Browsing by Author "Dyer, Silke"

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    Medicine and the Arts Week 4 - Birth and creativity
    (2015-01-21) Dyer, Silke
    In this video, gynaecologist and fertility specialist Silke Dyer speaks about the physiological processes of human reproduction, and some of the creative solutions in assisted reproductive technology (ART) to help infertile couples conceive. This is the fourth video in Week 4 of the Medicine and the Arts Massive Open Online Course.
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    Medicine and the Arts Week 4 - In dialogue about creativity
    (2015-01-21) Reid, Steve; Dyer, Silke; Bonnici, Francois; Baghai-Wadji, Alireza
    In this video, Steve Reid poses additional questions to Alireza Baghai-Wadji, François Bonnici, and Silke Dyer around the topic of creativity. Silke taslks about new developments in reproductive health, François comments on how to create new ways of thinking to tackle complex problems, and Alireza discusses how the biological conception in humans is analogus to the creation of new ideas. This is the fifthvideo in Week 4 of the Medicine and the Arts Massive Open Online Course.
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    Out of pocket payment for assisted reproductive techniques: How to households recover?
    (2017) Vinoos, Latiefa; Dyer, Silke
    Introduction: The cost of ART remains amongst the most prevalent barriers to treatment, especially in resource limited countries where many people are poor and inadequately covered by private and public health insurances. This study aims to assess the financial consequences of out of pocket payment for ART in the South African setting and the ability of couples to financially recover. Methods: A prospective follow-up study was carried out at the Infertility Clinic of the Reproductive Medicine Unit, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town. All 135 participants from the original study were invited to participate with no exclusion criteria. A six part questionnaire, developed for the original study, was adjusted to assess recovery from out of pocket expenditure for ART. Indicators of recovery included the recuperation of savings, settlement of debt and reacquisition of sold assets. Persistence of coping strategies such as reduction in spending and additional work was also assessed. Results: A follow-up rate of 54% percent was achieved. The minimum and maximum follow up period was three and five years respectively. Nineteen percent of couples reported complete financial recovery, assessed as the recovery of savings, repayment of all debt and recovery of a sold asset. Forty percent of couples were unable to settle their debt incurred during the original study. The average amount still owed was R 7 750 (SD R5 140). At follow up, 75% of couples who had reduced expenditure to offset the original cost of ART were still reporting a reduction in expenditure while 39% were still engaged in additional work. The majority of couples reporting difficulties at the time of follow up in paying bills or for basic amenities and healthcare were from the poorest socioeconomic tertiles with 64% of all couples indicating that they were not coping financially at the time of follow up. Conclusion: This study documented a long-lasting impact of OPP for ART among all HH but especially among the poorest. Given the high prevalence of infertility, its impact on individuals, couples and communities, the associated mental, emotional and financial consequences, and existing barriers to adequate and affordable treatment should be minimised as South Africa is moving towards the implementation of a national health system.
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    Out-of-pocket payment for assisted reproductive techniques in the public health sector in South Africa - how do households cope?
    (2011) Sherwood, Kerry Anne; Dyer, Silke
    In South Africa assisted reproductive techniques (ART) are poorly covered by health insurances or government funding thereby often inflicting out-of-pocket payment (OPP) on patients. This can create treatment barriers or high financial burdens for households, with unknown consequences of the latter. This is the first study from South and sub-saharan Africa which explores the impact of ART-related OPP on households. The study was undertaken at Groote Schuur Hospital, Cape Town, where ART is subsidized but patients have to contribute to the cost of treatment. Eighty six consecutive IVF/ICS/ cycles were prospectively analysed through patient interviews. Data included socio-demographic, economic, and infertility information, emotional and financial stress among participants, as well as coping and financial strategies adopted by households. In keeping with international recommendations, catastrophic expenditure was defined as a direct cost of all ART cycles in the last 12 months equal to or exceeding 40% of the annual non-food households expenditure.
