Browsing by Author "Matsaseng, Thabo"

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    The cost effective IVF strategies in assisted reproduction technology programmes (art)
    (Stellenbosch : Stellenbosch University, 2016-12) Matsaseng, Thabo; Kruger, T. F.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    CHAPTER I Understanding the physiology of oocyte(s) recruited, selected and retrieved in a cycle of assisted reproductive technology (ART) is fundamentally important towards the development of the embryo with great potential for conception and live birth. This is discussed in detail. More important is the interpretation and utilization of the scientific evidence in this chapter to explore less expensive methods of optimizing oocyte quality in mild ovarian stimulation in vitro fertilization (IVF). CHAPTER II Clomiphene citrate (CC) is an inexpensive and safe drug that can be used alone or in combination with gonadotropins in IVF. Clinical outcomes in different IVF treatments using CC were reviewed and discussed in detail. The major concern regarding CC in ART is the risk of premature luteinizing hormone (LH) surge with subsequent detrimental effect on the oocyte quality. This issue is discussed with outlined strategies (inexpensive) to minimize the risk. CHAPTER III The effective methods to prevent premature LH surge in ART include gonadotropin releasing hormone antagonists (GnRHa) and gonadotropin releasing hormone agonists (GnRH). But these methods are expensive and unaffordable in resourcelimited countries. We therefore performed a randomised controlled trial to evaluate a simple method of prolonged usage of CC as a strategy to prevent premature LH surge in ART treatment. The protocol is described in detail. The trial showed that prolonged usage of CC did not suppress premature LH surge in mild ovarian stimulation ART. But it motivated us to explore other inexpensive strategies for lowering the risk of premature LH surge such as pre-treatment with oral contraceptives, the use of tamoxifen and the use of progesterone during ovarian stimulation. CHAPTER IV Stellenbosch University https://scholar.sun.ac.za In our endeavour to explore strategies to make ART accessible, a public-private interaction (PPI) model is described in detail, highlighting different areas where the cost of IVF can be significantly reduced. They include infrastructure and equipment, personnel, ovarian stimulation protocol (detailed in Chapters II and III) and modification in the laboratory routine regarding oocyte retrieval. CHAPTER V This meta-analysis compared mild ovarian stimulation IVF with conventional treatment in order to counsel patients appropriately. The study showed significantly better outcomes in terms of live birth rates and ongoing pregnancy rates per started cycle, all in favour of conventional stimulation IVF, which therefore currently remains the preferred treatment of choice. CHAPTER VI Understanding the physiology of folliculogenesis has made it possible to integrate mild ovarian stimulation in our unit ART programme at a low cost. (Chapter I) Reassuring clinical outcomes of CC in ART also motivated the unit to maintain low cost of treatment with the use of safe and effective medication. (Chapter II) The finding that prolonged usage of CC does not reduce the risk of premature LH surge has also allowed the unit to maintain the old protocol of 5 days’ use, but motivated us to explore other inexpensive methods. (Chapter III) The PPI model certainly managed to make ART treatment accessible to subfertile couples that would have never had a chance to be proud parents. (Chapter IV) Because this model is feasible and can be implemented at a reasonably low cost, it presents a viable option to make ART accessible in resource-limited countries.
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    A new approach to tubal re-anastomosis in South Africa
    (Health & Medical Publishing Group, 2011-05) La Grange, Jane; Kruger, Thinus; Van der Merwe, Kobie; Siebert, Igno; Viola, Maria; Matsaseng, Thabo
    Contraception by means of fallopian tube sterilisation is the most common method used worldwide, and it is estimated that on average 138 million women of reproductive age are sterilised globally each year. Several studies have indicated that the incidence of tubal re-anastomosis in previously sterilised women is 1 - 2%.
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    Should home-based ovulation predictor kits be offered as an additional approach for fertility management for women and couples desiring pregnancy? a systematic review and meta-analysis
    (BMJ Publishing Group, 2019) Yeh, Ping Teresa; Kennedy, Caitlin E.; Van Der Poel, Sheryl; Matsaseng, Thabo; Bernard, Laura; Narasimhan, Manjulaa
    ENGLISH ABSTRACT: Introduction to inform the WHO Guideline on self-care interventions, we conducted a systematic review of the impact of ovulation predictor kits (OPKs) on time-topregnancy, pregnancy, live birth, stress/anxiety, social harms/adverse events and values/preferences. Methods Included studies had to compare women desiring pregnancy who managed their fertility with and without OPKs, measure an outcome of interest and be published in a peer-reviewed journal. We searched for studies on PubMed, CINAHL, LILACS and EMBASE through November 2018. We assessed risk of bias assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for observational studies, and conducted meta-analysis using random effects models to generate pooled estimates of relative risk (RR). Results Four studies (three RCTs and one observational study) including 1487 participants, all in high-income countries, were included. Quality of evidence was low. Two RCTs found no difference in time-to-pregnancy. All studies reported pregnancy rate, with mixed results: one RCT from the 1990s among couples with unexplained or male-factor infertility found no difference in clinical pregnancy rate (RR: 1.09, 95% CI 0.51 to 2.32); two more recent RCTs found higher self-reported pregnancy rates among OPK users (pooled RR: 1.40, 95% CI 1.08 to 1.80). A small observational study found higher rates of pregnancy with lab testing versus OPKs among women using donor insemination services. One RCT found no increase in stress/anxiety after two menstrual cycles using OPKs, besides a decline in positive affect. No studies measured live birth or social harms/adverse events. Six studies presented end-users’ values/preferences, with almost all women reporting feeling satisfied, comfortable and confident using OPKs. Conclusion A small evidence base, from high-income countries and with high risk of bias, suggests that homebased use of OPKs may improve fertility management when attempting to become pregnant with no meaningful increase in stress/anxiety and with high user acceptability.