1
|
Whittaker A, Gerrits T, Hammarberg K, Manderson L. Access to assisted reproductive technologies in sub-Saharan Africa: fertility professionals' views. Sex Reprod Health Matters 2024; 32:2355790. [PMID: 38864373 PMCID: PMC11172248 DOI: 10.1080/26410397.2024.2355790] [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] [Indexed: 06/13/2024] Open
Abstract
Across sub-Saharan Africa, there remains disagreement among local expert providers over the best ways to improve access to assisted reproduction in low-income contexts. Semi-structured qualitative interviews were conducted between 2021 and 2023 with 19 fertility specialists and 11 embryologists and one clinic manager from South Africa, Zimbabwe, Namibia, Kenya, Ethiopia and Uganda to explore issues surrounding access and potential low-cost IVF options. Lack of access to ART was variously conceptualised as a problem of high cost of treatment; lack of public funding for medical services and medication; poor policy awareness and prioritisation of fertility problems; a shortage of ART clinics and well-trained expert staff; the need for patients to travel long distances; and over-servicing within the largely privatised sector. All fertility specialists agreed that government funding for public sector assisted reproduction services was necessary to address access in the region. Other suggestions included: reduced medication costs by using mild stimulation protocols and oocyte retrievals under sedation instead of general anaesthetics. Insufficient data on low-cost interventions was cited as a barrier to their implementation. The lack of skilled embryologists on the continent was considered a major limitation to expanding ART services and the success of low-cost IVF systems. Very few specialists suggested that profits of pharmaceutical companies or ART clinics might be reduced to lessen the costs of treatments.
Collapse
Affiliation(s)
- Andrea Whittaker
- Professor of Anthropology, School of Social Sciences, Monash University, Melbourne, Australia
| | - Trudie Gerrits
- Associate Professor, Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, Netherlands
| | - Karin Hammarberg
- Senior Research Fellow, Global and Women’s Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lenore Manderson
- Distinguished Professor of Public Health and Medical Anthropology, School of Public Health, The University of the Witwatersrand, Johannesburg, South Africa and Professorial Adjunct, School of Social Sciences, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Age-related changes in serum anti-Müllerian hormone in women of reproductive age in Kenya. SOUTH AFRICAN JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2022. [DOI: 10.7196/sajog.2022.v28i2.2067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background. Anti-Müllerian hormone (AMH) is produced by the granulosa cells of ovarian antral follicles and plays a role in therecruitment of dominant follicles during folliculogenesis. The serum level of AMH is proportional to the number of developing folliclesin the ovaries and reflects ovarian reserve. Nomograms of AMH variation with age exist from Caucasian populations, but there are none drawn from local African data.Objectives. To establish age-specific median serum AMH levels in an unselected East African population of women of reproductive age.Methods. We retrospectively analysed data on 1 718 women who underwent AMH testing using the Beckman Coulter AMH Gen IIenzyme-linked immunosorbent assay during the period 2015 - 2019 at Aga Khan University Hospital, Nairobi, Kenya. Age-specific median AMH levels were derived and presented in 5-year age bands. AMH levels were then log-transformed and, using linear regression in a natural spline function, presented on a scatter plot to demonstrate variation across reproductive age.Results. The median (interquartile range (IQR)) age of women who were tested for AMH was 38 (19 - 49) years. For the study population, the median (IQR) serum AMH level was 0.87 (0.01 - 17.10) ng/mL. The AMH concentration was inversely related to age, with a progressive decline whereby an increase of 1 year resulted in a corresponding decrease in AMH of 0.18 ng/mL. The proportion of women with decreased ovarian reserve increased exponentially with age from 14.9% in those aged 20 - 24 years to 48.7% at 35 - 39 years.Conclusion. From a large dataset of mainly black African women, this study confirms that serum AMH declines with advancing age,as reported elsewhere in Caucasian populations. There was, however, a higher than expected number of women with diminished ovarian reserve for age. Future studies prospectively exploring ovarian reserve in the general population could unravel underlying biological, reproductive and environmental factors that may influence AMH levels and reproductive capacity in this indigenous population.