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    Outcome of assisted reproductive technology in women with poor ovarian response undergoing infertility treatment in the reproductive medicine unit of Groote Schuur hospital: a five-year review
    (2020) Senaya, Charles M; Pate, Malika; Dyer, Silke
    Background: Poor response of the ovaries to gonadotropin stimulation is associated with poor outcome following in vitro fertilization. The historical lack of a standard definition for poor ovarian response has resulted in a wide variation in prevalence and outcome measures. More recently, the Bologna criteria has emerged as the standard for identification of poor ovarian responders. There is paucity of literature on poor ovarian response in the African setting. This study was conducted to document the prevalence and the outcome of in vitro fertilization among poor ovarian responders in women undergoing assisted reproduction technology in the public sector of Western Cape Province of South Africa. Method: Retrospective review of data of women who underwent assisted reproduction technology between January 2011 and December 2015 was conducted. The Bologna criteria was used to identify women for inclusion into the study. For the analysis of prevalence and treatment outcomes, only a woman's first cycle at the Groote Schuur Hospital was included, however the occurrence of further cycles was recorded. Main results: A total of 40 women met the criteria for poor ovarian response in this study. The prevalence of poor ovarian response was 3.6%. The mean age among the study population was 37.8years (25 – 42yrs). Cycle cancellation rate due to poor ovarian response was 15.0% and the average number of eggs retrieved was 1.8. Twenty-four (60%) women had at least one embryo transferred. The clinical pregnancy and live birth rates were 10.0% and 5.0% respectively, per cycle initiated. Half of those with failed IVF due to poor ovarian response withdrew from the program. Conclusion: The prevalence of poor ovarian response among women who underwent assisted reproduction at Groote Schuur Hospital was 3.6% which is low compared to 9-24% reported in other studies. The clinical pregnancy and live birth rates were low. Half of the women did not continue with treatment after their first failed IVF cycle.
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    Psycho-social apsects of Turner Syndrome : a qualitative study
    (2008) Matebese, Nomathamsanqa Thandeka; van der Spuy, Zephne Margaret; Dyer, Silke
    Includes abstract. Includes bibliographical references (leaves 53-57).
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    A qualitative study exploring the fear of childbirth experienced by parous women in the Cape Town public obstetric service
    (2008) O'Callaghan, Kendall Jane; Dyer, Silke
    The aim of this study was to explore the nature of fear experienced by a group of pregnant women utilizing the Cape Town public obstetric service who reported having severe fear of childbirth. The study was undertaken at antenatal clinics within the Peninsula Maternal and Neonatal Service in Cape Town. The subjects included fifteen pregnant women, 21 years and older, irrespective of gestation, who previously carried one pregnancy to at least 28 weeks gestation regardless of pregnancy outcome and who reported severe fear of childbirth in their current pregnancy (defined for the purpose of this study as a score of 7 or more on a visual analogue scale for fear).
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    Systematic review: Availability, effectiveness and safety of assisted reproductive techniques in Sub-Saharan Africa
    (2018) Botha, Barend HJ; Dyer, Silke; Shamley, Delva
    STUDY QUESTION: What is the evidence pertaining to availability, effectiveness and safety of assisted reproductive technology (ART) in sub-Saharan Africa? SUMMARY ANSWER: According to overall limited and heterogeneous evidence, availability and utilization of ART are very low, clinical pregnancy rates largely compare to other regions but are accompanied by high multiple pregnancy rates, and in the near absence of data on deliveries and live births the true degree of effectiveness and safety remains to be established. WHAT IS KNOWN ALREADY: In most world regions, availability, utilization and outcomes of ART are monitored and reported by national and regional ART registries. In sub-Saharan Africa there is only one national and no regional registry to date, raising the question what other evidence exists documenting the status of ART in this region. STUDY DESIGN, SIZE, DURATION: A systematic review was conducted searching PUBMED, SCOPUS, AFRICAWIDE, WEB OF SCIENCE and CINAHL databases from January 2000 to June 2017. A total of 29 studies were included in the review. The extracted data were not suitable for meta-analysis. PARTICIPANTS/MATERIALS, SETTING, METHOD: The review was conducted according to PRISMA guidelines. All peer-reviewed manuscripts irrespective of language or study design that presented original data pertaining to availability, effectiveness and safety of ART in sub-Saharan Africa were eligible for inclusion. Selection criteria were specified prior to the search. Two authors independently reviewed studies for possible