Assisted Reproductive Technology Services Research Articles

Good deeds or exploitation?: Queer parents working for private assisted reproductive technologies companies in urban China.

This article examines the interplay of queer reproduction and private assisted reproductive technologies (ART) companies in urban China. While same-sex marriage has not gained legal recognition in mainland China and childbirth outside heterosexual marriage has been restricted, queer parents who have children through ART have gradually become visible. ART has emerged as an ideal way for Chinese queer citizens to have children, though they are not legally permitted to use ART services in domestic hospitals. Consequently, an increasing number of queer intended parents turned to underground ART businesses, with some of them becoming salespeople or business owners themselves. My ethnographic analysis comes from fieldworks conducted in Guangdong province, China, from 2018 to 2021. This paper shows that the legal and moral debates brought by queer people's use of ART are perceived differently among diverse gender and sexual groups in Chinese society. It founds that queer parents' participation in the ART industry has demonstrated the potential for queer forms of parenthood and family, while reinforcing stratified reproduction and gender inequalities. The tendency to reduce IVF/surrogacy to "womb-for-rent" business among Chinese ART businesses continues to impact queer people's reproductive and parenting rights. This paper hopes to offer insights into queer reproductive justice and reproductive technologies across the globe.

Non-binary patients in ART: new challenges and considerations.

To discuss the increasing visibility of non-binary individuals and inclusive policies and practices in Assisted Reproductive Technologies (ART). Comparison between traditional ART approach designed for binary genders and propose approach in non-binary individuals. Traditional ART services, designed for binary genders, must adapt to address the unique fertility needs of non-binary patients. This includes using gender-neutral language, providing comprehensive fertility assessments, and offering hormone therapy and fertility preservation options. Children of non-binary parents benefit from open communication about gender diversity, enhancing psychological well-being. Positive societal attitudes and inclusive environments in schools are crucial for preventing discrimination and promoting mental health. A systemic approach is required to make ART inclusive. This involves training staff, adjusting facilities, updating documentation, and advocating for supportive legislation. Addressing the reproductive needs of non-binary individuals ensures equitable access to care and supports their family-building goals. Ensuring the well-being of children in non-binary families requires psychological support, inclusive healthcare, legal recognition, social support, and comprehensive education.

O-121 Assisted Reproductive Technology (ART) in Europe 2021 and development of a strategy of vigilance: Preliminary results generated from European registers by the ESHRE EIM Consortium

Study question What are the reported data on cycles in ART, IUI and fertility preservation interventions in 2021 as compared to previous years and what are the main trends over the years? Summary answer The 25th ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, a small decrease in the number of transfers (IVF + ICSI) with more than one embryo with a trend to decreasing multiple delivery rates, outcomes for IUI cycles are similar to previous years. What is known already Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analyzed by the European IVF-monitoring Consortium (EIM) and reported in 23 manuscripts published in Human Reproduction and Human Reproduction Open. Study design, size, duration Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between January 1 and December 31, 2021, in 34 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. Participants/materials, setting, methods In all 1155 clinics offering ART services in 34 countries reported a total of 910 470 treatment cycles, involving 115 567 with IVF, 346 183 with ICSI, 311 487 with frozen embryo replacement (FET), 62 694 with preimplantation genetic testing (PGT), 69 883 with egg donation (ED), 246 with IVM of oocytes and 4410 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1242 institutions offering IUI in 29 and 21 countries, respectively. A total of 139 350 treatments with IUI-H and 45 532 treatments with IUI-D were included. A total of 28 692 fertility preservation (FP) interventions from 15 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and post-pubertal patients were reported. Main results and the role of chance In total, 1155 IVF clinics participated (81.4% of registered clinics in the participating countries). Next to these also 1242 IUI units reported their data. In the 34 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2021 were similar to those observed in 2020 (26.2% and 43.3% versus 25.4% and 40.9%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2020 (23.9% en 45.7% versus 25.2% and 45.3%). Also after FET with own embryos, the PR per thawing is stabilizing, 35.0% in 2020 and 36.2% in 2021. After ED the PR per fresh embryo transfer was slightly increased to 53.1% (51.3% in 2020) and per FOR 45.5% (43.9% in 2020). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 60.2%, 34.8%, 1.8% and 0.2% of all treatments, respectively (corresponding to 57.9%, 37.5%, 2.1% and 0.2% in 2020). This resulted in a proportion of singleton, twin and triplet DRs of 90.4%, 9.5% and 0.1%, respectively (compared to 88.9%, 10.9% and 0.2%, respectively in 2020). Treatments with FER in 2021 resulted in twin and triplet DR of 7.0% and 0.1%, respectively (versus 7.9% and 0.1% in 2020). After IUI, the DRs remained similar at 9.2% after IUI-H (8.8% in 2020) and at 14.0% after IUI-D (12.5% in 2020). Twin and triplet DRs after IUI-H were 7.4% and 0.2%, respectively (in 2020: 7.9% and 0.4%) and 5.9% and 0.2% after IUI-D (in 2020: 5.7% and 0.1%). The majority of FP interventions included the cryopreservation of oocytes (n= 11 966 from 15 countries) and of ejaculated sperm (n=14 688 from 15 countries). Limitations, reasons for caution As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. For this abstract, some countries were not able to provide adequate data about the number of centers and initiated cycles and deliveries. Wider implications of the findings The 25th ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived live births in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control and completeness of the data and offer higher transparency and vigilance in the field of reproductive medicine.

