Your parenting partner: from fertility to grade 1

FERTILITY

Male infertility: a growing social & financial burden

Male infertility is one of the least discussed aspects of reproductive health, despite evidence that male health factors contribute to 40–50% of infertility cases.

The impact of infertility extends far beyond the doctor’s consulting room. According to the Department of Health, infertility can affect a couple’s psychological, social, and financial well-being. They face higher risks of depression, anxiety, relationship breakdown, intimate partner violence, and social stigma.

JustMoney customer experience manager Sarah Nicholson says that many couples struggle needlessly due to a lack of information and the perception that infertility is a female issue.

“Understanding the causes of male infertility and treatment options can be life-changing for couples struggling to become parents.”

What is male infertility?

Male infertility is a man’s inability to contribute to conception. Fertility depends on the production of sufficient healthy sperm, the ability of sperm to move efficiently, and the successful delivery of sperm during ejaculation.

If a couple doesn’t conceive after 12 months of unprotected intercourse, or six months if the woman is older than 37 years, it’s advisable to have a basic fertility assessment at a fertility clinic, says Dr Paul le Roux, specialist in reproductive medicine at Cape Fertility.

“Many couples assume that infertility is caused by a medical problem in the female partner and some men are therefore reluctant to get tested. However, once we explain to couples that male factor infertility is common and can be treated successfully, they understand the importance of being tested and proceed to do the necessary testing,” he says.

This includes semen analysis for the male partner, a medical examination and trans-vaginal scan for the woman, blood tests for both partners, and in some cases, extra tests to check the fallopian tubes.

Research points to declining sperm counts globally. A landmark 2017 study published in the journal Human Reproduction Update found a steady 1.4% decline in sperm counts, with an overall decline of 52.4% over a 40-year period. Researchers analysed 185 studies involving 42,935 men in North America, Europe, Australia, and New Zealand.

Local findings indicate a similar trend in South Africa.

“We don’t have statistics on sperm decline specifically over the last few decades in our clinic, but a large proportion of infertile patients have male factor infertility. Approximately 30–40% of all cases have an abnormality on the semen analysis,” says Dr le Roux.

Medical experts identify several possible causes of male infertility:

Low sperm count. Sperm numbers are below normal levels and, in severe cases, no sperm is produced.
Poor sperm quality. Sperm may have an abnormal shape or poor movement.
Varicocele. Enlarged veins within the scrotum affect sperm production and quality.
Hormonal disorders. Conditions affecting the pituitary gland, thyroid gland, or testosterone production can affect fertility.
Genetic conditions. Inherited disorders, including chromosomal abnormalities.
Blockages in the reproductive tract. Caused by previous infections, surgery, or congenital abnormalities.
Infections. Sexually transmitted or other infections affecting the reproductive organs.
Lifestyle factors. Smoking, excessive alcohol consumption, obesity, drug use, poor diet, chronic stress, and exposure to environmental toxins are all linked to reduced fertility.

Where lifestyle factors are a concern, doctors may recommend stopping smoking, drinking less, losing weight, improving nutrition, exercising regularly, and managing stress.

Medical aid support

Prescribed Minimum Benefits (PMBs) are baseline healthcare benefits that every registered medical scheme must cover, regardless of the plan or option.

Assisted Reproductive Therapy (ART) involves specialised medical procedures that help improve the chances of conceiving. They include in vitro fertilisation (IVF), frozen embryo transfer, intracytoplasmic sperm injection – where one sperm is injected directly into an egg using a micromanipulation microscope – and intrauterine insemination.

Specialised ART procedures are available under Discovery Health’s Executive Plan and Comprehensive Series. Members on other Discovery Health plans can access infertility assistance.

While ART is not covered under PMBs, infertility is classified as a PMB condition, says Dr Noluthando Nematswerani, chief clinical officer at Discovery Health. “This means we will fund the diagnosis, treatment, and care for infertility as defined by the Council for Medical Schemes.”

PMB cover includes key blood tests, semen analysis, counselling and sexual health advice, diagnostic procedures, assistance with ovulation defects and deficiencies, surgery on the uterus and fallopian tubes, and treatment for local infections.

