Country Assessment Integration Tool – Addressing Fertility Care
The first WHO workshop was held in Geneva, Switzerland, (1-4 October 2013) to begin development of a Rapid Assessment Tool for fertility care (awareness, support and management). "Strategic assessments" are the first stage defined within the WHO Strategic Approach - an Approach used for countries to assess the feasibility of implementation of WHO global guidelines, recommendations or tools within their national health care systems.
When addressing specific needs, “rapid” strategic assessments have proven be a successful and cost-effective method. The unmet need for couples and individuals who desire children but require assistance is of emerging interest worldwide. The tool will help countries to identify components within their national policies, health systems or services which either directly or indirectly address aspects of fertility care.
The next objectives of will be finalization of the tool, eHealth adaptation, followed by pilot testing at country level. This is a critical initiative within the WHO/RHR strategy in fertility care which will help to integrate the various tools generated by our HRP partners in fertility and infertility care, and is being done in concert with the development of the WHO global guidelines on fertility care.
- Subfertility/infertility - HRP partners in infertility
Global infertility guidelines:
Strategy for development and dissemination
Potential for an affordable and effective IVF protocol
Defined as a simplified IVF procedure, using a low-cost culture system and an affordable clinical protocol, the Walking Egg (tWE) Foundation reported interim results at the European Society for Human Reproduction and Embryology congress in London, 8 July 2013. This clinical study is being conducted at an IVF clinic and laboratory in Genk, Belgium. The study participants are sub-fertile couples from Belgium; and, following a low ovarian stimulation clinical protocol, the woman’s oocytes were randomized to either a standard culture systems or to the new tWE low-cost culture system.
The highest quality embryo was chosen by the lab embryologist - blind to the randomization - and then transferred by the clinician to the woman’s uterus. tWE reported that high quality embryos were equally chosen from both culture systems. Thus far, the Walking Egg has reported 12 live births of healthy babies who have resulted from those embryos which had been chosen from the tWE low-cost culture system. A press conference resulted in high interest from global news agencies.
Argentina: Parliament Approves Law on Assisted Reproduction, June 2013
The Chamber of Deputies of Argentina on Wednesday approved a bill that guarantees free comprehensive access to assisted reproductive medicine for all citizens who desire to attempt to become a parent - without any distinction on the basis of marital status or sexual orientation.
The rule, (previously passed in the Senate) was approved (204 in favour and ten abstentions) with support from all political blocs. The law provides citizens with coverage for simple and complex fertilization techniques (including for example, with or without a donation of gametes or embryos.) The Mandatory Health Program will provide coverage throughout the country through social works prepaid medicine companies and the public health system.
Global consensus on pre-pregnancy care to reduce maternal and childhood mortality and morbidity
There is increasing realization that a gap exists in the continuum of care: A growing body of evidence is showing that pre-pregnancy care can increase the health and well-being of women and couples and improve subsequent pregnancy and child health outcomes.
The place for pre-pregnancy care as part of an overall strategy to prevent maternal and childhood mortality and morbidity is described. Consensus was developed around a package of promotive, preventive and curative health interventions to be delivered in the context during both the pre-pregnancy and inter-pregnancy periods; and mechanisms are described for delivering the package through existing public health programmes in low- and middle-income countries to prevent maternal and childhood mortality and morbidity.
Infertility/subfertility-related health problems, problem behaviours and risk factors that contribute to maternal and childhood mortality and morbidity have been described, and evidence-based interventions to address these factors, as well as mechanisms of delivering them through existing public health programmes have been outlined.
- INFERTILITY & SUBFERTILITY: Continuum of care to reduce maternal and childhood mortality and morbidity
Patient groups for couples with infertility/subfertility
International Consumer Support for Infertility (iCSi)
Patient associations within the infertility community are working hard in their respective countries to stand up for the reproductive rights of patients to have access to infertility diagnosis, management and treatment. In 1999, an International Consumer Support for Infertility (iCSi) patient leader network was established, with a vision to empower patients to become full partners in infertility/fertility healthcare and public policy by building effective relationships with providers, governments and media world-wide. iCSi has developed a tool kit to help patient organizations get started and to raise issues in order to help them evaluate and implement their own national vision.
iCSi has established alliances in regions of Africa, the Asia Pacific, the Americas and Europe. The work of the patient association members from around the globe are featured on the iCSi website: for example, Uganda, Zimbabwe, Czech Republic, Italy, the USA, Turkey, South Korea, India, Mexico and most recently, some activities in Argentina.
New trends in infertility prevalence data
Translations for wider dissemination of the ICMART-WHO glossary
(International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the WHO revised glossary on ART terminology – generate a direct link to the glossary -
The objective of the glossary is to develop an internationally accepted and continually updated set of definitions, which would be utilized to standardize and harmonize international data collection, and to assist in monitoring the availability, efficacy, and safety of assisted reproductive technologies being practiced worldwide. The ICMART-WHO glossary was a source for terminologies and definitions which have been incorporated and debated within the Beta version of the International Classification of Disease (ICD-11).
Other language versions: Japanese and Portuguese. The Portuguese translation is published in JBRA Assist Reprod 2(14)2010; 14-18 and is available at: www.redlara.com. The Japanese translation of the ICMART glossary was first published in Acta Obstetrica et Gynacecologica Japonica 63(1):78-91, 2011 and achieved the endorsement of the Japan Society of Obstetrics and Gynecology (JSOG). The glossary in Japanese recently re-appeared in the Glossary of Obstetrics and Gynecology, the 3rd edition” published by JSOG in May 2013.
In the newest translation into Dutch, in addition to a translation of the original alphabetical list, the authors have developed 3 tables depicting the laboratory, clinical and outcome terminologies – the tables provide a convenient way to retrieve intervention-related definitions.
Provision of access for infertility care in Costa Rica
The Inter American Court of Human Rights (IACHR) voted in favour of provision of access for infertility care, specifically in vitro fertilization (IVF), when indicated for men and women in Costa Rica. The grounds for the IACHR decision were based upon non-discrimination against persons with disability (WHO-World Bank Disability report), the disproportionate effect (medical, psycho-social and mental health) on women, defining infertility as a disease of the reproductive health system (ICMART-WHO Glossary), and with reference to CEDAW and other reproductive health and rights documents which extend to providing access to diagnosis, management and interventions for sub-fertility and infertility.
Due to the nature and deliberations of the IACHR, this decision supports reproductive rights and access to reproductive health – and specifically access to care for those with impaired fertility to attempt for a desired pregnancy when harbouring a child wish. The Inter Americas Human Rights Court Decision 21 December 2012.
- Corte Interamericana de Derechos Humanos
- WHO-ICMART glossary
- Definitions and terminology
- National, regional, and global trends in infertility: a systematic analysis of 277 health surveys
- World report on disability
Contribution to the International Classification of Disease (ICD-11)
The ICMART-WHO Glossary has provided terminologies and definitions which have been incorporated and debated within the Beta version of the International Classification of Disease (ICD-11). The ICD is the standard diagnostic tool for epidemiology, health management and clinical purposes.
This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems, to classify diseases and other health problems, and provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. It is used for reimbursement and resource allocation decision-making by countries.