Collapse
|
3
|
Experiences of infertile women pursuing treatment in Kenya: a qualitative study. BMC Womens Health 2022; 22:364. [PMID: 36056344 PMCID: PMC9440532 DOI: 10.1186/s12905-022-01950-4] [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: 04/29/2022] [Accepted: 08/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background The infertility treatment process is associated with various psychological, physical, social, moral, and financial challenges, especially for women. The women are likely to report low marital satisfaction and emotional distress due to fertility treatment demands. This study explored how infertile women described their treatment experience and how they coped with treatment demands as they underwent treatment at three gynecology outpatient clinics in Kenya. Methods A qualitative phenomenological research design was used to analyze and describe women’s fertility treatment experiences. The data were collected through semi-structured in-depth interviews with 33 infertile women selected purposively. Trustworthiness of the findings was ensured using Guba and Lincoln’s criteria. The recorded interviews were transcribed verbatim and then analyzed using reflective thematic analysis, developed by Braun and Clarkes. Results Three themes and 13 sub-themes related to women’s fertility treatment experiences and coping strategies were identified. The theme challenges encountered during fertility treatment have three sub-themes: emotional distressing, physical pain, and financial constraining. Theme impacts of fertility treatment on relationships have three sub-themes: relationship with their husband, relationship with their family, and relationship with their friends. Finally, coping with fertility treatment has six sub-themes: religious practices and personal faith, giving in to feelings, shifting focus, taking a break, staying with their relative’s children, and receiving support from others. Conclusion The experiences of women undergoing treatment are multi-dimensional. Therefore, incorporating psychosocial interventions or counseling into the fertility treatment routine with National Health Insurance Fund cards may reduce the treatment burden, improving women’s psychological well-being and relationships with their husbands, family, and friends.
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Kyei JM, Manu A, Kotoh AM, Meherali S, Ankomah A. Challenges experienced by clients undergoing assisted reproductive technology in Ghana: An exploratory descriptive study. Int J Gynaecol Obstet 2020; 149:326-332. [PMID: 32129885 DOI: 10.1002/ijgo.13132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 01/01/2020] [Accepted: 02/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore the experiences of clients accessing assisted reproductive technology (ART) services in selected health facilities in Greater Accra, Ghana. METHODS An exploratory, descriptive, qualitative design using a purposive sampling technique was employed. Overall, 12 women and six men participated in the study. In-depth interviews were conducted using a semi-structured interview guide. The Braun and Clarke (2006) procedure for data analysis was followed. Data collection spanned 9 months (January to October 2017). RESULTS Five major challenges were identified that were commonly experienced by our participants at every phase of the ART treatment, including the high cost of ART treatment, the long distance to treatment centers, drug treatment challenges, disturbances in daily routine and work, and anxiety about pregnancy outcome. CONCLUSION Given the emotional and psychological challenges reported by the participants in the present study, an integration of counseling units in the ART centers is recommended, manned by qualified personnel such as clinical psychologists and counselors to support clients at every stage of the treatment. Also, given the high cost of ART services, as reflected in the participants' views, it is recommended that private health insurance companies fund some aspect of ART services, such as laboratory investigations and medications.
Collapse
Affiliation(s)
- Josephine M Kyei
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
| | - Abubakar Manu
- Department of Population, Family and Reproductive Health School of Public Health, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Agnes M Kotoh
- Department of Population, Family and Reproductive Health School of Public Health, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Augustine Ankomah
- Department of Population, Family and Reproductive Health School of Public Health, College of Health Sciences, University of Ghana, Legon Accra, Ghana.,Population Council Ghana, Accra, Ghana
| |
Collapse
|
6
|
Knowledge of age-related fertility decline in women: A systematic review. Eur J Obstet Gynecol Reprod Biol 2018; 230:109-118. [PMID: 30248536 DOI: 10.1016/j.ejogrb.2018.09.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/23/2018] [Accepted: 09/12/2018] [Indexed: 01/18/2023]
Abstract
Age-related fertility decline (ARFD) knowledge has been evaluated in the past decade, showing that there is a general knowledge of the reduction of fertility with age. Here we review the studies published up to date which quantitatively measure this ARFD knowledge, to answer the question: how aware about ARFD is our society? We searched the terms "age", "fertility knowledge", "fertility awareness", "reproduction knowledge", "reproductive knowledge" and "reproductive health knowledge" in PubMed, Web of Science, PsychINFO and Scopus, within January 2000 and December 2016. We found 41 studies that quantitatively measured ARFD knowledge by asking for the most fertile age for a woman and/or when there are a slight and a marked decrease in female fertility. We obtained this searching for the questions: What is the most fertile age for a woman? (Q1). When there is a slight decrease in female fertility? (Q2) and, When there is a marked decrease in female fertility? (Q3). We further evaluated the knowledge increase in the 6 studies assessing an educational intervention, 4 of them randomized controlled trials (RCT). Participants reporting the most fertile age for women to be at 20-24 y.o. ranged 16%-89.4% (Q1); participants reporting a slight decrease in female fertility at 25-29 y.o. ranged 5.1%-83% (Q2), and those reporting that a marked decrease occurs between 35-39 y.o. ranged 5.6%-60% (Q3). On the whole, the studies included in this review conclude that ARFD knowledge is insufficient, particularly in determining when female fertility markedly decreases. ARFD knowledge can be increased through targeted campaigns, but few interventional studies have been performed up to date. In view of these results, ARFD campaigns targeted to reproductive age people and healthcare providers are necessary; this would help the society to make informed reproductive decisions throughout life.
