1. Natasha Davies Wits Reproductive Health and HIV Institute
A Safer Conception Clinic Fertility Assessment Tool and Case Discussion
Natasha Davies
Wits Reproductive Health and HIV Institute

2. Background Low cost, low technology safer conception service
Infertility suspected in many clients
No male or female fertility investigations
A history-based fertility assessment was needed to help identify couples with possible infertility

3. Fertility Assessment Tool Overview

10. Cases

11. Palesa and Abel* 30 years Living with HIV 2nd visit initiated ART
* Names changed for confidentiality
30 years
Living with HIV
2nd visit initiated ART
Enrolment CD4 = 314
Viral Load 141 after 3/12 on ART
34 years
Living with HIV
On first line ART already
Enrolment CD4=146
VL undetectable

12. Fertility Assessment Concerns Palesa no previous pregnancies
Irregular cycles
> 35 days
Variability > 5 days
Couple trying to conceive for 9 years
Condomless sex at least twice weekly

13. Outcome Paused conception attempts for 3 months
Cycle variability = wide fertile window
Frequent attempts from Day 7 – Day 21 of cycle
No pregnancy achieved in 6 months
Referred for fertility assessment at local hospital

14. Mercy and Phillip* 39 years 50 years Tested HIV negative
* Names changed for confidentiality
Mercy and Phillip*
39 years
Tested HIV negative
50 years
Living with HIV
On first line ART (2008)
Enrollment CD4 = 552
Viral Load undetectable
No living children

15. Fertility Assessment Minor concerns Mercy’s age (39 years)
BMI (28.6 kg/m2)
Mercy had two previous pregnancies
Regular intercourse 1-2 times per week
Always with condoms

16. Outcome 4 visits over 4 months
Advise = condomless sex from Day 13 – Day 16
Conceived on first attempted cycle
Condomless sex for 7 days (11 rounds)
Pregnancy confirmed at 7 weeks

17. Conclusion Usefully alerts clinicians to potential issues
Encourages realistic discussion with couples
Validation process would be worthwhile

18. Acknowledgements
Those who supported development of the tool, especially Dr Okeoma Mmeje, Dr Ian Cooke and Dr Yossi Unterslak
Department of Health and RHI staff who support the safer conception clinic
All the safer conception clinic clients