The problem of IVF cost in developing countries: has natural cycle IVF a place?

The impact of religion and culture on medically assisted reproduction in the Middle East and Europe

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.

Assisted reproduction in Indonesia: policy reform in an Islamic culture and developing nation

This article considers how religious and economic factors shape assisted reproductive technology (ART) policy in Indonesia, the world's most populous Muslim country. Infertility clinic policies are grounded on both the views of the country's powerful Islamic coalition and those of the worldwide Islamic community. Indonesian government officials, physicians, and Islamic scholars have expressed concern over who can use ART and which procedures can be performed. Indonesia has also faced economic challenges related to ART, including inadequate health insurance coverage, inequitable access to ART, and maintenance of expensive ART infrastructure. The prohibitive price of infertility treatment and regional differences in the provision of health care prohibit most Indonesians from obtaining ART. In the absence of a shift in religious mores and a rapid reduction in poverty and inequality, Indonesia will need to adopt creative means to make ART both more available and less necessary as a solution to infertility. This paper suggests policy reforms to promote more affordable treatment methods and support preventative health programmes to reduce infertility rates. This country-specific analysis of the laws and customs surrounding ART in Indonesia reveals that strategies to reduce infertility must be tailored to a country's unique religious and economic climate.

How do Egyptian gynecologists manage infertility? Cross-sectional study

AIM

The purpose of this study was to determine the knowledge and practices of a sample of Egyptian gynecologists with respect to the management and diagnosis of infertility and the variation between gynecologists according to qualifications.

METHODS

A questionnaire assessing knowledge, practice habits, and perception towards the management of infertility was distributed to gynecologists. Data were collected during the annual meeting of the Clinical Society of Obstetricians and Gynaecologists, which was held in Mansoura, Egypt. Two hundred and fifty-eight gynecologists attended the meeting. Two researchers distributed the questionnaires to the clinicians. Clinician responses to questions were assessed according to the National Institute of Clinical Excellence (NICE) fertility guidelines. The main outcome measures were knowledge and adherence of gynecologists to NICE infertility guidelines.

RESULTS

Significant differences were identified between clinicians with Master degree/Diploma and those with higher degrees (MD or PhD) with regard to knowledge as well as management options of different causes of infertility.

CONCLUSION

There is a need to develop and implement national strategies, including mandatory update of reproductive medicine curricula as well as providing continuous professional development programs, in order to boost infertility management in developing countries such as Egypt.

Management of the infertile couple: an evidence-based protocol

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.

Supplementation of clomiphene citrate cycles with Cimicifuga racemosa or ethinyl oestradiol--a randomized trial

The anti-oestrogenic activity of clomiphene citrate (CC) on the cervical mucous and endometrium may be the reason for the relatively low pregnancy rates in CC induction cycles. Various follicular-phase supplements have been tried to improve cycle outcome in these patients. This study compared follicular-phase supplementation with either phytoestrogen (PE) or ethinyl oestradiol (EE) in CC induction cycles for the treatment of unexplained infertility. A total of 134 patients were randomly allocated to each treatment group (67 each). The PE group needed significantly fewer days for adequate follicular maturation, had a thicker endometrium and higher oestradiol concentration at the time of human chorionic gonadotrophin injection (all P < 0.001). The PE group had higher luteal-phase serum progesterone compared with the EE group. No significant difference was found regarding clinical pregnancy rates (14.0% versus 21.1%, respectively). In conclusion, the cycle characteristics in unexplained infertility women treated with clomiphene citrate induction and timed intercourse improved after follicular-phase supplementation with PE compared with EE supplementation. Further studies are needed to confirm the mechanism beyond these effects.

Adding phytoestrogens to clomiphene induction in unexplained infertility patients--a randomized trial

This study investigated the role of oral phytoestrogens in improving pregnancy rate and cycle outcomes with clomiphene citrate. Patients with unexplained infertility and recurrent clomiphene citrate induction failure, were randomly divided into two groups: group I (n = 60) and group II (n = 59). Both groups received clomiphene citrate 150 mg per day (days 3 to 7). Group I received additional oral phytoestrogen (Cimicifuga racemosa) 120 mg/day from days 1 to 12. Human chorionic gonadotrophin (HCG) injection (10,000 IU i.m.) was given and timed intercourse was recommended when a leading follicle reached >17 mm and serum oestradiol exceeded 200 (pg/ml). There was a non-significant shortening of induction cycles in group I. Oestradiol and LH concentrations were higher in group I compared with group II. Endometrial thickness, serum progesterone and clinical pregnancy rate were significantly higher in group I (8.9 +/- 1.4 mm versus 7.5 +/- 1.3 mm, P < 0.001; 13.3 +/- 3.1 ng/ml versus 9.3 +/- 2.0 ng/ml, P < 0.01; 36.7% versus 13.6%, P < 0.01, respectively). It is concluded that adding C. racemosa rhizome dry extract to clomiphene citrate induction can improve the pregnancy rate and cycle outcomes in these couples.