Cost Implication: A Major Barrier Preventing Access to Fertility Treatment and Services (Part 1)

In most cultures, the notion of child bearing is regarded as a hallmark of womanhood. Chelsea polis of the Guttmacher institute estimated that about 31% of Nigerian couples fails to conceive a child after 12 months of unprotected sex- a rate at least as high in the western countries, but the high premium placed on children by extended families as well as difficulties in the procedure for legal or permanent adoption make stigmatizing attitudes experienced by infertile women particularly severe in non-western culture.

With the increasing awareness about the causes of infertility and acceptability of Assisted Reproductive Technology in Nigeria, there has been a corresponding proliferation of fertility clinics. This high incidence of fertility has also fostered the growth market for all other forms of fertility treatments which includes religious fertility treatment, traditional fertility treatment.

It has been reported that the desperate infertile woman go to varying lengths, visiting orthodox medical practitioners, herbalists, traditionalists and spiritualists In search of needed reprieve and solution while others visits clinics for regular counselling but not able to afford the treatment outlined, thus compounding more burden in fertility clinics. One of the fundamental human rights is the ‘Reproductive right’ because it is the fundamental rights of all people to decide freely and responsibly the number, spacing and timing of their children and to have the means to do so. It is the right to attain the highest sexual and reproductive health and to make decision concerning reproduction free of discrimination, coercion and violence.’’

While family planning program, a component of Reproductive Health enjoys huge support from government policy as well as renowned Non-Governmental organizations (NGOs), fertility treatment remains the business of the couples involved. Some western countries where the reproductive rights of the citizen are fairly valued, government are not only involved in family planning for couples needing it but also supports and funds infertility treatment even up to IVF cycles.

Social stigma is common in the African society as well as being unrecognized nor supported by the government. Cost remains the greatest barrier to the use of Assisted Reproductive Techniques (ART). The fact that no single ART technique guarantees a 100% success rate further compounds the issue. Although success rate of ART is influenced by factors such as age of the woman, egg quality, sperm quality, tubal and uterine factors etc. On the average, a cycle of IVF treatment is considered expensive and this cost usually will depend on the age of the couple and cause of their infertility. ART treatment ranges from conventional In-vitro Fertilization (cIVF) to Intra-cytoplasmic Sperm Injection (ICSI), Pre-Implantation Genetic Testing/Screening (PGT/PGS) and may involve third party reproduction (use of donor egg/sperm) and in some cases surrogacy.

Only very few fertility clinics are owned by the government and situated within teaching hospitals. Most IVF centers are owned by private practitioners. Even the government owned fertility clinics are not subsidized enough to offer treatments for average Nigerians, thus the big question is how many Nigerians can offer that type of fees for a fertility treatment that is not even 100% guaranteed?.

However, fact remains that the chances of success with fertility treatment increases with number of cycles attempted, while it is possible to get pregnant following one attempt of IVF or intra-uterine insemination (IUI), international guideline for management of infertility postulates after extensive researches that for every 6 cycles of IUI a couple does, they have a 50% chance of pregnancy and for another additional 6 cycles they have 75% chance of conception. A cycle of IVF may give about 30% chance of conception but 3 cycles of IVF is likely to increase the success rate to about 60-90%. The implication of this is that couples attempting IVF cycles are likely to back out following a first failed cycle due to financial constraint to try further cycles.
In the traditional African setting where the woman is viewed as always the culprit for the couple’s inability to conceive, a lot of women bear this huge financial responsibility alone without the supports of their husbands who in some cases do have a choice to remarry as the society and culture still permits polygamy.

WHY IS IVF EXPENSIVE?

IVF treatment is seen as the last resort in the management of infertility which may not necessarily be true. Many people wonder why IVF is so expensive, one of the reasons is that, unlike other medical procedures it is often not covered by insurance, so patients have to pay out of pocket.

IVF treatment may remain expensive for as long as the equipment or consumables used remains expensive, most of which are purchased and imported into the country using foreign currency. The field of Assisted Reproduction also requires personnel with specialized skills and trainings, most of which they undergo outside the country and mostly self-funded. Another key factor in fertility set up is power source. As we all know that the supply of electric power in the country is very erratic yet the incubator which is very important equipment in IVF centre must always be powered when in cycle. Most centres make use of heavy KVA inverters and generators as back up to ensure a 24 hours power supply while in cycle. All this summed together makes IVF/ART services expensive with add on costs………………..TO BE CONTINUED