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Majangara Karaga R, Archary P, Gwet Bell E, Khrouf M, Loto O, Wada I, Dyer S. The status of ART in the public health sector in Africa: a multi-country survey. Reprod Biomed Online 2023; 47:103213. [PMID: 37236886 DOI: 10.1016/j.rbmo.2023.04.004] [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: 11/15/2022] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 05/28/2023]
Abstract
RESEARCH QUESTION What is the current availability of treatment with assisted reproductive technology (ART) in the public sector in Africa, and what are the facilitators and barriers towards its provision? DESIGN Cross-sectional quantitative and qualitative data were collected in two phases from February 2020 to October 2021. Key informants were identified from countries known to provide ART in Africa based on data from the African Network and Registry for Assisted Reproductive Technology and the 2019 Surveillance from the International Federation of Fertility Societies. Quantitative data were collected via a structured questionnaire (Phase 1); public centre-specific quantitative and qualitative data were then collected via a semi-structured questionnaire followed by a virtual interview (Phase 2). Data were analysed descriptively. RESULTS Informants from 18 countries reported the existence of 185 ART centres in 16 countries. Twenty-four centres (13.0%) in 10 of 16 countries (62.5%) were public. The majority of public centres (20/22 [90.9%]) reporting on ART performed <500 ART cycles per annum. Although public institutions covered most of the cost for ART, copayments from patients were universally required. The number of ART cycles per annum was inversely correlated to the copayment. Lack of policy and legislation, high costs and bureaucratic obstacles were identified by participants as the leading challenges in the delivery of public service ART. CONCLUSION Lack of public ART services leads to chronic and profound health inequities. Enablers of public service ART in the region are the same known to support ART services in general, namely policy and legislation, appropriate funding and good health service infrastructure. Addressing these requires the collated efforts of many stakeholders.
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Affiliation(s)
- Rumbidzai Majangara Karaga
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Paversan Archary
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology, Cape Town, South Africa
| | - Ernestine Gwet Bell
- Groupe Interafricain d'Etude, de Recherche et d'Application sur la Fertilité, Lome, Togo
| | - Mohamed Khrouf
- Groupe d'Etude de la Fertilité de la Société Tunisienne de Gynécologie Obstétrique, Tunis, Tunisia
| | - Olabisi Loto
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University, Ile-Ife, Nigeria; Association for Fertility and Reproductive Health, Lagos, Nigeria
| | - Ibrahim Wada
- Association for Fertility and Reproductive Health, Lagos, Nigeria
| | - Silke Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology, Cape Town, South Africa
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Bittaye H, Mooney JP, Afferri A, Balen J, Kay V. Introducing assisted reproductive technologies in The Gambia, a survey on the perspectives of Gambian healthcare professionals and medical students. BMC Health Serv Res 2023; 23:203. [PMID: 36855053 PMCID: PMC9979844 DOI: 10.1186/s12913-023-09171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Infertility remains a global reproductive health burden with the highest prevalence in low and middle-income countries. In sub-Saharan Africa, the ability to procreate holds great societal importance. Couples, and particularly women, with infertility can face devastating challenges, leading to social stigma, isolation and/or divorce. However, attention to addressing infertility is lacking in sub-Saharan Africa. In The Gambia, where this study is based, little is known about the potential for introduction of assisted reproductive technologies (ART) in the public health sector. METHODS A quantitative survey was conducted using detailed questionnaires on infertility services available, staff knowledge, perceived barriers, and personal motivation to support assisted reproductive technologies. Data was collected electronically between April and June 2021 from healthcare providers (n = 70) in eleven health facilities throughout the country, as well as from medical students (n = 55) enrolled at The University of The Gambia. RESULTS Basic infertility services were found to be lacking in the rural areas. Furthermore, 39% of staff (n = 27) providing fertility care had not receive any formal training on the topic. However, 91% of staff (n = 64) showed interest in acquiring additional knowledge and had a positive attitude towards supporting the introduction of ART. Perceived challenges of doing so included: (i) the competing importance of other health priorities; and (ii) religious and cultural barriers. CONCLUSION This survey highlights that expansion of infertility services is needed, especially in rural areas. Staff perceived the introduction of ART as important, but this should be coupled with specialized training, as most medical staff had not received any formal infertility training. Future care providers (current medical students) showed both interest in ART and reported having received some basic training in infertility management. Given the reported lack of infrastructure and services, additional targeted investment in infertility care, including ART, will be needed to improve reproductive health for all, countrywide.
