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Erthal-Michelato RP, Quadreli DH, Zaninelli TH, Verri WA, Fernandes GSA. Lower malathion concentrations reduce testosterone biosynthesis by Leydig TM3 cells in vitro by altering cellular redox profile and inducing oxidative damage. Reprod Toxicol 2024; 126:108595. [PMID: 38641014 DOI: 10.1016/j.reprotox.2024.108595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/01/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024]
Abstract
Malathion is an organophosphate pesticide used in agriculture and control of the Aedes aegypti mosquito. As previous reports have indicated the potential of malathion to compromise testosterone production in in vivo models, the objective of this study was to elucidate the mechanisms underlying the impairment of Leydig cell function, considering its critical role in male reproductive function. To this end, murine Leydig TM3 cells were exposed to concentrations of 1, 10, 100 or 1000 μM malathion for 24 h for evaluation of the compound on cell viability. Subsequently, concentrations of 1, 10, and 100 μM malathion were employed for a 24-h period to assess testosterone biosynthesis, levels of cytokines IL-1β, IL-6, IL-10, and TNF-α, as well as the redox profile. Malathion exerted a concentration-dependent impact on cell viability. Notably, the lower concentrations of malathion (1 and 10 μM) were found to impair testosterone biosynthesis in TM3 cells. While there were changes in IL-1 and TNF-α levels at specific concentrations, no direct correlation with altered hormone production was established. Our investigation revealed that varied malathion concentrations induced oxidative stress by increase in superoxide anion and a compensatory rise in antioxidants. In conclusion, the observed changes in the oxidative profile of TM3 cells were linked to functional impairment, evidenced by reduced testosterone biosynthesis at lower malathion concentrations.
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Affiliation(s)
- Rafaela Pires Erthal-Michelato
- Department of General Biology, Biological Sciences Center, State University of Londrina - UEL, Rodovia Celso Garcia Cid, PR 445, Londrina, Paraná 86057-970, Brazil; Department of General Pathology, Biological Sciences Center, State University of Londrina - UEL, Rodovia Celso Garcia Cid, PR 445, Londrina, Paraná 86057-970, Brazil.
| | - Débora Hipólito Quadreli
- Department of General Biology, Biological Sciences Center, State University of Londrina - UEL, Rodovia Celso Garcia Cid, PR 445, Londrina, Paraná 86057-970, Brazil
| | - Tiago Henrique Zaninelli
- Department of General Pathology, Biological Sciences Center, State University of Londrina - UEL, Rodovia Celso Garcia Cid, PR 445, Londrina, Paraná 86057-970, Brazil
| | - Waldiceu Aparecido Verri
- Department of General Pathology, Biological Sciences Center, State University of Londrina - UEL, Rodovia Celso Garcia Cid, PR 445, Londrina, Paraná 86057-970, Brazil
| | - Glaura Scantamburlo Alves Fernandes
- Department of General Biology, Biological Sciences Center, State University of Londrina - UEL, Rodovia Celso Garcia Cid, PR 445, Londrina, Paraná 86057-970, Brazil
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2
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Xi Y, Cao YL, Tao LY, Gao SZ, Jin ZR, Cheng JX, Jiang H, Zhang Z. A global perspective: characteristics of infertility-related randomized clinical trials. Andrology 2024. [PMID: 38231194 DOI: 10.1111/andr.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/09/2023] [Accepted: 01/01/2024] [Indexed: 01/18/2024]
Abstract
BACKGROUND Infertility is a prevalent global condition, and emerging reproductive technologies may enhance its evaluation and treatment. Understanding the current features of randomized clinical trials in infertility is crucial for improving study design and ensuring the translation of results for patient benefits. OBJECTIVES To investigate the primary characteristics of randomized clinical trials related to infertility and areas where require improvement. MATERIALS AND METHODS We conducted a search on the International Clinical Trials Registry platform for eligible infertility trials between 2003 and 2022. The distribution ratio of various characteristics uploaded by infertility-related studies on the platform was analyzed and compared according to sex and registration year. RESULTS Out of the total trials, 85.3% (1,906) included only women, 8.6% (192) included only men, and 6.1% (136) included couples. The majority of retrieved trials followed a parallel arm design (91.0%) and were non-industry-funded (92.2%), with a median planned sample size of 131 patients (interquartile range 75-270). Among these trials, 54.5% (1,217) were conducted in Asia. The most common primary purpose of infertility-related trials was treatment (88.8%), with over half of the investigated interventions focusing on medication (57.9%). DISCUSSION Asia is the leading region for research, and the drug therapy is still widely used and updated. However, support care for infertile couples has also received some preference. Areas that require improvement and promotion include addressing male infertility and focusing on underserved regions like Africa. The results also highlight deficiencies in trial registration and masking methods, emphasizing the need for better regulation and facilitation of infertility trials in the post-COVID-19 era. CONCLUSION Based on the current status of infertility RCT studies, greater attention should be paid to infertile men and populations in underdeveloped regions like Africa in future studies, together with a standardized registration and implementation procedures.
