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Afferri A, Dierickx S, Bittaye M, Marena M, Pacey AA, Balen J. Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study. PLoS One 2024; 19:e0301700. [PMID: 38743724 PMCID: PMC11093356 DOI: 10.1371/journal.pone.0301700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/20/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION In the Global South, (in)fertility care is scarcely recognized as a priority, yet the government of The Gambia has recently included it as one of the key priorities in its reproductive health strategic plan. This inclusion appears to be the result of years of engagement between policy actors, academic researchers, and activists in the field of reproductive health and specifically of infertility. However, the operationalization of the strategic plan may be hampered by multiple factors. The research aims to identify and analyze challenges that may impede the effective implementation of the strategic plan, thereby providing policy action points and practical guidance into the operationalization of (in)fertility care in the context of The Gambia's health system. METHODS This is a mixed-methods study with data from a survey and semi-structured interviews collected between 2020 and 2021 in The Gambia that were separately published. In this paper, we present the triangulation of quantitative and qualitative data using a convergence coding matrix to identify relevant policy action points. RESULTS Six fertility care policy action points, driven by data, arose from the triangulation and interpretation process, specifically: (i) establishing and maintaining political commitment and national priority for fertility care; (ii) creating awareness and increasing the involvement of men in SRH and fertility; (iii) ensuring data-driven health policymaking; (iv) offering and regulating affordable IVF alternatives; (v) improving knowledge of and means for fertility care provision; and (vi) enhancing the collaboration among stakeholders and building links with the private healthcare sector. CONCLUSION This study found the implementation of the fertility care-related activities in the reproductive health strategic plan may face challenges that require careful mitigation through a holistic approach. Such an approach conceptualizes infertility not just as a biomedical issue but as a broader one that incorporates educational and socio-emotional aspects, including male and (not only) female involvement in sexual and reproductive health. Moreover, it is supported by a comprehensive health management information system that includes capturing data on the demand for, and access to, infertility services in The Gambia health system.
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Affiliation(s)
- Anna Afferri
- School of Health and Related Research–ScHARR, The University of Sheffield, Sheffield, United Kingdom
| | - Susan Dierickx
- Institute of Tropical Medicine, Antwerp, Belgium
- Department of Clinical Sciences, Research Centre Gender, Diversity and Intersectionality—RHEA, Vrije Universiteit Brussel, Brussel, Belgium
| | - Mustapha Bittaye
- Ministry of Health, Banjul, The Gambia
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Musa Marena
- Ministry of Health, Banjul, The Gambia
- School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia
| | - Allan Antony Pacey
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Julie Balen
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, United Kingdom
- Medical Research Council–MRC Unit The Gambia at LSHTM, Fajara, The Gambia
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Fauser BCJM, Adamson GD, Boivin J, Chambers GM, de Geyter C, Dyer S, Inhorn MC, Schmidt L, Serour GI, Tarlatzis B, Zegers-Hochschild F. Declining global fertility rates and the implications for family planning and family building: an IFFS consensus document based on a narrative review of the literature. Hum Reprod Update 2024; 30:153-173. [PMID: 38197291 PMCID: PMC10905510 DOI: 10.1093/humupd/dmad028] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/25/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. Not including the effects of migration, many countries are predicted to have a population decline of >50% from 2017 to 2100, causing demographic changes with profound societal implications. Policies that optimize chances to have a child when desired increase fertility rates and are gaining interest as a family-building method. Increasingly, countries have implemented child-friendly policies (mainly financial incentives in addition to public funding of fertility treatment in a limited number of countries) to mitigate decreasing national populations. However, the extent of public spending on child benefits varies greatly from country to country. To our knowledge, this International Federation of Fertility Societies (IFFS) consensus document represents the first attempt to describe major disparities in access to fertility care in the context of the global trend of decreasing growth in the world population, based on a narrative review of the existing literature. OBJECTIVE AND RATIONALE The concept of family building, the process by which individuals or couples create or expand their families, has been largely ignored in family-planning paradigms. Family building encompasses various methods and options for individuals or couples who wish to have children. It can involve biological means, such as natural conception, as well as ART, surrogacy, adoption, and foster care. Family-building acknowledges the diverse ways in which individuals or couples can create their desired family and reflects the understanding that there is no one-size-fits-all approach to building a family. Developing education programs for young adults to increase family-building awareness and prevent infertility is urgently needed. Recommendations are provided and important knowledge gaps identified to provide professionals, the public, and policymakers with a comprehensive understanding of the role of child-friendly policies. SEARCH METHODS A narrative review of the existing literature was performed by invited global leaders who themselves significantly contributed to this research field. Each section of the review was prepared by two to three experts, each of whom searched the published literature (PubMed) for peer reviewed full papers and reviews. Sections were discussed monthly by all authors and quarterly by the review board. The final document was prepared following discussions among all team members during a hybrid invitational meeting where full consensus was reached. OUTCOMES Major advances in fertility care have dramatically improved family-building opportunities since the 1990s. Although up to 10% of all children are born as a result of fertility care in some wealthy countries, there is great variation in access to care. The high cost to patients of infertility treatment renders it unaffordable for most. Preliminary studies point to the increasing contribution of fertility care to the global population and the associated economic benefits for society. WIDER IMPLICATIONS Fertility care has rarely been discussed in the context of a rapid decrease in world population growth. Soon, most countries will have an average number of children per woman far below the replacement level. While this may have a beneficial impact on the environment, underpopulation is of great concern in many countries. Although governments have implemented child-friendly policies, distinct discrepancies in access to fertility care remain.
