Published online 12 March 2008 | Nature | doi:10.1038/news.2008.668

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Developing countries "to get $200 IVF"

Fertility experts launch drive to provide affordable infertility treatment.

Having kids can make a huge difference to women in the developing world.Lewis Whyld/PA Wire/PA Photos

A task force has been established to provide infertile couples in poor countries with access to affordable reproductive treatments such as IVF, a European group of fertility experts announced today. They are aiming to roll out a network of cheap clinics that could offer IVF, for example, for as little as US$200 a time.

With the average marriage in sub-Saharan Africa yielding six children, and many national governments in the region striving to reduce birth rates, the move is likely to be controversial. But in much of the developing world, children are important — not only because many children tend crops and do other work, but also because of the stigma of childlessness that can lead to women being socially excluded.

“She might be disinherited, ostracized, accused of witchcraft or abandoned to a second-class life in a polygamous marriage.”

Oluwole Akande

An estimated 186 million women of reproductive age in the developing world suffer infertility problems — in some countries in sub-Saharan Africa, almost one-third of women are unable to conceive.

Assisted reproduction technologies (ARTs) such as IVF are available in richer countries, although at a cost of up to US$10,000 per attempt, or 'treatment cycle', the price tag is far beyond what can be afforded in developing countries.

The new proposal to provide much cheaper versions of the treatment was put forward at a meeting of members of the European Society for Human Reproduction and Embryology in Brussels, Belgium. "The most important goal is to provide treatment which is safe, affordable and culturally acceptable, said Willem Ombelet, a Belgian fertility expert and leader of the new task force set up to implement the plan.

Social stigma

"The inability to have children can create enormous problems, particularly for the woman," says another of the task force's members, Oluwole Akande of University College Hospital in Ibadan, Nigeria. "She might be disinherited, ostracized, accused of witchcraft, abused by local healers, separated from her spouse or abandoned to a second-class life in a polygamous marriage."

In December last year, the task force met in Arusha, Tanzania, to begin planning how to implement the strategy. Also at the meeting was Rita Sembuya, founder of the Joyce Fertility Support Centre in Uganda, and someone who knows the pain of childlessness. "Socially you are looked at as a person who never should have existed," says Sembuya, who tried in vain for 17 years to have a child. In countries such as Uganda, she says, marriages are not viewed as complete until they have produced a baby.

Bioethicists argue that cheaper fertility treatment is needed most in the world's poor regions, and that denying it to infertile couples is not an effective way to manage population on a national level. Far more effective would be to provide family-planning services to those who are capable of having children.

In a 2001 report on the issue1 for the World Health Organization, ethicists Abdallah Daar and Zara Merali wrote that: "A failure to even consider low-cost models of ART will be to conceive of developing countries as perpetually developing, rather than developed, with respect to public health".

Driving down the cost

Fertility treatments are available in a handful of clinics in Africa, although access to services such as IVF lags far behind the developed world, where test-tube babies swell in numbers every day. In some rich countries, as many as 4% of babies are now conceived by modern techniques.

"We will not be able to treat every type of infertility," says Luca Gianaroli, a fertility specialist based in Bologna, Italy. "But many women with tubal damage as a result of infection can be helped," he adds. They will drive down prices in part by improving on diagnostic techniques to work out the most likely obstacle to conception in different cases.

Ombelet and his colleagues aim to provide cheaper IVF by cutting down on the ovary-stimulating injections and other drug treatments that make Western fertility treatment so expensive. In a typical clinic on London's famous Harley Street, for example, women receive large doses of sex hormones to maximise the number of eggs produced per cycle, thus improving the chances of a successful birth.

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In Africa, that approach would not be viable, says Gianaroli. Not only do these hormone treatments drive up the price, but they also increase the chances of multiple births — something he argues would place too much strain on African healthcare providers.

The task force has already set up a pilot study involving two fertility clinics — one in Khartoum, Sudan; the other in Cape Town, South Africa. "We want to recruit patients who have never been offered fertility treatment before," says Ian Cooke of the University of Sheffield, UK, who is overseeing the pilot scheme. 

  • References

    1. Infertility and Assisted Reproductive Technologies in the Developing World (World Health Organization, 2001).
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