Cape Town – For couples who can’t conceive naturally, in vitro fertilisation (IVF) can cost thousands.
That may be changing.
Cecilia Biyela* is a 31-year-old mom from Nyanga, Cape Town, who struggled for eight years to fall pregnant.
Apart from her painful longing for a child of her own and feelings of inadequacy for not being able to conceive, Cecilia’s infertility also strained her marriage: “It was bad. We used to fight every day,” she admits.
Her self-esteem plummeted as she faced scornful labels such as idlolo (barren) and stjoekoe (failure).
After almost eight frustrating and tension-filled years, Cecilia and her husband Victor* opted for IVF – a medical procedure in which a woman’s egg and a man’s sperm are combined in a laboratory and then planted in the woman’s womb to increase her chance of pregnancy.
On their second try, she became pregnant and, just over a year ago, their son was born.
“I couldn’t be happier,” says Cecilia. “He is everything to me.”
While she says her marriage has improved since the birth of their son, she still fears judgment from her community about her infertility and does not want people to know she did not conceive naturally.
The inability to conceive could have a serious impact on the psychological well-being and social status of women, according to UCT Professor Silke Dyer, who studied the emotional and social experiences of women and men visiting an infertility clinic in Cape Town.
In the study, women reported being sworn at and physically abused by partners while in-laws shunned them. Most women interviewed by Dyer felt desperate, intensely lonely – and even suicidal.
Men reported feelings of sadness, isolation and inadequacy.
Dr Jack Biko, a gynaecologist at the Netcare Femina Hospital in Pretoria, says infertility often results in extramarital affairs, polygamy and divorce.
“Patients often feel pressure, guilt, shame, diminished self-esteem, indulge in self-blame, then isolate themselves or overcompensate,” said Biko.
“The family often adds pressure, humiliates and discriminates against these couples.”
Infertility in developing countries is on the rise and almost double that of affluent countries (15 percent). According to the World Health Organisation, the most common causes of infertility in Africa are untreated sexually-transmitted infections (STIs) and complications from past pregnancies.
Untreated STIs like gonorrhoea and chlamydia can damage a woman’s fallopian tubes, making it difficult for sperm to reach her ovaries. Other infections that spread to the pelvic area, like tuberculosis, can also result in infertility.
But couples interested in IVF, which is not covered by medical aids, are often met with a hefty price tag few can afford.
At a private clinic, you can expect to pay between R25 000 and R35 000 for one IVF treatment, and although there are some treatment options offered at state facilities, most will still charge tens of thousands for treatment.
But there is another option for couples on a budget.
Dr Thabo Matsaseng used to have a successful private gynaecological practice in KwaZulu-Natal but he became frustrated that he couldn’t assist patients with infertility.
“In my practice, I saw many women struggling to conceive,” said Matsaseng. “I witnessed their battles and desperation, and it frustrated me that I couldn’t do anything except refer them with a hope that they would get the necessary assistance.”
He knew many of them would not be able to afford IVF, so in 2008 he left his private practice and went back to university to specialise in infertility to figure out a way to help these couples.
Today, Matsaseng is the head of the Reproductive Medicine Unit at Stellenbosch University’s Faculty of Medicine and Health Sciences. He has developed a novel model through which he and his team are able to offer IVF services for about R6 000 at Tygerberg Hospital’s fertility unit.
“It’s a paradox that in a developing country, where there are so many children without parents, you want to offer cheap IVF,” said Matsaseng.
“But the impact of infertility among this group of women can be catastrophic, and it is paramount to establish at least some sort of system that is not too expensive so that people are able to access treatment and to try to minimise the stigma around infertility.”
He started by taking a critical look at the process of IVF treatment to see where they could reduce costs. First, they cut down on human resources and took more responsibility to save money that would have gone towards staff salaries.
Instead of having an IVF co-ordinator to book and confirm appointments, they communicate with patients using SMS. Through a public-private interaction with the Aevitas Clinic in Pinelands in Cape Town, they save on the price of consumables and certain laboratory services.
He also made some changes to the treatment process. Generally a patient would receive a large amount of hormone therapy to produce as many eggs as possible, but in Matsaseng’s model, lower doses of hormone therapy are used. The lower doses cut costs but still produce a sufficient number of eggs.
When harvesting the eggs, he uses local anaesthesia and conscious sedation instead of placing the patient under anaesthesia that requires theatre time and an anaesthetist.
At almost a quarter of the price of private IVF, Tygerberg Hospital’s fertility unit’s success rate is between 25 and 30 percent in comparison to the 35 to 40 percent achieved by their private colleagues.
The low-cost IVF programme at Tygerberg Hospital has been running for more than four years, and they service around 100 to 120 patients per annum.
But even at that low cost, it is still not accessible to everyone, and Matsaseng is continuing to look for ways to save costs and perfect an IVF business model that could be rolled out to underserved communities. – Health-e News
*Names changed on request
The Star