inclusion and critically appraised selected manuscripts. Data were analyzed descriptively, being unsuitable for statistical analysis. MAIN RESULTS AND THE ROLE OF CHANCE: The search yielded 810 references of which 29 were included based on the predefined selection and eligibility criteria. Extracted data came from 23 single centre observational studies, 2 global ART reports, 2 reviews, 1 national data registry and 1 community-based study. ART services were available in 10 countries and delivered by 80 centres in 6 of these. Data pertaining to number of procedures existed from 3 countries totalling 4619 fresh non-donor aspirations in 2010. The most prominent barrier to access was cost. Clinical pregnancy rates ranged between 21.2% to 43.9% per embryo transfer but information on deliveries and live births were lacking, seriously limiting evaluation of ART effectiveness. When documented, the rate of multiple pregnancy was high with information on outcomes similarly lacking. LIMITATIONS, REASONS FOR CAUTION: The findings in this review are based on limited data from a limited number of countries, and are derived from heterogeneous studies, both in terms of study design and quality, many of which include small sample sizes. Although representing best available evidence, this requires careful interpretation regarding the degree of representativeness of the current status of ART in sub-Saharan Africa. WIDER IMPLICATIONS OF THE FINDINGS: The true extent and outcome of ART in sub-Saharan Africa could not be reliably documented as the relevant information was not available. Current efforts are underway to establish a regional ART data registry in order to report and monitor availability, effectiveness and safety of ART thus contributing to evidence-based practice and possible development strategies. STUDY FUNDING/COMPETING INTEREST(S): No funding was received for this study. The authors had no competing interests. TRIAL REGISTRATION NUMBER: PROSPERO CRD42016032336
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    The status of assisted reproductive technology in the public health sector in Africa – a multi-country survey
    (2022) Majangara, Karaga Rumbidzai; Dyer, Silke
    Introduction: It was presumed that most Assisted Reproductive Technology (ART) centres in Africa existed in the private sector. Over 80% of the South African population accessed medical care at public rather than private institutions; hence availability of a health service in both private and public institutions would ensure equitable access to care. Objectives: To determine the availability and utilisation of ART services in the public sector in African countries; and the facilitators and barriers towards service provision. Methods: A mixed methods internet-based cross sectional survey was conducted in Africa in 2 phases. Countries providing ART in Africa were identified from the African Network and Registry of ART (ANARA) database and International Federation of Fertility Societies (IFFS) surveillance report 2019. For phase 1, purposeful sampling of key informants (leaders of fertility societies; contributors to ANARA and IFFS report) was done. Phase 1 participants identified and referred participants for Phase 2, ie- a fertility expert (clinician/ embryologist/ nurse) currently providing ART or previously involved in the establishment or running of a public ART centre. Data were collected via a mostly structured questionnaire (phase one); and semi-structured questionnaire followed by an interview via zoom or WhatsApp calling (phase 2). Data were analysed descriptively based on the principles of grounded theory for qualitative research. Results: Phase 1: participants from 17/27 (63.0%) countries known to provide ART responded. Data for South Africa were obtained from the South African Registry of ART (2019). Public sector ART was available in 10/18 participating countries (55.6%) and 10/16 (62.5%) countries that provided ART. Few of the reported African ART centres were public 24/185 (13.0%). Utilisation of ART was low, < 500 ART cycles per annum, in 13/15 public centres where utilisation was reported. Phase 2: Questionnaires were returned from 6/10 (60%) countries with public ART services and 13/24 (54.2%) identified public ART centres. 8 interviews were done; Nigeria (4), SA (2), Tunisia (1), and Benin (1). Centres mostly agreed there had been local research showing a high burden of infertility requiring ART and the need to help couples that could only access health care in public centres. Patient eligibility criteria for access to ART were utilised variably by 10/13 public centres. The government/ university hospital heavily subsidised ART. Out of pocket co-payments were unavoidable in all centres. The number of ART cycles per annum appeared inversely correlated to the co-payment. The top 3 barriers to ART in the public sector were lack of policy/ legislation; high costs; and bureaucracy. The top 3 measures to promote access to public ART were government buy in, minimising costs and minimising bureaucracy. Conclusion: Public ART services were available in Africa, but restricted and riddled by many challenges. Funding was the biggest challenge. Adopting measures that reduced copayments was associated with higher utilisation of services.
