Published 22 September 2023
The European Society of Human Reproduction and Embryology (ESHRE) is steadfast in its commitment to advancing knowledge, fostering research, and promoting best practices in the field of reproductive medicine and embryology. In alignment with our objectives and in collaboration with global peers, a curated session with ESHRE’s special interest group Global and Sociocultural Aspects of Infertility, at the esteemed 2023 World Congress of the International Federation of Fertility Societies (IFFS) that was held in Athens, Greece, from 10 to 13 September 2023.
The IFFS 2023 Congress gathered professionals and researchers in the field of reproductive medicine for a comprehensive exploration of the latest advancements and techniques in fertility and related areas. Key sessions spanned a wide range of topics; from artificial intelligence to environmental health, global demographic reproductive trends, cross-border reproductive care. Our session, titled “Global and Sociocultural Dynamics in Infertility and Infertility Care,” under the adept chairmanship of Miray Nilufer Cimsit Kemahli, delved into pressing topics presented by distinguished speakers. From exploring sociocultural dimensions of infertility with Papreen Nahar to understanding the intricacies of transnational surrogacy with Ezgi Darici and advancing fertility awareness through the European B2-InF project presented by Francisco Guëll.
Session’s first speaker Papreen Nahar started with the statement that infertility, while often viewed from a medical perspective, carries deep sociocultural connotations in many parts of the world. Through the lens of Papreen Nahar's research, it becomes evident that infertility is not just a clinical challenge but also a sociocultural crisis. In societies like Bangladesh, infertility is often tied to notions of personal identity, social worth, and marital stability. Nahar's investigations uncover the emotional and social toll on women who bear the brunt of blame and stigma. Women face ostracisation, are often deemed 'incomplete', and may encounter marital instability or abandonment. The societal emphasis on procreation compounds the distress, making infertility a profound source of social exclusion. Nahar's work underscores the necessity to address infertility not only as a health concern but also as a broader societal issue that requires cultural sensitivity, awareness campaigns, and community-based support systems.
Second speaker, Ezgi Darici, emphasised the complexities surrounding transnational surrogacy and donation among different cultures, an area that has been expanding rapidly but remains enveloped in cultural, ethical, and geographical challenges. Reflecting on the history of surrogacy, she recalled its biblical origins with Abraham and Sarah, drawing a timeline through to contemporary milestones. It was striking to note how the first legal surrogacy agreement came into existence, and how surrogacy evolved to the successful gestational surrogacy. As she delved deeper into the realm of transnational surrogacy, a notable segment of cross-border reproductive care (CBRC), it became evident that many resort to it mainly due to legal restrictions in their home countries. Global regulations revealed stark inconsistencies, leading to numerous legal and ethical quandaries, exemplified by cases like "Baby Gammy" and "Baby Manji". It was also intriguing to assess the role of religion, from the Muslim perspective to views held by Jewish, Christian, Hindu, and Buddhist communities. One of the primary challenges intended parents face is the inconsistency in international legislation, especially concerning the child's citizenship. Events like the surrogacy scandals during the COVID-19 pandemic underscored an assertion regarding the dire need for international regulations. In conclusion, she highlighted that while surrogacy provides hope for many desiring to start a family, it is essential to develop a comprehensive international framework to address its multifaceted challenges.
Last but not least, Francisco Guëll talked about his recent presentation on the B2-InF project, an initiative funded by the European Union focused on Medically Assisted Reproduction (MAR) and infertility awareness. The project encompassed nearly 100 interviews with European youth and collected data from 40 MAR clinics across eight European countries. A key takeaway was the considerable knowledge gap and misinformation that persists surrounding infertility. He emphasised the global impact of infertility, with the World Health Organization highlighting millions affected. Despite its magnitude, there is a distinct lack of awareness and proper communication about infertility and MAR treatments. His research uncovered that European youth, while generally positive towards MAR treatments, hold significant concerns, especially concerning gender biases. Issues like societal pressures, notably on women, and unequal access to MAR treatments due to costs, were prominent. A glaring concern was the reliability of information from private MAR clinics, with a demand for clearer data on success rates and potential risks. He also presented findings from an evaluation of MAR clinic websites. Common challenges include overuse of technical jargon, ambiguous or missing data on success rates, and a primary focus on white, heterosexual couples. Worryingly, despite existing legal standards, many clinics' communications lack transparency in essential areas, such as costs and potential risks. He stressed the urgent need for clinics to refine their communication strategies to align with public needs and legal requirements. He advocated for public campaigns that address infertility and its associated gender biases and misconceptions. In closing, he recommended the full adoption of B2-InF's guidelines, which aim to improve public awareness and decision-making, with more detailed guidelines available on the project's website.
Overall, the ESHRE-led session at the IFFS 2023 Congress in Athens provided an enlightening and comprehensive insight into the multi-faceted dimensions of infertility and its care. It is evident that the journey to optimal infertility care is complex and multifaceted. While advancements are being made, a harmonised, global approach that encompasses clinical, social, and ethical aspects is crucial to truly address and ameliorate the challenges faced by those grappling with infertility.
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