State support

Several academic hospitals provide IVF and ART in the public sector. Groote Schuur, Tygerberg, and Steve Biko Academic Hospital are active on the National ART Registry. A fourth public ART unit at Universitas Hospital provides fertility services to Free State patients. A fifth unit at Nelson Mandela Academic Hospital opened this year in the Eastern Cape.

Patients must first consult a local GP or a district day hospital to get a formal referral to a provincial reproductive medicine unit.

Public sector ART pricing is means-tested, so patients pay according to their income level and the hospital’s fee schedule. According to online fertility directory Fertility Solutions, costs are as follows:

Procedure cost at Groote Schuur and Tygerberg is approximately R6,700 per cycle at the subsidised rate. Laboratory and clinical care are subsidised.
Fertility stimulation medications are not available in state hospitals. Patients must self-fund medications, typically R8,000–R15,000 per IVF cycle.
Total estimated cost, including medication at a public hospital, is approximately R15,000–R22,000 per cycle, versus R45,000–R120,000 in the private sector.

Given long waiting lists, the public sector may not suit older couples or those requiring complex protocols, donor eggs, or surrogacy, says Nicholson. In such cases, the private sector is more practical, although it is more expensive.

“The encouraging news is that treatment options are available. The key is to seek medical advice early, understand the likely costs, and plan financially. By approaching fertility treatment with realistic expectations and a clear budget, couples can focus their energy on the journey to parenthood rather than worrying about unexpected costs.”

SOURCE: JustMoney is a South African financial services company providing a range of solutions, from loans to insurance, underpinned by the data and coaching individuals need to make good money choices.

JustMoney believes that money is personal, so its support is too. Customers are more than just a number; they are individuals with unique goals and dreams. From securing a loan or protecting what matters, to finally getting a handle on debt, JustMoney provides a personalised experience powered by insights that fit customers’ lives.

References

National Library of Medicine – Temporal trends in sperm count research

Department of Health – National Clinical Guidelines for Safe Conception and Infertility

Discovery Health Medical Scheme: Assisted Reproductive Therapy Benefit 2026.

SASREG: https://sasreg.co.za/

Take control of PCOS

Living with Polycystic Ovary Syndrome (PCOS) can feel overwhelming. Use Sinopol® to transform this feeling into empowerment and bring balance back to your health.

Irregular cycles, hormonal imbalances, insulin resistance, and fertility challenges are just a few of the daily struggles of PCOS. Fortunately, there’s a science-backed supplement with 13 clinical trials; a supplement that can help you reclaim your health: We’re talking about Sinopol®.

It contains three key ingredients that are designed to target the symptoms of PCOS and support metabolic and reproductive wellness. Each sachet or tablet contains a blend of Myo-Inositol, Alpha Lipoic Acid, and Folic Acid, ingredients clinically shown to improve insulin sensitivity, regulate menstrual cycles, and boost fertility outcomes.

What sets Sinopol® apart from other supplements is its patented fast-slow technology which ensures sustained absorption and 24-hour support. Whether you’re trying to conceive, manage weight, or simply feel more balanced, Sinopol® offers a way to support your journey.

Women using Sinopol® have reported*:

Improved cycle regularity: From 2 to 5 cycles in 6 months.
Reduced insulin resistance:
66,7 % reduction in postmenopausal women and 35 % reduction in adolescent girls.
Reduction of unwanted hair growth: 16,4 % reduction in hirsutism.
Better outcomes with fertility treatments: 44 % increase in pregnancy success in women undergoing IVF.
And the best part? You don’t need a prescription for it, and thanks to the NAPPI code you can potentially claim it from your medical aid.

Sinopol® is available over the counter nationwide, at Dis-Chem, Clicks and independent pharmacies.

The sachets taste pretty good, but if that’s too fussy for you, you can take it in tablet form. Both are equally effective.

Take control of your PCOS. Choose Sinopol®, because every woman deserves to feel her best.

Baby making prep

Falling pregnant isn’t always easy for everyone. Get your affairs and health in order to give yourself the best possible chance.

STEP #1

TALK TO YOUR PARTNER

Couples should decide together that the time is right. Talk about things like affordability, timing and the age gap between your children, childcare and work options. If this is your first baby, you can also talk about parenting style and possible support systems.

You can also both consult a doctor and tell them about your plan, so that any potential problems can be detected and treated early. This can prevent unnecessary stress and disappointment.

