In-vitro fertilization (IVF) for the poor

British scientist Robert Edwards won a Nobel Prize for helping develop in-vitro fertilization. Now, scientists are bringing the technology to the developing world.In-vitro fertilization is a fairly common method of aiding conception. But it's expensive, and only a small percentage of people around the world can afford it. Dr. Ian Cooke, one of the founders of the Low Cost IVF Foundation, wants to change that. His organization is trying to lower the cost of IVF treatment, to make it accessible to the poorest areas in the world.

"There's a huge need in many, many parts of the world," Cooke told us, including in parts of the world concerned about overpopulation. Infertility "leads to social isolation, physical and emotional abuse and ostracism and indeed suicide," Cooke says. The problem is also more widespread in the developing world. And in many parts of the world, according to Cooke, "particularly in rural areas such as Bangladesh, this leads to increasing poverty because husbands will not let wives who are not fertile work. And so they're even further diminished."

In the United Kingdom, IVF costs about $5,000, and it can be much higher in the United States. "We think that the technical side of it without the staff cost could be done for as little as $200," Cooke told The World. The organization would use cheap drugs and simpler incubation programs. "And because you have the intention of only transferring a single embryo instead of larger numbers," Cooke says, "laboratory costs are kept lower."

The organization has already started work in Tanzania and Sudan. "There end up being major staffing issues that need to be resolved so we don't have a long-term functioning clinic," Cooke says. At the same, he points out, "we've only been working on this in the last twelve months or so." So there may be opportunities in the future.

Experts warn of rising infertility in developing countries

Infertility levels are rising faster in developing countries than in developed countries, warned experts speaking at the 'Updates in Infertility Treatment (UIT) 2010' conference in Seville, Spain, last week. The infertility treatment specialists called for assisted reproductive technologies (ARTs) to be made accessible to those in the poorest parts of the world, where infertility has the greatest consequences. They proposed a low-cost IVF (in vitro fertilisation) programme that could be made available for only Rs 15,000 per couple, a fraction of the cost of treatment in the US and Western Europe.

Infertility affects a far greater proportion of couples in developing countries than in developed nations. Estimates suggest that infertility is over three times higher in some developing regions, often as a result of inadequate healthcare, unsafe abortions or untreated infections of the reproductive organs. In many of these countries, infertility treatment is almost non-existent. Professor Basil Tarlatzis, President of the International Federation of Fertility Society (IFFS) and a human reproduction expert at Aristotle University, Greece, commented that the poorest countries fall far short of the optimum target of 1500 cycles of IVF per million population per year. Most fail to reach even one per cent of the target.

The consequences of infertility are also greatest in developing countries, and this is especially true for women. Professor Tarlatzis commented that 'womanhood is defined by motherhood in some regions so infertile women can be seen as 'cursed' and are deprived of all social status'. Infertile women can also face domestic violence, separation or a polygamous marriage. So infertility treatment could prove particularly beneficial to women in the developing world.

Professor Tarlatzis suggested a two-pronged attack to manage infertility, focusing on 'prevention of avoidable infertility and making available assisted reproduction techniques'. The prevention of avoidable infertility will require many social changes including improved sexual education, treatment of sexually transmitted diseases and the introduction of safe birthing and abortion practices. Increasing the availability of ARTs will require the provision of inexpensive fertility treatment.

A Task Force from the European Society for Human Reproduction and Embryology (ESHRE) is currently developing a framework for the provision of cheap infertility treatment in developing countries. Meanwhile the Low Cost IVF Foundation (LCIF) of Massanfo, Switzerland has funded three clinics located in the Sudan, Tanzania and South Africa to pilot their budget IVF treatment package. The LCIF has managed to cut the cost of IVF dramatically by using inexpensive equipment, simplifying procedures and customising services so that couples are given the minimum level of treatment for their specific condition.