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Affiliation(s)
| | - Jason P. Mooney
- grid.4305.20000 0004 1936 7988Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Anna Afferri
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Julie Balen
- grid.11835.3e0000 0004 1936 9262School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Vanessa Kay
- grid.8241.f0000 0004 0397 2876School of Medicine, University of Dundee, Dundee, UK
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Archary P, Potgieter L, Elgindy E, Adageba RK, Mboloko J, Iketubosin F, Serour G, Dyer S. Assisted reproductive technologies in Africa: The African Network and Registry for ART, 2018 and 2019. Reprod Biomed Online 2023; 46:835-845. [PMID: 36959069 DOI: 10.1016/j.rbmo.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
RESEARCH QUESTION What were the utilization, practices and outcomes of assisted reproductive technology (ART) in Africa in 2018 and 2019? DESIGN Cycle-based data (CBD) and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres. RESULTS During 2018, 43,958 ART procedures were reported by 67 centres in 16 countries, increasing to 45,185 procedures reported by 70 centres in 18 countries in 2019. Autologous fresh procedures predominated at 70%, whereas autologous frozen embryo transfers (FET) increased from 21.2% to 23.1% and oocyte donation cycles remained below 10%. In 2019, the mean age of women undergoing autologous fresh embryo transfer was 33.9 years and received a mean number of 2.4 embryos per transfer. The clinical pregnancy rate (CPR) per fresh embryo transfer was 42.8% in 2018 and 38.4% in 2019, with corresponding rates of 38.3% and 31.8% after FET. In both years, most ART procedures, excluding single embryo transfer (SET), were associated with a multiple delivery rate above 20%, reaching over 30% after elective dual embryo transfer in autologous cycles and after fresh oocyte donation. Multiples were predominantly born preterm with a substantially increased perinatal mortality rate. The CBD for both years showed that elective SET (eSET) achieved a high CPR without compromising safety. CONCLUSION This third report of The African Network and Registry for Assisted Reproductive Technology documents the prevailing practice of multiple embryo transfers in a cohort of relatively young women while highlighting the importance of disaggregating eSET, non-eSET and double embryo transfer. The high CPR after eSET and the increase in cryopreservation cycles are encouraging trends towards decreasing the number of embryos transferred without compromising effectiveness. Improved follow-up of ART pregnancies is required.
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Affiliation(s)
- Paversan Archary
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology.