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Affiliation(s)
- Bart C J M Fauser
- University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Silke Dyer
- Groot Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ottun TA, Adewunmi AA, Jinadu FO, Olumodeji AM, Akinlusi FM, Rabiu KA, Akinola OI, Fabamwo AO. A decennial cross-sectional review of assisted reproductive technology in a Tertiary Hospital in Southwest Nigeria. BMC Pregnancy Childbirth 2023; 23:680. [PMID: 37730568 PMCID: PMC10510187 DOI: 10.1186/s12884-023-05964-0] [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: 02/11/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The World Health Organization recommends that Assisted Reproductive Technology be complementary to other ethically acceptable solutions to infertility. Whereas fertility centres are increasing in number in urban regions of Africa, published reports of their performance are sparse. We present a 10-year review of assisted reproductive technology performed in a public tertiary centre in Lagos, Nigeria. METHODS This was a hospital-based, retrospective, cross-sectional review of 604 women, over a 10-year period that had in-vitro fertilization or in-vitro fertilization with intra-cytoplasmic sperm injection at the Institute of Fertility Medicine, Lagos State University Teaching Hospital. Data obtained were expressed in descriptive statistics and Pearson correlation was used to determine the strength of linear relationship between two continuous variables at a significance level of p < 0.05. RESULTS The mean age of the women was of 37.7 ± 6.2 years and 89.7% had no previous parous experience. About 27.2% of the male partners had normal seminal fluid parameters while 4.6% had azoospermia. Median serum follicle stimulating hormone of the women was 8.1 IU/L and median serum anti-mullerian hormone was 6.3 pmol/L. There was weak positive correlation between age and serum follicle stimulating hormone (r = 0.306, p < 0.001); weak negative correlation between age and serum anti-mullerian hormone (r = -0.48, p < 0.001) and very weak correlation between body mass index and serum follicle stimulating hormone (r = 0.173, p = 0.011). In-vitro fertilization and intra-cytoplasmic sperm injection was the method of fertilization used in 97.4% of the cases and 81.8% of embryos formed were of good quality. Most women (94.5%) had 2 embryos transferred and 89.9% had day-5 embryo transfer done. About 1 in 4 of the women (143/604, 23.7%) had clinical pregnancy and 49.7% of women who got pregnant had delivery of a live baby at term while 11.9% had preterm delivery of a live baby. CONCLUSION Despite increasing use and success of assisted reproductive technology in south-western Nigeria, there is room for improvement in clinical pregnancy rates and live birth rates post- assisted reproductive technology. Complication rates are desirably low.
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Affiliation(s)
- Tawaqualit Abimbola Ottun
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria.
| | - Adeniyi Abiodun Adewunmi
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | | | - Ayokunle Moses Olumodeji
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Fatimat Motunrayo Akinlusi
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | - Kabiru Afolarin Rabiu
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | - Oluwarotimi Ireti Akinola
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
| | - Adetokunbo Olusegun Fabamwo
- Department of Obstetrics and Gynaecology, Lagos State University College of Medicine & Teaching Hospital, Lagos, Nigeria
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Oppenheimer D, Rego F, Nunes R. The search for the principle of justice for infertile couples: characterization of the brazilian population and bioethical discussion. BMC Med Ethics 2023; 24:69. [PMID: 37667304 PMCID: PMC10476313 DOI: 10.1186/s12910-023-00947-4] [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: 05/17/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Infertility is an increasingly prevalent disease in society and is considered by the World Health Organization to be a public health problem. An important ethical issue arises from the clarification of reproductive rights in a fair and equal way. The objective of this study was to deepen and update the knowledge and discussion about the difficulty of accessing infertility treatments in Brazil. METHODS A cross-sectional observational study was carried out through the application of an online questionnaire that collected the socioeconomic characteristics of couples and identify how barriers to infertility care affect the most vulnerable populations. We included couples who sought medical assistance to achieve pregnancy at two clinics in the states of São Paulo and Minas Gerais. RESULTS A total of 201 questionnaires were analyzed. Most couples self-declared as white and the average age of wives was 36 years and husbands 38 years. 65% (65%) of couples would proceed with the treatment in a different city to which they lived, 37% evaluated as having easy access to a medical specialist only after indication, and more than half of the participating have thought about giving up the treatment due to some difficulty in accessing it. 39% of participants sought more than one medical service to find better reception, 42% of couples sought more than one medical service to define where it would be better financially, and 67.2% referred to the high cost of treatments, that is, financial issues, as a great difficulty in accessing medical services and/or treatment. Although 72.6% of couples considered having a good quality of life, 54.2% admitted that infertility and the search for treatment generated anxiety/stress in the couple's life. CONCLUSION There is a need for public education on reproductive health and for policymakers to raise awareness of the importance of the difficulty that many couples face in seeking treatment to become pregnant, especially in countries with less financial resources. Indeed, it is commonly accepted that there is a universal human right to access healthcare of appropriate quality as a matter of justice. Discussion of access to reproductive technologies should be considered taking into account the longstanding ethical debate regarding fertility, fecundity, and infertility, as well as reproductive care.
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Affiliation(s)
- Drauzio Oppenheimer
- Faculdade de Medicina de Itajubá, Av. Rennó Junior, 368, São Vicente, Itajubá, CEP 37502-138, MG, Brasil.
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Francisca Rego
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rui Nunes
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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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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Bibi R, Jahan S, Afsar T, Almajwal A, Hammadeh ME, Alruwaili NW, Razak S, Amor H. The influence of paternal overweight on sperm chromatin integrity, fertilization rate and pregnancy outcome among males attending fertility clinic for IVF/ICSI treatment. BMC Pregnancy Childbirth 2022; 22:620. [PMID: 35931982 PMCID: PMC9354411 DOI: 10.1186/s12884-022-04953-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Low and middle-income countries are facing a rapid increase in obesity and overweight burden, particularly in urban settings. Being overweight in men is associated with infertility and a higher risk to have a low sperm count or no sperm in their ejaculate. Despite potential limitations, this is one of few studies conducted to determine the potential risk of paternal overweight on sperm standard parameters, sperm chromatin integrity and assisted conception outcome including fertilization, embryo quality, cleavage rate, reduce blastocyst development, implantation, and cumulative live birth rate (CLBR). Methods A cross-sectional study of 750 infertile couples undergoing assisted reproduction technique at a single reproductive medicine center of Salma Kafeel Medical Centre Islamabad. Sperm from men undergoing ART were analyzed for chromatin integrity using sperm chromatin dispersion assay (SCD), Chromomycin A3 staining (CMA3), and toluidine blue (TB) staining, while other semen parameters were assessed on same day includes; standard semen parameters, reactive oxygen species (ROS), sperm deformity index (SDI), teratozoospermic index (TZI), and hypo-osmatic swelling test (HOST). Paternal body mass index (BMI) < 24.5–20 kg/m2 served as the reference group, while the male patients with BMI > 24.5-30 kg/m2 were considered to be overweight. Results In the analysis of the percentage of spermatozoa with chromatin maturity (CMA3) and chromatin integrity (TB) was reduced significantly in overweight men (p < 0.01) compared with a reference group. Increase in paternal BMI correlate with the increase in sperm chromatin damage (SCD r = 0.282, TB r = 0.144, p < 0.05), immaturity (CMA3, r = 0.79, p < 0.05) and oxidative stress (ROS) (r = 0.282, p < 0.001). Peri-fertilization effects were increased in oocytes fertilization in couples with overweight men (FR = 67%) compared with normal-weight men (FR = 74.8%), similarly, after univariant regression paternal weight remain predictor of sperm chromatin maturity, successful fertilization and CLBR. In the embryo, developmental stage number of the embryo in cleavage was higher in normal weight men, while day 3 (D3) embryos, percent good quality embryo D3, and blastocyst formation rate were compared able between the groups. The paternal overweight group had significant (p < 0.001) increased neonatal birth weight (2952.14 ± 53.64gm; within normal range) when compared with the reference group (2577.24 ± 30.94gm) following assisted reproductive technology (ART). CLBR was higher (p < 0.05) in normal weight men compared to couples with overweight male partners. CLBR per embryo transfer and per 2PN was a statistically significant (p < 0.05) difference between the two groups. An inverse association was observed in the linear regression model between paternal BMI with fertilization rate and CLBR. Conclusion The present study demonstrated the impact of paternal overweight on male reproductive health, as these patients had a higher percentage of immature sperm (CMA3) with impaired chromatin integrity (SCD, TB) in their semen and had decreased fertilization rate, CLBR following assisted reproductive treatments. The present study supports that paternal overweight should be regarded as one of the predictors for fertilization, CLBR and useful for counseling, to consider body mass index not only in women but also for men, in those couples opting for ART treatment, and warrant a poor reproductive outcome in overweight men.
