Medical schemes cause further stress over infertility by not footing all bills

Tamlyn Norcott and her husband are undergoing infertility treatment. The cost of the procedure has them pondering to sell their house. (Oupa Nkosi, M&G)

Tamlyn Norcott and her husband are undergoing infertility treatment. The cost of the procedure has them pondering to sell their house. (Oupa Nkosi, M&G)

Three couples sit hand in hand in the reception area of Vitalab Fertility Clinic in Johannesburg. At first sight, the compact space resembles any other doctor’s waiting room. But the eerie silence tells a different story.

One couple clings to each other. Another couple is lost in thought. They’re all anxious, trying to distract themselves from what awaits them in the doctor’s consultation room.

Each one of these couples are here for the same reason: infertility. They’re desperate to conceive – and the clinic is their last resort.

According to the Infertility Awareness Association of South Africa (Ifaasa) – the country’s only non-profit company advocating for infertility awareness - one in six couples worldwide are affected by infertility. The US-based Mayo Clinic defines infertility as the inability to fall pregnant after attempting to conceive through frequent intercourse for twelve months.

Tamlyn Norcott (36) and her husband recently started infertility treatment after struggling to conceive for a year. The Norcotts were devastated when they found out that they would need to undergo fertility treatment to improve their chances of having a child.

“I went to see a fertility specialist and after going for my first treatment, I hoped that I would be pregnant. But I am not,” says a disappointed Norcott.

They’re not only worried and traumatised; they also have to face the high cost of fertility treatment.

“My bill so far is over R8 000. This was the cost of a hormone treatment that was supposed to help me fall pregnant naturally. I have to do more treatment and our doctor told us that we will need to go for In Vitro Fertilisation (IVF).”

“Infertility goes beyond the financial strain. It’s been emotionally draining because I also blame myself for waiting this long to try for a baby.”

IVF is a medical procedure where fertilisation occurs outside of the body. A man’s sperm sample is combined with a woman’s eggs – which are surgically extracted - to form an embryo, which is then surgically implanted into the woman’s womb.

Norcott says that her medical aid will cover only R2 000 of the cost of her hormone treatment, leaving her with no choice but to use her credit card to pay the outstanding amount.

Vitalab fertility specialist Dr Lawrence Gobetz says that the cost of treating infertility is exorbitant, with medical schemes only paying for certain aspects of the procedures.

“Medical aids do not pay for procedures such as semen analysis for our male patients nor the checking whether our female patients’ tubes are blocked or open. However, by right, fertility treatment is not a plastic surgery procedure – it is an illness.”

Gobetz says that because infertility is a prevalent condition, medical aids should contribute towards the treatment. “One piece of equipment in our lab costs about one million rand. Fertility treatment is expensive because of the materials involved.”

Procedures such as hormone treatment can cost up to R14 000, while one IVF treatment cycle amounts to approximately R42 000. If treatment is unsuccessful the first time, a patient would have to go for another cycle of IVF, at an additional cost of R18 000. That’s assuming that the specialist was able to freeze the patient’s eggs or embryos from the first IVF treatment cycle, which then reduces the costs of the second treatment cycle. Freezing the eggs or embryos at the clinic costs R 3 600 – and none of these costs are paid by the medical aid.

Because of the exorbitant costs of infertility treatment, Ifaasa has been engaged in a five year battle with South Africa’s largest medical scheme, Discovery Health, and the Council of Medical Schemes (CMS) to force the medcial aid to pay for all costs related to infertility treatment.

“We (fertility specialists) should be available to anyone with medical aid and not just the patients that have the financial means to come here. Many people cannot come for treatment simply because they cannot afford it,” Gobetz says.

The Norcotts are looking at other ways to save up for treatment.

“My husband and I have considered selling our house and moving into a smaller place. We are thinking of different ways of making the money for the infertility treatment. As it stands, we have no options. I am starting to lose hope,” says a distraught Norcott.

She is haunted by the fact that she is privileged enough to have that option – unlike the thousands of women and men who cannot even afford medical aid.

Asked about its stance on the issue, Discovery Health’s principal officer, Milton Streak, emphasised that “Discovery Health’s benefits are fully aligned with the requirements of the Medical Schemes Act and the CMS.”

Elsabé Conradie, the manager for stakeholder relations at the CMS, says that the council is in the process of reviewing the prescribed minimum benefit regulations. She says the inclusion of infertility treatment (such as IVF) can be discussed if a formal submission for the review is made by medical aid schemes.

Ifaasa CEO Meggan Zunckel says that it is preparing to tackle other medical aids, following an open letter to Discovery in which it pleaded with the scheme to foot the bill for members living with infertility.

“Nobody signs up to a medical aid that only covers critical diseases. Members have no way of telling what they will be diagnosed with during their lives and it is unacceptable for a medical aid to refuse cover for the treatment of an entire disease entity such as infertility,” says Zunckel.

Reproductive medicine specialist Paul Le Roux says that there is no ethical justification for medical aid schemes to exclude fertility treatment from members’ benefits.

“Internationally medical funders do pay a portion of IVF costs and there is no reason that South African funders should be different.”

Back at the clinic, the couples continue to hold hands as they leave the procedure room. Anxiety is written on their faces - but now there is a glimmer of hope too. In six weeks they’ll find out if their dream of having a child will come true.

WATCH THE VIDEO: ‘You cannot operate a patient into a state of pregnancy’ – fertility expert

 
Pontsho Pilane

Pontsho Pilane

Pontsho Pilane is a health journalist at the Mail & Guardian. She debuted as a journalist at The Daily Vox, where she wrote primarily about gender, race and how they intersect. She was previously a general news reporter at the M&G. Pilane holds two degrees in media studies from Wits University. Read more from Pontsho Pilane

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