Subfertility is the preferred terminology for individuals who have difficulties conceiving. A recent survey in Kenya suggested that about 1 in every 4 – 6 gynaecological consultations are related to subfertility. This translates into millions of individuals of child-bearing age. The biggest barrier to accessing modern fertility treatment is cost, coupled with a limited choice of treatment centres.
Some individuals with subfertility face endless consultations, tests and operations that leave them financially drained, and nowhere near to conception. We recommend these guidelines to mitigate the expenses related to fertility diagnoses and treatments.
Initial consultations can be with a general gynaecologist, with early referral to a fertility sub-specialist once infertility requiring intervention is realised. Suggested interventions should often be followed by questions. Will this take us closer to our desired goal? It is foolhardy to embark on expensive female tests and treatments if the male partner has never been evaluated. Treatment option, their expected success rates and a tabulation of costs should be discussed to make informed decisions and plan your finances.
Tubal disease (of the fallopian tubes in women) is the commonest cause of subfertility in Kenya, and usually responsive to IVF treatment. Standard IVF treatments cost about KES 600,000 – 800,000 and translate into decent success rates. For patients who cannot afford this, 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 is needed. If sperms are normal, success rates are no less than the more expensive option of intra-cytoplasmic sperm injection (ICSI). There can be further savings by avoiding “adjuvant therapies” that have no scientifically proven value-add.
Women with at least one normal fallopian tube and functional ovaries are usually responsive to insemination with sperm into the uterus (intrauterine insemination – IUI). IUI is easily achieved by use of oral medication and minimal monitoring, keeping costs down and allowing more couples to access treatment. Minor sperm abnormalities in men hardly require additional expensive tests, surgery or medications.
A visit to your insurance company or employer is worth a try. The WHO classifies subfertility as a disease, equating it to other insurable conditions. It’s time to advocate for fertility insurance cover.
Under desperate circumstances, low-interest ‘fertility loans’ may come in handy.
We have further information in our article The Financial cost of infertility in Kenya with guidance on Why is IVF not always the solution? and When to See a Fertility Doctor
