- K Floor OPD (OK78)
- Thursday Afternoon
- Phone: 021 404 6027 for appointment (please see referral criteria below)
Referral Criteria: All couples suffering from infertility (failure to conceive after at least one year of regular unprotected intercourse) and lesbian couples or single women requesting donor insemination may be referred subject to the criteria listed below (in alphabetical order). For bookings or queries please phone 021-404-6027.
1. Female Age ≥ 41
Forty-one years is the mean age of cessation of female fertility (10 years before the mean age of menopause). The prognosis of infertility treatment other than Assisted Reproductive Techniques (ART; also called in vitro fertilisation) is extremely poor and even in the case of ART is guarded unless egg donation is considered. Women who are 41 years or older should be discouraged from pursuing infertility treatment unless the couple can access ART, understanding the cost and guarded prognosis of the latter.
2. Female Body Mass Index (BMI) < 35
Overweight (BMI > 25) and especially obesity (BMI > 30) is associated with poorer infertility treatment outcome, and higher rates of miscarriage and pregnancy complications when compared to women with normal weight. Male obesity is also detrimental to couple fertility. Weight loss may result in spontaneous conception and reduces the risk of pregnancy complications. Women with a BMI above 35 must be asked to lose weight and should be offered appropriate dietary advise and referral to a dietician and/or weight loss support group. Once a BMI of < 35 has been achieved they may be referred. Men who are overweight or obese should also be encouraged to lose weight but raised male BMI is currently not an exclusion criterion for referral.
3. HIV infection
We currently do not offer infertility treatment to couples in whom both partners are HIV positive (sero-concordant couples). HIV positive, sero-discordant couples (only one partner suffering from HIV infection) may be referred provided
a. the HIV infected partner has a stable CD4 count in the previous 6 months AND
b. the HIV infected partner is on HAART or has, in principle, access to HAART in future, AND
c. the HIV negative partner has two negative HIV tests in the preceding 6 months (in case of recent diagnosis of HIV infection in the partner) or one recent HIV negative test in case of established infection
It must be noted that we can currently not offer Assisted Reproductive Techniques (In vitro fertilization) to HIV positive women due to the absence of specific IVF-HIV laboratory facilities. However, HIV positive women may undergo other infertility treatment depending on the underlying cause of infertility.
4. No more than one live child in union
Couples with two children in union will not be offered infertility treatment. Exceptions may be made for unusual and specific circumstances.
5. Previous Caesarean Sections
We do not offer infertility treatment to women with live children who have three or more previous Caesarean sections because of the increased risk or morbidity and possibly mortality. This risk increases significantly between 3 and 4 caesarean sections. Women without a live child may be considered for treatment depending on individual circumstances.
6. Appropriate socioeconomic conditions
In order to appropriately care for a child, patients must have a stable source of income and basic accommodation providing adequate shelter, electricity and water. Patients may also have to contribute to cost of infertility treatment necessitating some means of income.
7. Stable relationship
Couples need to be living in a stable relationship sharing the same household before infertility management can be commenced. Infertility may cause or increase relationship problems. Couples in unstable relationships should be referred for marital/relationship counselling.
8. Substance abuse
Patients with illegal substance abuse will not be treated until drug use has been successfully discontinued for a minimum of 1 year.