ART Reproductive Center

Background Declining fertility rates are a globally documented problem, affecting even regions that have historically high fertility rates. In the Asia Pacific (APAC) region, most countries and territories are seeing birth rates drop far below the replacement rate of 2.1 children per woman. Policymakers in these countries have switched from a historic focus on population control policies to investing in pronatalist policies that aim to boost the national fertility rate by tackling the socioeconomic drivers of falling fertility. In this paper, we examine policies affecting the often-overlooked medical aspect of this challenge: infertility. Objective To review challenges in fertility policy and propose solutions to improve equitable access to assisted reproductive technologies (ART) and associated services. Methods A review of literature was conducted on fertility policy challenges and developments in the APAC region, covering fertility recognition and awareness; egg freezing; and access to ART treatment, psychosocial care, and supplementary care. Experts from nine different countries and territories were invited to validate secondary research findings and provide their perspectives on policy implications. The experts participated in individual 60-minute interviews, then a half-day Policy Forum discussion was held at the Asia-Pacific Assisted Conception Congress 2024, held in Kuala Lumpur, Malaysia. Results Whilst several countries in the region have long recognised falling total fertility rates (TFR) as a cause for concern, many have been slow to recognise infertility as a disease, resulting in limited policy development to support patients experiencing infertility. Commonly this presents as lack of funding allocated towards fertility services, limited or no reimbursement of fertility treatment or egg freezing, and poor societal awareness of infertility and hence delays in seeking care. Various policy changes can be adopted to improve care for patients across the APAC region. Conclusion Our review identified multiple gaps in policy development for supporting individuals experiencing infertility. Looking to countries in which the TFR dropped below replacement level many years ago, the importance of timely policy intervention before negative demographic consequences occur is critical.

Complex cumulus cell-oocyte interactions govern energy utilization during oocyte development. This study investigates the relationship of cumulus cell mitochondria with oocyte development during ovarian stimulation for in vitro fertilization (IVF). This is a prospective cohort study. The setting was an academic center. Thirty women underwent ovarian stimulation for IVF. Pooled cumulus cells were collected; numbers of total and mature oocytes and two-pronuclear (day 1), six- to eight-cell cleavage (day 3), and blastocyst (day 5) embryos were recorded. A mitochondrial bioassay was developed with Jurkat cells and used with cumulus cells from IVF patients to correlate mitochondrial membrane potential resistance to carbonyl cyanide 3-chlorophenylhydrazone (CCCP) stress with oocyte development and embryogenesis. Adjusting for FSH administered and maternal age, cumulus cell mitochondrial membrane potential resistance to CCCP positively correlated with numbers of total (P < .025) and mature (P < .025) oocytes retrieved. The highest oocyte numbers that correlated with cumulus cell mitochondrial membrane potential occurred in women with the greatest ovarian response to FSH (mitochondrial membrane potential resistance to CCCP-log FSH interactions: total oocytes P < .025; mature oocytes P < .05). Multiple regression modeling of mature oocyte numbers, age, and cumulus cell mitochondrial membrane potential resistance to CCCP showed that numbers of mature oocytes best correlated with numbers of embryos at all stages (P < .0001). During ovarian stimulation for IVF, cumulus cell mitochondrial membrane potential resistance to stress correlates with numbers of total and mature oocytes retrieved, suggesting that cumulus cell-oocyte interactions involving energy facilitate oocyte development.