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Affiliation(s)
- Riffat Bibi
- Department of Animal Sciences, Faculty of Biological Sciences, Quaid-I-Azam University Islamabad, Islamabad, 45320, Pakistan
| | - Sarwat Jahan
- Department of Animal Sciences, Faculty of Biological Sciences, Quaid-I-Azam University Islamabad, Islamabad, 45320, Pakistan
| | - Tayyaba Afsar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali Almajwal
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Eid Hammadeh
- Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland University Clinic, Homburg, Germany
| | - Nawaf W Alruwaili
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Houda Amor
- Department of Obstetrics, Gynecology and Reproductive Medicine, Saarland University Clinic, Homburg, Germany
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Artificial Oocyte: Development and Potential Application. Cells 2022; 11:cells11071135. [PMID: 35406698 PMCID: PMC8998074 DOI: 10.3390/cells11071135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/25/2022] [Accepted: 03/26/2022] [Indexed: 02/07/2023] Open
Abstract
Millions of people around the world suffer from infertility, with the number of infertile couples and individuals increasing every year. Assisted reproductive technologies (ART) have been widely developed in recent years; however, some patients are unable to benefit from these technologies due to their lack of functional germ cells. Therefore, the development of alternative methods seems necessary. One of these methods is to create artificial oocytes. Oocytes can be generated in vitro from the ovary, fetal gonad, germline stem cells (GSCs), ovarian stem cells, or pluripotent stem cells (PSCs). This approach has raised new hopes in both basic research and medical applications. In this article, we looked at the principle of oocyte development, the landmark studies that enhanced our understanding of the cellular and molecular mechanisms that govern oogenesis in vivo, as well as the mechanisms underlying in vitro generation of functional oocytes from different sources of mouse and human stem cells. In addition, we introduced next-generation ART using somatic cells with artificial oocytes. Finally, we provided an overview of the reproductive application of in vitro oogenesis and its use in human fertility.
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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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Gilbert E, Walker R, Simon D, Derkenne R, Rumbold A, Campbell S, Boyle JA. "We are only looking at the tip of the iceberg in infertility": perspectives of health providers about fertility issues and management among Aboriginal and Torres Strait Islander people. BMC Health Serv Res 2021; 21:704. [PMID: 34271914 PMCID: PMC8285865 DOI: 10.1186/s12913-021-06714-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Aboriginal and Torres Strait Islander women and men are disproportionately affected by a range of risk factors for infertility. However, remarkably little is known about the prevalence of infertility in this group, or how Aboriginal and Torres Strait Islander people access fertility treatments including assisted reproductive technology (ART). This qualitative study aims to explore health care provider (HCP) perspectives on the health burden of infertility among Aboriginal and Torres Strait Islander people, as well as factors that may affect access to infertility treatment for this group. METHOD Semi-structured interviews were conducted with HCPs (8 doctors; 3 nurses and 1 Aboriginal Health Practitioner) working in fertility care in the Northern Territory, Australia. Transcribed interviews were analysed using an iterative thematic approach using the NVivo-9 software package. RESULTS Providers perceive infertility as an underestimated health issue in this patient population, reporting a high prevalence of infertility-related risk factors but fewer clinical encounters of diagnosis and treatment. Perceived barriers to accessing fertility care included cultural differences such as the shame and stigma associated with reproductive health and the separation of men's business and women's business; service-related barriers such as limited timely and affordable access to specialist health services and; a lack of culturally responsive and appropriate fertility services. Providers had mixed opinions on their role in ameliorating inequities of access, and hence a range of strategies to address barriers were suggested. These included a greater patient education, ongoing patient support and providing a culturally safe environment. CONCLUSION The current study adds to the understanding of how Aboriginal and Torres Strait Islander people access fertility treatments. There is a need for further research to quantify infertility in Aboriginal and Torres Strait Islander people, investigate community perceptions towards infertility and identify community-driven priorities to improve access to fertility care for this population.
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Affiliation(s)
- Emily Gilbert
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia
| | - Ruth Walker
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia
| | - David Simon
- Top End Health Service, NT, Casuarina, Australia
| | | | - Alice Rumbold
- South Australian Health and Medical Research Institute, SA, Adelaide, Australia
| | - Sandra Campbell
- Molly Wardaguga Research Centre, School of Nursing and Midwifery, Charles Darwin University, QLD, Brisbane City, Australia
| | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, VIC, Melbourne, Australia.
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Onofre J, Geenen L, Cox A, Van Der Auwera I, Willendrup F, Andersen E, Campo R, Dhont N, Ombelet W. Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries. Facts Views Vis Obgyn 2021; 13:79-93. [PMID: 33889864 PMCID: PMC8051200 DOI: 10.52054/fvvo.13.1.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing. Materials and methods A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject. Results Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination. Conclusions Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.