O-123 Trends and challenges in the practice of ART in China

Abstract China is a large country with a population of over 1.4 billion. In 1988, the first in-vitro fertilization-embryo transfer (IVF-ET) baby was born in Peking University Third Hospital. In the following 3 decades, assisted reproductive technology (ART) has developed rapidly in China, and the availability and accessibility of the ART service have improved markedly. In 2004 totally, only 37 institutions had passed the administrative licensing procedure to carry out ART. While in 2020, 536 institutions obtained the ART license. Since 2016, the total number of ART service cycles(Artificial insemination included)has exceeded 1 million, and the number of babies born has exceeded 300,000, accounting for about 2% of the total live births in China in 2016. At present, assisted reproductive technology has become one of the important medical interventions for the treatment of infertility in China, which has brought good news to infertile couples and their families, and has made great contributions to social harmony and family happiness. Cycles per million population (C/M) in 2009 was 120. In 2020, it has increased to 668, with more and more infertile couples having access to this technique in China. The success rate of assisted reproductive technology remained stable. In 2020, the clinical pregnancy rates (CPR)of conventional IVF and ICSI fresh embryo transfer cycles reached 52.4% and 49.4%, respectively, and the live birth rates were 43.0% and 40.6%, respectively. The clinical pregnancy rate and live birth rate of frozen-thawed embryo cycle were 51.3% and 40.5% per transfer. With the widespread application of embryo freezing technology, the cumulative live birth rate was estimated to reach 49.5% (CLBR estimate) in 2020. The safety monitoring indicators of assisted reproductive technology showed that since 2015, the multiple pregnancy rates of conventional IVF, ICSI and FET have decreased year by year, and have dropped to 22.4%, 21.4% and 17.6% in 2020, respectively. The incidence of moderate-severe ovarian hyper-stimulation syndrome (OHSS) and severe bleeding were also under control, within a reasonable range. Assisted reproductive technology, which involves many medical, social, ethical and legal issues, is a special clinical technology with limit application for medical indication. The Chinese government attaches great importance to the quality and safety management of assisted reproductive technology. A series of management documents such as the Administrative Measures for Human Assisted Reproductive Technology, the Regulations for Human Assisted Reproductive Technology and so forth, have been issued since 2001. Further improvement of key performance indicators (KPIs) correlated with ART quality and safety control is of the top priority and also challenging. In addition, the ART surveillance data in China is still aggregated data, which does not include important indicators such as age stratification, infertile factors or indications and delivery gestational age, maternal and infant outcomes, with some limitations for surveillance. Continuous improvement of data quality, and initiation of cycle-based data collection and security measures of case information are also challenging for the next step.

