Although the South African Constitution states that everybody has the right to bodily and psychological integrity, which includes the right to make decisions concerning reproduction, people who struggle with infertility do not enjoy their right to make decisions concerning reproduction due to lack of access to infertility care.

This was the view of Gerhard Boshoff, Acting Deputy Director: Medical Science at the Steve Biko Academic Hospital's Reproductive Biology Laboratory, during the Access to Infertility Care Symposium hosted by the University of Pretoria (UP) in collaboration with Hasselt University and The Walking Egg non-profit organisation, both based in Belgium.

“Infertility care is the combination of the various processes and procedures of medically assisted reproduction, where couples or persons who are having trouble in falling pregnant are assisted in this regard,” Boshoff said. “Unfortunately, the need for assistance far overshadows the access to these services. Less than 10% of the required assisted reproductive technology (ART) cycles are being offered in South Africa, according to the most recent national registry report.”

A world-first mobile IVF laboratory designed to be used with a simplified IVF culture system aims to provide assisted reproductive technology (ART) services to low- and middle-income couples struggling with infertility.

According to this report, there were only 16 South African ART centres contributing to the registry, of which only four performed 500 cycles or more per year. However, based on the global need of 1 500 ART cycles per year per 1 000 000 population, South Africa should have 180 ART centres, each performing 500 ART cycles per year.

Extra expense for infertility care patients

Three of these 16 participants in the national ART registry publication are public-sector academic hospitals, including the centres at Groote Schuur (Cape Town), Steve Biko Academic (Pretoria) and Tygerberg (Cape Town) Hospitals. The only other public-sector ART unit in South Africa, at Universitas Hospital (Bloemfontein), did not partake in the national registry report.

“Patients from any of the other provinces in South Africa must travel over at least one provincial border to access ART services in the public sector, or visit a private facility at a premium, which are only found in a few of the larger cities,” Boshoff said. “Due to the necessity of multiple visits to an ART centre during a single ART cycle, the additional cost for travel and accommodation can therefore be a significant extra expense for these patients. Apart from the lack of sufficient ART centres, affordability of reproductive health screening and subsequent ART procedures should also be considered.”

Professor Vanessa Steenkamp, Deputy Dean of Teaching and Learning at UP’s Faculty of Health Sciences, said that in recent years the prevalence of infertility has been on a steady rise both in South Africa and across the world, affecting people from all walks of life emotionally, psychologically and socially.

“Infertility can strain relationships, diminish self-esteem and evoke feelings of isolation,” Prof Steenkamp said. “To put this issue into perspective, let me share some statistics with you: In South Africa, approximately one in six couples experience infertility. Globally, this number stands at one in eight couples. These numbers are not just statistics; they represent real people, each with their own hopes, dreams and aspirations for starting or expanding their families.

Proof that IVF can be affordable

“The importance of addressing infertility care cannot be overstated. It goes beyond the realm of medical treatment; it touches the very essence of human life and the pursuit of happiness. Access to infertility care holds the promise of transforming lives, not only by enabling the dream of parenthood, but also by alleviating the emotional burden that infertility carries.” 

Professor Willem Ombelet, from Hasselt University and The Walking Egg, who started his career researching infertility and IVF in Pretoria in 1984, said he was proud to be part of such monumental discussions about improving and enhancing healthcare via a seamless and cost-effective model.

Guests were invited to view a mobile IVF laboratory, designed as a part of Boshoff’s ongoing PhD research project, supervised by Professor Carin Huyser (UP) and Prof Ombelet. The mobile laboratory will use the Walking Egg’s simplified IVF culture system, which has been developed and tested in Belgium under the supervision of The Walking Egg. The goal of this mobile laboratory is to provide ART services not often accessible to economically underprivileged and infertile couples in low- and middle-income communities.

“We try to prove to the world that IVF is affordable, even in a mobile unit. That it will work, and the results will be identical to high-cost and high-end IVF centres,” Prof Ombelet said. “The main importance of our collaboration is that we can prove that it is cheap, and then we can go look for grants and funding to explore the whole of South Africa. Then we can go out of South Africa and show the world that it works, and we can also be an example for the rest of the world.” 

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Read the World Health Organization's fact sheet on infertility