Medical aid schemes in South Africa may soon be paying for fertility treatment - something unheard of in most countries.

Negotiations between the Board of Healthcare Funders and the Southern African Society of Reproductive Science and Surgery are at an advanced stage, according to the society.

"We already have some stuff in writing and are expecting a reply within the next few weeks," says Dr Paul Dalneyer, chairperson of the society, which represents 180 fertility specialists.

"It's really sad that infertility has not been recognised as a medical condition in South Africa but we are aware that there has been a lot of abuse by medical professionals.

"Part of our negotiations is to include forms of accreditation for fertility specialists as a control mechanism and to ensure high standards of reproductive medicine," he says.

Medical professionals are asking for medical aids to fund medical investigations leading up to the assisted fertility treatments such as blood tests, semen analysis and exploratory surgical procedures.

Struggling

They are also negotiating for women struggling with their fertility to have assisted reproductive technology three times a year.

Private doctors are not specifying the costs but have estimated them at R6 000 to R7 000 per cycle - which is on par with what government hospitals would charge for the same procedures.

Infertility has become a common problem, with an estimated seven to 15 percent of the world's population suffering from it.

Acclaimed Johannesburg fertility specialist Dr Antonio Rodrigues says that in South Africa the infertility rate among adults could be as high as 20 percent and it's escalating.

"There are two main causes for infertility," he says.

"Among lower income groups you often find that they are having problems conceiving because of sexually transmitted infections in both male and female.

"In middle to upper income groups, the number one cause is stress and lifestyle. Women and men in this category tend to put off having children because of their careers, which often compounds the problem."

Male sperm increasingly affected

Despite the perception that infertility is a woman's disease, half of all conception problems are male-related.

"At least 40 percent to 50 percent of cases are due to male fertility problems," says Dr Suleiman Heylen, head of the Cape Fertility Clinic.

"We are seeing a slight increase in the number of men who have problems with their sperm. Anything that can cause damage to the testicles or male genital tracts can cause a fertility problem, including trauma of the testicles, an accident, a sexually-transmitted infection or toxic products in the environment."

According to Heylen, research in the last year has shown that up to 25 percent of problems in sperm production are related to a recently-discovered disorder of the Y chromosome.

No cause established yet

X and Y chromosomes determine gender: X is for females and Y is for males.

"Researchers have discovered a series of micro-deletions of the Y chromosome," he says.

"To date there are 100 different types of micro-deletions, we don't know what causes them."

Dr Irene Manana, a medical officer at Chris Hani Baragwanath hospital's Reproductive Health Research Unit, says: "What is becoming worrying is that couples are coming in younger and younger with fertility problems".

"Newly weds in particular are sometimes put under a lot of pressure to prove their fertility."

Specialists who deal with male fertility say that over the last five years, men have become more open about having themselves tested.

"Compared to five years ago, men are less reluctant," says Heylen.

"Discovering that they have a low sperm count can be a shock for men. It affects their self-image."

Men are facing the challenge

Prof Thinus Kruger, head of the Reproductive Biology at the University of Stellenbosch, says that today's open society could be the reason for the shift in men's attitudes.

"In the old days there was only the Bible to refer to and everyone knows about Sarah, Abraham's wife who was barren," he says.

"It created the perception that only women could be infertile - you never read about males with this problem.

"What we have found is that even though it's difficult, men face the challenge. I think it helps to know that treatment is available."

After three years of research at the Medfem clinic, Rodrigues and his colleagues have included stress and lifestyle management as part of fertility treatment.

Syndrome

"On a routine basis we now find both male and female in a couple having problems at the same time," he says.

"We have diagnosed a syndrome we call 'time-urgency-perfectionism stress'. We believe this is the root cause for many professionals' infertility."

Rodrigues says that bad eating habits, drinking and smoking all compound this lifestyle stress.

"We have seen the changes," he says.

"A couple who are relaxed, have a good support network and who make healthy choices increase their chances of conception.

"In the long term you aren't just treating someone's fertility, but also helping them prevent heart disease, cancer or other life threatening illnesses.

"Our approach to fertility is to manage the whole person and not just the symptom," Rodrigues concludes. - Medical reporter