The cost effective IVF strategies in assisted reproduction technology programmes (art)
| dc.contributor.advisor | Kruger, T. F. | en_ZA |
| dc.contributor.author | Matsaseng, Thabo | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology. | en_ZA |
| dc.date.accessioned | 2016-12-22T13:06:19Z | |
| dc.date.available | 2016-12-22T13:06:19Z | |
| dc.date.issued | 2016-12 | |
| dc.description | Thesis (PhD)--Stellenbosch University, 2016. | en_ZA |
| dc.description.abstract | CHAPTER I Understanding the physiology of oocyte(s) recruited, selected and retrieved in a cycle of assisted reproductive technology (ART) is fundamentally important towards the development of the embryo with great potential for conception and live birth. This is discussed in detail. More important is the interpretation and utilization of the scientific evidence in this chapter to explore less expensive methods of optimizing oocyte quality in mild ovarian stimulation in vitro fertilization (IVF). CHAPTER II Clomiphene citrate (CC) is an inexpensive and safe drug that can be used alone or in combination with gonadotropins in IVF. Clinical outcomes in different IVF treatments using CC were reviewed and discussed in detail. The major concern regarding CC in ART is the risk of premature luteinizing hormone (LH) surge with subsequent detrimental effect on the oocyte quality. This issue is discussed with outlined strategies (inexpensive) to minimize the risk. CHAPTER III The effective methods to prevent premature LH surge in ART include gonadotropin releasing hormone antagonists (GnRHa) and gonadotropin releasing hormone agonists (GnRH). But these methods are expensive and unaffordable in resourcelimited countries. We therefore performed a randomised controlled trial to evaluate a simple method of prolonged usage of CC as a strategy to prevent premature LH surge in ART treatment. The protocol is described in detail. The trial showed that prolonged usage of CC did not suppress premature LH surge in mild ovarian stimulation ART. But it motivated us to explore other inexpensive strategies for lowering the risk of premature LH surge such as pre-treatment with oral contraceptives, the use of tamoxifen and the use of progesterone during ovarian stimulation. CHAPTER IV Stellenbosch University https://scholar.sun.ac.za In our endeavour to explore strategies to make ART accessible, a public-private interaction (PPI) model is described in detail, highlighting different areas where the cost of IVF can be significantly reduced. They include infrastructure and equipment, personnel, ovarian stimulation protocol (detailed in Chapters II and III) and modification in the laboratory routine regarding oocyte retrieval. CHAPTER V This meta-analysis compared mild ovarian stimulation IVF with conventional treatment in order to counsel patients appropriately. The study showed significantly better outcomes in terms of live birth rates and ongoing pregnancy rates per started cycle, all in favour of conventional stimulation IVF, which therefore currently remains the preferred treatment of choice. CHAPTER VI Understanding the physiology of folliculogenesis has made it possible to integrate mild ovarian stimulation in our unit ART programme at a low cost. (Chapter I) Reassuring clinical outcomes of CC in ART also motivated the unit to maintain low cost of treatment with the use of safe and effective medication. (Chapter II) The finding that prolonged usage of CC does not reduce the risk of premature LH surge has also allowed the unit to maintain the old protocol of 5 days’ use, but motivated us to explore other inexpensive methods. (Chapter III) The PPI model certainly managed to make ART treatment accessible to subfertile couples that would have never had a chance to be proud parents. (Chapter IV) Because this model is feasible and can be implemented at a reasonably low cost, it presents a viable option to make ART accessible in resource-limited countries. | en_ZA |