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Affiliation(s)
- J Onofre
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - L Geenen
- University of Hasselt, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - A Cox
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - I Van Der Auwera
- Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | | | | | - R Campo
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - N Dhont
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
| | - W Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium.,Department of Obstetrics, Gynaecology and Infertility, Ziekenhuis Oost Limburg, Genk, Belgium
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11
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Shah V, Jobanputra A, Saxena B, Nivsarkar M. Development and Characterization of Saturated Fatty Acid-Engineered, Silica-Coated Lipid Vesicular System for Effective Oral Delivery of Alfa-Choriogonadotropin. AAPS PharmSciTech 2021; 22:118. [PMID: 33782790 DOI: 10.1208/s12249-021-01985-0] [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: 12/01/2020] [Accepted: 03/08/2021] [Indexed: 11/30/2022] Open
Abstract
The present study was designed to develop an efficient, safe, and patient-friendly dosage form, for oral delivery of alfa-choriogonadotropin, used in the treatment of female reproductive infertility. Silica-coated, saturated fatty acid (dipalmitoylphosphatidylcholine (DPPC))-engineered, nanolipidic vesicular (NLVs) system was developed for systemic delivery of therapeutic peptide, alfa-choriogonadotropin, through oral route. DPPC-based NLVs were formulated using the technique of thin-film hydration and were coated with silica to form a homogeneous surface silica shell. The formulated silica-coated NLVs were evaluated for physicochemical and physiologic stability under simulated conditions and were optimized based on physicochemical parameters like particle size, zeta potential, polydispersity index (PDI), entrapment efficiency, and in vitro release profile. Silica-coated, DPPC-based NLVs imparted physicochemical stability to entrapped alfa-choriogonadotropin against the biological environment prevailing in the human gastrointestinal tract (GIT). In vivo, subchronic animal toxicity studies were performed to assess the safety of the designed dosage form. Results of in vitro characterization and in vivo pharmacokinetic studies of fabricated formulation revealed that the silica-coated, DPPC-based NLV formulation was not only stable in human GIT but was also as efficacious as a marketed parenteral formulation for the systemic delivery of alfa-choriogonadotropin. In vivo toxicity studies revealed that silica-coated NLVs did not alter hematological and serum biochemical parameters. The histopathological studies also depicted no macroscopic changes in major organs; thus, the developed formulation was proven to be nontoxic and equally efficient as a marketed parenteral formulation for the delivery of alfa-choriogonadotropin with added benefits of possible self-medication, more patient acceptability, and no chances of infection.
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12
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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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13
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Zhang F, Dai J, Chen T. Role of Lactobacillus in Female Infertility Via Modulating Sperm Agglutination and Immobilization. Front Cell Infect Microbiol 2021; 10:620529. [PMID: 33569356 PMCID: PMC7868545 DOI: 10.3389/fcimb.2020.620529] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Infertility has become a common problem in recent decades. The pathogenesis of infertility is variable, but microbiological factors account for a large proportion of it. Dysbiosis of vaginal microbiota is reportedly associated with female infertility, but the influence of normal vaginal microbiota on infertility is unclear. In this review, we summarize the physiological characteristics of the vaginal tract and vaginal microbiota communities. We mainly focus on the bacterial adherence of vaginal Lactobacillus species. Given that the adherent effect plays a crucial role in the colonization of bacteria, we hypothesize that the adherent effect of vaginal Lactobacillus may also influence the fertility of the host. We also analyze the agglutination and immobilization effects of other bacteria, especially Escherichia coli, on ejaculated spermatozoa, and speculate on the possible effects of normal vaginal microbiota on female fertility.
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Affiliation(s)
- Fenghao Zhang
- Institute of Translational Medicine & School of Life Sciences, Nanchang University, Nanchang, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Beijing, China
| | - Tingtao Chen
- Institute of Translational Medicine & School of Life Sciences, Nanchang University, Nanchang, China
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14
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Olorunfemi O, Osian E, Oahimijie F, Osunde N, Oduyemi R. Acceptability of babies conceived through assisted reproductive technology among married women in University of Benin Teaching Hospital, Benin City, Nigeria. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2020. [DOI: 10.4103/cjhr.cjhr_110_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Crawford GE, Ledger WL. In vitro fertilisation/intracytoplasmic sperm injection beyond 2020. BJOG 2019; 126:237-243. [PMID: 30548407 DOI: 10.1111/1471-0528.15526] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 12/28/2022]
Abstract
Over 8 million babies have been born following IVF (in vitro fertilisation) and other artificial reproductive technology (ART) procedures since Louise Brown's birth 40 years ago. New innovations have added much complexity to both clinical and laboratory procedures over the last four decades. Translation of novel approaches from basic science into clinical practice continues unabated, widening the applicability of ART to new groups of people and helping improve both chances of healthy live birth and patient acceptability. However, the impact of ART on the health of both patients and their offspring continues to cause concern, and many ethical challenges created by new scientific developments in this field attract widely differing opinions. What is undeniable is that there will be a sustained global growth in utilisation of ART and that reproductive tourism will allow many people to access the treatment they desire notwithstanding national regulations that may forbid some approaches. The greatest challenge is to expand access to ART to those living in the less wealthy nations who are equally deserving of its benefits.
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Affiliation(s)
- G E Crawford
- The Royal Hospital for Women, Randwick, NSW, Australia.,School of Women's and Children's Health, The University of New South Wales, Randwick, NSW, Australia
| | - W L Ledger
- The Royal Hospital for Women, Randwick, NSW, Australia.,School of Women's and Children's Health, The University of New South Wales, Randwick, NSW, Australia
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16
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Perslev K, Msemo OA, Minja DTR, Møller SL, Theander TG, Lusingu JPA, Bygbjerg IC, Nielsen BB, Schmiegelow C. Marked reduction in fertility among African women with urogenital infections: A prospective cohort study. PLoS One 2019; 14:e0210421. [PMID: 30629655 PMCID: PMC6328149 DOI: 10.1371/journal.pone.0210421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 12/22/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is paucity of data on risk factors for reduced fertility in low-income countries. OBJECTIVE To investigate factors associated with fertility among women in rural north eastern Tanzania. SUBJECTS AND METHODS A cohort of 1248 non-pregnant women was followed with urine pregnancy testing every third month or more regularly if they reported a missed menstrual period. Pregnancy was confirmed with trans-abdominal ultrasound. Information regarding general health, socioeconomic status and obstetric-gynaecological history was collected. Factors associated with conceiving within 180 days were identified using multivariate logistic regression analyses. RESULTS Among the 1248 women, 736 were followed for 180 days and 209 of these had an ultrasound confirmed pregnancy. During the follow-up period, 169/736 women were diagnosed with urogenital infections, including suspected sexually transmitted or reproductive tract infections, urinary tract infection, and vaginal candidiasis. Urogenital infections were significantly associated with reduced odds of conceiving within 180 days (adjusted OR (AOR) 0.21, 95% CI 0.11-0.36). Being above 30 years of age was also negatively associated with odds of conceiving (AOR 0.45, 95% CI 0.26-0.77). In contrast, women who recently stopped using hormonal contraceptives (AOR 2.86, 95% CI 1.45-5.70) and women with low socioeconomic status (AOR 1.56, 95% CI 1.04-2.33) were significantly more likely to become pregnant within 180 days. CONCLUSION Urogenital infection seems to be a major health factor associated with reduced chances of conceiving. Considering the availability of effective treatment options for these diseases, public health authorities should increase awareness of diagnostic tools in settings with limited resources in order to improve fertility.
