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Fertility treatment in developing countries; a cycle of IVF for less than $200
July 08, 2008Barcelona, Spain: After 30 years of IVF, the rewards of treatment are still largely confined to industrialised countries and those who can afford it. Now, a Special Task Force of ESHRE has set about the immeasurable task of making fertility treatment more accessible to developing countries through a programme of pilot projects, professional awareness and involvement of government and non-governmental agencies.
The Task Force faces a huge challenge. According to a report just published in a special monograph of the journal Human Reproduction [1] even the most basic questions about infertility in developing countries cannot yet be answered: how should infertility be defined; how often does it occur; what is the burden-of-disease; what can be spent on health care; how cost-effective should IVF be in order to compete with other interventions . . . and so on.
However, if the task is great, the need is even greater. According to Professor Oluwole Akande from University College Hospital in Ibadan, Nigeria - who spoke at a press conference on Monday 7th July at 12.00 - infertility in developing countries raises problems beyond those known to developed nations. "In poor resource areas," he said, "the need for infertility treatment in general, and IVF in particular, is great. The inability to have children can create enormous problems, particularly for the woman. She might be disinherited, ostracised, accused of witchcraft, abused by local healers, separated from her spouse, or abandoned to a second-class life in a polygamous marriage."
The UN Population Division now estimates that 186 million women of reproductive age in developing countries (excluding China) are infertile, with more than 30% in many African countries unable to have children because of secondary infertility [2]. Six countries in the world have primary infertility rates over 4% - all of them in sub-Saharan Africa, the highest in Cameroon (7.3%) and Central African Republic (10.5%).
The ESHRE Task Force, which is led by gynecologist Dr Willem Ombelet, of Genk, Belgium, proposes three levels of treatment, but its cornerstone is the provision of affordable IVF. Currently, one cycle of IVF treatment in Europe or the USA costs between US$ 5000 and 10,000. A system of low-cost IVF now being pilot-studied in Khartoum and Cape Town (and shortly in Arusha, Tanzania) aims to provide one cycle of IVF for less than $200.
One of the instigators of the low-cost IVF scheme, Professor Luca Gianaroli from the SISMER Reproductive Medicine Unit, in Bologna, Italy, said: "It's a different approach to IVF. We will not be able to treat every type of infertility, but many women with tubal damage as a result of infection can be helped. We're looking at a low-cost scheme and low-cost baby." The scheme has been developed by The Low Cost IVF Foundation, which also aims to provide a complete start-up package of equipment for around $25,000.
The affordable IVF programme, as proposed by Gianaroli and the Foundation, represents level two of a three-level approach to treatment proposed by the task force: level one would offer investigation and IUI in a basic health setting (with semen analysis, hormone assays, follicular scanning and ovulation induction); level two would offer IVF (and diagnostic endoscopy) in a dedicated fertility clinic; and level three would offer ICSI in an advanced IVF unit (with cryopreservation). All three approaches would be developed around existing hospitals and clinics - as is now happening with the pilot schemes.
Said Ombelet: "A universally accessible treatment service is impossible in most developing countries, but a start can be made by integrating low cost treatments into existing family health services, where opportunities exist for contraception, health education, maternity and child care, prevention and treatment of STDs and HIV. We have to make a start, and this is how we're doing it."
But the real challenge, added Ombelet, lies in galvanising the various support agencies in the both the developed world and the developing countries, and that requires health economics data and the will to accommodate infertility treatment within the overstretched lists of healthcare priorities. "People feel uncomfortable talking about it, even indignant," he said. And that, he adds, has been his experience for the past 20 years. "That's why one of the most important aims of this ESHRE Task Force is to battle the silence that exists on the issue of infertility in most developing countries, even among the media and governments. Education in reproductive health is the message we have to take to the politicians, and we have to help them on this."
European Society for Human Reproduction and Embryology
The UN Population Division now estimates that 186 million women of reproductive age in developing countries (excluding China) are infertile, with more than 30% in many African countries unable to have children because of secondary infertility [2]. Six countries in the world have primary infertility rates over 4% - all of them in sub-Saharan Africa, the highest in Cameroon (7.3%) and Central African Republic (10.5%).
The ESHRE Task Force, which is led by gynecologist Dr Willem Ombelet, of Genk, Belgium, proposes three levels of treatment, but its cornerstone is the provision of affordable IVF. Currently, one cycle of IVF treatment in Europe or the USA costs between US$ 5000 and 10,000. A system of low-cost IVF now being pilot-studied in Khartoum and Cape Town (and shortly in Arusha, Tanzania) aims to provide one cycle of IVF for less than $200.
