Assuntos
Saúde Reprodutiva , Sociedades Médicas/organização & administração , Saúde da Mulher , Feminino , Saúde Global , Ginecologia/normas , Disparidades em Assistência à Saúde , Humanos , Recém-Nascido , Agências Internacionais/organização & administração , Mortalidade Materna , Obstetrícia/normas , Gravidez , Direitos da MulherRESUMO
The article examines religious and legal restrictions on third-party reproductive assistance in three Mediterranean countries: Sunni Egypt, Catholic Italy and multisectarian Lebanon. In Egypt, assisted reproduction treatments are permitted, but third parties are banned, as in the rest of the Sunni Islamic world. Italy became similar to Egypt with a 2004 law ending third-party reproductive assistance. In multisectarian Lebanon, however, the Sunni/Catholic ban on third-party reproductive assistance has been lifted, because of Shia rulings emanating from Iran. Today, third-party reproductive assistance is provided in Lebanon to both Muslims and Christians, unlike in neighbouring Egypt and Italy. Such comparisons point to the need for understanding the complex interactions between law, religion, local moralities and reproductive practices for global bioethics.
Assuntos
Catolicismo , Diversidade Cultural , Infertilidade , Islamismo , Religião e Medicina , Técnicas de Reprodução Assistida , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Egito , Feminino , Humanos , Infertilidade/psicologia , Infertilidade/terapia , Inseminação Artificial Heteróloga/ética , Inseminação Artificial Heteróloga/legislação & jurisprudência , Inseminação Artificial Heteróloga/psicologia , Itália , Líbano , Masculino , Turismo Médico/ética , Turismo Médico/legislação & jurisprudência , Turismo Médico/psicologia , Doação de Oócitos/economia , Doação de Oócitos/ética , Doação de Oócitos/legislação & jurisprudência , Doação de Oócitos/psicologia , Política Pública , Direitos Sexuais e Reprodutivos/psicologia , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/legislação & jurisprudência , Técnicas de Reprodução Assistida/psicologia , Mães Substitutas/legislação & jurisprudência , Mães Substitutas/psicologiaRESUMO
Both cost and effectiveness should be considered conjointly to aid judgments about drug choice. Therefore, based on the results of a recent published meta-analysis, a Markov model was developed to conduct a cost-effectiveness analysis for estimation of the cost of an ongoing pregnancy in IVF/intracytoplasmic sperm injection (ICSI) cycles. In addition, Monte Carlo micro-simulation was used to examine the potential impact of assumptions and other uncertainties represented in the model. The results of the study reveal that the estimated average cost of an ongoing pregnancy is 13,946 Egyptian pounds (EGP), and 18,721 EGP for a human menopausal gonadotrophin (HMG) and rFSH cycle respectively. On performing a sensitivity analysis on cycle costs, it was demonstrated that the rFSH price should be 0.61 EGP/IU to be as cost-effective as HMG at the price of 0.64 EGP/IU (i.e. around 60% reduction in its current price). The difference in cost between HMG and rFSH in over 100,000 cycles would result in an additional 4565 ongoing pregnancies if HMG was used. Therefore, HMG was clearly more cost-effective than rFSH. The decision to adopt a more expensive, cost-ineffective treatment could result in a lower number of cycles of IVF/ICSI treatment undertaken, especially in the case of most developing countries.
Assuntos
Países em Desenvolvimento , Hormônio Foliculoestimulante/administração & dosagem , Menotropinas/administração & dosagem , Indução da Ovulação , Análise Custo-Benefício , Feminino , Humanos , Cadeias de Markov , Gravidez , Proteínas Recombinantes/administração & dosagemRESUMO
OBJECTIVE: To evaluate the cost effectiveness of a clomiphene citrate (CC)/human menopausal gonadotropin (hMG)/GnRH antagonist protocol versus a long-acting GnRH agonist/hMG protocol. PARTICIPANTS AND METHODS: One hundred eighty nine couples having their first trial of ICSI for male factor infertility were divided into two groups. Group I (no = 33) received CC 100-150 mg/day for five days starting from day 2 of the cycle and 150 IU of hMG/day on days 6-10. GnRH antagonist (Centrorelix) 0.25 mg/day was started when the leading follicle reached 16 mm in the absence of an LH surge. Group II (no = 156) received 0.1 mg Deacapeptyl/day as our standard long protocol. RESULTS: Clinical pregnancy was observed in 8 out of the 33 cases in group I (24%) while in group II, 92 out of 156 achieved clinical pregnancy (59%), the difference was statistically significant (P = 0.019). The cost of medications/cycle was estimated to be 1110+/-492 E.P in group I, while it was 1928+/-456 E.P. in group II. However, the total cost per pregnancy was 19653 EP in group I and 10047 EP in group II. CONCLUSION: The use of the clomid/hMG/antagonist protocol is not a cost effective strategy and should not be recommended in IVF-ICSI cycles.