Collapse
|
7
|
Botha B, Shamley D, Dyer S. Availability, effectiveness and safety of ART in sub-Saharan Africa: a systematic review. Hum Reprod Open 2018; 2018:hoy003. [PMID: 30895245 PMCID: PMC6276690 DOI: 10.1093/hropen/hoy003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/17/2018] [Accepted: 03/05/2018] [Indexed: 01/02/2023] Open
Abstract
STUDY QUESTION What is the evidence pertaining to availability, effectiveness and safety of ART in sub-Saharan Africa? SUMMARY ANSWER According to overall limited and heterogeneous evidence, availability and utilization of ART are very low, clinical pregnancy rates largely compare to other regions but are accompanied by high multiple pregnancy rates, and in the near absence of data on deliveries and live births the true degree of effectiveness and safety remains to be established. WHAT IS KNOWN ALREADY In most world regions, availability, utilization and outcomes of ART are monitored and reported by national and regional ART registries. In sub-Saharan Africa there is only one national and no regional registry to date, raising the question what other evidence exists documenting the status of ART in this region. STUDY DESIGN, SIZE, DURATION A systematic review was conducted searching Pubmed, Scopus, Africawide, Web Of Science and CINAHL databases from January 2000 to June 2017. A total of 29 studies were included in the review. The extracted data were not suitable for meta-analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS The review was conducted according to Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. All peer-reviewed manuscripts irrespective of language or study design that presented original data pertaining to availability, effectiveness and safety of ART in sub-Saharan Africa were eligible for inclusion. Selection criteria were specified prior to the search. Two authors independently reviewed studies for possible inclusion and critically appraised selected manuscripts. Data were analysed descriptively, being unsuitable for statistical analysis. MAIN RESULTS AND THE ROLE OF CHANCE The search yielded 810 references of which 29 were included based on the predefined selection and eligibility criteria. Extracted data came from 23 single centre observational studies, two global ART reports, two reviews, one national data registry and one community-based study. ART services were available in 10 countries and delivered by 80 centres in six of these. Data pertaining to number of procedures existed from three countries totalling 4619 fresh non-donor aspirations in 2010. The most prominent barrier to access was cost. Clinical pregnancy rates ranged between 21.2% and 43.9% per embryo transfer but information on deliveries and live births were lacking, seriously limiting evaluation of ART effectiveness. When documented, the rate of multiple pregnancy was high with information on outcomes similarly lacking. LIMITATIONS, REASONS FOR CAUTION The findings in this review are based on limited data from a limited number of countries, and are derived from heterogeneous studies, both in terms of study design and quality, many of which include small sample sizes. Although representing best available evidence, this requires careful interpretation regarding the degree of representativeness of the current status of ART in sub-Saharan Africa. WIDER IMPLICATIONS OF THE FINDINGS The true extent and outcome of ART in sub-Saharan Africa could not be reliably documented as the relevant information was not available. Current efforts are underway to establish a regional ART data registry in order to report and monitor availability, effectiveness and safety of ART thus contributing to evidence-based practice and possible development strategies. STUDY FUNDING/COMPETING INTERESTS No funding was received for this study. The authors had no competing interests. TRIAL REGISTRATION NUMBER PROSPERO CRD42016032336
Collapse
Affiliation(s)
- Barend Botha
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Delva Shamley
- Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| | - Silke Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Observatory 7925, Cape Town, South Africa
| |
Collapse
|
8
|
