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Assisted Reproductive Technologies (Art) Equity, Justice and Autonomy in Ghana
Restrictive legislation, which is the main barrier to some assisted reproductive technology (ART) services in many countries, is non-existent in Ghana. However, ART services are concentrated in the capital cities of only four out of the sixteen regions, serving predominantly middle- and upper-class individuals. There is limited evidence about the factors preventing broader access to ART services in Ghana, and this study aims to document these barriers. A cross-sectional survey was conducted in July 2024 across all 22 fertility centers in Ghana, using two structured questionnaires administered via Google App to 61 ART personnel and 104 treatment defaulters. Results showed that mentorship from senior colleagues (65.57%) was the most common way for ART professionals to acquire skills. Almost all (91.80%) professionals offered a full range of ART procedures, but 86.89% advocated for regulated practice. They identified high treatment costs (70.49%) and lack of awareness (16.39%) as the most significant barriers. Among treatment defaulters, 88.47% had sought ART services based on word-of-mouth recommendations, compared to only 4.8% influenced by traditional or social media. More than half (50.96%) of the women were in their thirties, and 48.08% required in vitro fertilization (IVF). While 58.65% sought treatment within five years of infertility, 70.2% discontinued due to high costs, and 35.57% due to partner non-availability. Despite the absence of restrictive policies for ART services in Ghana, Prohibitive costs, partner non-availability, and lack of awareness limit access. However, ART professionals expressed the need for regulated practices. Restrictive legislation, which is the main barrier to some assisted reproductive technology (ART) services in many countries, is non-existent in Ghana. However, ART services are concentrated in the capital cities of only four out of the sixteen regions, serving predominantly middle- and upper-class individuals. There is limited evidence about the factors preventing broader access to ART services in Ghana, and this study aims to document these barriers. A cross-sectional survey was conducted in July 2024 across all 22 fertility centers in Ghana, using two structured questionnaires administered via Google App to 61 ART personnel and 104 treatment defaulters. Results showed that mentorship from senior colleagues (65.57%) was the most common way for ART professionals to acquire skills. Almost all (91.80%) professionals offered a full range of ART procedures, but 86.89% advocated for regulated practice. They identified high treatment costs (70.49%) and lack of awareness (16.39%) as the most significant barriers. Among treatment defaulters, 88.47% had sought ART services based on word-of-mouth recommendations, compared to only 4.8% influenced by traditional or social media. More than half (50.96%) of the women were in their thirties, and 48.08% required in vitro fertilization (IVF). While 58.65% sought treatment within five years of infertility, 70.2% discontinued due to high costs, and 35.57% due to partner non-availability. Despite the absence of restrictive policies for ART services in Ghana, Prohibitive costs, partner non-availability, and lack of awareness limit access. However, ART professionals expressed the need for regulated practices.
Assisted Reproductive Technologies (Art) Equity, Justice and Autonomy in Ghana
Restrictive legislation, which is the main barrier to some assisted reproductive technology (ART) services in many countries, is non-existent in Ghana. However, ART services are concentrated in the capital cities of only four out of the sixteen regions, serving predominantly middle- and upper-class individuals. There is limited evidence about the factors preventing broader access to ART services in Ghana, and this study aims to document these barriers. A cross-sectional survey was conducted in July 2024 across all 22 fertility centers in Ghana, using two structured questionnaires administered via Google App to 61 ART personnel and 104 treatment defaulters. Results showed that mentorship from senior colleagues (65.57%) was the most common way for ART professionals to acquire skills. Almost all (91.80%) professionals offered a full range of ART procedures, but 86.89% advocated for regulated practice. They identified high treatment costs (70.49%) and lack of awareness (16.39%) as the most significant barriers. Among treatment defaulters, 88.47% had sought ART services based on word-of-mouth recommendations, compared to only 4.8% influenced by traditional or social media. More than half (50.96%) of the women were in their thirties, and 48.08% required in vitro fertilization (IVF). While 58.65% sought treatment within five years of infertility, 70.2% discontinued due to high costs, and 35.57% due to partner non-availability. Despite the absence of restrictive policies for ART services in Ghana, Prohibitive costs, partner non-availability, and lack of awareness limit access. However, ART professionals expressed the need for regulated practices. Restrictive legislation, which is the main barrier to some assisted reproductive technology (ART) services in many countries, is non-existent in Ghana. However, ART services are concentrated in the capital cities of only four out of the sixteen regions, serving predominantly middle- and upper-class individuals. There is limited evidence about the factors preventing broader access to ART services in Ghana, and this study aims to document these barriers. A cross-sectional survey was conducted in July 2024 across all 22 fertility centers in Ghana, using two structured questionnaires administered via Google App to 61 ART personnel and 104 treatment defaulters. Results showed that mentorship from senior colleagues (65.57%) was the most common way for ART professionals to acquire skills. Almost all (91.80%) professionals offered a full range of ART procedures, but 86.89% advocated for regulated practice. They identified high treatment costs (70.49%) and lack of awareness (16.39%) as the most significant barriers. Among treatment defaulters, 88.47% had sought ART services based on word-of-mouth recommendations, compared to only 4.8% influenced by traditional or social media. More than half (50.96%) of the women were in their thirties, and 48.08% required in vitro fertilization (IVF). While 58.65% sought treatment within five years of infertility, 70.2% discontinued due to high costs, and 35.57% due to partner non-availability. Despite the absence of restrictive policies for ART services in Ghana, Prohibitive costs, partner non-availability, and lack of awareness limit access. However, ART professionals expressed the need for regulated practices.
Despite the relatively small portion in the structure of the infertility causes, hypergonadotropic hypogonadism (HH) is one of the greatest challenges in reproductive medicine. Diagnosis of HH chromosomal causes often occurs with a significant delay. This is due to the widespread stereotype of the necessary presence of typical phenotypic characters (eunuchoid habitus, pterygoid folds on the neck). This review deals with clinical recommendations for diagnosis of the most common chromosomal causes of HH in women (Turner syndrome (TS)) and in men (Klinefelter syndrome (KS)).TS is a chromosomal pathology associated with the complete or partial absence of one X chromosome accompanied by one or more specific phenotypic features and comorbidities. Persons with suspected TS need to have karyotyping of at least 20 cells (venous blood material). This allows determining the karyotype 45,X, structural anomalies of X chromosome and mosaicism if it is present in more than 10% of the cells. If the mosaic form of TS is suspected but not diagnosed with standard karyotyping, options for investigating more cells or fluorescence hybridization in situ (FISH) are possible. It is important to verify the mosaic forms, especially in cases of a clone with Y chromosome in TS, since such a karyotype carries an increased risk of gonadoblastoma. FISH increases the diagnostic rate of mosaic forms of aneuploidy. Primary hypogonadism in men is the insufficiency of testosterone synthesis and spermatogenesis failure due to the pathology of gonads. Chromosomal causes of primary hypogonadism and nonobstructive azoospermia account for about 15% and are included in the mandatory list of diagnostic examinations. The variants of karyotypes in KS and their clinical manifestations are considered. KS is much more often diagnosed with delay compared to TS. The main diagnostic method for KS is karyotyping and using FISH to detect mosaic forms.Thus, cytogenetic testing (karyotyping) is the first line of examination for women and men with primary (non-iatrogenic) HH; the use of FISH increases the diagnostics efficiency of mosaic forms of sex chromosome aneuploidy.
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