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Affiliation(s)
- Yu Xi
- Department of Urology, Peking University Third Hospital, Beijing, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Ya-Lei Cao
- Department of Urology, Peking University Third Hospital, Beijing, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Li-Yuan Tao
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Song-Zhan Gao
- Department of Andrology, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zi-Run Jin
- Department of Urology, Peking University Third Hospital, Beijing, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Jian-Xing Cheng
- Department of Urology, Peking University Third Hospital, Beijing, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
| | - Hui Jiang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
| | - Zhe Zhang
- Department of Urology, Peking University Third Hospital, Beijing, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing, China
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Afferri A, Allen H, Dierickx S, Bittaye M, Marena M, Pacey A, Balen J. Availability of services for the diagnosis and treatment of infertility in The Gambia`s public and private health facilities: a cross-sectional survey. BMC Health Serv Res 2022; 22:1127. [PMID: 36071443 PMCID: PMC9450453 DOI: 10.1186/s12913-022-08514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background Infertility is a long-standing reproductive health issue, which affects both men and women worldwide and it is especially problematic in the Global South. In sub-Saharan Africa, understanding the current availability of diagnostic and treatment services for infertility is important because this could guide health systems to improve access to fertility care for all. Yet, few studies have explicitly started from a health system perspective to grasp the availability and integration of infertility services in sub-Saharan Africa. This quantitative study, the first in The Gambia, West Africa, examines the availability of infertility services in public and private facilities as part of a wider endeavour to improve fertility care policy and practice in the country. Methods A cross-sectional survey using Qualtrics was administered to 38 health facilities. The survey was carried out between March and August 2021 and involved closed-ended questions. Data analysis consisted of descriptive statistics and t-tests performed using SPSS version 26. Results A total of 25 facilities (66%) offered infertility services, of which 13 (52%) were public and 12 (47%) private. Although the availability of screening tests was similar between health institutions, most diagnostic and treatment services were available only in the private sector. Treatment services included: (i) ovarian stimulation (n = 16, 42%); (ii) reversal of tubal ligation and/or blockage (tuboplasty) (n = 4, 11%); and (iii) intrauterine insemination (n = 3, 8%). Assisted reproductive technologies such as IVF and ICSI were not available in public or private sectors. The Gambian health management information system lacked a dedicated space to capture data on infertility. Reported barriers to integration of infertility services in existing reproductive health services included a lack of specialised training, an absence of national guidance on infertility management, and a shortage of appropriate equipment, supplies, and medication. Conclusions The availability of infertility services in The Gambia follows a trajectory that is similar to other SSA countries in which services are mostly obtainable through the private sector. Yet, access to private care is expensive and geographically restricted, which exacerbates inequalities in accessing fertility care for all. Improving the provision of infertility services in the public sector requires systematically capturing data on infertility and investing in the provision of a full-range fertility care package. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08514-0.
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Affiliation(s)
- Anna Afferri
- School of Health and Related Research - ScHARR, The University of Sheffield, Sheffield, UK.
| | - Haddijatou Allen
- Medical Research Council - MRC The Gambia Unit, Fajara, The Gambia
| | - Susan Dierickx
- Research Centre Gender, Diversity and Intersectionality - RHEA, Vrije Universiteit Brussel, Ixelles, Belgium
| | - Mustapha Bittaye
- The Gambia Ministry of Health, Banjul, The Gambia.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Musa Marena
- The Gambia Ministry of Health, Banjul, The Gambia.,School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Allan Pacey
- Department of Oncology and Metabolism, The Medical School, The University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research - ScHARR, The University of Sheffield, Sheffield, UK
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4
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Ombelet W, Van Blerkom J, Nargund G, Van der Auwera I, Janssen M, Dhont N, Bosmans E, Boshoff G, Vertessen VJ, Campo R. Multiyear outcomes using sibling oocytes demonstrates safety and efficacy of a simplified culture system consistent with use in a low-cost IVF setting. Reprod Biomed Online 2022; 45:481-490. [DOI: 10.1016/j.rbmo.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/07/2022] [Accepted: 04/14/2022] [Indexed: 01/15/2023]
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5
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Christ JP, Vu M, Mehr H, Jackson-Bey T, Herndon CN. See one, do one, teach one: Reimagining reproductive endocrinology and infertility training programs to expand access to care. F S Rep 2022; 3:114-121. [PMID: 35937450 PMCID: PMC9349230 DOI: 10.1016/j.xfre.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/29/2021] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To provide a review of the current literature surrounding barriers to reproductive medicine and present examples of how resident and fellow education can be used to overcome these barriers. Design A review of the relevant literature addressing barriers to reproductive medicine, resident and fellow education, and related materials was completed. Setting Academic medical institutions. Patient(s) None. Intervention(s) None. Main Outcome Measure(s) Health disparities and barriers in access to care. Result(s) Of barriers in access to care, 3 were reviewed in detail: cost of health care, racial inequities, and marginalization of immigrant communities. The suggested strategies to mitigate these barriers include the following: reducing racial inequities through improved diversity within reproductive medicine and through antiracism training, developing opportunities for trainees to engage in advocacy, strengthening reproductive endocrinology and infertility clinical exposure and educational curricula in training programs, inclusion of residents and fellows in clinical care, and improving the accessibility of fertility care through implementing approaches to optimize the management of infertility in challenging, resource-constrained settings. Conclusion(s) Infertility is one of the most prevalent reproductive health diseases, yet profound disparities and inequities in access to care exist today in the United States. Lower-income, minority, and immigrant communities are among those most marginalized. Improved access to care begins with broadened obstetrics and gynecology and reproductive endocrinology and infertility trainee education, which acknowledges the barriers these communities face and provides strategies to help overcome these obstacles to care.
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Affiliation(s)
- Jacob P. Christ
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Michelle Vu
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Holly Mehr
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California
| | - Tia Jackson-Bey
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York
| | - Christopher N. Herndon
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
- Reprint requests: Christopher N. Herndon, M.D., Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, Washington 98195-6460.