Coronavirus disease and assisted reproduction in South Africa: a qualitative study

Objective: Little has been written about the effects of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproduction services in low and middle-income countries. The purpose of this study was to investigate the immediate and long-term effects of assisted reproductive technology services in South Africa after 27 months of various lockdowns and restrictions associated with the pandemic. Methods: This article draws on data collected in 2020–2023 as part of a qualitative study of assisted reproduction within sub-Saharan Africa. Twenty-nine infertility specialists and other clinical staff including embryologists, clinic coordinators, ova donor coordinators, and nurses were interviewed and asked about the effects of the pandemic on their clinics and patients. A semistructured in-depth interview technique was used to collect the data. The analysis was conducted using the thematic analysis method. Result: Findings revealed that the immediate effects of the pandemic included the cancellations and deferral of assisted reproductive technology cycles and decreased numbers of cross-border patients. Challenges experienced by clinics in making decisions included whether to treat COVID-positive patients, increased costs of testing, and economic losses. Longer-term effects included the reconsideration of life priorities by both specialists and patients, and improved remote consultations and networking opportunities facilitated by the widespread dissemination of online platforms. There was also increased acceptability of the shipping and use of frozen gametes, leading to a perceived growth of the South African frozen oocyte trade. There was also decreased demand for add-ons, associated with the economic downturn post-pandemic in the region. Conclusion: COVID-19 carried costs (cancellation of cycles, a decrease in international patients, decrease in some procedures with the post-COVID economic downturn) but also unanticipated benefits for the practices and provision of services within infertility clinics in South Africa (increased gamete and embryo shipping; virtual patient consultations; improved virtual networking; greater use of local in vitro fertilization services). Further comparisons postpandemic in other low and middle-income countries are needed to understand the long-term implications.

Geographic Disparities in Access to Assisted Reproductive Technology Centers in China: Spatial-Statistical Study.

A study on infertility in China found that while 543 health care institutions are approved for assisted reproductive technology (ART), only 10.1% offer all ART services, with a significant skew toward the eastern regions, highlighting the accessibility challenges faced by rural and remote populations; this study recommends government measures including travel subsidies and education initiatives to improve ART access for economically disadvantaged individuals.

Medicine in the marketplace: clinician and patient views on commercial influences on assisted reproductive technology

Research questionWhat are the views and experiences of patient and expert stakeholders on the positive and negative impacts of commercial influences on the provision of assisted reproductive technology (ART) services, and what are their suggestions for governance reforms? DesignSemi-structured interviews were conducted with 31 ART industry experts from across Australia and New Zealand and 25 patients undergoing ART from metropolitan and regional Australia, between September 2020 and September 2021. Data were analysed using thematic analysis. ResultsExpert and patient participants considered that commercial forces influence the provision of ART in a number of positive ways – increasing sustainability, ensuring consistency in standards and providing patients with greater choice. Participants also considered commercial forces to have a number of negative impacts, including increased costs to government and patients; the excessive use of interventions that lack sufficient evidence to be considered part of standard care; inadequately informed consent (particularly with regard to financial information); and threats to patient–provider relationships and patient-centred care. Participants varied in whether they believed that professional self-regulation is sufficient. While recognizing the benefits of commercial investment in healthcare, many considered that regulatory reforms, as well as organizational cultural initiatives, are needed as means to ensure the primacy of patient well-being. ConclusionsThe views expressed in this study should be systematically and critically examined to derive insights into how best to govern ART. These insights may also inform the design and delivery of other types of healthcare that are provided in the private sector.

