SISTER ACT

Biddy Collings and Krina von Mollendorf are two of South Africa's top 21 fertility sisters, nurses who specialise in helping couples achieve the dream of having a baby.

They'll give you hormones, take your blood and monitor your reproductive cycle. They'll schedule your scans and make sure you understand every treatment process. They'll even teach you and your partner how to support each other through the toughest moments on your journey to pregnancy. Above all, they'll hold your hand when your pregnancy test is negative. And, though their hearts will be breaking for you, you won't see them cry. But when your test is positive... well, that's another story. That's the time you might catch one of them shedding a tear.

'They' are South Africa's 21 specialist fertility sisters, the most exclusive group of professional nurses in South Africa today. If your quest to fall pregnant has involved fertility treatment, chances are you know one of these angels personally. Between them, they touch the lives of about 50 000 women every year.

Make no mistake, it's tough for them to keep their emotions under wraps. "When I first started working in fertility I used to go home feeling deeply sad every day," says Biddy Collings, who has specialised in fertility nursing for over a decade, spending the last seven years at Bryanston's Medfem Clinic.

"I can't imagine how hard it must be to go through life without children and even now I often want to weep with a patient, especially if it was her last or only chance," she says softly. "But we're the last stronghold and we have to keep enough distance to contain our patient's emotions."
What helps Biddy and her colleagues cope is the fact that fertility treatment has a high success rate. Generally, it takes an average of three cycles for a woman on treatment to fall pregnant, which can mean three months if she opts for consecutive treatments. Women who take longer than three cycles to fall pregnant are in the minority.

"Just a week ago we had four pregnancies in a row and we were all on a high," says Biddy. "when a couple walks in to get their results, they can sense immediately if it's positive. Then the tears flow, especially among the men, and the whole waiting room buzzes with hope.'

A fertility sister needs distinctive qualities to get her patients through what is always an emotionally charged time. It takes maturity, experience and, above all, a dedicated love of the job. Most of South Africa's fertility sisters have operated professionally in this field for 10 years or more. "If you're not the right person for this job it becomes very draining and you don't last long,"says Biddy. "You learn early on that you can't take every heartache home with you and you learn to keep your personal life separate."

Patience is a key quality. "We have to be available to answer the same questions over and over again. Our patients are particularly vulnerable and the more information they have, the less stressful their treatment," she says. Another abiding quality among these nurses is empathy. "Most of us are mothers ourselves, we understand what our patients yearn for."
It's no surprise that Biddy is something of an expert on her colleagues across the country. Several years ago she initiated informal yet highly effective co-operation between South Africa's 21 fertility sisters by getting them together for their first specialist conference. "We used to learn about new medical advances from our own doctors, but through the conferences we're now learning directly from one another as well. All our patients benefit from this shared wisdom. And, of course, the feedback and support we give one another is invaluable."

With up to 100 patients coming in every day, Medfem is one of the largest fertility clinics in the country and is closed only two days a year: Christmas and New Year's Day. Biddy has the constant support of colleague Krina von Mollendorf. Between them they make sure that each patient remains an individual. Says Krina, "This is an intimate business and some people stay with us for many months. The only way to counsel someone going through fertility treatment is to reach out to them from your heart."

Once a patient has agreed with her doctor on the appropriate course of treatment, the next step is a face-to-face counselling session with one of the fertility sisters. "Very few women understand the physiology and anatomy of their bodies, so our first responsibility is to explain how everything works," says Biddy.

Because of the expense involved and the value of taking every opportunity for a successfid pregnancy, timing is everything, so fertility treatment generally requires daily monitoring. "We deal with the logistics of fitting treatments into the couple's work schedule during our initial counselling session."

In her experience, even when the female is the only partner who has a specific physical role, the emotional roles of both partners are equally essential. "When a woman starts to focus on her inability to fall pregnant, her self-esteem takes a knock and her partner's emotional support is an important reminder of her ongoing viability. Another thing we see is that the quest to have children often isolates couples from their family and friends. No one wants to be constantly faced with the question of whether or not they're pregnant yet, so they tend to withdraw, and that's when they need each other more than ever."

Although dealing with infertility can strengthen a relationship, it is undeniably a very difficult time. Women sometimes unwittingly begin to take the support of their partners for granted, believing that they're carrying the bulk of the emotional burden. The truth is that men get just as anxious, especially if their role is reduced to inelegant tasks such as producing semen samples on demand. It is when the relationship between the couple becomes strained that the fertility sister's ability to remain emotionally detached really counts.

