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Human Reproduction Update Advance Access originally published online on September 26, 2008
Human Reproduction Update 2008 14(6):605-621; doi:10.1093/humupd/dmn042
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
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Infertility and the provision of infertility medical services in developing countries

Willem Ombelet1,6, Ian Cooke2, Silke Dyer3, Gamal Serour4 and Paul Devroey5

1 Department of Obstetrics and Gynaecology, Genk Institute for Fertility Technology, Schiepse Bos 6, 3600 Genk, Belgium 2 Emeritus Professor of Obstetrics and Gynaecology, 80 Grove Road, Millhouses, Sheffield S7 2GZ, UK 3 Reproductive Medicine Unit, Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa 4 Department of Obstetrics and Gynaecology, Al Azhar University, The Egyptian IVF-ET Center, 3 Street 161, Hadayek El-Maadi, Cairo 11431, Egypt 5 The Center for Reproductive Medicine of the Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Jette, Belgium

6 Correspondence address. E-mail: willem.ombelet{at}telenet.be

BACKGROUND: Worldwide more than 70 million couples suffer from infertility, the majority being residents of developing countries. Negative consequences of childlessness are experienced to a greater degree in developing countries when compared with Western societies. Bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections is the most common cause of infertility in developing countries, a condition that is potentially treatable with assisted reproductive technologies (ART). New reproductive technologies are either unavailable or very costly in developing countries. This review provides a comprehensive survey of all important papers on the issue of infertility in developing countries.

METHODS: Medline, PubMed, Excerpta Medica and EMBASE searches identified relevant papers published between 1978 and 2007 and the keywords used were the combinations of ‘affordable, assisted reproduction, ART, developing countries, health services, infertility, IVF, simplified methods, traditional health care'.

RESULTS: The exact prevalence of infertility in developing countries is unknown due to a lack of registration and well-performed studies. On the other hand, the implementation of appropriate infertility treatment is currently not a main goal for most international non-profit organizations. Keystones in the successful implementation of infertility care in low-resource settings include simplification of diagnostic and ART procedures, minimizing the complication rate of interventions, providing training-courses for health-care workers and incorporating infertility treatment into sexual and reproductive health-care programmes.

CONCLUSIONS: Although recognizing the importance of education and prevention, we believe that for the reasons of social justice, infertility treatment in developing countries requires greater attention at National and International levels.

Key words: developing countries / infertility / low-cost ART / politics / simplified infertility treatment

Received on May 6, 2008; revised August 5, 2008; accepted on August 13, 2008


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