Promising Perinatal Outcome after Using a Simplified Low-Cost IVF Culture System Specifically Designed for Resource-Poor Countries

Abstract

Background: Assisted reproductive techniques services are often not accessible to the majority of infertile couples in Low and Middle Income Countries (LMIC) due to high costs. Lowering IVF laboratory costs is a crucial step to make IVF affordable for a larger part of the world population. We developed a simplified culture system (SCS) which has proven to be effective, and the next step is to prove its safety.Methods: Preterm birth (PTB) and low birthweight (LBW) of 176 singletons born after using the SCS, 105 after fresh embryo transfer (fresh ET), and 71 after frozen embryo transfer (frozen ET) were compared with all IVF/ICSI singletons born in Belgium between 2013 and 2018. When comparing our 105 SCS babies born after fresh ET with all Belgian babies born after conventional IVF only, we also adjusted for 7 risk factors known to influence perinatal outcome, namelythe mother’s age, day of transfer, pituitary inhibition protocol, rank of cycles, number of oocytes retrieved, number of embryos transferred, and gender of the baby.Findings: Before adjustment, we found a significantly higher PTB (10.2% vs. 3.8%, OR 2.852, 95% CI [1.042–7.803], p-value 0.0413) and LBW (9.8% vs. 2.9%, OR 3.692, 95% CI [1.163–11.721], p-value 0.0267) in the conventional IVF group versus SCS after fresh ET. After adjusting for seven risk parameters, these differences remained significant (PTB: OR 2.627, 95% CI [1.013–6.816], p-value 0.0471) and LBW: OR 3.267, 95% CI [1.118–9.549], p-value 0.0305). PTB and LBW between both groups was not significantly different for singletons born after frozen ET. Interpretation: Taking into account the small series, PTB and LBW rates in SCS singletons in FRET cycles are very reassuring and significantly lower compared to babies born after conventional IVF in Belgium. Being aware of its effectiveness, our results offer a good perspective for SCS to become an important tool to implement low-cost IVF in LMIC.

Perinatal Outcome of Singletons Born after Using a Simplified Low-Cost IVF Culture System and All Singletons Born in Flanders (Belgium) between 2012 and 2020

“…We recently reported a favourable perinatal outcome for SCS singletons born after fresh embryo transfer when compared to singletons born after conventional IVF in Belgium [22]. The low prevalence of PTB and LBW we observed after using SCS prompted us to initiate a study to compare our results with a large cohort of naturally conceived newborns.…”

“…In a recent report and making use of BELRAP data (Belgian Register for Assisted Procreation), we found that for babies born after a fresh embryo transfer (ET), the prevalence of PTB and LBW was significantly lower in SCS singletons when compared to all singletons born after conventional IVF in Belgium during the same study period [22]. Because of this unexpected finding, we decided to compare our SCS singletons with naturally conceived singletons.…”

Tertiary care for infertile couples: aetiological diagnoses and conventional treatment outcomes in Kisangani, Democratic Republic of the Congo

“…The goal of LCIVF is to make in vitro fertilization (IVF) safe, affordable, efficient, and accessible to infertile couples living in resource-constrained nations. For this, Ombelet et al [ 39 , 40 ] created the simplified low-cost IVF culture system. Similar to traditional intracytoplasmic sperm injection (ICSI), this cutting-edge low-cost IVF method produces outcomes.…”

Current global status of male reproductive health

“…There are a number of opportunities to improve the current situation. Among them are health education and lifestyle improvement programs to prevent disease and thus reduce the need for MAR, one-stop clinics for infertility investigations, and the use of alternative treatments for mild and moderate male infertility, such as soft stimulation protocols and low-cost IVF laboratories ( Ombelet et al , 2022 , 2023 ). However, many other challenges remain, such as persistent unhealthy lifestyle, environmental pollutants, socio-cultural, and religious barriers for some modalities of male infertility treatment, the high cost of MAR medications, scarcity of MAR centers in the public sector, lack of coverage of infertility treatment by health insurance policies, and lack of economic support by international agencies and philanthropies to support infertility treatment in Africa.…”