Economic Costs of Infertility Care for Patients in Low-income and Middle-income Countries: a Systematic Review Protocol

Overview

Journal BMJ Open

Specialty General Medicine

Date 2020 Nov 11

PMID 33172951

Citations 7

Authors

Purity Njagi

Wim Groot

Jelena Arsenijevic

Silke Dyer

Gitau Mburu

James Kiarie

Affiliations

Soon will be listed here.

Abstract

Introduction: Infertility, a condition of the reproductive system, affects millions of individuals and couples worldwide. Despite infertility treatment's existence, it is largely unavailable and inaccessible in low/middle-income countries (LMICs) due to the prohibitive costs compounded by an absence of financing. Previous systematic reviews have shown that there is scanty information in LMICs on out-of-pocket (OOP) payments for infertility treatment. This protocol outlines the methodological approach and analytical process to appraise the extent of economic burden due to payments for infertility care services in LMICs.

Method And Analysis: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, we will primarily search for articles indexed in PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature, EconLit and PsycINFO databases. Grey literature from relevant organisations' virtual libraries shall also be searched. Backward and forward searches on the articles selected will also be done. Quantitative studies on infertility treatment costs from LMICs across the world regions within the last 20 years will be considered. The primary outcome of interest shall include OOP payments, catastrophic health expenditure and direct costs for infertility services. Conversely, informal payments and indirect costs related to infertility treatments shall be considered as secondary outcomes. Integrated quality Criteria for Review Of Multiple Study designs will be used to assess the quality of the studies included in the review. Meta-analysis shall be considered if sufficient studies identified are homogenous in characteristics. Also, the review shall analyse the average cost of infertility treatment against the respective countries' economic indicators like gross domestic product per capita if data permit.

Ethics And Dissemination: Research and ethics approval will not be required given this will be a review of published articles on the subject. The findings shall be disseminated through publication in a peer-reviewed journal and presentation to the WHO and its partners.

Prospero Registration Number: CRD42020199312.

Citing Articles

Scientific landscape and visualization analysis of the link between adenomyosis and infertility from 2000 to 2024.

Yang Q, Zheng X, Zhong F, Chen L, Hong J, Liu X Front Med (Lausanne). 2025; 12:1488866.

PMID: 40046932 PMC: 11879839. DOI: 10.3389/fmed.2025.1488866.

Trends in the burden of female infertility among adults aged 20-49 years during 1990-2019: an analysis of data from the Global Burden of Disease Study 2019.

Wang Y, Wang W, Li H, Du Q BMJ Open. 2024; 14(7):e084755.

PMID: 39079919 PMC: 11293414. DOI: 10.1136/bmjopen-2024-084755.

Policy action points and approaches to promote fertility care in The Gambia: Findings from a mixed-methods study.

Afferri A, Dierickx S, Bittaye M, Marena M, Pacey A, Balen J PLoS One. 2024; 19(5):e0301700.

PMID: 38743724 PMC: 11093356. DOI: 10.1371/journal.pone.0301700.

Timed intercourse for couples trying to conceive.

Gibbons T, Reavey J, Georgiou E, Becker C Cochrane Database Syst Rev. 2023; 9:CD011345.

PMID: 37709293 PMC: 10501857. DOI: 10.1002/14651858.CD011345.pub3.

The search for the principle of justice for infertile couples: characterization of the brazilian population and bioethical discussion.

Oppenheimer D, Rego F, Nunes R BMC Med Ethics. 2023; 24(1):69.

PMID: 37667304 PMC: 10476313. DOI: 10.1186/s12910-023-00947-4.