Availability of subfertility management services in Colombo District, Sri Lanka

Introduction: Affordable and accessible quality services reduce treatment defaults and improve patient satisfaction in subfertility management. Assessment of the available services is a necessity to advocate for the relevant authorities to improve services.Objectives: To assess the availability of subfertility management services at healthcare institutions in Colombo District, Sri LankaMethods: This survey was performed in 2019 in 18 medical officer of health (MOH) units that provide field level healthcare; seven secondary and tertiary level government hospitals; and 32 registered private clinics/hospitals in Colombo District. Two separate checklists were developed for field-level and clinic/hospital-based services assessment. The interviews were performed to administer the checklist for clinical and administrative staff at different units of service provision. The availability of the services was presented as numbers and percentages.Results: Field-level availability of facilities; only 44.5% of MOHs had conducted awareness programmes on subfertility for the public during the past year and only 27.7% of MOHs had referred sub-fertile couples to secondary or tertiary hospitals for further management during the preceding month. Seminal fluid analysis (SFA) was available in 71.5% of the government sector and 84.3% of the private sector hospitals; abdominal and transvaginal ultrasound scans (USS) in 100% of government sector hospitals; and 93.7% of abdominal and 84.3% of transvaginal USS available in the private sector. Intra-uterine insemination (IUI) was available in 71.5% of the government sector hospitals but in only 40.6% of the private sector hospitals. Assisted reproductive technologies (ART) such as in vitro fertilization (IVF) was available in 12.5% of the private sector hospitals while none of the government sector hospitals provided this facility.Conclusions & Recommendations: The provision of field level facilities for subfertility was not satisfactory and less integrated. Notably, the ART services were available in the private sector hospitals predominantly. Rational public health policies need to be developed regarding the provision of field level and advanced care.

Experiences of female clients in the assisted reproductive technology process in Nigeria.

Though assisted reproductive technology (ART) has been a source of hope for many infertile couples, it is known to be associated with physical, social, psychological, and ethical challenges in different settings. The study objective was to explore the experiences of female clients who accessed services in ART clinics in Nigeria. An exploratory qualitative design, using snowballing technique was employed. It involved in-depth interviews of eight women who had gone through the assisted conception process, using an interview guide. Data collection was from November 2019 to January 2020. Results: The age range of the participants was 30 - 52 years with a mean of 41.88 years. Majority of the clients presented at advanced age to their ART providers because of lack of funds and ignorance. Other challenges were suboptimal risk disclosure, high cost of services, feelings of shame and stigmatization during and after the process. Cost of ART remain unaffordable to most Nigerians hence the need for government subsidization and in-corporation of ART services into the National Health Insurance Scheme. Additionally, lack of adequate information disclosure, shared decision-making and gendered suffering are areas of great concern among the study participants. A national regulatory guideline will ensure uniform international standard of care.

O-153 Assisted Reproductive Technology (ART) in Europe 2020 and development of a strategy of vigilance: Preliminary results generated from European registers by the ESHRE EIM Consortium

Abstract Study question What are the reported data on cycles in ART, IUI and fertility preservation interventions in 2020 as compared to previous years and what are the main trends over the years? Summary answer: author The 24rd ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, a small decrease in the number of transfers (IVF + ICSI) with more than one embryo with a trend to decreasing multiple delivery rates, outcomes for IUI cycles are similar to previous years. WHAT IS KNOWN ALREADY: Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analyzed by the European IVF-monitoring Consortium (EIM) and reported in 23 manuscripts published in Human Reproduction and Human Reproduction Open. Study design, size, duration Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between January 1 and December 31 2020 in 35 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. Participants/materials, setting, methods In all, 1157 clinics offering ART services in 35 countries reported a total of 713 708 treatment cycles, involving 110 097 with IVF, 253 095 with ICSI, 239 759 with frozen embryo replacement (FET), 46 610 with preimplantation genetic testing (PGT), 59 906 with egg donation (ED), 344 with IVM of oocytes and 3897 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1176 institutions offering IUI in 28 and 18 countries, respectively. A total of 102 702 treatments with IUI-H and 36 476 treatments with IUI-D were included. A total of 18 270 fertility preservation (FP) interventions from 15 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and post-pubertal patients were reported. Main results and the role of chance In total, 1157 IVF clinics participated (88.5% of registered clinics in the participating countries). Next to these also 1176 IUI units reported their data. In the 35 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2020 were similar to those observed in 2019 (27.9% and 32.9% versus 28.5% and 34.6%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2019 (24.3% en 32.2% versus 26.2% and 33.5%). After FET with own embryos, the PR per thawing is stabilizing, 35.1% in 2019 and 34.6% in 2020. After ED the PR per fresh embryo transfer was 50.4% (50.5% in 2019) and per FOR 45.3% (44.8% in 2019). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 62.1%, 32.3%, 2.2% and 0.3% of all treatments, respectively (corresponding to 55.4%, 39.9%, 2.6% and 0.2% in 2019). This resulted in a proportion of singleton, twin and triplet DRs of 90.5%, 9.3% and 0.2%, respectively (compared to 87.7%, 12.0% and 0.3%, respectively in 2019). Treatments with FER in 2020 resulted in twin and triplet DR of 7.0% and 0.1%, respectively (versus 9.3% and 0.1% in 2019). After IUI, the DRs remained similar at 8.9% after IUI-H (9.2% in 2019) and at 12.4% after IUI-D (12.1% in 2019). Twin and triplet DRs after IUI-H were 8.3% and 0.4%, respectively (in 2019: 8.7% and 0.3%) and 5.8% and 0.2% after IUI-D (in 2019: 6.2% and 0.2%). The majority of FP interventions included the cryopreservation of oocytes (n = 5 365 from 14 countries) and of ejaculated sperm (n = 11 571 from 14 countries). Limitations, reasons for caution As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. For this abstract, some countries were not able to provide adequate data about the number of centers and initiated cycles and deliveries. WIDER IMPLICATIONS OF THE FINDINGS: The 24rd ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived live births in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control and completeness of the data and offer higher transparency and vigilance in the field of reproductive medicine. Trial registration number XXXX