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Affiliation(s)
- K. Perslev
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - O. A. Msemo
- National Institute for Medical Research, Korogwe, Tanga, Tanzania
| | - D. T. R. Minja
- National Institute for Medical Research, Korogwe, Tanga, Tanzania
| | - S. L. Møller
- Division of Global Health, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - T. G. Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - J. P. A. Lusingu
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research, Korogwe, Tanga, Tanzania
| | - I. C. Bygbjerg
- Division of Global Health, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - B. B. Nielsen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - C. Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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17
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Zheng D, Zhou Z, Li R, Wu H, Xu S, Kang Y, Cao Y, Chen X, Zhu Y, Xu S, Chen ZJ, Mol BW, Qiao J. Consultation and treatment behaviour of infertile couples in China: a population-based study. Reprod Biomed Online 2019; 38:917-925. [PMID: 30928300 DOI: 10.1016/j.rbmo.2018.11.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 01/18/2023]
Abstract
RESEARCH QUESTION The prevalence of infertility in couples actively trying to conceive is 25%. What is the consultation-seeking behaviour, diagnosis and related treatment in infertile couples across China? DESIGN Large cross-sectional population-based study in 2010-2011, in which 25,270 couples from eight provinces/municipalities in China were approached by a multistage stratified cluster sampling strategy. RESULTS Among the 2680 couples reporting infertility, 1246 infertile couples consulted a fertility doctor. Age of the couple, man's body mass index and women's educational level were found to be associated with consultation behaviour. After the fertility work-up, diagnoses were tubal infertility (n = 353, 28.3%), unexplained infertility (n = 311, 25.0%), male infertility (n = 234, 18.8%), ovulatory disorder (n = 194, 15.6%) and endometriosis (n = 34, 2.7%), while 8.6% (n = 107) were not classified. Most couples received non-assisted reproductive technology (ART) fertility treatment (n = 906, 89.3%), with a proportion using traditional Chinese medicine (TCM) (n = 298, 29.4%). Intrauterine insemination (n = 62, 6.1%) and IVF/intracytoplasmic sperm injection (n = 57, 5.6%) were less frequent. Medical treatment and outcomes among five subtypes of infertility were also reported: about 30% of couples with unexplained infertility (n = 94, 30.3%) or male infertility (n = 67, 29.0%) used TCM to treat infertility. Apart from patients with endometriosis, of whom 20.6% (n = 7) received ART, patients with other infertility subtypes rarely received ART. For subsequent fertility outcome, 94% of them did not achieve a pregnancy. CONCLUSION The prevalence of infertility in China is high, but the uptake of treatment is relatively low.
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Affiliation(s)
- Danni Zheng
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China; Beijing Advanced Innovation Centre for Genomics, Beijing 100871, China; Peking-Tsinghua Centre for Life Sciences, Peking University, Beijing 100871, China
| | - Zehong Zhou
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Guangzhou 510623, China
| | - Rong Li
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China; Beijing Advanced Innovation Centre for Genomics, Beijing 100871, China; Peking-Tsinghua Centre for Life Sciences, Peking University, Beijing 100871, China
| | - Hongping Wu
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China; Beijing Advanced Innovation Centre for Genomics, Beijing 100871, China; Peking-Tsinghua Centre for Life Sciences, Peking University, Beijing 100871, China
| | - Suxin Xu
- Reproductive Medical Centre, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yuefan Kang
- Reproductive Medical Centre, Maternal and Children's Health Hospital of Fujian Province, Fuzhou 350001, China
| | - Yunxia Cao
- Department of Obstetrics and Gynecology, Reproductive Medical Centre, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xiujuan Chen
- Reproductive Medical Centre, Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010059, China
| | - Yimin Zhu
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Shuguang Xu
- Population and Family Planning Research Institute of Heilongjiang Province, Harbin 150020, China
| | - Zi-Jiang Chen
- Centre for Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250001, China
| | - Ben Willem Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Australia
| | - Jie Qiao
- Centre for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China; National Clinical Research Centre for Obstetrics and Gynecology, Beijing 100191, China; Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing 100191, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China; Beijing Advanced Innovation Centre for Genomics, Beijing 100871, China; Peking-Tsinghua Centre for Life Sciences, Peking University, Beijing 100871, China.