References

Boivin J, Bunting L, Collins J, Nygren K . International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod. 2007; 22(6):1506-12. DOI: 10.1093/humrep/dem046. View

Ombelet W, Onofre J . IVF in Africa: what is it all about?. Facts Views Vis Obgyn. 2019; 11(1):65-76. PMC: 6822948. View

Zingg W, Castro-Sanchez E, Secci F, Edwards R, Drumright L, Sevdalis N . Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS). Public Health. 2015; 133:19-37. DOI: 10.1016/j.puhe.2015.10.012. View

Inhorn M, Patrizio P . Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update. 2015; 21(4):411-26. DOI: 10.1093/humupd/dmv016. View

Sharma S, Mittal S, Aggarwal P . Management of infertility in low resource countries. BJOG. 2009; 116 Suppl 1:77-83. DOI: 10.1111/j.1471-0528.2009.02311.x. View

Tiu M, Hong J, Cheng V, Kam C, Ng B . Lived experience of infertility among Hong Kong Chinese women. Int J Qual Stud Health Well-being. 2019; 13(1):1554023. PMC: 6319451. DOI: 10.1080/17482631.2018.1554023. View

Makuch M, Padua K, Petta C, Osis M, Bahamondes L . Inequitable access to assisted reproductive technology for the low-income Brazilian population: a qualitative study. Hum Reprod. 2011; 26(8):2054-60. DOI: 10.1093/humrep/der158. View

Domar A, Gordon K, Garcia-Velasco J, La Marca A, Barriere P, Beligotti F . Understanding the perceptions of and emotional barriers to infertility treatment: a survey in four European countries. Hum Reprod. 2012; 27(4):1073-9. DOI: 10.1093/humrep/des016. View

Bitler M, Schmidt L . Utilization of infertility treatments: the effects of insurance mandates. Demography. 2011; 49(1):125-49. PMC: 5833298. DOI: 10.1007/s13524-011-0078-4. View

10.

Rooney K, Domar A . The relationship between stress and infertility. Dialogues Clin Neurosci. 2018; 20(1):41-47. PMC: 6016043. View

11.

Dyer S, Sherwood K, McIntyre D, Ataguba J . Catastrophic payment for assisted reproduction techniques with conventional ovarian stimulation in the public health sector of South Africa: frequency and coping strategies. Hum Reprod. 2013; 28(10):2755-64. DOI: 10.1093/humrep/det290. View

12.

Dyer S, Patel M . The economic impact of infertility on women in developing countries ‑ a systematic review. Facts Views Vis Obgyn. 2014; 4(2):102-9. PMC: 3987499. View

13.

Nachtigall R . International disparities in access to infertility services. Fertil Steril. 2006; 85(4):871-5. DOI: 10.1016/j.fertnstert.2005.08.066. View

14.

Asemota O, Klatsky P . Access to infertility care in the developing world: the family promotion gap. Semin Reprod Med. 2015; 33(1):17-22. DOI: 10.1055/s-0034-1395274. View

15.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

16.

Zegers-Hochschild F, Adamson G, Dyer S, Racowsky C, de Mouzon J, Sokol R . The International Glossary on Infertility and Fertility Care, 2017. Fertil Steril. 2017; 108(3):393-406. DOI: 10.1016/j.fertnstert.2017.06.005. View

17.

Casebolt M . Barriers to reproductive health services for women with disability in low- and middle-income countries: A review of the literature. Sex Reprod Healthc. 2020; 24:100485. DOI: 10.1016/j.srhc.2020.100485. View

18.

Dyer S, Vinoos L, Ataguba J . Poor recovery of households from out-of-pocket payment for assisted reproductive technology. Hum Reprod. 2017; 32(12):2431-2436. DOI: 10.1093/humrep/dex315. View

19.

Klitzman R . How much is a child worth? Providers' and patients' views and responses concerning ethical and policy challenges in paying for ART. PLoS One. 2017; 12(2):e0171939. PMC: 5313146. DOI: 10.1371/journal.pone.0171939. View

20.

Sharma R, Saxena R, Singh R . Infertility & assisted reproduction: A historical & modern scientific perspective. Indian J Med Res. 2019; 148(Suppl):S10-S14. PMC: 6469376. DOI: 10.4103/ijmr.IJMR_636_18. View