Current Status and Challenges of Assisted Reproductive Technology(ART) Services in Nepal

Abstract

Nepal, a developing country in South Asia, has a population of 29,164,578 according to the 2021 census, with 8,060,560 individuals falling within the reproductive age group (15-49 years). Subfertility affects approximately 10% of this group. Assisted Reproductive Technology (ART) treatment was
regularly introduced in Nepal since 2004, prior to which individuals often travelled abroad for treatment. 

A recent survey identified 51 ART centers in Nepal, with 66.7% located within the Kathmandu Valley. Of these, 94% are privately owned, while only one is government-operated, and two function as semi-government centers. Among the 51 centers, 35 are fully operational, but only 23 (45.1%) have been licensed by the Ministry of Health and Population (MoHP). Despite increasing number of ART centers, the proper ART policy and guidelines are under discussion but not finalized. Most of the centers follow different ART guidelines like European Society of Human Reproduction and Embryology (ESHRE), American Society for Reproductive Medicine (ASRM), ICMR (India) guidelines etc.

Data from 34 functioning ART centers were analyzed, as one declined to participate. All centers have in-house fertility experts, but only 58.8% have in-house embryologists. While 79.4% of centers provide regular In-vitro fertilization (IVF) treatments, 11.8% offer batch only IVF due to lack of skilled embryologist. Most centers practice IVF- antagonist protocol (85.3%) for autologous and oocyte donor cycles. Oocyte, embryo, and semen donation are practiced by almost all centers. Intracytoplasmic Sperm Injection (ICSI) for all with frozen embryo transfer cycles are common, with 2-3 embryos typically transferred per cycle. Only few centers offer Preimplantation Genetic Testing (PGT), which is usually outsourced.

ART data recording is done individually by 94.1% of centers, either in hardcopy or softcopy, as there is no national ART registry yet. Only one center submits ART data to International Committee for Monitoring Assisted Reproductive Technology (ICMART), reflecting limited awareness of international standards. Despite the growth in ART services, challenges remain in policy finalization, equitable access, and standardized practices.