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18
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Dyer SJ, Vinoos L, Ataguba JE. Poor recovery of households from out-of-pocket payment for assisted reproductive technology. Hum Reprod 2018; 32:2431-2436. [PMID: 29069451 DOI: 10.1093/humrep/dex315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/27/2017] [Indexed: 01/15/2023] Open
Abstract
STUDY QUESTION How do households recover financially from direct out-of-pocket payment for government subsidized ART? SUMMARY ANSWER After a mean of 3.8 years, there was poor recovery from initiated financial coping strategies with the poorest households being disproportionatley affected. WHAT IS KNOWN ALREADY Out-of-pocket payment for health services can create financial burdens for households and inequities in access to care. A previous study conducted at a public-academic institution in South Africa documented that patient co-payment for one cycle of ART resulted in catastrophic expenditure for one in five households, and more frequently among the poorest, requiring diverse financial coping strategies to offset costs. STUDY DESIGN, SIZE, DURATION An observational follow-up study was conducted ~4 years later to assess financial recovery among the 135 couples who had participated in this previous study. Data were collected over 12 months from 73 informants. PARTICIPANTS/MATERIALS, SETTING, METHOD The study was conducted at a level three referral hospital in the public-academic health sector of South Africa. At this institution ART is subsidized but requires patient co-payments. A purpose-built questionnaire capturing socio-economic information and recovery from financial coping strategies which had been activated was administered to all informants. Financial recovery was defined as the resolution of strategies initiated for the specific purpose of covering the original ART cycle. Results were analysed by strategy and household with the latter including analysis by tertiles based on socio-economic status at the time of the original expenditure. In addition to descriptive statistics, the Pearson Chi squared test was used to determine differences between socioeconomic tertiles and associations between recovery and other variables. MAIN RESULTS AND THE ROLE OF CHANCE The participation rate in this follow-up study was 54.1% with equal representation from the three socio-economic tertiles. The average duration of follow-up was 46.1 months (±9.78 SD) and respondents' mean age was 42 years (range 31-52). The recovery rate was below 50% for four of five strategies evaluated: 23.1% of households had re-purchased a sold asset; 23.5% had normalized a previous reduction in household spending, 33.8% had regained their savings, and 48.7% were no longer bolstering income through additional work. Two-thirds of households (60.0%) had repaid all loans and debts. The poorest households showed lower rates of recovery when compared to households in the richest tertile. Complete recovery from all strategies initiated was reported by only 10 households (13.7%): 1 of 19 in the lowest tertile, 3 of 30 in the middle and by 6 of 24 households in the richest tertile (P > 0.05). No association was found between the degree of financial recovery and additional cost burdens incurred, including related to babies born; or between the degree of recovery and ongoing pursuit of ART. LIMITATIONS, REASONS FOR CAUTION The sample size was limited. The participation rate was just over 50%. Results were dependent on participants' narrative and recall. WIDER IMPLICATIONS OF THE FINDINGS The willingness of patients to pay for ART does not necessarily imply the ability to pay. As a result, the lack of comprehensive third-party funding for ART can create immediate and long-term financial hardship which is more pronounced among poorer households. While more data on the impact of out-of-pocket payment for ART are needed to illustrate the problem in other low resource settings, the results from South Africa provide useful information for similar developing countries. The current absence of more extensive data should therefore not be a barrier to the promotion of financial risk protection for infertile couples, especially the poorest, in need of ART. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by a Masters Student Grant from the Faculty of Health Sciences, University of Cape Town. The authors had no competing interests. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Silke J Dyer
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Main Road, Observatory 7925, Cape Town, South Africa
| | - Latiefa Vinoos
- Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Main Road, Observatory 7925, Cape Town, South Africa
| | - John E Ataguba
- Health Economics Unit, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa
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Cardoso-dos-Santos AC, Boquett J, de Oliveira MZ, Callegari-Jacques SM, Barbian MH, Sanseverino MTV, Matte U, Schuler-Faccini L. Twin Peaks: A spatial and temporal study of twinning rates in Brazil. PLoS One 2018; 13:e0200885. [PMID: 30028857 PMCID: PMC6054405 DOI: 10.1371/journal.pone.0200885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/05/2018] [Indexed: 11/28/2022] Open
Abstract
Twin births are an important public health issue due to health complications for both mother and children. While it is known that contemporary factors have drastically changed the epidemiology of twins in certain developed countries, in Brazil, relevant data are still scarce. Thus, we carried out a population-based study of live births in spatial and temporal dimensions using data from Brazil's Live Birth Information System, which covers the entire country. Over 41 million births registered between 2001 and 2014 were classified as singleton, twin or multiple. Twinning rates (TR) averaged 9.41 per 1,000 for the study period and a first-order autoregressive model of time-series analysis revealed a global upward trend over time; however, there were important regional differences. In fact, a Cluster and Outlier Analysis (Anselin Local Moran's I) was performed and identified clusters of high TR in an area stretching from the south of Brazil's Northeast Region to the South Region (Global Moran Index = 0.062, P < 0.001). Spearman's correlation coefficient and a Wilcoxon matched pairs test revealed a positive association between Human Development Index (HDI) and TRs in different scenarios, suggesting that the HDI might be an important indicator of childbearing age and assisted reproduction techniques in Brazil. Furthermore, there was a sharp increase of 26.42% in TR in women aged 45 and over during study period. The upward temporal trend in TRs is in line with recent observations from other countries, while the spatial analysis has revealed two very different realities within the same country. Our approach to TR using HDI as a proxy for underlying socioeconomic changes can be applied to other developing countries with regional inequalities resembling those found in Brazil.
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Affiliation(s)
- Augusto César Cardoso-dos-Santos
- Post-graduate Program in Genetics and Molecular Biology, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Juliano Boquett
- Post-graduate Program in Genetics and Molecular Biology, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marcelo Zagonel de Oliveira
- INAGEMP ‒ Instituto Nacional de Genética Médica, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sidia Maria Callegari-Jacques
- Department of Statistics, Institute of Mathematics and Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Márcia Helena Barbian
- Department of Statistics, Institute of Mathematics and Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Teresa Vieira Sanseverino
- Post-graduate Program in Genetics and Molecular Biology, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- INAGEMP ‒ Instituto Nacional de Genética Médica, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ursula Matte
- Post-graduate Program in Genetics and Molecular Biology, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- INAGEMP ‒ Instituto Nacional de Genética Médica, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lavínia Schuler-Faccini
- Post-graduate Program in Genetics and Molecular Biology, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- INAGEMP ‒ Instituto Nacional de Genética Médica, Department of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
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20
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Derivation of human induced pluripotent stem cell line (HUSTi001-A) from a 40-year-old patient with idiopathic infertility. Stem Cell Res 2018; 27:136-139. [PMID: 29414604 DOI: 10.1016/j.scr.2018.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/04/2018] [Accepted: 01/18/2018] [Indexed: 01/21/2023] Open
Abstract
Human fibroblasts were isolated from foreskin of a clinically diagnosed 40-year old patient with idiopathic infertility. The fibroblasts were reprogrammed with the Yamanaka KOSM transcriptional factors using the retroviral vectors. The obtained induced pluripotent stem cell (iPSC) line showed pluripotency verified by the expression of pluripotency markers, NANOG, SOX2, OCT4, TRA-1-60, and SSEA-4. And the iPSC line was demonstrated to have the three germ layers differentiation capacity in vivo by teratoma assay. The iPSC line also showed normal karyotype. This patient-specific iPSC line can be used to explore the mechanism for idiopathic male infertility.
