SCIENCE AND NATURE: Embryologist Roxy Gentis prepares to examine an egg under micron-telescope while Dr Sascha Edelstein, the fertility specialist, watches. Christiaan Barnard Hospital has opened a fertility clinic on Loop Street,in Cape Town. Picture: Thomas Holder
Infertility treatment has not been prioritised in the country, with limited resources allocated to only two government-funded academic hospitals providing infertility services.

This according to Dr Zozo Nene, a local reproductive medicine specialist, who said that to adequately address the problem of infertility in the country, serious focus needed to be put on service delivery, training and research.

According to the World Health Organisation (WHO), more than 180 million couples in developing countries (one in every four couples) suffer from primary or secondary infertility. In Sub-Saharan Africa infertility is caused by infections in more than 85 percentof women compared to 33 percent worldwide.

The Infertility Awareness Association of SA (IFASSA) estimates that one in six couples in the country battle with infertility.

The organisation explained that about one-third of infertility cases are owing to female factors; one-third are owing to male factors; and the remaining one-third are owing to a combination of male and female issues.

Infertility is a disease of the reproductive system defined by the failure to achieve pregnancy after regular, unprotected sexual intercourse.

Nene said that patients were diagnosed as having infertility after a period of more than 12 months of trying to conceive if the women were over 35 years old.

“In the context of SA, well over 70 percent of the population is reliant on public health services and the medical training is mostly, if not solely, done in by and in the public health arena, both undergraduate, specilisation and super-specilisation...

“There is a scarcity of fertility specialists and embryologists in the country both in the public and private sector,” Nene said.

The two government hospitals (Steve Biko Academic Hospital in Pretoria and Groote Schuur Hospital in Cape Town) are also aided by the fact that Tygerberg Hospital and Universitas Hospital also offer infertility service through public/private partnerships.

But even with four public hospitals, it isn’t enough.

“The government must recognise that infertility is a disease.

“The WHO has defined infertility as a disability (an impairment of function). They (WHO) have declared that access to health care for infertility treatment falls under the Convention on the Rights of Persons with Disability.

“A” reduction of costs of intervention and increasing access to infertility services across racial boundaries are possible initiatives,” she said.

For years, infertility has been somewhat a taboo subject, something that people hid from the world and did not talk about.

As part of Reproductive Health Month 2017, IFAASA not only encourages couples to seek help to ensure a proper diagnosis and make an informed decision, but also for the general population to educate themselves about infertility and to remember that pregnancy is a privilege that not every couple is afforded.

“Everyone needs to be supportive of these families and couples struggling with infertility, because they are going through a huge emotional and financial challenge,” said Meggan Zunckel, the chief executive of IFAASA.

Nene echoed these sentiments saying that many other misconceptions of infertility were that included that it was “only the problem of the woman”.

“Families therefore blame the woman for the inability to fall pregnant.

“There are a lot of undiagnosed male factors. Some patients believe they are bewitched and spend a lot of money with sangomas and present to fertility clinics late, or others think that fertility treatments will result in abnormal babies,” Nene added.

While the cost of infertility treatments differ according to the procedure done, Nene said they range from R5 000 to R80 000 – the cheapest being ovulation induction and timed intercourse. The most expensive being Intracytoplasmic sperm injection (ICSI) and embryo biopsy.

Zunckel said that all infertile couples who exhibited the warning signs for infertility deserved a full diagnostic investigation with a fertility specialist no matter what age they presented with these warning signs.

“We currently sit with a situation where patients in their 20s and 30s are told to just relax, go on holiday and be patient as they are too young to be fertile.

“The reality is that women and men well under 40 are also distracted by the physical, financial and emotional hardships of this disease.

“Infertility is more than a disease; it is a devastating life crisis which can greatly impact the health, relationships, job performance and social interactions,” said Zunckel.

Nene advised couples diagnosed with infertility to consider:

The cause of infertility, and if it can be treated surgically or with assisted reproduction technology (ART).

If no treatment can be offered to consider:

  • Gamete domation
  • Surrogacy
  • Adoption
  • Accept their condition and find ways to move on
  • They should not delay seeking treatment for infertility from fertility specialists.
  • Financial implications of the treatment.
  • Understand that there is no guarantee.
  • Possibility of failed fertility intervention(s).
  • There is a possibility of medical complications before, during and after the birth for the baby.
  • They must have adequate emotional support.
  • Discuss issues of ownership of embryos should the couple divorce.
  • Understand that there are safer conception options for people living with HIV.

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