The status of ART in the public health sector in Africa: a multi-country survey

Research questionWhat is the current availability of treatment with assisted reproductive technology (ART) in the public sector in Africa, and what are the facilitators and barriers towards its provision? DesignCross-sectional quantitative and qualitative data were collected in two phases from February 2020 to October 2021. Key informants were identified from countries known to provide ART in Africa based on data from the African Network and Registry for Assisted Reproductive Technology and the 2019 Surveillance from the International Federation of Fertility Societies. Quantitative data were collected via a structured questionnaire (Phase 1); public centre-specific quantitative and qualitative data were then collected via a semi-structured questionnaire followed by a virtual interview (Phase 2). Data were analysed descriptively. ResultsInformants from 18 countries reported the existence of 185 ART centres in 16 countries. Twenty-four centres (13.0%) in 10 of 16 countries (62.5%) were public. The majority of public centres (20/22 [90.9%]) reporting on ART performed <500 ART cycles per annum. Although public institutions covered most of the cost for ART, copayments from patients were universally required. The number of ART cycles per annum was inversely correlated to the copayment. Lack of policy and legislation, high costs and bureaucratic obstacles were identified by participants as the leading challenges in the delivery of public service ART. ConclusionLack of public ART services leads to chronic and profound health inequities. Enablers of public service ART in the region are the same known to support ART services in general, namely policy and legislation, appropriate funding and good health service infrastructure. Addressing these requires the collated efforts of many stakeholders.

The time has come for harmonized international ART registration

For more than two decades, the European IVF-Monitoring Consortium has collected data on IVF in Europe with the aim of monitoring the quality and safety of assisted reproductive technology (ART) treatments, to ensure the highest performance with the lowest risk for patients and their offspring. Likewise, the Society for Assisted Reproductive Technology in the USA and the Australia/New Zealand Assisted Reproduction Database collect, process and publish data in their regions. The better the legal framework for ART surveillance, the more complete and reliable are the datasets. Worldwide, the landscape of ART regulation is fragmented, and until there is a legal obligation to report ART data in all countries, with an appropriate quality control of the data collected, the reported outcomes should be interpreted with caution. Once uniform and harmonized data are achieved, consensus reports based on collective findings can begin to address key topics such as cycle segmentation and complications. Improved registration systems and datasets allowing optimized surveillance should be developed in collaboration with patient representatives to consider patients’ needs, especially aiming to provide higher transparency around ART services. Support from national and international reproductive medicine societies will also be essential to the future evolution of ART registries.