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Concepción-Zavaleta M, Paz Ibarra JL, Ramos-Yataco A, Coronado-Arroyo J, Concepción-Urteaga L, Roseboom PJ, Williams CA. Assessment of hormonal status in male infertility. An update. Diabetes Metab Syndr 2022; 16:102447. [PMID: 35272174 DOI: 10.1016/j.dsx.2022.102447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/26/2022] [Accepted: 03/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The prevalence and incidence of infertility are increasing worldwide; they are associated with a significant economic and social impact. Infertility is defined as the inability to achieve pregnancy after 12 months or more of regular unprotected sex. In recent times, the male factor has gained importance and currently it contributes to approximately 50% of infertility cases. Multiple etiologies are stated, such as metabolic, anatomical, genetic or even idiopathic causes; however, the main cause is semen abnormalities. The aim of this manuscript is to provide a complete review of hormonal assessment of male infertility, as well as to review the physiology and pathophysiology related to the male gonadal axis. METHODS This study is a narrative abstract carried out on basis of systematic bibliographic review, using articles indexed in PubMed/Medline, Scopus, Embase and Scielo, which were published during the last 20 years. RESULTS The cornerstone of the evaluation of the hormonal status is semen analysis. Clinicians must rule out hypogonadism in those patients who present oligospermia and azoospermia, by determining levels of testosterone and gonadotropins, which provide the functionality status of the hypothalamic-pituitary-testicular axis. Evaluation of the adrenal, thyroid, and lactotroph axis are indicated in those patients with central hypogonadism. CONCLUSIONS Despite advances in the diagnosis of male infertility, some causes are not fully understood, therefore, it is crucial to perform a timely hormonal evaluation of the male factor in infertile couples, in order to provide adequate treatment and improve fertility rates.
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Affiliation(s)
| | - José Luis Paz Ibarra
- Division of Endocrinology, National Hospital Edgardo Rebagliati Martins, Lima, Peru
| | | | - Julia Coronado-Arroyo
- Division of Obstetrics and Gynecology, National Hospital Edgardo Rebagliati Martins, Lima, Peru
| | | | - Pela J Roseboom
- Division of Emergency Medicine, Regional Academic Hospital of Trujillo, Trujillo, Peru
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7
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Abdollahpour S, Taghipour A, Mousavi Vahed SH, Latifnejad Roudsari R. The efficacy of cognitive behavioural therapy on stress, anxiety and depression of infertile couples: a systematic review and meta-analysis. J OBSTET GYNAECOL 2021; 42:188-197. [PMID: 34109898 DOI: 10.1080/01443615.2021.1904217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Infertility is considered globally to be a stressful and hard experience that affects the couples psychologically, socially and individually. The aim of this study was to systematically review the effectiveness of cognitive behavioural therapy (CBT) on depression, stress and anxiety in infertile couples. In this systematic review and meta-analysis, databases were searched up to August 2019. Twelve articles were included in the meta-analysis and analysed with Comprehensive Meta-Analysis (CMA) v2. The results of pooled studies showed that the mean scores for depression and anxiety decreased in patients receiving CBT as compared to the control group. The results of three pooled studies showed no significant difference on stress in patients receiving CBT as compared to the control group. The findings of this study provides valuable suggestions for improving mental health status through applying CBT to manage anxiety and depression in infertile couples.
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Affiliation(s)
- Sedigheh Abdollahpour
- Department of Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Taghipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Houra Mousavi Vahed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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8
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Chiware TM, Vermeulen N, Blondeel K, Farquharson R, Kiarie J, Lundin K, Matsaseng TC, Ombelet W, Toskin I. IVF and other ART in low- and middle-income countries: a systematic landscape analysis. Hum Reprod Update 2021; 27:213-228. [PMID: 33238297 PMCID: PMC7903111 DOI: 10.1093/humupd/dmaa047] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/06/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infertility affects 48.5 million couples worldwide with a prevalence estimated at 3.5-16.7% in low- and middle-income countries (LMIC), and as high as 30-40% in Sub-Saharan Africa. ART services are not accessible to the majority of these infertile couples due to the high cost of treatments in addition to cultural, religious and legal barriers. Infertility and childlessness, particularly in LMIC, have devastating consequences, which has resulted in considerable interest in developing affordable IVF procedures. However, there is a paucity of evidence on the safety, efficiency and ability to replicate techniques under different field conditions, and how to integrate more affordable ART options into existing infrastructures. OBJECTIVE AND RATIONALE This review was performed to investigate the current availability of IVF in LMIC and which other ART options are under development. This work will unfold the landscape of available and potential ART services in LMIC and is a key element in positioning infertility more broadly in the Global Public Health Agenda. SEARCH METHODS A systematic literature search was performed of articles and gray literature on IVF and other ART options in LMIC published between January 2010 and January 2020. We selected studies on IVF and other ART treatments for infertile couples of reproductive age (18-44 years) from LMIC. The review was limited to articles published after 2010, based on the recent evolution in the field of ART practices in LMIC over the last decade. Citations from high-income countries, including data prior to 2010 and focusing on specialized ART procedures, were excluded. The literature search included PubMed, Popline, CINHAL, EMBASE and Global Index Medicus. No restrictions were applied with regard to study design or language. Two reviewers independently screened the titles and abstracts, and extracted data. A search for gray literature was performed using the 'Google' search engine and specific databases (worldcat.org, greylit.org). In addition, the reference lists of included studies were assessed. OUTCOMES The search of the electronic databases yielded 3769 citations. After review of the titles and abstracts, 283 studies were included. The full texts were reviewed and a further 199 articles were excluded. The gray literature search yielded 586 citations, most of which were excluded after screening the title, and the remaining documents were excluded after full-text assessment due to duplicate entries, not from LMIC, not relevant or no access to the full document. Eighty-four citations were included as part of the review and separated into regions. The majority of the studies were observational and qualitative studies. In general, ART services are available and described in several LMIC, ranging from advanced techniques in China to basic introduction of IVF in some African countries. Efforts to provide affordable ART treatments are described in feasibility studies and efficacy studies; however, most citations were of low to very low quality. We found no studies from LMIC reporting the implementation of low-cost ART that is effective, accessible and affordable to most of those in need of the services. WIDER IMPLICATIONS The World Health Organization is in a unique position to provide much needed guidance for infertility management in LMIC. This review provides insight into the landscape of ART in LMIC in various regions worldwide, which will guide efforts to improve the availability, quality, accessibility and acceptability of biomedical infertility care, including ART in these countries.