| | - Liezel Potgieter
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology
| | - Eman Elgindy
- Egypt IVF Registry; Department of Obstetrics and Gynecology, Zagazig University School of Medicine, Zagazig Sharkia 44511, Egypt
| | | | - Justin Mboloko
- Groupe Interafricain d'Etude, de Recherche et d'Application sur la Fertilité
| | | | - Gamal Serour
- African Federation of Fertility Societies; Department of Obstetrics and Gynaecology, Al Azhar University, The Egyptian IVF-ET Center, 3 Street 161, Hadayek El-Maadi, Cairo 11431, Egypt
| | - Silke Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology
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Nabhan A, Salama M, Elsayed M, Nawara M, Kamel M, Abuelnaga Y, Ghonim M, Elshafeey F, Abdelhadi R, Gebril S, Mahdy S, Sarhan D, Mburu G, Kiarie J. Indicators of infertility and fertility care: a systematic scoping review. Hum Reprod Open 2022; 2022:hoac047. [PMID: 36339250 PMCID: PMC9632452 DOI: 10.1093/hropen/hoac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/06/2022] [Indexed: 12/26/2022] Open
Abstract
STUDY QUESTION What is the scope of literature regarding infertility and fertility care indicators in terms of types and dimensions of these indicators? SUMMARY ANSWER Most available infertility and fertility care indicators are outcomes indicators of effectiveness and efficiency dimensions. WHAT IS KNOWN ALREADY The use of appropriate, relevant and valid indicators of infertility and fertility care is critical for monitoring access, equity and utilization. STUDY DESIGN SIZE DURATION A systematic scoping review was conducted. We searched MEDLINE, Pubmed, JSTOR, CINAHL, Web of Science and Scopus electronic databases from inception to May 2022 without imposing language or date restrictions. We searched gray literature and online libraries of relevant organizations. We hand-searched the list of relevant references. PARTICIPANTS/MATERIALS SETTING METHODS This scoping systematic review followed the framework of Arksey and O'Malley and the Joanna Briggs Institute guidelines. Records identified by the search were independently screened and data were extracted. We performed conceptual synthesis by grouping the reported indicators by typology and dimensions. Structured tabulation and graphical synthesis were used along with narrative commentary. MAIN RESULTS AND THE ROLE OF CHANCE We included 46 reports from 88 countries. The reporting of infertility and fertility care indicators was voluntary in 63 countries (72%) and compulsory in 25 countries (28%). Reporting for cycles or deliveries was based on individual cycles in 56 countries (64%) and on cumulative cycles in 32 countries (36%). Most indicators were utilized as outcome indicators with fewer being process indicators or structural indicators. For the dimension of indicators, most indicators were utilized as effectiveness and efficiency indicators with fewer utilized as indicators of safety, patient-centeredness, equity and timeliness. LIMITATIONS REASONS FOR CAUTION Most indicators fall into the domain of assisted reproductive technology and are reported by fertility clinics. Indicators of safety, patient-centeredness, equity and timeliness as well as non-clinical indicators are almost invisible. WIDER IMPLICATIONS OF THE FINDINGS A wide range of indicators of infertility and fertility care exist in literature. Most indicators were effectiveness and efficiency indicators, while indicators of safety, patient-centeredness, equity and timeliness remain almost invisible. The scope of the current indicators indicates a predominant focus on clinical metrics, with substantial invisibility of non-clinical indicators and indicators outside the ART domain. These gaps need to be considered in further work of identifying a core set of indicators. STUDY FUNDING/COMPETING INTERESTS This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization (WHO). The authors had no competing interests. TRIAL REGISTRATION NUMBER Open Science Framework vsu42.
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Affiliation(s)
- Ashraf Nabhan
- Correspondence address. Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, El-Khalifa El-Maamoun Street, Cairo 11341, Egypt. E-mail:
| | - Mohamed Salama
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mortada Elsayed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Maii Nawara
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Menna Kamel
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | | | - Mohanad Ghonim
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | | | - Rana Abdelhadi
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Sara Gebril
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Shahd Mahdy
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | - Dana Sarhan
- Egyptian Center for Evidence Based Medicine, Cairo, Egypt
| | | | - James Kiarie
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Geneva, Switzerland
