IVF in Africa: what is it all about?

Abstract

Infertility is a universal problem with the highest prevalence in low-resource countries, particularly in sub-Saharan Africa where infection-related tubal damage is the commonest cause. It is estimated that more than 180 million couples in developing countries suffer from primary or secondary infertility. In most African countries, the social stigma of childlessness still leads to isolation and abandonment. Differences between the developed and developing world are emerging because of the different availability in infertility care and the different socio-cultural value surrounding procreation and childlessness. Although reproductive health education and prevention of infertility are number one priorities, the need for accessible diagnostic procedures and affordable assisted reproductive technologies (ART) is very high. The success and sustainability of ART in resource-poor settings will depend, to a large extend, on our ability to optimise these techniques in terms of availability, affordability and effectiveness. Different new innovations and techniques can make the diagnostic work-up and treatment through assisted reproductive technologies (ART), including in-vitro fertilization (IVF), more affordable. These include automated smartphone-based assays for semen analysis and simplified IVF culture systems. The initiative of African Network and Registry for Assisted Reproductive Technology (ANARA) to register all IVF cycles in Africa needs our support and will be of paramount importance in the future. The hurdles to implement ART in most African countries are numerous and although more and more IVF centres are founded, the accessibility to ART remains very low.

Keywords: ART; Africa; IVF; accessible; affordable; assisted reproductive technologies; childlessness; developing countries; infertility.

Figure 1

Continuum of the consequences of infertility and childlessness: In developed countries, the consequences of infertility rarely extend beyond level two; in developing countries, at least in Asia and Africa, the consequences of infertility are infrequently as mild as level three (Daar and Merali, 2001).

Figure 2

Access to IVF procedures: estimated need of IVF cycles per million (population) (Fauser et al., 2002). Calculation for Belgium (reimbursement of 6 IVF cycles per woman) and Africa. (If 10 % of the population consist of cohabiting women aged 18-44 years, taking into account that 10 % of these have a fertility problem, among them 50 % will seek infertility care. Of the remaining 5000 infertile couples 2500 would qualify for IVF due to persistent infertility and 500 because of tubal factor or severe male infertility. Assuming that only half of them will accept

Figure 3

Overview of the number of registred IVF units in the different African countries.

Figure 4

Cost analysis per IVF and ICSI procedure in private centres in South Africa (Huyser and Boyd, 2013).

Figure 6

Association between infertility and other socio-cultural determinants and high sexual behavior in Africa.

Figure 7a

Building the centre with the (financial) support of the Pentecost Church of Ghana.

Figure 7b

The final result.

Figure 7c

The Accra team in Genk (Belgium): training in hysteroscopy by Dr. Campo.

Figure 7d

Starting-up the first IVF trials with a batch of selected couples. Oocyte retrieval and laboratory performance.

Figure 7e

On August 7, 2017, the first TWE baby was born in Accra.