The high cost of hope: How to budget for your fertility journey

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According to the World Health Organization, about one in every six people of reproductive age worldwide experiences infertility in their lifetime. Infertility is defined as the failure to achieve a pregnancy after 12 or more months of regular, unprotected sexual intercourse.

Fertility treatment fees in South Africa vary, depending on the type and complexity of the procedures, says Sarah Nicholson, operations manager at JustMoney.co.za, a platform that helps South Africans make good money choices.

According to Lizle Oosthuizen, a specialist in reproductive medicine at Cape Fertility, costs for each aspect of treatment vary according to the medication used, the duration of the cycle, the use of egg or sperm donors, and additional procedures that may be required such as genetic testing.

Further pricing disparity occurs with differences in location. An initial consultation and scan at Cape Fertility, for example, costs R2,560, and a sperm test costs R900.

The treatments and associated costs set out below are a guideline only and do not indicate precisely what a patient may pay, says Joanne Pottow, a board member of the Southern African Society of Reproductive Medicine and Gynaecological Endoscopy (SASREG).

Prices will vary depending on individual circumstances and provider rates:

• Ovulation-induction medications can cost between R500 and R2,500 per cycle. Intrauterine insemination, which involves placing sperm inside a woman’s uterus close to the fallopian tubes to increase the chances of conceiving, can range from R4,000 to R8,000 per cycle.
• During conventional in vitro fertilisation (IVF), the woman’s eggs are collected and fertilised by mixing the eggs ‘in vitro’ (in glass) in a laboratory with tens of thousands of washed sperm. The embryo is then implanted in the uterus.

  This is not a once-off medical procedure, but a series of procedures taking place over several weeks. A single IVF cycle can cost around R70,000, excluding medication. IVF medications can add R10,000 to R20,000 per cycle.

• Additional procedures, such as Intracytoplasmic sperm injection (ICSI), where one sperm is injected directly into an egg using a micromanipulation microscope, can cost an extra R5,000 to R10,000.
• Donor eggs can increase costs by R20,000 to R40,000. Sperm-donation costs range from R5,000 to R10,000. Surrogacy can cost at least R200,000, including legal fees and compensation for the surrogate.

Assisted reproductive therapy coverage

Several South African medical aids offer some level of infertility treatment cover, although the specifics can vary significantly among plans.

Noluthando Nematswerani, chief clinical officer at Discovery Health, says that the Assisted Reproductive Therapy (ART) benefit gives Executive and Comprehensive plan members access to a list of female infertility procedures and treatments up to a limit of R129,000 per person, per year, subject to specific rules. The benefit covers a comprehensive basket of care.

A member is liable for a 25% co-payment of the costs, any amount over the Discovery Health Rate, and any other expenses not covered by the benefit. Discovery pays for up to two cycles of IVF if you are 25 to 39 years old, and one cycle from the age of 40, up to and including 42 years of age, per year.

Enhancements to the benefit in 2022 include egg-donated cycles, embryo freezing, and cryopreservation. The inclusion of egg-donated cycles also provides cover for one cycle for women up to the age of 50 when undergoing IVF with egg donation.

Infertility care gaps

There is no service for infertility at primary healthcare institutions in South Africa. However, help is available at some tertiary institutions, such as Tygerberg and Groote Schuur hospitals in the Western Cape. These offer extensive investigations and treatment in their respective infertility programmes.

A referral from a local primary healthcare facility or private healthcare provider is required. The costs will depend on the specific treatment and the individual's situation.

Budgeting for fertility treatment

Given the high costs associated with some fertility treatments, careful financial planning is essential, advises Nicholson. Here are some tips to help you plan and budget for your fertility journey:

• Obtain a professional opinion. Seek help as soon as you become concerned about your fertility. Choose a reputable clinic for an accurate diagnosis and treatment plan. Some problems, such as hormonal issues, can be detected and addressed easily.
• Check with your medical aid. Review policies and contact the provider to understand the extent of coverage and associated conditions or limits.
• Investigate your employee benefits. Some employers – generally larger companies and multinationals – offer fertility treatment benefits as part of their staff healthcare packages.
• Assess your financial situation. Evaluate your financial status, including income, monthly expenses, and savings. Determine how much you can realistically allocate towards fertility treatments without compromising your essential needs.
• Create a dedicated fertility fund. Open a savings account specifically for fertility treatment costs. Set up automatic transfers from your main account to ensure consistent savings.
• Explore clinic options. Compare prices at various clinics to find the most cost-effective options without compromising quality. Some clinics allow you to pay off treatment costs over time.
• Plan for the long term. Be prepared for the possibility of needing multiple treatment cycles. Factor in costs such as travel, accommodation, and time off work.

Embarking on a fertility journey can be emotionally and financially taxing, and it requires careful planning, says Nicholson. Choosing a reputable clinic, understanding all the recommended procedures and costs, and budgeting carefully can help you navigate this challenging path.

“Infertility treatment requires not just medical expertise, but also emotional resilience and financial preparedness. Thoughtful preparation and support are essential for making informed decisions and achieving your dream of parenthood.

“Don’t lose hope,” Nicholson concludes.