Factors Influencing Outcome Of Assisted Reproductive Technology In Sub Saharan Africa: Systematic Review And Meta-Analysis
Date
2020-12
Authors
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Publisher
University Of Ghana
Abstract
Background: Infertility affects a significant number of people worldwide and has serious psycho-social effects, but too often neglected, particularly in Sub-Saharan Africa (SSA). Childlessness in most SSA countries is considered a failure and affected persons face severe social discrimination. Assisted Reproductive Technology (ART) is a cure for infertility which has revolutionized the management of infertility and its use has increased since its introduction in the 1980s. Unfortunately, the practice of ART in SSA has not been normalised. Most countries in Sub-Saharan Africa do not have ART included in their health insurance system which limits accessibility to only a few people who need it. There is a lack of adequate data and virtually no ART registries to support policy development in SSA. It is therefore extremely important that ART availability, utilization and outcome be assessed to provide evidence driven change to improve its practice in SSA.
Objective: To determine the common causes of infertility for which ART is implored, assess the availability of ART and the factors that inform the decision to seek ART as well as the factors that influence the outcome of ART in SSA.
Methods: The research was a systematic review of studies meeting pre-specified eligibility criteria. Six databases were searched including Cochrane central, African journals online, LILAC, CINAHL, PUBMED and google scholar for studies from January 2000 to October 2020. A total of 1,629 studies were retrieved, de-duplicated and screened for inclusion. Ten (10) studies met the inclusion criteria. Narrative descriptions of key outcomes were carried out and meta-analysis was conducted for the studies that assessed quantitative outcomes, presenting the results as forest plots. The quality of each of the included studies was assessed and the overall evidence level reported.
The standard reporting of systematic review and meta-analysis was followed to guide the reporting of this review.
Results: The majority of the studies was conducted in Nigeria (7 out of 10). Results from the pooled estimates Male factor infertility was more prevalent than female factor infertility (prevalence of 48.1% and 41.6% respectively) The positive outcomes with their corresponding pooled prevalence that were realised included pre-clinical pregnancy (37.5%), clinical pregnancy (27.5%), live births (12.6%). Multiple birth had a prevalence of 6.5%. The adverse outcomes that were measured was pregnancy loss (7.4%) and still birth. The ART complications identified from the studies analysed were multiple pregnancy, pre mature birth, intrauterine foetal death and ectopic gestation. The factors that were identified to be associated with ART outcomes included maternal age, the type of infertility, endometrial thickness, number of embryos transferred, number of oocytes retrieved as well as the ovulation protocol used.
Conclusions: From the present review, male-factor infertility was more common than female-factor infertility. Assisted Reproductive Technology use resulted in more positive outcomes than negative ones. The review of exiting studies showed that there is a dearth in information on ART use, outcomes and its correlates, and the costs involved in SSA. We recommend the expansion of research efforts in this area, to provide the necessary baseline data for public health practice and formulation of policies.
Description
MPH
Keywords
Meta-Analysis, Sub Saharan Africa, Reproductive Technology