The cost effective IVF strategies in assisted reproduction technology programmes (art)

[摘要] CHAPTER IUnderstanding the physiology of oocyte(s) recruited, selected and retrieved in a cycleof assisted reproductive technology (ART) is fundamentally important towards thedevelopment of the embryo with great potential for conception and live birth. This isdiscussed in detail.More important is the interpretation and utilization of the scientific evidence in thischapter to explore less expensive methods of optimizing oocyte quality in mild ovarianstimulation in vitro fertilization (IVF).CHAPTER IIClomiphene citrate (CC) is an inexpensive and safe drug that can be used alone or incombination with gonadotropins in IVF.Clinical outcomes in different IVF treatments using CC were reviewed and discussedin detail. The major concern regarding CC in ART is the risk of premature luteinizinghormone (LH) surge with subsequent detrimental effect on the oocyte quality. Thisissue is discussed with outlined strategies (inexpensive) to minimize the risk.CHAPTER IIIThe effective methods to prevent premature LH surge in ART include gonadotropinreleasing hormone antagonists (GnRHa) and gonadotropin releasing hormoneagonists (GnRH). But these methods are expensive and unaffordable in resourcelimitedcountries. We therefore performed a randomised controlled trial to evaluate asimple method of prolonged usage of CC as a strategy to prevent premature LH surgein ART treatment. The protocol is described in detail. The trial showed that prolongedusage of CC did not suppress premature LH surge in mild ovarian stimulation ART.But it motivated us to explore other inexpensive strategies for lowering the risk ofpremature LH surge such as pre-treatment with oral contraceptives, the use oftamoxifen and the use of progesterone during ovarian stimulation.CHAPTER IVStellenbosch University https://scholar.sun.ac.zaIn our endeavour to explore strategies to make ART accessible, a public-privateinteraction (PPI) model is described in detail, highlighting different areas where thecost of IVF can be significantly reduced. They include infrastructure and equipment,personnel, ovarian stimulation protocol (detailed in Chapters II and III) andmodification in the laboratory routine regarding oocyte retrieval.CHAPTER VThis meta-analysis compared mild ovarian stimulation IVF with conventional treatmentin order to counsel patients appropriately. The study showed significantly betteroutcomes in terms of live birth rates and ongoing pregnancy rates per started cycle,all in favour of conventional stimulation IVF, which therefore currently remains thepreferred treatment of choice.CHAPTER VIUnderstanding the physiology of folliculogenesis has made it possible to integrate mildovarian stimulation in our unit ART programme at a low cost. (Chapter I)Reassuring clinical outcomes of CC in ART also motivated the unit to maintain lowcost of treatment with the use of safe and effective medication. (Chapter II) The finding that prolonged usage of CC does not reduce the risk of premature LHsurge has also allowed the unit to maintain the old protocol of 5 days' use, butmotivated us to explore other inexpensive methods. (Chapter III)The PPI model certainly managed to make ART treatment accessible to subfertilecouples that would have never had a chance to be proud parents. (Chapter IV) Because this model is feasible and can be implemented at a reasonably low cost, itpresents a viable option to make ART accessible in resource-limited countries.

[发布机构] Stellenbosch University