The nightmare of fertility treatment costs; what’s the way out?

Sub-fertility is the preferred terminology for couples who have difficulties conceiving. A recent survey in Kenya suggested that about 1 in every 4 - 6 Gynecological consultations are related to sub-fertility. This translates into millions of couples of child-bearing age. The biggest barrier to accessing modern fertility treatment is cost, coupled with limited choice of treatment centres.Any couple who have faced subfertility are aware of the costs involved. Some face endless consultations, tests and operations that leave them drained out of cash, and nowhere near to conception.

Couples should take reasonable steps to reduce expenses. Initial consultations can be with a general Gynecologist, but if things are dragging on, early referral to a fertility sub-specialist is advisable. Tests after tests, often leading to operations may not necessarily lead to conception. Suggested interventions should often be followed by questions. Will this take us closer to our desired goal? And no cutting corners, it is foolhardy to embark on expensive female tests and treatments if the male partner has never been evaluated. Treatment choices should be discussed in detail. You should expect to be told the expected success rates, with costs being tabulated upfront. Such information enables you to make the right decisions.

Tubal disease is the commonest cause of subfertility in Kenya, and easily amenable to IVF treatment. Standard IVF treatment costs about KES 400,000 and translates into decent success rates. For patients who cannot afford such amounts, low-cost IVF is a better alternative to no treatment at all. Such approaches yield less eggs and embryos, and consequently lower success rates, but at a considerably lower cost. Less medication and monitoring are needed. If sperms are normal, success rates are no better if the more expensive option called ICSI (intra-cytoplasmic sperm injection) is chosen. More savings are accrued by avoiding so called adjuvant therapies, they are not for free, and scientific proof of their value is wanting.

What about insemination of sperms into the uterus (called IUI)? Only women with at least one normal tube and functional ovaries are amenable to IUI treatment. IUI is easily achievable by use of oral medication and minimal monitoring. Expensive injectable medications and intense monitoring are avoided, enabling more couples to afford treatment.

What about male problems that require advanced treatments? Potential savings depend on the specific diagnosis. Minor sperm abnormalities hardly require additional expensive tests, surgery or medications. Such interventions hardly improve pregnancy rates. The money is better diverted to proven treatments, not endless consultative ventures and procedures.

A visit to your insurance company or employer is worth a try. The WHO classifies sub-fertility as a disease, equating it to other insurable conditions. It’s time to advocate for fertility insurance cover. In desperate circumstances, low-interest ‘fertility loans’ come in handy.