Sexual and reproductive health

Infertility

What's new

ASRM – new status as an NGO in official relations with WHO

Following the World Health Organization Executive Board Meeting, January 2014, and approval through the 67th World Health Assembly, May, 2014, the American Society for Reproductive Medicine (ASRM) has joined into official relations as a Nongovernmental Organization (NGO) with the World Health Organization.

“Illness is not limited by political boundaries. It is vital that we work with our colleagues from all over the world to improve the care of reproductive disorders. We are anxious to work with governments and other NGO's as we all strive to improve global reproductive health. Patients the world over deserve access to the best care possible. In an increasingly interconnected world, it is clear that this cannot happen by nations acting alone,” stated Rebecca Z. Sokol, MD, MPH, Acting President of the ASRM.

The ASRM has had a long established relationship with WHO-HQ/RHR-HRP, and the global joint plan of work is in the area of fertility care, infertility and subfertility.

International Federation of Fertility Societies:

Global Surveillance Report 2013

In order to study trends in global fertility care policies and practices, WHO has partnered with the International Federation of Fertility Societies (IFFS), an NGO in official relations with WHO. Founded in 1951, IFFS has representation and membership from 65 national fertility societies, and 4 associated regional societies. Every three years, the IFFS has issued a triennial IFFS Surveillance Report.

The IFFS Surveillance report is intended to monitor relevant and changing policies and regulations and to provide “a snapshot of assisted reproductive technology” and associated fertility care activities worldwide, emphasizing changes that have occurred during the ensuing 3 years. The first reports in 1999 and 2001, were presented as research articles, that attempted to address how various issues were being covered globally. From 2004 onward, the IFFS produced surveillance reports accomplished through canvassing IFFS members, with an objective of “depicting and recording the situation as it existed” in countries. Ten years ago, the IFFS Report had underscored “the development of in vitro fertilization (IVF) and its subsequent variations and extensions … [and] appear[ed] to have generated more interest and concern among religious leaders, bioethicists and the general public, than any other medical procedure.” The surveillance presented a clear tension that had arisen from the various viewpoints of religious organizations and populations concerning ART.

Is there an increased risk of birth defects in children following use of Assisted Reproductive Technologies?

Use of assisted technologies for reproduction have consistently raised fears for the potential of abnormal infant outcomes. Joe Leigh Simpson, current President of the IFFS, and senior Vice President for Research and Global Programmes at the March of Dimes, presents a review of the literature and concludes that “The major question at present is whether this increase {in birth defects in ART children} is due to ART protocols per se or merely reflective of the biological perturbations that generated the infertility {subfertility} that necessitated ART to achieve pregnancy.” Seminars in Fetal & Neonatal Medicine 19 (2014) 177-182

Are we overusing IVF?

The value of in vitro fertilization for tubal blockage and severe male factor infertility is clear. However, the evidence for newer indications such as unexplained subfertility is unclear. Unexplained subfertility accounts for 25-30% of all couples presenting for IVF, many of whom could conceive before treatment. The Evidence-based IVF Group presented a case to address the risks and benefits of using IVF for subfertility and unexplained infertility. BMJ 2014; 348: g252

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.

Photo of the group
(Left to right, front row) David Adamson (ICMART, FIGO-RMC), Sheryl van der Poel (WHO/RHR/HRP), Ian Askew (Population Council, Kenya), Marleen Temmerman (Director, WHO/RHR/HRP), Jacky Boivin (Cardiff University, Wales), Liz Sullivan (University of New South Wales, Australia). (left to right, back row) Ian Cooke (Professor Emeritus, UK), Chris Herndon (University of California San Francisco, USA), Allan Pacey (University of Sheffield, UK), Petra de Sutter (University of Ghent, Belgium)

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.

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.

Patient groups for couples with infertility/subfertility

International Consumer Support for Infertility (iCSi)

  • iCSi web site
    Empowering patients to become full partners in ART health care and public policy by building effective relationships with providers, governments and media worldwide.

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.

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.

Share
Image of a painting
"Femme fleur"
Painting by C. Meynent

The beauty of the flower, but no fruit

(Translation of a Sukuma proverb: "Wiza w'ilaba, buti wa kisumo").

Global consensus on preconception care to reduce maternal and childhood mortality and morbidity