Ethical issues surrounding the use of assisted reproductive technologies in Ghana: An analysis of the experiences of clients and service providers

Since the advent of Assisted Reproductive Technologies (ART) in Ghana about three decades ago, IVF and ICSI treatments have enabled infertile Ghanaian couples to fulfill their aspirations and dreams of having children. In this extremely pronatalist society, ART has provided relief to many childless couples by reducing, if not eliminating, the shame of childlessness that they would otherwise have to suffer. However, as the provision and utilization of ART continue to increase, so do worries regarding the ethical difficulties surrounding this field of medicine, which challenge cultural ideals and personal desires. The study explores client and service provider experiences with ART in urban Ghana. Observation and in-depth interviews were employed to collect data, and the ethical dimensions of people's experiences relative to Ghanaian cultural and ethical values were analyzed. The results show that the provision of ART services for heterosexual couples in marital unions, the availability of PGT for sickle cell clients, the preference for multiple births emerging from embryo transfers, the lower preference for cryopreservation, the high cost of ART treatment, and the need for regulation of the provision of ART services in Ghana were some of the ethical concerns expressed by both clients and service providers.

Knowledge, Attitude and Perception of Assisted Reproductive Technology Among Patients Attending Health Clinics at Babcock University Teaching Hospital Ilishan-Remo Ogun State

Female infertility was reported to account for about 55% of infertility cases, male factor accounted for about 30% to 40% of infertility cases and unexplained infertility accounted for the remaining 5 percent to 15 percent of cases. In Africa, infections resulting in tubo-peritoneal factor and oligo-azoospermia (low sperm count) are the most common causes of infertility. Infertility is widespread in Sub-Saharan Africa ranging from 13–17 in most countries with pockets of high prevalence at 32%. The general objective of this study is to assess the knowledge, attitude, and perception of Assisted Reproductive Technology among patients attending health clinics within the prevailing fragile health infrastructure in Nigeria. The aims of study, therefore, are to assess the knowledge of Assisted Reproductive Technology (ART) among patients attending BUTH health clinics, to ascertain the attitudes of BUTH patients towards ART as a treatment method for infertility, and to ascertain the perception of ART among patients attending clinics at BUTH. It was observed that the overall level of awareness in this study was high but with a fair knowledge level that can be attributed to the rise in social media use. Both men and women were able to correctly describe the major causes of infertility. Most importantly was the visible change in narrative against the previous belief of ART being majorly for female causes of infertility to both male and female causes. However, many participants had a negative attitude towards the use of ART and gamete donation. These findings have implications for the planning and implementation of infertility-related programmes that will help to tackle inherent challenges undermining the full utilization of ART services in Nigeria.

Review of the impact of COVID-19 on male reproduction, and its implications on assisted reproductive technology services.

The announcement in 2019 of a new coronavirus disease that quickly became a major pandemic, is an exceptional challenge to healthcare systems never seen before. Such a public health emergency can largely influence various aspects of people's health as well as reproductive outcome. IVF specialists should be vigilant, monitoring the situation whilst contributing by sharing novel evidence to counsel patients, both pregnant women and would-be mothers. Coronavirus infection might adversely affect pregnant women and their offspring. Consequently, this review paper aims to analyse its potential risks for reproductive health, as well as potential effects of the virus on gamete function and embryo development. In addition, reopening fertility clinics poses several concerns that need immediate addressing, such as the effect of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) on reproductive cells and also the potential risk of cross-contamination and viral transmission. Therefore, this manuscript summarizes what is currently known about the effect of the SARS-CoV-2 infection on medically assisted reproductive treatments and its effect on reproductive health and pregnancy.

Geographic distribution of assisted reproductive technology clinics in the USA: a multilevel sociodemographic analysis.