| dc.description.abstract | HOOFSTUK I Dit is uiters belangrik om die fisiologie van oosiet(e) werwing, seleksie en onttrekking in ‘n geassisteerde reproduktiewe tegnologie (ART) siklus te verstaan om ‘n embrio met groot potensiaal vir konsepsie en lewendige geboorte te ontwikkel. Dit word in meer detail bespreek. Meer belangrik is die interpretasie en gebruik van wetenskaplike bewyse in hierdie hoofstuk om goedkoper metodes te ondersoek om oosiet kwaliteit met matige ovariële stimulasie in vitro bevrugting (IVB) te verhoog. HOOFSTUK II Klomifeen sitraat (CC) is ‘n goedkoop en veilige middel wat alleen of in kombinasie met gonadotropiene in IVB gebruik kan word. Kliniese uitkomste in verskillende IVB behandelings met CC is ondersoek en in detail bespreek. Die grootste bekommernis rakende CC in ART is die risiko van voortydige LH styging met daaropvolgende nadelige invloed op die oosiet kwaliteit. Dit word bespreek met ‘n verduideliking van strategieë (goedkoop) om die risiko te verminder. HOOFSTUK III Effektiewe metodes om voortydige LH styging in ART te voorkom sluit gonadotropien vrystellende hormoon antagoniste (GnRHa) en gonadotropien vrystellende hormoon agoniste (GnRH) in. Hierdie metodes is egter duur en onbekostigbaar in lande met beperkte hulpbronne. Ons het dus ‘n gerandomiseerde gekontroleerde studie uitgevoer om ‘n eenvoudige metode van verlengde gebruik van CC te ondersoek as ‘n strategie om voortydige LH oplewing in ART behandeling te voorkom. Die protokol is in detail bespreek. Die studie het bevind dat langdurige gebruik van CC nie voortydige LH styging met matige ovariële stimulasie ART onderdruk het nie. Dit het ons egter motiveer om na ander goedkoop maniere te kyk om die risiko van voortydige LH oplewing te verminder, soos vooraf behandeling met orale voorbehoedmiddels, die gebruik van tamoksifeen en die gebruik van progesteroon gedurende ovariële stimulasie. HOOFSTUK IV In ons poging om metodes te ondersoek om ART toeganklik te maak, word die publieke-privaat interaksie (PPI) model breedvoerig beskryf met die klem op verskillende areas waar die koste van IVF aansienlik verminder kan word. Dit sluit in infrastruktuur and toerusting, personeel, ovariële stimulasie protokol (verduidelik in Hoofstukke II en III) en aanpassing van laboratorium roetine betreffende die onttrekking van oosiete. HOOFSTUK V Hierdie meta-analiese het matige stimulasie IVF met gebruiklike behandeling vergelyk sodat pasiënte deeglik ingelig kon word. Die studie het merkbaar beter uitkomste in terme van lewendgebore syfers en voortgaande geboorte syfers per aanvang siklus, almal ten gunste van gebruiklike stimulasie, getoon wat tans die behandeling van keuse bly. HOOFSTUK VI Om die fisiologie van follikulogenese te verstaan het dit moontlik gemaak om matige ovariële stimulasie in ons eenheid se ART program te integreer teen ‘n lae koste.(Hoofstuk I) Gerusstellende kliniese uitkomste van CC in ART het ook die eenheid motiveer om ‘n laekoste behandeling te handhaaf met die gebruik van veilige en effektiewe medikasie. (Hoofstuk II) Die bevindinge dat langdurige gebruik van CC nie die risiko vir voortydige LH styging verminder nie het ons eenheid in staat gestel om ‘n ou protokol van 5 dae gebruik te handhaaf, maar ons gemotiveer om ander goedkoop metodes te ondersoek. (Hoofstuk III) Die PPI model het beslis ART behandeling toeganklik gemaak vir subfertiele egpare wat geen kans sou hê om trotse ouers te word nie. (Hoofstuk IV) Omdat hierdie model haalbaar is en dit uitgevoer kan word teen ‘n redelike lae koste, skep dit ‘n lewensvatbare opsie om ART toeganklik te maak in lande met beperkte hulpbronne. | af_ZA |
| dc.description.version | Doctoral | en-ZA |
| dc.format.extent | 172 pages : illustrations | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/100022 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | IVF (Reproduction) | en_ZA |
| dc.subject | Ovum | en_ZA |
| dc.subject | Reproductive technology | en_ZA |
| dc.subject | Fertilization in vitro | en_ZA |
| dc.subject | UCTD | en_ZA |
| dc.title | The cost effective IVF strategies in assisted reproduction technology programmes (art) | en_ZA |
| dc.type | Thesis | en_ZA |