Addressing the inequities in access to assisted reproductive technology (ART) treatments in high-income countries- a scoping review

Thesis

Background: Subfertility is defined as the inability to conceive after twelve months or more of regular unprotected sexual intercourse. The World Health Organisation estimates that about 17.5% of adults worldwide seek help to conceive (WHO, 2023). A proportion of patients will need Assisted Reproductive Technology Treatment (ART) as their last resort. ART treatments are expensive and often involve out-of-pocket expenses, including in High-Income Countries (HICs) (Dyer, 2017, Chambers and Sullivan, 2009).
Subfertile individuals experience significant psychosocial morbidity (Boivin and Lancastle, 2010, Volgsten and Ekselius, 2008, Volgsten and Ekselius, 2010).

Objective: This scoping review aims to identify the causes of inequities in accessing ART treatments in HICs and how to address them.

Methods: The Joanna Briggs Institute Manual of Evidence Synthesis Methodology for Scoping Reviews (Aromataris and Lockwood, 2024) and Open Science Framework (OSF) methodologies (Lely, 2023) are followed. The evidence is mapped using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

Inclusion Criteria: The PCC framework for Scoping Reviews—participants, Concept, and Context—is applied.

Exclusion Criteria: To best align with the objective, ART treatments for fertility preservation and cross-border access are excluded.

Outcomes: After a full-text study and data extraction from 58 studies, seven distinct themes emerged representing the barriers to access: Access Screening, Affordability, Ethnic and Racial inequity, high BMI, HIV-positive status, Geography, Same-Sex couples, and Single women.

Conclusions:
Six evidence-based interventions are identified and proposed in this review to address the inequity. The updated Consolidated Framework for Implementation Research (Damschroder et al., 2022), along with a systems leadership and bottom-up change management process, are suggested for delivering the objective by educating, engaging, and empowering patients and practice staff, organisational leadership, funders, and policymakers, backed up with comprehensive data collection and insights.

Authors: Kalra, GS

• Alternative title: Addressing the inequities of access to ART treatments in high income countries
• DOI: 10.5287/ora-bpyb96vbk
• Type of award: MSc taught course
• Level of award: Masters
• Awarding institution: University of Oxford
• Language: English
• Keywords: IVF; inequity; fertility; assisted reproductive treatments; access
• Subjects: Leadership; Reproductive health; Global healthcare; Fertility health