One out of every six couples is affected by infertility, and treatment isn’t covered by medical aids. Here’s what you need to know.
One of the most daunting aspects of any medical procedure is the cost involved. For couples that are afflicted with infertility, these costs are high and medical aids offer very little cover, if any at all. There’s not much that can be done to reduce these costs, but if you are faced with infertility, being aware can help you to prepare for what’s ahead and to recoup what little money you can.
We spoke to Meggan Zunckel, the CEO of the Infertility Awareness Association of South Africa (IFAASA) about the procedures and costs involved in infertility treatment. This is what she had to say.
Meggan explains that the first step in treating infertility is correctly diagnosing it. This is the one area in which medical aids will help. Diagnosing infertility is defined in South Africa as a prescribed minimum benefit (PMB), which means that no medical aid can refuse to cover the costs for this condition, and that the costs may not come out of your medical savings account.
A full list of the diagnostic procedures that are covered as a PMB can be found on IFAASA’s website. But it’s important to understand that this is where the cover stops. Once the condition is diagnosed, no medical aid will cover the treatment.
“Be sure that your medical aid is paying for your diagnoses as a PMB and not using your medical savings,” says Meggan. “And if they haven’t done so, insist that they do.”
There are three basic infertility treatments, and your fertility specialist will help you decide which one you should try, based on your condition (and possibly, budget):
- A home-care plan: This involves the stimulation of ovulation with hormones, either taken as a tablet or injected, with intercourse at the recommended time. The costs of the hormones are not usually too high, starting in the region of R100 per treatment cycle, and the costs of scans and monitoring by a fertility specialist start at around R1 000.
- Artificial insemination: The male partner donates sperm, which goes through a procedure called “washing” to separate it from the semen. Then the woman’s ovaries are stimulated to ovulate and the sperm is inserted directly into her uterus, so that it has a shorter distance to travel. This usually costs between R10 000 and R20 000 per treatment cycle.
- In-vitro fertilisation (IVF). Ovulation is stimulated and the woman’s eggs are harvested. They are then mixed with sperm or a sperm can be injected directly into the egg and once a viable embryo has formed, it is inserted back into the woman’s uterus. These costs start at R40 000 per treatment cycle.
“It’s worth bearing in mind that it usually takes more than one cycle of infertility treatment for a woman to conceive,” says Meggan. “But in most cases, the treatment will work within three cycles.”
This means that a couple should budget for three times the cost of a single cycle of treatment to give themselves a fair chance at falling pregnant. So if you are going the IVF route, this could cost you as much as R120 000 or more.
There are a few things that you can do to reduce the costs of fertility treatment. The first among these, says Megan, is to visit a fertility specialist as soon as you suspect infertility. This is because fertility specialists often want to carry out their own tests and procedures, even if a gynaecologist has already done so, so you’ll save yourself the double costs.
A specialist will also be better able to identify what the contributing factors to your condition might be, and will reduce the need for unnecessary procedures.
As a rule of thumb, if you are under 35 and have been trying to conceive for one year with no success, and if you are over 35 and have been trying for six months with no success, you should visit a fertility specialist. If you have any indication of a pre-existing condition like polycystic ovaries, early ovarian ageing (menopause) or male factor infertility (low sperm count), then you should seek out a fertility specialist as soon as you are considering trying for a baby.
Interestingly, a few government hospitals cover ALL infertility treatment options. Groote Schuur, Tygerburg and Steve Biko hospitals have full IVF facilities and the patient only has to pay for their medication. Couples with infertility but without the funds to support a full course of private treatment should seriously consider going the public healthcare route.
it seems that infertility is unfairly discriminated against
“Infertility treatment is the only PMB on the list of exclusions at most medical aids,” says Meggan. “Other exclusions include things like wilful injury as the result of terrorism, crime or adventure sports. However, they will cover a stay in rehab for the treatment of alcoholism or drug addiction. In light of these exclusions and allowances, it seems that infertility is unfairly discriminated against.”
She adds that couples who are short of cash and funding their own treatment might try to get the most out of their treatment by choosing to implant multiple embryos – which results in complicated pregnancies and a far higher risk of the babies having to spend time in the Neonatal ICU. All of these costs – which can end up in the hundreds of thousands or even millions of rands – have to be covered by the parents’ medical aid, which makes it strange that they will not cover the less expensive treatments, which would more likely result in healthier pregnancies.
For these reasons, IFAASA continues to campaign for medical aids to cover the treatment of infertility in South Africa.
Infertility requires expensive medical treatment that is not covered by medical aids. If you are confronted with the prospect of infertility treatment and you would like to go the private route, start saving. Otherwise, find out about how to access infertility treatment through a government hospital in your area. If you are struggling with infertility, get in touch with IFAASA for support and information about the best way to approach treatment.