By Harshita Rai, Wayzata High School, Plymouth, Minnesota, USA
Introduction
On July 25, 1978, the birth of the first “test tube baby” changed infertility treatments forever (Nugent, 2018). Since then, assisted reproductive technology (ART) has evolved significantly. According to the definition of the CDC, ART includes all fertility treatments in which either eggs or embryos are handled (CDC, 2019). 186 million individuals suffer from infertility globally, but assisted reproductive technologies have proven to alleviate this burden and have helped patients reach their dream of having a family (WHO, 2020). Despite these positive developments, access to ART remains limited in many parts of the world, particularly in low- and middle-income countries. To meet the goals of global health, lack of ART access needs to be addressed and resolved.
Factors That Affect ART Access
The access to reproductive technologies varies greatly internationally due to several factors such as the nature of the healthcare system, cost of treatment, the availability of high technology, insurance coverage, government regulations, culture and religion. Due to major economic disparities, it is not surprising that wealthier countries can provide more ART services as it involves highly specialized health professionals, expensive medications, surgical procedure facilities and particular laboratories. A study done by Jie Dong, a professor at Tsinghua University in China, reported that the number of ART treatment cycles increased as the GDP per capita increased (Dong, 2022). Global access to ART has clearly been geographically distributed and highly concentrated among the world’s richest countries (Okhovati, 2015). ART can also be quite expensive, and the cost of these procedures can be a significant barrier to access. In many parts of the world, insurance coverage for ART is limited or unavailable, which can make it difficult for individuals and couples to afford these procedures. For example, in a hospital in Kumasi, Ghana, women undergo roughly 500 IVF cycles per year for an out-of-pocket cost of $4,000 to $5,000, which is a fortune for many Ghanaians while being considered low cost in richer nations (Silberner, 2020). Ghana has a strong health insurance system, but there is no financial assistance available for fertility treatments. Furthermore, social and cultural factors can also play a role in the willingness to seek out ART and may limit access to these procedures. In some societies, infertility may be stigmatized, and individuals and couples may face social pressure or discrimination because of their inability to have children (Mahboubeh, 2021). In certain nations, access to ART may be restricted by laws or regulations governing the practice. For instance, these laws may restrict the number of embryos that can be transferred during in vitro fertilization or that outlaw particular types of ART. Overall, access to ART is influenced by a complex set of factors that can vary depending on the individual and their background.
Strategies to Increase ART Access
There are various effective strategies in which we can increase global access to assisted reproductive technology (ART). One strategy is to invest in training more healthcare professionals and increasing the capacity of existing fertility clinics. Deena Shakir, partner at VC firm Lux Capital, which specializes in early-stage investments in science and technology believes that “[infertility] is a huge, huge market, and one that is only getting bigger, if you look at demographic data, declining sperm rates, global numbers…” (Turi, 2021). In fact, between 2017 and 2020, venture capital funding for firms in the fertility industry increased considerably and the year 2021 set a record amount of interest in the sector, with global investments rising by 89 percent from $93 million in 2020 to $176 million in 2021 (Turi, 2021).These investments can increase the number of qualified experts who can help facilitate access to global ART treatments, as well as strengthen the capacity of current clinics to develop a more affordable method of ART access. Another strategy that can be implemented is to increase knowledge about the availability and benefits of ART as many people may be unaware of these procedures. Women who don't have children often experience social exclusion and financial hardships if their partners leave them (Sochas, 2019). Awareness of these treatments in clinics and by healthcare professionals can help to reduce stigma and increase demand. Overall, increasing access to ART will require a combination of efforts, including significant investments in training and infrastructure, and a concerted effort to raise awareness about ART procedures.
Conclusion
In a world where overpopulation and limited resources are a serious concern, infertility treatments may seem counterintuitive. These are the two key arguments against infertility treatment in developing countries. The world's population is expected to increase by nearly 2 billion persons in the next 30 years, from the current 8 billion to 9.7 billion in 2050 and could peak at nearly 10.4 billion in the mid-2080s (United Nations, 2022). Therefore, international health strategies have put more focus on reducing total fertility rates rather than infertility care. It is also difficult to justify expensive fertility treatment in settings with few resources and other challenges. Most developing countries are prioritizing issues such as reproductive health education and contraception. However, this does not make involuntary childlessness a less important issue. In an article published in the journal Public Health Ethics, Canadian ethicist Marie-Eve Lemoine and colleagues made the case for fertility as a fundamental human right and concluded that it is unethical to accept infertility in the context of overall population growth (Silberner, 2020). The needs of the infertile minority cannot be overlooked in the effort to address overpopulation. Infertility is a disease that deserves equal attention and care to ensure better health outcomes for all populations and communities. On the other hand, we also need to recognize that there may be other priorities influencing our focus on combating infertility and our limited resources may need to be allocated to address more pressing health issues. In essence, it is important to approach the issue of infertility and ART access in a thoughtful and balanced way, taking into account the needs and priorities of individuals and couples as well as the broader social and economic context.
References