Systematic review of challenges and prospective recommendations of Medically assisted reproductive technology in developing countries

Dereje Mesfin Melese^1,2*Dahabo Galgalo^1,3Leman Atmaca¹¹Kálmán Kovács^1,4,5Ákos Várnagy^1,5,6Viktória Prémusz^1,6,7,8

• ¹Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, H-7621 Pécs, Hungary, Pecs, Hungary
• ²College of Medicine and Health Sciences, Wolkite University, 251 Wolkite, Ethiopia, Wolkite, Ethiopia
• ³Department of Health, 57-60 700 Marsabit, Kenya, Mersabit, Kenya
• ⁴National Laboratory on Human Reproduction, University of Pécs, H-7622 ,Pecs Hungary, Pecs, Hungary
• ⁵Department of Obstetrics and Gynaecology, Medical School, University of Pécs, H-7624 Pécs, Hungary, Pecs, Hungary
• ⁶Directorate for Human Reproduction, National Directorate General for Hospitals, H-1125 Budapest, Hungary, Pecs, Hungary
• ⁷Faculty of Health Sciences, University of Pécs, H-7621 Pécs, Hungary, Pecs, Hungary
• ⁸National Laboratory on Human Reproduction, University of Pécs, H-7622 Pécs, Hungary, Pecs, Hungary

Infertility is a global public health issue which affects significant portion of adult population. In developing nations, infertility has long been disregarded as a reproductive health problem. Despite being available for almost for five decades, most people in resource-poor nations still face challenges to access assisted reproductive technology. We conducted this systematic review to explore the reasons behind such gaps and solutions outlined to address them. After a study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), we conducted a comprehensive search using predefined keywords and medical subject headings across major electronic databases: - Ovid MEDLINE, PubMed, Web of Science, and Google Scholar which resulted in total of 3097 citations; after removal of 2256 duplicates, 765 citations were selected for title and abstract review. A full text review was conducted on the 137 articles 43 studies were included in the final analysis. The majorly cited challenge was the high costs associated with treatment, followed by accessibility and infrastructural obstacles, psychosocial and cultural barriers including the unacceptance of a baby born from assisted reproduction. Absence of supportive policies coupled with religious factors worsen the problem. Governmental, non-governmental, and international organizations should collaborate to address affordability and accessibility issues and to resolve socio-cultural and religious challenges through the inclusion of infertility treatment in the existing health system, revisiting the financial mechanisms, and creating supportive policies in partnership with community and religious leaders.