Indicators of infertility and fertility care: a systematic scoping review
Authors: Nabhan Ashraf , Salama Mohamed , Elsayed Mortada , Nawara Maii , Kamel Menna , Abuelnaga Yasmeen , Ghonim Mohanad , Elshafeey Farida , Abdelhadi Rana , Gebril Sara , Mahdy Shahd , Sarhan Dana , Mburu Gitau , Kiarie James 
Published: October 2022

Abstract

STUDY QUESTION
What is the scope of literature regarding infertility and fertility care indicators in terms of types and dimensions of these indicators?

SUMMARY ANSWER
Most available infertility and fertility care indicators are outcomes indicators of effectiveness and efficiency dimensions.

WHAT IS KNOWN ALREADY
The use of appropriate, relevant and valid indicators of infertility and fertility care is critical for monitoring access, equity and utilization.

STUDY DESIGN, SIZE, DURATION
A systematic scoping review was conducted. We searched MEDLINE, Pubmed, JSTOR, CINAHL, Web of Science and Scopus electronic databases from inception to May 2022 without imposing language or date restrictions. We searched gray literature and online libraries of relevant organizations. We hand-searched the list of relevant references.

PARTICIPANTS/MATERIALS, SETTING, METHODS
This scoping systematic review followed the framework of Arksey and O’Malley and the Joanna Briggs Institute guidelines. Records identified by the search were independently screened and data were extracted. We performed conceptual synthesis by grouping the reported indicators by typology and dimensions. Structured tabulation and graphical synthesis were used along with narrative commentary.

MAIN RESULTS AND THE ROLE OF CHANCE
We included 46 reports from 88 countries. The reporting of infertility and fertility care indicators was voluntary in 63 countries (72%) and compulsory in 25 countries (28%). Reporting for cycles or deliveries was based on individual cycles in 56 countries (64%) and on cumulative cycles in 32 countries (36%). Most indicators were utilized as outcome indicators with fewer being process indicators or structural indicators. For the dimension of indicators, most indicators were utilized as effectiveness and efficiency indicators with fewer utilized as indicators of safety, patient-centeredness, equity and timeliness.

LIMITATIONS, REASONS FOR CAUTION
Most indicators fall into the domain of assisted reproductive technology and are reported by fertility clinics. Indicators of safety, patient-centeredness, equity and timeliness as well as non-clinical indicators are almost invisible.

WIDER IMPLICATIONS OF THE FINDINGS
A wide range of indicators of infertility and fertility care exist in literature. Most indicators were effectiveness and efficiency indicators, while indicators of safety, patient-centeredness, equity and timeliness remain almost invisible. The scope of the current indicators indicates a predominant focus on clinical metrics, with substantial invisibility of non-clinical indicators and indicators outside the ART domain. These gaps need to be considered in further work of identifying a core set of indicators.

STUDY FUNDING/COMPETING INTEREST(S)
This work received funding from the UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the World Health Organization (WHO). The authors had no competing interests.

TRIAL REGISTRATION NUMBER
Open Science Framework vsu42.