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Kuhnt AK. Families formed through assisted reproductive technology: Causes, experiences, and consequences in an international context. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:289-296. [PMID: 35419497 PMCID: PMC8907601 DOI: 10.1016/j.rbms.2022.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Moll T, Gerrits T, Hammarberg K, Manderson L, Whittaker A. Reproductive travel to, from and within sub-Saharan Africa: A scoping review. REPRODUCTIVE BIOMEDICINE & SOCIETY ONLINE 2022; 14:271-288. [PMID: 35419496 PMCID: PMC8907603 DOI: 10.1016/j.rbms.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Scholarly interest in reproductive travel has increased in recent years, but travel within, to and from the African continent has received much less attention. We reviewed the literature on cross-border reproductive travel to and from countries of sub-Saharan Africa in order to understand the local forms of this trade. Access to fertility care remains deeply stratified, which is an ongoing concern in a region with some of the highest rates of infertility. We found a wide variety of reasons for reproductive travel, including a lack of trusted local clinics. Destinations were chosen for reasons including historical movements for medical treatment broadly, diasporic circulations, pragmatic language reasons, and ties of former colonial relations. We describe the unique tempos of treatment in the region, ranging from some intended parents staying in receiving countries for some years to the short-term contingent support networks that reprotravellers develop during their treatment and travel. Unique to the region is the movement of medical professionals, such as the 'fly-in, fly-out' clinic staff to deliver fertility care. Future research should include practices and movements to presently neglected 'reprohubs', particularly Kenya and Nigeria; the impact of pandemic-related lockdowns and border closures on the movements of intended parents, reproductive assistors and reproductive material; and the impact of low-cost protocols on treatment access within the region. This scoping review provides insight into the relevant work on cross-border reproductive care in sub-Saharan Africa, where a unique combination of access factors, affordability, and sociocultural and geopolitical issues fashion individuals' and couples' cross-border reproductive travel within, to and from Africa.
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Affiliation(s)
- Tessa Moll
- School of Public Health, University of the Witwatersrand, Parktown, South Africa
| | - Trudie Gerrits
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Victorian Assisted Reproductive Treatment Authority, Melbourne, VIC, Australia
| | - Lenore Manderson
- School of Public Health, University of the Witwatersrand, Parktown, South Africa
- School of Social Sciences, Faculty of Arts, Monash University, Clayton, Melbourne, VIC, Australia
| | - Andrea Whittaker
- School of Social Sciences, Faculty of Arts, Monash University, Clayton, Melbourne, VIC, Australia
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Afferri A, Allen H, Booth A, Dierickx S, Pacey A, Balen J. Barriers and facilitators for the inclusion of fertility care in reproductive health policies in Africa: a qualitative evidence synthesis. Hum Reprod Update 2021; 28:190-199. [PMID: 34888683 DOI: 10.1093/humupd/dmab040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infertility affects over 50 million couples worldwide and impacts people's social and emotional wellbeing. In low- and middle-income countries, particularly across Africa, the inclusion of fertility care into reproductive health (RH) policies remains fragmented or non-existent. OBJECTIVE AND RATIONALE This review aims to provide a framework for understanding the inclusion (or lack thereof) of fertility care in RH policies in African settings. It synthesizes the barriers and facilitators to such inclusion, with a view to uncovering the positioning of fertility care in broader health systems and on the agendas of key stakeholders such as health policymakers and practitioners. SEARCH METHODS A qualitative evidence synthesis was performed, systematically searching papers and grey literature. Searches were conducted in MEDLINE, EMBASE, CINAHL, Web of Science and Scopus between February and April 2020. No date restrictions were applied. Language was limited to publications written in English and French. Two reviewers independently screened titles and abstracts, and extracted data, applying thematic coding. The quality of the included papers was evaluated using The Joanna Briggs Institute Checklist for Text and Opinion Papers. OUTCOMES The search identified 744 papers, of which 20 were included. Findings were organized under four cross-cutting categories, namely: perceived importance of infertility; influence of policy context; resource availability and access; and perceived quality of care. Across these categories, key barriers to the inclusion of fertility care in RH policies were limited political commitment, under-recognition of the burden of infertility and high costs associated with ART. Conversely, facilitators comprised specialized training on infertility for healthcare providers, standard procedures for ART safety and guidelines and North-South/South-South collaborations. WIDER IMPLICATIONS The inclusion of fertility care in African RH policies depends upon factors that include the recognition of infertility as a disease, strong political engagement and proactivity and affordability of ART through opportunities for partnership with the private sector, which ease costs on the public health system. Further qualitative and quantitative research, including context-specific analysis and in-depth comparative approaches across diverse African countries, will help to delineate differential impacts of local and global factors on fertility care to address this neglected RH issue.
