JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):125
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263759

P-113. Global Sustainable Models in Assisted Reproductive Care: A Scoping Review Towards a Brazilian Public Health Adaptation

Katherine Ann Reimão Miller¹, Priscila Luiza dos Santos², Julia Roverso Correia Silveira¹, Gabriel Monteiro Pinheiro¹

¹ Universidade Santo Amaro - São Paulo - SP – Brasil
² Faculdade Santa Marcelina - São Paulo - SP – Brasil

Objective: This scoping review aims to identify and analyze international models of assisted reproductive technology (ART) service delivery that incorporate sustainability principles and assess their transferability to Brazil's Unified Health System (SUS). Infertility is a growing public health concern amid declining fertility rates, delayed motherhood, aging, and rising reported cases. Expanding equitable ART access requires innovative, cost-effective, and system-compatible care models.
Methods: A scoping review was based on the Joanna Briggs Institute (JBI) methodology and aligned with PRISMA-ScR reporting guidelines. The protocol was prospectively registered in the Open Science Framework (ID: 8k26e). A systematic search was performed across PubMed, EMBASE, Scopus, LILACS, SciELO, and WHO IRIS, covering publications from 2010 to 2025 in English, Portuguese, and Spanish. Search terms included "ART" "sustainable models," "low- cost IVF" and "public health". Inclusion criteria comprised empirical studies (qualitative, quantitative, or mixed methods) and institutional or governmental documents describing real or proposed ART models. Exclusion criteria included studies unrelated to ART, focused solely on clinical/laboratory outcomes, or lacking structured model descriptions. A initial search strategy encompassed 255 studies, screened independently by two reviewers. Data were extracted into a standardized spreadsheet and classified using a structured taxonomy of health system models: (1) Public-Universal, (2) Public with Copayment, (3) Hybrid Subsidized, (4) Private Low-Cost, (5) Corporate Private, (6) NGO/Philanthropic, and (7) Academic/Translational. We scored each model according to the WHO Health System Framework (WHO-F) domains: (i) Service Delivery; (ii)Health Workforce; (iii) Financing; (iv) Governance; (v) Access to Essential Technologies; and (vi) Health Information Systems. The sum of domain scores (range 0–12) determined each model's maturity level: limited (0–4), emerging (5–8) or mature (9–12). The 10 higher scored models were selected for the transferability assessment for implementation in the SUS (TX), using a bespoke matrix addressing: (a) compatibility with SUS values; (b) technological and infrastructure requirements; (c) local workforce capacity; (d) economic feasibility under public funding; (e) regulatory and legal alignment with Brazilian legislation; and (f) presence of analogous SUS initiatives. Finally, most adaptable practices were identified through thematic synthesis of strategies recurrent across these high-scoring models.
Results: Fifteen ART models, from 10 different countries (Belgium, Italy, Portugal, Australia, United States of America, Africa, China, Canada, Brazil and Colombia), were identified and classified according to health system taxonomy: 20% (1), 33.3% (2), 6% (3), 27% (4), 7% (5), and 7% (6). According to WHO-F scores, the top 10 ART models were: Normative Public ART (12), Decision tree model (11), Eritrean Basic Fertility Care (9), Jinxin's Model (9), Quebec's model (9), the Walking Egg Project (8), QALY-based futility model (8), INVOcell model(8), Australias's Medicare (8) and Tygerberg Model (6). The TX assessment showed that Eritrean Ferility Care model (11), the Walking Egg Project (11) and the INVOcell model (10) were the most adaptable ART models for SUS implementation. The most common adaptable practices were: use of low-cost incubator or in vivo incubation, basic fertility tools (HyCoSy, cycle tracking) instead of a full ART lab infrastructure, use of minimal/mild stimulation protocols (use of clomiphene citrate and low-dose gonadotropins), decentralized service delivery (existing SUS maternities/hospitals), task-shifting to non-specialists (simplified protocols and training for non-ART professionals), integration with existing public health structures (family planning), public- private and academic partnerships and structured regulatory inclusion of infertility as a health right.
Conclusion: This scoping review identified key practices from high-performing ART models aligned with SUS principles. Simplified protocols, frugal innovations, and decentralized care emerged as adaptable strategies. Findings support sustainable, equity-oriented ART policy development within Brazil's public health system.