Assisted reproduction services provision in a developing country: time to act?

Objective: To conduct a survey in a developing country to gauge the extent of subfertility and the current state of assisted reproductive technology (ART) service provision and explore factors limiting access to ART services. Design: Cross-sectional online survey. Setting: The study was co-ordinated at the Aga Khan University Hospital, Nairobi, Kenya. Subject(s): One hundred eighty-eight obstetricians and gynecologists registered with the Kenya Obstetrics and Gynecology Society were invited to complete the survey. Intervention(s): None. Main Outcome Measure(s): None. Result(s): A total of 47 responses (25%) were received after completion of the survey. The overall rate of subfertility was 26.1% among the gynecology consultations, with 50% attributed to tubal factors and 15% due to male factors. Assisted reproductive service provision (IVF/intracytoplasmic sperm injection) was severely limited to only three units, despite the reported high rate of tubal disease. The high cost of treatment, patients’ limited finances, and limited local services were almost universally cited as the main barriers to ART services in Kenya. Conclusion(s): The demand for ART in developing countries is not in doubt. Simplified, less costly, and more accessible ART approaches need to be considered in developing countries, even though the benefits and outcomes of such approaches may not be apparent immediately