By the time most couples decide they need fertility treatment, they will have been trying to have a baby for six to 12 months. Medfem recommends that, if you don't fall pregnant naturally after a year or if you're over 35, you shouldn't delay seeking professional help. The more flexible and open you are to all options, the more likely you are to have a baby. 'We put patients in the position to make an educated decision. For some the answer is adoption. If you're determined to have a baby you will - how you do so is a personal decision."

Naturally calm and quietly spoken, both Biddy and Krina come across as so secure that it's impossible to imagine either of them in a situation they couldn't cope with. Their contention is that nursing not only attracts this type of character but also develops it.

"Our brand of nursing is no more difficult than any other," says Krina. "It's about life and death, and you learn early on that you simply can't cry every time you feel sad. And although we're the constant thread in the process for most of our patients, we're just two members of a much bigger specialised team. It's the patient who is the hero."

Biddy agrees. "I think we're lucky. We get to experience more of the joy of life than nurses on critical wards do. Ultimately we get to give most of our patients good news."

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Uploaded 04 July 2007, www.cryobank.co.za, editor: Petrus Loubser.

Words
Shirley Fairall.

Photographs
Giséle Wuifsohn.

Source
Fair Lady, 10 April 2002.

Fertility treatment: facts and figures

INCIDENCE
ft is estimated that about 20 percent of women between the ages of 20 and 40 experience fertility problems. Lack of knowledge and high costs mean only a small percentage of them seek specialist treatment.

COSTS
Assisted reproduction can be expensive. All the hi-tech laboratory equipment, materials and medication are sourced internationally and a high level of expertise is involved. One IVF (in-vitro fertilisation) cycle can cost anything from
R 20 000 to R 30 000 and one ICSI (Intracytoplasmic Sperm Injection) cycle anything between
R 30 000 to R60 000+ depending on where you decide to go. Unlike most of the developed world, fertility treatment is no longer subsidised by the South African government. Couples who simply can't afford these prices will go to their local GPs or gynaecologists but, with limited resources and treatment options, their success rate is not as high as a specialist fertility clinic.

SUCCESS RATES
The general success rate for an IVF cycle is 35 percent. This must be viewed against the 25 percent success rate the average young couple with no fertility problems has on their own each month.

MEDFEM CLINIC
Medfem specialises in the full range of hi-tech fertility procedures: intracytoplasmic sperm injection (ICSI), a relatively new procedure where one sperm is injected directly into an egg using a specialised, high-powered microscope known as a micromanipulator; in-vitro fertilisation (IVF); artificial insemination; the use of donor eggs and sperm; and egg or sperm surrogacy programmes. Medfem also runs a donor sperm bank.
Medfem Clinic holds free monthly educational evenings for anyone who is interested in fertility treatment. Couples who attend these sessions before they start treatment benefit hugely because it answers so many of their questions. Family members and friends are also encouraged to attend so they can learn how to offer appropriate support.

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Specialist fertility clinics
in Southern Africa

A specialist fertility clinic is defined as one that has a hi-tech IVF lab and employs a professional fertility sister. There are only 15 such clinics in southern Africa.

Bloemfontein
Universitas Hospital
(051) 405-3385

Cape Town
Paniab Fertility Unit, Panorama Medi-Clinic (021) 930-4433
Aevftas Clinic, Tygerberg Hospital (021) 938-4911
Newlands Fertility Clinic
(021) 674-2088

Durban
Dr BN Naidoo & Dr D Sanker (031) 309-3399

Johannesburg
Medfem Clinic, Bryanston
(011) 463-2244
Vitalab Clinic, Linksfield
(011) 640-5049
Gynomed, Wilgeheuwei Hospital (011) 794-4995
Nordica Clinic Brenthurst
(011) 484-6625

Port Elizabeth
PE Infertility Clinic
(041) 374-2905

Pretoria
Nordica Clinic, Wingatepark
(012) 998-8665xl 22
Wilgers Infertility Clinic, Wilgers Hospital
(012) 807-0299
Infertility Unit, Pretoria Academic Hospital
(012) 354-6209
Femina Clinic, Arcadia
(012) 326-3730

Zimbabwe
Dr Robertson & Dr Sudden, Harare
(09 263 4) 70-6406

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Please note that all information on this page has been reproduced as published in April 2002 by Fair Lady.

Fertility treatment: facts and figures

Specialist fertility clinics in Southern Africa

For a more up-to-date list, visit the following link:

Fertility Clinics & Services
A comprehensive list for South Africa