To investigate whether sociodemographic characteristics of US Census tracts and counties and state-level infertility insurance policy are associated with the presence of assisted reproductive technology (ART) clinics. Multilevel logistic regression analyses using publicly available reports of ART clinic locations (2014-2018) matched with sociodemographic data from the US Census Bureau and state infertility insurance policy information. At the tract-level, multivariate multilevel logistic regression found significant associations with the likelihood of an ART clinic in a tract and the size of the tract population (adjusted odds ratio (aOR): 1.063, SE = 0.018, p < .001), the tract median household income (aOR = 0.990, SE = 0.002, p < 0.001), and the percentages of the population who were Hispanic (aOR = 0.975, SE = 0.007, p < 0.001), women over 25 with a bachelor's degree or higher (aOR: 1.052, SE = 0.004, p < 0.001), and foreign-born (aOR: 1.037, SE = 0.009, p < .001). At the county-level, significant associations were found with the county median household income (aOR: 1.016, SE = 0.006, p < .01) and the percentage of the population that identified as Black (aOR = 1.013, SE = 0.006, p < .05) and Hispanic (aOR = 1.028, SE = 0.009, p < .05). Multivariate models showed no associations between tract clinic counts and state infertility policy. There is mixed evidence that clinic concentration is associated with expected sociodemographics. In particular, physical proximity may not principally drive racial disparities in ART access. Furthermore, insurance mandates are not associated with the presence of an ART clinics in a tract, suggesting alternative policy levers may be needed to address differential access and utilization of ART services.

Impact of satellite clinics on geographic access to assisted reproductive technology services in the United States

BackgroundMany assisted reproductive technology (ART) centers utilize satellite clinics to expand reach and access to clinical services, but their contribution to lowering geographic barriers in access to care has not been examined. This study’s purpose is to determine the extent to which satellite clinics impact geographic access to ART and estimate the percentage of reproductive-age women who have geographic access to ART services.MethodsA systematic web-search collected the locations of all main and satellite ART clinics in the United States (US). Driving times were calculated between satellite clinics and main clinics. The percentage of women with geographic access to care was characterized by clinic type using US Census Core Based Statistical Areas (CBSAs). Logistic regression was used to statistically model the presence of main and satellite clinics as a function of CBSA median income and female reproductive-age population.ResultsFour hundred sixty-nine main clinics with embryology labs and 583 satellite clinics were found in the US. Practices with satellite clinics tend to perform more ART cycles. Satellite clinics are located on average 66 minutes from their practice’s main clinic and 31 minutes from any main clinic. 22% of satellite clinics were in CBSAs without a main clinic. 46 M (72%) US reproductive-age women live in a CBSA with a main clinic, 5.1 M (8%) women live in a CBSA without a main clinic but at least one satellite clinic, and 13 M (20%) women live in an area with no ART clinic of either type. Female reproductive-age population was found to be a more important predictor of clinic presence than median income.ConclusionsThe majority of satellite clinics in the US are positioned in relative proximity to a main clinic. 85% of satellite clinics are located closer to the main clinic of other practices than to their own main clinic. Less than a quarter of ART satellite clinics expand geographic access to ART services by being located in areas without a main clinic, and the vast majority of practices with satellite clinics position their satellite clinics close to another practice’s main clinic.Trial registrationNot applicable.

O-150 Assisted reproductive technology (ART) in Europe 2019 and development of a strategy of vigilance Preliminary results generated from European registers by the ESHRE EIM consortium