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    Trans-vaginal ultrasound diagnosis of adenomyosis with histologic correlation
    (2013) Chunda, Reginald George; Dyer, Silke; Stewart, Chantal
    Adenomyosis, defined as the presence of ectopic endometrial tissue in the myometrium, is a cause of morbidity in afflicted women. Classically it presents with menorrhagia, dysmenorrhoea and dyspareunia. Traditionally the diagnosis has been by histology of post-hysterectomy specimens with reported prevalence of 5%-70%. With advances in imaging techniques, pre-surgical diagnosis can be made with a reasonable accuracy using trans-vaginal ultrasound (TVS) and magnetic resonance imaging (MRI) with the former being preferred due to cost effectiveness. Accurate presurgical diagnosis would facilitate alternative treatment options to hysterectomy. Different sonographic features of adenomyosis have been reported and well correlated with histology; there is however no general consensus as to the most specific features and whether the frequencies of these sonographic features hold true in other population settings like South Africa. We therefore conducted a cross-sectional diagnostic study of presurgical TVS diagnosis of adenomyosis with post-hysterectomy histological correlation. The primary objective was to determine the diagnostic performance of TVS for the diagnosis of adenomyosis using posthysterectomy histology as the reference standard. Secondary objectives were to determine the signs and symptoms in women with histologically confirmed adenomyosis and the prevalence of histological adenomyosis. The study was conducted at Groote Schuur Hospital and New Somerset Hospital over a period of 11 months (May 2011 to April 2012). There were two study groups. In study group A, women scheduled for hysterectomy completed a questionnaire capturing clinical symptoms and underwent TVS examination. A TVS diagnosis of adenomyosis was made if three or more features suggestive of adenomyosis were present. After hysterectomy, the uteri were examined by histopathologists. Both ultrasonographers and histopathologists were blinded to other findings. The TVS diagnosis of adenomyosis was compared with histopatholgy results. In study group B, histopathological results were collected prospectively in all women undergoing hysterectomy during the study period (including those in study group A). From the results, a histopathological profile of posthysterectomy specimens was made. There were 78 participants in group A. Histologically confirmed adenomyosis was found in 16 of the 78 women (20.5%). Seventy one clinical questionnaires were completed (missing data n=7). The only clinical finding that reached statistical significance was presence of a tender uterus in 31.5% of women with adenomyosis compared to 5.4% without adenomyosis (p<;0.05). Other clinical features seen in women with adenomyosis were heavy menstrual bleeding (62.5%), dysmenorrhea (50%) and a uterus that was less than twelve weeks gestation (62.5%) but these findings did not reach statistical significance compared to women without adenomyosis (p>0.05). Despite presence of characteristic signs and symptoms, a preoperative clinical diagnosis of adenomyosis was made in only 12.5% [95% CI: 3.5 - 36] of patients with histologically confirmed adenomyosis. TVS diagnosis of adenomyosis had a sensitivity of 50% [95% CI: 28-72], specificity of 80.6% [95% CI: 69.2 -88.6], accuracy of 74.4% [95% CI: 63.7- 82.7] and diagnostic odds ratio of 4.2 [95% CI: 1.3-13.4]. Of all TVS diagnostic features evaluated, heterogenous myometrial echotexture had the highest sensitivity 68.8% [95% CI: 44.4-85.8] but a poor specificity 62.9% [95% CI: 50.5-73.8]. The presence of subendometrial echogenic linear striations had the highest specificity 96.8% [95%CI: 89-99] and accuracy 78.2% [95% CI: 67.8-85.9] for the diagnosis of adenomyosis. TVS diagnosis of adenomyosis was ultrasonographer dependent. Study group B comprised 261 women. Leiomyomas were the most prevalent histopathological diagnosis (63.2% ; 95% CI: 57.2-68.4), followed byadenomyosis with a prevalence of 20.3% [95% CI: 15.9-25.6]. Data from this prospective study showed that a clinical presentation of menorrhagia, dysmenorrhea and a tender uterus less than twelve weeks suggested a diagnosis of adenomyosis. Despite characteristic signs and symptoms, clinicians only diagnosed adenomyosis in about one in ten women.