should not undergo treatment with clomiphene or injectable fertility medication unless this equipment is available for routine monitoring. If intra-uterine insemination is being planned, ultrasound monitoring is required to accurately time insemination.
An on-site laboratory to do semen evaluation and sperm preparation for insemination, post-coital tests, as well as advanced facilities for IVF and micromanipulation of oocytes.
Patient Counseling
Support for the greater variety of life’s challenges invariably comes from family, friends and colleagues. However, for those who are experiencing fertility problems, these avenues of support are often excluded for reasons of privacy or more often, the growing awareness of the general lack of understanding and sensitivity in this area.
Experience in fertility problems has shown that supportive counselling must be readily available and encouraged from the beginning of the process.
At VITALAB the couple is treated as the patient. We have trained support therapists, both inside and outside our consulting rooms who deal with the issues of distress, anxiety and the sense of loss fertility problems can create.
We feel it is important to normalise these feelings and to harness alternative coping skills to enable the couple or individual to move forward towards a more positive outcome.
Semen Banking
Vitalab offers cryostorage (freezing) of sperm for patients with sperm production problems, prior to chemotherapy, prior to a vasectomy and prior to treatment by drugs which may affect fertility.
Support Program
Do you feel:
· Lonely and isolated at times?
· That no-one understands how difficult infertility can be?
· That everyone else is having babies?
· That infertility is affecting your work and your personal relationships?
· Out of control of your body and/or your life?
· Unreasonably angry or impatient with others?
· That holidays and coping with family and friends are becoming increasingly difficult?
Vitalab offers in-house counselling and ongoing support for our patients. If further in-depth counselling is required we have experienced therapists to whom we can refer you.
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