PG23: Training People In Low-Cost Infertility And ART Treatment

Date:October 13, 2013

Time:8:15 am - 5:00 pm

Location:Room 207 - Boston Convention and Exhibition Center

Presenters

Ian D. Cooke, M.B., FRCOG, F.Med.Sci. (Chair), University of Sheffield

Luca Gianaroli, M.D., S.I.S.Me.R.

M. Cristina Magli, Ph.D., S.I.S.Me.R.

Pasquale Patrizio, M.D., M.B.E., Yale University

Supporters

Developed in Cooperation with the International Federation of Fertility Societies

ACGME Competency
Systems-based practice 

NEEDS ASSESSMENT AND COURSE DESCRIPTION
Access to infertility diagnosis and treatment is extremely poor in the developing world. There are too few clinics or private doctors interested in and competent to manage infertility problems, no adequate referral systems, and few trained staff. National health services provide few treatments as many countries struggle with major disease, such as human immunodeficiency virus (HIV), malaria and tuberculosis (TB). Available private services are usually too costly for the average patient and can result in catastrophic expense. The most common cause of infertility in developing nations is tubal obstruction from infection, either chlamydia, gonorrhea or postpartum or postabortion sepsis, where the only realistic management plan includes in vitro fertilization (IVF). However, public health education on reproduction is minimal and infertility is surrounded by fear and superstition and compounded by local religious attitudes. Treatment options are not widely known and sophisticated methods, such as assisted reproductive technology (ART), are not available. 

Management of infertility needs to be conducted within a framework of adequate reproductive health services, so that preparation for pregnancy, the pregnancy and the delivery are competently managed, in places where skilled attendance at delivery may not be standard practice. Health professionals, either nationals of low resource economies or altruistic academics from developed countries, wanting to implement infertility treatments and ART in the developing world must understand the problems and acquire the competence to approach them in ways that are cost-effective for their region and not simply attempt to transfer systems developed for more-affluent environments. 

This live course will describe how to develop assisted-conception services in low-resource environments. Discussion will cover how to find suitable laboratory space, provide robust equipment and maintain it in working order, maintain lab records with a view to quality control, trouble shoot, and use the laboratory data to develop the service. Identifying potential patients, patient screening, meeting with both partners, and treatment prior to ART will be emphasized as well as the principles of preparation for pregnancy and obstetric care. The indications for intra-uterine insemination (IUI) and IVF (and the need for intra-cytoplasmic sperm injection [ICSI]) will be elaborated in the context of education about reproductive biology, pathology and specific treatment for the couple and the implications for public health education. Minimal ovarian stimulation will be discussed in the context of avoiding hyperstimulation and multifetal pregnancy. The critical role of ultrasound will be presented with technical details of appropriate apparatus and the skill requirements and methods for acquiring them will be presented. The role of various staff members will be elaborated and include quality standards. 

Finally, an appraisal of the financial viability of developing an assisted-conception clinic and the use of data obtained from such a clinic will be detailed. Data can be reported to national and international registries and used to attract patients and influence policy related to service provision at a national level, thus helping to extend local health service to a greater proportion of the population in accordance with the World Health Organization rubric of appropriately-stratified healthcare.

LEARNING OBJECTIVES
At the completion of this seminar, the participant will be able to: 

  1. Explain the rationale for providing assisted-conception services in low-resource environments.
  2. Develop a clinic offering suitable ART services and competently manage patients in such a setting.
  3. Specify the steps required for financial viability and for quality data retention and reporting.
  4. Develop educational programs suitable for patients, the general public and health service administrators.

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