Fertility in developing countries: words into action

For almost 30 years - since the world’s first ‘test-tube’ baby was born in July 1978 - the benefits of modern infertility treatments have been largely confined to couples in developed countries. There, we have seen more than three million babies born as a result of in vitro fertilisation (IVF) and, in some countries, as many as four percent of all babies born are conceived by modern fertility techniques.
The plight of couples in developing countries, especially women, has been acknowledged, but rarely advanced from words into action. Now, a task force of ESHRE (the European Society of Human Reproduction and Embryology), the world’s leading professional organisation in reproductive medicine, has devised a programme of fertility treatment for developing countries which aims to integrate fertility clinics within broader family health services. Two pilot IVF services have already opened in Africa.
There are many reasons why infertility treatment has not been widely introduced in developing countries. The main explanations are poverty and limited health resources, but there is also the paradox that most of the countries where needs are greatest are also the countries where population growth is running out of control. Dr Willem Ombelet from the Institute for Fertility Technology in Genk, Belgium, and coordinator of the ESHRE task force, says that the ESHRE task force plans are to integrate infertility treatment within existing family planning and mother-care services. The most important goal is to provide treatment that is safe, affordable and culturally acceptable. The ESHRE programme proposes three levels of treatment, but its cornerstone is the provision of affordable IVF. Currently, one cycle of IVF treatment in Europe or the USA costs between US$ 5000 and 10,000. A system of low-cost IVF now being pilot-studied in Khartoum and Cape Town aims to provide one cycle of IVF for less than $200.
One of the instigators of the low-cost IVF scheme, Dr Luca Gianaroli from the SISMER Reproductive Medicine Unit in Bologna, Italy, says that the approach to IVF will be different. Every type of infertility will not be able to be treated, but many women with tubal damage as a result of infection can be helped. While the scheme has limited laboratory facilities for incubation, embryo selection and embryo freezing, triplets and high-order pregnancies will be avoided. The cornerstones in the treatment of infertility in low-resource settings are the simplification of techniques, minimising of complications, training for healthcare workers as well as and the incorporation of fertility treatments into existing healthcare programmes.