One of the instigators of the low-cost IVF scheme, Professor Luca Gianaroli from the SISMER Reproductive Medicine Unit, in Bologna, Italy, said: "It's a different approach to IVF. We will not be able to treat every type of infertility, but many women with tubal damage as a result of infection can be helped. We're looking at a low-cost scheme and low-cost baby." The scheme has been developed by The Low Cost IVF Foundation, which also aims to provide a complete start-up package of equipment for around $25,000.
The affordable IVF programme, as proposed by Gianaroli and the Foundation, represents level two of a three-level approach to treatment proposed by the task force: level one would offer investigation and IUI in a basic health setting (with semen analysis, hormone assays, follicular scanning and ovulation induction); level two would offer IVF (and diagnostic endoscopy) in a dedicated fertility clinic; and level three would offer ICSI in an advanced IVF unit (with cryopreservation). All three approaches would be developed around existing hospitals and clinics - as is now happening with the pilot schemes.
Said Ombelet: "A universally accessible treatment service is impossible in most developing countries, but a start can be made by integrating low cost treatments into existing family health services, where opportunities exist for contraception, health education, maternity and child care, prevention and treatment of STDs and HIV. We have to make a start, and this is how we're doing it."
But the real challenge, added Ombelet, lies in galvanising the various support agencies in the both the developed world and the developing countries, and that requires health economics data and the will to accommodate infertility treatment within the overstretched lists of healthcare priorities. "People feel uncomfortable talking about it, even indignant," he said. And that, he adds, has been his experience for the past 20 years. "That's why one of the most important aims of this ESHRE Task Force is to battle the silence that exists on the issue of infertility in most developing countries, even among the media and governments. Education in reproductive health is the message we have to take to the politicians, and we have to help them on this."
European Society for Human Reproduction and Embryology
Infertility Current Events and Infertility News RSSTeen girls diagnosed with STI more likely to seek treatment for partners after watching video
A study at Johns Hopkins Children's Center found that girls diagnosed with pelvic inflammatory disease (PID) who watched a short educational video were three times more likely to discuss their condition with their partners and to ensure partner treatment than girls diagnosed and treated without seeing the film.
NIH-funded researchers transform embryonic stem cells into human germ cells
Researchers funded in part by the National Institutes of Health have discovered how to transform human embryonic stem cells into germ cells, the embryonic cells that ultimately give rise to sperm and eggs.
IVF insurance coverage yields fewer multiple births, Yale researchers find
The proportion of in vitro fertilization (IVF) multiple births was lower in the eight states that provide insurance coverage for couples seeking IVF treatment, primarily due to fewer embryos transferred per cycle.
Identifying the metabolism of a healthy embryo could improve infertility treatment
Embryos that are most likely to result in a pregnancy are crucial to the success of in vitro fertilization (IVF) but are difficult to identify. Researchers at Yale School of Medicine, led by Emre Seli, M.D., are developing a fast, non-invasive test to help assess embryo viability for IVF.
New therapy for vasculitis will help patients avoid infertility and cancer
Researchers have identified that Rituxan, a drug previously approved for the treatment of non-Hodgkin's B cell lymphoma and rheumatoid arthritis, can treat severe ANCA-associated vasculitis as effectively as cyclophosphamide, the current standard therapy.
Drug could provide first treatment for scleroderma
Investigators have identified a drug that is currently approved to treat certain types of cancer, Gleevec, that could provide the first treatment for scleroderma, a chronic connective tissue disease for which a treatment has remained elusive.
Researchers identify mechanism that helps bacteria avoid destruction in cells
Infectious diseases currently cause about one-third of all human deaths worldwide, more than all forms of cancer combined. Advances in cell biology and microbial genetics have greatly enhanced understanding of the cause and mechanisms of infectious diseases.
Researchers Identify Gene with Possible Link to Infertility in Mice
Virginia Commonwealth University researchers have identified the role of a gene in regulating molecular signals involved with ovarian follicle development, which may one day help shed light on some of the causes of fertility issues in humans.
Possible Genetic Factor for Male Infertility Identified
Virginia Commonwealth University School of Medicine researchers have discovered a gene involved with the production of sperm that may contribute to male infertility and lead to new approaches to male contraception.
Master gene that switches on disease-fighting cells identified by scientists
The master gene that causes blood stem cells to turn into disease-fighting 'Natural Killer' (NK) immune cells has been identified by scientists, in a study published in Nature Immunology today.
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