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Affiliation(s)
- Anna Afferri
- School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Haddijatou Allen
- Medical Research Council, Department of Vaccines and Immunity, The Gambia Unit, Serekunda, Gambia
| | - Andrew Booth
- School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
| | - Susan Dierickx
- Research Center Gender, Diversity and Intersectionality (RHEA), Vrije Universiteit Brussel, Brussel, Belgium
| | - Allan Pacey
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, The Medical School, University of Sheffield, Sheffield, UK
| | - Julie Balen
- School of Health and Related Research (ScHARR), Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
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Zegers-Hochschild F, Crosby JA, Musri C, Souza MDCBD, Martínez AG, Silva AA, Mojarra JM, Masoli D, Posada N. Celebrating 30 years of ART in Latin America; and the 2018 report. JBRA Assist Reprod 2021; 25:617-639. [PMID: 34608795 PMCID: PMC8489817 DOI: 10.5935/1518-0557.20210055] [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] [Indexed: 11/30/2022] Open
Abstract
Objective What are the trends in patient characteristics, effectiveness and safety of assisted reproductive technology (ART) performed in Latin America over the past three decades, as well as the detailed outcomes of procedures initiated in 2018?. Design Retrospective collection of multinational data including epidemiology and outcomes of ART performed between 1990 and 2018. Results Over these 30 years we report 955,117 initiated cycles, 191,191 deliveries and 238,045 live births. In 1990, 66.5% of women were ≤34 years and 8.7% ≥40 years; in 2018, 26.4% of women were ≤34 years and 32.0% were ≥40 years. In 1990, 60.4% of transfers included ≥3 embryos, falling to 13.5% in 2018, and single embryo transfer (SET) increased from 13.8% to 30.4% between 1990 and 2018. Delivery rate per fresh transfer increased from approximately 17% in the 1990s to 25% in 2018, with a meaningful drop in high-order multiples, from 5-9% in the 1990s to 0.4% in 2018. This drop is associated with increasing use of frozen embryo transfer (FET) (57% in 2018) compared with 10% in 2000. In 2018, delivery rate in FET was 28.3%, reaching 31.2% in freeze-all cycles; and the cumulative live birth rate (fresh + FET) was 41.9%. Elective SET also increased, from 0.9% in 2010 to 10% in 2018. The delivery rate in elective SET (31.7%) was only 5.4% lower than elective double embryo transfer (DET) (37.1%); however, multiple births increased from 2.1% to 25.5% twins and 0.4% triplets in elective DET. Conclusions The Latin American Registry of Assisted Reproduction (RLA) celebrates 30 years of voluntary reporting from a total of nearly 200 centres in 15 countries. This South-South Cooperation network has proven to be an efficient and safe system for technological transfer and regional growth.
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Affiliation(s)
- Fernando Zegers-Hochschild
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile.,Program of Ethics and Public Policies in Human Reproduction, Facultad de Medicina, Universidad Diego Portales, Ejercito 260, Santiago, Chile
| | - Javier A Crosby
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile
| | - Carolina Musri
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile
| | | | - A Gustavo Martínez
- Fertilis, Av. Fondo de la Legua 277 (B1609JEC), San Isidro, Provincia de Buenos Aires, Argentina
| | - Adelino Amaral Silva
- Genesis-Centro de Assistência em Reprodução Humana, SHLS cj L, Aales Tes L331, Brasília DF 70390-907, Brazil
| | - José María Mojarra
- Hospital CIMA Hermosillo, Paseo Río San Miguel 35, Col. Proyecto Rio Sonora C.P, Hermosillo Sonora 83280, Mexico
| | - Diego Masoli
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile
| | - Natalia Posada
- INSER, Calle 12 No. 39-60, Sector El Poblado Medellín, Colombia
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Serour GI, Serour AG. The impact of religion and culture on medically assisted reproduction in the Middle East and Europe. Reprod Biomed Online 2021; 43:421-433. [PMID: 34344602 DOI: 10.1016/j.rbmo.2021.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
Infertility is a medico-socio-cultural problem associated with gender-based suffering. Infertility treatment, including assisted reproductive technology (ART), is a human right. Culture and religion were among the stumbling blocks to early acceptance of ART, particularly in the Middle East and to a lesser extent in Europe. This was mostly due to the different cultural and religious perspectives on the moral status of the embryo in the two regions and the concerns about what could be done with human embryos in the laboratory. There is an increased demand for ART in both the Middle East and Europe, although the reasons for this increased demand are not always the same. Although Europe leads the world in ART, there is an unmet need for ART in many countries in the Middle East. Where ART is not supported by governments or insurance companies, a large percentage of couples paying for ART themselves will stop before they succeed in having a baby. There are similarities and differences in ART practices in the two regions. If a healthcare provider has a conscientious objection to a certain ART modality, he/she is ethically obliged to refer the patient to where they could have it done, provided it is legal.
