Two years after the following article was published where are we ?
Anonymous. The Economist; London412.8896 (Jul 19, 2014): 53.
Abstract
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In France, says Fabrice Houdart, as he dandles his baby, we are like a circus attraction. The Frenchman lives in Washington, DC, with his American boyfriend and their two children, who were conceived using eggs from a Californian donor and born by a surrogate in Pennsylvania. Families built with such a variety of help are still rare enough to raise eyebrows. But across the rich world test-tube babies no longer draw a second glance. For the infertile couples it helps, IVF is close to a miracle. But for many more, the cost is prohibitive.
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In vitro fertilisation, once seen as miraculous, is now mainstream in rich countries. Soon it may be cheap enough to help infertile people in poor places, too
"IN FRANCE," says Fabrice Houdart, as he dandles his baby, "we are like a circus attraction." The Frenchman lives in Washington, DC, with his American boyfriend and their two children, who were conceived using eggs from a Californian donor and born by a surrogate in Pennsylvania. Families built with such a variety of help are still rare enough to raise eyebrows. But across the rich world "test-tube babies" no longer draw a second glance. Since the first, Louise Brown, was born in 1978, 5.5m more have followed, half of them in the past six years.
Back then, doctors had to hope that the single egg they retrieved would be fertilised when mixed with sperm, and that the resulting embryo would be a winner. Success rates were just a few percent. Now, with stronger drugs to stimulate ovulation and better laboratory techniques to manipulate and store embryos, more than a quarter of IVF attempts result in a baby.
For the infertile couples it helps, IVF is close to a miracle. But for many more, the cost is prohibitive. Public health programmes in some rich countries, including Australia, Japan and several European ones, cover IVF for some who need it, but rarely all. Britain's National Health Service, for example, does not manage to pay for the three tries its guidelines recommend for all who would benefit. In America, where IVF is rarely covered by insurance and an attempt costs around $15,000, at most a quarter of those for whom IVF is clinically indicated are actually treated.
The unmet need in developing countries is higher still. That is partly because people have less money, but also because infertility is more common. Genital mutilation, unsafe abortion and poorly attended births cause infections that leave women with blocked Fallopian tubes, making normal conception impossible. Sexually transmitted diseases scar both men's and women's reproductive systems. The World Health Organisation estimates that around 50m couples worldwide have been trying to conceive for at least five years without success. Almost none of those in developing countries can hope to get treatment.
The grief of infertility is sharper in poor countries, too. In Africa and much of Asia it carries a stigma, nearly all borne by women. Male-factor infertility is rarely acknowledged except when a man has failed to father children with several women. A "barren" wife is often ostracised, beaten or abandoned, or infected with HIV/AIDS as a result of her husband straying in the hope of a child. She is at higher risk of being murdered or committing suicide.
Better health care would mean fewer people in developing countries becoming infertile in the first place. Now fertility doctors are trying to make IVF cheap enough to help many more of those who will still need it. Some are simplifying diagnosis, skipping some tests that are currently standard, but still doing enough to tell, for most patients, which treatment would be best.
Others are cutting spending on equipment. Last year Belgian researchers tested a shoebox-sized IVF laboratory built from cheap glass tubes that uses baking soda and citric acid to create the carbon dioxide needed for fertilisation to occur. Pregnancy rates matched those from a standard laboratory and set-up costs are 85-90% lower. With fewer tests and less monitoring, running costs are slashed, too. Though of no use when the man's sperm is sub-par and thus needs to be injected into the egg under a pricey microscope, it should be sufficient for about 70% of infertile couples, says Willem Ombelet of the Genk Institute for Fertility Technology, who led the first trial.
The Low-Cost IVF Foundation, a non-profit based in Switzerland, is working with Zambia's health ministry to set up an IVF programme later this year. Costs will be shaved wherever possible, with the biggest saving coming from using clomiphene citrate, an oral drug that provides a modest boost to ovulation and costs just $12 per IVF attempt, instead of the standard injectable drugs, which cost thousands.
Cut-price approaches will not be suitable for all couples, and success rates per IVF cycle may be lower. But if the savings are big enough, more infertile couples will be able to try at least once and the cost per baby will plummet. The Foundation's long-term aim is to show IVF can be included in a developing country's public health-care system for as little as $300 per attempt, plus staffing costs. Gauging how achievable that figure is will only be possible once such treatment is up and running, says Ian Cooke, an emeritus professor at Sheffield University in England and one of its founders. If the programme in Zambia gets anywhere close to it, clinics in rich countries could start slashing prices, too.
from Anonymous. The Economist; London
412.8896 (Jul 19, 2014): 53.
412.8896 (Jul 19, 2014): 53.
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