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Affiliation(s)
- Tendai M Chiware
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont Medical Center, Burlington, VT, USA
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Nathalie Vermeulen
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
| | - Karel Blondeel
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Roy Farquharson
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
| | - James Kiarie
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Kersti Lundin
- European Society of Human Reproduction and Embryology, Central Office, Grimbergen, Belgium
- Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thabo Christopher Matsaseng
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
- Reproductive Medicine Unit, Department of Obstetrics & Gynaecology, Stellenbosch University, Cape Town, South Africa
| | - Willem Ombelet
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium
- Genk Institute for Fertility Technology, ZOL Hospitals, Genk 3600, Belgium
| | - Igor Toskin
- Department of Reproductive Health and Research, UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Arakkal D, Mascarenhas M, Mangalaraj AM, Karthikeyan M, Prasad JH, Kunjummen AT, Kamath MS. Comparison of Low Cost Versus Conventional Assisted Reproductive Technology Treatment: A Prospective Micro Costing Study. FERTILITY & REPRODUCTION 2020. [DOI: 10.1142/s2661318220500164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: Among multiple barriers for infertility treatment, the major deterrent appears to be the high cost of assisted reproductive technology (ART). Low-cost ART employing mild stimulation protocols among other cost cutting measures has been advocated in resource limited settings. In the current study, we compared the actual cost incurred for conventional and low-cost ART treatment. Study Design: Prospective micro-costing study at a university-level infertility unit, including women undergoing conventional and low-cost ART. The data collection for micro-costing was done primarily through direct observation of the resources utilized and time involved on a prospective basis. Only direct medical cost involved in ART treatment was calculated. The outcome measures included the cost per cycle and cost per clinical pregnancy. Results: The average cost per couple per initiated cycle for the conventional ART was almost 50% higher as compared to low-cost ART ($1,433 vs. $739). The cost per clinical pregnancy per initiated cycle for conventional ART was lower compared to low-cost ART ($4248 vs. $4960). In a limited number of patients, the clinical pregnancy rate per embryo transfer was 40% (2/5 patients) in the conventional cycle as compared to 17% (1/6) in the low-cost ART cycle. Conclusion: Using mild stimulation protocol in the low-cost ART program resulted in reduction in actual cost per cycle to almost half, but the cost per clinical pregnancy was higher compared to conventional ART.
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Affiliation(s)
- Darshana Arakkal
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Mariano Mascarenhas
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Ann M. Mangalaraj
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | | | - Jasmin H. Prasad
- Department of Community Medicine, Christian Medical College, Vellore, India
| | | | - Mohan S. Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
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Agrawal N, Fayyaz S. Evaluation of endoscopic procedures in terms of achieving pregnancy in female infertile patients: An experience at a single tertiary care center. J Gynecol Obstet Hum Reprod 2018; 47:425-429. [PMID: 30153506 DOI: 10.1016/j.jogoh.2018.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the success rate of endoscopic procedures in terms of achieving pregnancy at an interval of three months for 12 months or till achievement of fetal cardiac activity whichever is earlier. METHODS We prospectively evaluated 157 female patients (age range 19-35 years; mean age 27.75 years), who were diagnosed as infertile. During their diagnostic work, all underwent hysterolaparoscopy. The detected anatomical abnormalities on the hysterolaparoscopy were tackled at the same time during diagnostic work-up if possible. After hysterolaparoscopy, Patients were advised for regular sexual activity. The follow-up of all recruited patients was done at an interval of three months for 12 months or till achievement of fetal cardiac activity. RESULTS Of the 157 infertile female patients, 93 (59.2%) were of primary infertility and remaining 64 (41.74%) were secondary infertility patients. Hysterolaparoscopy revealed abnormalities in 125/157 patients. The detected hysterolaparoscopic anatomical abnormalities were distributed in 77/93 (82.8%) primary and 48/64 (75%) secondary infertility patients. Of the 125 patients with abnormal hysterolaproscopic findings, 121 underwent active therapeutic interventions. All of the secondary infertility patients with hysterolaparoscopic abnormalities experienced active hysterolaparoscopic interventions. Of 77 patients with hysterolaparoscopic abnormality in primary infertility group, 73 patients experienced active intervention. Out of the 125 abnormal hysterolaparoscopic patients, 121 underwent active intervention and 43 patients conceived during next 12 months. Among 32 patients with normal hysterolaparoscopic findings, 7 conceived within 12 months. Significantly higher conception was observed in hysterolaparoscopic intervention patients as compared to normal hysterolaparoscopy patients (p∼0.001). Independently in primary infertility patients, the conception rate in the patient with hysterolaparoscopic intervention was significantly higher than nonintervention group (p<0.0001). Similarly, conception rate was significantly higher in secondary infertility patients (p∼0.004). CONCLUSION We concluded that the conception rate was significantly high in infertility patients, who underwent hysterolaproscopic intervention. In short hysterolaparoscopy should be considered as a potential gold standard approach in the evaluation of female infertility.