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Affiliation(s)
- Gamal I Serour
- International Islamic Center for Population Studies and Research, Al-Azhar University, Al-Darrasah Cairo, Egypt; The Egyptian IVF-ET Center, Maadi Cairo, Egypt
| | - Ahmed G Serour
- International Islamic Center for Population Studies and Research, Al-Azhar University, Al-Darrasah Cairo, Egypt.
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Zegers-Hochschild F, Crosby JA, Musri C, Borges de Souza MDC, Martínez AG, Amaral Silva A, Mojarra JM, Masoli D, Posada N. Celebrating 30 years of ART in Latin America; and the 2018 report. Reprod Biomed Online 2021; 43:475-490. [PMID: 34315694 DOI: 10.1016/j.rbmo.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 11/19/2022]
Abstract
RESEARCH QUESTION What are the trends in patient characteristics, effectiveness and safety of assisted reproductive technology (ART) performed in Latin America over the past three decades, as well as the detailed outcomes of procedures initiated in 2018? DESIGN Retrospective collection of multinational data including epidemiology and outcomes of ART performed between 1990 and 2018. RESULTS Over these 30 years we report 955,117 initiated cycles, 191,191 deliveries and 238,045 live births. In 1990, 66.5% of women were ≤34 years and 8.7% ≥40 years; in 2018, 26.4% of women were ≤34 years and 32.0% were ≥40 years. In 1990, 60.4% of transfers included ≥3 embryos, falling to 13.5% in 2018, and single embryo transfer (SET) increased from 13.8% to 30.4% between 1990 and 2018. Delivery rate per fresh transfer increased from approximately 17% in the 1990s to 25% in 2018, with a meaningful drop in high-order multiples, from 5-9% in the 1990s to 0.4% in 2018. This drop is associated with increasing use of frozen embryo transfer (FET) (57% in 2018) compared with 10% in 2000. In 2018, delivery rate in FET was 28.3%, reaching 31.2% in freeze-all cycles; and the cumulative live birth rate (fresh + FET) was 41.9%. Elective SET also increased, from 0.9% in 2010 to 10% in 2018. The delivery rate in elective SET (31.7%) was only 5.4% lower than elective double embryo transfer (DET) (37.1%); however, multiple births increased from 2.1% to 25.5% twins and 0.4% triplets in elective DET. CONCLUSION The Latin American Registry of Assisted Reproduction (RLA) celebrates 30 years of voluntary reporting from a total of nearly 200 centres in 15 countries. This South-South Cooperation network has proven to be an efficient and safe system for technological transfer and regional growth.