Abstract Study question What are the reported data on cycles in ART, IUI and fertility preservation interventions in 2019 as compared to previous years, as well as the main trends over the years? Summary answer The 23rd ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, a small decrease in the number of transfers (IVF + ICSI) with more than one embryo with a trend to decreasing multiple delivery rates, outcomes for IUI cycles are similar to previous years. What is known already Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analyzed by the European IVF-monitoring Consortium (EIM) and reported in 22 manuscripts published in Human Reproduction and Human Reproduction Open. Study design, size, duration Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between January 1 and December 31 2019 in 32 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. Participants/materials, setting, methods In all, 1133 clinics offering ART services in 32 countries reported a total of 784 192 treatment cycles, involving 116 615 with IVF, 285 481 with ICSI, 250 997 with frozen embryo replacement (FER), 55 121 with preimplantation genetic testing (PGT), 71 413 with egg donation (ED), 473 with IVM of oocytes and 4092 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1033 institutions offering IUI in 25 and 20 countries, respectively. A total of 123 106 treatments with IUI-H and 43 798 treatments with IUI-D were included. A total of 20 400 fertility preservation (FP) interventions from 12 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and post-pubertal patients were reported. Main results and the role of chance In total, 1133 IVF clinics participated (90.0% of registered clinics in the participating countries). Next to these also 1033 IUI units reported their data. In the 32 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2019 were similar to those observed in 2018 (28.5% and 34.7% versus 28.8% and 34.1%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2018 (25.3% en 33.1% versus 27.3% and 32.1%). After FER with own embryos the PR per thawing is still on the rise, from 33.4% in 2018 to 35.0% in 2019. After ED the PR per fresh embryo transfer was 50.1% (49.6% in 2018) and per FOR 44.1% (44.9% in 2018). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 61.1%, 36.2%, 2.6% and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9% and 0.3% in 2018). This resulted in a proportion of singleton, twin and triplet DRs of 89.7%, 10.1% and 0.2%, respectively (compared to 87.4%, 12.4% and 0.2%, respectively in 2018). Treatments with FER in 2019 resulted in twin and triplet DR of 8.3% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 9.5% after IUI-H (8.9% in 2018) and at 12.0% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.8% and 0.4%, respectively (in 2018: 8.4% and 0.3%) and 6.4% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%). The majority of FP interventions included the cryopreservation of oocytes (n = 9 813 from 10 countries) and of ejaculated sperm (n = 9 521 from 12 countries). Limitations, reasons for caution As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. For this abstract some countries were not able to provide adequate data about the number of centers and initiated cycles and deliveries. Wider implications of the findings The 23rd ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control and completeness of the data and offer higher transparency and vigilance in the field of reproductive medicine. Trial registration number

Reproductive Empires and Perverse Markets: Unpacking the Paradoxical Dynamics of ART Market Expansion in Non-urban India and Beyond

The global use of assisted reproductive technologies (ARTs) to address structural infertility has burgeoned since the early 2000s. Large corporate in vitro fertilization (IVF) providers from the metropolitan north quickly identified India as a prime location for service delivery, creating satellite clinics in its metropolitan centers. Having learnt from their European masters the colonizer’s art of exporting ART services from the metropolitan core to the periphery, a leading cabal of senior Indian reproductive specialists have since created their own “reproductive empires” perfusing service provision into peri-urban and even semi-rural localities in India and equally underserved emerging markets in Africa, the Middle East, and Latin America. In this paper, we chart the contours of these new empires and explore the implications of this progressive colonization for the quality of service delivery. We argue that the vast scale of expansion has resulted in unwelcome stratification as unscrupulous providers dilute the quality of services to render them affordable to lower socioeconomic groups. Weakly formulated iterations of ART legislation have also allowed this market to thrive under chaotic and uncertain conditions. These dynamics, we argue, create perverse markets that increase, rather than reduce, patient infertility, by holding unsuspecting clients in extended regimes of indentured therapy. In unpacking the drivers of this phenomenon, we identify several key factors: the neoliberalism of health service provision in India; the privatization and corporatization of care; gendered competitiveness; and potent cultural preferences for biologically related children.

A desirable future or unaffordable hope? Queer people becoming parents through assisted reproductive technology (ART) in Guangdong, China

Based on one-year’s ethnographic fieldwork, this article unpacks experiences of assisted reproductive technology (ART) among queer parents and queer wannabe parents in Guangdong, China. Although existing state regulation on the use of ART and birth planning tends to deny parenthood to single and queer people and further limits their ability to form legible family units, queer parents who have had children through ART are growing in number in urban China. This research delineates how state and cultural conventions, together with market and economic conditions, have shaped queer individuals’ decision making regarding whether, when and how to have children. Findings make an original contribution to studies of the use of reproductive technology in Chinese queer lives. Narratives regarding how queer parents employ ART services unscramble links between sexual citizenship and reproductive agency, as individuals make consumer choices and reproductive decisions synchronously. The paper also explores alleged LGBT-friendly ART companies and the image of a desirable ‘rainbow baby’ they have created. Chinese queer parents’ participation in assisted reproduction has destabilised the dominant hetero-reproductive family matrix while simultaneously contributing to stratified reproduction.