Page 16 - ESHRE2019

Case of Zambia (maybe)
Cardiff Fertility Studies
Causes of country variations in prevalence (unrelated to methods)
 Variationinevolvedcapacitytoreproduce(fecundity)1
 Change in the biologic capacity to reproduce irrespective of intentions (e.g.,
decline in semen quality, survival in gene pool of infertile)  Cannot yet be evaluated due to lack of appropriate data
 Variation in proximate and distal determinants of fertility (target: population control)
 E.g., in Ghana2: SES (income, education), urbanization, age of first marriage, child mortality, cultural/religious beliefs (valuing of high fertility)
 Well known impact, addressed through diverse programs
 Variation in risk factors for reduced fertility (target: prevention)
 Risk in LMIC = Non communicable diseases (global NCDs) + communicable (e.g., tuberculosis, HIV) + medical procedures (repeat D & C, unsafe abortion) + cultural practices (FGM, consangunity3), etc.
 Variation in access to effective treatment (target: treatment)
 Only 4.2% of all available ART is in Global South (excluding Middle East)4  Help-seeking patterns in LMIC poorly understood
1Smarr 2017 Hum Reprod; 2Agyei-Mensah 2015 J Pop Res; 3Bosdou 2016; 4Dyer 2016
Cardiff Fertility Studies
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