Single women and fertility treatment: a specialist answers all our questions
Many women are opting for single parenthood by choice. Luckily, fertility treatment has been able to award them the gift of motherhood without worrying about finding a partner.
Dr Wiswedel, a pioneer of fertility treatment in South Africa, kindly agreed to answer the most frequently asked questions many women have.
After heading the infertility unit at Groote Schuur Hospital for 10 years, Dr Wiswedel founded the private Cape Fertility clinic in 1993, with a highly successful international egg donor programme. We chatted with him in his office at HART Fertility Clinic to learn about infertility and how it's treated.
Also read: Fertility clinics in South Africa
Dr Wiswedel, what does your job entail?
I'm a fertility management specialist. You first have to become a gynaecologist and train for a few years in fertility. Then you can call yourself a fertility specialist or a specialist in reproductive medicine.
Do you just see women until they conceive or do you see them throughout their pregnancy?
You only go to a specialist to conceive. I look after patients until they are about 8 weeks pregnant and then they go to their referral gynae. We don't do deliveries [chuckles] – I don't have to get up at 3 o'clock to deliver babies. No late calls and usually no action at night.
When someone opts for fertility treatment, do they have to undergo any psychological assessments to see if they're ready for parenthood? There's a perception that that should be the case.
We don't victimise infertility patients at all. People who are able to conceive without the aid of fertility treatment do not have to go through any tests, so why must infertility patients go through that? If we see that the patient has problems with coping, we'll refer them to a psychologist, but no, it is not a routine for them to undergo any tests. Why should they? It's not fair, is it?
Do you feel the same about single women who opt for motherhood through sperm donors?
I think it's very sensible, I don't see any problem with women going for that. Look, first we'll run tests, but it's to see if they're healthy and to see if she knows what she's embarking on. But no, no need to go see a psychologist. There's also a stigma about seeing a psychologist, people will think you're calling them crazy!
I recently read a story about a 29-year-old pregnant virgin. People were very judgmental about her decision. What are your thoughts? If you were faced with a similar case would you be comfortable with performing that procedure?
Yes! I wouldn't have any reservations at all. It's everyone and every woman's prerogative to have a baby and also her prerogative to terminate her pregnancy. Why must I tell a woman to not have a baby? "You're 29, go get a boyfriend." That's none of my business.
Would the fact that she's a virgin cause any complications during birth?
No, not at all.
How many single women have you treated in your career?
I did my first IVF pregnancy in 1982. So I have seen a lot of women and a lot of single women during these years.
If I think of the number of single women I've treated, most of them have not told me that they're gay. And some are in their late stage in their life (their late thirties or forties) and haven't found the men of their lives yet but really want to have a baby now, irrespective of a man. That's probably the biggest group.
South Africa has become very liberal over the last few years, much more than it was before. Before, if you treated a gay couple, everybody was up in arms. Now, it's perfectly acceptable. I also think that people's personal opinions are changing as well. But that's only in the urban areas. If you go to the countryside, things tend to still be very old fashioned and intolerant.
So, I don't commonly see a lot of young women, but when I do, most of them belong to the gay community.
Which procedure is popular among single mom patients?
We always do what is indicated. If she's healthy with no complications, we'll opt for artificial insemination. We'll inseminate her with sperm from a donor during ovulation. She can choose her donor, blond and blue eyed, dark and handsome... if there are additional fertility problems, then we will use IVF.
- Also read: Artificial insemination (IUI): how it works
What do you need to prepare for the procedure?
So you don't need two months or anything like that?
You wait for a period to start and then start with the treatment.
So, fun fact: according to my period tracker, I'm ovulating. If I came to you right now and said "Doctor, I want to be a mom. Here's the money, here's my little vile of sperm... let's do this!" What would happen?
No no! [chuckles] Then I'd say no! Especially if you come with a vile of sperm. You have to understand that the donors are also checked. They're screened for viruses, infections and genetic history of health complications. And we have to see if the sperm is healthy. We have to make sure it's good-quality sperm.
Do you screen eggs like you do sperm?
Not really, because there isn't a large turn-out of egg donors.
Although now lots of women in their thirties are saying, "I've got a big career ahead of me and I want to sort that out first and only have a baby in my forties." So they freeze their eggs in their early thirties so they have the same chance of a 30-year-old woman to fall pregnant later in life.
Also read: So what's the deal with donating eggs?
Women are normally told to start panicking after the age of 30. Would there be any complications if a 40-year-old woman fell pregnant with the eggs she froze earlier in life? We're conditioned to believe that pregnancy is a big problem after 40.
The carrying of a child is not a problem. If you're a healthy woman you can carry a child after the age of 30, 40 it makes no difference. After the age of 50, there could be slight complications but it shouldn't be a problem. The chance of falling pregnant depends on the age of the egg, not the woman.
The normal chance of a woman to fall pregnant during her cycle at the right time is less than 20%. Now IVF makes it 50%.
How many eggs do you implant?
No more than two.
Why do you think there's pressure for women to fall pregnant?
That I cannot say. Background, tradition, demographic.
Women are also told that if you use oral contraception for a long time, you will not be able to conceive easily after you get off it...
That's not true. If you go off the Pill, the chances of falling pregnant are almost immediate. But the injection – very popular in rural areas – the injection is highly dosed so it may take the woman's cycle some time to regulate.
Has fertility treatment for single women gained popularity in the last few years?
I think when I started, the only clinic in Cape Town was Groote Schuur. And there the stigmas abounded. Everyone had an opinion about fertility. As people are becoming more accepting and understanding, the patients are now increasing.
I recently opened a clinic in Namibia – those patients no longer have to come to South Africa anymore. They have their own clinic. Most of the patients are in their forties and in past times these things were not spoken about because men blamed women for fertility problems.
- Also read: Being an egg donor
Do you think more men are owning up to be the problem too?
Sperm abnormalities are extremely common. Extremely common. They're becoming more common as compared to 20 to 30 years ago.
Environmental reasons could be the reason why this seems to be the case. Before we start infertility treatment in any couple, we check the sperm first. It is harder to treat sperm quality. It's basically hard to increase sperm count, there's no medication that can really do this.
There's a new trend where women are choosing the gender of their kids. Is that gaining popularity in SA?
Most patients are mostly happy to have a healthy child. However, there are some women who want to pick the sex of their child for a number of reasons.
Sex selection is not legal in South Africa. I don't agree with it. I did a study on antenatal women 20 years ago and we devised a questionnaire asking them: if they could choose the sex of the baby, what would it be? And it turned out: women who had children wanted the opposite of what they had. If they were first-time mothers, there was an equal amount of women who wanted a boy to those who wanted a girl. Sex selection makes no difference!
It's also really expensive to do sex selection.
Speaking of which: what procedure is cheaper, IVF or IUI?
Artificial insemination is much, much cheaper, for sure.
- Also read: The IUI (AI) journey
Do you see a lot of couples or single women bring their own donors? Like male best friends, and so on?
It's not uncommon but I haven't seen that many couples do that. In fact, then I'd propose psychological assessment because that person becomes involved. If the donor is anonymous, they sign their fatherly rights away. A known sperm donor is much more complicated.
Finally: how fulfilling has this job been?
It's one of the greatest experiences you can have. The happiness you bring is amazing. There's the trauma that your patients go through as well, and once they fall pregnant, the joy is so satisfying.
Have you seen the children you've helped conceive?
Oh my God! So many. Some of them are in their 20s already. I'll be walking in the mall and a lady will stop me to show me how big their child has gotten and they'll nudge their children and say, "You see this man, you're here because of him!" [chuckles].