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21
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Eyni H, Ghorbani S, Shirazi R, Salari Asl L, P Beiranvand S, Soleimani M. Three-dimensional wet-electrospun poly(lactic acid)/multi-wall carbon nanotubes scaffold induces differentiation of human menstrual blood-derived stem cells into germ-like cells. J Biomater Appl 2017; 32:373-383. [PMID: 28752802 DOI: 10.1177/0885328217723179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Infertility caused by the disruption or absence of germ cells is a major and largely incurable medical problem. Germ cells (i.e., sperm or egg) play a key role in the transmission of genetic and epigenetic information across generations. Generation of gametes derived in vitro from stem cells hold promising prospects which could potentially help infertile men and women. Menstrual blood-derived stem cells are a unique stem cell source. Evidence suggests that menstrual blood-derived stem cells exhibit a multi-lineage potential and have attracted extensive attention in regenerative medicine. To maintain the three-dimensional structure of natural extra cellular matrices in vitro, scaffolds can do this favor and mimic a microenvironment for cell proliferation and differentiation. According to previous studies, poly(lactic acid) and multi-wall carbon nanotubes have been introduced as novel and promising biomaterials for the proliferation and differentiation of stem cells. Some cell types have been successfully grown on a matrix containing carbon nanotubes in tissue engineering but there is no report for this material to support stem cells differentiation into germ cells lineage. This study designed a 3D wet-electrospun poly(lactic acid) and poly(lactic acid)/multi-wall carbon nanotubes composite scaffold to compare infiltration, proliferation, and differentiation potential of menstrual blood-derived stem cells toward germ cell lineage with 2D culture. Our primary data revealed that the fabricated scaffold has mechanical and biological suitable qualities for supporting and attachments of stem cells. The differentiated menstrual blood-derived stem cells tracking in scaffolds using scanning electron microscopy confirmed cell attachment, aggregation, and distribution on the porous scaffold. Based on the differentiation assay by RT-PCR analysis, stem cells and germ-like cells markers were expressed in 3D groups as well as 2D one. It seems that poly(lactic acid)/multi-wall carbon nanotubes scaffold-seeded menstrual blood-derived stem cells could be viewed as a novel, safe, and accessible construct for these cells, as they enhance germ-like generation from menstrual blood-derived stem cells.
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Affiliation(s)
- Hossein Eyni
- 1 Department of Anatomical Sciences, School of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Sadegh Ghorbani
- 1 Department of Anatomical Sciences, School of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Reza Shirazi
- 2 Department of Anatomical Sciences, Iran University of Medical Sciences University, Tehran, Islamic Republic of Iran
| | - Leila Salari Asl
- 1 Department of Anatomical Sciences, School of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Shahram P Beiranvand
- 1 Department of Anatomical Sciences, School of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
| | - Masoud Soleimani
- 3 Department of Hematology, School of Medical Sciences, Tarbiat Modares University, Tehran, Islamic Republic of Iran
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22
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Ho JR, Hoffman JR, Aghajanova L, Smith JF, Cardenas M, Herndon CN. Demographic analysis of a low resource, socioculturally diverse urban community presenting for infertility care in a United States public hospital. Contracept Reprod Med 2017; 2:17. [PMID: 29201422 PMCID: PMC5683225 DOI: 10.1186/s40834-017-0044-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 04/19/2017] [Indexed: 11/10/2022] Open
Abstract
Background Infertility is a prevalent disease of reproductive health that exerts an impact on an estimated 80 million people worldwide. For many, involuntary childlessness becomes a central and preoccupying issue in their lives, the impact of which is exacerbated by lack of access to basic care and treatment. These effects maybe further magnified among immigrant communities, a growing but highly marginalized population that has been shown in other areas of reproductive health to experience worse health outcomes and delays in access to care. To date, few studies have examined the unique medical and sociocultural considerations of infertility among immigrant populations in the United States. Methods Our study is a cross-sectional analysis of women presenting for infertility evaluation at a county hospital serving a low resource, socioculturally diverse largely immigrant communities in comparison to infertile women from a largely affluent population presenting to a high resource, comprehensive fertility center. We employed surveys to evaluate demographics and socioeconomic parameters as well as abstracted data from medical records to obtain infertility diagnoses. Multivariate regression analysis was applied to examine impact of sociocultural factors as predictors of duration of untreated infertility disease burden experienced by patients. Results Eighty-seven women were included in our analysis. In the county hospital/low resource clinic (LR), the mean age was 32.9 ± 4.9 vs 36.4 ± 6.3 years in the fee-for-service/high resource clinic (HR). The mean reported duration of infertility in LR and HR patients was 3.4 ± 3.0 vs 2.3 ± 1.5 years. 70% of LR patients were monolingual non-English speakers vs 5.4% of HR patients. 59% of LR patients reported an annual household income of less than $25,000 and 70% did not have a college degree. 81.1% of HR patients reported an income of higher than $100,000, and 81.1% had completed college or graduate school. The most common infertility diagnosis in the LR was anovulation (38%) and tubal factor (28%) compared to diminished ovarian reserve (37.8%) and male factor (51.4%) in the HR. After controlling for age at the initiation of pregnancy attempt, lower education level, lower income, and immigrant status were significantly correlated with a longer duration of infertility. Conclusions Women presenting for infertility care to a low resource county medical center represent immigrant communities and are generally of younger age, but with a longer duration of infertility. This study identifies lower educational level, income, and immigrant status as barriers in access to care.
