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Achieving more equitable access to assisted reproduction

BMJ 2024; 385 doi: https://doi.org/10.1136/bmj-2023-077111 (Published 26 April 2024) Cite this as: BMJ 2024;385:e077111
  1. Silke J Dyer, professor1,
  2. G David Adamson, professor2,
  3. Marcia C Inhorn, professor3,
  4. Fernando Zegers-Hochschild, professor4
  1. 1Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  2. 2ARC Fertility, Cupertino, CA, USA
  3. 3Yale University, New Haven, CT, USA
  4. 4Universidad Diego Portales, Santiago, Chile
  1. Correspondence to: S J Dyer silke.dyer{at}uct.ac.za

Equitable access to fertility care must be recognised as a human right so that it can be better balanced with other societal needs, say Silke Dyer, David Adamson, Marcia Inhorn, and Fernando Zegers-Hochschild

Infertility affects one in six people in their lifetime yet remains a neglected global health problem.1 The World Health Organization (WHO) recognises infertility as a disease and has highlighted the need for prevention and management to be more central in health research and policy, including wider and more equitable access to assisted reproductive technology (box 1).

Box 1

Infertility and assisted reproduction

  • The World Health Organization defines infertility as a disease of the male or female reproductive system, characterised by the failure to achieve a pregnancy after ≥12 months of regular unprotected sexual intercourse

  • Infertility is defined as a disease because of its effect on the quality of life, especially of women, as measured by levels of anxiety, depression, loss of self-esteem, and severe social effects, including stigmatisation, marital instability, social discrimination, neglect, isolation, and abuse

  • Assisted reproductive technology is the only treatment for some of the most common and severe causes of infertility. It is also increasingly used for family building by people in non-heterosexual unions; for the prevention of inheritable genetic disorders; and for fertility preservation before cancer treatment or to extend the reproductive lifespan

  • Wider and more equitable access to assisted reproduction helps to reduce the burden of disease, supports the reproductive health and rights of those unable to have the children they desire, and advances reproductive justice

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Assisted reproduction exemplifies how breakthrough technological advances can rapidly spread around the globe, resulting simultaneously in remarkable progress and very unequal access (fig 1). Though the technology cannot guarantee success, over 10 million babies were born globally through assisted reproduction between the first birth in 1978 and 2018, …

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