How do you know a couple is facing infertility challenges?

Infertility is the inability to conceive a child for at least six months or more of continuous, uninterrupted sexual intercourse. Fertility normally declines as a woman ages, from the onset of thirty-three years onwards.



History Taking and Work-up for Infertile Couples

History taking and work-up for infertile couples involves taking a comprehensive history, which may indicate the possible causes of infertility. The key elements to extract include the total duration of infertility and the results of previous tests and examinations. The consultation will include a comprehensive gynaecological examination, looking for possible causes of delayed fertility, counselling regarding special investigations e.g. a hysteroscopy, saline infusion sonography, or a hysterosalpingogram. The benefits and risks of these investigations and the need to possible gynaecological surgery will also be assessed.

Interpreting Semen Analysis Results

Interpreting semen analysis results entails analysing the results of a semen analysis, which involves providing a sample of semen within the comfort of a private room by masturbating into a sterile container, or the provision of a specific condom for collection of semen at home.

Several components are measured during a semen analysis, such as:

  • A pH scale that checks for the amount of acids and bases present in semen.
  • The density of sperm (the exact concentration).
  • Sperm motility and morphology
  • Duration of liquefaction.
  • Number of white blood cells.
  • Vitality of sperm.

Depending on the semen analysis results, additional investigations might be indicated, example blood tests, referral to a Urologist for assessment and discussing the need for possible surgery.

Working with Urologists for referral/assessment of male infertility

A Urologist can assist by assessing causes of male infertility, for example, assessing for varicoceles, retrograde ejaculation, surgery and prescribing certain medications which could improve hormone levels for sperm production.


A hysterosalpingogram is an imaging study designed to determine the shape of the uterine cavity and whether the fallopian tubes are patent or occluded. A hysterosalpingogram relies on the use of a radiopaque dye, which is directly administered into the uterus and viewed extensively using X-ray imaging. The hysterosalpingogram can help to determine if surgery is needed to confirm tubal occlusion and for the possiblity to open the fallopian tubes.

Infertility affecting women involves a complicated work-up, which is done to check for hormonal variations and changes to the structure of the reproductive system.

Saline infusion sonography

A saline infusion sonogram (SIS) or sonohysterogram is a medical procedure to view the inside of the uterus. A specialised computerised system and high-frequency sound waves are used to produce images of the uterine cavity. One can determine if there are uterine polyps, fibroids and distortions to the uterine cavity.


A hysteroscopy is a procedure where direct visualization of the uterine cavity is done using a small camera. One can assess for abnormalities of the womb which can be surgically corrected, for example, resection of endometrial polys, intrauterine adhesions, and fibroids.

Ovulation induction

Ovulation induction is a specialised medical treatment that enhances ovulation patterns by helping the ovaries make an egg (oocyte) or eggs with each monthly cycle. Typical treatments include oral medicine example clomiphene citrate or letrozole and sometimes injectable medication. Ovulation induction needs to be monitored when initially started to ensure that not too many eggs get produced. Ideally, only one egg should be produced per month, but sometimes multiple eggs can be produced with one cycle of ovulation induction.

Intrauterine insemination

By utilising a tiny catheter, sperm can be placed directly inside the uterus. Intrauterine insemination aims to enhance the fertilisation process by selecting the fastest swimming sperm and bringing it closer to the released egg. In certain cases, intrauterine insemination can be offered before the couple embarks on the process of in vitro fertilization.  



1Are women solely the cause of infertility?
Infertility affects both males and females.
2What can cause infertility in men?
The following contributes to infertility in men:
  • Varicoceles occur when the veins within the testicle become enlarged.
  • Testicular trauma affects the health of the sperm, resulting in a reduced number of sperm produced.
  • Treatment of cancer (chemotherapy, radiation therapy and surgery).
  • Underlying medical conditions such as autoimmune disorders, diabetes and forms of infection result in testicular failure.
3How do you usually resolve infertility?
Typical forms of treatment for infertility include medication, surgery and artificial forms of insemination (intrauterine insemination and assisted reproductive technology). There is a demand for fertility care and imaging studies, and few service centres are accessible in the North West province. It's for this reason that patients who require ICSI and IVF will be referred to a fertility specialist who has laboratory facilities for IVF and ICSI.