International disparities in access to infertility services.

OBJECTIVE: To characterize the international availability of infertility services.
DESIGN: A PubMed computer search to identify relevant articles.
SETTING: Academic medical center. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): None. RESULT(S): Epidemiological data suggests that approximately 80 million people worldwide are infertile. Most countries in the industrial west have declining fertility rates marked by late marriage, postponed childbearing, and primary infertility. In contrast, in the developing world, there is little voluntary effort to postpone childbearing and early first marriage is common. However, a high prevalence of sexually transmitted infections and infections acquired as a result of inadequate health care result in increased rates of secondary infertility. In developing societies, childlessness is often highly stigmatized and leads to profound social suffering for infertile women in particular, yet most infertile people in the developing world have virtually no access to effective treatment. Internationally, a minority of countries offer IVF, and even where it is available, on average it is prohibitively expensive and utilized by a fraction of those who could benefit from its use. CONCLUSION(S): Wide disparities exist in the quality, availability, and delivery of infertility services between the developed and developing nations of the world.