Sons are seen to strengthen the lineage and the inheriting capacity of a family ([@B8]) - consequently girl-children are seen as less important thereby reinforcing gender inequality.

The socioeconomic consequences of infertility are not easily overcome by availability to care. Cost of ART is an indicator of the underlying costliness of the countries health system. Consequently, it differs between countries, as does the out-of-pocket payment per individual couple. The cost to consumer is a function of the underlying cost of treatment, the level of subsidization or third party cost coverage and the available income of the consumer.

A study conducted in South Africa identified the extent of out-of-pocket-payment and financial coping mechanisms in couples accessing ART at a public, tertiary referral hospital where ART was subsidized but couples had totreatment does not lead to inappropriate perpetuation of ART in some couples are caught in an unrelenting pursuit for a child.

The benefits of ART are difficult to quantify but important. They centre on quality of life and happiness. The majority of people consider parenthood as part of the fulfilment of life goals. Cost utility analysis is the main method governments use to guide allocations of public resources to specific health outcomes. This is usually measured in quality adjusted life years (QALY's), which captures improvement in health among living patients. It is very difficult to quantify this for fertility treatment as the creation of new life cannot be captured in the indicator. However, United Kingdom National Institute of Clinical Excellence fertility guidelines incorporated QALY's and concluded that under most