The younger the better: the case for continuing use of IUI as a first-line infertility treatment in a Ghanaian population

Abstract Background In vitro fertilisation (IVF) treatment is one of the most expensive infertility treatments. Cost has been described as a substantial barrier to access. In France all infertility treatments, including IVF, are fully reimbursed, but are there other barriers to access? Methods Based on the French national health insurance database that exhaustively records reimbursed healthcare, this cohort study included all women aged 18–49 years unsuccessfully treated with ovarian induction (first-line infertility treatment) between January–August 2016. Outcome was IVF access within 24 months of starting first-line treatment. Univariate and multivariate regressions explored age, disadvantaged social status, driving time to nearest IVF centre, and deprivation index of area of residence. Results Over 20,000 women unsuccessfully received first-line treatment. Almost 80% did not access IVF within 24 months. After age 34, probability of access decreased. Disadvantaged social status and living in a disadvantaged area were associated with lower probability of accessing IVF. Driving time to the nearest IVF centre was not significantly associated with access. Conclusions Socio-economic barriers to access IVF exist despite full treatment reimbursement in France. To reduce health inequalities, we need to better understand the nature and patterns of these barriers among less socially advantaged people. Key messages After failure of first-line infertility treatment, only 20% of women access IVF although it is fully reimbursed in France. Age, but most importantly socio-economic status, is a key determinant of access to IVF treatment. Distance from nearest IVF centre does not appear significant in explaining access to treatment in France.

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Medication Adherence Among Women Undergoing Infertility Treatment: A Systematic Review

International Journal of Women s Health and Reproduction Sciences ◽

10.15296/ijwhr.2019.24 ◽

2018 ◽

Vol 7 (2) ◽

pp. 141-149

Author(s):

Diane E. Mahoney ◽

Cynthia L. Russell ◽

An-Lin Cheng

Keyword(s):

Medication Adherence ◽

Side Effects ◽

Intrauterine Insemination ◽

Infertility Treatment ◽

Oral Medication ◽

Secondary Outcome ◽

Future Research ◽

First Line ◽

First Line Therapy ◽

Line Therapy

Objectives: The present study aimed to investigate medication adherence awareness among women undergoing infertility treatment. Materials and Methods: Several databases were searched including PubMed, Embase, CINAHL, PsycINFO, as well as ProQuest dissertations in order to collect the required data. In addition, based on the purpose of the study, English-language prospective, retrospective, observational, cross-sectional, quasi-experimental, and randomized controlled trial studies were selected which focused on medication adherence as a primary or secondary outcome in women with a diagnosis of infertility. Finally, critical appraisal for the quality of the study was assessed using Downs and Black Quality Checklist (1998) and STROBE guidelines. Results: Three studies conducted during 1993-2011 were analyzed. Further, sample sizes varied from 30 to 626 subjects with average rates of oral medication adherence ranging from 26% to 81% when used as the first-line therapy. More frequent daily dosing was associated with lower adherence rates. Based on the results, adherence was significantly lower when women were concerned about the side effects of medication adherence or reported 3 or more side effects rather than one or 2 cases. Furthermore, women with a body mass index of <23 kg/m² or those who viewed medical treatment as convenient had higher adherence rates. It is noteworthy that none of the studies evaluated medication adherence during controlled ovarian hyperstimulation (COH) cycles, along with intrauterine insemination (IUI) or in vitro fertilization (IVF). Conclusions: In general, rates of oral medication adherence are found suboptimal when used alone as first-line therapy. Accordingly, further studies regarding medication-taking behaviors are warranted in future research trials involving injection medications and COH cycles associated with IUI and IVF cycles in order to strengthen the clinical practice.

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The Potential Use of Intrauterine Insemination as a Basic Option for Infertility: A Review for Technology-Limited Medical Settings

Obstetrics and Gynecology International ◽

10.1155/2009/584837 ◽

2009 ◽

Vol 2009 ◽

pp. 1-11 ◽

Cited By ~ 15

Author(s):

Abdelrahman M. Abdelkader ◽

John Yeh

Keyword(s):

Intrauterine Insemination ◽

Uterine Cavity ◽

Infertility Treatment ◽

Semen Parameters ◽

Male Factor Infertility ◽

Review Of Literature ◽

First Line ◽

Male Factor ◽

Medical Settings ◽

Potential Use

Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings.Study design. Review of articles on treatment of infertility using IUI.Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized.Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be offered three to six IUI cycles in technology-limited settings.

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