When Ramokone Mogotlane stepped into the labour ward of a Limpopo village clinic to witness her midwife grandmother bring life into the world, she knew her calling was gynaecology.
Fast-forward to today and the specialist gynaecologist of 18 years and daughter of famed late anatomy academic and surgeon Ramaranka Mogotlane, is now delving into male infertility, a common problem in SA.
Mogotlane is the recent recipient of a Discovery Foundation award, which aims, among other things, to improve medical skills by boosting sub-specialist training and academic medicine in the country.
She is based at the Universitas Academic Hospital in Bloemfontein, where she is conducting a year-long study as part of her fellowship with the University of the Free State (UFS). It focuses on fertility preservation in young, male cancer patients.
Fertility preservation is the effort to help cancer patients retain their fertility or ability to procreate by saving or protecting sperm.
It was inevitable Mogotlane would gravitate towards a career in medicine, with her grandmother and parents all having been involved in the field.
“My grandmother, also Ramokone Phaahle Mosadi Mogotlane, was a trained midwife who worked in the village of Moletlane in Zebediela.
“From the moment I set my foot in the labour ward as a third-year student at the Medical University of South Africa, I knew this is where I belonged. I had a fair amount of support compared with [my grandmother], who only had a clinic and bicycle at night, but she still managed very well.
“My father was a professor of anatomy and a surgeon. My mother is a professor of nursing. Both my parents encouraged me and my siblings to pursue higher education. In my instance, my parents decided I would study medicine.”
Mogotlane grew up in Umlazi, south of Durban, and later moved to Pretoria.
After studying medicine at the Medical University of South Africa, she specialised in obstetrics and gynaecology at the University of Pretoria.
After a marathon run in private practice, Mogotlane was elated to receive the Discovery Foundation award, which has given her an opportunity to sub-specialise in reproductive medicine and endocrinology.
Men don’t generally present to health facilities for preventative health. In some instances, they may not even know where to get general health checks. As a result, some of the factors that are preventable or modifiable remain untreated.
— Dr Ramokone Mogotlane
“More people survive cancer. However, treatment for cancer could result in irreversible damage to parts of the reproductive system responsible for sperm production, resulting in infertility.
She believes the public sector is lacking when it comes to dealing with infertility in men.
Mogotlane’s study cohort is aged between 14 and 25 years old, newly diagnosed with leukaemia, lymphomas and bone cancers.
“They are a group with no children yet. The treatment cures them of cancer, but does impact fertility or future fertility negatively.
“These poor guys are young, confused and not really paying too much attention to the future. Discussing fertility in such a short time from diagnosis to treatment is really challenging for them.”
She wants her research, which she aims to have published in a scientific journal, to contribute to addressing the issue of male infertility within the public health system.
“Female reproductive health has received the bulk of attention.
“Of couples who seek assistance to conceive, up to 40% of causes are due to a male factor.
“Men don’t generally present to health facilities for preventative health. In some instances, they may not even know where to get general health checks. As a result, some of the factors that are preventable or modifiable remain untreated.”
Mogotlane said infertility impacts negatively on relationships.
“The thing about male infertility is that males have been protected by blame being assigned to females.
“However, it is now known that male factor infertility can contribute up to 40%, even 50%, to infertility. Females have more choices and are more outspoken.
“As a result of this, more males with infertility are exposed, so to speak. This really makes the males feel emasculated and gives poor self confidence, and may also contribute to them not presenting to medical facilities for further investigations and treatment.”
Dr Johan van Schouwenburg, a fertility specialist at Medfem Clinic in Johannesburg, said while fertility preservation has proven “very successful”, sperm freezing before surgery, chemotherapy or radiation is seldom requested.
“This is because the patient may not know or think about this option, or because the medical team treating the patient does not think about it since they are preoccupied [with] the cancer and only consider the best ways of getting rid of the cancer to heal the patient as quickly and effectively as possible.”
Dr Johan Mouton, a urologist at the Urology Hospital in Pretoria, said: “In South Africa we are seeing more couples battling with infertility and there seems to be a definite increase in the incidence of male infertility.
“There are several ongoing studies being done, especially in the malaria areas where dichloro-diphenyl-trichloroethane is still used. However, more research is desperately needed, specifically in areas with high environmental pollution.”
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