Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century
Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century
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DOI：
10.1093/humupd/dmv016
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发表时间：
2015-07-01
影响因子：
13.3
通讯作者：
Patrizio, Pasquale
中科院分区：
文献类型：
--
作者：
Inhorn, Marcia C.;Patrizio, Pasquale
据估计，全世界有多达1.86亿人患有不孕症。虽然男性不育症占全球无子女病例的一半以上，但不育症仍然是妇女的社会负担。不幸的是，世界上不育率最高的地区往往是那些难以获得辅助生殖技术的地区。在这种情况下，妇女可能被抛弃，注定没有子女。然而，新出现的数据表明，使抗逆转录病毒疗法可获得和负担得起是一项重要的性别干预措施。为此，本文概述了我们对全球不孕症，ART和不断变化的性别关系的了解，提出了五个关键问题：（i）为什么不孕症是一个持续的全球生殖健康问题？(ii)不孕症的性别影响是什么，它们会随着时间的推移而变化吗？(iii)我们对ART全球化到资源匮乏环境了解多少？(iv)新的全球倡议如何试图改善IVF的可及性？(v)最后，我们可以做些什么来克服不孕症，帮助不孕症患者并加强低成本IVF（LCIVF）的积极性？使用MEDLINE、Google Scholar和耶鲁大学图书馆提供的关键词搜索功能进行详尽的文献综述（即同时扫描多个数据库）确定了2000 - 2014年期间的103篇同行评审期刊文章和37篇专著、章节和报告，涉及以下领域：（i）不孕症人口统计，（ii）资源匮乏环境下的抗逆转录病毒疗法，（iii）资源匮乏环境下的性别与不孕症，（iv）LCIVF倡议的兴起。国际生育学会联合会的监测报告特别有助于确定2002年至2010年间IVF诊所分布的重要全球趋势。此外，跟踪全球跨境生殖保健（CBRC）趋势的学者以及参与日益增长的LCIVF运动的其他人发表的一系列文章非常宝贵。最近的全球人口调查表明，不孕症仍然是一个持续的生殖问题，有六个关键的人口特征。尽管在过去十年（2005 - 2015年），抗逆转录病毒治疗服务在全球范围内大规模扩展，但在世界许多地区，特别是在撒哈拉以南非洲，大多数国家仍然没有试管婴儿诊所，仍然无法获得抗逆转录病毒治疗。对于生活在这种缺乏抗逆转录病毒治疗环境中的妇女来说，不孕症的性别影响可能是毁灭性的。相反，在ART丰富的地区，如中东，不孕症的负面性别影响随着时间的推移而减少，特别是在国家补贴ART的情况下。此外，男性越来越多地承认他们的男性不育症并寻求ICSI。因此，获得抗逆转录病毒疗法可能会改善性别歧视，特别是在全球南方。为此，正在制定一些由临床医生领导的LCIVF倡议，以提供负担得起的抗逆转录病毒疗法，特别是在非洲。由于无法获得LCIVF，许多不孕夫妇必须承担灾难性的支出来资助他们的IVF，或者参与CBRC以寻求其他更低成本的IVF。鉴于目前的现实，建议未来的研究和干预方向有三个：㈠解决可预防的不孕症原因，㈡为不孕症患者提供支助和替代办法，㈢鼓励LCIVF采取新的举措，以提高可用性，抗逆转录病毒疗法在地球仪的可负担性和可接受性。
Infertility is estimated to affect as many as 186 million people worldwide. Although male infertility contributes to more than half of all cases of global childlessness, infertility remains a woman's social burden. Unfortunately, areas of the world with the highest rates of infertility are often those with poor access to assisted reproductive techniques (ARTs). In such settings, women may be abandoned to their childless destinies. However, emerging data suggest that making ART accessible and affordable is an important gender intervention. To that end, this article presents an overview of what we know about global infertility, ART and changing gender relations, posing five key questions: (i) why is infertility an ongoing global reproductive health problem? (ii) What are the gender effects of infertility, and are they changing over time? (iii) What do we know about the globalization of ART to resource-poor settings? (iv) How are new global initiatives attempting to improve access to IVF? (v) Finally, what can be done to overcome infertility, help the infertile and enhance low-cost IVF (LCIVF) activism?An exhaustive literature review using MEDLINE, Google Scholar and the keyword search function provided through the Yale University Library (i.e. which scans multiple databases simultaneously) identified 103 peer-reviewed journal articles and 37 monographs, chapters and reports from the years 2000-2014 in the areas of: (i) infertility demography, (ii) ART in low-resource settings, (iii) gender and infertility in low-resource settings and (iv) the rise of LCIVF initiatives. International Federation of Fertility Societies Surveillance reports were particularly helpful in identifying important global trends in IVF clinic distribution between 2002 and 2010. Additionally, a series of articles published by scholars who are tracking global cross-border reproductive care (CBRC) trends, as well as others who are involved in the growing LCIVF movement, were invaluable.Recent global demographic surveys indicate that infertility remains an ongoing reproductive problem, with six key demographic features. Despite the massive global expansion of ART services over the past decade (2005-2015), ART remains inaccessible in many parts of the world, particularly in sub-Saharan Africa, where IVF clinics are still absent in most countries. For women living in such ART-poor settings, the gender effects of infertility may be devastating. In contrast, in ART-rich regions such as the Middle East, the negative gender effects of infertility are diminishing over time, especially with state subsidization of ART. Furthermore, men are increasingly acknowledging their male infertility and seeking ICSI. Thus, access to ART may ameliorate gender discrimination, especially in the Global South. To that end, a number of clinician-led, LCIVF initiatives are in development to provide affordable ART, particularly in Africa. Without access to LCIVF, many infertile couples must incur catastrophic expenditures to fund their IVF, or engage in CBRC to seek lower-cost IVF elsewhere.Given the present realities, three future directions for research and intervention are suggested: (i) address the preventable causes of infertility, (ii) provide support and alternatives for the infertile and (iii) encourage new LCIVF initiatives to improve availability, affordability and acceptability of ART around the globe.