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Affiliation(s)
- Namita Agrawal
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India.
| | - S Fayyaz
- Department of Obstetrics & Gynaecology, Santokba Durlabhji Memorial Hospital & Research Centre (SDMH), Jaipur, Rajasthan 302015, India
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Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, Coll-Seck AM, Grover A, Laski L, Roa M, Sathar ZA, Say L, Serour GI, Singh S, Stenberg K, Temmerman M, Biddlecom A, Popinchalk A, Summers C, Ashford LS. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet 2018; 391:2642-2692. [PMID: 29753597 DOI: 10.1016/s0140-6736(18)30293-9] [Citation(s) in RCA: 459] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/02/2018] [Accepted: 02/08/2018] [Indexed: 01/10/2023]
Affiliation(s)
| | - Alex C Ezeh
- African Population and Health Research Center, Nairobi, Kenya; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Center for Global Development, Washington, DC, USA
| | | | - Alaka Basu
- Department of Development Sociology, Cornell University, Ithaca, NY, USA
| | - Jane T Bertrand
- Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Robert Blum
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | - Monica Roa
- Independent Consultant, Islamabad, Pakistan
| | | | - Lale Say
- World Health Organization, Geneva, Switzerland
| | - Gamal I Serour
- International Islamic Center For Population Studies And Research, Al Azhar University, Cairo, Egypt
| | | | | | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University, Nairobi, Kenya
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Anokye R, Acheampong E, Mprah WK, Ope JO, Barivure TN. Psychosocial effects of infertility among couples attending St. Michael's Hospital, Jachie-Pramso in the Ashanti Region of Ghana. BMC Res Notes 2017; 10:690. [PMID: 29208028 PMCID: PMC5718012 DOI: 10.1186/s13104-017-3008-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/28/2017] [Indexed: 11/26/2022] Open
Abstract
Objective Infertility is a life crisis with a wide range of socio-cultural, emotional, physical and financial problems. This study sought to determine the psychosocial effects of infertility among couples attending St. Michael’s hospital, Jachie-Pramso. A descriptive study design was adopted using a quantitative approach. A simple random technique was used to select 100 respondents and a structured closed ended questionnaire was administered to couples who visited the St. Michaels Hospital at Jachie-Pramso. Results The study has revealed that the social effects of infertility on couples included exclusion, verbal and physical abuse, divorce as well as stigma. There is high level of despondence among couples who are considered infertile. Reliance on family members for emotional support as well as avoidance of sensitive conversations was the main coping strategies adopted by the couples to cope with their conditions. Infertility has psychological, emotional and social consequences on individuals as well as couples. Families should support infertile individuals in every way that they can so that they will not be isolated.
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Affiliation(s)
- Reindolf Anokye
- Department of Community Health, Centre for Disability and Rehabilitation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Enoch Acheampong
- Department of Community Health, Centre for Disability and Rehabilitation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Wisdom Kwadwo Mprah
- Department of Community Health, Centre for Disability and Rehabilitation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Janet Opia Ope
- Department of Nursing, Garden City University College, Kumasi, Ghana
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Outcomes from a university-based low-cost in vitro fertilization program providing access to care for a low-resource socioculturally diverse urban community. Fertil Steril 2017; 108:642-649.e4. [DOI: 10.1016/j.fertnstert.2017.06.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022]
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Whittaker A. Cross-border assisted reproduction care in Asia: implications for access, equity and regulations. REPRODUCTIVE HEALTH MATTERS 2017; 19:107-16. [DOI: 10.1016/s0968-8080(11)37575-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Mocé E, Fajardo AJ, Graham JK. Human Sperm Cryopreservation. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10313056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
As the demand for assisted reproductive techniques in humans increases, so does the demand for the oocytes and sperm that are essential for these techniques. Human sperm banks play a key role in assisted human reproduction, as a reservoir of sperm from the semen of donors and as an option for genetic preservation for some patients. There are different techniques that can be used to store human sperm. This paper will provide an overview of the available techniques of human sperm preservation.
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Affiliation(s)
- Eva Mocé
- Centro de Tecnología Animal-Instituto Valenciano de Investigaciones Agrarias (CITA-IVIA), Segorbe (Castellón), Spain
| | - Andrés J. Fajardo
- Centro de Tecnología Animal-Instituto Valenciano de Investigaciones Agrarias (CITA-IVIA), Segorbe (Castellón), Spain
| | - James K. Graham
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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16
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Chakravarthi I. Regulation of Assisted Reproductive Technologies: Gains and Losses. INDIAN JOURNAL OF GENDER STUDIES 2016. [DOI: 10.1177/0971521515612866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technology assessment and regulatory strategies have been proffered as ways of addressing concerns and problems arising from availability of certain medical technologies. Regulation especially is invoked as a remedy that can deliver several objectives—as a way of assuring quality care; as a way of preventing medical malpractice and negligence; as a remedy for market failure; as a way of improving performance and efficiency; and as a way of even achieving national health objectives or wider social goals such as equity and accountability. It is assumed that the key issues in regulation are its design and having proper monitoring and enforcement. The article reviews the regulations instituted to address issues arising from the use of reproductive technologies. Through such analysis, the article seeks to draw attention to the field of technology assessment and regulation in general as applicable to biomedical technologies, in a context of overall commercialisation of medical and health care.