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Affiliation(s)
- Fernando Zegers-Hochschild
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile; Program of Ethics and Public Policies in Human Reproduction, Facultad de Medicina, Universidad Diego Portales, Ejercito 260, Santiago, Chile
| | - Javier A Crosby
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile
| | - Carolina Musri
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile
| | | | - A Gustavo Martínez
- Fertilis, Av. Fondo de la Legua 277 (B1609JEC), San Isidro Provincia de Buenos Aires, Argentina
| | - Adelino Amaral Silva
- Genesis-Centro de Assistência em Reprodução Humana, SHLS cj L, Aales Tes L331, Brasilia DF 70390-907, Brazil
| | - José María Mojarra
- Hospital CIMA Hermosillo, Paseo Río San Miguel 35, Col. Proyecto Rio Sonora C.P., Hermosillo Sonora 83280, Mexico
| | - Diego Masoli
- Unit of Reproductive Medicine, Clínica Las Condes, Lo Fontecilla 441, Santiago, Chile
| | - Natalia Posada
- INSER, Calle 12 No. 39-60, Sector El Poblado Medellín, Colombia
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Monden C, Pison G, Smits J. Twin Peaks: more twinning in humans than ever before. Hum Reprod 2021; 36:1666-1673. [PMID: 33709110 PMCID: PMC8129593 DOI: 10.1093/humrep/deab029] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How many twins are born in human populations and how has this changed over recent decades? SUMMARY ANSWER Since the 1980s, the global twinning rate has increased by a third, from 9.1 to 12.0 twin deliveries per 1000 deliveries, to about 1.6 million twin pairs each year. WHAT IS KNOWN ALREADY It was already known that in the 1980s natural twinning rates were low in (East) Asia and South America, at an intermediate level in Europe and North America, and high in many African countries. It was also known that in recent decades, twinning rates have been increasing in the wealthier parts of our world as a result of the rise in medically assisted reproduction (MAR) and delayed childbearing. STUDY DESIGN, SIZE, DURATION We have brought together all information on national twinning rates available from statistical offices, demographic research institutes, individual survey data and the medical literature for the 1980-1985 and the 2010-2015 periods. PARTICIPANTS/MATERIALS, SETTING, METHODS For 165 countries, covering over 99% of the global population, we were able to collect or estimate twinning rates for the 2010-2015 period. For 112 countries, we were also able to obtain twinning rates for 1980-1985. MAIN RESULTS AND THE ROLE OF CHANCE Substantial increases in twinning rates were observed in many countries in Europe, North America and Asia. For 74 out of 112 countries the increase was more than 10%. Africa is still the continent with highest twinning rates, but Europe, North America and Oceania are catching up rapidly. Asia and Africa are currently home to 80% of all twin deliveries in the world. LIMITATIONS, REASONS FOR CAUTION For some countries, data were derived from reports and papers based on hospital registrations which are less representative for the country as a whole than data based on public administrations and national surveys. WIDER IMPLICATIONS OF THE FINDINGS The absolute and relative number of twins for the world as a whole is peaking at an unprecedented level. An important reason for this is the tremendous increase in medically assisted reproduction in recent decades. This is highly relevant, as twin deliveries are associated with higher infant and child mortality rates and increased complications for mother and child during pregnancy and during and after delivery. STUDY FUNDING/COMPETING INTEREST(S) The contribution of CM was partially supported by the European Research Council (ERC) under the European Union's Horizon 2020 Research and Innovation Programme (grant No 681546, FAMSIZEMATTERS), Nuffield College, and the Leverhulme Trust. The contribution of GP was partially supported by the French Agence Nationale de la Recherche (grant No ANR-18-CE36-0007-07). The authors declare no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Christiaan Monden
- University of Oxford, OX1 2JD Oxford, UK
- Nuffield College, OX1 1NF Oxford, UK
- Leverhulme Centre for Demographic Science, OX1 1JD Oxford, UK
| | - Gilles Pison
- French Institute for Demographic Studies (INED), 75980 Paris, France
- French Museum of Natural History (UMR 7206), 75005 Paris, France
| | - Jeroen Smits
- Global Data Lab, Institute for Management Research, Radboud University, 6525 XZ Nijmegen, the Netherlands
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