Olang'o CO, Nyambedha E, Aaagard-Hansen J, Aagaard J. Practice of sumo kodhi among the Luo and implications for HIV transmission in western Kenya. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 13:383-91. [PMID: 25555104 DOI: 10.2989/16085906.2014.985238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This paper discusses the practice of sumo kodhi among the Luo ethnic group and its implications for spread of HIV in western Kenya. Sumo kodhi is a practice in which a woman arranges to have sex with a man other than her legitimate sexual partner (husband or levir/inheritor) to give birth to children with specific qualities she wants in them. Data were drawn from a 16-month ethnographic study on reproductive aspirations of women living with HIV/AIDS (WLWHA). The study found that WLWHA engaged in sumo kodhi as they believe they will get gender balanced, beautiful, and academically talented and healthy children who are free from HIV. The WLWHA targeted agnates of their husbands living in distant villages, former boyfriends (before marriage) and other men who were new in the area such as civil servants, employees in local institutions and businessmen who would not suspect their HIV status. These WLWHA kept their HIV status secret and exposed the targeted men to the risk of being infected with HIV. It can be deduced that having knowledge of HIV status does not always translate into taking action towards protecting sexual partner(s). Moreover, continued childbearing is not always as a result of unmet contraceptives needs. It is apparent from this study that social factors sometimes overrule health considerations. The study recommends that further research be conducted among other ethnic groups to gauge whether they also have a practice similar to sumo kodhi. Women living with HIV/AIDS should be involved in HIV/AIDS control and prevention strategies. There is also need for an intervention that would ensure that WLWHA meet their reproductive aspirations without putting their sexual partners at risk of contracting HIV.
Collapse
|
9
|
Mmeje O, Cohen CR, Murage A, Ong’ech J, Kiarie J, van der Poel S. Promoting reproductive options for HIV-affected couples in sub-Saharan Africa. BJOG 2014; 121 Suppl 5:79-86. [PMID: 25335844 PMCID: PMC4206833 DOI: 10.1111/1471-0528.12876] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2014] [Indexed: 11/28/2022]
Abstract
HIV-affected couples face unique challenges that require access to information and reproductive services to prevent HIV transmission to the uninfected partner and offspring while allowing couples to fulfil their reproductive goals. In regions of high HIV prevalence in sub-Saharan Africa, HIV-affected couples require multipurpose prevention technologies (MPTs) to enhance their reproductive healthcare options beyond contraception and prevention of HIV/sexually transmitted infections (STIs) to include assistance in childbearing. The unique characteristics of the condom and its accepted use in conjunction with safer conception interventions allow HIV-serodiscordant couples an opportunity to maintain reproductive health, prevent HIV/STI transmission, and achieve their reproductive goals while timing conception. Re-thinking the traditional view of the condom and incorporating a broader reproductive health perspective of HIV-affected couples into MPT methodologies will impact demand, acceptability and uptake of these future technologies.
Collapse
Affiliation(s)
- Okeoma Mmeje
- University of Michigan; Department of Obstetrics and Gynecology
| | - Craig R. Cohen
- University of California, San Francisco; Department of Obstetrics, Gynecology and Reproductive Sciences
- Family AIDS Care and Education Services (FACES)
| | - Alfred Murage
- Aga Khan University Hospital, Nairobi, Kenya; Department of Obstetrics and Gynecology
| | - John Ong’ech
- Kenyatta National Hospital and University of Nairobi; Department of Reproductive Health
| | - James Kiarie
- Kenyatta National Hospital and University of Nairobi; Department of Obstetrics and Gynaecology
| | | |
Collapse
|
10
|
Abstract
Despite the development of in vitro fertilization (IVF) more than 30 years ago, the cost of treatment remains high. Furthermore, over the years, more sophisticated technologies and expensive medications have been introduced, making IVF increasingly inaccessible despite the increasing need. Globally, the option to undergo IVF is only available to a privileged few. In recent years, there has been growing interest in exploring strategies to reduce the cost of IVF treatment, which would allow the service to be provided in low-resource settings. In this review, we explore the various ways in which the cost of this treatment can be reduced.
Collapse
Affiliation(s)
- Pek Joo Teoh
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
| | - Abha Maheshwari
- Aberdeen Fertility Centre, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
11
|
IVF in Developing Economies and Low Resource Countries: An Overview. J Obstet Gynaecol India 2014; 63:291-4. [PMID: 24431660 DOI: 10.1007/s13224-013-0477-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
|