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Affiliation(s)
- Indira Chakravarthi
- Public Health Researcher, Visiting Fellow, Centre for Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, India
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Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update 2015; 21:411-26. [PMID: 25801630 DOI: 10.1093/humupd/dmv016] [Citation(s) in RCA: 847] [Impact Index Per Article: 94.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/28/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Infertility is estimated to affect as many as 186 million people worldwide. Although male infertility contributes to more than half of all cases of global childlessness, infertility remains a woman's social burden. Unfortunately, areas of the world with the highest rates of infertility are often those with poor access to assisted reproductive techniques (ARTs). In such settings, women may be abandoned to their childless destinies. However, emerging data suggest that making ART accessible and affordable is an important gender intervention. To that end, this article presents an overview of what we know about global infertility, ART and changing gender relations, posing five key questions: (i) why is infertility an ongoing global reproductive health problem? (ii) What are the gender effects of infertility, and are they changing over time? (iii) What do we know about the globalization of ART to resource-poor settings? (iv) How are new global initiatives attempting to improve access to IVF? (v) Finally, what can be done to overcome infertility, help the infertile and enhance low-cost IVF (LCIVF) activism? METHODS An exhaustive literature review using MEDLINE, Google Scholar and the keyword search function provided through the Yale University Library (i.e. which scans multiple databases simultaneously) identified 103 peer-reviewed journal articles and 37 monographs, chapters and reports from the years 2000-2014 in the areas of: (i) infertility demography, (ii) ART in low-resource settings, (iii) gender and infertility in low-resource settings and (iv) the rise of LCIVF initiatives. International Federation of Fertility Societies Surveillance reports were particularly helpful in identifying important global trends in IVF clinic distribution between 2002 and 2010. Additionally, a series of articles published by scholars who are tracking global cross-border reproductive care (CBRC) trends, as well as others who are involved in the growing LCIVF movement, were invaluable. RESULTS Recent global demographic surveys indicate that infertility remains an ongoing reproductive problem, with six key demographic features. Despite the massive global expansion of ART services over the past decade (2005-2015), ART remains inaccessible in many parts of the world, particularly in sub-Saharan Africa, where IVF clinics are still absent in most countries. For women living in such ART-poor settings, the gender effects of infertility may be devastating. In contrast, in ART-rich regions such as the Middle East, the negative gender effects of infertility are diminishing over time, especially with state subsidization of ART. Furthermore, men are increasingly acknowledging their male infertility and seeking ICSI. Thus, access to ART may ameliorate gender discrimination, especially in the Global South. To that end, a number of clinician-led, LCIVF initiatives are in development to provide affordable ART, particularly in Africa. Without access to LCIVF, many infertile couples must incur catastrophic expenditures to fund their IVF, or engage in CBRC to seek lower-cost IVF elsewhere. CONCLUSIONS Given the present realities, three future directions for research and intervention are suggested: (i) address the preventable causes of infertility, (ii) provide support and alternatives for the infertile and (iii) encourage new LCIVF initiatives to improve availability, affordability and acceptability of ART around the globe.
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Affiliation(s)
- Marcia C Inhorn
- Department of Anthropology, Yale University, 10 Sachem Street, New Haven, CT 06520-8277, USA
| | - Pasquale Patrizio
- Department of Obstetrics and Gynecology, Yale Fertility Center, Yale School of Medicine, 150 Sargent Drive, 2nd Floor, New Haven, CT 06511-6110, USA
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Snow RC, Laski L, Mutumba M. Sexual and reproductive health: progress and outstanding needs. Glob Public Health 2015; 10:149-73. [PMID: 25555027 PMCID: PMC4318113 DOI: 10.1080/17441692.2014.986178] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/06/2014] [Indexed: 10/25/2022]
Abstract
We examine progress towards the 1994 International Conference on Population and Development (ICPD) commitment to provide universal access to sexual and reproductive health (SRH) services by 2014, with an emphasis on changes for those living in poor and emerging economies. Accomplishments include a 45% decline in the maternal mortality ratio (MMR) between 1990 and 2013; 11.5% decline in global unmet need for modern contraception; ~21% increase in skilled birth attendance; and declines in both the case fatality rate and rate of abortion. Yet aggregate gains mask stark inequalities, with low coverage of services for the poorest women. Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 80 developing countries highlight persistent disparities in skilled birth attendance by household wealth: in 70 of 80 countries (88%), ≥80% of women in the highest quintile were attended by a skilled provider at last birth; in only 23 of the same countries (29%) was this the case for women in the lowest wealth quintile. While there have been notable declines in HIV incidence and prevalence, women affected by HIV are too often bereft of other SRH services, including family planning. Achieving universal access to SRH will require substantially greater investment in comprehensive and integrated services that reach the poor.
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Affiliation(s)
- Rachel C. Snow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Laura Laski
- Sexual and Reproductive Health Branch, UNFPA, New York, NY, USA
| | - Massy Mutumba
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Bahamondes L, Makuch MY. Infertility care and the introduction of new reproductive technologies in poor resource settings. Reprod Biol Endocrinol 2014; 12:87. [PMID: 25201070 PMCID: PMC4180834 DOI: 10.1186/1477-7827-12-87] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/01/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The overall prevalence of infertility was estimated to be 3.5-16.7% in developing countries and 6.9-9.3% in developed countries. Furthermore, according to reports from some regions of sub-Saharan Africa, the prevalence rate is 30-40%. The consequences of infertility and how it affects the lives of women in poor-resource settings, particularly in developing countries, has become an important issue to be discussed in reproductive health. In some societies, the inability to fulfill the desire to have children makes life difficult for the infertile couple. In many regions, infertility is considered a tragedy that affects not only the infertile couple or woman, but the entire family. METHODS This is a position paper which encompasses a review of the needs of low-income infertile couples, mainly those living in developing countries, regarding access to infertility care, including ART and initiatives to provide ART at low or affordable cost. Information was gathered from the databases MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, and ICTRP with the key words: infertility, low income, assisted reproductive technologies, affordable cost, low cost. RESULTS There are few initiatives geared toward implementing ART procedures at low cost or at least at affordable cost in low-income populations. Nevertheless, from recent studies, possibilities have emerged for new low-cost initiatives that can help millions of couples to achieve the desire of having a biological child. CONCLUSIONS It is necessary for healthcare professionals and policymakers to take into account these new initiatives in order to implement ART in resource-constrained settings.