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Affiliation(s)
- Jacqueline R Ho
- Obstetrics & Gynecology, University of Southern California, 2020 Zonal Ave, Los Angeles, CA 90033 USA.,Obstetrics, Gynecology, & Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA
| | - Jacquelyn R Hoffman
- Obstetrics, Gynecology, & Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA
| | - Lusine Aghajanova
- Obstetrics, Gynecology, & Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA
| | - James F Smith
- Obstetrics, Gynecology, & Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA.,Department of Urology, University of California, 400 Parnassus, Box 0738, San Francisco, CA 94143 USA.,UCSF Philip R. Lee Institute for Health Policy Studies, 3333 California St, San Francisco, CA 94118 USA
| | | | - Christopher N Herndon
- Obstetrics, Gynecology, & Reproductive Sciences, University of California, 550 16th Street, San Francisco, CA 94158 USA.,Alta Bates IVF Program, 2999 Regent St Suite 101A, Berkeley, CA 94705 USA
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23
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Mouka A, Tachdjian G, Dupont J, Drévillon L, Tosca L. In Vitro Gamete Differentiation from Pluripotent Stem Cells as a Promising Therapy for Infertility. Stem Cells Dev 2016; 25:509-21. [PMID: 26873432 DOI: 10.1089/scd.2015.0230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Generation of gametes derived in vitro from pluripotent stem cells holds promising prospects for future reproductive applications. Indeed, it provides information on molecular and cellular mechanisms underlying germ cell (GC) development and could offer a new potential treatment for infertility. Great progress has been made in derivation of gametes from embryonic stem cells, despite ethical issues. Induced pluripotent stem cells (iPSCs) technology allows the reprogramming of a differentiated somatic cell, possibly emanating from the patient, into a pluripotent state. With the emergence of iPSCs, several studies created primordial GC stage to mature gamete-like cells in vitro in mice and humans. Recent findings in GC derivation suggest that in mice, functional gametes can be generated in vitro. This strengthens the idea that it might be possible in the future to generate functional human sperm and oocytes from pluripotent stem cells in culture.
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Affiliation(s)
- Aurélie Mouka
- 1 AP-HP, Service d'Histologie, Embryologie et Cytogénétique, Hôpitaux Universitaires Paris-Sud , Clamart, France .,2 Université Paris-Sud , Le Kremlin-Bicêtre Cedex, France
| | - Gérard Tachdjian
- 1 AP-HP, Service d'Histologie, Embryologie et Cytogénétique, Hôpitaux Universitaires Paris-Sud , Clamart, France .,2 Université Paris-Sud , Le Kremlin-Bicêtre Cedex, France
| | - Joëlle Dupont
- 3 Unité de Physiologie de la Reproduction et des Comportements, Institut National de la Recherche Agronomique , Nouzilly, France
| | - Loïc Drévillon
- 1 AP-HP, Service d'Histologie, Embryologie et Cytogénétique, Hôpitaux Universitaires Paris-Sud , Clamart, France
| | - Lucie Tosca
- 1 AP-HP, Service d'Histologie, Embryologie et Cytogénétique, Hôpitaux Universitaires Paris-Sud , Clamart, France .,2 Université Paris-Sud , Le Kremlin-Bicêtre Cedex, France
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24
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Hasdemir PS, Kamali MB, Calik E, Ozcakir HT. A Comparison of Success Rates of Embryo Transfer on Weekdays and Weekends. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:48-52. [PMID: 27123200 PMCID: PMC4845529 DOI: 10.22074/ijfs.2016.4768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/04/2015] [Indexed: 11/29/2022]
Abstract
Background The aim of this study is to examine the effect of the embryo transfer
(ET) day on clinical pregnancy success rates in in vitro fertilization-ET (IVF-ET)
cycles. Materials and Methods In this retrospective study, we divided patients with infertility who underwent IVF-ET with fresh embryos into two groups depending on whether
the ET was performed on weekdays or weekends. The main outcome measure was to
compare the clinical pregnancy rates of patients with similar demographic and clinical
characteristics who underwent ET on weekdays or weekends. Results A total of 188 patients underwent IVF-ET on weekdays (n=156) or weekends
(n=32). Both groups had similar demographic and cycle characteristics. The overall
pregnancy rate was 42.8%. Among the study groups, the weekday group had a 40.2%
ET success rate and the weekend group had a 54.8% success rate (P=0.517). Although
no statistically significant difference existed between the two groups, we observed an
absolute 14.6% increase in pregnancy rate for ETs performed during weekends compared to those performed on weekdays, with a 35% statistical power. Conclusion ETs performed during weekends were more successful than ETs performed during weekdays with an absolute 14.6% increase in clinical pregnancy rate.
This finding should be confirmed by conducting further studies with larger groups of
patients.
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Affiliation(s)
- Pinar Solmaz Hasdemir
- Celal Bayar University Medical School, Department of Obstetrics and Gynecology, Manisa, Turkey
| | - Melek Bulut Kamali
- Celal Bayar University Infertility Research and Treatment Center, Grand Medical Hospital IVF Center, Manisa, Turkey
| | - Esat Calik
- Celal Bayar University Medical School, Department of Obstetrics and Gynecology, Manisa, Turkey
| | - Hasan Tayfun Ozcakir
- Celal Bayar University Medical School, Department of Obstetrics and Gynecology, Manisa, Turkey; Celal Bayar University Infertility Research and Treatment Center, Grand Medical Hospital IVF Center, Manisa, Turkey
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25
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Nikolic A, Volarevic V, Armstrong L, Lako M, Stojkovic M. Primordial Germ Cells: Current Knowledge and Perspectives. Stem Cells Int 2015; 2016:1741072. [PMID: 26635880 PMCID: PMC4655300 DOI: 10.1155/2016/1741072] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/17/2015] [Indexed: 01/11/2023] Open
Abstract
Infertility is a condition that occurs very frequently and understanding what defines normal fertility is crucial to helping patients. Causes of infertility are numerous and the treatment often does not lead to desired pregnancy especially when there is a lack of functional gametes. In humans, the primordial germ cell (PGC) is the primary undifferentiated stem cell type that will differentiate towards gametes: spermatozoa or oocytes. With the development of stem cell biology and differentiation protocols, PGC can be obtained from pluripotent stem cells providing a new therapeutic possibility to treat infertile couples. Recent studies demonstrated that viable mouse pups could be obtained from in vitro differentiated stem cells suggesting that translation of these results to human is closer. Therefore, the aim of this review is to summarize current knowledge about PGC indicating the perspective of their use in both research and medical application for the treatment of infertility.
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Affiliation(s)
- Aleksandar Nikolic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozara Markovica Street, 34000 Kragujevac, Serbia
| | - Vladislav Volarevic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozara Markovica Street, 34000 Kragujevac, Serbia
| | - Lyle Armstrong
- Institute of Genetic Medicine, Newcastle University, The International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK
| | - Majlinda Lako
- Institute of Genetic Medicine, Newcastle University, The International Centre for Life, Central Parkway, Newcastle upon Tyne NE1 3BZ, UK
| | - Miodrag Stojkovic
- Center for Molecular Medicine and Stem Cell Research, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozara Markovica Street, 34000 Kragujevac, Serbia
- Spebo Medical, Norvezanska 16, 16 000 Leskovac, Serbia
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