SPECIAL TASK FORCES // DEVELOPING COUNTRIES AND INFERTILITY //
Pilot projects for Africa, Asia and South America The Task Force held a precongress meeting ahead of the Forum for Women’s Health and Development in Alexandria in March to take forward the Arusha project. Proposals from three of the working groups (1, 2 and 3) were presented and discussed. Low cost diagnostics The minimal requirements for an effective low-cost diagnostic phase as suggested by working group 1 (Rudi Campo and Willem Ombelet) were shown and adjusted to remarks of the experts. A questionnaire to be filled in by infertile couples was introduced and will be finalised at the next follow-up meeting in Amsterdam. It was concluded that all the diagnostic examinations suggested (except the postcoital test) can be done on a day basis and in an inexpensive setting. A search for inexpensive good quality ultrasound and hysteroscopic equipment will be crucial. Ovarian stimulation for IUI and IVF The proposal of Working Group 2 (ovarian stimulation for IUI and IVF) was presented by Peter Platteau and was based on results of a literature search performed by Anne Loft and Anders Nyboe Andersen (co-ordinator WG2). For IUI the combination of clomiphene citrate 50-100 mg for five days in combination with 5000 IU hCG was suggested as the most cost-effective protocol. This same protocol was proposed for IVF, but with an oral contraceptive pill recommended for at least 12 days before stimulation to minimise the risk of a premature LH surge and ovulation. The costs of the presented protocols were expected to be less than E20 per cycle. This seems to be very promising for resource-poor countries, at least if an acceptable success rate can be obtained from the pilot studies due to be organised in the near future in both developed and developing countries. Low cost laboratory As the co-ordinator of WG3 (low cost laboratory) Jonathan Van Blerkom based his proposal on the use of a simplified stimulation protocol intended to produce a small number of oocytes and the transfer of just one or two embryos on days 1 or 2, with no cryopreservation. In such circumstances, said Jonathan, the conditions for culture can be greatly simplified without sacrificing outcome potential. He added that the combination of a small, self-contained, single-temperature incubator with simple medium buffered to maintain pH in air may be the most expeditious approach to clinical IVF in different and perhaps challenging conditions and circumstances. The first pilotproject will be started in April 2009. 22
The issue of which countries and which patients for the first pilot projects on ‘accessible infertility services’ was discussed and will be finalised in the near future. However, it was decided to start the first pilot project in two to four centres in Africa, one in Asia and one in South America. The full protocol, including the one-stop diagnostic phase, the ovarian stimulation protocol and the laboratory phase, has to be finalised within two months and will be sent to the different ethical committees for approval. Frank Van Balen presented the future activities of the study group dealing with the sociocultural and ethical aspects of childlessness in developing countries. Egbert te Velde proposed a new organogram for the practical organisation of the Task Force, and last but not least Ian Cooke presented his blue-print of how to organise training programmes, stressing the difficulties which can be expected. Ian also reviewed the history and activities of the Low Cost IVF Foundation. Finally, the difficulties and opportunities for fundraising were discussed. The next follow-up meeting of the Task Force will be organised on Wednesday morning 1st July in Amsterdam during the annual ESHRE meeting. The programme of this meeting can be found on our STF link of the ESHRE website. Willem Ombelet Co-ordinator STF Developing Countries and Infertility
Our host in Alexandria, Hassan Sallam, persuaded Suzanna Mubarak, Egypt’s first lady, to join the meeting for a few minutes. She was accompanied by four Egyptian Ministers and they all showed great interest in our project and promised to support our work at the international level. Pictured with her at the Suzanne Mubarak Regional Centre for Women's Health and Development in Alexandria are Hassan Sallam, right, and Willem Ombelet, left.
Focus on Reproduction January 2009