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Affiliation(s)
- Luis Bahamondes
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP Brazil
| | - Maria Y Makuch
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP Brazil
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20
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Is global access to infertility care realistic? The Walking Egg Project. Reprod Biomed Online 2014; 28:267-72. [DOI: 10.1016/j.rbmo.2013.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/21/2013] [Accepted: 11/21/2013] [Indexed: 11/18/2022]
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Van Blerkom J, Ombelet W, Klerkx E, Janssen M, Dhont N, Nargund G, Campo R. First births with a simplified culture system for clinical IVF and embryo transfer. Reprod Biomed Online 2013; 28:310-20. [PMID: 24456702 DOI: 10.1016/j.rbmo.2013.11.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/12/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
Abstract
This study reports the outcome results from a pilot clinical trial using a simplified laboratory method for human IVF. This system reproducibly generates de novo the atmospheric and culture conditions that support normal fertilization and preimplantation embryogenesis to the hatched blastocyst stage without the need for specialized medical-grade gases or equipment. Development from insemination to the hatched blastocyst stage occurs undisturbed in a completely closed system that enables timed performance assessments for embryo selection in situ that, in this study, involved single-embryo transfers on day 3. With the simplified culture system, 8/23 embryos implanted, one miscarried at 8weeks of gestation and seven healthy babies have been born. The methodology and results are discussed with regard to how this simplified system can be adopted worldwide to meet the growing need for accessible and affordable IVF. A common notion concerning the demographics of infertility is that it is largely a phenomenon associated with developed countries, where infertility treatments are commonplace. In fact, most infertile couples reside in developing/low-resource countries where infertility diagnosis and treatment is nonexistent, inaccessible or unaffordable by the vast majority of young men and women in need. The irony of this situation is that bilateral tubal occlusions, for which IVF was originally indicated and is the most effective treatment, is by far the most common cause of their infertility. We have addressed one aspect of this issue, the IVF laboratory, as part of a wider effort by the Walking Egg Project to design and establish small, dedicated centres in developing countries to provide assisted reproduction technologies that are affordable and accessible to a wider proportion of the population in need. The methods for conventional IVF designed to addresses tubal obstructions are relatively simple and free of complex instrumentation and the highly developed infrastructure common to high-resource centres. This simplified IVF system self-generates culture conditions in a closed system. After prolonged preclinical testing, a pilot clinical study was initiated in 2012 in Genk, Belgium. The findings suggest that a significant first step has been achieved in the effort to bring advanced assisted reproduction to developed countries using a low-resource but highly effective IVF system capable of bringing modern reproductive medicine to infertile couples in low-resource societies.
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Affiliation(s)
- Jonathan Van Blerkom
- Department of Molecular, Cellular and Developmental Biology, University of Colorado, Boulder, CO, USA; Colorado Reproductive Endocrinology, Rose Medical Center, Denver, CO, USA.
| | - Willem Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium; Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium
| | - Elke Klerkx
- Genk Institute for Fertility Technology, Genk, Belgium
| | - Mia Janssen
- Genk Institute for Fertility Technology, Genk, Belgium
| | | | - Geeta Nargund
- Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium; Create Health Clinic, London, United Kingdom
| | - Rudi Campo
- Genk Institute for Fertility Technology, Genk, Belgium
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Ha JO. Risk disparities in the globalisation of assisted reproductive technology: the case of Asia. Glob Public Health 2013; 8:904-25. [PMID: 23941180 DOI: 10.1080/17441692.2013.826270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper analyses the disparities in risks associated with biomedical technology focusing on the results of assisted reproductive technology (ART). ART among biomedical technologies transferred to Asia is a representative case that reveals in its clinical use and related scientific research the global politics of technology. This study notes the global politics at work in the recognition of and reaction to such risks. While many Asian countries aggressively pursue technological development, weak legislative and administrative regulations have created various problems and controversial cases. This study asserts that risks associated with technology are characterised as social facts not natural ones or mere 'side effects', since technological development and risk are closely intertwined.
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Affiliation(s)
- Jung-Ok Ha
- a Institute for Gender Research , Seoul National University , Seoul , Republic of Korea
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Dyer SJ, Sherwood K, McIntyre D, Ataguba JE. Catastrophic payment for assisted reproduction techniques with conventional ovarian stimulation in the public health sector of South Africa: frequency and coping strategies. Hum Reprod 2013; 28:2755-64. [DOI: 10.1093/humrep/det290] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Infertility in resource-constrained settings: moving towards amelioration. Reprod Biomed Online 2013; 26:189-95. [DOI: 10.1016/j.rbmo.2012.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 10/19/2012] [Accepted: 11/07/2012] [Indexed: 11/21/2022]
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Aleyamma TK, Kamath MS, Muthukumar K, Mangalaraj AM, George K. Affordable ART: a different perspective. Hum Reprod 2011; 26:3312-8. [PMID: 21987524 DOI: 10.1093/humrep/der323] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although ≈ 10% of the population is affected by infertility, the treatment option of in-vitro fertilisation (IVF) remains unaffordable for the majority of infertile couples. We have initiated a lowcost programme incorporating an uncommonly used, but recognized, ovarian stimulation protocol, together with certain costlimiting initiatives in an established assisted reproductive technology (ART) set up. METHODS The medical records of women who underwent the lowcost programme were analysed. Clomiphene citrate 50 mg daily was administered from Day 2 of the cycle and continued till the day of hCG trigger, thus preventing the LH surge. Intermittent doses of human menopausal gonadotrophin 150 IU were administered on alternate days from the 5th day onwards. Oocyte retrieval was carried out once at least two follicles of >18 mm were identified. The cycle was monitored by ultrasound only, with embryo transfer being carried out on Day 3. Clinical outcomes were recorded together with an estimation of the direct costs per cycle. Direct cost calculations did not include professional charges or facility costs. RESULTS Of 143 women evaluated, 104 women underwent embryo transfer. The live birth rate and clinical pregnancy rate per embryo transfer were 19 and 22%. The live birth rate per initiated cycle was 14% (20/143). The multiple pregnancy rate was 26% with no case of ovarian hyperstimulation syndrome being recorded. The average direct cost per cycle was US$ 675 for IVF and US$ 725 for an ICSI treatment cycle. CONCLUSIONS Using this protocol, together with several costcutting measures, we achieved an acceptable live birth rate per transfer of 19% at a reasonable cost. This approach could be used by established ART centres to provide treatment to couples who cannot afford conventional ART.
