Introduction

The Executive Committee of the European Society of Human Reproduction and Embryology (ESHRE) started with a new ‘Special Task Force’ dedicated to infertility in developing countries. This Special Task Force aims to encourage more and affordable infertility diagnosis and treatment in developing countries. The organization of the expert meeting on the topic of ‘Developing countries and infertility’ in Arusha, Tanzania, from 15 until 17 December 2007, was the first project. Worldwide >80 million couples suffer from infertility, the majority being residents of developing countries. Negative consequences of childlessness are experienced to a greater degree in developing countries when compared with Western societies. Childless women are often stigmatized resulting in isolation, neglect, domestic violence and even suicide. The most common cause for infertility in developing countries is bilateral tubal occlusion due to sexually transmitted diseases and pregnancy-related infections, a condition that is potentially treatable with assisted reproductive technologies (ART). New reproductive technologies are, however, either unavailable or very costly in developing countries, and as a result the large majority of the population does not benefit from ART. While recognizing the importance of prevention and education, we believe that for reasons of social justice infertility treatment in developing countries requires greater attention at national and international levels. Keystones in the successful implementation of infertility care in low-resource settings include simplification of diagnostic procedures and ART, minimizing the complication rate of interventions, providing training courses for health-care workers and incorporating infertility treatment into existing reproductive health-care programmes. The aims of the meeting were the following: The challenge will be to identify efficiently and cheaply the couples who would benefit from ART. Optimizing a concurrent and affordable infertility treatment programme will be an important challenge for developing countries in the near future. We have to liaise with the authorities and discuss the integration of infertility treatment in the public health-care system. to register and document the problem of infertility in developing countries; to study the ethical aspects surrounding this controversial topic; to study the effectiveness of a simplified ‘one-step clinic for the diagnosis of infertility’; to study the effectiveness of simplified IVF-related procedures; to develop strategies for minimizing the risks and complications of ART; to promote the go-together of family planning, infertility treatment and safe pregnancy and motherhood; to search for the optimal strategy algorithm for subfertile couples in developing countries with emphasis on non-IVF treatment and other (surgical or medical) options before starting IVF; the organization of training courses for fertility specialists and paramedical health-care providers from developing countries: Reproductive endocrinology, Diagnosis and prevention of infertility in developing countries, Endoscopic surgery, Clinical aspects of IUI and IVF, Laboratory aspects of IVF/ICSI; to find the best methods to convince politicians and representatives of the industry through the media (medical and non-medical); how can we work together with other non-profit organizations with common interests? search for ‘private’ and ‘non-private’ funding. In this Monograph, most experts of the Arusha-meeting contributed in writing their message on the topic of infertility in developing countries, and I am very grateful to all of them. As a result of this meeting, an action plan and a road plan to the future have been outlined. After a fascinating period of almost 30 years of IVF and 15 years of ICSI, we must admit that only a small part of the world population benefits from these new reproductive technologies. Time has come to give adequate attention to the issue of infertility in developing countries.