Since the first IVF baby was born in 1978, the process has aided around 5 million babies worldwide. Nevertheless, the truth is that this number has always had the potential to be much higher. If ART were more accessible, both in terms of medical assets and financial capabilities, many would be the couples who would desire to try these technologies and stop the grief of not having a child.

Access to fertility treatments is limited by the cost in both high- and low-income countries. Why? Assisted Reproduction Technologies are very advanced and complicated procedures that cannot guarantee to be successful. For example, In-Vitro-Fertilization, which is the most common and well-known ART process, consists in inducing the ovaries to produce eggs, which are then retrieved using an ultra-sound guided needle before being mixed with the sperm in the laboratory, artificially fertilizing the eggs. These are then grown into embryos in the laboratory for a certain number of days before being introduced back in the female patient’s uterus. Hopefully, it will attach to the uterine lining, allowing a baby to grow.

In low-income countries, ART is often private, if available at all, meaning that for most of the population, this remains unattainable. In these countries, often governments and international aid tend to focus on more life-threatening problems and on contraception rather than fertility, as these problems are directly related to the general problems of the Nation.

Even in wealthy countries, the provision of fertility care can be challenging and restrictive. Some countries put effort into making ART available to everyone, while others leave it to private clinics. We must understand that the argument of fertility is seen mainly as a very lucrative industry rather than an essential section of healthcare. Therefore, where the government does not provide these services, couples are led in entering a private process with private clinics that set fees based on whatever the market will bear. This means that couples are often led to buy “extras” that may be completely ineffective, with the hope of having a better chance at having a healthy baby.

Luckily, a small but increasing number of gynecologists and fertility specialists worldwide are beginning to focus on bringing down the costs of fertility treatment to make it more accessible. One solution might be to assess the severity of a couple’s infertility more carefully, aiding natural conception before resolving to artificial methods. Also, money could be saved from minimizing blood tests and other laboratory investigations, cutting down the unnecessary procedures.  A ground-breaking approach aiding cost efficiency and well-being of mother and child is Doctor Nargund’s gentle or mild IVF which stimulates egg production with drugs at a lower dose and often lower cost, and for a shorter duration than with conventional IVF, taking care of quality over quantity. Finally, many advocates suggest that doctors and clinics in wealthier nations could offer expertise and used equipment to clinics in low-income countries.

In the context of ART as an industry, the needs of the patients are therefore not always put first as they should be. There is often information asymmetry and a simple lack of attention to patient needs on service providers’ side. What does society really need? What questions often remain unanswered or blurry in the minds and hearts of individuals seeking reproduction aid? This is what B2-InF is about, closing this gap and giving a stronger voice to patients in this healthcare sector. Together with a scientific breakthrough like Doctor Nargund’s, B2-InF aims to change the way things are done, addressing policymakers, governments, and other stakeholder groups. Fertility Aid must be improved for a better tomorrow.



Nature | Vol 588 | 17 December 2020 | S175

“How much is a baby worth?”, by Sarah DeWeerdt

Geeta Nargund