Dr Mokgohloe Phasha, an obstetrician-gynaecologist practising at Netcare Park Lane Hospital in Johannesburg, says that a pre-conception visit “offers the chance for women to enter pregnancy as their healthiest self, and lay the optimal foundation for their future baby. Although pre-conception appointments have an important role in ensuring a healthy pregnancy, sadly, few people fully appreciate the value this holds both for mother and baby and for managing potential risks before falling pregnant,” she says.

STEP #2

FOCUS ON HEALTH

Your fertility depends on your age, health, emotions, menstrual cycle and the type of contraception you use, and how long you have been using it. Young women tend to get pregnant easily because their eggs are younger and because the cervix remains open longer during ovulation (the fertile days of the cycle).

Women who are overweight can have a hormone imbalance because oestrogen is stored in fat cells and because their insulin regulation can be messed up.

It’s also not good to be too thin. Underweight women can stop ovulating.

So the sooner you and your partner start eating right, the better. You also feel better when you eat healthily. Include a wide variety of nutritious foods, and eat from all the food groups. Eating fruits, vegetables, whole grains, lean meats and dairy every day will help ensure that you get your daily recommended amount of vitamins and minerals needed for optimal fertility. It’s also a good idea to start taking a special pregnancy supplement now.

The benefits of folic acid supplementation during pregnancy are well known, but often women only realise they are pregnant after their first trimester, missing a golden window of opportunity to prevent neural tube defects. “This inexpensive intervention has proven to significantly reduce the risk of spina bifida, which can lead to paralysis of the baby’s legs. The mom-to-be’s folic acid requirements are met ahead of conception,” Dr Phasha advises.

Women who are under unusually high stress can also temporarily stop ovulating or ovulate at longer intervals, which means there is less opportunity to conceive a baby. A messy menstrual cycle makes things difficult and frustrating and also takes the fun out of sex.

STEP #3

UNDERSTAND THE SCIENCE

A woman’s fertility is related to a complex network of hormones that connect the pituitary gland in her brain to her ovaries, uterus, cervix and breasts. These organs have receptor cells that are sensitive to the amount of hormones in the blood. The concentration varies daily, depending on whether you are fertile or infertile, pregnant, breastfeeding or in your menopause.

Men are fertile all the time, but a woman is only fertile for five days in her menstrual cycle. Measure your cycle from the first day of your period to the first day of your next period. During this time, there is a 24-hour window period in which you can get pregnant.

Usually, a woman is in her fertile phase in the middle of her cycle – when she ovulates. This is when an egg is prepared for fertilisation, the ovary releases it, and it slides down the Fallopian tube. Fertilisation (when the egg and sperm meet) must occur within 24 hours. The key to conception is knowing when this 24-hour period has arrived. To conceive a baby, a couple must have sex when the woman’s body is receptive to the sperm. This happens during ovulation when the vagina becomes a sperm-friendly environment thanks to special mucus at the cervix. The slippery mucus is released into the vagina and helps the sperm swim. Once the sperm reaches the cervix, the mucus can keep it alive for five days while it waits for the egg.

Men should be able to produce a teaspoon of semen that contains between 300 and 500 million sperm. Most of the sperm gets lost in the vagina during sex, and less than a third eventually makes it to the cervix.

STEP #4

MAKE A BABY

Yes, you need to get busy between the sheets, but improve your chances of conception with the following knowledge.

Avoid sex during your period.
For the four days after your period, you can have sex every other night. Although sperm cannot pass through the cervix at this stage, regular sex can ensure a constant fresh supply of sperm.
When your ovaries become active, your cervix will first secrete sticky mucus. Avoid sex during this time for a few days, as this will help increase sperm count.
When your vaginal mucus becomes as smooth as raw egg white, and your genitals feel slightly swollen and sensitive, it’s time to have as much sex as you want. Sperm can survive in your body for up to six days, but an egg only lives for 12 to 24 hours. That’s why sex before, during and after ovulation is recommended, as it increases the chance that sperm and egg will meet.
After the ovulation period, you can of course remain sexually active, but the window period for conception is over for now.
Wait until your period is a week late before taking a pregnancy test. If fertilisation has occurred, it takes the egg 10 days to travel to the uterus. During this time, the cell mass increases (it is called a blastocyst) and the cells that will become the placenta already exist. The cells attach to the lining of the uterus. The lining is what is usually shed and excreted during menstruation. You will produce the hormone hCG, which is excreted in your urine, and this is what makes a pregnancy test positive.