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Affiliation(s)
- T K Aleyamma
- Reproductive Medicine Unit, Christian Medical College Hospital, Vellore, Tamil Nadu 632004, India
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Záchia S, Knauth D, Goldim JR, Chachamovich JR, Chachamovich E, Paz AH, Felberbaum R, Crosignani P, Tarlatzis BC, Passos EP. Assisted reproduction: what factors interfere in the professional's decisions? Are single women an issue? BMC WOMENS HEALTH 2011; 11:21. [PMID: 21627812 PMCID: PMC3125239 DOI: 10.1186/1472-6874-11-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 05/31/2011] [Indexed: 12/02/2022]
Abstract
Background With the development of medical technology, many countries around the world have been implementing ethical guidelines and laws regarding Medically Assisted Reproduction (MAR). A physician's reproductive decisions are not solely based on technical criteria but are also influenced by society values. Therefore, the aim of this study was to analyze the factors prioritized by MAR professionals when deciding on whether to accept to perform assisted reproduction and to show any existing cultural differences. Methods Cross-sectional study involving 224 healthcare professionals working with assisted reproduction in Brazil, Italy, Germany and Greece. Instrument used for data collection: a questionnaire, followed by the description of four special MAR cases (a single woman, a lesbian couple, an HIV discordant couple and gender selection) which included case-specific questions regarding the professionals' decision on whether to perform the requested procedure as well as the following factors: socio-demographic variables, moral and legal values as well as the technical aspects which influence decision-making. Results Only the case involving a single woman who wishes to have a child (without the intention of having a partner in the future) demonstrated significant differences. Therefore, the study was driven towards the results of this case specifically. The analyses we performed demonstrated that professionals holding a Master's Degree, those younger in age, female professionals, those having worked for less time in reproduction, those in private clinics and Brazilian health professionals all had a greater tendency to perform the procedure in that case. A multivariate analysis demonstrated that the reasons for the professional's decision to perform the procedure were the woman's right to gestate and the duty of MAR professionals to help her. The professionals who decided not to perform the procedure identified the woman's marital status and the child's right to a father as the reason to withhold treatment. Conclusion The study indicates differences among countries in the evaluation of the single woman case. It also discloses the undervaluation of bioethics committees and the need for a greater participation of healthcare professionals in debates on assisted reproduction laws.
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Affiliation(s)
- Suzana Záchia
- Post-Graduate Program in Medicine, Assisted Reproduction Service, Gynecology and Obstetrics Department, Hospital de Clínicas de Porto Alegre 90035-903, Porto Alegre, Brazil.
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Makuch MY, Simonia de Padua K, Petta CA, Duarte Osis MJ, Bahamondes L. Inequitable access to assisted reproductive technology for the low-income Brazilian population: a qualitative study. Hum Reprod 2011; 26:2054-60. [DOI: 10.1093/humrep/der158] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dhont N, van de Wijgert J, Coene G, Gasarabwe A, Temmerman M. 'Mama and papa nothing': living with infertility among an urban population in Kigali, Rwanda. Hum Reprod 2011; 26:623-9. [PMID: 21216790 DOI: 10.1093/humrep/deq373] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Not being able to procreate has severe social and economic repercussions in resource-poor countries. The purpose of this research was to explore the consequences of female and/or male factor infertility for men and women in Rwanda. METHODS Both quantitative and qualitative methods were used. Couples presenting with female and/or male factor infertility problems at the infertility clinic of the Kigali University Teaching Hospital (n = 312), and fertile controls who recently delivered (n = 312), were surveyed about domestic violence, current and past relationships and sexual functioning. In addition, five focus group discussions were held with a subsample of survey participants, who were either patients diagnosed with female- or male-factor fertility or their partners. RESULTS Domestic violence, union dissolutions and sexual dysfunction were reported more frequently in the survey by infertile than fertile couples. The psycho-social consequences suffered by infertile couples in Rwanda are severe and similar to those reported in other resource-poor countries. Although women carry the largest burden of suffering, the negative repercussions of infertility for men, especially at the level of the community, are considerable. Whether the infertility was caused by a female factor or male factor was an important determinant for the type of psycho-social consequences suffered. CONCLUSIONS In Rwanda, as in other resource-poor countries, infertility causes severe suffering. There is an urgent need to recognize infertility as a serious reproductive health problem and to put infertility care on the public health agenda.
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Affiliation(s)
- N Dhont
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
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Kamel RM. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol 2010; 8:21. [PMID: 20205744 PMCID: PMC2844387 DOI: 10.1186/1477-7827-8-21] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/06/2010] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility. OBJECTIVES The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload. METHODS A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib) by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Canadian Fertility and Andrology Society (CFAS), and Royal College of Obstetricians and Gynaecologists (RCOG). RESULTS A simple guide for the clinicians to manage the infertile couples. CONCLUSIONS The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.
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Affiliation(s)
- Remah M Kamel
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
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A call to provide multiple options for women in developing countries. Fertil Steril 2009; 92:e35. [DOI: 10.1016/j.fertnstert.2009.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 05/19/2009] [Indexed: 11/17/2022]
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