Commonly Missed Cause of Male Infertility: Varicocele

Source: Morton & Partners Radiologists

A varicocele is the most frequently identified correctable cause of male factor infertility. It causes no pain, no visible symptoms, and is present in up to 40 percent of men being investigated for fertility difficulties. Many are never told it can be treated without surgery.

When a couple discovers that male factor infertility is contributing to their difficulty conceiving, the conversation in many fertility clinics moves quickly. A semen analysis raises questions; IVF is discussed; a path is laid out that is expensive, physically demanding for both partners, and not always the necessary first step.

What is frequently not discussed at that point, not because it is irrelevant, but because the question is not always asked, is a varicocele. It causes no pain. There is no visible swelling, no discomfort, no reason a man would seek help on his own. The only indication is what shows up on a semen analysis.

A varicocele is an enlargement of the veins within the scrotum, the same mechanism as varicose veins in the legs, occurring in the vessels that drain blood away from the testicle. It is present in approximately 15 percent of men in the general population. In men being investigated for fertility difficulties, that figure rises to 35 to 40 percent, making it the most commonly identified correctable cause of male factor infertility.

Why Temperature Is Everything

The mechanism, once explained, is straightforward. Sperm production is acutely sensitive to temperature. The body's design, the testes positioned outside the core, exists precisely to maintain the cooler environment that healthy sperm production requires. It is not incidental anatomy. It is a specific biological requirement. When the draining veins of the testicle become enlarged and fail to clear blood efficiently, it pools. The local temperature rises. The effect on sperm production is measurable: reduced count, impaired motility, abnormal morphology. All three are the kinds of findings that appear on a semen analysis and prompt a fertility investigation. All three can, in many cases, improve when the underlying cause is addressed.

The Referral Conversation That Does Not Always Happen

Varicoceles are well understood. The evidence for their impact on fertility is not disputed. What falls short, in many cases, is the referral pathway. A couple presents with a poor semen analysis. The male factor is noted. The next step is often a fertility specialist, and the next step after that is often a conversation about assisted reproduction.

Varicocele embolization, a minimally invasive, non-surgical procedure with a strong track record, is sometimes raised, and sometimes not. The cost is lower than IVF. The burden on both partners is significantly less. And for couples where the varicocele is the primary contributing factor, the outcomes can be meaningful. It is not that the procedure is unavailable or experimental. It is that the question of whether a varicocele has been looked for is not always the first one asked.

Varicocele Embolisation

The procedure is performed through a small puncture, typically at the neck or groin, without surgery or general anaesthetic. A catheter is guided under real-time X-ray imaging to the affected testicular vein. From the inside, the vein is closed, blood reroutes through healthier vessels, the pooling stops, and temperature normalises. The procedure takes 30 to 45 minutes. Recovery is typically a day or two of relative rest, with no surgical wound and no hospital stay. For many men, the impact on semen parameters becomes measurable within three to six months. It is not a guarantee. Not every case of male factor infertility is attributable to a varicocele, and not every varicocele responds to embolisation in the same way. But for couples facing a semen analysis that raises questions and a fertility pathway that is moving quickly, it is a step that deserves to be part of the conversation before more complex interventions are considered.

What to Ask

If a semen analysis has shown reduced sperm count, impaired motility, or abnormal morphology, it is worth asking specifically whether a varicocele has been identified on examination or ultrasound. If one has been found, it is worth asking whether embolisation has been considered, and if not, why not.

The procedure is available at Morton and Partners. Referrals are accepted from fertility specialists, gynaecologists, urologists, and GPs. For couples who have been told the next step is IVF, this is a question worth asking before that step is taken. It takes one conversation to find out whether it applies. For some couples, that conversation changes everything.

Morton and Partners Radiologists provides interventional radiology services across 16 branches in the Western Cape and KwaZulu-Natal. GP and specialist referrals are accepted. Visit morton.co.za or contact your nearest branch.

This article is intended for general informational purposes and does not constitute medical advice. Consult your GP or specialist for guidance specific to your clinical situation.

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